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Cefoxitin, Cefotetan, and Other Cephamycins
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Cefotetan is active against Haemophilus influenzae and Neisseria gonorrhoeae, including strains of both that produce beta-lactamase. Cefoxitin has a lesser degree of intrinsic activity against H. influenzae (Kammer et al., 1975; Norrby et al., 1976; Yourassowsky et al., 1976; Phillips et al., 1978; Phillips and Shannon, 1978; Bulger and Washington, 1980). Cefoxitin is active against meningococci, but to a lesser extent than cephalothin or cefuroxime (Eickhoff and Ehret, 1976; Norrby et al., 1976).
Complications of Antibiotic Therapy
Published in Stephen M. Cohn, Matthew O. Dolich, Complications in Surgery and Trauma, 2014
Mohamed Fahim, Chad M. Thorson, Nicholas Namias
Myriad adverse events have been reported for a remarkably safe class of drugs, the cephalosporins. Most of them are reported rarely or in <1%. The clinically relevant adverse events that occur with any meaningful frequency are diarrhea (1%–19%), nausea/vomiting (1%–6%), and transient transaminase elevation (1%–7%). Cefotetan can cause a hypoprothrombinemia in <1% of patients that is reversible with vitamin K. Ceftriaxone in high doses can lead to biliary sludge from crystallization in the biliary tree. Reports of this problem are in children receiving high doses of ceftriaxone.26
Cephalosporins
Published in Thomas T. Yoshikawa, Shobita Rajagopalan, Antibiotic Therapy for Geriatric Patients, 2005
Cefoxitin has Gram-negative activity that is similar to cefuroxime. However, compared with other first- and second-generation cephalosporins, its activity against streptococci and MSSA is significantly reduced (15). It is the most active cephalosporin against B.fragilis, although its activity against the other Bacteroides spp., such as B. thetaiotaomicron or B ovatus, is less. It is highly active against N. gonorrhoeae, and is used in empirical therapy for pelvic inflammatory disease. Cefotetan is similar to cefoxitin except for a long half-life that permits twice-daily dosing, and less activity against the non-fragilis Bacteroides spp.(16). Unlike cefoxitin, it has an jV-methylthiotetrazole (NMTT) group, which has been associated with hypopro-thrombinemia and bleeding. Most hospital pharmacies consider cefoxitin and cefotetan interchangeable, and may have only one on their formulary. The cephamycins are effective in the treatment of mixed aerobic-anaerobic infections, such as pelvic, abdominal, or diabetic foot infections. However, metronidazole and clindamycin have superior activity against Bacteroides spp. The cephamycins should not be used as monotherapy for nosocomial infections and serious nursing-home infections, or when reliable coverage against MSSA is needed. They are used for antimicrobial prophylaxis of colorectal surgery or for appendectomy, which would have clinical relevance to the elderly.
Parabacteroides distasonis: intriguing aerotolerant gut anaerobe with emerging antimicrobial resistance and pathogenic and probiotic roles in human health
Published in Gut Microbes, 2021
Jessica C. Ezeji, Daven K. Sarikonda, Austin Hopperton, Hailey L. Erkkila, Daniel E. Cohen, Sandra P. Martinez, Fabio Cominelli, Tomomi Kuwahara, Armand E. K. Dichosa, Caryn E. Good, Michael R. Jacobs, Mikhail Khoretonenko, Alida Veloo, Alexander Rodriguez-Palacios
Bacteroides spp. and Parabacteroides spp. are becoming increasingly more resistant to certain antibiotics62 because of an increase in the number of antimicrobial resistance-related virulence genes. Within the genus Parabacteroides, P. distasonis has a wide spectrum of resistance to various beta-lactams, being particularly resistant to the penicillin class.63–67 Nakano et al.67 demonstrated that up to 99% of P. distasonis isolates were resistant to penicillin and the first generation cephalosporin, cephalexin, while more than 85% of the P. distasonis isolates could be resistant to amoxicillin and ampicillin. Resistance to the second generation of cephalosporin, cefoxitin, was less frequent; it was found in only 12% of isolates tested.67 Differential resistance to cephalosporins, including cefotetan, cephalothin,63,68 cephalexin,67 cefoxitin,64,68 cefotaxime,64 cefazolin,68 and cefotetan,69 have also been reported, with resistances higher in earlier generations.
Cefoperazone-sulbactam and risk of coagulation disorders or bleeding: a retrospective cohort study
Published in Expert Opinion on Drug Safety, 2020
Wen Wang, Yanmei Liu, Chuan Yu, Jing Tan, Weiyi Xiong, Duo Dong, Sheyu Li, Rui Zhang, Jijie Li, Yu Wu, Zhiyong Zong, Na Su, Kang Zou, Guizhi Wu, Xin Sun
However, the occurrence of adverse effects (i.e. hypoprothrombinemia) may differ among antibiotics containing the NMTT chain [18]. A study involving patients with hepatobiliary disorders found that treatment with cefotetan – an antibiotic containing the NMTT chain – may not induce hypoprothrombinemia or bleeding [18]. Similarly, a prospective study suggested that antibiotics containing NMTT chain (e.g. cefotetan) did not increase the risk of coagulation disorders among patients with critical illness [25]. In addition, the beta-lactamase inhibitor may exert effects on the coagulation disorder. Our study found that, unlike cefoperazone-tazobactam, cefoperazone-sulbactam increased the risk of PT prolongation and coagulation disorders compared with ceftazidime. However, the mechanism involved in this process remains unclear. Previous studies suggested that NMTT-containing antibiotics were not an independent risk. In contrast, the severity of illness, poor nutrition status, and failure to use vitamin K supplementation may be potential risk factors for developing hypoprothrombinemia and bleeding [6,11,25]. Another possible hypothesis is that sulbactam may exhibit a synergistic effect with cefoperazone on hypoprothrombinemia. Our findings suggested that the risk of coagulation disorders among patients treated with cefoperazone-sulbactam was significantly increased compared with that reported in patients receiving cefoperazone-tazobactam. Nevertheless, this hypothesis warrants further exploration.
Surgical antimicrobial prophylaxis and its dose appropriateness among paediatric patients in a Nigerian teaching hospital
Published in Journal of Chemotherapy, 2019
Kazeem Adeola Oshikoya, Ibrahim Abayomi Ogunyinka, Comfort Adamaigbo, Ahmed Olowo-Okere
Over half of the surgeries recorded in our study were gastrointestinal related. SAP is indicated in most gastrointestinal surgeries.4,11,13 Perhaps this explains the high rate of appropriate indications (94.7%) for SAP and the overall high use of single or combined antimicrobial agents in our patients. Other studies evaluating SAP in paediatric surgical patients had reported similar high rates.27–31 By contrast, rates lower than ours had been reported in other studies.4,16 Although cefoxitin and cefotetan were the second-generation cephalosporin recommended in the SAP guidelines, cefuroxime was used mostly by our patients. Several reasons may explain this deviation. Lack of cefoxitin and cefotetan in the Nigerian market, and choice of the surgeons to use safe and cost-effective antimicrobials with activity against commonly encountered pathogens across different procedures or based on local resistance pattern.13,33–36 In spite of the pertinent role of cefazolin in preventing SSIs due to gram-negative or anaerobic bacteria, it was not recommended for any of our patients. The ability of cefazolin to provide adequate coverage for most gastrointestinal and other types of procedures necessitates its recommendation in the major SAP guidelines.