title: [Combination use of second generation cephem and isepamicin for the treatment of post-surgical infection of the lower digestive tract].
abstract: Effects of combination use of a second generation cephem and an aminoglycoside antibiotic isepamicin (ISP), for the treatment of post-surgical infections of the lower digestive tract were examined from a laboratory and clinical perspective. Thirty-three out of total 35 cases were included in the analysis of the test, while the other 2 cases did not meet the criteria for analysis. ISP was administered in combination with one of the second generation cephems among cefotiam (CTM), cefmetazole (CMZ), or cefuroxime (CXM) for 26 cases of wound infection and 7 cases of peritonitis. The overall efficacy rate was 88%; 92% in wound infection and 71% in peritonitis individually. There was no significant difference in efficacy among different groups. Bacteriological study showed the combination use of any one of the second generation cephems and ISP was very effective in all 14 cases of infections with a single species of bacterium, the efficacy rate was 100%. It was also effective in 9 out of 10 cases with mixed infections of 2 species of bacteria (90%), but effectiveness was diminished in only 6 out of 9 cases with mixed infections of 3 species (67%). Sixty-nine strains were isolated from the 35 cases, more than half of which (44 strains) were Gram-negative; 14 strains of E. coli (20%), 13 strains of E. faecalis (13%) and 6 strains of P. aeruginosa (9%). The MIC50 and MIC90 were, respectively, 1.56 micrograms/ml and 100 micrograms/ml for ISP, 6.25 micrograms/ml and 100 micrograms/ml for CTM, 12.5 micrograms/ml and 100 micrograms/ml for CMZ, and 25 micrograms/ml and 100 micrograms/ml for CXM. The MICs in any combination uses decreased synergistically according to ISP concentration. Adverse events were observed in 3 out of 35 cases, but they were not severe. The results indicated that the combination use of a second generation cephem and ISP was useful and should be one of the choices for the treatment of post-operative infections of the lower digestive tract.
authors.affiliation: Department of Surgery, Sendai National Hospital.
authors.forename: R
authors.initials: R
authors.lastname: Masamune
authors.forename: Y
authors.initials: Y
authors.lastname: Kunii
authors.forename: I
authors.initials: I
authors.lastname: Watanabe
authors.forename: Y
authors.initials: Y
authors.lastname: Imaoka
authors.forename: S
authors.initials: S
authors.lastname: Momono
authors.forename: T
authors.initials: T
authors.lastname: Toyoshima
authors.forename: T
authors.initials: T
authors.lastname: Toyoda
authors.forename: M
authors.initials: M
authors.lastname: Abe
authors.forename: K
authors.initials: K
authors.lastname: Oouchi
authors.forename: Y
authors.initials: Y
authors.lastname: Kamiyama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D015311:Cefmetazole / Q000008:administration & dosage; D015310:Cefotiam / Q000008:administration & dosage; D002444:Cefuroxime / Q000008:administration & dosage; D002511:Cephalosporins / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage; D006801:Humans; D007410:Intestinal Diseases / Q000188:drug therapy*; D007422:Intestines / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000188:drug therapy*; D011183:Postoperative Complications / Q000188:drug therapy*; D013530:Surgical Wound Infection / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D005839:Gentamicins; D015311:Cefmetazole; D015310:Cefotiam; C016927:isepamicin; D002444:Cefuroxime