The efficacy of cefotaxime in gram-positive surgical infections.

In order to evaluate the efficacy of cefotaxime in gram-positive surgical infections, three clinical studies were re-evaluated. Antibiotic susceptibility tests were carried out on clinical isolates from our hospital during the period of clinical use of cefotaxime. The tissue fluid concentrations measured were compared to minimal inhibitory concentrations of gram-positive pathogens. Following 2 g cefotaxime i.v., tissue fluid concentrations were higher than 8 mg/l for more than 6 h and higher than 4 mg/l for more than 8 h. More than 90% of gram-positive pathogens excluding enterococci were inhibited at 4 mg/l. A comparison was made on the clinical efficacy of cefotaxime on infections caused by gram-positive organisms (group I) versus infections due to gram-negative bacteria (group II). 89 patients entered this study. In 40 patients only gram-positive bacteria were isolated initially (group I) and in 49 mainly gram-negative bacteria (group II). The mean age was 43 years (range 8-80 years) in group I and 61 years (range 19-92 years) in group II. Most patients received 2 g cefotaxime every 12 h. 40 skin and soft tissue infections (group I = 25, group II = 15), 25 pulmonary infections (group I = 7, group II = 18), 17 biliary infections (group I = 4, group II = 13) and nine bone and joint infections (group I = 4, group II = 5) were treated. The mean duration of therapy was nine (group I) and 11.2 (group II) days. Surprisingly, the cure rate was better in group I (70%) than in group II (59%).(ABSTRACT TRUNCATED AT 250 WORDS)