[Cefminox concentration in tissues and clinical efficacy of cefminox in acute peritonitis]

Cefminox sodium (CMNX, MT-141), a new semisynthetic cephamycin, having marked resistance to beta-lactamase, and a broad spectrum of antibacterial activity against various bacterial species, including Haemophilus influenzae, Serratia marcescens and Citrobacter freundii, CMNX has higher activity in vivo than in vitro. For therapeutic purpose, CMNX was given in a daily dose of 0.5 g (0.5 g X 1) to 2 g (1 X 2) by intravenous drip infusion for 4 to 8 days to 24 cases with acute peritonitis (17 cases with acute appendicitis, 1 with localized peritonitis after gastrectomy, 1 with diffuse peritonitis due to perforative duodenal ulcer and 5 with panperitonitis due to intestinal obstruction). The clinical response was rated excellent in 9 cases, good in 14 cases and fair in 1 case and poor in none. No adverse effect was observed. There were 29 strains isolated organisms included 12 Escherichia coli, some Enterococcus faecalis and Pseudomonas aeruginosa. These isolated organisms were eradicated after CMNX treatment, except a strain of E. faecalis was decreased. In 19 cases of them, 16 cases with acute peritonitis due to acute appendicitis and 3 cases with acute panperitonitis due to intestinal obstruction, CMNX was administered intravenously in a dose of 1 g (1 case was 0.5 g) before or during the operation, and tissue specimens and body fluids samples were taken during the operation. CMNX concentration was determined to a bioassay with Escherichia coli NIHJ or Vibrio vercolans ATCC 8461 as the test organisms. CMNX concentrations in purulent ascites were 47.2 +/- 38.5 micrograms/ml (n = 23), those in infected appendix wall were 32.2 +/- 21.7 micrograms/g (n = 16), that in pus in appendix were 22.1 +/- 24.3 micrograms/ml (n = 8) and that in other non infected tissues were 24.3 +/- 22.0 micrograms/g (n = 8). CMNX concentrations in infected tissues were higher than the non infected tissues. In the 3 cases with empyemic appendicitis, CMNX levels in pus in appendix were more higher than that in appendix wall itself. Therefore, CMNX sodium appears to be a very useful drug when used for chemotherapy on acute peritonitis.