Cefamandole therapy in hand infections

Hand lacerations, especially when inadequately treated, may result in infections caused by aerobic or anaerobic bacteria. Anaerobic infections most commonly result from human bite injuries in which there is contact between hand and mouth. The search continues for an ideal antibiotic to employ when anaerobic organisms are suspected. In this study cefamandole, a new cephalosporin antibiotic, was employed whenever anaerobic hand infections were suspected following trauma. In each patient quantitative cultures for both aerobic and anaerobic organisms were obtained. All organisms isolated were tested by standard susceptibility assays for both aerobes and anaerobes. In the case of anaerobes, minimum inhibitory concentration assays were also performed. After the initial culture was obtained, each patient received approximately 1.5 gm of cefamandole every 6 hours for a period of 5 days. This therapy was changed only if susceptibility studies indicated resistance to cefamandole. In our patients, 58% of the infectious organisms were aerobic and facultative anaerobic and 42% were obligate anaerobes. The predominant organisms isolated were Staphylococcus aureus and Peptostreptococcus anaerobius, which accounted for 42% of the infections. In most of the aerobic infections a single organism was isolated, whereas multiple organisms were identified in the anaerobic infections. All but one of the infections responded to cefamandole; the one that didn't was caused by Enterobacter cloacae and required treatment with an aminoglycoside. Because of its broad-spectrum coverage, which includes both aerobes and anaerobes, cefamandole is useful in treating infections, especially those resulting from human bites.