Treatment of osteomyelitis and septic arthritis with cefamandole

Fourteen patients with bone and joint infections caused by a variety of bacterial pathogens were treated with intravenous cefamandole, 4 to 12 g/day; ten received additional therapy with 2 g/day of cefaclor and one with 2 g/day of cephalexin. Ten of 14 patients were cured. Of those cured, infecting pathogens had minimal inhibitory concentrations of cefamandole of 4 micrograms or less/ml. Of those who were not cured, two had recurrent infections that had not responded to other previously administered antibiotics, one had a mixed infection with resistant strains, and one had positive bone cultures five months after a favorable clinical response. Peak and valley cefamandole serum concentrations were 48.0 to 173.0 micrograms/ml and 23.4 micrograms or less/ml, respectively. Synovial fluid concentrations were 11.1 to 16.7 micrograms/ml and bone concentrations were 0.2 to 20.4 micrograms/g. Adverse effects included leukopenia in one and hepatic enzyme elevations in four patients. Cefamandole, with and without cefaclor, was efficacious in therapy of bone and joint infections caused by susceptible organisms.