Twice-daily intramuscular
ceforanide therapy of Staphylococcus aureus
endocarditis in parenteral drug abusers was compared in a randomized prospective trial with intravenous
cephapirin therapy. Dosage regimens were
ceforanide, 1 g every 12 h, and
cephapirin, 2 g every 4 h. Mean minimal inhibitory and bactericidal concentrations of
ceforanide for S. aureus treated with
ceforanide were 0.78 and 1.56 microgram/ml compared to
cephapirin for patient isolates of 0.08 and 0.14 microgram/ml, respectively. Serum killing levels with
ceforanide were 1:5.7 and 1:1.5 at peak and trough levels, compared to 1:134 (peak) and 1:4.2 (trough) with
cephapirin. Despite this apparent in vitro advantage of
cephapirin, patients treated with
ceforanide did as well as those with
cephapirin. Of 16
ceforanide-treated patients, all responded initially to
therapy, and 15 were cured with 28 days of
therapy. One patient relapsed at the end of
therapy. Of 16
cephapirin-treated patients, 1 was a clinical and microbiological failure, and 3 other relapsed at the end of
therapy. In addition, one
ceforanide-treated patient and two
cephapirin-treated patients developed central nervous system
abscesses. These were cured with drainage and continuation of
antibiotic therapy.
Ceforanide was well tolerated by the intramuscular route. Cost analysis suggests that
therapy with intramuscular
ceforanide would result in an approximate 70% decrease in
drug therapy cost when compared to intravenous
cephapirin.
Ceforanide appears to be a safe, efficacious, convenient, and relatively inexpensive
drug for treating staphylococcal
endocarditis in parenteral drug abusers.