A cooperative study in 46 institutions and clinics in Tohoku and Hoddaido districts in Japan was carried out to compare the efficacy, usefulness and safety of
cefamandole and
cefazolin in treatment of repiratory tract
infections by randomized double blind technique. Two grams of either of the two
cephalosporins were given by
intravenous drip infusion to the two groups of patients aged over 16 years twice a day for 14 days. Of a total of 232 patients included in the study, 120 patients were treated with
cefamandole and 122 patients with
cefazolin. Of these patients treated with either of the both drugs, 27 patients were excluded from evaluation for efficacy. All 232 patients were adopted for analysis of side effects. Characteristics of the population, sex and age distribution, severity of
infections and infecting organisms before treatment were similar in each treatment group and no statistically significant differences could be found between the two groups. Both groups included nearly equal numbers of patients with underlying diseases or with complications. The patients pre-treated with other
antibiotics before the start of the study or treated simultaneously with anti-inflammatory drugs were equally distributed in the both treatment groups. Clinical cure rate was 69.2% in groups of the patients treated with
cefamandole, whereas that in
cefazolin treatment group was 62.2%. Thus, there was a difference of 7% in clinical cure rate between two treatment groups, though it was not statistically significant. In groups of patients with acute
bacterial pneumonia or lung abcess, clinical cure rate with
cefamandole was 76.7%, whereas that with
cefazolin was 67.7%. Thus, the clinical cure rate was 9% higher in the group of patients treated with
cefamandole, though the difference was again statistically not significant. In the group of patients with
infections associated with chronic
respiratory diseases,
cefamandole cured 50% of the patients treated, whereas
cefazolin cured 48.1%. Comparison of the curves of cumulative distribution of MICs of
cefamandole and
cefazolin proved the superiority of
cefamandole to
cefazolin in antimicrobial activities against strains of various species isolated from the patients in the study. Rate of eradication of potential pathogenic microorganisms was 82.4% in the patients with
pneumonia or
lung abscess who were treated with
cefamandole, whereas that with
cefazolin was 83.3%. Taking efficacy and adverse effects into consideration, usefulness of the two
cephalosporins in the treatment of
respiratory tract infections was evaluated by doctors in charge. In 33.3% of patients treated,
cefamandole was evaluated as quite useful in the treatment of
pneumonia or
lung abscess. In contrast,
cefazolin was evaluated as quite useful in only 18.3% of patient treated. This difference was statistically significant (P smaller than 0.1). In treatment of patients with
infections associated with chronic respiratory disease,
cefamandole and
cefazolin were evaluated as quite useful or useful in 53.1% and in 51...