Immunologic Evaluation of Patients with Cefotetan-Induced Anaphylaxis

Cefotetan is a commonly prescribed second-generation cephalosporin that acts against a wide range of bacteria. However, cefotetan-induced hypersensitivity has rarely been reported. We report 2 cases of cefotetan-induced anaphylaxis with immunologic evaluation. The first case was a 70-year-old asthmatic woman who had dyspnea and hypotension during administration of cefotetan, in which high serum-specific IgE to cefotetan-human serum albumin (HSA) conjugate was detected by enzyme-linked immunosorbent assay. The second case was a 63-year-old asthmatic woman who complained of chest tightness and dyspnea during cefotetan infusion, in which high serum-specific IgG1 and IgG4 with no serum specific IgE to cefotetan-HSA conjugate was detected. The basophil activation test using basophils from the patient showed a significant up-regulation of CD63 with the addition of anti-IgG4 antibody compared with that in non-atopic healthy controls. In conclusion, cefotetan can induce anaphylaxis, which may involve both IgE- and IgG4-mediated responses in the pathogenic mechanism.

Pharmacokinetics of cefotetan for injection in healthy volunteers / 中国药学杂志

OBJECTIVE: To investigate the pharmacokinetics of cefotetan for injection in Chinese healthy volunteers.

Determination of residual solvents in cefotetan disodium by headspace gas chromatography / 中国药学杂志

OBJECTIVE: To establish a method for determining nine residual solvents in cefotetan disodium by headspace gas chromatography. METHODS: The residual solvents including methanol, acetone, acetonitrile, dichloromethane, butanone, ethyl ace-late, tetrahydrofuran in cefotetan disodium were quantitatively determined on a DB-624 column (30 m×0.32 mm, 1.8 μm). Water was solvent media. The residual solvents of anisole and isocaprylic acid in cefotetan disodium were quantitatively determined on a HP-FFAP column (25 m×0.32 mm, 0.5 μm). The 20% dimethylsulfoxide (DMSO) was used as the solvent. RESULTS: Nine residual solvents were completely separated. Good linearity of the solvents were obtained within the determination ranges. There between 0.9988 and 0.9997. The average recoveries of three levels were in the range of 95.71%-103.55%. The RSDs were 0.39%-2.28%. CONCLUSION: The established two methods are accurate and sensitive, and can be used for the determination of residual solvents in cefotetan disodium.

Pharmacokinetic study of cefotetan disodium for injection in Chinese healthy volunteers / 中国药学杂志

OBJECTIVE: To study the pharmacokinetics of cefotetan disodium for injection in Chinese healthy volunteers. METHODS: Thirty healthy volunteers were randomly divided into 3 groups with 5 males and 5 females in each group. The volunteers in each group were administered a single dose of cefotetan disodium of 0.5, 1.0, or 2.0 g, respectively. Those who got dose of 1.0 g were administered twice daily for 7 d. The concentrations of cefotetan disodium in plasma were determined by HPLC while the pharmacokinetic parameters were calculated by DAS software. RESULTS: The main pharmacokinetic parameters of cefotetan disodium after single-dose intravenous administration were as follows: ρmax(68.03 ± 15.95), (110.77 ± 17.67), (225.34 ± 19.63) mg · L-1; AUC0-15(242.88 ± 56.60), (415.22 ± 54.24), (856.18 ± 82.72) mg · h · L-1; t1/2(3.67 ± 0.48), (3.69 ± 0.40), (3.53 ± 0.26) h, respectively. The main pharmacokinetic parameters of cefotetan disodium after multiple-dose administration were as follows: ρmax(123.60 ± 15.74) mg · L-1; AUC0-15 (444.38 ± 62.78) mg · h · L-1; AUCSS(426.87 ± 59.36) mg · h · L-1; t1/2(3.29 ± 0.36) h; ρav(35.57 ± 4.95) mg · L-1, respectively. CONCLUSION: Cefotetan disodium for injection displays linear pharmacokinetics in the dose range of 0.5 to 2.0 g after single intravenous dosing. There is no significant accumulation after repeated dosing. There is no significant difference in the pharmacokinetic parameters between female and male subjects. Copyright 2012 by the Chinese Pharmaceutical Association.

Delayed Anaphylactic Shock to Intravenous Cefotetan in a Pregnant Woman: A Case Report / 대한구급학회지

Anaphylactic reactions to agents administered intravenously usually occur within minutes. We present an unusual case of a delayed onset anaphylactic shock to intravenous cefotetan in a pregnant woman who underwent an epidural cesarean section. She sustained hypotension, tachycardia, bronchospasm, and rash 90 min after administering intravenous cefotetan. The possibilities of high epidural blocks or amnionic fluid embolisms were excluded by the height of sensory blocks or different presenting symptoms and signs, respectively. Allergic skin tests for exposed materials were performed 6 weeks after discharge and no immediate reactions occurred. However, delayed systemic allergic reactions, such as urticaria, rash, and edema on her face, neck, back, and abdomen, occurred 3 h after skin test to cefotetan.

Cefotetan versus Conventional Triple Antibiotic Prophylaxis in Elective Colorectal Cancer Surgery

This study examined infectious outcomes in elective colorectal cancer surgery between cefotetan alone or conventional triple antibiotics. From January to December 2007, 461 consecutive primary colorectal cancer patients underwent elective surgery. Group A contained 225 patients who received conventional triple antibiotics (cephalosporin, aminoglycoside and metronidazole) for prophylaxis, and group B contained 236 patients who received cefotetan alone for prophylaxis. Treatment failure was defined as the presence of postoperative infection including surgical-site infection (SSI), anastomotic leakage, and pneumonia or urinary tract infection. The two groups were similar in terms of demographics, American Society of Anesthesiologists (ASA) score, tumour location, stage, surgical approach (conventional open vs. laparoscopy-assisted), and type of operation. The treatment failure rates were 3.1% in Group A and 3.4% in Group B (absolute difference, -0.3%; 95% confidence interval [CI], 0.39 to 3.07, P=0.866), with SSI being the most common reason for failure in both groups (2.7% in Group A and 3.0% in Group B [absolute difference, -0.3%; 95% CI, 0.37 to 3.37, P=0.846]). Cefotetan alone is as effective as triple antibiotics for prophylaxis in primary colorectal cancer patients undergoing elective surgery.

Anaphylactic Reaction to Cefotetan during Spinal Anesthesia: A case report / 대한마취과학회지

A 37-year-old male was admitted for a hemorrhoidectomy. He received uneventfully spinal anesthesia for a hemorrhoidectomy. He had no previous history of any allergic tendency. By the request of the general surgeon, a cefotetan was intravenously administered slowly to reduce the incidence of infection. A few minutes later, anaphylactic reaction developed with hypotension, tachycardia, consciousness change and urticaria. After appropriate management, he recovered without any complication.

Anaphylactic Reaction to Cefotetan during Spinal Anesthesia: A case report / 대한마취과학회지

A 37-year-old male was admitted for a hemorrhoidectomy. He received uneventfully spinal anesthesia for a hemorrhoidectomy. He had no previous history of any allergic tendency. By the request of the general surgeon, a cefotetan was intravenously administered slowly to reduce the incidence of infection. A few minutes later, anaphylactic reaction developed with hypotension, tachycardia, consciousness change and urticaria. After appropriate management, he recovered without any complication.