Acta Derm Venereol, 1981, 61(2), 171 - 3 Stevens-Johnson syndrome associated with intrahepatic cholestasis and respiratory disease: a case report; Schonheyder H; In an 8-year-old boy, the Stevens-Johnson syndrome (SJS) was associated with protracted intrahepatic cholestasis and ultimately fatal respiratory disease . No precipitating factors of SJS were identified, but a Mycoplasma pneumoniae infection was suspected . The appearance of jaundice on the seventh day of illness was preceded by the prescription of erythromycin ethyl succinate, but intrahepatic cholestasis has never before been associated with this derivative of erythromycin . It is suggested that there may exist a subtype of SIS with severe hepato-pulmonary pathology. Nucleic Acids Res, 1980 Dec 20, 8(24), 6081 - 97 Conformational alteration of mRNA structure and the posttranscriptional regulation of erythromycin-induced drug resistance; Gryczan TJ et al.; The DNA sequence of the ermC gene of plasmid pE194 is presented . This determinant is responsible for erythromycin-induced resistance to the macrolide-lincosamide-streptogramin B group of antibiotics and specifies a 29,000 dalton inducible protein . The locations of the ermC promoter, as well as that of a probable transcriptional terminator, are established both from the sequence and by transcription mapping . The sequence contains an open reading frame sufficient to encode the previously identified 29,000 dalton ermC protein . Between the promoter and the putative ATG start codon is a 141 base pair leader sequence, within which several regulatory (constitutive) mutations have been mapped and sequenced . The leader has a second open reading frame, sufficient to encode a 19 amino acid peptide . It is suggested that induction by erythromycin involves a shift between alternative ribosome-bound mRNA conformations, so that the ribosome binding sequence and the start codon for synthesis of the 29K protein are unmasked in the presence of inducer . Possible active and inactive folded configuration of the leader sequence are presented, as well as the effects on these configurations of regulatory mutations. Br J Surg, 1980 Dec, 67(12), 895 - 6 Pseudomembranous colitis after whole gut irrigation with neomycin and erythromycin base; Weidema WF et al.; An unprecedented fatal case of pseudomembranous colitis (PMC) is described, associated with the use of topical antibiotics (neomycin and erythromycin base) during whole gut irrigation . This case was one of a cluster of five, occurring within a period of 4 months in 1978 . These observations tend to support the hypothesis that disturbances in bacterial flora give rise to PMC and furthermore that the short-term use of antibiotics does not prevent the occurrence of PMC. Pediatrics, 1980 Dec, 66(6), 884 - 8 An explosive outbreak of Mycoplasma pneumoniae infection in a summer camp; Broome CV et al.; An outbreak of Mycoplasma pneumoniae infection occurred in the summer of 1978 in a boys' camp in northern Wisconsin and affected 139 of 196 persons (71%); 115 (59%) had laboratory evidence of infection . In 77% of the cases, onset of disease occurred within three weeks after arrival at camp, in contrast to the usually indolent spread of the disease . Attack rates decreased with increasing age . The sensitivity of serology for detecting M pneumoniae disease may have been as low as 79% . There was shorter duration of cough in those treated with erythromycin within four days after onset of symptoms. JAMA, 1980 Nov 21, 244(20), 2291 - 3 Erythromycin ointment for ocular prophylaxis of neonatal chlamydial infection; Hammerschlag MR et al.; We compared the efficacy of erythromycin ophthalmic ointment vs 1% silver nitrate drops for the prevention of neonatal conjunctivitis or respiratory tract infection from Chlamydia trachomatis . The organism was isolated from the cervix of 67 (12%) of 572 pregnant women . They gave birth to 559 infants who were randomly assigned to either prophylaxis immediately after birth . Thirty-six of 60 infants born to Chlamydia-positive women received silver nitrate; 24 received erythromycin . Twelve (33%) of the 36 infants who received silver nitrate had chlamydial conjunctivitis, but none of the 24 infants who received erythromycin did . Ten (29%) of 36 infants receiving silver nitrate had chlamydial nasopharyngeal infection (three later had pneumonia), as opposed to five (21%) of 24 who received erythromycin (one had pneumonia) . Thus, erythromycin ointment is effective in prevention of chlamydial conjunctivitis, but it may not reduce nasopharyngeal infection or subsequent pneumonia. Nouv Presse Med, 1980 Nov 15, 9(43), 3245 - 8 {Interstitial pneumonia due to Chlamydia trachomatis in infants . Three cases (author's transl)}; Couvreur J et al.; The early onset of the disease (between the 13th and 15th days of life) and its long duration in 2 out of 3 cases, the absence of infectious symptoms and the efficacy of erythromycin treatment were characteristic features . The diagnosis was confirmed by positive (greater than 1/32th) serological tests in both infants and parents . Chlamydia trachomatis lung infection should be suspected in infants presenting, during the first weeks of life, with cough and dyspnoea unaccompanied by fever, radiological evidence of interstitial pneumonia, blood eosinophilia and raised immunoglobulin levels . The disease results from intranatal contamination and might represent, in France as in the U.S.A., an important percentage of respiratory infections occurring during the early months of life. Schweiz Med Wochenschr, 1980 Nov 15, 110(46), 1727 - 38 {Clinical data on Legionnaires' disease . Report on 8 sporadic cases of Legionella pneumonia}; Mordasini C et al.; In 1978 and 1979, eight sporadic cases of Legionella pneumonia were observed in the Berne and Ticino areas of Switzerland . In all cases the diagnosis was established serologically using indirect immunofluorescence . Seroconversion was observed in five patients . In three cases initially high antibody titers decreased progressively . The clinical picture was characterized by acute onset with high fever, frequent chills, and dry cough . Occasional concomitant symptoms included muscular pains, headache, thoracic pain, dyspnea, hemoptysis, and gastrointestinal and central nervous symptoms . Laboratory findings showed markedly increased BSR as well as slightly increased WBC with a pronounced shift to the left . In all cases, X-ray examinations demonstrated extended, mainly unilateral and often remarkedly peripheral infiltrations of the lung . On the basis of the clinical course, two groups could be distinguished: (a) non-complicated cases of pneumonia with rapid improvement within 2-3 weeks; and (b) cases with a protracted sometimes severe course with persistence of the infiltrations up to 4 months and more . All patients with a protracted course suffered from concomitant symptoms . Whereas none of the patients died of legionellosis, two patients died six months later from their underlying disease . Most patients were treated with several antibiotics . In three patients definite improvement occurred only after therapy had been changed to doxycycline . Erythromycin, currently recommended as the drug of choice, was used in none of these cases. Schweiz Med Wochenschr, 1980 Nov 15, 110(46), 1720 - 7 {Legionnaires' disease in the Lake Zurich area . Report on 6 sporadic cases}; Strebel U et al.; Six sporadic cases of Legionnaires' disease seen over 13 months in the region of Lake Zurich (Switzerland) are reported . The disease was severe in all cases; 2 patients died while on artificial respiration; 5 patients were heavy smokers; 3 had probably acquired the infection in France . These 6 patients showed the following typical symptoms and signs: fever above 39 degrees C (6 patients), nonproductive cough (4), gastrointestinal symptoms (4), encephalopathy (4), renal insufficiency (5), hepatic involvement (4), bilateral pneumonia (4), and pO2 below 60 mm Hg (4) . The disease was diagnosed serologically in all cases and by staining and culturing Legionella pneumophila from lung tissue in one case . The authors propose to treat unusual cases of pneumonia with erythromycin from the outset. J Pharm Sci, 1980 Nov, 69(11), 1307 - 10 Correlation of in vivo bioavailability of erythromycin stearate tablets with in vitro tests; Stavchansky S et al.; Correlations between the bioavailability parameters for erythromycin stearate tablets from five manufacturers and in vitro tests of these tablets were examined using forward (stepwise), multiple linear regression analysis . Bioavailability parameters were determined in clinical studies employing a balanced, incomplete block design . In vitro tests used disintegration, dissolution, and dissolution/dialysis as the independent variables in regression equations . Significant correlations were found between linear combinations of these parameters and the time of peak and the peak serum levels . The inclusion of an in vitro disintegration test to describe peak serum levels of erythromycin is noteworthy since it has been suggested that disintegration tests are of less value than dissolution techniques employed in the present investigation may be useful for selection of appropriate physicochemical tests for continued monitoring of the bioavailability of erythromycin stearate tablets. Arch Intern Med, 1980 Nov, 140(11), 1537 - 9 Cold agglutinin disease in a patient with Legionnaires' disease; King JW et al.; We present a case of Legionnaires' disease complicated by cold agglutinin disease . Therapy with erythromycin gluceptate was associated with resolution of both the pneumonia and the hemolysis . Complement-fixing antibody levels to Mycoplasma pneumoniae, influenza A, and adenoviruses were measured repeatedly throughout the clinical illness and were persistently nondiagnostic . The cold agglutinin present in the patient's serum was characterized as an IgM that demonstrated anti-I specificity . Thus, Legionella pneumophila should be considered a potential causative agent in patients with pneumonia and cold agglutinin disease. Antimicrob Agents Chemother, 1980 Nov, 18(5), 829 - 31 Influence of food on absorption of erythromycin ethyl succinate; Thompson PJ et al.; Erythromycin plasma concentrations were determined in 18 subjects after a single dose (800 mg) of a new formulation of erythromycin ethyl succinate taken immediately before, immediately after, and 1 h after food . Adequate absorption occurred with all treatments, although bioavailability was best when the drug was taken before food . Absorption was delayed by food, with the highest and earliest peak plasma erythromycin levels occurring under fasting conditions. J Am Acad Dermatol, 1980 Nov, 3(5), 483 - 91 Topical erythromycin with zinc in acne . A double-blind controlled study; Feucht CL et al.; This double-blind controlled study investigated the effectiveness of 4% topical erythromycin liquid with 1.2% zinc acetate and 4% topical erythromycin gel with 1.2% zinc octoate applied twice daily in comparison with 250 mg of oral tetracycline twice daily and placebo . One hundred forty-nine patients began and one hundred forty-one completed the study . Three judges recorded acne measurements of severity grade, papule counts, pustule counts, comedo grades, and comedo counts without mutual consultation on visits at 0, 2, 4, 6, 8, and 10 weeks . Analysis of the reduction in the acne severity grade and papule count showed that the erythromycin/zinc liquid and gel were statistically significantly better than placebo and as effective as the oral tetracycline . Analysis of comedo grades showed that at weeks 8 and 10 the 4% topical erythromycin/zinc liquid showed a reduction statistically better than placebo. J Am Acad Dermatol, 1980 Nov, 3(5), 478 - 82 Topical erythromycin solution in acne . Results of a multiclinic trial; Dobson RL et al.; In a multiclinic double-blind trial, 253 patients with moderate to severe acne vulgaris were treated with erythromycin, 1.5% topical solution (n = 127), or the vehicle (n = 126) . The preparations were applied twice daily for 12 weeks . The response to treatment was evaluated by lesion counts and overall clinical judgment at 2, 4, 8, 10, and 12 weeks after initiation of treatment . The reduction in the number of inflammatory lesions, papules, and pustules was significantly greater (p less than 0.01) in the erythromycin-treated group . The global evaluation of the clinical response correlated well with the reduction in the lesion counts . No serious adverse effects were encountered. Can Med Assoc J, 1980 Oct 7, 123(7), 639 - 44 Eight cases of Legionnaires' disease; Cheung MT; Eight patients with Legionnaires' disease were seen at one hospital in the summer of 1979 . They presented in the same 12-day period with an illness of rapid onset characterized by fever, chills, malaise, profuse sweating and neurologic symptoms . Neutrophilia, a high erythrocyte sedimentation rate, proteinuria, hypoalbuminemia, hyponatremia, hypochloremia and abnormal liver enzyme levels in the serum were usually noted . The roentgenographic findings in the lungs ranged from segmental interstitial infiltration to panlobar pneumonia . Seven patients responded to erythromycin treatment, though one died suddenly, presumably of unrelated cardiac disease . The other patient died of a combination of renal and respiratory failure, with pulmonary edema. Br J Vener Dis, 1980 Oct, 56(5), 337 - 40 Subclinical pneumonia due to serotypes D-K of Chlamydia trachomatis . Case reports of two infants; Dunlop EM et al.; Pneumonia due to serotypes D-K of Chlamydia trachomatis occurred in a 10-week-old baby, who had been successfully treated with chlortetracycline eye ointment for chlamydial ophthalmia neonatorum, and in a 7-week-old baby being treated for the same condition . Clinical signs of pneumonia were minimal . Such chlamydial pneumonia in infants must be under-diagnosed . Infants with chlamydial ophthalmia neonatorum are now routinely treated with erythromycin suspension by mouth in addition to chlortetracycline eye ointment. Am J Hosp Pharm, 1980 Oct, 37(10), 1333 - 8 Drug interferences with tests performed by a 12-channel autoanalyzer; Yosselson-Superstine S et al.; The information reported in a variety of sources on drug interferences with routine laboratory tests (serum concentrations of sodim, potassium, carbon dioxide, chloride, glucose, BUN, cholesterol, total protein, albumin, total bilirubin, alkaline phosphatase, and SGOT) performed by a 12-channal autoanalyzer was reviewed . A determination was made whether or not the information was based on an evaluation of original articles, if the study was done in vitro or in vivo, what medium was used, if the drug level causing the interference would be encountered in a patient's serum, and if the reported conclusions were clinically significant . The review narrowed considerably the list of drug interactions with laboratory tests performed by 12-channel autoanalyzer methods . Clinically significant interactions were found for (1) aminosalicylic acid and the test for serum glucose; (2) gamma globulins and cholesterol measurement; (3) sulfonamides and paramethadione and the test for albumin; (4) albumin from placental sources and alkaline phosphatas measurement; (5) erythromycin estolate and aminosalicylic acid and the determination of SGOT; and, possibly (5) medications releasing bromide ions and the measurement of serum chloride . The study showed the need to determine the relevancy of drug interactions to the specific methods used in the laboratory of each medical institution. Postgrad Med J, 1980 Oct, 56(660), 707 - 10 Plasma and salivary concentrations of erythromycin after administration of three different formulations; Henry J et al.; In a 6-volunteer cross-over study the pharmacokinetics of 3 erythromycin preparations were compared . A single oral dose of 500 mg of each preparation was administered at each occasion and the levels measured in timed samples of plasma and saliva . Markedly higher blood concentrations of the estolate and propionate were obtained compared to the stearate . Comparison of serum and plasma concentration of the drugs from each split sample showed no significant differences . Plasma concentrations always exceeded those in saliva but for any one preparation a similar ratio was obtained at different times . This may be useful to ascertain compliance and to measure concentration of the compounds where direct measurement in plasma is not practicable. J Pharmacobiodyn, 1980 Oct, 3(10), 493 - 9 Effects of various therapeutic agents on leukocytes in vivo and in vitro: competition between the cytotoxic drugs and colony stimulating factors (CSF) in the action on the proliferation of myeloid stem cells (CFU-C); Onoda M et al.; The effect of a single or repeated intraperitoneal injection(s) of various therapeutic agents on peripheral leukocyte count in mice was studied . The results revealed a great deal of initial variation of leukocyte number in the animals and also variants in the capability of the animals to restore the decreased leukocyte level . On the other hand, a simple reproducible and highly sensitive method for the evaluation of the toxic effect of the chemicals on leukopoiesis has been provided by culturing mouse bone marrow cells in a semi-solid agar medium in the presence of purified colony stimulating factor (CSF) . There was three groups of chemicals in regard to the effect on the proliferation of the myeloid cells (CFU-C) in culture: (1) Anti-cancer drugs such as mitomycin C and 5-fluorouracil were inhibitory to CFU-C at 10(-8) - 10(-7)M . (2) Many drugs such as erythromycin, cephalosporin etc . showed apparent toxicity in 10(-5) - 10(-4)M . (3) Drugs like penicillin, streptomycin, cysteine etc . showed no significant toxicity at concentrations higher than 10(-4)M . It was noted that the inhibition of CFU-C proliferation either by mitomycin C (an inhibitor of DNA synthesis) or by erythromycin(an inhibitor of protein synthesis) occurred in a manner competitive to the added CSF activity . The results suggest that CSF is capable of specifically protecting the myeloid stem cells from the toxic action of the chemicals. Epilepsia, 1980 Oct, 21(5), 489 - 96 Carbamazepine intoxication due to triacetyloleandomycin administration in epileptic patients; Mesdjian E et al.; In 17 epileptics receiving carbamazepine (CBZ) alone or in combination with other anticonvulsant drugs, administration of triacetyloleandomycin (Tri A) led to an acute and unexpected intoxication (drowsiness, nausea, vomiting, and dizziness) . Similar symptoms occurred again in 3 patients after Tri A was administered a second time . The same toxic manifestations were observed in two patients receiving CBZ and erythromycin . A rapid increase in plasma levels of CBZ occurred after institution of Tri A therapy in 6 patients, the CBZ levels quickly returning to normal after withdrawal of Tri A . Thus, it is suggested that the observed intoxication is due to the simultaneous administration of CBZ and Tri A (or erythromycin) . The possible role of hepatic dysfunction in this syndrome of intoxication is discussed . Furthermore, the intoxication may be at least partially related to serum electrolyte disturbances, as suggested by one case in which obvious signs of water intoxication were detected . The severity and frequency of intoxication should lead to proscribing Tri A or other macrolide antibiotics in patients receiving CBZ. J Clin Periodontol, 1980 Oct, 7(5), 374 - 80 Influence of eating frequency upon plaque formation and periodontal bone loss; Savoff K et al.; The normal oral flora of weanling Osborne-Mendel rats was suppressed with penicillin, then bone resorption was induced in the test group by inoculation with Actinomyces viscosus Ny 1 . In the control group the oral flora was suppressed with erythromycin . A programmable feeding machine forced the rats into extremely varied eating frequencies . Rats which ate less frequently than normal exhibited significantly less bone loss . Frequent eating was correlated with elevated plaque accumulation . AVIS-inoculated animals exhibited significantly (P less than 0.001) more plaque than antibiotic-treated rats . Both inoculated as well as non-inoculated animals exhibited significantly more plaque (P less than 0.001) when fed 28 times per day, in comparison to all other feeding schedules . AVIS-inoculated animals exhibited significantly (P less than 0.001) more bone loss than the antibiotic-treated rats . Inoculated animals which were fed only seven times per day exhibited significantly (P less than 0.05) less bone loss than similarly inoculated animals fed more frequently . Bone loss in the antibiotic-treated animals was independent of feeding frequency . Among the other feeding frequencies (14 and 28 x/day, and ad libitum), there were no significant differences either in AVIS-inoculated or in antibiotic-treated animals. Minerva Chir, 1980 Sep 30, 35(18), 1393 - 400 {Fistulas complicating diverticular disease of the colon}; Griffa B et al.; Five patients were admitted to the 1st and 2nd Division of General Surgery of Soronno Hospital between July '75 and September '78 suffering from fistulas complicating colon diverticulosis . A sixth patient, operated on for diverticulitis, developed a stercoraceous cutaneous fistula in the postoperative period . This was closed by conservative therapy . A woman patient suffering from colo-enteric fistula, was not operated because she refused . In all operated patients, broad resection of the sigmoid was carried out with end-to-end anastomosis . In three cases a caecostomy was formed to protect the anastomosis . All operated patients were treated preoperatively with laxatives, clysters and intestinal antibiotics, prevalently paromomycin and in one case neomycin plus base erythromycin . Surgery led to the cure of all patients treated. JAMA, 1980 Sep 5, 244(10), 1101 - 2 Gonococcal tenosynovitis-dermatitis and septic arthritis . Intravenous penicillin vs oral erythromycin; Thompson SE 3rd et al.; Twenty-three patients with disseminated gonococcal infections--15 with acute tenosynovitis, six with septic monoarticular arthritis, and two with both--were randomly given five days of erythromycin stearate or estolate, 500 mg orally every six hours (13 patients), or crystalline aqueous penicillin G potassium, 1 million units intravenously every three hours for three days (ten patients) . There were no treatment failures . Cultures taken one and seven days and two and four weeks after completion of therapy were uniformly negative . Clinical resolution was rapid in both groups, as judged by response of fever, joint tenderness, and disappearance of joint effusion . Orally administered erythromycin is a useful alternative to penicillin in the treatment of disseminated gonococcal infections, particularly in penicillin-allergic pregnant women. Am J Hosp Pharm, 1980 Sep, 37(9), 1199 - 205 Selection of an oral erythromycin product; Fraser DG; The chemistry, bioavailability, and adverse effects of erythromycin base, stearate, estolate, and ethylsuccinate are reviewed . Criteria for the evaluation of erythromycin bioavailability studies include study design, patient population, meal composition and timing, and assay methodology . Based on these criteria, the bioavailability of individual erythromycin products are evaluated in this paper . Compared with other antibiotics, the erythromycins have a good safety record . However, both the estolate and ethylsuccinate forms of erythromycin may cause hepatotoxity . Considering bioavailability and adverse effect data, a specific brand of enteric-coated erythromycin base tablets is recommended for erythromycin-sensitive infections in adults . For pediatric patients, a liquid formulation of erythromycin estolate or erythromycin ethylsuccinate is recommended. Infect Immun, 1980 Sep, 29(3), 1040 - 9 Long-term incorporation of tritiated adenine into deoxyribonucleic acid and ribonucleic acid by Treponema pallidum (Nichols strain); Norris SJ et al.; Treponema pallidum (Nichols strain), extracted in medium containing Eagle minimal essential medium 50% fresh, heat-inactivated normal rabbit serum, and 1.0 mM dithiothreitol, was incubated under 3% oxygen in the presence of tritiated nucleic acid precursors . {8-3H}adenine was incorporated with high efficiency into trichloroacetic acid-insoluble material; 2'-deoxyadenosine and uridine were incorporated in lower quantities, and thymine and thymidine were not incorporated . Incorporation of {3H}adenine was inhibited by penicillin G, mitomycin C, actinomycin D, and erythromycin, but was not affected by cycloheximide . Partial purification of nucleic acids from T . pallidum incubated with {8-3H}adenine for 36 to 72 h and subsequent treatment with ribonuclease and deoxyribonuclease revealed that 15 to 20% of the trichloroacetic acid-precipitable counts were resistant to ribonuclease but susceptible to deoxyribonuclease . A simple assay was developed in which NaOH treatment was used to distinguish incorporation into ribonucleic acid and deoxyribonucleic acid . Both ribonucleic acid and deoxyribonucleic acid synthesis continued for 6 days of incubation under 3% O2, whereas incorporation was limited to the first day of incubation in samples incubated under aerobic or anaerobic conditions . T . pallidum thus appears to be capable of significant de novo deoxyribonucleic acid and ribonucleic acid synthesis under microaerobic conditions. Boll Soc Ital Biol Sper, 1980 Aug 30, 56(16), 1621 - 5 {Alterations in liver function produced by erythromycin estolate in isolated and perfused rat liver}; Adinolfi L et al.; Erythromycin estolate (EE) added to perfusing medium of isolated rat liver caused a dose-dependent decrease of both perfusate and bile flows . Biliary bile acid analysis showed that EE decreased both bile acid excretion rate and concentration . This suggests that EE interferes with the formation of bile acid dependent fraction of bile . EE is known to cause, in some individuals a reversible cholestatic hepatic injury . Our data if applicable to clinical setting indicate that an intrinsic toxicity of EE may contribute to the development of hepatic damage. Ann Intern Med, 1980 Aug, 93(2), 240 - 3 Legionnaires' disease: unusual clinical and laboratory features; Meyer RD et al.; During a nosocomial epidemic of Legionnaires' disease, clinical and laboratory observations led to the recognition of remarkable aspects in six patients . Features included two episodes of disease, dual or sequential infections with Legionella pneumophila and other pathogens; transient deafness with erythromycin therapy, and Legionnaires' disease with a pleural effusion but no pulmonary infiltrate . Expectorated sputum culture yielded two serogroups of L . pneumophila in one patient . Cultures of transtracheal and endotracheal aspirates and of blood led to the diagnosis, permitted evaluation of confounding potential pathogens, and confirmed Legionnaires' disease in the absence of seroconversion . Although many manifestations of Legionnaires' disease were quite typical in this outbreak, these additional unusual features expand the spectrum and illustrate the value of rapid diagnostic methods. Nucleic Acids Res, 1980 Jul 25, 8(14), 3229 - 46 Ribosome binding by tRNAs with fluorescent labeled 3' termini; Wells BD et al.; Yeast and E . coli tRNAPhe samples were oxidized and labeled at the 3' end with dansyl hydrazine or fluorescein thiosemicarbazide . These tRNAs can bind to poly(U)-programmed E . coli 70S tight couple ribosomes in 25 mM magnesium at 8 degrees C . Two binding sites with binding constants of about 1 X 10(9) M-1 (P) and 3 X 10(7) M-1 (A) were determined for the yeast tRNAPhe derivatives . With E . coli tRNAPhe the A site affinity is similar to yeast tRNAPhe but the P site affinity is 5-fold weaker . Singlet-singlet energy transfer showd that the distance from the 3' end of tRNAPhe in the P site to a fluorescein derivative of erythromycin is 23 A . This supports in vitro studies suggesting that erythromycin binds near the peptide moiety of peptidyl tRNA . A distance of 34 A between the 3' ends of 2 tRNAs bound simulatneously on the ribosome was also measured . This long distance may mean that the deacylated fluorescent tRNA binds to the A site in an orientation like that in the stringent response rather than in protein synthesis. J Clin Pharmacol, 1980 Jul, 20(7), 437 - 43 Comparative bioavailability evaluation of erythromycin base and its salts and esters . I . Erythromycin estolate capsules versus enteric-coated erythromycin base tablets; DiSanto AR et al.; A randomized crossover study in 16 healthy volunteers given multiple doses of erythromycin base enteric-coated tablets or erythromycin estolate capsules revealed essentially no difference in the resultant plasma concentration of bioactive erythromycin . This similarity in bioactivity persisted despite the fact that total eryghromycin levels (bioactive erythromycin base plus bioinactive erythromycin propionate) were at least three times higher after administration of the estolate than after administration of the base. Drug Intell Clin Pharm, 1980 Jul-Aug, 14(7-8), 531 - 6 Consumer reactions to differing amounts of written drug information; Morris LA et al.; Four prototype patient package inserts (PPIs) for erythromycin were tested in an analog study using 325 individuals drawn from a college community . There was no difference in the total amount of knowledge communicated by the different PPIs, but results for individual test items suggest (1) that more explicit information may be better recalled, and (2) that longer PPIs may aid in information integration, whereas shorter PPIs may aid in pure recall of facts . PPIs containing elaboration on why drug effects occur were rated by the subjects as more "accurate." Subjects tended to rate PPIs that provided behavioral instructions on what to do if certain drug effects occurred as designed to promote better care. Arch Intern Med, 1980 Jun, 140(6), 833 - 4 Relapse of Legionnaires' disease in a renal transplant recipient; Sanders KL et al.; We describe a 44-year-old man who recently received a cadaveric renal transplant and had a relapse of Legionnaires' disease after an appropriate course of therapy . The relapse occurred within two weeks after completion of a three-week course of therapy with erythromycin stearate . A transbronchial biopsy specimen was positive for Legionella pneumophila by direct immunofluorescence, although the Dieterle silver impregnation stain was negative . The patient responded to a repeated course of erythromycin for an additional 21 days, and no further sequelae or relapses have been noted . The importance of early rapid diagnostic modalities in the immunocompromised patient is emphasized, and the need to consider the possibility of relapse after effective therapy is warranted. Int J Oral Surg, 1980 Jun, 9(3), 157 - 65 Effect of azidocillin, erythromycin, clindamycin and doxycycline on postoperative complications after surgical removal of impacted mandibular third molars; Bystedt H et al.; Treatment of osteitis after surgical removal of the third molar of the mandible is still a clinical problem . A total of 140 patients undergoing operations for removal of an impacted third molar of the mandible, were included in a double-blind study . Placebo or antibiotics - azidocillin, erythromycin, clindamycin and doxycycline - were given to the patients preoperatively and for the following 7 days . The concentrations in serum, alveolar serum and mandibular bone were measured and the postoperative courses - pain, trismus, swelling and wound-healing - were recorded . No correlation was obtained between the antibiotic concentration and the postoperative complaints, except in the azidocillin group on day 2, in which fewer complaints were noticed in patients with high concentrations of the drug at the time of operations . The 80 patients in the antibiotic groups responded significantly better with respect to wound-healing than the 60 patients in the placebo groups . Only 15 operations lasted more than 15 min and the three of them which subsequently resulted in alveolitis were in the placebo groups . Antibiotics significantly reduced pain on day 7 postoperatively . In general, no statistically significant differences in trismus and swelling could be demonstrated between the patient groups . However, there was a significant difference between the placebo and doxycycline groups with respect to swelling (day 2 postoperative, P < 0.01; day 5 postoperative, P < 0.05) . Thus systemically administered antibiotics offered only slight advantages in routine operations of impacted third mandibular molars, but could decrease the rate of infections after traumatic operations. Arch Dermatol, 1980 Jun, 116(6), 693 - 5 Erythema elevatum diutinum treated with niacinamide and tetracycline; Kohler IK et al.; A 60-year-old woman with recurrent papular and vesiculobullous lesions of erythema elevatum diutinum responded to treatment with 100 mg of oral niacinamide three times a day and 250 mg of tetracycline hydrochloride four times a day . Prior therapy with 2.5 mg of dexamethasone daily and 1.0 g of erythromycin daily had been unsuccessful . After four weeks, tetracycline therapy was discontinued, and niacinamide alone sufficed to suppress the disorder . Recurrent lesions developed whenever niacinamide therapy was stopped. Sem Hop, 1980 May 8-15, 56(17-18), 911 - 5 {The association tretinoin-erythromycin base: a new topical treatment for acne . Results of a multicentric trial on 347 cases (authors transl)}; Amblard P et al.; A multicentric trial involving ten dermatological departments was conducted to evaluate the efficacy and tollerance of ANTIBIO-ABEREL (an association of Tretinoin and Erythromycin base) in 347 patients with persistant acne . Complete healing or considerable improvement was obtained in 85% of cases . This new treatment was active against both inflammatory lesions (papules and pustules) and retentional elements (microcysts and open comedones) . It was also rapidly active, as very favorable results were obtained in ten weeks or less, in more than half of the cases . The tolerance was remarkable (less than 1% of cases had to interrupt treatment) . This product represents an important progress as compared to Tretinoin alone . No other local or systemic therapy, especially long term antibiotherapy, is required. Am J Med Sci, 1980 May-Jun, 279(3), 177 - 83 Legionnaires' disease with acute renal failure; Williams ME et al.; We describe two patients with Legionnaires' disease (LD) and acute renal failure not associated with hypotension or therapy with nephrotoxic antibiotics . The first patient ran a fulminant course unresponsive to erythromycin therapy and intensive supportive care including mechanical assisted ventilation and peritoneal dialysis . The second patient recovered after erythromycin therapy and hemodialysis . The clinical course of both patients and the renal pathology of the first patient were compatible with acute tubular necrosis . LD is a disease with many extrapulmonary manifestations . The pathogenic mechanism of acute renal failure in LD is presently unknown. Hautarzt, 1980 May, 31(5), 263 - 7 {Genital chlamydia infections}; Petzoldt D et al.; Cylamydia are bacteria . The serotypes D-K cause 40% of nongonococcal urethritis and 60-70% of postgonococcal urethritis . Chlamydia can be detected in 60% of women with hypertrophic cervicitis . The isolation of Chlamydia trachomatis is carried out in cell culture . For treatment tetracyclines, erythromycin and sulfonamides are suggested. Cutis, 1980 May, 25(5), 552 - 5 Clinical evaluation of a new erythromycin solution for acne vulgaris; Rivkin L et al.; The effects of a 1.5 percent solution of erythromycin, especially formulated for the topical treatment of acne vulgaris, were compared with those of its vehicle in a twelve week, double-blind study involving twenty-six patients . A statistically significant difference between the responses to the two treatments was seen in both lesion counts and overall evaluations . The final reductions in the mean number of papules and pustules in the erythromycin group were 70.8 and 77.6 percent of the initial values, respectively, and the overall evaluations of this group showed that 91.7 percent of the patients had achieved good or excellent results . A group of fourteen patients continued therapy with the erythromycin solution for an additional nine months . Effective control of their acne was maintained, and no serious side effects were observed. Med J Aust, 1980 Apr 19, 1(8), 368 - 71 Legionnaires' disease in South Australia . Four case reports; Gilligan J et al.; Four severe cases of Legionnaires' disease are described . In addition to multilobar pneumonia with respiratory failure, involvement of the central nervous, cardiovascular, renal, hepatic and coagulation systems had occurred . Adult respiratory distress syndrome complicated respiratory management . Early development of acute renal failure was associated with a poor prognosis . Erythromycin was the most commonly used antibiotic . Review of stored pathological material from patients who died from unidentified pneumonias enabled confirmation of the existence of Legionnaires' disease in Australia in 1974. Scott Med J, 1980 Apr, 25(2), 126 - 8 Mycoplasma pneumonia: failure of erythromycin therapy; Ford MJ et al.; Two cases of mycoplasma pneumonia are described which failed to respond to prolonged treatment with erythromycin . The substitution of oxytetracycline therapy resulted in rapid clinical and radiological resolution. J Am Acad Dermatol, 1980 Apr, 2(4), 318 - 21 Topically applied erythromycin in inflammatory acne vulgaris; Bernstein JE et al.; We evaluated the effectiveness of 2% erythromycin and its alcohol/propylene glycol vehicle in the treatment of three hundred forty-eight patients with inflammatory acne vulgaris . A significantly greater reduction was noted in the papulopustule count for the erythromycin-treated group compared to the vehicle-treated group . Additionally, clinical improvement, as measured by physician global ratings, was significantly greater in the erythromycin-treated group . A lower adverse reaction rate observed in the erythromycin-treated patients may result from previously demonstrated anti-inflammatory properties of this antibiotic. Antibiotiki, 1980 Mar, 25(3), 170 - 4 {Instability of natural, multiple drug resistance in actinomycetes}; Fedorenko VA et al.; Resistance to tetracycline, chloramphenicol, penicillin, polymyxin, erythromycin, lincomycin and ristomycin in a number of strains of Str . coelicolor A3 (2) was studied . It was found that their resistance to the above antibiotics was not associated with plasmids SCP1 and SCP2 . The frequency of spontaneous variants sensitive to one and several antibiotics amounted in Str . coelicolor to 0.1--0.3 per cent . Ethidium bromide had no significant effect on the frequency of the sensitive variants . However, after growth of the culture at 37 degrees C the number of the variants sensitive to tetracycline and polymyxin significantly increased . The sensitive variants of Str . coelicolor A3 (2) formed resistant revertants at various frequencies (10(-2)--10(-6)) . The frequency of variants of Str . rimosus 183 simultaneously sensitive to kanamycin, monomycin, neomycin and chloramphenicol was high . They also reverted to the resistant ones with a frequency of about 10(-3) . The results of the study are indicative of the genetic instability of the antibiotic natural resistance in some actinomycetous strains . Such instability is probably not connected with the plasmid elimination. Mayo Clin Proc, 1980 Mar, 55(3), 129 - 37 Legionnaires' disease: a review of the epidemiology and clinical manifestations of a newly recognized infection; Keys TF; During the 2-year period 1977 through 1979, 26 patients with Legionnaires' disease were seen at the Mayo Clinic and affiliated hospitals . The patients ranged in age from 17 to 81 years with a median of 51 years . Twelve (46%) were immunologically compromised . Most of the other patients had underlying chronic tobacco bronchitis . Hectic fever, cough, and diarrhea were common symptoms . Chest radiographs showed patchy perihilar infiltrates that often progressed to consolidation . Diagnosis was made by indirect fluorescent antibody testing in 15 patients (58%), but in no case was the test diagnostic during the first week of illness . In seven patients the diagnosis was established by positive direct flourescent antibody testing of lung tissue, in two cases by culture of lung tissue, and in one case each by direct fluorescent antibody positivity of sputum or bronchial washing . Of the 26 patients, 3 (12%) required hemodialysis for acute renal failure and 5 (19%) died . A favorable clinical response to therapy with erythromycin was noted . The differential diagnosis of Legionnaires' disease must include other bacterial pneumonias, as well as mycoplasma, psittacosis, Q fever, and viral pneumonia . For critically ill patients, open-lung biopsy may be necessary to provide a rapid diagnosis . Current evidence suggests that erythromycin alone or in combination with rifampin is the treatment of choice . A 3-week course of therapy is recommended in order to prevent relapse. Zentralbl Bakteriol A, 1980 Mar, 246(2), 228 - 35 {Mycoplasmas isolated from the genital tract of mares (author's transl)}; Kirchhoff H et al.; Mycoplasmas were isolated from 11 (=#6,8%) of 161 cervix swabs from infertile mares . A total of 17 strains was isolated and characterized by indirect immunofluorescent test and metabolic inhibition test as Mycoplasma equigenitalium (11 strains), Mycoplasma subdolum (2 strains), Acholeplasma laidlawii (3 strains) and Acholeplasma equifetale (1 strain) . In addition cervix swabs of the mares were investigated for bacteria . There was no specific correlation between presence of mycoplasmas and bacteria (table 1) . In clinical investigations 5 of the 11 mares which harboured mycoplasmas showed a pneumovagina (table 1) . The isolated mycoplasmas were tested for senstivity to antibiotics (table 2) . All of the isolates were sensitive to Chloramphenicol (10 microgram), Tetracyclin (10 microgram), Tylosin (30 microgram) and Gentamycin (10 microgram) and resistant to Penicillin (6 IU) and Polmyxin B (300 IU) . Against Erythromycin (15 microgram) all of the Acholeplasma-isolates were sensitive and all of the Mycoplasma-isolates resistant . Against Streptomycin (10 microgram) the two M . subdolum strains showed resistance, whereas M . equigenitalium and the Acholeplasma-isolates were sensitive . It is not yet possible to elucidate the significance of acholeplasmas and mycoplasmas in the genital organs of mares. Nouv Presse Med, 1980 Feb 2, 9(6), 371 - 4 {Human chlamydial infections (author's transl)}; Nabli B; Due either to Chlamydia psittaci or to Chlamydia trachomatis, Chlamydial infections are transmitted to man directly or indirectly via birds or mammals . Directly transmitted chlamydial infections may be located in the eye (trachoma, inclusion body conjunctivitis), the urogenital tract (above all urethritis but other sites are possible) or in the ENT or respiratory systems (giving rise in particular to atypical pneumonias) . Reiter's syndrome (urethritis, conjunctivitis, polyarthritis, enterocolitis) and lymphogmauloma venereum are two more examples . Combinations of them are not rare . Indirectly transmitted chlamydial infections rarely affect man with the exception of psittacosis . Treatment is dominated by cyclines, erythromycin and for chlamydia trachomatis by sulphonamides. Xenobiotica, 1980 Feb, 10(2), 97 - 101 The metabolism of oxamniquine in the gut wall; Kaye B et al.; 1 . The extent of metabolism of oxamniquine, 6-hydroxymethyl-7-nitro-2-isopropylaminomethyl-1,2,3,4-tetrahydroquinoline, in the gut of the dog has been studied using an intestinal preparation which allows collection of the outflow from the portal vein . 2 . Oxamniquine undergoes substantial conversion to 2-isopropylaminomethyl-7-nitro-1,2,3,4,-tetrahydroquinoline-6-carboxylic acid before or during absorption . 3 . This oxidation is not significantly inhibited by pretreatment with pyrazole, erythromycin or gentamicin . 4 . Results indicate that appreciable oxidation of oxamniquine is mediated via enzymes in the gut wall. J Otolaryngol, 1980 Feb, 9(1), 60 - 2 Erythromycin ototoxicity; Thompson P et al.; Erythromycin is considered one of the safest antibiotics in common use today . In its otolaryngologic use, the authors have found it effective in treating acute suppurative sinusitis and occasionally otitis media, when combined with sulfonamides . There are few complications of erythromycin administration . Probably the least generally acknowledged of these is ototoxicity . There have been three reports of six cases with ototoxic complications from erythromycin, primarily from administration of its intravenous form . The authors present a case study of an 18 year old girl in severe renal failure, who suffered a reversible sensorineural hearing loss from high doses of an oral erythromycin preparation . The clinical manifestations of this case are compared to those previously reported. Scand J Infect Dis, 1980, 12(3), 175 - 84 Central nervous system manifestations associated with serologically verified Mycoplasma pneumoniae infection; Ponka A; Among 560 hospitalized patients with serologically verified Mycoplasma pneumoniae infection (significant titre rise of complement-fixing antibodies in paired sera), 27 (4.8%) had central nervous system (CNS) manifestations for which no evidence incriminating any other causal agent could be found . Of these patients 18 had encephalitis or meningoencephalitis, 8 aseptic meningitis and 1 polyradiculitis . Of the patients with meningoencephalitis 4 died and 3 had permanent sequelae . The cases of aseptic meningitis were benign without any deaths or sequelae . There was a predominance of young age groups, 13 patients (48%) being below 10 years of age . Neither erythromycin nor tetracycline had a beneficial effect on the course of the illness in a few patients treated . Another 15 patients had CNS manifestations for which an alternative aetiology was suspected . The specificity of the M . pneumoniae CF test in the diagnostics of CNS manifestations is discussed, as well as the pathogenesis of the CNS complications associated with M . pneumoniae infection . Some features are summarized from 87 case reports presented earlier in the literature. J Int Med Res, 1980, 8 Suppl 2, 9 - 14 Erythromycin pharmacokinetics in man; Houin G et al.; This study shows that high serum concentrations are reached after either ethylsuccinate or lactobionate erythromycin administration . But the short elimination half-life implies repetitive administration to obtain efficacy, the ideal being represented by continuous infusion. J Int Med Res, 1980, 8 Suppl 2, 41 - 6 Erythromycin infusions for treatment of infections in the ear, nose and throat region; Blenk H et al.; Sixteen adult male patients (aged between 20-38 years) with ear, nose and throat infections, caused by bacteria sensitive to erythromycin, received daily infusions of 2 x 1 g erythromycin for 48 hours . The duration of infusion was 30 or 60 minutes, administered at intervals of 12 hours between infusions . Symptoms of intolerance such as nausea, retching, feeling of pressure in epigastric angle as well as abdominal cramps occurred as side-effects in many cases . A spasmolytic was given intravenously to twelve patients; it rapidly eliminated the symptoms . However, these side-effects were considered insignificant compared to the excellent clinical results obtained during infusion therapy . We, therefore, believe that 2 x 1 g/day erythromycin per infusion can be regarded as the drug of choice in chronic and acute ear, nose and throat infections . The rapid resolution of infections, which are otherwise difficult to treat, and the concomitant decrease in confinement to bed by about 8 to 10 days are the most important results in this study. J Int Med Res, 1980, 8 Suppl 2, 1 - 8 Binding of erythromycin base to human plasma proteins; Prandota J et al.; The binding of erythromycin base (EB) to human plasma (HP) proteins was measured by equilibrium dialysis using EB-14C at approximately 0.5 microgram/ml in the plasma phase, expected therapeutic concentration . EB was 64.5 +/- 0.4% (mean +/- S.D.) bound to HP . The percentage of bound EB was linearly related to the logarithm of HP dilution . Physiological concentrations linearly related to the logarithm of HP dilution . Physiological concentrations of human serum albumin (HSA) and a1 acid glycoprotein (a1AGP) bound 8.7 +/- 1.6 and 54.5 +/- 0.6%, respectively, of the drug . No binding of EB to HDL or LDL or human gamma globulins was found . For HSA separately, EB binding followed a non-saturable phenomenon with n'K' = 100 +/- 5, while for a1AGP the binding was following a saturable phenomenon with n" = 1 +/- 0.045, K" = 35,000 +/- 5000 M-1 . It can then be shown that, in human plasma, EB is only bound to those two proteins: firstly by computing the binding of EB to HSA and a1AGP with the previously indicated parameters, and secondly by measuring the binding of EB to HP . The computed curve fairly fits to the measured one . Interaction of EB with HP involved hydrophobic, ionic and hydrogen forces . Lower than 37 degrees C temperatures decreased EB binding . Significant competitive binding was demonstrated between EB and acetylsalicylic acid, furosemide, phenylbutazone, warfarin and bilirubin. Pharmacology, 1980, 20(6), 285 - 91 Erythromycin estolate vs . erythromycin base, surface excess properties and surface scanning changes in isolated liver cell systems; Dujovne CA et al.; Chang liver cells and isolated rat hepatocytes were exposed to medium containing different concentrations of erythromycin estolate or erythromycin base for 1-5 h . Hepatotoxicity was quantitated by measuring leakage of enzymes from cells into surrounding medium and the damage to the plasma cell membrane seen under surface scanning electron microscopy . Only the cells exposed to erythromycin estolate showed significantly greater enzyme leakage than controls and appeared severely affected by cytopathic changes when observed under scanning electron microscopy. Chemotherapy, 1980, 26(3), 164 - 70 Effects of phenobarbitone on the distribution, metabolism and biliary excretion of erythromycin in rats; Manzo L et al.; The administration of phenobarbitone to the rat (8 mg/100 g BW) once daily for 3 days significantly decreased the serum and tissue levels of erythromycin administered intraperitoneally (5 mg/100 g BW) . Furthermore, phenobarbitone stimulated the hepatic microsomal N-demethylation of erythromycin and increased the biliary concentration and the biliary excretion rate of the unmetabolized antibiotic . These effects were accompanied by augmented liver mass and bile flow . The possibility is discussed that erythromycin concentrates in the bile through a specialized hepatic drug transport system, activated by phenobarbitone. Res Commun Chem Pathol Pharmacol, 1980 Jan, 27(1), 203 - 6 Drug-specific antibodies in human serum? Nakatsu K, Scully K. In view of the fact that all drugs possess the potential to stimulate an immunological response when administered to man, it was proposed that certain individuals in the general population may have developed high antibody titres to certain commonly used drugs . Human serum samples were incubated with radioactively-labelled drugs and the amount of IgG antibody present was determined by coprecipitation . Using the method outlined, we were unable to detect any antibodies specific for acetylsalicylic acid, ampicillin, erythromycin, lidocaine, penicillin, procainamide or tetracycline, and conclude that drug-specific immunoglobulins are not one of the major factors involved in the equilibrium between the free and bound drug forms. Mech Ageing Dev, 1980 Jan, 12(1), 1 - 6 Cytotoxic effects of erythromycin estolate and chlorpromazine on hepatocytes isolated from rats of varying ages: a brief note; Abernathy CO et al.; Hepatocytes isolated from young (1 month) rats were as sensitive to the cytotoxic effects of erythromycin estolate and chlorpromazine as were liver cells obtained from older (3, 10 and 24 months) rats . The hepatocytes from the 24-month-old rats released aspartate transaminase more slowly than did parenchymal cells isolated from the younger rats. Arch Dermatol Res, 1980, 269(3), 275 - 80 Inhibition of PMN leukocytes chemotaxis by thalidomide; Faure M et al.; The effects of thalidomide on chemotaxis of normal human peripheral blood PMN leukocytes have been studied in vitro . The chemotaxis factor was generated by interacting normal human serum with bovine gamma globulin-antibovine-gamma globulin immune complexes . At concentrations of 1, 10, and 100 microgram/ml, thalidomide failed to inhibit the chemotactic factor . At the same concentrations, erythromycin caused a marked inhibition of chemotaxis . Pre-incubation of PMNs with thalidomide or erythromycin caused a marked, dose-independent inhibition of chemotaxis . Random mobility did not appear to be affected . Inhibition of PMN chemotactic ability by thalidomide may account for its ability to improve inflammatory dermatoses, such as aphthosis. Acta Biochim Pol, 1980, 27(3-4), 213 - 20 Comparison of the mechanism of action of cyclic 11,12-erythromycin A carbonate and erythromycin A; Klita S et al.; Synthesis of polyphenylalanine and polylysine in the E . coli MRE 600 and Q 13 cell-free systems was inhibited by erythromycin A and cyclic 11, 12-erythromycin A carbonate to a similar or identical extent . Both compounds inhibited translation of phage f2 RNA in the E . coli Q13 cell-free system . Neither antibiotic affected binding of initiator tRNA or phage f2 RNA to E . coli ribosomes, and neither inhibited translation of BMV RNA in the wheat-germ cell-free system. Vet Med Nauki, 1980, 17(6-7), 31 - 7 {Attempt at eliminating the multiple drug resistance of E . coli in pigs with enteritis using Rimactin}; Karaivanov L et al.; The eliminating effect of rimactan was studied in vivo on resistance markers of E . coli, isolated from 18 new-born pigs with a clinic of enteritis . Rimactan is given per os in 15 mg/kg, liver weight, once a day in the course of 6 days . The sensitivity of the strains eliminated was checked in vitro in respect of 16 medicinal preparations (Pe, Sm, Km, Neo, Chl, Novo, Te, Er, Ty, Sp, Le, Am, Ox, Oxte, Ge-penicillin, streptomycin, kanamycin, neomycin, chlornitromycin, novobiocin, tetracycline, erythromycin, tylan, spectam, lentamycin, ampicillin, oxacillin, oxytetracycline, gentamicin and borgal) . To 11 of them E . coli were resistant . After a treatment with rimactan an elimination of resistance markers was observed right on the first day, namely, with regard to Sm, Chl, Novo, Te, Er, Sp, Oxte . On the second day was eliminated the Pe-marker, on the third--the Ty-marker, and it was not until on the fifth day that Am and Ox-markers were eliminated . The elimination frequency was the highest between the third and the fifth days . The experiments studied also the sensitivity of the investigated coli strains with regard to different rimactan concentrations (2-256 mg/cm3) in vitro . It was most pronounced for a concentration of 16-32 mg/cm3 . It was proved that rimactan can be used as a preparation for eliminating resistance markers (R-factors) of E . coli in pigs suffering from enteritis. Scand J Infect Dis, 1980, 12(4), 313 - 4 Pneumonia due to Legionella pneumophila: the first imported case in Finland; Ponka A et al.; The first imported case of legionnaires' disease in Finland is reported . A 64-year-old woman fell ill 1 day after returning from a holiday in mallorca . Chest film revealed a bronchopneumonic infiltrate; however, the patient had no respiratory symptoms at all during her illness . The course of disease was benign, possibly due to early onset of treatment with erythromycin. Annu Rev Med, 1980, 31, 219 - 32 Legionnaires' disease; Meyer RD et al.; Legionella pneumophila infections frequently manifest themselves as a multisystem disease with acute pneumonia . Certain clinical and laboratory features are helpful in diagnosis but none are pathognomonic . Diagnosis frequently must be made clinically and erythromycin given presumptively because of the delay in seroconversion but culture and direct fluorescent antibody testing are quite useful for rapid diagnosis . Epidemiologic and laboratory investigations will undoubtedly yield considerable information about this fascinating bacterial disease. Biochimie, 1980, 62(1), 69 - 77 {Purification of the bacterial ribosome using chloramphenicol and erythromycin columns}; LeGoffic F et al.; Chloramphenicol and erythromycin are antibiotics whose target is the bacterial ribosome . We have studied the possibility of isolating the bacterial ribosome by affinity chromatography on chloramphenicol and erythromycin columns . Several columns have been prepared using different spacers and methods of attachment of the ligands (cyanogen bromide, bis-expoxyde) . The efficiency and specificity of these columns is discussed . Ethylene diamine is not always suitable as a spacer, because it presents non specific affinity for the ribosome . Pure tight ribosomes have been prepared by ultracentrifugation . They have been compared to ribosomes from affinity columns . These columns have no denaturing effect on ribosomes . They allow a good purification of ribosomes starting from crude bacterial extracts, but the separation of tight couples from loose subunits is not possible. J Int Med Res, 1980, 8(1), 1 - 6 Preliminary results of a clinical trial relative to the use of rifamycin SV in the treatment of herpes zoster; Bruni L et al.; In a controlled clinical trial undertaken in ten Italian centres, rifamycin SV was compared to associations of various drugs such as erythromycin, aureomycin, multivitamin preparations, etc, in the treatment of herpes zoster . Up to now 144 patients, suffering from herpes zoster at different localizations, were divided into three groups and randomly given either rifamycin SV by intramuscular injection and topically, or rifamycin SV by injection only, or the routine treatment used at the particular centre in question . To evaluate the effectiveness of the treatments, the presence of subjective and objective symptoms was determined before treatment started and daily thereafter . The duration, in days, of the most important symptoms, such as erythema, vesicles, scabs and pain, was considered for this partial evaluation . All the above-mentioned symptoms constantly showed a shorter duration in the two groups treated with rifamycin SV compared to the group treated with other therapies, with differences as significant on statistical calculation as they were important on the level of a clinical evaluation of the disease's course. Mol Gen Genet, 1980, 180(3), 563 - 72 Genetic interactions in the control of mitochondrial function in Paramecium . II . Interactions between nuclear and mitochondrial genomes; Ruiz F et al.; In an attempt to understand the genetic interactions between nuclear and mitochondrial genomes leading to mitochondrial biogenesis, different combinations of known nuclear and mitochondrial mutations have been constructed by microinjection . Eleven different tetrazolium resistant mutant strains, many clearly affecting mitochondrial function, were injected with mitochondria from four different erythromycin resistant mitochondrial mutants . Cases were found in which mutant mitochondria were unable to replicate in tetrazolium resistant mutants . The successful mitochondrial transfers were characterized for growth rate, temperature and cold sensitivity . Several selected combinations were characterised also for cytochrome spectra and cyanide resistance . Many different phenotypes were produced by the interaction of the different nuclear and mitochondrial mutations . These ranged from a positive interaction in which mutant mitochondria were selected by a nuclear mutant in preference to wild-type, through apparent absence of interaction, to negative interaction in which the mitochondrial-nuclear combination was temperature sensitive even though both 'parents' were thermoresistant . The possible molecular basis of these interactions is discussed. CRC Crit Rev Diagn Imaging, 1980, 12(4), 385 - 415 Mycoplasma pneumonia; Jensen PS et al.; M . pneumoniae is a common cause of pneumonia . The diagnosis is suspected when the patient presents with symptoms suggesting primary atypical pneumonia including cough, fever, chills, headache, and malaise in association with a segmental or subsegmental pulmonary infiltrate(s), the white blood cell count is normal or only slightly elevated, and the Gram stain of the sputum (if any can be obtained) reveals polymorphonuclear leukocytes and few bacteria . The diagnosis is more difficult when the patient presents with symptoms not suggestive of pneumonia including lethargy, dyspnea, and a 1- to 4-week history of shortness of breath without cough or fever in association with diffuse reticulonodular or interstitial pulmonary infiltrates . The disease in the previously healthy host is usually benign and self-limiting . However, the course is shortened by the administration of tetracycline derivatives or erythromycin . M . pneumoniae pneumonia can occur in association with other diseases including sickle cell anemia, sarcoidosis, systemic lupus erythematosus, Hodgkin's disease, and various other immunodeficiency states . In these patients mycoplasma pneumonia can be very serious . Although there is no pathognomonic clinical or radiographic presentation, careful consideration of epidemiologic, clinical, laboratory, and radiographic data are usually sufficient to suggest the diagnosis in most patients. Dtsch Med Wochenschr, 1979 Dec 7, 104(49), 1735 - 6 {A case of legionnaire's disease in Germany (author's transl)}; Missalek W et al.; Severe bronchopneumonia in a 66-year-old patient failed to respond to sensitivity-tested antibiotics, with only erythromycin providing improvement . The indirect immunofluorescence test for legionnaire's disease gave a highly significant titre rise (eightfold) . Legionnaire's disease should be considered in the differential diagnosis of treatment-resistant bronchopneumonia. Proc Natl Acad Sci U S A, 1979 Dec, 76(12), 6529 - 33 Genetic control of enhanced mutability of mitochondrial DNA and gamma-ray sensitivity in Saccharomyces cerevisiae; Foury F et al.; Five nuclear mutants enhancing the spontaneous mutation rate of mtDNA have been isolated in Saccharomyces cerevisiae . These mutators fall into five complementation groups and are located at five genetic loci different from rad50 to rad57 loci . Three mutants (gam1, gam2, and gam4), insensitive or weakly sensitive to gamma-rays, exhibit increased frequency of spontaneous production of mutants with large deletions of the mtDNA (p-) and of all tested mitochondrial drug-resistant mutants . Two other mutants (gam3 and gam5), highly sensitive to gamma-rays, increase only the mutation rate of particular alleles of the mtDNA . The mutant gam5 enhances only the production of p- and erythromycin-resistant clones . The mutant gam3 exhibits an enhanced rate of oligomycin-resistant clones as well as a collateral increase of nuclear mutability . The existence of gam3 and gam5 mutants indicates that at least two common steps control both nuclear DNA repair and the mutability of particular alleles of the mtDNA . However, the general spontaneous mutability of the mtDNA includes at least three steps not involved in the repair of nuclear DNA, as revealed by the gam1, gam2, and gam4 mutations. Mutat Res, 1979 Dec, 63(2), 291 - 300 Mitochondrial mutagenesis in Saccharomyces cerevisiae . III . Nitrous acid; Baranowska H et al.; Nitrous acid (NA) induced mutations efficiently in mitDNA, conferring resistance to erythromycin and weakly induces mit- mutations . In some strains of yeast it also enhanced rho- mutations . The frequencies of nuclear and mitochondrial mutations induced with NA are compared. J Am Dent Assoc, 1979 Dec, 99(6), 995 - 6 The interaction of erythromycin and theophylline in the asthmatic dental patient; Walker J et al.; Possible interaction of erythromycin with theophylline is a problem in the dental treatment of asthmatic patients . This interaction can be circumvented by using other antibiotics or adjusting the dose of theophylline. Biochim Biophys Acta, 1979 Nov 8, 548(2), 236 - 52 The respiratory chain of Paramecium tetraurelia in wild type and the mutant Cl1 . II . Cyanide-insensitive respiration . Function and regulation; Doussiere J et al.; 1 . The cyanide-insensitive respiration in Paramecium tetraurelia was found to be located in mitochondria . 2 . Sensitivity of the mitochondrial respiration to cyanide depended on growth conditions . Under standard conditions of growth, 15--20% of respiration was insensitive to 1 mM cyanide . Full resistance to 1 mM cyanide was observed by growing cells in the presence of erythromycin (100--400 microgram/ml) 0.2 mM cyanide . The mitochondrial respiration of the mutant Cl1 harvested during the exponential phase of growth was largely insensitive to cyanide (more than 80%) . 3 . Pyruvate was oxidized at the same rate by wild type mitochondria and mitochondria of the mutant Cl1 . In contrast, succinate oxidation was 2--3 times faster in mitochondria of the mutant Cl1 than in wild type mitochondria . 4 . The cyanide-insensitive respiration was inhibited by 1 mM salicylhydroxamic acid to nearly 100% . Other efficient respiratory inhibitors included amytal and heptylhydroxyquinoline . Antimycin was not inhibitory even at concentrations as high as 5 microgram/mg protein, a finding consistent with the lack of antimycin binding sites. Obstet Gynecol, 1979 Nov, 54(5), 558 - 61 T mycoplasma in human reproductive failure; Graber CD et al.; In a study of 50 women of child-bearing age, half of whom had infertility problems, it was demonstrated that the infertile group more commonly yielded Ureaplasma urealyticum on culture (84% versus 60%), had more than twice the recoveries from the endocervical canal than fertile women had (80% verse 36%), and grew a much higher log number of T mycoplasma from this locus . No particular serotype predominated as an isolate from infertile women in this study, although antisera to serotype 3 inhibited growth of most of the T mycoplasma recovered . Strains insensitive to erythromycin were recoverable from more than half of the fertile women . Of 143 patients without fertility problems there was no significant difference in Ureaplasma isolation between women who used an intrauterine device (IUD) and those who did not. Anaesthesia, 1979 Nov-Dec, 34(10), 1028 - 31 Nasal continuous positive airway pressure in the treatment of whooping cough; Theilade D; A 3-week-old baby, suffering from whooping cough with severe attacks of apnoea and hypoxia, was treated by nasal CPAP with a positive airway pressure of about 5 cm H2O . The respiration improved rapidly and the transcutaneous oxygen tension increased to a normal level . The treatment was carried on for 7 days and discontinued gradually in the course of 3 days . The child was also treated with pertussis immunoglobulin and erythromycin . The CPAP system employed is easily and rapidly applied and allows normal nursing of the child during the treatment and manual lung physiotherapy in upright position . The treatment probably proved lifesaving. J Bacteriol, 1979 Nov, 140(2), 734 - 7 Selection for Escherichia coli mutants with proteins missing from the ribosome; Dabbs ER; Antibiotic-independent revertants of an erythromycin-dependent strain of Escherichia coli were isolated by spontaneous selection . Their ribosomal proteins were analyzed by two-dimensional polyacrylamide gel electrophoresis . In contrast to most ribosomally targeted selections, the specific absence of a certain protein from the ribosome, rather than alterations in ribosomal proteins, was observed . Mutants were found with protein S20, L11, L15, L28, L29, or L30 missing. MMW Munch Med Wochenschr, 1979 Oct 19, 121(42), 1343 - 8 {Legionaire's disease (author's transl)}; Meyer RD; In a review of all cases of legionaire's disease known so far the epidemiology, diagnosis and therapy of this disease are discussed . Risk factors have been shown to be stays in hotels and hospitals, especially if the rooms were subject to faulty air conditioning, water containers or to earthworks . Furthermore, the male sex and an immunosuppressive therapy were established as risk factors . The diagnosis can only be confirmed by increased titer in the indirect fluorescence test . Erythromycin and Rifampicin (as a supplementary medication) have proved the antibiotics of choice. Br J Clin Pharmacol, 1979 Oct, 8(4), 343 - 7 The influence of food on the bioavailability of new formulations of erythromycin stearate and base; Rutland J et al.; 1 . The effect of food on the bioavailability of two new formulations of erythromycin, 1) erythromycin stearate, 500 mg (Erythrocin, 250 mg capsule-shaped tablets) and 2) erythromycin base, 500 mg (Eryc, 250 mg capsules containing enteric-coated pellets) was studied in 16 healthy subjects . 2 . The study was a balanced, randomized Latin square design and was conducted on 4 days . The four treatments were erythromycin stearate immediately before (EB) and after EA) breakfast and erythromycin base immediately before (eB) and after (eA) breakfast . 3 . The mean +/- s.d . maximal plasma erythromycin concentrations were 2.09 +/- 1.06, 0.37 +/- 0.40, 1.8+ +/- 1.15 and 1.91 +/- 1.57 micrograms/ml and the mean +/- s.d . times at which these occurred were 1.3 +/- 0.7, 2.3 +/- 0.9, 4.4 +/- 1.9 and 4.3 +/- 1.1 h for EB, EA, eB and eA respectively . 4 . The mean +/- s.d . areas under the curves (0 to 8 h) were 4.99 +/- 2.41, 1.04 +/- 1.57, 4.93 +/- 2.98 and 4.98 +/- 3.14 for EB, EA, eB and eA respectively . 5 . The bioavailability of erythromycin stearate was significantly reduced by the prior administration of food, whereas the absorption of the base was not inhibited by food. Ann Clin Res, 1979 Oct, 11(5), 196 - 8 Erythromycin levels in serum during treatment with erythromycin stearate and base; Saarni H et al.; The serum concentrations of erythromycin during treatment with erythromycin stearate and erythromycin base were compared in a randomised cross-over study with 21 hospital patients . No statistically significant differences between the brands were found in the serum erythromycin levels at any time or in the areas under the serum level-time curve. J Clin Periodontol, 1979 Oct, 6(5), 308 - 16 Clinical evaluation of spiramycin and erythromycin in control of periodontal disease; Mills WH et al.; Two studies are reported . Each was double-blind in which Spiramycin was compared to Erythromycin and a placebo, to determine the value of Spiramycin as a therapeutic agent in the control of periodontal disease . In Study 1, 48 adults with varying degrees of periodontal disease were randomly assigned to treatment and control groups . Assessments of gingival index, plaque height, pocket depth, crevicular fluid volume and wet plaque weight were made . During this 4-week clinical trial, the patients maintained their usual oral hygiene . The medication was administered systemically for 5 days, starting at the conclusion of week 2 . Spiramycin significantly reduced the scores for the five parameters recorded . When comparison were made, the greatest recorded effect with Spiramycin treatment was found in patients with advanced periodontal disease . The indication of this trend favouring Spiramycin led to an extension of this clinical trial involving only patients with advanced periodontal lesions . This second study comprised 54 adults . The same parameters were measured over the same time period as in Study 1 . Spiramycin again was responsible for the greatest reduction in the recorded scores . For example, average pocket depth was decreased by approximately 30%, whereas Erythromycin produced a reduction of 15% . It would appear that Spiramycin is of definite benefit in the management of periodontal disease, especially in the more advanced cases. Somatic Cell Genet, 1979 Sep, 5(5), 585 - 95 Erythromycin resistance in mouse L cells; Molloy PL et al.; The sensitivity of mouse cell lines in culture to the macrolide antibiotic, erythromycin stearate, was investigated . Both resistant and sensitive lines were found . Experiments indicated that in sensitive cells erythromycin stearate inhibits mitochondrial protein synthesis . Mutants resistant to erythromycin stearate were selected from the line LM(TK-), and these are also less sensitive to other macrolide antibiotics such as carbomycin and spiramycin . Attempts to transfer the erythromycin resistance of either the mutants or naturally resistant lines by fusion of cytoplasts with sensitive cells were unsuccessful, and it is concluded that resistance to erythromycin stearate is controlled by nuclear genetic factors. J Antibiot (Tokyo), 1979 Sep, 32(9), 915 - 9 Rosamicin, a macrolide with in vitro activity against Ureaplasma urealyticum; Hill AC et al.; A new macrolide antibiotic, rosamicin, was shown to have much greater activity in vitro against ureaplasmas isolated from humans than erythromycin or the tetracyclines tested . A marked ureaplasmacidal effect was also shown. J Antimicrob Chemother, 1979 Sep, 5(5), 591 - 9 Effect of food on absorption of erythromycin . A study of two derivatives, the stearate and the base; Malmborg AS; Two derivatives of erythromycin, the stearate and the enteric-coated base have been given in a cross-over study to both fasting and non-fasting volunteers . The stearate gave higher plasma concentrations in non-fasting than in fasting subjects . The area under the curve was significantly larger during steady state day 7 than after a single dose . The base showed larger individual variations in concentrations . The release of the drug from the enteric-coated tablets was depressed by food, but the absorption was not prevented. Postgrad Med, 1979 Sep, 66(3), 95 - 102 The atypical pneumonias: a diagnostic and therapeutic approach; Cunha BA et al.; Mycoplasmal pneumonia, tularemic pneumonia, Q fever pneumonia, psittacosis, and Legionnaires' disease are the most frequently encountered treatable atypical pneumonias . Mycoplasmal pneumonia, the most common, is often accompanied by nonexudative pharyngitis, conjunctivitis, or otitis . The nonproductive cough is characteristic . Tularemic pneumonia is characterized by substernal chest pain, bloody pleural effusion, and bilateral hilar adenopathy . Although the clinical presentation is mild, roentgenographic findings are impressive . Q fever pneumonia resembles psittacosis but is less serious; it may be accompanied by subacute bacterial endocarditis, hepatitis, or both . Psittacosis is characterized by prominent headache, bloody sputum, and relative bradycardia . Tetracycline is the drug of choice for either . In Legionnaires' disease, pneumonia is accompanied by prominent extrapulmonary symptoms . The most important diagnostic clues include diarrhea and mental confusion . Relative bradycardia and laboratory abnormalities are also helpful . Erythromycin is the drug of choice unless doubt exists as to the diagnosis. Proc Natl Acad Sci U S A, 1979 Sep, 76(9), 4549 - 53 Cytoplasmic inheritance of erythromycin resistance in human cells; Doersen CJ et al.; An erythromycin-resistant mutant, ERY2301, was isolated from ethidium bromide-treated HeLa cells in the presence of erythromycin at 300 micrograms/ml . ERY2301 cells were enucleated and the anucleate cytoplasts were fused with D98/AH-2, a hypoxanthine phosphoribosyltransferase-deficient variant of HeLa cells . The resultant cybrids were isolated in a double selective medium containing erythromycin and 6-thioguanine . Cybrid formation occurred at a frequency of 10(-3) to 10(-4) . In vitro protein synthesis by intact and Triton X-100 treated mitochondria isolated from ERY2301 was resistant to the macrolide antibiotics erythromycin and carbomycin, but was sensitive to chloramphenicol . These results suggest that the site of erythromycin resistance in ERY2301 may be at the level of mitochondrial protein synthesis and indicate that this trait is cytoplasmically inherited and, therefore, presumably encoded in the mitochondrial genome. Jpn J Med Sci Biol, 1979 Aug, 32(4), 219 - 23 Deletion of mitochondrial genetic markers in yeast by ethidium and the photoaffinity probe, ethidium azide; Fukunaga M et al.; Induction of petite (cytoplasmic-respiration-deficient, rho-,rho-) mutations in yeast and deletion of mitochondrial drug-resistance genetic markers were compared after after treatment with ethidium and the corresponding photoaffinity probe, ethidium azide . Deletion of mitochondrial drug-resistance markers for chloramphenicol, erythromycin and oligomycin in these petite mutants was observed during prolonged treatment times with ethidium and with ethidium azide in the dark . A similar loss of drug-resistance markers was also observed in petites produced by photolytic treatment with the azide analogue, although the rate of loss appeared to be somewhat less . These results confirmed the usefulness of photoaffinity labeling with ethidium monoazide for studies of mitochondrial mutations. Zh Mikrobiol Epidemiol Immunobiol, 1979 Aug, (8), 41 - 7 {Rickettsia conorii and prowazekii plaque study in a chick fibroblast cell culture}; Balaeva NM; The results of the study of plaques formed by R . conorii (strain M 1) and R . prowazeki (strain E and erythromycin-resistant strain E) in chick fibroblast cell culture are presented . In this study the tissue monolayer was inoculated with rickettsiae suspended in various media, and media of different composition were used in the nutrient cover and for cell cultivation . The maximum plaque formation was observed under the following conditions: the monolayer of chick fibroblasts (seeding density was not less than 375,000 cells per 1 sq . cm) was grown in medium 199 with 5-10% of fresh fetal or calf serum and inoculated with rickettsiae suspended in heart-brain infusion; the nutrient cover was prepared on the basis of Seakem agarose (USA) and contained medium 199 (without antibiotics) and 10% of fresh fetal or calf serum . In these conditions R . conorii formed plaques 2 mm in diameter, the first plaques being observed on day 6, and most of them on days 7-9; the both strains of R . prowazeki formed plaques 1 mm in diameter, the first plaques being observed on days 8-9, and most of them on days 10-13. Mutat Res, 1979 Jul, 61(2), 207 - 13 Mitochondrial mutagenesis in Saccharomyces cerevisiae . II . Methyl methanesulphonate and diepoxybutane; Polakowska R et al.; In Saccharomyces cerevisiae, methyl methanesulphonate and diepoxybutane produced efficiently lethal, as well as mutagenic, damage in nuclear DNA . However, in the same conditions, these agents did not induce cytoplasmic petite mutations and poorly induced point mutations (resistance to erythromycin and chloramphenicol) in mitochondrial DNA . Possible reasons for these differences are discussed. SSO Schweiz Monatsschr Zahnheilkd, 1979 Jul, 89(7), 689 - 98 {Relative gnotobiosis: a possibility for studying periodontal diseases in the rat}; Hefti A; An animal model was presented to study periodontal disease in Osborne-Mendel rats with depressed indigenous oral flora . In connection with the inoculation of an erythromycin-resistant strain A . viscosus Ny 1 E after 40 experimental days only the animals showed plaque formation, bleeding from the gingival sulcus upon gentle probing and severe alveolar bone loss . 56% sucrose in the diet counteracted the establishment of A . viscosus Ny 1 E in dental plaques . As a consequence plaque formation, gingival bleeding and bone loss diminished . Plaque formation, gingival bleeding and bone loss were correlated. Dig Dis Sci, 1979 May, 24(5), 385 - 96 Cholestatic and hepatocellular injury associated with erythromycin esters: report of nine cases; Zafrani ES et al.; A combined cholestatic and hepatocellular injury occurred in nine patients, following therapy with erythromycin estolate (EE) or other erythromycin derivatives . Eight of the nine patients developed jaundice within three weeks after initiation of treatment; pain was one of the main symptoms in five patients while fever and itching were noted in four patients . Symptoms and signs subsided and abnormal tests of liver function returned to normal after withdrawal of the drug . The major histologic finding was cholestasis, but the majority of cases also had evidence of hepatocellular injury of variable severity; one biopsy specimen showed centrilobular necrosis . Ultrastructural findings in one case included changes related to cholestasis as well as hepatocellular injury with striking mitochondrial abnormalities . Our data are compared with those of the literature, with special reference to morphologic features. Acta Paediatr Scand, 1979 May, 68(3), 323 - 8 Clinical course of whooping cough in children younger than six months; Trollfors B; The patient records of 59 children aged 2--26 weeks with culture-verified pertussis were analysed . Twenty-four of them were hospitalized, in most cases for social reasons . Only one child with hypothyroidism and a complicating pneumonia was critically ill . Seventeen of the 35 non-hospitalized patients had a mild disease without developing typical whooping attacks . Thirteen children were treated with erythromycin in the catarrhal stage . There was a tendency towards milder disease in this group but the differences compared to untreated children were not statistically significant. Gastroenterology, 1979 May, 76(5 Pt 1), 1007 - 8 Erythromycin ethylsuccinate-induced cholestasis; Viteri AL et al.; A 52-year-old Caucasian female developed abdominal pain, fever, and jaundice after erythromycin ethylsuccinate administration . Similar symptoms followed the administration of the same drug 5 mo earlier . It is believed that this is the first published case of erythromycin ethylsuccinate-induced cholestasis. Sem Hop, 1979 Apr 8-15, 55(13-14), 670 - 7 {Value of the antibiogram technic for the treatment of urogenital infection with Ureaplasma (author's transl)}; Bonissol C et al.; We have currently established the spectrum of sensitivity of the isolated strains to various antibiotics before prescribing the appropriate treatment . A microtechnic has been used . The most active antibiotics are: minocyclin, pristinamycin, erythromycin, chloramphenicol, oxytetracyclin, kanamycin, tobramycin, streptomycin, in this order. Nouv Presse Med, 1979 Apr 7, 8(16), 1311 - 4 {Measurement of blood theophylline levels in the child: will this affect methods of prescription? (author's transl)}; de Blic J et al.; Twelve children aged between 2 and 13 years received an oral dose of 5 mg/kg of pure theophylline, and 28 children aged between 2 and 15 years were given 10 mg/kg/day of the same drug in 3 or 4 divided doses for 3 days . In the first group blood theophylline levels were higher than 10 microgram/ml, after 1 or 3 hours, in only 3 children, two of whom were receiving erythromycin at the same time . Six hours and 12 hours later, none of the serum levels were higher than 10 microgram/ml . In the second group, estimations were performed on the 4th day . At 8 a.m., when the last dose had been given 12 hours previously, blood theophylline levels were all less than 10 microgram/ml (mean: 4.03 +/- 0,88 microgram/ml) . Two hours and four hours after the usual morning dose, serum levels of greater than 10 microgram/ml were found in respectively 35 and 25% of the children only . Since the bronchodilator effect of theophylline is optimal for serum levels of greater than 10 microgram/ml, the dose currently recommended in France (10 mg/kg/day) would thus appear to be insufficient in most instances . However, increase in individual doses must be guided by serum estimations, which make it possible to avoid complications related to overdosage. Ann Intern Med, 1979 Apr, 90(4), 518 - 21 Sporadic cases of Legionnaires' disease: the expanding clinical spectrum; Gregory DW et al.; An analysis of seven sporadic cases of Legionnaires' disease confirmed clinical features recorded during epidemics and identified aspects of the illness either unreported or not emphasized . Four patients had central nervous system abnormalities . Mental status changes included somnolence, obtundation, delirium, disorientation, and confusion . Three patients experienced visual hallucinations, and one patient without pneumonia had a grand mal seizure with residual memory deficit . Two patients had disseminated intravascular coagulation with thrombocytopenia, elevated split fibrin products, and prolonged partial thromboplastin and prothrombin times . Four patients had severe hypoxia; one patient had an exudative pleuritis . One patient whose treatment included erythromycin had radiologic improvement of his pneumonia despite deteriorating ventilatory function that led to death . The concept of Legionnaires' disease as a severe, diagnostically perplexing pneumonic illness is valid but too narrow . The emerging spectrum is that of a multisystem disease that, besides the lungs, often involves the central nervous system and can be accompanied by disseminated intravascular coagulation. Ann Intern Med, 1979 Apr, 90(4), 509 - 17 Legionnaires' disease: clinical features of the epidemic in Philadelphia; Tsai TF et al.; A review of the medical records of 123 persons with Legionnaires' disease hospitalized in the 1976 Philadelphia epidemic showed that the manifestations of infection ranged from mild grippe to a severe pneumonia that also involved other organ systems . Early in the illness, constitutional symptoms predominated . Fever, malaise, myalgia, rigors, confusion, headache, and diarrhea were usually followed by nonproductive cough and dyspnea . Physical examination showed few abnormalities other than rales . Moderate leukocytosis with left shift, elevated erythrocyte sedimentation rate, elevation of serum levels of liver enzymes, and hematuria and proteinuria were characteristic . Chest radiograph showed patchy, often nodular, areas of consolidation . Progression of pneumonia led to respiratory failure and the need for mechanical ventilatory assistance for 19 patients; renal failure, primarily after shock, occurred in 18 persons . Twenty-six patients died . Treatment with erythromycin or tetracycline resulted in the lowest case-fatality ratios, but the associations were not statistically significant. Ann Intern Med, 1979 Apr, 90(4), 492 - 5 Clinical aspects of Legionnaires' disease; Swartz MN; Since the initial description of Legionnaires' disease 2 years ago, a clearer picture of its clinical manifestations has emerged as a result of investigations of further epidemics and studies of laboratory-confirmed sporadic cases . Although individual clinical features are not sufficiently distinctive to distinguish Legionnaires' disease from other types of acute pneumonia, a composite can provide a sufficiently characteristic clinical profile to indicate the likelihood of this diagnosis . Such a profile includes high fever (above 39.4 degrees C); recurrent chills; relative bradycardia; early gastrointestinal symptoms (particularly diarrhea); prominent myalgias; microscopic hematuria; liver function abnormalities; toxic encephalopathy; nonproductive cough; absence of bacterial pathogens on Gram stain and culture of transtracheal aspirate; progression from patchy bronchopneumonia to lobar and multilobar consolidation; and frequently prompt and sometimes dramatic response to treatment with erythromycin. Mutat Res, 1979 Apr, 60(2), 173 - 80 Mitochondrial mutagenesis in Saccharomyces cerevisiae . I . Ultraviolet radiation; Ejchart A et al.; UV efficiently induces mutations in mitDNA , conferring resistance to erythromycin . Mitochondrial chloramphenicol-resistant mutants are probably also induced by UV, but almost 90% of mutants with such phenotype are non-mitochondrial; therefore it is possible to estimate accurately the frequences of the induced presumptive mitochondrial capr mutations. Mol Gen Genet, 1979 Mar 5, 170(3), 327 - 31 Nuclear mutations in Saccharomyces cerevisiae which increase the spontaneous mutation frequency in mitochondrial DNA; Johnston LH; Fourteen mutants have been identified in which the frequency of spontaneous mutations in mitochondrial DNA is increased . As well as increasing the frequency of mutations to resistance to erythromycin, oligomycin and spiramycin, all the mutants also show changes in the frequency of spontaneous petite induction . None of the mutants has any effect on the frequency of spontaneous nuclear mutations . Nine of the mutants are in one complementation group and five are in another . The phenotype of both groups is caused by a single nuclear mutation. J Trauma, 1979 Mar, 19(3), 201 - 2 Case report: treatment of catbite injuries of the hand; Veitch JM et al.; Catbite or scratch injuries frequently contain mixed organisms, and penicillin or erythromycin alone may not give adequate coverage, as shown in the cases described . Incision and drainage should not be neglected or deferred when a deep infectious process is present or bones, joints, or tendon sheaths are involved . Finally, a catbite injury is a deep penetration injury with potentially virulent organisms that require close followup and awareness of potential problems. Am J Med Sci, 1979 Mar-Apr, 277(2), 223 - 32 Case report . Clinical manifestations and treatment of Legionnaires' disease; Baird IM et al.; Eight patients with atypical pneumonia caused by the Legionnaires' disease organism were seen during the spring and summer of 1977 . Two died of the acute illness . All patients were febrile and presented with symptoms of acute respiratory infection . Other symptoms included malaise, anorexia, chills, myalgia, and headache . Severe hypoxemia was a striking feature . Conventional methods to determine the etiology of these pneumonias were unsuccessful but subsequent serological studies confirmed the diagnosis of Legionnaires' disease . Seven patients were treated with beta-lactam antibiotics alone or with an aminoglycoside and all failed to respond . Six were subsequently treated with erythromycin and five who received this drug for at least 48 hours were markedly improved within this time period . We believe that erythromycin is effective in the treatment of Legionnaires' disease. J Bacteriol, 1979 Mar, 137(3), 1464 - 7 23S ribosomal ribonucleic acid of macrolide-producing streptomycetes contains methylated adenine; Graham MY et al.; Coresistance to macrolide, lincosamide, and streptogramin B-type (MLS) antibiotics by a common biochemical mechanism characterizes clinically resistant pathogens . Of 10 streptomycetes tested for resistance to macrolide, lincosamide, and streptogramin B-type antibiotics, only 1, Streptomyces erythreus, the organism used for production of erythromycin, was found resistant to all three classes; moreover, it was the only streptomycete in the series tested found to contain N6-dimethyladenine (m62A) in 23S ribosomal ribonucleic acid, the structural alteration of ribosomal ribonucleic acid associated with clinical resistance . Of the seven streptomycetes tested for the presence of m62A and N6-methyladenine (m6A), two, S . fradiae and S . cirratus, which produce the macrolide antibiotics tylosin and cirramycin, respectively, were found to contain m6A, but not m62A . The remaining strains tested, including strains which produce lincomycin and streptogramins, contained neither m6A nor m62A. Surgery, 1979 Mar, 85(3), 317 - 21 Reduction of postoperative infection in elective colon surgery with preoperative administration of kanamycin and erythromycin; Wapnick S et al.; The results of a randomized prospective preoperative antibiotic study in colon surgery is presented . Antibiotics were given by mouth for 2 days prior to operation: kanamycin (1 gm four times a day) and erythromycin (750 mg three times a day) . Kanamycin combined with erythromycin significantly reduced wound infection as compared to kanamycin with a placebo (three of 38 vs . 16 of 39, P less than 0.001) . Thus oral aminoglycoside given alone appears to be inadequate to offer protection against postoperative infection in elective colon surgery. Pediatrics, 1979 Feb, 63(2), 198 - 203 Treatment of chlamydial pneumonia of infancy; Beem MO et al.; Infants with untreated chlamydial pneumonia shed Chlamydia trachomatis and are symptomatic for may weeks . We used sulfisoxazole, 150 mg/kg/day, or erythromycin ethyl succinate, 40 mg/kg/day, for approximately 14 days to treat 32 patients with chlamydial pneumonia of infancy, and observed them for nasopharyngeal shedding of C trachomatis and changing clinical status . All infants stopped shedding chlamydiae soon after treatment was started . After treatment, three of the 25 infants tested again became culture positive (but did not have clinical relapse) . All infants improved clinically . In 24 (83%) of 29 infants, where the onset of improvement could be times, improvement began within seven days of starting treatment . Progression to complete recovery was observed in 27 of 28 infants examined between two weeks and two months of treatment completion . Neither the existence of concomitant viral infection nor the duration of illness or hospitalization before starting treatment influenced the interval between initiation of treatment and onset of clinical improvement . While these observations do not prove, they are at least compatible with the hypotheses that C trachomatis plays a central etiologic role in this illness and that termination of chlamydial infection is beneficial clinically . Pending the availibility of data from controlled studies, we believe that either of the treatment programs outlined warrant consideration in the clinical management of patients with chlamydial pneumonia of infancy. J Pharm Sci, 1979 Feb, 68(2), 150 - 5 Plasma levels following single and repeated doses of erythromycin estolate and erythromycin stearate; Welling PG et al.; The pharmacokinetics of erythromycin and erythromycin 2'-propanoate were studied in healthy male volunteers following single and repeated doses of erythromycin stearate tablets, erythromycin estolate capsules, and a suspension . Estolate dosages gave rise to higher plasma levels of total drug than the stearate . However, the stearate yielded higher plasma levels of erythromycin base . Absorption of all dosage forms, except the suspension, was delayed, and pharmacokinetic interpretation of both single- and multiple-dose data required incorporation of an absorption lag time . The absorption of erythromycin stearate was inhibited by food and also by low fluid volumes in fasted subjects . Absorption of erythromycin estolate was increased in the presence of food and was not greatly affected by fluid volume . Although single-dose data poorly predicted circulating levels of erythromycin following repeated doses, trends observed after single doses were maintained during chronic treatment. Hautarzt, 1979 Feb, 30(2), 89 - 91 {The effect of collagenase inhibition on bullous eruption and healing process in epidermolysis bullosa}; Coradello H et al.; The collagenase inhibiting effect of erythromycin already observed in vitro was demonstrated also after oral administration of the drug in vivo in one child with epidermolysis bullosa letalis and one child with epidermolysis bullosa dystrophica . Despite inhibition of skin collagenase activity during administration of the drug the frequency of bullous eruptions and healing process of affected skin areas remained unchanged . This suggests no direct causal relation existing between skin collagenase activity and epidermolysis bullosa . Whether increased collagenase activity reflects a secondary reaction of the organism cannot be concluded from this study. Mol Gen Genet, 1979 Jan 16, 169(1), 27 - 34 Rifampicin supersensitivity of rho strains of E . coli, and suppression by sur mutation; Guterman SK et al.; Escherichia coli strains with mutations rho-115, rho-ts15, rho-101 (psu-1) or rho-102 (psu-2) are more sensitive ("supersensitive") to rifampicin than isogenic parent strains, as measured by growth rate in broth and colony forming efficiency on solid media with 5, 10, or 20 microgram of rifampicin per ml . There is no change in sensitivity of rho mutants to the antibiotics penicillin, erythromycin, chloramphenicol, or the detergent desoxycholate . The rho-101 or rho-102 mutations confer rifampicin supersensitivity at 32 degrees C but not 42 degrees C . Mutants of a rho-115 strain that have lost polarity suppression can be isolated by selection for rifampicin resistance . This phenotype, Sur, is not due to reversion of the original rho gene mutation but to a second mutation perhaps in the gene for rho protein or the gene for the beta subunit of RNA polymerase . One class of Sur mutation, occurring in rho-115 cells isolated as resistant to 20 microgram of rifampicin per ml, is co-transducible with the marker ilv, and the gene order is rbs-ilv-sur-38 . A model suggested by this map position is that the mutations rho-115 and sur-38 define the domain of rho protein which interacts with the beta subunit of RNA polymerase. Pharmacology, 1979, 18(4), 202 - 9 Effect of chlorpromazine and erythromycin on bile salt-induced cholestasis in the rat; Drew R et al.; The effects of subacute administration of chlorpromazine HCI (CPZ), erythromycine base and erythromycin estolate on the cholestatic response to intravenous taurolithocholate (TLC) and taurochenodeoxycholate (TCDC) in the rat were investigated . All three enhanced the recovery of bile flow after TCDC but not after TLC . Erythromycin base and estolate enhanced bile flow recovery after TCDC and potentiated the increase of plasma 5'-nucleotidase, as did CPZ . Neither erythromycin estolate nor CPZ precipitated a cholestatic response in rat maintained for 9-13 days on a diet supplemented with 0.05% lithocholic acid . It is concluded that the interaction of CPZ and erythromycins with bile salts is not based on the cholestatic properties of the drugs, and hence is not a practical way of distinguishing cholestatic from non-cholestatic drugs. Curr Med Res Opin, 1979, 6(2), 118 - 23 Plasma and saliva concentrations for a new formulation of erythromycin stearate; Berend N et al.; Erythromycin saliva and plasma concentrations were determined in 10 subjects after the first and fourth doses of a new formulation of erythromycin stearate ('Erythrocin'), 500 mg 8-hourly, taken immediately before food . Consistent absorption occurred and the steady state plasma levels compared favourably with the minimal inhibitory concentrations of erythromycin for common respiratory pathogens . There was a significant positive correlation between steady state saliva and plasma levels. Infection, 1979, 7 Suppl 2, S228 - 30 {The role of chlamydiae in male urethro-adnexitis (author's transl)}; Hofstetter A; Chlamydiae belonging to Subgroup A occur in both the normal male urethra and in patients with urethro-adnexitis, which means that Chlamydiae must be attributed with a significant pathogenetic role in certain cases of abacterial urethroadnexitis . Susceptibility to erythromycin therapy confirms this. Mol Gen Genet, 1979, 177(1), 39 - 46 Mitochondrial and nuclear mutations that affect the biogenesis of the mitochondrial ribosomes of yeast . I . Genetics; Bolotin-Fukuhara M; We have isolated about five hundred temperature-sensitive mutants specific for the mitochondrial functions . Their growth on glycerol is defective at 36 degrees C and/or 20 degrees C . While most of the mutations were nuclearly inherited, about thirty were found to be of mitochondrial origin . 1) Four mitochondrial mutations (three cryosensitive, one thermosensitive) were localized close to chloramphenicol and erythromycin resistance loci of the mitochondrial DNA, that is in the region coding for the 23 S ribosomal RNA . One of the mutation interfered with the expression of the chloramphenicol resistance gene . 2) A dozen nuclear mutations were isolated from a strain which is labelled with mitochondrial drug resistance markers (chloramphenicol, erythromycin, and paromomycin) . Among the temperature sensitive respiratory deficient mutants, we have selected the mutations that supress the resistant phenotypes . We describe two non allelic such mutations, one being cryosensitive, the other thermosensitive . Both supress the expression of the mitochondrial chloramphenicol resistance gene . The temperature sensitive growth on glycerol and the modified antibiotic phenotype segregated together as a single recessive mutation . A biochemical study of these mutants is presented in a joint paper, confirming their presumed ribosomal nature. Arch Immunol Ther Exp (Warsz), 1979, 27(3), 425 - 32 Practical aspects of selection of streptomyces mutants; Ostrowska-Krysiak B et al.; The methods of industrial strains selection on the basis of some regulatory mechanisms are presented . The selection of the producing S . erythreus mutants exhibiting higher activity for transformation of erythromycin C to erythromycin A is one of the examples for the practical use of the presented method . Some new techniques including isotopic methods are presented. Infection, 1979, 7 Suppl 2, S207 - 10 {Erythromycin determination in organ tissues (author's transl)}; Dette GA et al.; The recovery rates of erythromycin after in vitro and in vivo administration were studied comparatively in liver, lung, and kidney . Using buffer standards the recovery rate in homogenates of in vitro administered erythromycin decreased with increasing protein concentration . At constant protein concentration the erythromycin administered recovered correlated linearly . Mincing the tissues with scissors was not found to be adequate, even when followed by a diffusion period of up to 24 hours . Similarly, shock freezing resulted in lower values . Even and optimal breaking down of tissues was found after homogenisation or ultrasonics . The recovery rates were not raised by treating the tissue with trypsin . There was no evidence of enzymatical erythromycin degradation in liver homogenates under the assay conditions. Am J Surg, 1979 Jan, 137(1), 68 - 74 Preoperative prophylactic cephalothin fails to control septic complications of colorectal operations: results of controlled clinical trial . A Veterans Administration cooperative study; Condon RE et al.; Data obtained from a survey of the membership of the Society for Surgery of the Alimentary Tract and the American Society of Colon and Rectal Surgeons indicated that concomitant administration of oral neomycin-erythromycin base and systemic cephalothin, together with mechanical colon cleansing, was the most popular method of colon preparation . We designed a prospective double blind clinical trial to compare administration of intravenous cephalothin, oral neomycin-erythromycin base, and the combination of both the intravenous and oral antibiotics . Intake of patients to the intravenous cephalothin group was stopped because the data indicated that this method of prophylaxis resulted in significantly higher numbers of septic complications . The incidence of wound infection was 30 per cent and the overall incidence of septic complications was 39 per cent in patients receiving only intravenous cephalothin combined with mechanical colon cleansing . The incidence of wound infection and the overall incidence of septic complications was only 6 per cent in the comparison group, and the differences are highly significant. Genetika, 1979, 15(10), 1730 - 8 {Determination of Streptomyces coelicolor A3(2) resistance to erythromycin}; Puzynina GG et al.; Resistance to erythromycin is genetically unstable in strains of Streptomyces coelicolor A3(2) . The frequent loss of resistance as well as reversion of sensitive variants to the original unstable resistance phenotype excluded the possibility that plasmid elimination is involved . The spontaneous frequency of occurrence of sensitive clones was 0.14 to 1.5%, the rate of reversion ranging from 1.10(-6) to 1.10(-8) . Resistance to erythromycin has been mapped on the chromosomes of two S . coelicolor A3(2) derivatives in different sites: between markers adeC (v 10) and ArgA1 in the strain A617, between pheA1 and SCP1 in the strain S18 . It is suggested that genetic instability of erythromycin resistance determinants having chromosomal location is due to transposition of genetic material. Chest, 1979 Jan, 75(1), 85 - 6 Endocarditis due to strain of Cardiobacterium hominis resistant to erythromycin and vancomycin; Prior RB et al.; Endocarditis caused by Cardiobacterium hominis was observed in a penicillin-allergic patient with a prosthetic cardiac valve who had received prophylactic therapy with erythromycin for dental extractions . The organism was resistant to erythromycin and vancomycin, with minimal inhibitory concentrations of 12.5 microgram/ml and 25 microgram/ml, respectively, but was sensitive to penicillin G, tetracycline, cephalexin, and cefaclor . This case suggests that currently recommended antibiotic prophylactic therapy for endocarditis, especially in penicillin-allergic patients, may be inadequate for unusual pathogens such as C hominis. Nephron, 1979, 24(2), 93 - 5 Collagenase activity of rat kidney with glomerulonephritis is inhibited by erythromycin; Lubec G et al.; Collagenolytic activity of rat kidney with glomerulonephritis (GN) of Masugi's type was determined by a series of biological experiments . The determination was carried out during the heterologous phase of the disease together with inhibition studies in vivo and in vitro . Erythromycin has been tested in vivo for its inhibitory activity and an activity of collagenase was found in untreated rats with GN only, the panel treated with erythromycin did not show any collagenolysis . Statistical calculations indicate the significance of the inhibition (p less than 0.001) . In addition, kidneys of test animals with GN have been investigated for their enzymatic activity and the inhibition by erythromycin in vitro where the kidneys failed to show collagenolytic activity . It can be concluded that erythromycin is able to inhibit in vivo and in vitro the activity of the collagenolytic enzyme produced by polymorphonuclear leukocytes during the heterologous phase of the nephritis, an effect which leads to the recovery of the physiological equilibrium of the protease and its inhibitor. Z Naturforsch {C}, 1979 Jan-Feb, 34(1-2), 131 - 5 Osmotic