Bactericidal

J Nat Prod, 1991 Jul-Aug, 54(4), 1068 - 76
New cytotoxic beta-carboline alkaloids from the marine bryozoan, Cribricellina cribraria; Prinsep MR et al.; Bioactivity-directed separations led to the isolation of the new alkaloid, 1-vinyl-8-hydroxy-beta-carboline {1}, as the major cytotoxic component of the marine bryozoan Cribricellina cribraria . Another new beta-carboline alkaloid 2 with the novel sulfone structure was isolated, together with a number of known beta-carboline compounds . Cytotoxicity and antimicrobial effects are reported for these compounds and for other synthesized beta-carbolines.

Steroids, 1991 Jul, 56(7), 395 - 8
Antimicrobial activity of basic cholane derivatives . X . Synthesis of 3 alpha- and 3 beta-amino-5 beta-cholan-24-oic acids; Bellini AM et al.; A simple and convenient route to 3 alpha- and 3 beta-amino-5 beta-cholan-24-oic acids was developed via Leuckart-Wallach amination reduction and subsequent acid hydrolysis . Two epimeric formylamino derivatives were produced (alpha and beta), approximately in a 1:1 ratio, as determined by 13C nuclear magnetic resonance spectroscopy . The two isomers were separated by making use of their different solubilities in ethyl ether . The absolute configuration of the two amino acids was assigned by comparison with authentic reference samples.

J Antimicrob Chemother, 1991 Jul, 28(1), 79 - 86
The penetration of cefpirome into the potential sites of pulmonary infection; Baldwin DR et al.; The concentrations of cefpirome, a new semi-synthetic cephalosporin, in the bronchial mucosa and serum were assessed after a single 1 g intravenous dose in 37 patients . Bronchoalveolar lavage allowed epithelial lining fluid (ELF) concentrations to be measured in eight subjects . The mean concentration for serum was 34.5 mg/L (S.E.M . 3.3), for bronchial mucosa 19.3 mg/kg (S.E.M . 1.9) and for ELF 7.2 mg/L (S.E.M . 1.1) . The progressive reduction in cefpirome concentration in serum compared to that in bronchial mucosa and ELF is consistent with the permeability characteristics of beta-lactam antimicrobials and the barriers to movement of antimicrobial agents present in the lung.

Mikrobiyol Bul, 1991 Jul, 25(3), 277 - 84
{Urogenital Chlamydia trachomatis infections}; Dereli D et al.; Urogenital Chlamydia trachomatis infections are the most common sexually transmitted diseases which have shown a significant increase in the last few years . This organism presents a major health problem in many countries . It is recognized as the cause of both complicated and uncomplicated infections in men, women and infants passing through an infected birth canal . Tissue culture is accepted as the gold standard in the diagnosis of chlamydial infections . But, since this technique is expensive and cumbersome, antigen detection tests such as DFA and EIA are more widely used . Tetracyclines and erythromycins are the first-choice antimicrobials in the treatment of chlamydial infections.

Vnitr Lek, 1991 Jul-Aug, 37(7-8), 695 - 702
{Antibiotics and antimycotics in oncology}; Krcmery V; The submitted review gives an account of therapeutic and prophylactic indications in oncology, in aimed, not aimed (empirical) treatment of febrile neutropenic patients, prophylaxis of infection during neutropenic episodes and selective decontamination before and during transplantation of bone marrow, focused on new antimicrobial and antimycotic agents.

Arzneimittelforschung, 1991 Jul, 41(7), 744 - 6
Synthesis of {carbonyl-14C}sparfloxacin; Kagemoto A et al.; A new antimicrobial quinolone, sparfloxacin (5-amino-1-cyclopropyl-7- (cis-3,5-dimethyl-1-piperazinyl)-6,8-difluoro-1,4-dihydro-4-oxoquinoline -3- carboxylic acid, AT-4140; CAS 110871-86-8), was labeled by 14C for studies of disposition and metabolism . Ethyl pentafluoro{carbonyl-14C}benzoylacetate (I) was reacted with ethyl orthoformate, cyclopropylamine and then potassium tert-butoxide to give a quinolone intermediate (IV) . A benzylamino derivative (V) obtained by condensation of IV and benzylamine was subject to catalytic hydrogenolysis and hydrolyzed to give the carboxyl derivative (VII), which was condensed with cis-2,6-dimethylpiperazine to form {carbonyl-14C}sparfloxacin . The average yield of 3 preparations was 41.5% and specific activities were 310.8-366.3 MBq (8.4-9.9 mCi)/mmol . Both chemical and radiochemical purities were greater than 99%.

Orthop Clin North Am, 1991 Jul, 22(3), 379 - 88
Bacterial resistance; Gentry LO; Pathogenic bacteria remain adaptable to an increasingly hostile environment and a wider variety of more potent antibiotics . Organisms not intrinsically prepared for defense have been able to acquire resistance to newer antimicrobial agents . Chromosomal mutations alone cannot account for the rapid emergence and spread of antibiotic resistance . It has been established that plasmids and transposons are particularly important in the evolution of antibiotic-resistant bacteria . Plasmid- or transposon-mediated resistance provides the bacteria with pre-evolved genes refined to express high-level resistance . In particular, transposons can transfer these resistance determinants in diverse bacterial species, and nature provides in humans and animals large intestinal reservoirs in which such communications are facilitated . Antibiotic therapy exerts selection pressures on bacteria . Eradication or marked reduction in the populations of susceptible organisms promotes the overgrowth of intrinsically resistant strains and favors those resistant as a result of favorable chromosomal mutations or via plasmids or transposons . In our hospitals, where antibiotic consumption continues to increase, the nosocomial flora consists of many resistant bacteria, and infections acquired in the nosocomial setting are now far more severe than their community-acquired counterparts . There is convincing evidence that infection control measures must take into further consideration the contribution of the hospital worker as carrier and mediator of antibiotic resistance.

J Immunol, 1991 Jun 15, 146(12), 4295 - 300
Stimulus-induced maturation of probactenecins, precursors of neutrophil antimicrobial polypeptides; Zanetti M et al.; The antimicrobial polypeptides Bac7 and Bac5 (bactenecins) are stored in the large granules of bovine neutrophils as precursor forms, or probactenecins . Maturation of probactenecins has been investigated by studying the effects of stimulus-induced degranulation on this process . Stimulation of neutrophils with PMA, which is a secretagogue for specific and large granules but not for azurophils, induces a substantial discharge of uncleaved probactenecins in the extracellular medium, as revealed by Western blot analysis . When neutrophils are exposed to opsonized bacteria in the presence of cytochalasin B, resulting in exocytosis of the content of azurophils in addition to that of specific and large granules, probactenecins are secreted and rapidly converted into the corresponding mature antimicrobial peptides . Such a conversion is prevented if serine proteases, stored in the azurophils, are inhibited by pretreatment of neutrophils with PMSF . Phagocytosis, while causing a rapid discharge of the contents of azurophil and of the large granules into phagocytic vacuoles, as indicated by immunogold electron microscopy, also induces cleavage of probactenecins into mature peptides, as revealed by Western blot analysis . We conclude that the final processing of the storage forms of bactenecins arises from their interaction with the serine protease(s) of azurophils during bacteria-induced degranulation of neutrophils.

J Immunol, 1991 Jun 15, 146(12), 4338 - 43
Macrophage cytostatic effect on Trypanosoma musculi involves an L-arginine-dependent mechanism; Vincendeau P et al.; Peritoneal macrophages from mice infected with an extracellular parasite, Trypanosoma musculi were effective in inhibiting parasite proliferation in vitro . This trypanostatic activity could be suppressed by NG monomethyl-L-arginine (NGMMA), a specific inhibitor of a biochemical pathway synthesizing L-citrulline and inorganic nitrogen oxides from L-arginine . Macrophages exerted this in vitro antiproliferative effect from the 10th day of infection on and this activity was maximum around 14th day of infection . Nitrite production paralleled development of macrophage trypanostatic activity . Macrophages collected from BCG-infected mice or treated with IFN-gamma in vitro also exerted a trypanostatic activity which was suppressed by NGMMA . A trypanostatic activity suppressed by NGMMA was also exerted by splenic macrophages from T . musculi-infected mice . Trypanostatic activity of IFN-gamma-treated macrophages was reduced by addition of anti-TNF-alpha showing the participation of TNF-alpha in IFN-gamma-mediated macrophage trypanostatic activity . Nitric oxide (NO) gas inhibited T . musculi proliferation . Addition of excess iron reversed the trypanostatic effect of both macrophages and NO gas . All these data showed that, as reported for a broad spectrum of microorganisms, activated macrophages displayed an antimicrobial effect on trypanosomes through the L-arginine: NO pathway that could participate in controlling infection in T . musculi-infected mice before appearance of antibody-dependent mechanisms . NO production by activated macrophages could trigger iron loss from critical target enzymes in trypanosomes.

Biochim Biophys Acta, 1991 Jun 5, 1096(4), 338 - 44
Lysozyme is an ozone-sensitive component of alveolar type II cell lamellar bodies; Shelley SA et al.; Exposure of rats to 3 ppm ozone for up to 8 h results in significant changes in lamellar bodies, the surfactant storing organelles of type II cells . We have previously shown that a 14 kDa lamellar body protein is decreased as early as 4 h after the onset of ozone exposure . We have isolated this ozone-sensitive protein from rat lung lamellar bodies and identified it as lysozyme by immunochemical methods, as well as by its amino acid composition, N-terminal amino acid sequence and bacteriolytic activity . Reduced lysozyme activity in isolated lamellar bodies is detected as early as 4 h after the start of ozone exposure . Following an 8 h ozone exposure, the activity does not return to control levels for at least 48 h . Lamellar body lysozyme is expected to be secreted with surfactant phospholipids, thereby contributing to the antimicrobial defense of the alveolar lining layer . The acute lysozyme deficiency seen in ozone-induced oxidant injury may reduce the resistance of the lung to infection.

Oral Surg Oral Med Oral Pathol, 1991 Jun, 71(6), 684 - 8
Penetration of erythromycin into periapical lesions after repeated doses of erythromycin acistrate and erythromycin stearate: a pilot study; Tuominen RK et al.; In 26 patients who had undergone apicectomy and extirpation of granulomas (n = 9) or radicular cysts (n = 17), concentrations of erythromycin, 2'-acetyl erythromycin, and their anhydro forms were determined with a novel chemical method in plasma and periapical lesions after at least 2 days of treatment with erythromycin acistrate (EA) (400 mg three times daily, n = 11) or erythromycin stearate (ES) (500 mg three times daily, n = 15) . Oral surgery was performed 2 1/2 to 3 hours after the last dose . Blood samples were collected at the time of operation, and immediately before antibiotic treatment, and 1, 2, and 6 hours after treatment . At all time points EA produced at least twice the total antibiotic (2'-acetyl erythromycin plus erythromycin) concentrations in plasma as ES . Erythromycin levels in plasma were at least as high after EA treatment as after ES . In periapical lesions erythromycin concentration after EA was three times higher (1.34 +/- 0.28 micrograms/gm) than after ES treatment (0.40 +/- 0.17 micrograms/gm) . Although the total drug concentration in periapical lesions was about the same after EA (2.64 micrograms/ml) and ES (3.41 micrograms/ml), most of the drug recovered after ES was antimicrobially inactive anhydroerythromycin (3.01 micrograms/gm) . The concentration of anhydroerythromycin in plasma was approximately the same as that of erythromycin after ES throughout the dose interval . After EA treatment both plasma and the periapical lesion samples contained hardly detectable amounts of anhydroerythromycin . Hence EA has a good bioavailability essential for treatment and prophylaxis of bacterial infections in dentistry.

J Trauma, 1991 Jun, 31(6), 775 - 82; discussion 782-4
The cytotoxic effects of commonly used topical antimicrobial agents on human fibroblasts and keratinocytes; Cooper ML et al.; This study evaluated the cytotoxicity of commonly used topical agents to human dermal fibroblasts and epidermal keratinocytes, which play a prominent role in wound healing . The effects of these topical agents were assessed using two separate assays for the fibroblasts--tritiated thymidine incorporation and the uptake of a vital dye (neutral red) . Keratinocytes were evaluated with the neutral red assay . Serial dilutions of each of 10 commonly used topical agents produced decreases in both the uptake of neutral red and the incorporation of thymidine at clinically relevant doses . Only Neosporin G.U . irrigant showed no significant difference compared with controls in the assays for both the fibroblasts and the keratinocytes . Careful attention must be paid to which agent is used in the clinical setting, since many of these can have profound effects on cells that influence wound healing.

Am J Obstet Gynecol, 1991 Jun, 164(6 Pt 1), 1556 - 61; discussion 1561-2
Antibiotic treatment of tuboovarian abscess: comparison of broad-spectrum beta-lactam agents versus clindamycin-containing regimens; Reed SD et al.; One hundred nineteen patients with tuboovarian abscess were evaluated for response to antibiotics . Results were stratified into three groups by antimicrobial regimen . Group 1 consisted of 37 patients treated with a single-agent broad-spectrum intravenous antibiotic and oral doxycycline . Initial clinical response (defined as decreased pain, diminished white blood cell count, or defervescence) in group 1 was 31/37 (84%) . Group 2 consisted of 64 patients treated with clindamycin in combination with an aminoglycoside with or without a penicillin . There was an initial clinical response in 45 of 64 (70%) . Group 3 consisted of 18 patients from group 1 who were changed to a clindamycin-containing regimen after 2 to 3 days of initial treatment with a single-agent broad-spectrum antibiotic . The decision to switch antibiotics was not based on treatment failure but occurred when delayed ultrasonography confirmed the diagnosis of tuboovarian abscess . The switch reflected physician preference for clindamycin-containing regimens in the treatment of tuboovarian abscesses . The response rate in this subset of patients was 14 of 18 (78%) . Overall initial clinical response rate was 90 of 119 (75%) . There were no statistically significant demographic or clinical differences among the three groups . There was no statistical difference in the rate of early and late antibiotic failure rates among the groups . Our study demonstrates that extended-spectrum antibiotic coverage, including single-agent broad-spectrum antibiotics such as cefoxitin, in conjunction with doxycycline has efficacy that is equivalent to that of clindamycin-containing regimens . An overall medical treatment success rate of 75% suggests that conservative treatment of tuboovarian abscesses is warranted.

Nurs Clin North Am, 1991 Jun, 26(2), 341 - 60
Update on antimicrobial agents; Walsh ML et al.; A variety of antimicrobial agents are currently in use to treat bacterial, fungal, and viral infections . Pharmacologic and microbiologic properties unique to the classes of drugs are reviewed in this article . Home parenteral antibiotics are an acceptable and efficacious way to treat certain infections and may lead to shorter hospitalizations . Knowledge of general drug characteristics, indications, and toxicities will help the nurse to manage effectively the patient receiving antimicrobial therapy.

Arch Ophthalmol, 1991 Jun, 109(6), 869 - 72
An evaluation of saline irrigation and comparison of povidone-iodine and antibiotic in the surface decontamination of donor eyes; Nash RW et al.; We evaluated the effect of saline irrigation on 38 pairs of donor eyes and determined the relative efficacy of antibiotic rinse/storage (neomycin-polymyxin B-gramicidin) and povidone-iodine immersion . Microbial growth was found in 49 (64.5%) of 76 eyes from which cultures were taken before irrigation, and only four (8.2%) became culture negative after irrigation . Of 27 eyes culture negative before irrigation, 15 (55.6%) became positive after irrigation . One eye of each pair was then assigned randomly to antibiotic rinse/storage and the other eye to 3-minute immersion in 1% povidone-iodine . Both antimicrobial treatments decreased the numbers of positive cultures, with povidone-iodine showing an advantage that did not reach significance . These results demonstrate that saline irrigation of donor eyes in situ does not reduce surface contamination and that povidone-iodine immersion should be considered as an alternative for donor eye decontamination.

Gastroenterology, 1991 Jun, 100(6), 1571 - 5
Helicobacter pylori-associated exaggerated gastrin release in duodenal ulcer patients . The effect of bombesin infusion and urea ingestion; Graham DY et al.; Recent studies have shown that the exaggerated meal-stimulated gastrin release in patients with duodenal ulcer abates after eradication of Helicobacter pylori infection . Bombesin-stimulated gastrin release was compared in 11 H . pylori-infected patients with chronic duodenal ulcer and 8 uninfected healthy volunteers both before and after therapy to eradicate H . pylori . Bombesin infusion significantly increased the gastrin release both in control subjects and in patients with duodenal ulcer . Antimicrobial therapy (bismuth, tetracycline, and metronidazole) to eradicate the H . pylori infection was associated with a significant reduction in bombesin-stimulated gastrin release in patients with duodenal ulcer (from 116.9 +/- 19 pg/mL to 69.5 +/- 7 pg/mL following 50 pmol.kg-1.h-1 bombesin; and from 158 +/- 29 to 83.4 +/- 10 following 200 pmol.kg-1.h-1 bombesin: P = 0.01 for each) . Antimicrobial therapy had no effect on gastrin release in uninfected volunteers, thus excluding a nonspecific effect of antimicrobial therapy on antral G-cell function . Serum gastrin was also not increased by feeding 500 mg of urea to 5 H . pylori-infected volunteers . This suggests that access of hydrogen ion to the pH-sensitive sites governing gastrin release by mucosal ammonia produced by H . pylori urease is not a critical factor . These data suggest that exaggerated gastrin release present in patients with duodenal ulcer disease is secondary to H . pylori infection.

Obstet Gynecol Clin North Am, 1991 Jun, 18(2), 289 - 99
Respiratory insufficiency due to pneumonia in pregnancy; Maccato M; Respiratory insufficiency is a common complication of pneumonia in pregnancy . Respiratory insufficiency may progress to respiratory failure, requiring mechanical ventilation . Prompt diagnosis of the pneumonia and rapid institution of supportive care and effective antimicrobial therapy results in the best possible outcome for both mother and fetus . If the patient requires mechanical ventilation, resolution of the pneumonia usually allows for uneventful weaning from the respirator.

Zentralbl Bakteriol, 1991 Jun, 275(2), 223 - 32
Modulation of antimicrobial effects of beta-lactams by amino acids in vitro; Gillissen G et al.; Glycine as well as 11 and 10, respectively, out of a total of 12 D-amino-acids tested increased the antimicrobial efficacy of imipenem (IMI) and of ampicillin (AMP) using the serosensitive strain E . coli ATCC 8739 . D-proline was ineffective in assays with IMI as well as D-proline and D-leucine in assays with AMP . - In contrast, L-amino-acids behaved differently: In assays with IMI, 9 out of 13 isomers were ineffective whereas 3 were antagonistic (L-phenylalanine, L-serine, L-tryptophan) . In combination with AMP, however, 10 L-amino acids had an antagonistic effect and 2 (L-leucine, L-methionine) were ineffective . L-alanine was an exception and showed a synergism with both antibiotics which was assumed to have been due to a racemase activity of cells . - Seroresistance of E . coli apparently reduced the synergistic effect of glycine and beta-lactams . - Glycine, alanine and tryptophan lost their typical synergistic or antagonistic effect with AMP when tested as di- or tri-amino-acid compounds . This was not the case with di-L-alanine - It is supposed that the synergistic effect of glycine or of D-amino-acids with beta-lactams can be explained mainly by an inhibition of carboxypeptidases.

Ann Soc Belg Med Trop, 1991 Jun, 71(2), 81 - 113
{Epidemiology of sexually transmissible diseases in developing countries in the era of AIDS}; Goeman J et al.; Recent developments in the epidemiology of sexual transmitted diseases (STD) in developing countries are reviewed . STD are very frequent in the tropics, particularly in large urban areas . They put a heavy burden on public health because they affect the economically most important age groups and because their sequellae may be fatal . Pelvic inflammatory disease and its consequences, and morbidity during pregnancy and the neonatal period are among the most important causes of mother and child morbidity . STD favour sexual transmission of HIV and may therefore explain the explosive AIDS epidemics in many developing countries . Antimicrobial resistance has made treatment of gonorrhoea and chancroid more difficult and more expensive . STD and HIV infection may be responsible for up to 17% of productive years lost to disease in certain regions . Strategies to control STD should be developed and linked with the AIDS programs . Both should be integrated in the primary health care system.

Antimicrob Agents Chemother, 1991 Jun, 35(6), 1232 - 4
In vitro activities of aminoglycosides, lincosamides, and rifamycins against Mycobacterium leprae; Franzblau SG; The in vitro activities of a variety of aminoglycosides, lincosamides, and rifamycins against Mycobacterium leprae were evaluated with the BACTEC 460 system . At 20 micrograms/ml, gentamicin, kanamycin, tobramycin, streptomycin, and amikacin were inactive . Lincomycin was active at 20 micrograms/ml, and clindamycin was active at 0.31 micrograms/ml . Rifamycin SV, rifabutin, and rifampin were active at 3.1, 3.1 to 12.5, and 200 ng/ml, respectively . The in vitro assay correlates well with the in vivo response of M . leprae to antimicrobial agents, with the exception of the aminoglycosides.

Antimicrob Agents Chemother, 1991 Jun, 35(6), 1153 - 9
Beta-lactam antibiotics potentiate magainin 2 antimicrobial activity in vitro and in vivo; Darveau RP et al.; The ability of magainin 2 to augment antibiotic therapy was examined . Susceptibility to magainin 2 was determined on Escherichia coli incubated in the presence and absence of sublethal concentrations of antibiotics both in vitro and in vivo . Experiments in buffer and normal human serum revealed that E . coli exposed to sublethal amounts of cefepime, a beta-lactam antibiotic, was significantly more susceptible to the antimicrobial activity of magainin 2 . Bacteria incubated with subinhibitory concentrations of other beta-lactam type antibiotics, but not amikacin (an aminoglycoside) or ciprofloxacin (a quinolone), were also more susceptible to magainin 2 in normal human serum . Bacteria were less susceptible to magainin 2 when they were examined in heat-inactivated serum . Complement was shown to be required for magainin 2 activity in serum by using C8-deficient sera . The combination of magainin 2 and cefepime was shown to be more antimicrobial in normal human serum for a variety of bacterial strains . Magainin 2 was completely inactive as a therapeutic agent when it was administered alone (2 mg per mouse) but significantly increased the survival of mice when it was administered with a low level of cefepime.

Eur J Clin Microbiol Infect Dis, 1991 Jun, 10(6), 509 - 11
Peritonitis with CDC group IVc-2 bacteria in a patient on continuous ambulatory peritoneal dialysis; Zapardiel J et al.; A case of CDC group IVc-2 peritonitis in a patient on continuous ambulatory peritoneal dialysis (CAPD) is described . To the authors' knowledge, this is the first case reported of CAPD peritonitis in which a member of this unusual group of bacteria was isolated as the sole microorganism . As this microorganism is usually resistant to most antibiotics commonly used to treat peritonitis in patients on CAPD, microbiological investigations with identification and antimicrobial susceptibility tests are mandatory.

Biometrics, 1991 Jun, 47(2), 361 - 72
The 2 x 2 matched-pairs trial: exact unconditional design and analysis; Suissa S et al.; An exact unconditional method for the design and analysis of the 2 x 2 matched-pairs trial is presented . Unlike the exact conditional method, which is based on only the number of discordant pairs, the exact unconditional method uses the total number N of sampled pairs . This unconditional test, based on a simple Z statistic, yields sample sizes that are generally smaller than those produced by the exact conditional test for the cases tabulated herein, namely one-sided alpha = .01, .025, and .05 along with 80% and 90% power . Moreover, it is found to be uniformly more powerful than the latter for all the combinations of parameters considered in this paper, namely alpha = .01, .025, and .05, and N = 10(1)200 . The method is illustrated by assessing various design options of an in vitro study of the effectiveness of antimicrobial agents . Some numerical examples of matching efficiency are also given.

Nihon Kyobu Shikkan Gakkai Zasshi, 1991 Jun, 29(6), 698 - 702
{A clinical study of twelve cases of drug-induced pneumonitis}; Suzuki K et al.; Twelve cases of drug-induced pneumonitis were clinically investigated . Treatment of antimicrobial agents in 8 cases of drug-induced pneumonitis ranged from 7-21 days (mean 12 days) and that of other drugs in 4 cases from 18-150 days (mean 70 days) . The patients developed fever and dyspnea at a high rate of frequency . Abnormal laboratory findings included increased IgE (44%), eosinophilia (36%), and increased GOT and GPT in 33% . Chest X-ray films revealed a large reticulo-nodular or ground glass shadows in both lung fields . The results of lymphocyte stimulation tests were positive in 5 of 11 cases (45%) . Eight cases demonstrated a rapid improvement by discontinuation of the drug and corticosteroid was administered in 4 cases . The drug received by the patient and their known risk of pulmonary toxicity should be kept in mind in order to reach a diagnosis of drug-induced pneumonitis and grasp the clinical picture of this disease . A provocation test is potentially dangerous, therefore it should not be carried out lightly.

Jpn J Antibiot, 1991 Jun, 44(6), 614 - 24
{Clinical study on fleroxacin in surgical infections}; Yura J et al.; We conducted clinical studies on fleroxacin (FLRX), a new pyridone carboxylic acid derivative, for the treatment of periproctal abscess, secondary infections (due to wounds, burns or surgical operations), mastitis or areolitis and others with once daily dose of 200 mg or 300 mg . We obtained the following results . Clinical efficacy was evaluated in total 27 cases including periproctal abscess 11, secondary infection 8, mastitis or areolitis 6, phlegmon 1 and infected atheroma 1 . Clinical efficacies were rated as excellent in 14, good in 9, fair in 4 cases . The overall efficacy rate was 85.2% . Bacteriological studies identified 14 strains of aerobic Gram-positive organisms, 12 of aerobic Gram-negative organisms and 6 of anaerobic organisms . The overall bacteriological efficacies were: eradicated in 26 strains, unchanged 2 and unidentified 4, hence the eradication rate was 92.9% . As for side effects, anorexia and nausea were observed in one of the 27 cases . In clinical laboratory tests, slight elevations of GPT and BUN were observed in 1 case each . We consider FLRX to be a useful antimicrobial agent at once daily dose for surgical infections.

Curr Eye Res, 1991 Jun, 10(6), 557 - 63
Topical fluoroquinolones: antimicrobial activity and in vitro corneal epithelial toxicity; Cutarelli PE et al.; To assess the potential of fluoroquinolones as topical antimicrobial agents, we evaluated in vitro the antimicrobial activity of five fluoroquinolones (ciprofloxacin, norfloxacin, ofloxacin, pefloxacin, and temafloxacin), as well as gentamicin, tobramycin, and cefazolin against 96 isolates of common bacterial corneal pathogens . Ciprofloxacin and temafloxacin were the most active quinolones {minimal inhibitory concentration inhibiting 90% of stains (MIC90) of 1 microgram/ml}, followed by ofloxacin (MIC90 2 micrograms/ml), and norfloxacin and pefloxacin (MIC90s 4 micrograms/ml) . In contrast, gentamicin and tobramycin MIC90s were 32 and 64 micrograms/ml, respectively; cefazolin MIC90 was greater than 2048 micrograms/ml . The corneal epithelial cytotoxicity of the fluoroquinolones also was evaluated utilizing an in vitro assay of 3H-thymidine uptake of rabbit corneal epithelial cell cultures . The least to greatest toxicity of the fluoroquinolones were as follows: ciprofloxacin and temafloxacin less than norfloxacin less than ofloxacin less than pefloxacin . Our study suggests that the fluoroquinolones, especially ciprofloxacin and temafloxacin, possess excellent in vitro activity against common bacterial corneal pathogens and are less toxic to the corneal epithelium than the aminoglycosides.

Jpn J Antibiot, 1991 Jun, 44(6), 635 - 42
{Dose calibration of aztreonam in pediatric patients by means of pharmacokinetic analysis}; Kawasaki H; One of the current pharmacological problems with antibiotics is possible overdose among children of 7 years of age and older, when their dose was calculated on a per kg basis . In order to evaluate the difficulties, a pharmacokinetic analysis of aztreonam (AZT), which is a monocyclic beta-lactam antimicrobial agent, was undertaken in 2 groups consisting of 5 children of ages 1-6 and 5 older children of 7-15 . Data from the younger children were fitted both to one- and two-compartment models while those from the older age group perfectly were fitted to a two-compartment model . Using these fitted curve, a simulation dose study was carried out in order to see if we can find a clue for a better dose calibration for the older group of children . The results suggested that the dose of AZT in per kg basis for the older children can be reduced to 60% levels of the younger, that is, 60 mg/kg for the older in contrast to 100 mg/kg for the younger.

Ophthalmology, 1991 Jun, 98(6), 847 - 53
Use of corticosteroids in combination with antimicrobial drugs in the treatment of infectious corneal disease; Stern GA et al.; The use of corticosteroids in the management of infectious eye disease is controversial . In this study, the authors attempt to analyze the goals and risks of the use of corticosteroids in the treatment of various forms of infectious keratitis with reference to generally recognized principles for the treatment of infectious diseases . Existing clinical and research data are reviewed in this context to make appropriate recommendations for the use of corticosteroids in the treatment of bacterial, fungal, and acanthamoeba keratitis . The authors conclude that corticosteroids are definitely contraindicated in the treatment of fungal keratitis, and relatively contraindicated in the treatment of Acanthamoeba keratitis . Topical corticosteroid therapy may have a role in the treatment of bacterial keratitis if appropriate guidelines are followed.

J Clin Microbiol, 1991 Jun, 29(6), 1249 - 51
Antimicrobial susceptibility testing of veterinary clinical isolates with the Sceptor System; Papp JR et al.; The Sceptor System (Becton Dickinson) was compared with an agar dilution method for antimicrobial susceptibility testing of veterinary clinical isolates . The results indicate that the Sceptor System may be used to test gram-positive and fastidious gram-negative bacteria.

J Clin Microbiol, 1991 Jun, 29(6), 1157 - 61
Characterization of Gardnerella vaginalis and G . vaginalis-like organisms from the reproductive tract of the mare; Salmon SA et al.; Gardnerella vaginalis has been isolated from women with bacterial vaginosis, from the genital tracts of asymptomatic women, and from several other infected body sites in humans . However, until recently, it has not been isolated from any other animal species . Between June 1988 and October 1989, 31 isolates identified as G . vaginalis and 70 isolates identified as G . vaginalis-like organisms have been recovered from the genital tracts of 93 mares from Michigan and Ohio . Identification was based on biochemical reactions, hemolysis on media containing blood from various animal sources, and susceptibility to select antimicrobial agents . This report details the characterization of G . vaginalis and G . vaginalis-like organism isolates obtained from the reproductive tracts of these mares and compares the equine isolates with human isolates.

Am J Hosp Pharm, 1991 Jun, 48(6), 1220 - 7
Use of antimicrobial drugs in adults before and after removal of a restriction policy; Himmelberg CJ et al.; The effects on the quantity and quality of antimicrobial drug use of removing an antimicrobial restriction policy are reported . Monthly totals for the number of courses of antimicrobial therapy and expenditures based on grams used were obtained from pharmacy records on adult inpatients for a portion (July-December 1987) of the restriction policy term and for the six months (July-December 1988) immediately after the policy ended . Data were obtained for nine restricted drugs and for three that were never restricted . Retrospective drug-use reviews were conducted for ceftazidime and imipenem-cilastatin . For the restricted agents, the total number of courses of therapy increased by 158% after the restriction policy was removed, and total expenditures increased by 103% . There were no significant changes in the number of courses of therapy or cost for the unrestricted antimicrobials . In the postrestriction period, ceftazidime and imipenem-cilastatin were used more often in patients who were less critically ill . Inappropriate use of imipenem-cilastatin occurred significantly more often after the restrictions were removed . Other factors potentially affecting the use of antimicrobials, such as patient age and the incidence of nosocomial infections, did not differ substantially between the two periods . The removal of an antimicrobial restriction policy resulted in increased use of and higher expenditures for previously restricted agents, as well as an increase in the inappropriate use of at least one agent.

Semin Respir Infect, 1991 Jun, 6(2), 122 - 8
Sputum antimicrobial levels and clinical outcome in bronchitis; Hitt JA et al.; The role of antimicrobials in the treatment of bronchitis remains controversial . Antimicrobials are rarely indicated in acute bronchitis . Antimicrobials are indicated in a subset of patients with acute exacerbations of chronic bronchitis . The efficacy of an antimicrobial agent in bronchitis can be estimated by the ratio of the sputum concentration of the antimicrobial to its in vitro activity against common respiratory pathogens (S/M90) . These S/M90 rates are presented in tabular form . However, given the lack of solid data to support antimicrobial treatment for most episodes of bronchitis, use of the S/M90 to select antimicrobial therapy remains theoretical rather than of proven clinical benefit.

Semin Respir Infect, 1991 Jun, 6(2), 112 - 21
Antimicrobial penetration into polymorphonuclear leukocytes and alveolar macrophages; Murdoch MB et al.; Infections caused by intracellular organisms often involve the lung and may be implicated in chronic disease . These intracellular bacteria may be protected from otherwise lethal concentrations of extracellular antimicrobials . Knowledge of the intracellular concentration of usual antimicrobials used to treat pneumonia may allow physicians to refine their initial choice of therapy . Lipid-insoluble antimicrobials, such as penicillin, cephalosporins, aminoglycosides, trimethoprim, and imipenem penetrate poorly into cells, if they penetrate at all . Isoniazid, tetracycline, and lincomycin have intermediate intracellular penetration, and chloramphenicol, rifampin, ethambutol, quinolones, and lincosamides, plus macrolides, are avidly concentrated . Nonetheless, to date it has been difficult to correlate intracellular concentrations of antimicrobials with cellular killing or clinical outcome . Information derived from a more standardized approach to the evaluation of antimicrobial agent intracellular penetration will be useful in improving the direct application of in vitro study results to the clinical care of patients with pneumonia.

Arch Pharm (Weinheim), 1991 Jun, 324(6), 379 - 80
Antimicrobial activity of some isoquinoline alkaloids; Abbasoglu U et al.; The isoquinoline alkaloids are of great importance to humanity because of their medicinal value and different structure . During the last ten years, many isoquinoline alkaloids were isolated from Fumaria and Corydalis species growing in Turkey . There have been many researches on the antimicrobial activity of extracts of higher plants, but relatively few pure compounds have been investigated.

Arch Pharm (Weinheim), 1991 Jun, 324(6), 355 - 7
Synthesis of new benzimidazole derivatives as potential antimicrobial agents; Badawey ES et al.; Barbiturates 3 as possible antimicrobial agents were obtained by reacting the N,N'-disubstituted urea 1a or the thiourea analogues 1b,c with the magic malonates 2a,b . On the other hand, reaction of 1a with ethoxycarbonyl isocyanate (4) yielded the substituted s-triazine-2,4,6(1H,3H,5H)-trione 5 . The reaction of 4 with 2-aminomethyl-benzimidazole (6) gave the allophanate 7 which upon treatment with Na2CO3 yielded N-(1H-benzimidazol-2-yl)urea 8.

Boll Chim Farm, 1991 Jun, 130(6), 234 - 8
Evaluation of the interfacial properties of a new potent antimicrobial surfactant C31G; Unlu N et al.; The surface activity of a new potent antimicrobial mixture (C31G) of alkyl betaines and alkyl amine oxides were evaluated in order to determine the relationship between its antimicrobial effectiveness and physical properties . Therefore the surface tension measurements were performed at different temperatures using an interfacial tensiometer . Critical micelle concentrations, interfacial and thermodynamic parameters of C31G were obtained from the surface tension data.

J Hosp Infect, 1991 Jun, 18 Suppl A, 473 - 80
Epidemiology, bacteriology and control of an outbreak of Nocardia asteroides infection on a liver unit; Sahathevan M et al.; An outbreak of Nocardia asteroides infection affecting seven patients is described . Over a 5-week period, five patients with liver disease admitted to a ward developed clinical and laboratory evidence of nocardiosis, and two further cases were diagnosed 3 and 5 months later . Three out of the five patients who received specific antimicrobial therapy responded to treatment; in three patients nocardia infection was considered to have contributed to death . In six out of the seven patients, nocardiosis followed immunosuppression . A common-source outbreak was considered to be responsible for infection in the first five patients . In two patients, presentation of infection 5 and 7 months after the first case may have been due to prolonged colonization or subclinical infection with Nocardia . Biotyping of the seven isolates using a fluorogenic biochemical method identified three distinct strains of N . asteroides . The most probable source of Nocardia was contaminated brick and plaster dust arising from building work in an area adjacent to the ward . However, samples of air, dust and water failed to yield N . asteroides . Infection control measures included ward closure followed by thorough cleaning, and formaldehyde fumigation.

J Hosp Infect, 1991 Jun, 18 Suppl A, 424 - 31
The HELP system and its application to infection control; Burke JP et al.; The HELP system is a comprehensive hospital information system that is linked to an allied financial data base . The clinical data base integrates information from areas such as admitting, pharmacy, radiology, surgery, pathology, nursing, respiratory therapy, and the clinical laboratories, including microbiology . This allows for the creation of an electronic medical record that contains all the clinical and financial data for each patient . The HELP system combines both communication and advice features through the use of data- and time-driven algorithms . We have used the HELP system to automate the surveillance and analysis of hospital-acquired infections and to identify patients at high risk for nosocomial infection . The expert system features have also been used to suggest alternatives for patients receiving inappropriate antimicrobial therapy, to improve the timing of antibiotic prophylaxis in surgery, and to curtail unnecessarily prolonged prophylaxis . Automated hospital information systems such as HELP can facilitate the investigation of a broad range of infection control, quality improvement, and cost-containment issues.

J Hosp Infect, 1991 Jun, 18 Suppl A, 211 - 21
The future contribution of transposition to antimicrobial resistance; Bennett PM et al.; Antibiotic resistance is commonplace in clinical bacterial isolates . Many of the resistance genes are transposon-borne and have the potential for rapid dispersal throughout the bacterial kingdom . Resistance genes are constantly subject to mutation and reassortment . Given appropriate selection pressure, the new resistance determinants can emerge rapidly to pose significant treatment problems . It seems likely that in the future bacterial resistance will continue to be a problem, both with respect to current antibiotics and to new ones and that transposon-borne resistance genes will continue to figure prominently.

J Hosp Infect, 1991 Jun, 18 Suppl B, 57 - 63
The influence of cosmetic additives on the acceptability of alcohol-based hand disinfectants; Rotter ML et al.; A prospective, randomized double-blind study with intra-individual comparison of the results was undertaken with 20 volunteers to assess the influence of cosmetic additives on the acceptability of a mixture of n-propanol (50% v/v) and isopropanol (30% v/v) for hand disinfection . Three to 5 ml of antiseptic was rubbed into the hands until dry 15 times a day, 5 days a week and for 2 weeks per preparation . For self-assessment the parameters 'appearance', 'intactness', 'turgor' and 'sensation' were evaluated weekly by visual analogue; for assessment by a dermatologist the same parameters except 'sensation' were used . Each score was compared before and after treatment . The antimicrobial efficacy of the alcoholic mixture was equivalent to or better than the standard (isopropanol 60% v/v, 1 min) . The frequent application of these antiseptic preparations caused a slight but significant deterioration of the skin condition as judged by both self-assessment and dermatologist; however, this was significantly less when the antiseptic contained cosmetic additives . It is concluded that the addition of suitable emollients can significantly increase the acceptability of alcoholic disinfectants.

J Hosp Infect, 1991 Jun, 18 Suppl B, 13 - 22
Computerized image analysis of full-hand touch plates: a method for quantification of surface bacteria on hands and the effect of antimicrobial agents; Leyden JJ et al.; A method is described for quantification of the bacterial flora on the hand surface . Computer-assisted image analysis of bacterial growth of large full-hand touch plates provides a quantifiable measure of the bacterial flora on the hand surface . Image analysis pixel intensity values showed a significant correlation (P less than 0.0001) with colony forming unit values determined by the glove juice method . Image analysis of impressions from hands treated with various antimicrobial agents in detergent bases showed that 4% chlorhexidine gluconate produces a 96% reduction after a 30 s washing and 98% reduction after a 3 min washing while 7.5% povidone-iodine and 1% triclosan produce a 77% and 70% reduction after 3 min respectively, and 70% isopropanol produces a 98% reduction after a 30 s wash.

Vestn Khir Im I I Grek, 1991 Jun, 146(6), 31 - 2
{The clinico-morphological characteristics of suppurative wound healing depending on the treatment method}; Nuzov BG et al.; Experimental and clinical investigations carried out in treatment of purulent wounds in 63 rabbits and in 80 patients have shown high curative efficiency of the local application of millet oil . It has a pronounced antiinflammatory, antimicrobial effect, stimulates reparative processes in the wounds in combination with a considerable reaction of cells responsible for immune defense.

Clin Biochem, 1991 Jun, 24(3), 241 - 7
Regulation of cytoplasmic pH in phagocytic cell function and dysfunction; Grinstein S et al.; To ensure effective antimicrobial or tumouricidal function, phagocytic cells must maintain their cytoplasmic pH (pHi) at a level conductive to optimal intracellular enzyme activity . The mechanisms by which neutrophils and macrophages regulate their cytoplasmic pH include bicarbonate-independent ion transport systems, most notably the Na+/H+ exchanger, and bicarbonate-dependent ion transport systems, which can be subdivided into the cation-independent and Na(+)-dependent forms of chloride/bicarbonate exchange . In addition, macrophages have been shown to recover from intracellular acid loading by means of an ATP-dependent proton extrusion mechanism, which has the characteristics of a vacuolar-type H+ ATPase . In the microenvironment typically associated with abscesses, the low extracellular pH and the presence of short chain fatty acid by-products of bacterial metabolism tend to induce cytoplasmic acid loading . In this setting, the ability of the various pHi regulatory mechanisms to protect pHi may be overcome, leading to cytoplasmic acidification . Several investigators have shown that cytoplasmic acidification impairs the ability of neutrophils to migrate in response to chemotactic stimuli, and also impairs their ability to generate a respiratory burst, thus inhibiting the release of toxic oxygen radicals . This may result in the inability of phagocytes to effect complete abscess resolution.

Am J Pathol, 1991 Jun, 138(6), 1405 - 11
Pneumonitis associated with coinfection by human herpesvirus 6 and Legionella in an immunocompetent adult; Russler SK et al.; The authors report a case of pneumonitis in a young healthy man caused by coinfection with human herpesvirus 6 (HHV-6) and Legionella pneumophila . The patient's course was complicated by severe respiratory, renal, hepatic, and central nervous system dysfunctions, which were believed to be primarily the results of his Legionella infection . Aggressive antibiotic treatment produced no response, and Legionella remained isolatable from lung tissue throughout several weeks of antimicrobial therapy . Human herpesvirus 6 was isolated from a sample of peripheral blood during the acute stage of the patient's illness, and numerous HHV-6--infected macrophages and lymphocytes were detected by immunohistochemical staining of biopsy-derived lung tissue . Paradoxically treatment of the patient with high-dose corticosteroids resulted in dramatic improvement of his condition, including clearance of the Legionella infection . The demonstration that corticosteroids efficiently inhibit HHV-6 replication in vitro suggests that the virus may have contributed to the patient's pneumonitis by enhancing tissue inflammation, by compromising the function of pulmonary macrophages, and, perhaps, by destroying the patient's CD4+ T lymphocytes . Human herpesvirus 6 may be able to function as a synergistic cofactor in lung infections by Legionella and other pathogens.

Am J Ophthalmol, 1991 May 15, 111(5), 601 - 10
Current practices in the management of ocular toxoplasmosis; Engstrom RE Jr et al.; To determine current practices in the management of ocular toxoplasmosis, 72 of 85 uveitis specialists (85%) in the American Uveitis Society completed a detailed questionnaire . Questions involved the indications for beginning treatment, choice of antiparasitic/antimicrobial agents, and experience with treatment of ocular toxoplasmosis in special situations including pregnancy, neonatal infections, and immunocompromised patients . Most of the respondents treat patients whose visual acuity had decreased to worse than 20/200, lesions located in the peripapillary, perifoveal, or maculopapillary bundle regions, and lesions associated with severe vitreous inflammation . Most would not treat patients who retained visual acuity of 20/20, lesions located in the far peripheral retina, or lesions associated with only trace to mild vitreous inflammation . Treatment of other combinations of factors remains controversial . Eight different antimicrobial drugs are used in various combinations for lesions threatening the macula or optic nerve head . Systemic corticosteroids are used by 59 of 62 respondents (95%) as part of their initial treatment regimen . The most commonly used regimens are pyrimethamine/sulfadiazine/corticosteroids (20 of 62 {32%}) and pyrimethamine/sulfadiazine/clindamycin/corticosteroids (17 of 62 {27%}) . Adjunctive therapies (photocoagulation, cryotherapy, or vitrectomy) have been used by 20 of 60 respondents (33%) . Most alter treatment during pregnancy, in newborn patients, and in patients with the acquired immunodeficiency syndrome.

Blood, 1991 May 15, 77(10), 2109 - 17
Combined therapy with recombinant granulocyte colony-stimulating factor and erythropoietin decreases hematologic toxicity from zidovudine; Miles SA et al.; Twenty-two patients with acquired immunodeficiency syndrome (AIDS) or severe AIDS-related complex and multilineage hematopoietic defects were treated with recombinant granulocyte colony-stimulating factor (G-CSF) and erythropoietin (EPO) in a phase I/II trial . All patients were neutropenic and anemic after withdrawal of all bone marrow-suppressive drugs . Daily, G-CSF was subcutaneously self-administered until an absolute neutrophil count (ANC) greater than 6,000/microL was achieved and maintained for 2 weeks . Subcutaneous EPO was added to the regimen and the dose increased until an increase of 15 g/L of hemoglobin was observed . Groups of patients were administered increasing doses of zidovudine to determine their tolerance . G-CSF and EPO therapy was continued with dose modification to maintain an ANC greater than 1,500/microL and hemoglobin greater than 100 g/L . The dose of zidovudine was not altered . All 22 patients responded to G-CSF with a mean 10-fold increase in neutrophils occurring in less than 2 weeks . Significant increases in CD4 and CD8 cell number, lymphocyte proliferative response, and bone marrow cellularity were seen . EPO therapy increased hemoglobin in all 20 evaluable patients within 8 weeks . Sixteen patients received 1,000 mg and four patients received 1,500 mg of zidovudine per day . The reinstitution of zidovudine resulted in a decline in reticulocytes and hemoglobin and the reappearance of transfusion requirements in eight of the 20 patients, six of whom had the study medications stopped . No patient had the study medications stopped because of neutropenia or thrombocytopenia . Toxicities were mild and did not require dose modifications . Limiting dilution plasma and lymphocyte co-cultures for HIV as well as serum p24 antigen levels did not change significantly during G-CSF or combined G-CSF and EPO therapy . HIV p24 antigen decreased significantly with zidovudine therapy . Opportunistic infections occurred in 14 patients but were successfully treated with myelosuppressive antimicrobial agents, including ganciclovir, without the development of neutropenia . These results suggest that combined therapy with G-CSF and EPO may improve the neutropenia and anemia of AIDS . Combined therapy may allow the resumption of full-dose zidovudine in most patients intolerant of the hematologic effects of zidovudine without apparent alteration of HIV expression or the efficacy of zidovudine.

Biochemistry, 1991 May 14, 30(19), 4671 - 8
Hemolytic and antimicrobial activities of the twenty-four individual omission analogues of melittin; Blondelle SE et al.; Although melittin's hemolytic activity has been extensively studied, the orientation of membrane-bound melittin remains uncertain . We have investigated the effect of individually omitted amino acid residues on melittin's activity and related these results to the existing models of melittin-membrane interaction . The extent of hemolysis of the omission analogues closely followed the four known conformational regions of melittin: omission of any of the residues making up the two alpha-helical regions decreased the hemolytic activity relative to melittin, while omission of any of the residues making up the "hinge" or the C-terminal regions had little or no effect . Our results correlate best with a proposed model in which melittin initially forms "holes" in the membrane, resulting in an initial rapid loss of hemoglobin; the membrane-bound melittin is then internalized into the membrane, resulting in a later slow phase of hemoglobin loss . It was also found that induced structural effects caused by peptide-lipid interactions could be studied by using RP-HPLC, with an excellent correlation found between the retention times of the individual omission analogues and their hemolytic activities.

N Z Med J, 1991 May 8, 104(911), 179 - 81
Pyogenic liver abscesses: a retrospective review of 24 cases; Burt MJ et al.; OBJECTS: to review our experience of pyogenic liver abscess with attention to the value of ultrasound and computerised tomography, and the duration of antimicrobial therapy . METHOD: retrospective review of all pyogenic liver abscesses in Christchurch hospitals between 1972 and 1989 . RESULTS: twenty-four cases were identified . The presentation of these cases was typical of those described in other series . Ultrasound scanning was positive in 69% of cases, and computerised tomography in 94% . Enteric organisms were isolated from blood or abscess cavities in all but two cases . Two patients died soon after admission and three were treated with antimicrobial therapy alone . The remainder underwent either a percutaneous or surgical drainage procedure, and received antimicrobial therapy . The antimicrobial therapy was clearly inappropriate in two patients . Eight patients (67%) with single abscesses received less than 10 days of antimicrobial therapy . Four patients (50%) with multiple abscesses received less than 18 days therapy . No patient relapsed . CONCLUSIONS: ultrasound is a convenient initial imaging technique, but may give false negative results . Computerised tomography should be done promptly if clinical suspicion of a liver abscess persists . Both surgical and percutaneous drainage techniques gave good results in combination with antimicrobial therapy . It is probably unnecessary to give prolonged courses of antimicrobial therapy following drainage of single liver abscess, provided there is rapid resolution . Multiple abscesses, or those which are not drained, may require longer courses of antimicrobial therapy.

Rinsho Byori, 1991 May, 39(5), 474 - 7
{Present status and problems of clinical bacteriology}; Yokota T et al.; This symposium was made to clear the problems of clinical microbiology and discussed on the accurate identification of an etiological agent from a clinical specimen, proper specimen collection, susceptibility testing and the mechanism of antimicrobial resistance of bacteria . Some difficulties arise in the entire process of making use of a clinical microbiology laboratory, ranging from specimen collection to interpretation of results . One of the major limitations in the accurate identification of an etiological agent is imposed by poor communication between clinician and laboratory personnel . A number of problems in the entire process, from specimen collection to the interpretation of results, have remained unresolved . It came to the conclusion that important things are the information required to make a clinical decision, clear guidelines for specimen collection, rapid specimen transport, rapid transmission of the results and the establishment of a dialogue between clinician and microbiologist.

Drug Saf, 1991 May-Jun, 6(3), 171 - 82
Adverse reactions in children . Special considerations in prevention and management; Leary PM; Adverse reactions occur in only 2 to 5% of children for whom drugs are prescribed . Most of those which do occur are mild and transient in nature . Practitioners who treat children should be familiar with the adverse effects of every drug they use and be certain that every drug prescribed is strictly necessary . Antimicrobials and antipyretic/analgesics are the drugs most commonly prescribed for children . Serious adverse reactions such as aplastic anaemia (with chloramphenicol) are fortunately rare . Erythromycin prescribed for intercurrent infection may precipitate signs of toxicity in children receiving carbamazepine or theophylline . Anticonvulsants impair cognitive function and thereby affect school performance . Phenothiazines and metoclopramide prescribed as antiemetics may cause spectacular dystonic posturings, although this adverse reaction is rapidly reversed with intravenous biperiden . The duration of drug therapy in paediatric practice should be limited to the minimum time compatible with full recovery . The management of adverse reactions in childhood hinges on early recognition and prompt withholding of the offending drug . Urgent resuscitation is essential when anaphylactic collapse occurs, but in most instances of adverse reaction symptomatic treatment of discomfort is all that is necessary . It is important that parents of a child who has suffered an adverse reaction be aware of this and know the name of the drug responsible . Practitioners who encounter an unreported adverse reaction have an obligation to notify the appropriate drug monitoring authority.

J Antibiot (Tokyo), 1991 May, 44(5), 479 - 85
Tetrazomine, a new antibiotic produced by an actinomycete strain . Taxonomy, fermentation, isolation and characterization; Suzuki K et al.; A new antibacterial antibiotic tetrazomine was found from the fermentation broth of an actinomycete strain which was isolated from beach sand collected at Chichijima, Ogasawara Islands, Tokyo, Japan . The strain Y-09194L, was identified as Saccharothrix mutabilis subsp . chichijimaensis subsp . nov . The antibiotic exhibited broad antimicrobial activity against Gram-positive and Gram-negative bacteria in vitro . It also exhibited strong cytotoxic activity against P388 leukemia cells and showed antitumor activity against P388 leukemia . The apparent molecular formula of tetrazomine was determined as C24H34N4O5 . It has a rare structure which consists of six rings including piperidine, piperadine, oxazole, and pyrrolidine.

J Antibiot (Tokyo), 1991 May, 44(5), 472 - 8
Kedarcidin, a new chromoprotein antitumor antibiotic . I . Taxonomy of producing organism, fermentation and biological activity; Lam KS et al.; Strain L585-6 (ATCC 53650) is an actinomycete isolated from a soil sample collected in Maharastra State, India . It produces a new chromoprotein antitumor antibiotic, designated kedarcidin . Taxonomic studies demonstrated that strain L585-6 is an unidentified and unknown actinomycete . Kedarcidin shows potent antitumor activity against implanted P388 leukemia (3.3 micrograms/ml/kg) and B16 melanoma (2 micrograms/kg) in mice . Kedarcidin also shows potent antimicrobial activity against Gram-positive bacteria but no activity against Gram-negative bacteria.

Am J Obstet Gynecol, 1991 May, 164(5 Pt 2), 1377 - 80
Patient costs for prophylaxis and treatment of obstetric and gynecologic surgical infections; Stein GE; The use of newer broad-spectrum antimicrobials for prophylaxis and treatment in obstetric and gynecologic surgery can reduce patient morbidity and hospital costs . For prophylaxis, a single dose of a cephalosporin with a long elimination half-life can be as effective as a more prolonged course . Single-dose prophylaxis reduces not only toxicity and cost to the patient but also the likelihood of colonization of the vagina by resistant organisms . Treatment regimens for postoperative pelvic infections should have broad-spectrum coverage against aerobic and anaerobic pathogens to ensure high cure rates and prevent subsequent abscess formation . With the introduction of newer cephalosporins and penicillin combinations that include a beta-lactamase inhibitor, it is now possible to treat these polymicrobial infections effectively with monotherapy . Compared with traditional antibiotic combinations, these drugs can reduce side effects and the costs of drug administration as well as the need for therapeutic monitoring . The use of oral antibiotics to complete a course of treatment can also help decrease the high costs of parenteral antibiotic therapy and hospitalization.

Mutat Res, 1991 May, 248(1), 145 - 53
Induction of chromosomal aberrations and SCE by chloramphenicol; Sbrana I et al.; The induction of chromosomal aberrations and sister-chromatid exchanges (SCE) was studied in human lymphocyte cultures treated with chloramphenicol (CAP), an antimicrobial agent acting by inhibiting protein synthesis . Moreover chromosomal aberrations and sister-chromatid exchanges were studied in bone marrow cells of treated mice and in Chinese hamster cell cultures (V79) respectively . While no aberrations were induced by short treatments in human lymphocytes exposed in G1 and G2 phases, high frequencies of aberrations, exclusively of the chromatid type, were induced when the drug was administered during a whole cell cycle . Aberrant metaphases were detected only at the end and a few hours after the end of treatment; at later times aberrant cells reached control values . Doses producing aberrations only slightly increased SCE both in human lymphocytes and in V79 cells . In mouse bone marrow cells CAP induced a high mitotic delay and few structural aberrations; intrachromosomal vacuoles were observed.

Arch Intern Med, 1991 May, 151(5), 886 - 95
Mechanisms of bacterial resistance to antibiotics; Dever LA et al.; The three fundamental mechanisms of antimicrobial resistance are (1) enzymatic degradation of antibacterial drugs, (2) alteration of bacterial proteins that are antimicrobial targets, and (3) changes in membrane permeability to antibiotics . Antibiotic resistance can be either plasmid mediated or maintained on the bacterial chromosome . The most important mechanism of resistance to the penicillins and cephalosporins is antibiotic hydrolysis mediated by the bacterial enzyme beta-lactamase . The expression of chromosomal beta-lactamase can either be induced or stably depressed by exposure to beta-lactam drugs . Methods to overcome resistance to beta-lactam antibiotics include the development of new antibiotics that are stable to beta-lactamase attack and the coadministration of beta-lactamase inhibitors with beta-lactam drugs . Resistance to methicillin, which is stable to gram-positive beta-lactamase, occurs through the alteration of an antibiotic target protein, penicillin-binding protein 2 . Production of antibiotic-modifying enzymes and synthesis of antibiotic-insensitive bacterial targets are the primary resistance mechanisms for the other classes of antibiotics, including trimethoprim, the sulfonamides, the aminoglycosides, chloramphenicol, and the quinolone drugs . Reduced antibiotic penetration is also a resistance mechanism for several classes of antibiotics, including the beta-lactam drugs, the aminoglycosides, chloramphenicol, and the quinolones.

J Clin Invest, 1991 May, 87(5), 1585 - 93
In vitro killing of oral Capnocytophaga by granule fractions of human neutrophils is associated with cathepsin G activity; Miyasaki KT et al.; The Capnocytophaga are inhabitants of the hypoxic human gingival crevice that are normally prevented by neutrophils from causing periodontal and systemic infection . To identify potential nonoxidative bactericidal mechanisms against Capnocytophaga within human neutrophils, gel filtration chromatography was used to fractionate neutrophil granule extracts . Seven granule fractions, designated A through G, were obtained . The Capnocytophaga were most sensitive to killing by fraction D . Fraction D exhibited substantial bactericidal activity under aerobic and anaerobic conditions . The bactericidal activity associated with ion-exchange subfractions D8-D11, which contained primarily cathepsin G as assessed by enzymatic activity, amino acid composition, and NH2-terminal sequence . Heat-inactivation, diisopropylfluorophosphate, PMSF, and N-benzyloxycarbonylglycylleucylphenylalanyl-chloromethyl ketone inhibited bactericidal activity against Capnocytophaga sputigena but not Escherichia coli . We conclude that (a) human neutrophil cathepsin G is an important antimicrobial system against the Capnocytophaga, (b) the bactericidal activity of cathepsin G against Capnocytophaga is oxygen independent, and (c) an intact enzyme active site is involved in the killing of C . sputigena but not E . coli . We suggest that human neutrophil cathepsin G is an important antimicrobial system against certain oral bacteria and that cathepsin G kills bacteria by two distinct mechanisms.

Arch Pathol Lab Med, 1991 May, 115(5), 464 - 6
In vitro antimicrobial susceptibility testing for the newly identified AIDS-associated Mycoplasma . Mycoplasma fermentans (incognitus strain); Hayes MM et al.; Mycoplasma fermentans (incognitus strain) has recently been recognized as a possible infectious pathogen in humans . This mycoplasma is associated with an acute fatal disease in previously healthy patients who do not have the acquired immunodeficiency syndrome . Many patients with the acquired immunodeficiency syndrome suffer a systemic infection with this microbe . Quantitative assay of antimicrobial susceptibility for M fermentans (incognitus strain) in cultures to representative antibiotics has revealed that the microbe is not sensitive to erythromycin, the most commonly used antibiotic for human mycoplasma infections . The testing shows that M fermentans (incognitus strain) is sensitive in vitro to the antibiotics tetracycline, doxycycline, chloramphenicol, clindamycin, lincomycin, and ciprofloxacin.

J Infect Dis, 1991 May, 163(5), 951 - 8
Vancomycin added to empirical combination antibiotic therapy for fever in granulocytopenic cancer patients . European Organization for Research and Treatment of Cancer (EORTC) International Antimicrobial Therapy Cooperative Group and the National Cancer Institute of Canada-Clinical Trials Group; Isolation and characterization of two antimicrobial agents from mace (Myristica fragrans); Department of Pharmacognosy and Medicinal, College of Pharmacy, King Saud University, Riyadh, Saudi ArabiaThe two antimicrobial resorcinols malabaricone B {1} and malabaricone C {2} were isolated from mace, the dried seed covers of Myristica fragrans . Both compounds exhibited strong antifungal and antibacterial activities . Structure modifications by methylation or reduction resulted in diminished activity.

J Nat Prod, 1991 May-Jun, 54(3), 774 - 84
Biologically active metabolites from Xenorhabdus spp., Part 1 . Dithiolopyrrolone derivatives with antibiotic activity; McInerney BV et al.; Five related antibiotic compounds, named xenorhabdins, were isolated from cultures of Xenorhabdus spp., bacteria symbiotically associated with insect-pathogenic nematodes . Their chemical structures were elucidated by X-ray crystallography, nmr, and mass spectral analyses to be N-acyl derivatives of either 6-amino-4,5-dihydro-5-oxo-1,2-dithiolo {4,3-b} pyrrole (compounds 1-3) or 6-amino-4,5-dihydro-4-methyl-5-oxo-1,2-dithiolo{4,3-b} pyrrole (compounds 4 and 5) . They are previously unreported members of the pyrrothine family of antibiotics . Antimicrobial and insectidical activities were found . These metabolites are specific to phase one Xenorhabdus.

Farmaco, 1991 May, 46(5), 677 - 83
Synthesis and biological evaluation of N-salicyloyl-N-benzyl thiourea and 2,2-dimethyl-4-oxo-6-methoxy benzo-1,3-dioxin; Rashan LJ et al.; The synthesis of N-salicyloyl-N-benzyl-thiourea and 2,2-dimethyl-4-oxo-6-methoxy-benzo-1,3-dioxin are described . They were studied for their antiviral, antiproliferative and antimicrobial activities in vitro . N-salicyloyl-N-benzyl-thiourea exhibited significant activity against Gram-positive bacteria and against influenza viruses types A/Philippine/H3N2, A/Chilli/H1N1 and B/Paraha, as well as against K562 cell proliferation . By contrast, no such activity was demonstrated by 2,2-dimethyl-4-oxo-6-methoxy-benzo-1,3-dioxin.

Farmaco, 1991 May, 46(5), 669 - 76
Synthesis and antimicrobial activity of hydroxy-isophthalaldehyde acid derivatives; Piscopo E et al.; 4-hydroxy-isophthalaldehyde acid (1), its alkyl esters (methyl, ethyl, propyl and butyl) and alkyl ethers (propyl, butyl, pentyl and esyl), as well as 6-hydroxy-isophthalaldehyde acid (2) ita alkyl esters (methyl and ethyl), 4-hydroxy-5-iodo-isophthalaldehyde acid (3) and its methyl ester were synthesized and characterized . Antimicrobial and antifungal activity was tested and the LD50 of the most active compound 4 was determined.

Antibiot Khimioter, 1991 May, 36(5), 12 - 4
{Quantitative relationships of structure and antimicrobial activity in azole-containing chemotherapeutics}; Prodanchuk NG et al.; Several novel azole-containing compounds belonging to condensed heterocycles were studied in vitro within the program of screening antimicrobial substances . Changes in the activity of the compounds against 8 representatives of the microbial genera dependent on the chemical structure were followed up . The changes in the structure referred to the radicals at positions 1 and 3.

J Ethnopharmacol, 1991 May-Jun, 33(1-2), 51 - 5
Isolation and identification of the antibacterial compounds from Helichrysum stoechas; Rios JL et al.; Fractionation of the dicholoromethane extract of the aerial parts of Helichrysum stoechas yielded seven isolates (1-7), which exhibited varying antimicrobial activity against Gram-positive bacteria . Pure compounds 1-3 have been previously reported in the same species and 4 and 5 were identified as italipyrone and plicatipyrone, previously isolated from H . italicum and H . plicatum . The two other isolates are helipyrone (6) and homoarenol (7) mixed with related substances . Compound 6c (4,4'-dihydroxy-5,6,5',6'-tetramethyl-3,3'-methylen-di-pyr-2-one) and 6b helipyrone with one methyl substitution, have not been previously reported in other species.

Pathol Biol (Paris), 1991 May, 39(5), 539 - 42
{Determination of antibacterial activity of antiseptic biotextiles in vitro after standard washings}; Lehmann B et al.; A method in vitro is developed for evaluating antibacterial activity of antiseptic "biotextiles" . The latter are particular in that they possess remanent antimicrobial properties, given their ability to carry antiseptic molecules . The method has to detect and measure a potential activity, but also point out it's stability . The biotextile and an appropriated control were repeatedly washed, put in contact with reference bacterial strains and subsequently incubated . The survival bacteria are then plated and counted by method of successive dilution . Compared with the controls, all the washed biotextiles presented a significant activity.

Chin Med J (Engl), 1991 May, 104(5), 402 - 8
Survey on use of antimicrobial agents and bacterial resistance in Huashan Hospital; Tung HH et al.; A cross-section study was carried out to assess the general patterns in use of antimicrobial agents and the trends of bacterial resistance in Huashan Hospital . Of 2,400 patients whose charts were reviewed, 61% were given such drugs . 3,596 antibiotic courses were prescribed . Gentamicin was most frequently used . Results of the susceptibility test of 320 bacterial strains showed a high percentage of resistance against gentamicin, ampicillin, and chloramphenicol . Our findings suggest that antibiotic policies in the hospital need reappraising.

Rev Infect Dis, 1991 May-Jun, 13 Suppl 6, S486 - 91
Nutritional effects on response of children in developing countries to respiratory tract pathogens: implications for vaccine development; Keusch GT; Malnutrition and respiratory disease commonly occur together, and the immunologic defects caused by malnutrition may affect clinical responses and the impact of vaccines . These defects include impaired maturation and function of T lymphocytes, diminished secretory immune responses, poor humoral antibody responses to polysaccharide antigens, deficient complement activity (especially the alternative pathway), and impaired antimicrobial mechanisms by phagocytic cells . In addition, protein-energy malnutrition often leads to very high serum levels of IgE as a result of altered T cell regulation of IgE production and may contribute to IgE-mediated pathologic responses to respiratory syncytial virus or parainfluenza virus infection . Correction of these deficits may improve host response to infection and enhance vaccine-related protection . Both vitamin A and iron deficiency states have been epidemiologically associated with increased morbidity due to respiratory infection . The impact of preventive therapy with either vitamin A or iron is still uncertain, but such therapy has the potential for diminishing the incidence of respiratory infections and their consequences.

J Infect Dis, 1991 May, 163(5), 1145 - 8
Immune cell activation in melioidosis: increased serum levels of interferon-gamma and soluble interleukin-2 receptors without change in soluble CD8 protein; Brown AE et al.; To evaluate immune cell activation in patients with melioidosis, serum samples were assayed for interferon-gamma (IFN-gamma), soluble interleukin-2 receptors (sIL-2R), and soluble CD8 protein (sCD8) . Forty patients with sepsis (23 fatal cases, 17 survivors) and 13 with localized disease were studied during acute illness; 12 additional patients were studied after discharge while on maintenance antimicrobial therapy . Serum concentrations of IFN-gamma and sIL-2R were greatly elevated, but sCD8 concentrations were not . These levels increased with disease severity and were associated with fatal outcomes . Macrophage activation by high concentrations of the cytokine IFN-gamma may contribute to pathophysiology and death in septicemic patients . Both IFN-gamma and sIL-2R seem to be predictive of outcome in patients with severe melioidosis and may prove useful in detection of relapse.

Infect Immun, 1991 May, 59(5), 1633 - 8
Gamma interferon suppresses acute and chronic Trypanosoma cruzi infection in cyclosporin-treated mice; McCabe R et al.; To determine if exogenous gamma interferon is effective in immunosuppressed mice infected with Trypanosoma cruzi, recombinant murine gamma interferon was administered to cyclosporin-treated mice with either acute or chronic T . cruzi infection . Gamma interferon significantly decreased parasitemia and prevented death in acutely infected mice . Parasitemias and mortality of mice treated with both gamma interferon and cyclosporin were similar to those of immunocompetent controls . In chronically infected mice, cyclosporin treatment produced significantly more organ explant cultures positive for T . cruzi . Fewer positive cultures, particularly for spleen and heart, were obtained from cyclosporin-treated mice when they also received gamma interferon . Ketoconazole treatment of mice resulted in no positive cultures . Cyclosporin treatment did not prevent activation of peritoneal macrophages by parenteral gamma interferon, nor did it have a consistent effect on serum titers of alpha/beta or gamma interferon in response to a second challenge inoculum of T . cruzi . These data indicate that exogenous gamma interferon suppresses acute and chronic T . cruzi infection in cyclosporin-treated mice but that gamma interferon is not as effective as the relatively specific antimicrobial ketoconazole . Gamma interferon activates macrophages despite cyclosporin treatment, and its effects appear to be tissue specific.

Pathol Biol (Paris), 1991 May, 39(5), 451 - 4
{Importance of the antimicrobial mode of action of antibiotics for their combined effect with glycine in subinhibitory concentrations on microbial growth}; Gillissen G et al.; Following previous observations of an increase in microbial sensitivity to the bactericidal beta-lactams ampicillin and imipenem in the presence of glycine, the aim of the presented study was to examine if such an effect is due to the antimicrobial mode of action of an antibiotic and/or to its bactericidal or bacteriostatic capacity . Using growth curves as an experimental parameter the same synergistic glycine effect could be shown if tested concomitantly with a number of other antibiotics acting equally on bacterial cell wall formation as cefaclor, cefadroxil, or fosfomycin . This glycine effect is, therefore, associated with the antibiotic mode of action, but is independent of wether the antibiotics are beta-lactams or not (fosfomycin) . In contrast, glycine had no particular effect in combination with antibiotics inhibiting protein synthesis (sisomicin, kanamycin, chloramphenicol, oxy-tetracycline) or nucleic acid polymerase activity (ciprofloxacin, cinoxacin; rifampicin being a certain exception) as well as with those acting on cytoplasmic and external membrane as polymyxin B . The synergistic effect of glycine and cell wall active antibiotics was interpreted predominantly by an action on carboxypeptidases.

Jpn J Antibiot, 1991 May, 44(5), 506 - 14
{Clinical studies on ciprofloxacin in chronic respiratory tract infection}; Yoshida M et al.; Ciprofloxacin (CPFX), a new pyridone carboxylic acid, was administered orally to the patients with chronic respiratory tract infection and its clinical efficacy and safety were studied in a multicenter open trial . The results and summarized as follows . 1 . The efficacy rate for the patients with acute exacerbation as 52.5% (21/40) in 2 week-treatment, and 75.0% (24/32) in 4 week-treatment . 2 . The efficacy rate for the patients with chronic phase was 23.1% (6/26) in 2 week-treatment, and 26.9% (7/26) in 4 week-treatment, but acute exacerbation was not observed in any of the patients . 3 . CPFX was administered to 6 patients over 60 days for the prophylaxis of acute exacerbation . Only 2 patients had acute exacerbation in 2 and 3 months after the start of the therapy, respectively . 4 . Bacteriological eradication rate was high except P . aeruginosa, for which the eradication rate was about 20% . 5 . Side effects were observed in 3 patients, and abnormal findings of laboratory tests were observed in 5 patients, though they were not severe . These results show that CPFX is a useful antimicrobial agent for the treatment of chronic respiratory tract infections.

J Pharm Sci, 1991 May, 80(5), 441 - 4
Relation between structure and antimicrobial activity of 2-(N,N,N-trialkylammonio)alkyl hydrogen phosphates; Tsubone K et al.; A series of phosphobetaines {2-(N,N,N-trialkylammonio)alkyl hydrogen phosphates}, having different alkyl chains and a methylene bridge separating the phosphate and ammonio group, was investigated in order to provide a new antimicrobial agent . Maximal activity was obtained with the compound having a hexadecyl group as a long-chained alkyl group, two methyl groups as short-chained alkyl groups, and a dimethylene bridge as an intercharge distance . In contrast, sodium 2-(N-hexadecyl-N-methylamino)ethyl hydrogen phosphate, 2-(N-hexadecyl-N,N-dimethylammonio)-1-hydroxyethyl iodide, and N-octadecyl-N,N-dimethylammonio acetate showed decreased activity, indicating that the presence of a phosphobetaine moiety was essential for activity . Thus, 2-(N-hexadecyl-N,N-dimethylammonio)ethyl hydrogen phosphate has been found to possess strong antimicrobial activity and a broad antimicrobial spectrum against nine kinds of bacteria (e.g., fungi, yeast, gram-negative and gram-positive bacteria), which are comparable with those of chlorhexidine digluconate.

Dtsch Tierarztl Wochenschr, 1991 May, 98(5), 167 - 70
{The "protective acid coat" of the skin of our domestic animals}; Meyer W et al.; The study reviews and discusses functional aspects of the so-called "acid mantle" of the integumentum commune of domesticated mammals and birds . The problems referred to are closely related to the skin surface-pH and different factors influencing this phenomenon (chemical composition of the skin surface film, secretory activity of apocrine tubular glands, structure of the microflora, lack of skin glands in birds) . It becomes evident, that an "acid mantle" of the skin of domesticated animals cannot be verified, and that normal skin-pH (medium values weakly acid to alkaline) exerts no microbicidal effects . Integumental antimicrobial properties may rather be connected with free fatty acids as decomposition products of skin lipids.

J Antimicrob Chemother, 1991 May, 27 Suppl C, 129 - 39
Empirical antimicrobial therapy with a single daily dose of ceftriaxone plus amikacin in febrile granulocytopenic patients: a pilot study; Meunier F et al.; The optimal management of fever in granulocytopenic patients remains controversial . This pilot study investigated the potential value of single daily doses of amikacin administered empirically with ceftriaxone in febrile granulocytopenic patients . None of the patients died as a result of infection or toxicity from the prescribed regimen . Serum concentrations failed to show drug accumulation . Modifications of empirical antimicrobial therapy were made at a similar rate to other conventional regimens . Vancomycin seemed to increase the incidence of nephrotoxicity . Overall, this pilot study suggests that empirical therapy with single daily doses of amikacin plus ceftriaxone is safe and effective and should be further investigated in a larger number of patients.

Antimicrob Agents Chemother, 1991 May, 35(5), 995 - 7
In vitro susceptibilities of clinical isolates of cysteine-requiring Escherichia coli to 12 antimicrobial agents; McIver CJ et al.; The MICs of 12 antimicrobial agents for 42 cysteine-requiring strains of Escherichia coli showed a high concordance when determined on three different media, one of which was supplemented with cysteine . Differences in the MICs of several agents were detected between 18 prototrophic revertants and their parent auxotrophs . A total of 64.7% of the isolates were fully susceptible to all agents, and no particular resistance pattern was evident.

Antimicrob Agents Chemother, 1991 May, 35(5), 873 - 8
Prospective randomized evaluation of ciprofloxacin versus piperacillin plus amikacin for empiric antibiotic therapy of febrile granulocytopenic cancer patients with lymphomas and solid tumors . The European Organization for Research on Treatment of Cancer International Antimicrobial Therapy Cooperative Group; Meunier F et al.; Empiric therapy for febrile granulocytopenic patients is mandatory, but whether monotherapy is a safe alternative and whether fluoroquinolones are useful agents for this indication are still controversial issues . The use of monotherapy with intravenous ciprofloxacin (200 to 300 mg every 12 h) was evaluated against combined therapy with piperacillin plus amikacin in febrile granulocytopenic patients with solid tumor or lymphoma . The study was discontinued prematurely because patients treated with ciprofloxacin had a significantly lower overall success rate than patients treated with piperacillin plus amikacin (31 of 48 patients {65%} versus 48 of 53 patients {91%}, P = 0.002) . Patients with gram-positive coccal bacteremia had a particularly poor outcome: therapy failed for six of eight patients (75%) treated with ciprofloxacin, while therapy failed for none of four patients treated with piperacillin plus amikacin . Death from primary infection during initially randomized protocol therapy occurred in 7 of 48 patients (14.5%) treated with ciprofloxacin and in 3 of 53 (6%) treated with piperacillin plus amikacin . This study does not support the use of this dose of intravenous ciprofloxacin as empiric monotherapy for fever in granulocytopenic patients.

Antimicrob Agents Chemother, 1991 May, 35(5), 869 - 72
Bactericidal effect of amoxicillin on Helicobacter pylori in an in vitro model using epithelial cells; Megraud F et al.; The treatment of Helicobacter pylori with antimicrobial agents has largely been ineffective, and susceptibility results are in disagreement with those obtained by standard in vitro testing . The bactericidal effect of amoxicillin was tested in an in vitro model by using sessile bacteria attached to HEp-2 cells; this bactericidal effect was compared with that against planktonic bacteria . Viable cell counts were performed by standard procedures after 1, 6, and 24 h of contact with the antibiotic at different concentrations . A bactericidal effect (99.9% killing) was observed against sessile bacteria after 24 h with concentrations of only 10, 1, and 0.1 mg/liter, while against planktonic bacteria it was also noted at concentrations of 0.01 and 0.001 mg/liter, and the effect was observed after 6 h with the three highest concentrations . When the results for five strains were studied by analysis of variance at 6 and 24 h, the main variable was the antibiotic concentration, followed by the culture conditions, e.g., planktonic or sessile bacteria, the strain tested, and the time of contact . A decreased pH of 5.4 did not affect the action of amoxicillin . The bactericidal effect of the combination of amoxicillin and metronidazole was additive against sessile H . pylori.

Arch Surg, 1991 May, 126(5), 603 - 8
Effects of topical antimicrobial agents on the human neutrophil respiratory burst; Hansbrough JF et al.; The neutrophil oxidative burst plays an important role in killing intracellular microorganisms . We studied the effects of topical antimicrobial agents on the N-formyl-L-methionyl-L-leucyl-L-phenylalanine-stimulated oxidative burst of human peripheral blood neutrophils, using a flow cytometric assay . Mafenide acetate, sulfadiazine silver, gentamicin sulfate, neomycin sulfate-polymyxin B sulfate (Neosporin GU irrigant), acetic acid, amphotericin B, and povidone-iodine inhibited the neutrophil oxidative burst at or below clinical concentrations, while 0.25% modified diluted sodium hypochlorite (Dakin's) solution caused cell death . Bacitracin-polymyxin B sulfate (Polysporin) greatly augmented the respiratory burst; this effect was due to the bacitracin component . Diluted gentamicin and acetic acid also augmented intracellular hydrogen peroxide production, but to a lesser extent than Polysporin . Inhibition of the respiratory burst of neutrophils might be considered when these agents are used for topical wound care, although clinical correlates of these effects have not been determined.

Infection, 1991 May-Jun, 19(3), 195 - 200
Treatment of severe sepsis in bone marrow transplant recipients with teicoplanin in combination with beta-lactams and aminoglycosides; Fauser AA et al.; We evaluated teicoplanin for suspected gram-positive infections after inadequate response to initial empiric beta-lactam and aminoglycoside combination therapy . All 20 patients included in this study received either an allogeneic (8 patients) or an autologous (12 patients) bone marrow transplant for acute myeloid leucaemia (AML), non-Hodgkin's-lymphoma (NHL, high grade) or other malignant diseases . All patients developing primary septicaemia of unknown origin (18 patients) or catheter-related septicaemia (2 patients) were treated with 400 mg teicoplanin, administered i.v . once daily in combination with a cephalosporin and an aminoglycoside (ceftazidime 2 g i.v., t.i.d.; netilmicin 400 mg once daily) . All patients responded to therapy, 19 patients were clinically cured and one patient improved under therapy . The therapeutic regimen was well tolerated; only one adverse drug reaction was observed . We did not observe any delayed take or prolonged neutropenia or thrombocytopenia with this therapeutic regimen when our patients were compared to other bone marrow transplant patients (who did not receive this antimicrobial therapy) . Our results suggest that teicoplanin is a potentially effective and well tolerated antimicrobial agent in bone marrow transplant patients with infections not responding primarily to beta-lactams and aminoglycosides.

Int Endod J, 1991 May, 24(3), 119 - 25
The antimicrobial effect of calcium hydroxide as a short-term intracanal dressing; Sjogren U et al.; The antibacterial effect of calcium hydroxide as a short-term intracanal dressing was clinically evaluated by applying the medicament for 10 minutes or 7 days in root canals of teeth with periapical lesions . The results showed that the 7-day dressing efficiently eliminated bacteria which survived biomechanical instrumentation of the canal, while the 10-minute application was ineffective.

Placenta, 1991 May-Jun, 12(3), 285 - 8
Antibacterial properties of human amniotic membranes; Talmi YP et al.; Amniotic membranes are widely used in a multitude of surgical applications and have been shown to reduce bacterial counts and promote healing in infected wounds . Antibacterial properties of amniotic fluid are well documented and the presence of many potentially antibacterial factors has been demonstrated . No such factors have yet been found in amniotic membranes . We have applied a direct disc-diffusion susceptibility test to try to establish the possible existence of such a factor . Amniotic membranes did not inhibit five bacterial species when tested at 3 X 10(6) and 3 X 10(8) colony forming units/ml . However, complete growth inhibition of all organisms was seen immediately under the amniotic membrane discs . These results support the hypothesis that the antimicrobial effect of amniotic membranes in vitro is due to their close adherence to the wound surface.

Z Naturforsch {C}, 1991 May-Jun, 46(5-6), 442 - 50
Podoscyphic acid, a new inhibitor of avian myeloblastosis virus and Moloney murine leukemia virus reverse transcriptase from a Podoscypha species; Erkel G et al.; A novel enzyme inhibitor of RNA-directed DNA-polymerases of avian myeloblastosis and murine leukemia virus was isolated from fermentations of an tasmanian Podoscypha species . Its structure was elucidated by spectroscopic methods and oxidative degradation as (E)-4,5-dioxo-2-hexadecenoic acid (1) . The enzyme inhibitor, which was named podoscyphic acid, did not inhibit DNA and RNA synthesis in permeabilized L 1210 cells nor did it affect RNA synthesis in isolated nuclei of L 1210 cells . 1 inhibits protein synthesis in whole L 1210 cells and rabbit reticulocyte lysate and shows very weak antimicrobial and cytotoxic properties . The testing of ethyl (E)-4,5-dioxo-2-hexadecenoate (2) and (E)-4-oxo-2-tetradecenoic acid (11) revealed the importance of the free gamma-oxoacrylic acid unit for the biological activities of 1.

Anticancer Res, 1991 May-Jun, 11(3), 1039 - 43
Effects of antimicrobial drugs on the cytotoxicity of epirubicin, bleomycin, estramustine and cisplatin; Bergstrom P et al.; The effect of concomitant treatment with different antibiotics on the cytotoxicity of epirubicin, bleomycin, estramustine and cisplatin was studied in vitro on fibroblasts (V79) and two cancer cell lines (colon cancer HT29 and lung cancer P31) . The cell lines were propagated under standard tissue culture conditions and evaluated as the number of surviving cell clones in comparison to untreated controls . Fifteen commonly used antibiotics were tested and thirteen of these were found to modify the cytotoxic effect in one or several of the combinations tested . One antibiotic agent could affect the toxicity of different cytostatics in opposite directions and there were marked differences between the cell lines tested . Only in one of the situations, the combination of bleomycin and ceftazidim, did the antibiotic cause opposite effects on the toxicity of a cytostatic when comparing fibroblasts and carcinoma cells . A most impressive observation was the pronounced increase in cisplatin-induced cytotoxicity by amphotericin B . In conclusion, the results suggest that antibiotics can interact with the cytotoxicity of antitumoral drugs but that the feature of this interaction is seemingly an erratic phenomenon . Further studies are certainly justified, especially regarding the effects of amphotericin B and its mechanisms in enhancing the cytotoxicity of cisplatin.

Kansenshogaku Zasshi, 1991 Apr, 65(4), 457 - 64
{Study on Chlamydia trachomatis antigen detection by an EIA kit using a monoclonal antibody--comparison with a polyclonal EIA kit in urogenital infections}; Hayashi K et al.; We evaluated the clinical usefulness of a new EIA kit using a monoclonal antibody, IDEIA CHLAMYDIA (IDEIA, Novo Nordisk), for detection of C . trachomatis antigen from the genital tracts of male and female cases . The results were compared with those by Chlamydiazyme (Abbott) . 1 . C . trachomatis antigen detection by the IDEIA and Chlamydiazyme tests before treatment; IDEIA has a significantly higher detection rate (38.0%, 105/276) than Chlamydiazyme (29.8%, 80/276), for C . trachomatis antigen from urethral smears of 276 male patients with urethritis . In 646 female cases, including cervicitis and so on, IDEIA detected C . trachomatis antigen from cervical smears in 14.5% (94/648) of the total, while Chlamydiazyme did so in 11.9% (77/648) . When considering the different results using IDEIA and Chlamydiazyme, approximately 20% of the IDEIA-positive cases were Chlamydiazyme-negative . However, when IDEIA was negative, less than 1% showed Chlamydia-positive . 2 . C . trachomatis antigen detection during and after treatment; We studied the clinical courses of 14 male urethritis and 8 female cervicitis cases who had had positive results with both IDEIA and Chlamydiazyme before treatment . Two of the 14 urethritis cases showed positive results with IDEIA, but not with Chlamydiazyme after either 7 or 14 days treatment by an antimicrobial agent . These two also had symptoms indicating persistent urethritis . One of the 8 female cervicitis cases showed a positive result with IDEIA but not with Chlamydiazyme after 7 days treatment by an antimicrobial agent, and this case also had symptoms indicating persistent cervicitis . Thus, these clinical findings suggest that IDEIA can detect even a small quantity of antigen soon after treatment, but Chlamydiazyme can not . In conclusion, IDEIA has a higher sensitivity than Chlamydiazyme, in the detection of C . trachomatis antigen, suggesting that IDEIA is more useful.

Antimicrob Agents Chemother, 1991 Apr, 35(4), 741 - 6
Killing of nongrowing and adherent Escherichia coli determines drug efficacy in device-related infections; Widmer AF et al.; Antimicrobial therapy of device-related infections often fails, despite the in vitro susceptibility of the infecting strain . Therefore, alternative laboratory-based in vitro tests are required to predict the outcome . Fleroxacin, ciprofloxacin, aztreonam, and co-trimoxazole were tested against Escherichia coli ATCC 25922 in vitro and in the tissue-cage animal model . The importance of early treatment was evaluated by starting the drugs either 30 min before or 4, 12, and 24 h after bacterial challenge . Results were compared with the in vitro drug efficacy against nongrowing and adherent Escherichia coli ATCC 25922 . The alternative in vitro tests correlated highly with the outcome in the tissue-cage animal model . In the prophylaxis group (drug given 30 min before bacterial challenge), co-trimoxazole was less efficacious than the other three drugs (P less than 0.001) . In delayed treatment, ciprofloxacin showed the highest cure rate . It was also more potent than the other drugs against nongrowing and adherent E . coli ATCC 25922 . The efficacies of aztreonan, fleroxacin, and ciprofloxacin dropped significantly (P less than 0.01) when the time interval between bacterial challenge and the start of treatment was delayed to greater than 4 h . These data emphasize (i) the need for proper timing of prophylaxis in patients undergoing implant surgery, and (ii) the possibility of successful treatment of established device-related infections with drugs which kill not only growing but also nongrowing and adherent bacteria.

Pediatr Infect Dis J, 1991 Apr, 10(4), 294 - 8
Concentration of cefuroxime in serum and middle ear effusion after single dose treatment with cefuroxime axetil; Haddad J Jr et al.; Antimicrobial agents play an important role in the treatment of patients with acute otitis media and otitis media with effusion (OME) . The study was undertaken to determine the concentrations of cefuroxime in the blood and middle ear effusions (MEE) of children between 6 and 12 years of age with acute otitis media and chronic OME after a single oral dose administration of cefuroxime axetil, the ester prodrug of cefuroxime . Cefuroxime axetil (250 mg) was administered 2 to 6 hours before either myringotomy for acute otitis media or myringotomy and tube insertion for chronic OME . Blood samples and middle ear aspirates were obtained from 31 children and the samples were analyzed by high performance liquid chromatography . Cefuroxime was recovered in measurable concentrations in all serum samples and in 15 (79%) of the 19 MEE specimens analyzed . No correlation was seen between cefuroxime MEE concentrations and effusion type, bacteriology or serum concentrations . This study shows that cefuroxime does penetrate into MEE when OME is present and that therapeutic concentrations can be achieved in some patients.

Clin Podiatr Med Surg, 1991 Apr, 8(2), 341 - 57
A sensible approach to early postoperative foot infection in the otherwise healthy patient; Krantz JG; Many excellent articles published deal with the very important didactic minutiae of postoperative infection, including discussions about specific antimicrobial therapy, operatory sterility, surgical and aseptic technique, and other similar subjects . Very few discussions deal at great length with the more subjective aspects of the infected wound and its management, which is very much a learned art . Nonetheless, this article has been devoted to primarily three subjects: the patient, the wound, and the surgeon.

Vet Clin North Am Equine Pract, 1991 Apr, 7(1), 53 - 61
Bacterial pneumonia; Traub-Dargatz JL; Bacterial pneumonia in the horse often occurs secondary to viral respiratory infection; however, primary infections can occur . A diagnosis of bacterial pneumonia is made on the basis of history, physical examination, and laboratory and radiographic findings . Treatment consists of appropriate antimicrobial therapy for at least 7 to 10 days; further therapy may be needed in more severe cases . Prevention of bacterial pneumonia includes attempting to prevent viral respiratory infections and appropriate management to prevent stress to the respiratory tract.

Burns, 1991 Apr, 17(2), 155 - 8
The use of Omiderm as an interface for skin grafting; Eldad A et al.; Burn wounds which require skin grafts are often heavily contaminated . Conventional methods of skin grafting demand bulky dressings and immobilization for 3-5 days . During this period, we cannot treat the wound topically, but can only hope that the skin graft will win the battle against infection and survive on the wound . The concept of an interface that has emerged in the past few years allows us to treat the wound topically through a transparent, permeable membrane that covers the skin graft without disturbing it . Omiderm, a hydrophilic polyurethane film that was developed as a burn dressing, has been used as an interface on 10 patients . Skin grafts on problematical areas and heavily contaminated wounds were covered with 1:1.5 non-expanded meshed Omiderm . An external layer of dressing with a topical antimicrobial agent was changed 8-24 h postoperatively and then at regular intervals . About 75 per cent 'take' was achieved, which was better than expected with other dressings under similar conditions.

Int J Oral Maxillofac Surg, 1991 Apr, 20(2), 65 - 8
Mediastinitis from odontogenic infection . Report of three cases and review of the literature; Garatea-Crelgo J et al.; Descending necrotizing mediastinitis secondary to dental infection occurs infrequently . The diagnosis of this condition is difficult and often a surgical approach is delayed due to initial clinical improvement after antimicrobial therapy . An incorrect evaluation of this apparent improvement may result in fatal mediastinitis and septic shock . We report 3 cases of mediastinitis of odontogenic origin . In one patient, a nonproductive cough was the first sign of thoracic involvement . A total of 25 similar cases of mediastinitis from odontogenic infection have been collected from the literature in the last 15 years . Some features have to be emphasized, such as the polymicrobial flora, the higher prevalence in males, and the high mortality rate of approximately 44%.

Mol Gen Genet, 1991 Apr, 226(1-2), 214 - 23
Identification and chromosomal locations of a family of cytochrome P-450 genes for pisatin detoxification in the fungus Nectria haematococca; Miao VP et al.; The ability to detoxify the phytoalexin, pisatin, an antimicrobial compound produced by pea (Pisum sativum L.), is one requirement for pathogenicity of the fungus Nectria haematococca on this plant . Detoxification is mediated by a cytochrome P-450, pisatin demethylase, encoded by any one of six Pda genes, which differ with respect to the inducibility and level of pisatin demethylase activity they confer, and which are associated with different levels of virulence on pea . A previously cloned Pda gene (PdaT9) was used in this study to characterize further the known genes and to identify additional members of the Pda family in this fungus by Southern analysis . DNA from all isolates which demethylate pisatin (Pda+ isolates) hybridized to PdaT9, while only one Pda- isolate possessed DNA homologous to the probe . Hybridization intensity and, in some cases, restriction fragment size, were correlated with enzyme inducibility . XhoI/BamHI restricted DNA from reference strains with a single active Pda allele had only one fragment with homology to PdaT9; no homology attributable to alleles associated with the Pda- phenotype was found . Homology to this probe was also limited to one or two restriction fragments in most of the 31 field isolates examined . Some unusual progeny from laboratory crosses that failed to inherit demethylase activity also lost the single restriction fragment homologous to PdaT9 . At the chromosome level, N . haematococca is highly variable, each isolate having a unique electrophoretic karyotype . In most instances, PdaT9 hybridized to one or two chromosomes containing 1.6-2 million bases of DNA, while many Pda- isolates lacked chromosomes in this size class . The results from this study of the Pda family support the hypothesis that deletion of large amounts of genomic DNA is one mechanism that reduces the frequency of Pda genes in N . haematococca, while simultaneously increasing its karyotypic variation.

Clin Pharm, 1991 Apr, 10(4), 280 - 91
Current and investigational therapies for AIDS-associated Mycobacterium avium complex disease; Rathbun RC et al.; The epidemiology, pathogenesis, clinical manifestations, and treatment of Mycobacterium avium complex (MAC) infection are reviewed . MAC infection is one of the most common infections in AIDS patients . Its pathogenesis is poorly understood, but it is believed to develop by gastrointestinal colonization followed by systemic invasion . The relatively poor response to treatment may be partly accounted for by the tremendous mycobacterial load present by the time patients develop systemic symptoms . Clinically, MAC infection is difficult to differentiate from the signs and symptoms of AIDS or from other opportunistic infections . Signs and symptoms include fever, malaise, anorexia, night sweats, and weight loss; diarrhea and abdominal pain may also be present . There is no established therapy for MAC infection, although combinations of three to five antimicrobial agents are typically used . There has been consistently poor correlation between in vitro results and in vivo outcomes in the treatment of MAC infection . Currently, the role of treatment is mainly to suppress the progression of infection and to relieve symptoms . Recent in vitro studies and animal studies have revealed possible alternative agents and combinations of agents (e.g., macrolide antibiotics, quinolones, amikacin, cytokines) that may influence therapy of MAC infection . No known therapy for MAC has been shown to prolong survival in AIDS patients, possibly because of the high organism load that exists once patients become symptomatic . Research is needed to find improved methods for earlier detection of MAC infection, determine optimal dosage regimens of current antimycobacterial agents, develop better antimycobacterial drug-delivery systems (e.g., liposomes), and discover new antimicrobials with better activity against MAC and methods of immune modulation that will overcome immune system defects.

J Laryngol Otol, 1991 Apr, 105(4), 252 - 6
Biocompatible implantable antimicrobial release for necrotizing external otitis; Ostfeld EJ et al.; The efficacy of a biocompatible, surgically implantable, antimicrobial release system (IARS) as the exclusive antimicrobial therapy of necrotizing external otitis (NEO) was evaluated in six NEO patients . Gentamicin incorporated polymethyl-methacrylate beads were implanted, following surgical debridement and were removed two months later . Post-implantation alleviation of clinical symptoms: pain, periauricular tissue swelling, otorrhoea, eradication of pseudomonal infection (100 per cent) and substantially shortened hospitalization (4-15 days) were the salient results of this therapeutic modality . Three patients recovered . Two patients who died, one of sudden cardiac arrest and the other of paralytic ileus, 15 and 60 days post-operatively while the beads were still implanted, were symptomless . Recurrence was seen in one patient with early bead extrusion . Ipsilateral sensorineural hearing loss (one patient) and external meatal stenosis were the main complications . IARS appears to offer an effective alternative to long-term systemic antibiotic administration for the eradication of NEO-pseudomonal infection in patients who are sensitive, develop resistance, or when quinolone medical treatment has failed or is contra-indicated.

Hematol Oncol Clin North Am, 1991 Apr, 5(2), 195 - 214
Hematologic abnormalities in AIDS; Aboulafia DM et al.; The hematologic manifestations of HIV infection include morphologic abnormalities of peripheral blood and bone marrow changes . Laboratory abnormalities, including measures of coagulation, serum vitamin B12 levels, and positive Coombs's test, are seen with HIV infection and may not carry the same clinical consequence as when noted in non-HIV infected populations . Antibodies to circulating red blood cells, platelets, and granulocytes may represent alterations in autoimmunity or nonspecific HIV-induced B-cell stimulation, but they do not necessarily correlate with development of peripheral blood cytopenias . The advent of commercially available hematopoietic growth factors has allowed greater insight into specific host-virus-drug interactions that may be important in regulating viral growth and expression . Novel clinical approaches using hematopoietins alone or in combination with antimicrobial, antiviral, and antitumor drugs represent exciting developments in the treatment of HIV infection.

Am J Med, 1991 Apr, 90(4), 528 - 9
Acute psychoses associated with the use of ciprofloxacin and trimethoprim-sulfamethoxazole; McCue JD et al.; Although adverse drug reactions are a well-recognized cause of mental status changes in the elderly, antimicrobials are rarely implicated . Three patients with serious organic brain disease developed paranoid psychosis after therapy with trimethoprim-sulfamethoxazole or ciprofloxacin was begun . One of the patients was accidently rechallenged and again developed a psychotic reaction . The acute psychoses did not improve with moderate doses of major tranquilizers but resolved completely with drug discontinuation.

Pediatrics, 1991 Apr, 87(4), 466 - 74
Amoxicillin or myringotomy or both for acute otitis media: results of a randomized clinical trial; Kaleida PH et al.; A total of 536 infants and children with acute otitis media were randomly assigned to one of six consistent year-long regimens involving the treatment of nonsevere episodes with either amoxicillin or placebo, and severe episodes with either amoxicillin, amoxicillin and myringotomy, or, in children aged 2 years or older, placebo and myringotomy . Nonsevere episodes had more favorable outcomes in subjects assigned to treatment with amoxicillin than with placebo, as measured by the proportions that resulted in initial treatment failure (3.9% vs 7.7%, P = .009) and the proportions in which middle-ear effusion was present at 2 and 6 weeks after onset (46.9% vs 62.5%, P less than .001; and 45.9% vs 51.5%, P = .09, respectively) . In subjects whose entry episode was non-severe, those assigned to amoxicillin treatment had less average time with effusion during the succeeding year than those assigned to placebo treatment (36.0% vs 44.4%, P = .004), but recurrence rates of acute otitis media in the two groups were similar . In the 2-year-and-older age group, severe episodes resulted in more initial treatment failures in subjects assigned to receive myringotomy alone than in subjects assigned to receive amoxicillin with, or without, myringotomy (23.5% vs 3.1% vs 4.1%, P = .006) . In the study population as a whole, severe episodes in subjects assigned to receive amoxicillin alone, and amoxicillin with myringotomy, had comparable outcomes . It is concluded that children with acute otitis media should routinely be treated with amoxicillin (or an equivalent antimicrobial drug) . The data provide no support for the routine use of myringotomy either alone or adjunctively.

J Am Geriatr Soc, 1991 Apr, 39(4), 388 - 93
Epidemiology of asymptomatic bacteriuria in elderly women; Abrutyn E et al.; We studied asymptomatic bacteriuria in elderly ambulatory women residents without indwelling catheters in self-contained apartment houses at the Philadelphia Geriatric Center (PGC), in the nursing home at PGC, and in several life-care communities (LCC) . Subjects were studied every 6 months from January 1983 through January 1989, and since enrollment was continuous some participated in more surveys than others . PGC residents were middle class and lived either in a self care apartment house (CL) or nursing home (NH); LCC residents were middle or upper class . Antimicrobial therapy for asymptomatic bacteriuria was not given by the study team . The ages of the 865 women studied averaged 80.3, 82.8, and 83.3 years in LCC, CL, and NH, respectively . On each survey about 11% at LCC, 18% at CL, and 25% at NH sites had positive cultures . Turnover was high . The conversion rate from a negative to a positive culture was 5% at LCC, 11% at CL, and 8% at NH . The reversion rate from a positive to a negative culture was 33% at LCC, 34% at CL and 31% at NH (P greater than 0.05) . Persistent infection with the same organism was uncommon . Infection risk was associated with residence, which was partially explained by a factor evaluating mobility, but was unrelated to age or scores evaluating activities of daily living or mental status . Besides mobility, other more complex factors play a role in the acquisition of infection.

Am Fam Physician, 1991 Apr, 43(4), 1365 - 8
Use of antibiotics during pregnancy; Lynch CM et al.; Pregnancy is occasionally complicated by infections that necessitate antibiotic therapy . When considering therapeutic options for pregnant women, both the physiologic changes of pregnancy and the prenatal effects of the drug must be weighed . Antibiotics should be selected with regard to the trimester of pregnancy . Some antibiotics are safe for use throughout pregnancy, while others are completely contraindicated . Choosing the proper antibiotic requires balancing the seriousness of the infection with the antibiotic's safety and antimicrobial activity.

Infect Immun, 1991 Apr, 59(4), 1368 - 77
Contribution of rabbit leukocyte defensins to the host response in experimental syphilis; Borenstein LA et al.; In the companion paper (L . A . Borenstein, M . E . Selsted, R . I . Lehrer, and J . N . Miller, Infect . Immun . 59:1359-1367, 1991), we report that rabbit alveolar macrophage and neutrophil derived defensins possess antimicrobial activity against Treponema pallidum subsp . pallidum, the etiologic agent of syphilis . In this study, antisera specific for NP-1 and NP-2 (defensins present in certain macrophages and polymorphonuclear leukocytes) and NP-5 (a defensin produced only in neutrophils) were used to detect these peptides by immunoperoxidase staining in testicular lesions from infected rabbits . Profound amounts of cell-free and cell-associated defensins were detected in the tunica albuginea and interstitial spaces during the first 24 h of infection . The presence of defensins was transient and almost undetectable by day 4 . Interstitial defensins were detected again at day 10 and increased through day 16, at which time lesion healing was evident by hematoxylin and eosin staining . The appearance and increase in detectable defensins between days 10 and 16 of infection correlated with a reduction in numbers and disappearance of T . pallidum, as demonstrated by using silver staining . The extent and pattern of immunostaining for NP-1 and NP-2 corresponded with immunostaining for NP-5 and identified neutrophils as the cellular source of the defensins . These findings indicate that defensins may contribute to the control of local T . pallidum infection and suggest a role for acute inflammatory processes in the resolution of early experimental syphilis.

Infect Immun, 1991 Apr, 59(4), 1359 - 67
Antimicrobial activity of rabbit leukocyte defensins against Treponema pallidum subsp . pallidum; Borenstein LA et al.; Defensins, which are peptides with broad antimicrobial activity, are major constituents of rabbit neutrophils and certain macrophages . We tested six rabbit defensins, NP-1, NP-2, NP-3a, NP-3b, NP-4, and NP-5, for activity against Treponema pallidum subsp . pallidum . Mixtures of T . pallidum and defensin in 10% normal rabbit serum (NRS) or heat-inactivated NRS (HI-NRS) were incubated anaerobically for various time periods ranging between 0 and 16 h and then examined by dark-field microscopy for treponemal motility or inoculated intradermally into rabbits to assess treponemal virulence . Immobilization of T . pallidum by NP-1 (400 micrograms/ml) occurred after 4 and 8 h of coincubation in mixtures containing NRS and HI-NRS, respectively . Similarly, neutralization of T . pallidum by NP-1 occurred more rapidly and was complete when incubations were performed in NRS as compared with that in HI-NRS . Endpoint titration confirmed the augmentation of NP-1 antitreponemal activity by heat-labile serum factors; NP-1 showed neutralizing activity at 4 micrograms/ml (about 1 microM) in NRS and at 40 micrograms/ml in HI-NRS . When NP-1 was tested in serum that was deficient in C6, the T . pallidum neutralizing activity of NP-1 was reduced to levels slightly greater than that observed in HI-NRS . NP-1 that had been reduced and alkylated was inactive against T . pallidum . When NP-2, NP-3a, NP-3b, NP-4, and NP-5 were tested at 400 micrograms/ml, all exerted potent treponemicidal activity, manifested by abrogation or delayed development of cutaneous lesions relative to that of controls . These data suggest that defensins may equip certain macrophages and neutrophils to participate in host defense against T . pallidum, that the direct activity of defensins against T . pallidum is enhanced by heat-labile serum factors (presumably complement), and that conformational factors influence the biological activity of the defensin molecule.

Ann Intern Med, 1991 Apr 1, 114(7), 582 - 92
Infections in HIV-infected travelers: risks and prevention; Wilson ME et al.; OBJECTIVE: To review risks for infection and to outline strategies to protect the health of travelers infected with human immunodeficiency virus (HIV) . DATA SOURCES: Original reports and summaries of the geographic distribution and frequency of infections as well as of special risks these infections impose on HIV-infected persons . The recommendations incorporate guidelines published by the Centers for Disease Control (CDC) and the World Health Organization . STUDY SELECTION: Sources containing the most recent, pertinent information . DATA SYNTHESIS: Infections of the gastrointestinal tract are common in all travelers to developing countries and are likely to be more frequent, severe, and difficult to treat in HIV-infected persons . Prominent among the respiratory tract infections that pose special risks to HIV-infected travelers are influenza, measles, and fungal infections with geographically focal distributions . The most common vector-borne infection, malaria, appears to present relatively little, if any, incremental risk to the HIV-infected traveler . Persons with HIV infection respond less vigorously to vaccines and have a higher frequency of adverse reactions to antimicrobial agents . Nevertheless, immunizations and chemoprophylaxis can reduce the risk for many travel-related infections . Additionally, there are protective measures that travelers can take to minimize exposure to pathogens . CONCLUSIONS: By understanding the risks for disease in different destinations, assessing patients' HIV status, counseling patients about travel plans and personal protective measures, appropriately using vaccines and chemoprophylaxis, as well as instituting early treatment of infection, physicians can help HIV-infected patients to preserve their health during travel.

Med Lab Sci, 1991 Apr, 48(2), 114 - 7
Continuous ambulatory peritoneal dialysis: factors influencing recovery of organisms from effluents; Howe PA et al.; In order to establish reasons for a decreased yield of positive culture results from peritoneal dialysates of patients with continuous ambulatory dialysis peritonitis 60 specimens were examined, 47 (78%) of which were positive . A negative result was associated with a delay in processing the specimen and the presence of antimicrobial substances in the dialysate . The application of a method involving dilution of a large volume of effluent in broth did not substantially increase the positive yield.

J Med Assoc Thai, 1991 Apr, 74(4), 224 - 9
Elucidation on acidity and low glucose concentration in parapneumonic effusion; Limthongkul S; Studies were conducted on three consecutive patients with parapneumonic effusions by (a) serial analyses of plasma -pleural fluid glucose, pH, PCO2, and antimicrobial levels, and (b) serial analyses to determine the pH and PCO2 levels of pleural fluids that underwent in vitro incubation, before and after antimicrobial administration . The pleural fluid pharmacokinetics of the three antimicrobials followed a large reservoir model by increasing drug levels gradually, reaching the peak values at about two to seven hours following administration, while serial pleural fluid glucose levels showed a delayed rise or no rise in concentration, respectively . The molecular weights of the three antimicrobials are greater than that of the glucose, thus suggesting that over-utilization of glucose within the pleural cavity is more likely the cause of this situation than the transport defect . In the in vitro incubation study, the serial pleural fluid pH and PCO2 levels before antimicrobial administration progressively decreased, while those following the administration of antimicrobials were stable during the first few hours . The results indicate that, in cases of parapneumonic effusion, the inflamed pleurae and the infectious pleural fluid (empyema) over-utilizes pleural fluid glucose leading to increased fluid acidity.

Baillieres Clin Haematol, 1991 Apr, 4(2), 511 - 43
Infections in the compromised child; Viscoli C et al.; Children receiving chemotherapy for malignant diseases show different patterns of infection depending on their underlying disease and its therapy . Granulocytopenia carries the risk of bacterial infection, and also, if prolonged, of fungal infection . Impairment of cell-mediated immunity predisposes to infections with Pneumocystis carinii and is thought to be responsible for severe primary infections with varicella and measles, as well as the severe cytomegalovirus infections seen after allogeneic bone marrow transplantation . Absence or impairment of splenic function predisposes to overwhelming septicaemia with encapsulated organisms, while defects in the normal mechanical barriers to infection provide routes for bacterial and fungal invasion . Despite the lack of physical signs of a normal inflammatory response, clinical evaluation may be critical to the localization of infection in the immunocompromised child . Blood culture and biopsy remain pivotal investigations in the achievement of a microbiological diagnosis . Empirical treatment with a combination of antibiotics has been shown in comparative studies to be effective in initial management of the febrile neutropenic patient: continuing studies are evaluating the role of monotherapy and of different antibiotic combinations, particularly in the light of changing patterns of bacterial infections . Empirical antifungal therapy has been shown to be necessary for persistent or recurrent fever, particularly as persistent fungal infection may compromise the outcome of continuing cytotoxic therapy . Continuing uncertainties over many aspects of management of the infected immunocompromised child provide scope for clinical trials in parallel with trials evaluating new anticancer regimens . The use of new diagnostic methods, the role of prophylaxis, the most appropriate empirical regimen, the evaluation of new antimicrobial agents, all require careful evaluation for efficacy and safety . Perhaps the greatest dilemma of all is how far results from trials in adults can be extrapolated to paediatric practice.

Antibiot Khimioter, 1991 Apr, 36(4), 15 - 7
{Structure-activity relationship of cephalosporins . III . Effect of sulfur-containing functional groups on the biological activity of cephalosporins--derivatives of 7-aminocephalosporanic acid}; Grabarnik MS et al.; The relationship between the in vitro antimicrobial activity of cephalosporin antibiotics and the presence and space arrangement of sulfur-containing descriptors of the radical at position 7 in the cefem nucleus was studied . It was noted that the sulfur-containing fragments were markedly less frequent in the structures of the known cephalosporins than the nitrogen- and oxygen-containing descriptors . It was concluded that at present information related only to two of the fragments under investigation might be used as characteristics in predicting antimicrobial activity of cephalosporins by the pattern recognition . On the basis of the studies there were defined two principle paths for synthesis of new antibiotics: introduction into the molecule structure of the functional groups providing with high probability improvement of the antimicrobial properties and preparation of compounds containing descriptors whose impact on the biological activity is not known.

Antibiot Khimioter, 1991 Apr, 36(4), 12 - 5
{Structure-activity relationship of cephalosporins . II . Effect of oxygen-containing functional groups on the biological activity od cephalosporins--derivatives of 7-aminocephalosporanic acid}; Grabarnik MS et al.; The statistical analysis of 529 compounds belonging to the group of cephalosporins revealed a significant influence of oxygen-containing descriptors of the radical at position 7 in the cefem nucleus on the biological activity of the compounds . It was concluded that prediction of the antimicrobial properties of the antibiotics by the pattern recognition was possible with using factors reflecting the presence and space arrangement of the following functional groups in the cephalosporin molecules:-OH (phenolic group), C-O-C (ether), C = O (ester, amide) and -O- (in the heterocycle) . The results of the study were compared with the data on the impact of nitrogen-containing descriptors on the biological activity of cephalosporins and practical recommendations for synthesis of new active compounds were proposed.

Am J Med, 1991 Apr, 90(4), 439 - 44
Cost-effectiveness of prospective and continuous parenteral antibiotic control: experience at the Palo Alto Veterans Affairs Medical Center from 1987 to 1989; Coleman RW et al.; PURPOSE: Controlling inappropriate antibiotic usage is a major focus for hospital quality assurance and cost-containment programs . We assessed the impact of strengthening a parenteral antibiotic control policy and instituting continuous infectious disease service (IDS) reviews of the appropriateness of antimicrobial therapy on cost and patient outcomes . PATIENTS AND METHODS: All patients receiving intravenous antibiotics during a 3.5-year period from 1986 to 1989 were included in either the pre- or post-policy study group . Antibiotic costs 16 months before were compared with antibiotic costs 26 months after implementation of a new policy to restrict inappropriate usage of (1) broad-spectrum antibiotics when not necessary, (2) expensive agents when a less costly agent could be used, and (3) an excessive dosage or interval . Patient subgroups treated 4 months before and 4 months after policy implementation were compared further within diagnosis-related group (DRG) assignments using patient demographic, cost, and outcome measures . RESULTS: The average monthly antibiotic costs during the 26-month post-policy period were $7,600 less than during the 16-month pre-policy period (p less than 0.0001), resulting in an average yearly drug cost reduction of $91,200 . The IDS team altered therapy in 611 (34.5%) of 1,769 reviews of antibiotic usage during the 26-month period . The comparisons among similar patient groups by DRG classification revealed the average number of antibiotic doses per study patient admission was decreased 24% (p = 0.005) and drug costs were reduced 32% (p = 0.004) after policy implementation . In two DRG categories (i.e., respiratory infections plus pneumonia), patients in the post-policy group had a 33% decrease in average number of doses (p = 0.05) and 45% decrease in antibiotic costs (p = 0.04) compared with the pre-policy group . Similar trends were observed in most DRG categories . There was an average $70 per admission decrease in drug cost and a reduction of eight antibiotic doses per admission after policy initiation . The overall prevalence of deaths (p = 0.22) and average length of antibiotic therapy (p = 0.29) were less in the post-policy period despite group similarities in patient characteristics and lengths of hospital stay . CONCLUSION: Antibiotic control policies can be developed to ensure quality care and can be designed to select for cost-effective agents . Prospective and continuous monitoring of antibiotic usage by the IDS resulted in a significant and sustained reduction in antibiotic costs without detrimental effect on the length of therapy or deaths.

J Chemother, 1991 Apr, 3(2), 117 - 20
Comparative efficacy of cefotetan and clindamycin plus amikacin as antimicrobial prophylaxis for major head and neck surgery; Venditti M et al.; A total of 41 patients were randomly allocated to receive either cefotetan (total dose, 20 g) or clindamycin (total dose, 12 g) plus amikacin (total dose, 5 g) as perioperative antimicrobial prophylaxis for major head and neck surgery . The two groups were similar in age, male to female ratio, stage of cancer, and the various types of surgery . No patient received radiotherapy or chemotherapy before surgery . The wound infection rate was 4% in the group of patients receiving cefotetan and 0% in the group receiving clindamycin plus amikacin . No major side effects were observed in either group . On the basis of this study a five-day perioperative course with cefotetan may be considered effective antimicrobial prophylaxis in patients undergoing major head and neck oncologic surgery.

Klin Med (Mosk), 1991 Apr, 69(4), 58 - 60
{Use of chlotazol as an immunomodulating agent in chronic bronchitis}; Kleiner AI et al.; A positive immunomodulatory effect was found in chronic bronchitis patients examined immunologically before and after treatment including chlotazol . T- and B-cell immunity recovered, clinical condition of the patients improved . A combination of known antimicrobial and antiinflammatory effects with an uncovered immunomodulatory one made chlotazol a valuable modality in the treatment of chronic bronchitis associated with secondary immune deficiency.

Eur J Clin Microbiol Infect Dis, 1991 Apr, 10(4), 384 - 9
Post-marketing surveillance of quinolones 1988-1990; Davey PG et al.; It has been much easier to obtain original data on adverse drug reactions (ADR) of quinolones from the pharmaceutical industry than it was two years ago . This is to be welcomed and, as anticipated, the new data continue to suggest that the new 4-quinolones have an ADR profile which is very similar to that of other antimicrobials . Visual disturbance is not a prominent feature, in contrast to the ADR profile of nalidixic acid . Better definition of quinolone ADRs requires prospective study, and the results of a newly completed prescription event monitoring study are awaited with interest . The potential use of computerised databases and record linkage is examined, but at present the number of quinolone prescriptions is too small to assess documentation of serious but rare events such as convulsions . Physicians need to be aware of the limitations of current data on suspected ADRs . Further investment in computerised databases is required to satisfy the requirements for attributing causality of an event to a drug.

Eur J Clin Microbiol Infect Dis, 1991 Apr, 10(4), 296 - 303
Use of quinolones for treatment of ear and eye infections; Barza M; Malignant otitis externa is a severe, necrotizing infection of the external auditory canal which is sometimes fatal . The traditional antimicrobial treatment has usually been the combination of an antipseudomonal beta-lactam and an aminoglycoside, given intravenously for 4 to 8 weeks . Over 100 patients have been treated with a fluoroquinolone alone, most commonly ciprofloxacin given by mouth in a dosage of 750 mg b.i.d . for 6 to 12 weeks . About 90% of patients have been cured . Treatment with a quinolone has the advantage over older treatments that it can be given orally and has a low rate of side-effects . The ocular penetration of the fluoroquinolones has been studied in patients with unifected eyes . After the administration of a single dose of ciprofloxacin, pefloxacin, ofloxacin or norfloxacin, penetration into the aqueous humor, expressed as the ratio of the peak concentration in the aqueous humor to that in the serum, is about 20% . The penetration of ciprofloxacin into the vitreous humor, based primarily on the data from one report, is about 20% . The concentrations are likely to be higher after repeated doses or in the inflamed eye . Whether the concentrations achieved will be adequate for therapeutic or prophylactic purposes has not been determined.

Eur J Clin Microbiol Infect Dis, 1991 Apr, 10(4), 267 - 74
Pharmacokinetics of quinolones: newer aspects; Wolfson JS et al.; Differences in pharmacokinetic properties are emerging as important determinants in distinguishing among clinical uses of individual new quinolone antimicrobial agents . Selected data on pharmacokinetics, new pharmacokinetic studies, and pharmacodynamics are reviewed, with reference to norfloxacin, ciprofloxacin, ofloxacin, pefloxacin, enoxacin, fleroxacin, lomefloxacin, and other new quinolones . Considering pharmacokinetics, oral bioavailability is excellent (greater than 95%) for most quinolones . Differences in peak serum concentrations and beta-half-lives of elimination exist, however, and are reflected in up to ten-fold differences in values of the area under the curve of serum concentration versus time for administration of similar drug doses . As suggested by high apparent volumes of distribution and low binding to serum proteins, penetration into many body tissues and fluids is favorable . Considering new findings, orally administered ciprofloxacin has been found to be absorbed primarily in the duodenum and jejunum . Studies also suggest this drug to be cleared by transepithelial elimination into the bowel lumen as well as by the renal route . Oral bioavailability of quinolones has been demonstrated to be in general good in ill as well as healthy subjects but is reduced on co-administration with magnesium- and aluminum-containing acids, sucralfate (which contains aluminum), or ferrous sulfate . Pharmacodynamic parameters, such as the relationship of serum concentrations and drug potency in vitro to clinical response and suppression of bacterial resistance, have been little studied and merit further investigation.

Arch Pharm (Weinheim), 1991 Apr, 324(4), 249 - 53
Synthesis, antimicrobial, inotropic, and chronotropic activities of novel 1,2,4-triazolo{4,3-a}quinolines; Khalil MA et al.; Starting from the 2-quinolylhydrazine 1 the title compounds were prepared according to Schemes 1 and 2 . Some of them show activities described in the title of this paper.

Int Angiol, 1991 Apr-Jun, 10(2), 95 - 9
Management of vascular injuries of the extremities . One hundred and fifteen cases; Kurtoglu M et al.; In between the years 1984-1989, 115 peripheral arterial injuries were admitted to the Emergency Surgical Unit of Istanbul Medical Faculty . Seventy-two patients (62%) had upper extremity and 43 patients (38%) had lower extremity vascular injuries . Twenty-eight of these cases (24%) were due to blunt trauma, angiographic studies were obtained in 26 patients . There were 9.5% mortality and 7% amputation rate . We conclude that arterial injuries deserves early recognition, rapid fixation of osseous injuries, wide debridement, fasciotomy in blunt injuries and proper antimicrobial therapy.

J Dairy Sci, 1991 Apr, 74(4), 1428 - 32
Use of antibiotics in livestock and human health concerns; Gustafson RH; Animal feed additives have for many years constituted the largest and most controversial category of antimicrobial use . The primary concerns addressed have been the generation of antibiotic resistance in animal bacterial and the influence of such resistance on human health . Studies designed to shed light on the controversy generally have yielded information leading to ambiguous conclusions . A 1989 report from the National Academy of Sciences was the latest of a long collection of assessments that have been meant to provide expert guidance to regulatory authorities on this matter . The FDA has been trying for some time to determine whether a regulatory decision on existing products is warranted . After several decades of research directed at this question, most qualified study groups have reported a paucity of appropriate information necessary to judge the reality of a public health risk.

J Clin Periodontol, 1991 Apr, 18(4), 245 - 51
Comparison of the antimicrobial effect of the application of chlorhexidine gel, amine fluoride gel and stannous fluoride gel in debrided periodontal pockets; Oosterwaal PJ et al.; The clinical and microbiological effect of locally-applied chlorhexidine gel 2%, amine fluoride gel 1.25%, stannous fluoride gel 4% or placebo gel in 40 periodontal pockets of 10 patients were studied . The gels were applied 3 x within 10 min . after mechanical debridement of the pockets . The treatment effect on the subgingival microflora was evaluated by microscopic and culture studies of the subgingival plaque samples . In addition, supragingival plaque, bleeding after probing and probing pocket depth were scored . Examination were carried out before and during a period of 36 weeks after treatment . At the start, the cultured microflora consisted mainly of anaerobic Gram-positive bacteria . Following treatment, the clinical parameters were significantly reduced . Concomitantly, the %s of spirochetes, motile rods and non-motile rods decreased significantly . A significant decrease was also found in the total anaerobic count, whereas the facultative counts remained at the same level found before treatment . This suggested that the treatment resulted in a mainly facultative subgingival microflora . The % Gram-negative rods showed a significant reduction after treatment, but returned to base line at week 12 . Statistical analysis of the bacteriological and clinical examinations failed to demonstrate any significant differences between the 4 treatment groups . Thus, in comparison to the placebo gel, subgingival application of chlorhexidine gel 2%, amine fluoride gel 1.25% or stannous fluoride gel 4% did not augment the effect of mechanical debridement on bacteriological and clinical parameters during the experimental period of 36 weeks . However the indicated treatments resulted in a facultative subgingival microflora which is compatible with the host.

Q J Med, 1991 Apr, 79(288), 301 - 6
Rickettsial infection of the central nervous system: the role of prompt antimicrobial therapy; Shaked Y; Rickettsial diseases of man, which are prevalent in all the continents (except Antartica) continue to be a major health problem in tropical and temperate parts of the world . Rickettsioses must be considered in every traveller seeking medical attention soon after returning from endemic areas, since the disease can be associated with significant morbidity . When a definite diagnosis has been made by specific serological tests, prompt antimicrobial therapy is indicated . A tetracycline should be regarded as the drug of choice due to its high efficacy, low toxicity, superior in vitro activity and the possibility of relapse which can follow chloramphenicol therapy.

Rev Clin Esp, 1991 Apr, 188(7), 358 - 61
{Trimethoprim-sulfamethoxazole++ in the treatment of a case of localized Wegener's granulomatosis}; Villegas Fernandez FR et al.; A 50 year old man, affected by a Wegener's granulomatosis limited to lung, is presented . The indirect immunofluorescence test for "Anticytoplasmic Antibodies" (ACPA) was negative and we got the definitive diagnostic by the histological study from thoracotomy and biopsy samples . We started treatment with trimethoprim-sulfamethoxazole and a good evolution with an adequate clinical control, x-ray study and blood test was obtained . Some aspects of the value of the ACPA as diagnostic and activity markers of the disease and also the use of an antimicrobial agent on the treatment of this nosological entity are discussed.

Chir Organi Mov, 1991 Apr-Jun, 76(2), 133 - 43
Antibiotic and antithromboembolic prophylaxis in prosthetic surgery of the knee; Fontanesi G et al.; The prevention of deep sepsis and venous thromboembolism in knee replacement surgery is of great importance for the final success of treatment . General rules of prevention must be followed when using antimicrobial drugs (environment, surgical method, patient selection) . Although it does have some negative aspects (overuse, high costs, development of resistant bacteria) the administration of antibiotics is recommended, but only when it is timely, correct, and carried out for a suitable amount of time . The prevention of thromboembolism is based first on the selection of patients who risk the occurrence of angiology-related diseases, on continuous passive postoperative movement, and, finally, on intentional normovolemic hemodilution, for which the procedures used and the advantages obtained are described.

J Med Chem, 1991 Apr, 34(4), 1297 - 301
Synthesis and properties of some peptide analogues of actinomycin D; Mauger AB et al.; Analogues of actinomycin D (AMD) were synthesized in which amino acid replacements were made at various sites in the peptide moieties . These include (i) replacement of both N-methylvalines by N-methylleucine, (ii) replacement of both sarcosines by N-{2-(methoxycarbonyl)ethyl}glycine, and (iii) replacement of one or both D-valines by D-threonine . The purpose of replacements ii and iii was to ascertain the effect upon biological activity of introducing a new side chain which could be functionalized to allow the attachment of carrier molecules such as antibodies . NMR data indicated that none of the analogues had solution conformations significantly different from that of AMD . Difference spectra with DNA revealed that replacement i enhanced binding while the other analogues bound less strongly to DNA . All the analogues had lower antimicrobial activities than AMD . In contrast, 5,5'-(MeLeu)2AMD displayed in vitro antitumor activity comparable with that of AMD at approximately 100-fold lower concentrations.

Rev Latinoam Microbiol, 1991 Apr-Sep, 33(2-3), 105 - 8
Effects of minimum inhibitory concentrations of three antimicrobials on the growth cell and fimbriation of uropathogenic Escherichia coli; Padilla C et al.; Uropathogenic E . coli 36692 cells synthesize fimbriae during the first half of the exponential growth curve . The presence of the appendices was detected by electron microscopy and it was correlated with a high haemagglutination activity . Norfloxacin, amoxicillin and gentamicin supply 1/4 of their respective MICs, inhibiting the cell growth . Also all these drugs with the same sub MICs alter the haemagglutination titre and inhibit the fimbriation process of the uropathogenic E . coli . Gentamicin showed the highest inhibition of the haemagglutinating activity and fimbriae synthesis.

Curr Opin Biotechnol, 1991 Apr, 2(2), 203 - 10
Natural products of commercial potential as medicines; Yamada H; Recent advances in research on natural products (of both low and high molecular weight) of plant origin and their commercial potential as medicines are discussed . Substances with immunomodulating, antiviral, antimicrobial, antiparasite, antitumor, anti-inflammatory, hypoglycemic, tranquillizer and antifeedant activities are focused on.

Vet Rec, 1991 Mar 30, 128(13), 296 - 300
Efficacy of danofloxacin in the therapy of acute bacterial pneumonia in housed beef cattle; Giles CJ et al.; Danofloxacin, a novel fluoroquinolone antimicrobial drug was evaluated in the treatment of acute bacterial pneumonia in recently housed beef cattle of approximately 300 kg liveweight . The clinical responses of 67 pneumonic cattle treated with danofloxacin were compared with those of 65 cattle treated with oxytetracycline, both treatments being given by intramuscular injection for either three or five days, depending on clinical response . Both treatments resulted in a rapid fall in group mean rectal temperature and improved the clinical condition of the majority of cases . However, in comparison with oxytetracycline, danofloxacin therapy was characterised by significantly fewer treatment days, a higher response rate, significantly better reduction of pyrexia and fewer cattle requiring re-treatment.

FEBS Lett, 1991 Mar 25, 280(2), 287 - 91
Characterization of cDNA clones encoding guinea pig neutrophil cationic peptides; Nagaoka I et al.; cDNA clones encoding antimicrobial guinea pig neutrophil cationic peptides GNCP-1 and GNCP-2 were isolated from a bone marrow cell cDNA library . Analysis of these clones indicated that both GNCPs were produced as precursor proteins comprising 93 amino acid residues, which were composed of signal sequences (N-terminal 19 residues), pro-peptide sequences (43 residues) and mature GNCP sequences (31 residues) . The deduced amino acid sequences showed that there were only two amino acid differences between GNCP-1 and GNCP-2, one in the pro-peptide region and one in the mature peptide region . Interestingly, Northern blot analysis and transcription run-off assay revealed that the expression of GNCP mRNA and the transcription of GNCP gene was observed in bone marrow cells but not in mature neutrophils . These observations suggest that mature neutrophils, despite their abundant content of GNCPs, lose the capacity to synthesize GNCPs.

Med Clin (Barc), 1991 Mar 23, 96(11), 405 - 9
{Infectious complications in bone marrow transplantation}; Gomez Casares MT et al.; BACKGROUND: Initially, the aim of the present study was to evaluate the incidence and implicated organisms in the infections in patients receiving a bone marrow transplants (BMT) . METHODS: 194 febrile episodes (FE) were evaluated in 115 patients having received a BMT between 1980 and 1987 . The analysis was carried out at three different moments: during the period of most marked neutropenia (period I) to the 100th day after BMT (period II) and beyond the 100th day (period III) . RESULTS: The unequivocal confirmation that FE was infective was found in 62% of cases (confirmation was microbiological in 46% and clinical in 16%), while 31% of FE were considered as possible infections and the remaining 7% as doubtful infections . The causative organisms were bacteria (73%), viruses (10%), fungi (8%), and combinations of them (polymicrobial infections) (9%) . Gram negative and Gram positive organisms were more common, respectively, in period I and in periods II and III (p = 0.02) . Bacteremia was the commonest cause of confirmed infection . The overall mortality rate due to infection was 18% . There was a remarkably high mortality from pneumonia (54%) and a low mortality in patients with sepsis (6%) (p less than 0.0001) . The number of FE was lower in patients with autografts than those with allografts (p = 0.08) . 33% of the FE in patients with allografts were coincident with acute or chronic graft-versus-host disease, and in two thirds of them infections was confirmed . CONCLUSIONS: Infection represents a major complication of BMT . The different antimicrobial treatments used in association with bone marrow grafting allowed us to control most FEs . Pneumonia was the most severe infective localization and the leading cause of death . Mortality rate due to sepsis was small.

Biochim Biophys Acta, 1991 Mar 18, 1063(1), 162 - 70
Physicochemical determinants for the interactions of magainins 1 and 2 with acidic lipid bilayers; Matsuzaki K et al.; Permeability enhancement of acidic lipid small unilamellar vesicles (dioleoylphosphatidylglycerol, DOPG; dipalmitoylphosphatidylglycerol, DPPG; bovine brain phosphatidylserine, PS) induced by magainins 1 and 2, basic antimicrobial peptides from Xenopus skin, was investigated at 30 degrees C based on leakage of calcein, an entrapped fluorescent marker . Both the peptide concentration and the lipid concentration dependencies of the leakage rate were analyzed to obtain the binding isotherms of the peptides to the membranes and the 'membrane-perturbing activities' of the membrane-bound peptides . For both peptides, the binding affinity was in the order DOPG greater than DPPG greater than PS, which coincided with the zeta potential order (-54, -39, and -9 mV, respectively) . An increase in salt concentration of the medium reduced binding and leakage . Electrostatic interactions play a crucial role in the binding process . On the other hand, the membrane-perturbing activity is regulated by membrane fluidity: The fluid membranes (DOPG and PS) were leakier . A circular dichroism study suggested that at least 14 positively charged residues in the N-terminal regions can form amphiphilic helices which interact with the membranes . An even stronger binding of magainin 2 can be explained in terms of more positive charges in its N-terminal region . A tentative model for the magainin-lipid interactions is hypothesized.

J Immunol, 1991 Mar 15, 146(6), 1849 - 57
Differential susceptibility of activated macrophage cytotoxic effector reactions to the suppressive effects of transforming growth factor-beta 1; Nelson BJ et al.; We examined the effects of TGF-beta 1 on induction of several activated macrophage antimicrobial activities against the protozoan parasite Leishmania, and on induction of tumoricidal activity against the fibrosarcoma tumor target 1023 . TGF-beta by itself did not affect the viability of either the intracellular or extracellular target in concentrations up to 200 ng/ml . As little as 1 ng/ml TGF-beta, however, suppressed more than 70% of the intracellular killing activity of macrophages treated with lymphokines . In contrast, more than 100 ng/ml TGF-beta was required to suppress intracellular killing by cells activated with an equivalent amount of recombinant IFN-gamma . Addition of TGF-beta for up to 30 min after exposure to activation factors significantly reduced macrophage killing of intracellular parasites . Pretreatment of macrophages with TGF-beta was even more effective: treatment of cells with TGF-beta for 4 h before addition of activation factors abolished all macrophage intracellular killing activity . Regardless of treatment sequence, however, TGF-beta had absolutely no effect, at any concentration tested, on activated macrophage resistance to infection induced by lymphokines or by the cooperative interaction of IFN-gamma and IL-4 . Effects of TGF-beta on tumoricidal activity of activated macrophages was intermediate to that of its effects on intracellular killing or resistance to infection . Lymphokine-induced tumor cytotoxicity was marginally (25%) affected by TGF-beta; 200 ng/ml was able to suppress IFN-gamma-induced tumoricidal activity by 40% . Thus, TGF-beta dramatically suppressed certain activated macrophage cytotoxic effector reactions, but was only partially or not at all effective against others, even when the same activation agent (IFN-gamma) was used . The biochemical target for TGF-beta suppressive activity in these reactions may be the pathway for nitric oxide production from L-arginine, because TGF-beta also inhibited the generation of nitric oxide by cytokine-activated macrophages.

Anticancer Res, 1991 Mar-Apr, 11(2), 993 - 9
Induction of immunopotentiation activity by a protein-bound polysaccharide, PSK (review); Sakagami H et al.; A protein-bound polysaccharide, PSK, extracted from the mycelium of Coriolus versicolor (Fr.) Quel, has been recognized for its host-mediated induction of antitumor and antimicrobial activities in mice . Intravenous administration of PSK, in association with OK-432 (Picibanil), transiently induced endogenous production of a cytotoxic factor (CF) (possibly tumor necrosis factor, TNF) in normal mice . The ability to produce CF depended greatly on both dose and interval between administration of the PSK and OK-432 . Although PSK has been reported to contain several active ingredients, unfractionated PSK has been used in almost all experiments performed so far . We recently reported that, of the four subfractions separated by successive filtration through membrane filters, only the highest molecular weight fraction F4 (MW greater than 200 kD) induced significant antimicrobial activity in mice . PSK stimulated the NBT-reducing activity of mouse peritoneal macrophages and the iodination (incorporation of radioactive iodine into an acid-insoluble fraction) of human peripheral blood polymorphonuclear cells (PMN) . Among the subfractions of PSK, the highest molecular weight fraction F4, and the fraction precipitated at pH 4.0-4.5 (Fr . 4), stimulated macrophage NBT-reducing activity and PMN iodination most . In contrast, natural and chemically modified glucans had little or no stimulating activity . PSK, F4 or Fr . 4 additively or synergistically stimulated TNF-induced cytotoxicity against L-929 cells, differentiation of human myelogenous leukemia cell lines toward monocytes/macrophages, and iodination of human peripheral blood PMN . The active PSK subfractions significantly reduced the down regulation of specific 125I-TNF or 125I-IFN-gamma binding to cellular receptors . These data suggest that (i) immunopotentiation activity of PSK might be ascribed, at least in part, to stimulation of cytokine action and production, and (ii) PSK might have some unique structural features.

Zentralbl Hyg Umweltmed, 1991 Mar, 191(2-3), 277 - 301
{Regulation of the intestinal flora by food}; Gedek BR; The purpose of probiotics is to regulate the bacterial colonisation of the digestive tract . In contrast to antibiotics, with the probiotics it is not a certain metabolic product of bacteria or fungi with a known spectrum of antimicrobial activity which, for example when used as performance enhancers under the conditions permitted according to the EEC guidelines for feed additives, reduce the numbers of bacteria, which appear in the small intestines of domestic animals and compete with the host for nutrients and vitamins, but there it is rather the living micro-organisms themselves which are intended to, to help to improve the performance of domestic animals on the basis of a fundamentally different mechanism of action . Recent findings on the effect of the phenomena of bacterial competition on the processes of an infection, with penetration, adhesion, and multiplication as prerequisites for development of the parasitic mechanism of a pathogen, have shown that by controlling the processes of colonization of the intestines with micro-organisms and also their metabolic activity it is possible to at least reduce the incidence of the diarrhoeal diseases which are responsible for the the greatest economic damage . The numerical displacement of bacterial pathogens is not the only effect of the bacterial competition resulting from the orally administered micro-organisms . The fact that antagonistically acting bacteria or yeasts prevent the pathogenic species from entering the intestinal epithelial cells plays a role here . As a result of which, especially the small intestines are not colonized by pathogens (E . coli and others), the liver is largely relieved of substances accumulating in the course of bacterial protein metabolism, the absorption of fatty acids and other energy-providing compounds is increased, and not readily soluble salts are transformed into soluble compounds . Effects comparable to those obtained with small amounts of antibiotics added to the feed of farm animals as regards increased growth rate and improved feed conversion, can also achieved with the addition of probiotics.

J Med Entomol, 1991 Mar, 28(2), 275 - 9
Nutritional factors and antimicrobials on development of infective larvae of subperiodic Brugia malayi (Nematoda: Filarioidea) in Anopheles quadrimaculatus and Aedes aegypti (Diptera: Culicidae); Nayar JK et al.; The effects of nutritional factors and antimicrobials on the development of infective larvae of subperiodic Brugia malayi in susceptible Anopheles quadrimaculatus Say and Aedes aegypti (L.) were investigated . Larvae of both species of mosquitoes were reared on brewers yeast or a 1:1 brewers yeast-liver powder mixture . After emergence, one-half of the adults from each rearing condition were maintained on a 10% sucrose solution and the other half on a 10% sucrose solution containing 0.1% p-aminobenzoic acid (PABA) . Females of both species of mosquitoes that fed on B . malayi-infected jirds showed a significant increase in the ineffective rate and intensity of infectiveness when the mosquito larvae were reared on the brewers yeast-liver powder diet . The addition of 0.1% PABA to the adult diet increased numbers of infective larvae of B . malayi that developed in Ae . aegypti but not in An . quadrimaculatus . The intensity of infectiveness of B . malayi was significantly greater when An . quadrimaculatus females were provided with a second blood meal from an uninfected jird and when females of both species were maintained on different concentrations of an antimicrobial solution.

J Inorg Biochem, 1991 Mar, 41(4), 299 - 304
Antimicrobial and cytotoxic activity of transition metal chelates with some heterocyclic imines; Sharma RC et al.; Cu(II), Ni(II), Co(II), and Zn(II) chelates with two heterocyclic imines derived from 2-furylglyoxal-2(1)-aminothiophenol (FGATP) and 2-thiophenylglyoxal-anthranilicacid (TGAA) were synthesized . Elemental analysis, molar conductance, magnetic measurements and IR and electronic spectral data were explored to elucidate their probable structures . Different crystal field parameters were also calculated to ascertain the geometry of the resulting chelates . All the ligands and their metal chelates were screened, in vitro, for their antimicrobial activity against two bacteria: S . aureus and E . coli and two fungi, viz: A . niger and C . albicans . The in vitro cytotoxic activity of all the compounds was also assessed.

J Burn Care Rehabil, 1991 Mar-Apr, 12(2), 132 - 5
Preventing postoperative burn wound aspergillosis; Levenson C et al.; Between January 1, 1984, and December 31, 1988, 35 patients at the Los Angeles County + University of Southern California Burn Center had postoperative cultures from their burn wounds that grew Aspergillus species; clinical burn-wound aspergillosis occurred in 66% of these cases and death occurred in 53% of these cases . Beginning in November 1984, several modifications in the air-conditioning system and topical antimicrobial wound therapy were undertaken . Cleaning and 8Cu-quinolinolate treatment of air ducts every 2 months did not reliably clear Aspergillus species from the air in patient care areas . Several changes in topical therapeutic regimen failed to prevent both burn wound culture positivity and clinical aspergillosis . Finally, installation of high-efficiency particulate air filters, installation of new air ducts, and inception of wound irrigation with a solution of mafenide hydrochloride plus nystatin both during and after operation were associated with a reduction in wound culture positivity rate to one occurrence in 1988 (Poisson probability less than 0.01 versus the rate in 1984) and no occurrences during the 18 months after the false ceiling of the burn ward was sealed.

Rev Infect Dis, 1991 Mar-Apr, 13 Suppl 5, S431 - 5
In vitro evaluation of antimicrobial compounds for cysticidal activity against Acanthamoeba; Osato MS et al.; Amebic keratitis presents a therapeutic dilemma because Acanthamoeba, unlike Naegleria, encysts in infected tissues . To date, the results of medical therapy have been disappointing, and the optimal medical regimen for acanthamoeba keratitis is yet to be defined . Clinical cure necessitates eradication of the encysted amebae with medications known to have ocular toxic effects in combination with surgical maneuvers . Antiinfective agents possessing in vitro cysticidal activity include paromomycin, neomycin, ketoconazole, natamycin, and ciclopirox olamine, but no agent has been shown to be uniformly effective against all isolates of Acanthamoeba . Treatment of amebic cysts with propamidine isethionate plus either paromomycin or neomycin has produced slightly additive cysticidal effects . Multiple factors, including the varied clinical presentation and the lack of standardized in vitro techniques for the assay of cysticidal activity, account for the lack of correlation between in vitro activity and in vivo efficacy.

Rev Infect Dis, 1991 Mar-Apr, 13 Suppl 4, S325 - 31
Oral rehydration therapy for invasive diarrhea; Varavithya W et al.; Current guidelines for the management of diarrheal diseases focus on the use of oral rehydration therapy (ORT) . Clinically evident dehydration of a moderate degree is not uncommon with invasive diarrhea, and when it occurs, the response to ORT is satisfactory . Studies from hospitals and the community each document the effectiveness of ORT for rehydration of patients with invasive diarrhea . This has been confirmed in a clinical trial of oral rehydration solution (ORS) for the treatment of diarrheal diseases in children less than 5 years of age . Children with moderate dehydration benefited most from ORS, especially those who had culture-proven invasive diarrhea . Significant early weight gain was observed for this group of patients alone after rehydration with ORS . In developing countries, there is no reason to withhold ORT at the first signs of watery or dysenteric diarrhea regardless of the cause and independent of the decision to treat the patient with antimicrobial agents.

Int J STD AIDS, 1991 Mar-Apr, 2(2), 97 - 101
Analysing the workload from HIV inpatients: a 10-month retrospective study; Lau RK et al.; To assess the clinical and laboratory workload arising from human immunodeficiency virus (HIV)-related inpatient admissions in a London teaching hospital, a 10-month retrospective audit was performed of the casenotes of all HIV-infected inpatients admitted under the care of one consultant physician . During this period, 84 inpatients were identified who generated 371 admissions, of whom 71 (84.5%) had acquired immunodeficiency syndrome (AIDS) . Over two-thirds of admissions were essentially day cases, attributed to blood transfusions, antimicrobial and tumour, chemotherapy, and minor surgery; with blood transfusions alone accounting for 43% of all admissions . Pulmonary infections (pyogenic and cell-mediated opportunist) accounted for 46 (12%) of admissions, with Pneumocystis carinii pneumonia second only to blood transfusions in caseload prevalence score (see below) . Neurological complications of AIDS were associated with the longest admissions . Laboratory-based investigations were heavily utilized by AIDS inpatients, particularly bacteriological services . Choice of radiological investigation correlated with the anatomical site of disease presentation: plain radiology for chest symptoms, ultrasound for abdominal symptoms and computerized tomography (CT scanning) for neurological presentations . Drug-induced anaemia accounted for a substantial number of HIV-related admissions for red cell transfusions, which together with the disproportionate workload from daycase-type admissions, might be better handled in lower dependency day wards.

Rev Infect Dis, 1991 Mar-Apr, 13(2), 211 - 5
Risk factors for candidemia in patients with acute lymphocytic leukemia; Richet HM et al.; Between 1983 and 1987 the overall incidence of candidemia at the Institut Gustave Roussy, a tertiary care referral hospital for patients with cancer, increased from 0.1% (7 of 6,801) to 0.32% (24 of 7,515) (P = .009) . Because acute lymphocytic leukemia (ALL) was the most common underlying disease in patients with candidemia, risk factors for candidemia were analyzed in this subset of patients . A case-control study comparing the eight ALL patients who had candidemia with 18 ALL control patients revealed that previous bacteremia, prolonged neutropenia, prolonged fever, prolonged administration of antimicrobial agents, treatment with multiple antimicrobial agents, and a relatively high concentration of Candida organisms in stool were significant risk factors for candidemia . In a logistic regression analysis, however, only receipt of vancomycin and/or imipenem was identified as an independent risk factor for candidemia . Further analysis showed that administration of vancomycin promoted proliferation of Candida organisms in the gastrointestinal tract and that this proliferation was associated with an increased risk of candidemia.

Nippon Jibiinkoka Gakkai Kaiho, 1991 Mar, 94(3), 351 - 6
{Respiratory tract diseases due to Chlamydia pneumoniae}; Ogawa H et al.; A newly recognized chlamydial species, Chlamydia pneumoniae causes acute respiratory infections including pneumonia, bronchitis and pharyngitis . In this paper, eight cases of bronchitis and tonsillitis associated with C . pneumoniae are presented . Three cases came to the clinic because of persistent cough and productive sputum . C . pneumoniae was isolated from sputum of a patient and cultured in HeLa 229 cells . Other two patients were diagnosed serologically; Antibodies were measured by microimmunofluorescence using formalized elementary bodies of C . pneumoniae . A titer of 512 in the IgG class was detected . Four patients had sore throat . C . pneumoniae was isolated and cultured from tonsillar swabs in all of them . A patient with sore throat and cough diagnosed as pharyngolaryngitis was sero-positive . Antibodies to C . pneumoniae in IgG and IgM class were 128 and 32, respectively . All the patients were treated with macrolide antibiotics (erythromycin and rokitamycin), and clinical symptoms subsided . In five patients from whom the organism was isolated, the agents were eradicated by the treatment . However, clinical courses of those patients revealed that patient takes a long time to recover from the illness, if diagnosis and first choice of antimicrobial agent are not appropriate.

Antimicrob Agents Chemother, 1991 Mar, 35(3), 484 - 9
Pseudomonas pseudomallei, a common pathogen in Thailand that is resistant to the bactericidal effects of many antibiotics; Sookpranee T et al.; The purpose of this investigation was to identify newer antimicrobial agents that may be useful in the therapy of melioidosis . The in vitro susceptibilities of 199 clinical isolates of Pseudomonas pseudomallei to 22 antibiotics were determined by standard disk diffusion, and those to 13 antibiotics were determined by agar dilution . Over 90% of the isolates were susceptible to imipenem, piperacillin-tazobactam, piperacillin, ceftazidime, ticarcillin-clavulanate, ampicillin-sulbactam, and carumonam by both methods . Standard disk diffusion yielded unacceptably high false-susceptibility results with aztreonam, ciprofloxacin, and temafloxacin . Piperacillin, ceftazidime, imipenem, and ciprofloxacin were not bactericidal for three selected P . pseudomallei strains as determined by time-kill curve methods . Furthermore, addition of ciprofloxacin to piperacillin, ceftazidime, or imipenem did not enhance bactericidal activity . One hundred ninety-four strains showed weak beta-lactamase production that did not increase upon incubation with cefoxitin . These findings suggest that several newer antimicrobial agents may prove useful in the treatment of melioidosis . However, results of susceptibility studies involving P . pseudomallei and newer agents must be interpreted with caution.

Ann Pediatr (Paris), 1991 Mar, 38(3), 189 - 92
{Extrinsic allergic alveolitis . Apropos of a severe case}; du Lac P et al.; A case of atypical extrinsic allergic alveolitis in a 13-year-old is reported . Onset was sudden with gradually increasing dyspnea on exertion over a four-day period . The chest film evidenced a reticulonodular syndrome with decreased respiratory movements . The patient's clinical status worsened over the next 48 hours with the development of respiratory distress . Under oxygen therapy (3 l/min), PO2 was 49 mmHg and SO2 was 82% . Dramatic improvement occurred after initiation of corticosteroid and antimicrobial therapy . Etiologic investigations were negative except for the immunofluorescence test with pigeon droppings which showed three precipitation arcs . A CT scan of the chest disclosed diffuse micronodular densities without thickening of connective tissue trabeculae, suggesting alveolar disease . Mediastinal lymph nodes were not enlarged . Vital capacity was 26% of the theoric value . Corticosteroids were given for one month . On follow-up chest films, the reticulomicronodular syndrome was seen to abate, globally at first, then from the apices to the bases of the lungs . However, a repeat CT scan at the 4th month showed that diffuse lesions were still present although the chest film was normal; 8 months after onset, there was only a bulla in the left lung base, with no evidence of fibrosis . Lung function tests slowly returned to normal, as did CT scan findings.

J Clin Microbiol, 1991 Mar, 29(3), 533 - 8
Comparison of the E Test to agar dilution, broth microdilution, and agar diffusion susceptibility testing techniques by using a special challenge set of bacteria; Baker CN et al.; The E Test (AB Biodisk, Solna, Sweden) is a new method for performing antimicrobial susceptibility tests . It consists of an impervious carrier (5- by 50-mm strip) with a predefined antimicrobic gradient which is placed on an inoculated agar plate and processed like a disk diffusion test . Results are generated directly as MICs from a continuous concentration gradient covering 15 twofold dilutions, and MICs are read where the edge of the inhibition zone intersects the strip . We compared the E Test with disk diffusion, broth microdilution, and agar dilution tests by using a challenge set of 195 gram-positive and gram-negative bacteria for 14 antimicrobial agents . Also, disk diffusion, broth microdilution, and agar dilution tests were compared with each other . All test method comparisons gave greater than 94% agreement for the category of susceptibility . The E Test category agreement with disk diffusion and broth microdilution was 95.1%, and with agar dilution it was 95.2% . The E Test results were as reliable as the results obtained by the standard antimicrobial susceptibility testing methods.

J Antimicrob Chemother, 1991 Mar, 27(3), 343 - 53
Inhibition of Legionella pneumophila in guinea pig peritoneal macrophages by new quinolone, macrolide and other antimicrobial agents; Kitsukawa K et al.; The effect of 14 antimicrobial agents, including new quinolones and a new macrolide, on the intracellular multiplication of Legionella pneumophila in cultured guinea pig peritoneal macrophages was examined . Gentamicin and beta-lactam antibiotics did not inhibit the intracellular growth of L . pneumophila . Minocycline, erythromycin and DR-3355 inhibited multiplication at concentrations of 1, 0.5 and 0.1 mg/l respectively . Rifampicin, the new macrolide roxithromycin, and the new quinolones ofloxacin, ciprofloxacin and AT-4140 all inhibited the intracellular growth of L . pneumophila at concentrations of less than 0.03 mg/l . The minimal extracellular concentration inhibiting intracellular multiplication (MIEC), compared with conventional MIC measurements, provides a better indication of antimicrobial efficacy against bacteria, such as L . pneumophila, which can multiply in phagocytes.

In Vitro Cell Dev Biol, 1991 Mar, 27A(3 Pt 1), 239 - 44
In vitro toxicity of various classes of test agents using the neutral red assay on a human three-dimensional physiologic skin model; Triglia D et al.; A new three-dimensional human skin model consisting of several layers of actively dividing and metabolically active human neonatal foreskin-derived fibroblasts and epidermal keratinocytes grown on nylon mesh has been used to assess the in vitro toxicity of test agents from various classes . Utilizing a slight modification of the published neutral red viability assay for endpoint determination, we have assayed and obtained dose-dependent toxicity curves for test agents from the following classes: detergents (n = 15), alcohols (n = 5), metal chlorides (n = 10), perfumes and colognes (n = 5), shampoos (n = 4), conditioners (n = 3), moisturizers (n = 3), pesticides (n = 3), and antimicrobial preservatives (n = 4) . Limited comparisons to in vivo ocular irritancy data with alcohols and detergents are encouraging . We have demonstrated the utility of this metabolically active dermal substrate containing naturally secreted collagen and other extracellular matrix proteins along with the neutral red viability assay for assessing the toxicity of a number of test agents from a variety of different classes with broad industrial applications.

J Hand Surg {Am}, 1991 Mar, 16(2), 311 - 4
Herpetic whitlow with bacterial abscess; Hurst LC et al.; The herpetic whitlow should be treated nonoperatively . However, a difficult therapeutic dilemma occurs when a whitlow is seen with an established bacterial abscess . We report a case of an adult whose first herpetic whitlow was complicated by secondary periungual abscesses that progressed despite intravenous antimicrobial therapy . Surgical drainage of these periungual abscesses was successfully done in conjunction with intravenous acyclovir with no adverse effects.

Am Surg, 1991 Mar, 57(3), 131 - 3
Bilaminate synthetic dressing for partial thickness burns . Lack of cost reduction for inpatient care; Bauman LW et al.; Forty-nine cases of second degree burns initially treated as inpatients from April 1984 through December 1987 are reviewed . Thirty-four patients were treated with bilaminate synthetic dressing (Biobrane) application, while 15 were treated with a topical antimicrobial, usually silver sulfadiazine . The burns ranged from 1 to 25 per cent total body surface area and were comparable in both groups . The mean age in each group was 30 years . Thirty patients were successfully treated with Biobrane, and their average hospital stay was 9.1 +/- 5.4 days compared with 9.2 +/- 8.6 days for the topically treated group . The mean hospital cost for dressings and supplies for the Biobrane group was $360 +/- $90 compared with $310 +/- $190 for the topical group . Four patients (12%) required Biobrane removal during their hospitalization, one due to increasing burn depth and three due to purulent fluid collections beneath the Biobrane . These burns were subsequently treated with topical antimicrobial agents and healed primarily . The mean total hospital stay for this group was 18.0 +/- 11.9 days with the costs being much higher secondary to the initial cost of the Biobrane, the costs associated with topical antibiotic therapy, and extended hospital stay . Although there was a decrease in nursing time and a subjective decrease in patient discomfort associated with using synthetic dressing, no benefit was found in either decreasing hospital stay or total cost of hospitalization and supplies used for inpatients treated at this institution.

J Trauma, 1991 Mar, 31(3), 316 - 25
Treatment of mice with sepsis following irradiation and trauma with antibiotics and synthetic trehalose dicorynomycolate (S-TDCM); Madonna GS et al.; Compromise of antimicrobial defenses by irradiation can result in sepsis and death . Additional trauma can further predispose patients to infection and thus increase mortality . We recently showed that injection of synthetic trehalose dicorynomycolate (S-TDCM) significantly augments resistance to infection and increases survival of mice compromised either by whole-body irradiation with gamma radiation or equal mixtures of fission neutron and gamma radiation . In this study, C3H/HeN mice were given a lethal dose of gamma radiation (8.0 Gy) and an open wound (15% total body surface area {TBSA}) 1 hr later while anesthetized . Irradiated/wounded mice became more severely leukopenic and thrombocytopenic than mice exposed to radiation alone, and died from natural wound infection and sepsis within 7 days . S-TDCM given 1 hr postirradiation increased survival of mice exposed to radiation alone . However, this treatment did not increase survival of the irradiated/wounded mice . Systemic antibiotic therapy with gentamicin or ofloxacin for 10 days significantly increased survival time compared with untreated irradiated/wounded mice (p less than 0.01) . Combination therapy with topical gentamicin cream and systemic oxacillin increased survival from 0% to 100% . Treatment with S-TDCM combined with the suboptimal treatment of topical and systemic gentamicin increased survival compared with antibiotic treatment alone . These studies demonstrate that post-trauma therapy with S-TDCM and antibiotics augments resistance to infection in immunocompromised mice . The data suggest that therapies which combine stimulation of nonspecific host defense mechanisms with antibiotics may increase survival of irradiated patients inflicted with accidental or surgical trauma.

Fertil Steril, 1991 Mar, 55(3), 647 - 9
Studies on the in vitro spermicidal activity of synthetic magainins; Edelstein MC et al.; Two synthetic magainins A and G are shown to have spermicidal activity . Transmission electron microscopic micrographs show that both magainins alter the plasma membranes of sperm and that these actions are rapid . Further studies will better delineate the contraceptive potential of synthetic magaininsPIP: 2 synthetic magainins--A and G-- have been shown, through transmission electron microscopy, to have spermicidal activity . Magainins, a class of peptides isolated from the skin of the African clawed frog . I have been demonstrated to have wide spectrum in vitro antimicrobial activity . In this study, semen sample collected from 7 healthy volunteers were diluted with magainins A and G and then examined for spermiostatic activity . Sperm diluted only with saline were used as a control . Sperm assays indicated the potency of magainin A to be significantly greater than that of magainin G . Magainin A demonstrated spermiostatic activity at concentrations of 0.024-0.095 mg/mL compared to concentrations of 0.095-0.380 mg/mL for magainin G . A similar pattern was identified in the concentration of peptide required to inhibit sperm motility . Magainin A inhibited sperm motility when diluted in seminal plasma at concentrations of 0.77-1.54 mg/mL, while 1.54-3.08 mg/mL of magainin G were required to produce this effect . In the transmission electron microscopic studies, magainin-treated sperm cells incubated with either peptide consistently demonstrated denudation of the outer plasma membrane and partial disappearance of the acrosome, while sperm incubated in saline remained unaltered . It is hypothesized that magainins exert their spermicidal activity by disrupting the outer plasma membrane . The contraceptive potential of synthetic magainins should be explored through animal studies that measure the in vivo effects of seminal fluid and vaginal secretions on magainin activity and the effects of these agents on vaginal and cervical mucosa .

Pediatrics, 1991 Mar, 87(3), 352 - 60
Sweeteners, flavorings, and dyes in antibiotic preparations; Kumar A et al.; Even though a variety of adverse effects caused by sweeteners, flavorings, and dyes in susceptible individuals have been reported, there is no good single reference with information about these substances in pediatric antimicrobials . Data on sweeteners, flavorings, and dyes in 91 antimicrobial preparations were collected . Sucrose was present in 74 (85%) of 87 preparations, followed by saccharin in 30 (34%) preparations . Mannitol, lactose, and sorbitol were each present in 7 preparations . None of the preparations were free of sweeteners . Thirty-four (37%) of 91 preparations did not specify the flavoring content . While cherry was the most common flavoring used, there were 25 other flavorings . Thirteen different dyes and coloring agents were used in these antimicrobials . Red dye no . 40 was present in 45% of preparations . Tables detailing sweeteners, flavorings, and dyes in different groups of antimicrobials (amoxicillin, ampicillin, cephalosporins, erythromycin, penicillins, sulfonamides, and others) and adverse effects reported with these inert ingredients are presented . These tables should be helpful to physicians in selecting an antimicrobial containing a different sweetener and/or dye when an adverse reaction occurs.

Med Hypotheses, 1991 Mar, 34(3), 230 - 1
Implication of thromboxane in the pathogenesis of Kawasaki disease and a suggestion for using novel thromboxane synthetase inhibitors in its treatment; Backon J; Kawasaki disease, a mucocutaneous lymph node syndrome predominantly prevalent in children, presents with coronary artery aneurysms and thrombocytosis, and investigators have suggested use of anticoagulants in addition to platelet inhibiting drugs . In Kawasaki disease, hypersensitivity reactions due to antigen/antibody complexes (Arthus type III) may damage the vessel wall and induce arteritis, and antigens may be of microbial or viral origin . Since thromboxane has been implicated in the pathogenesis of Kawasaki disease, I suggest use of ginger and carbon dioxide, novel thromboxane synthetase inhibitors . Thromboxane synthetase inhibitors may act as anticoagulants, platelet inhibitors, anti-inflammatory agents, and agents with both antimicrobial and antiviral activity.

Oncol Nurs Forum, 1991 Mar, 18(2 Suppl), 7 - 15
Current strategies for managing myelosuppression in patients with cancer; Rostad ME; Myelosuppression in patients with cancer is usually the result of tumor invasion of the bone marrow, cytotoxic chemotherapy, or radiation therapy, all of which suppress bone marrow function . Anemia, thrombocytopenia, and neutropenia are the three most clinically significant complications that result from bone marrow depression . Although anemia and thrombocytopenia can produce serious clinical problems, blood-component transfusions--despite having inherent problems of their own--usually are successful in correcting or minimizing these complications . Although neutropenia is manageable in most situations, it remains a serious problem that, at its worst, can progress to life-threatening septicemia . The longer neutrophil counts remain low, the more susceptible patients become to infection by endogenous and exogenous microbial flora . Accordingly, the oncology nurse increases the frequency of patient assessment and monitoring for infection . Control measures are introduced to minimize environmental contaminants . These measures attempt to reduce the incidence of opportunistic infections that frequently occur in patients with severe or prolonged neutropenia and for which antimicrobial therapy is indicated . Implementing specific infection-control interventions and thoroughly educating the patient and his/her family help to limit the clinical problems associated with myelosuppression for most patients.

Trans R Soc Trop Med Hyg, 1991 Mar-Apr, 85(2), 156 - 62
Travel medicine--prevention based on epidemiological data; Steffen R; In travel medicine efforts should be concentrated on preventive measures that are necessary, and travellers should be spared the side effects, costs and stress of superfluous measures . Excess mortality abroad is mainly due to traffic and swimming accidents, indicating the need for appropriate control strategies . The morbidity in travellers to developing countries is high, and is primarily due to traveller's diarrhoea . As prophylaxis is ineffective or unrealistic, and as travellers often need fast relief, it is recommended to include loperamide and an antimicrobial agent in the travel kit . Recent studies have shown that the incidence rate per month of Plasmodium falciparum malaria in Africa may reach 24/1000 . The most frequently occurring immunizable diseases are hepatitis A (3/1000) and hepatitis B (0.8/1000) . For many tourists and some expatriates pre-travel advice (hygiene, measures against mosquito bites, etc.) as well as chemoprophylaxis and immunization can be limited to these infections, but those travelling or staying outside large centres need additional measures.

Cesk Farm, 1991 Mar, 40(1), 25 - 8
{The effect of piperidinoethylesters of n-alkoxyphenyl-carbamic acids on bacterial cells}; Mlynarcik D et al.; The inhibitory effect of local anaesthetic agents of this type on the bacteria Escherichia coli were evaluated . The dependence between antimicrobial activity and structure (log 1/MIC = f/m) was studied with the use of a bilinear model . In the positional paraisomers a lower effect of spherical and electron effects than in the case of ortho- and meta-isomers is assumed . The efficacy of these agents depends on their lipophilicity . Membrane activity of these agents was confirmed . In subinhibitory concentrations they cause leakage of cytoplasmic material lysis of spheroplasts, they increase the permeability of the membrane for protons and inhibit dehydrogenase activity of cells . The mode of action of heptacainium chloride and its positional isomers on cells is identical and is similar as in organic ammonium salts and amine oxides.

Antibiot Khimioter, 1991 Mar, 36(3), 24 - 8
{Structure-activity relationship in cephalosporin antibiotics . I . Impact of nitrogen functions on biological activity of cephalosporins--7-aminocephalosporanic acid derivatives}; Grabarnik MS et al.; The impact of the nitrogen containing functional groups of the radical at position 7 in the cefem nucleus on antimicrobial activity of cephalosporins against gram-positive and gram-negative organisms was studied . 235 compounds were tested . It was shown that the presence or absence of the above mentioned functional groups could not be used as the only factor for estimating the pharmacological properties of the antibiotics under investigation . There were different and, occasionally, diametrically opposite effects of the spatial arrangement of the nitrogen-containing descriptors on gram positive and gram negative organisms . It was concluded that prediction of the biological activity of cephalosporins by the pattern recognition according to the presence and spatial arrangement of the functional groups was possible . A way for designing novel compounds with the required biological activity is proposed.

Diagn Microbiol Infect Dis, 1991 Mar-Apr, 14(2), 157 - 66
Effect of including recommendations for antimicrobial therapy in microbiology laboratory reports; Bartlett RC et al.; Innovative approaches are needed to improve cost-effective antibiotic use in hospitals . We established an algorithm to provide a recommendation for both a single oral and a single parenteral antimicrobic, including dosage, to be placed in the bacteriology laboratory report for therapy guidance of 174 episodes of lower respiratory infection in a group of "program" patients with no evidence of infection at other sites . The initial recommendation was based on the Gram-stained direct smear of secretions . The recommendation was updated when preliminary culture results were available, and again with final identification and susceptibility data . We compared the severity of illness, length of stay, and cost of therapy for 68 episodes in program patients who received the recommended therapy with 111 episodes in a control group of patients who received antimicrobial therapy but for whom no recommendations were reported . There was a significantly greater use of the recommendations for sicker patients . Antimicrobial therapy, in general, was more often used for the program patients than for the controls . There was no difference in length of stay or therapy cost . We recommend that this approach be used in settings where there is more problematic use of antimicrobics.

Minerva Stomatol, 1991 Mar, 40(3), 157 - 61
{Ceftizoxime in oral surgery}; Pancotti G et al.; Clinical and statistical investigation on the use of ceftizoxime in the treatment of peri- and postoperative infections in odontostomatological and maxillofacial surgery . A sample of 48 patients in the Odontostomatologic Division of the Hospital of Asti is examined . Principles and experience of surgical antimicrobial prophylaxis according to its antibacterial activity, pharmacokinetic properties and therapeutic use are reported.

Arzneimittelforschung, 1991 Mar, 41(3), 253 - 6
In vitro and in vivo effects of N-methyl-3,5-dichloro-benzylamine hydrochloride on Mycobacterium leprae; Dhople AM et al.; The antimicrobial effects of a new benzylamine, ME-93 (N-methyl-3,5-dichloro-benzylamine hydrochloride), alone and in combination with dapsone and rifampicin, have been evaluated in vitro in cell-free culture system and in vivo in mouse foot pad system . Even at 50 micrograms/ml, ME-93 did not completely inhibit the in vitro growth of M . leprae, and the effects were bacteriostatic . However, there was a synergism when ME-93 was combined with rifampicin, and the effects were bactericidal . Similar findings were also obtained in the mouse foot pad system . Thus, there is a new drug that needs further attention in the chemotherapy of leprosy.

J Biol Buccale, 1991 Mar, 19(1), 29 - 33
The effect of an antimicrobial releasing varnish on root demineralisation in situ . The influence of the demineralisation period; Huizinga ED et al.; Caries in exposed root surfaces is becoming a significant problem in dentistry . Varnish applications have interesting preventive possibilities against root caries . The effect of such a varnish, containing two antimicrobials, was studied on the demineralisation of roots with a twofold aim . Firstly, the efficacy of the varnish was investigated in situ as a function of the demineralisation period . Ten participants wore sound intact roots treated with the varnish in an intra oral appliance for 2, 4 and 6 weeks . Secondly, the effect of the varnish on root demineralisation after removal of the varnish was measured . The results showed that the reduction, in demineralization of about 80% after 2 weeks, decreased in magnitude with the length of the in situ demineralisation period . After 4 weeks there was no longer statistically significant difference compared with untreated roots . The acid attack by plaque was, however, substantial in this model; after 6 weeks in situ untreated roots were so strongly demineralised that microradiography was no longer possible anymore . In the second experiment in which the varnish was removed 2 days after application there was a trend toward a reduction of about 30% in root demineralisation after 2 weeks . This was not statistically significant when compared with no application.

Clin Ther, 1991 Mar-Apr, 13(2), 270 - 80
Lincocinamides and the incidence of antibiotic-associated colitis; Jaimes EC; Reports of antibiotic-associated colitis (AAC) and of pseudomembranous colitis in patients treated with lincocinamides and other antimicrobial agents are reviewed . It is apparent that the incidence of colitis in patients treated with antimicrobials is declining . The greatest risk for AAC is seen in patients treated with ampicillin, followed by the cephalosporins, and then the lincocinamides . Treatment of AAC with vancomycin, metronidazole, or bacitracin is usually effective.

Enferm Infecc Microbiol Clin, 1991 Mar, 9(3), 148 - 53
{Abscess of the psoas: a not-so-rare entity . Analysis of a series of 18 cases}; Jimenez-Mejias ME et al.; We have studied 18 patients with abscess at the psoas who had a mean age of 43.55 +/- 18.9 years and a predominance of males (77.8%) . In nine cases the abscess was secondary to a lumbar discal spondylitis, in 5 cases to a sacroiliitis, in one case to abdominal disorder, and 3 cases the abscess was considered of a primary origin . The etiologic agents were S . aureus (8 cases), E . granulosus (5 cases), M . tuberculosis (3 cases), and B . melitensis (1 case) . In one patient the infective agent was not isolated and in two cases the abscesses were infected by E . granulosus and P . aeruginosa . The clinical picture on admission was studied in all cases . Microbiological and pathologic analysis of the abscess allowed to establish the diagnosis in 11 cases (yield: 84.6%) . Computerized axial tomography was the most useful imaging technique . Antimicrobial treatment was undertaken in 16 cases . Four patients recovered with pharmacological treatment alone . Surgical treatment was performed in 13 cases . Aspirative punction/drainage was carried in only one patient . The clinical course was favourable in 16 patients (88.9%) . Our data indicate that the incidence of abscess of the psoas in cases of intraabdominal infections is low . In our series the incidence of abscesses secondary to hydatidosis is relatively high.

Clin Prev Dent, 1991 Mar-Apr, 13(2), 13 - 7
Taurolin as an oral rinse . I . Antimicrobial effects in vitro and in vivo; Reynolds S et al.; Taurolin, a synthetic antimicrobial agent, has been suggested to be of potential value as an inhibitor of dental plaque . Although data on the antibacterial activity of Taurolin are available there is a dearth of information for effects on oral bacterial isolates and antibacterial activity in the mouth . This study assessed the in vivo and in vitro antibacterial properties of a Taurolin rinse by a) determining the MID values against seven oral isolates and b) measuring salivary bacterial counts following a single rinse . By comparing activity with chlorhexidine, it was hoped to determine substantivity and predict the relative ability of Taurolin to inhibit plaque through an antimicrobial effect . For Taurolin, MID values against the test organisms were found to range between 1:20 and 1:80, while for chlorhexidine, values between 1:320 to 1:640 were obtained . The effects on salivary bacterial counts revealed that Taurolin significantly reduced salivary bacterial counts compared to saline up to 5 hours post rinsing, but was significantly less effective than chlorhexidine after 30 minutes and up to 7 hours . Results indicate that Taurolin has some persistence of antimicrobial activity in the mouth . This suggests that Taurolin would possess some plaque inhibitory properties albeit less than chlorhexidine . These conclusions were confirmed in a subsequent investigation.

West Indian Med J, 1991 Mar, 40(1), 11 - 5
Helicobacter pylori; Omardeen FL et al.; Since 1983, rapid advances in the knowledge of Helicobacter pylori have given new insights into the pathogenesis of upper gastrointestinal diseases . Several methods are now available for the diagnosis of the infection . Antimicrobial therapy has emerged as a new and effective treatment for peptic ulcer disease in a proportion, as yet to be determined, of patients in the Caribbean.

Mt Sinai J Med, 1991 Mar, 58(2), 179 - 82
The risk of wound infection in lumbar disk surgery; Savitz SI et al.; A number of questions were left unanswered by the empirical success of a 15-year regimen of prophylactic antibiotics in preventing postoperative sepsis at three community hospitals . Although intraoperative cephalosporins have eliminated the morbidity of primary wound infection, the susceptibility to these agents of nosocomial flora has fallen considerably . The principles of antimicrobial prophylaxis have been established, but the debate over the importance of meticulous aseptic technique versus prophylactic antibiotics goes on . We investigated the microbiologic factors in lumbar disk surgery at Nyack Hospital over one year to study (a) potential sources of random contamination, (b) the flora of the operating room, and (c) the efficacy of various aspects of antiseptic routine.

Cell Immunol, 1991 Mar, 133(1), 178 - 86
Th2 lymphocyte clone can activate macrophage antileishmanial defense by a lymphokine-independent mechanism in vitro and can augment parasite attrition in vivo; Sypek JP et al.; Antileishmanial defense has been ascribed to the antimicrobial effects induced by soluble macrophage-activating lymphokines (MAFs), such as interferon-gamma and granulocyte-macrophage colony-stimulating factor . Recently, we identified an additional mechanism of T cell-mediated macrophage activation of defense against Leishmania that is apparently lymphokine independent, requires cell-cell contact, and is not cytotoxic to host cells . By employing antigen-specific murine T cell hybridoma lines, we observed that this property was associated with CD4+ subpopulations possessing the characteristics of the Th1 subset . In the present study, we address the question of whether contact-mediated macrophage activation can also be induced by Th2 lymphocytes . We employed as T effector cells in antileishmanial defense assays the Th2 cell line D10.G1.4 (D10) which is specific for conalbumin . We observed that D10 cells were able to induce activation of Leishmania-infected macrophages only when the macrophages were also primed with conalbumin, and that this activation apparently occurred by a mechanism without the secretion of MAF . Moreover, when mice infected with L . major were injected into footpad lesions with conalbumin and D10 cells, in situ parasite replication was partially inhibited . The expression of this antimicrobial mechanism by Th1 as well as Th2 clones suggests that the property of contact-mediated (lymphokine-independent) activation may be shared by certain lymphocytes in both Th1 and Th2 subpopulations . We hypothesize that this activation mechanism may involve the interaction of a lymphocyte membrane-associated MAF (such as tumor necrosis factor) and its receptor on the infected macrophage, resulting in the induction of antimicrobial effects but not cytotoxicity to the host cell.

In Vivo, 1991 Mar-Apr, 5(2), 101 - 5
Macrophage stimulation activity of antimicrobial N,N-dimethylaminoethyl paramylon; Sakagami H et al.; Pretreatment with N,N-dimethylaminoethyl (DMAE) paramylon significantly protected mice from infection by various microorganisms . When mouse peritoneal macrophages were cultured with DMAE-paramylon, they showed morphological change (spreading) and elevated NBT-reducing activity . Macrophages prepared from DMAE-paramylon-treated mice had higher NBT-reducing activity than those from control mice . On the other hand, carboxymethyl paramylon and paramylon sulfate, which did not induce appreciable antimicrobial activity, failed to stimulate macrophage functions . The data suggest a significant role of macrophages in antimicrobial activity induction by cationized glucans.

Biochem Biophys Res Commun, 1991 Feb 28, 175(1), 325 - 32
Special considerations in the purification of the GM3 ganglioside-forming enzyme, CMP-sialic acid:lactosylceramide alpha 2-3 sialyltransferase (SAT-1): effects of protease inhibitors on rat hepatic SAT-1 activity; Melkerson-Watson LJ et al.; Co-purification of an endogenous proteolytic activity has been proposed as the cause for the size heterogeneity of sialyltransferases . Reported herein are results on the effects of various protease inhibitors, sulfhydryl-reducing agents and antimicrobial agents on SAT-1 activity . Addition of protease inhibitors to immunoaffinity-purified rat liver SAT-1 dramatically affects its activity . All protease inhibitors examined, with the exception of PMSF, inhibited the purified enzyme . The most inhibitory were the cysteine (thiol) protease inhibitors . This effect is less spectacular when the effect of these inhibitors was studied on SAT-1 activity in Golgi-enriched microsomes, although the inhibition was greatest by the cysteine protease inhibitors . One dramatic effect, found in both cases, was the apparent activation of SAT-1 activity in the presence of beta-mercaptoethanol.

J Infect Dis, 1991 Feb, 163(2), 325 - 30
Therapy for women hospitalized with acute pyelonephritis: a randomized trial of ampicillin versus trimethoprim-sulfamethoxazole for 14 days; Johnson JR et al.; The efficacy of the traditionally recommended ampicillin (Amp) plus gentamicin (GM) regimen was compared with that of a trimethoprim-sulfamethoxazole (TMP/SMZ)-plus-GM regimen and the adequacy of 14 days total therapy for acute uncomplicated pyelonephritis (AUPN) . Eighty-five women hospitalized for AUPN were randomly assigned to receive either Amp, 1 g intravenously (iv) every 6 h for 3 days, then 500 mg orally four times daily, or TMP/SMZ, 160/800 mg iv every 12 h for 3 days, then 160/800 mg orally twice daily . Initially, all patients also received GM every 8 h iv (mean, 606 doses) . Antimicrobial resistance necessitated modifying therapy of 14 (32%) of the Amp recipients but of none of the TMP/SMZ recipients (P less than .001) . Both regimens produced a satisfactory bacteriologic and clinical response in all cases . Reinfection occurred in 11% of Amp and in 8% of TMP/SMZ recipients . No patient experienced relapsing infection . The TMP/SMZ regimen was less costly and less likely to require modification due to antimicrobial resistance.

Curr Opin Immunol, 1991 Feb, 3(1), 65 - 70
Role of nitric oxide synthesis in macrophage antimicrobial activity; Nathan CF et al.; Research over the past 5 years has demonstrated that immunologic activation of mouse macrophages induces the activity of nitric oxide synthase, which oxidizes a guanidino nitrogen of L-arginine, yielding citrulline and the reactive radical, nitric oxide . A review of the biochemistry and immunologic regulation of this pathway in macrophages provides a backdrop against which to evaluate its effector functions . Reports published in the past 2 years suggest that synthesis of NO mediates much of the antimicrobial activity of mouse macrophages against some fungal, helminthic, protozoal and bacterial pathogens.

Quintessence Int, 1991 Feb, 22(2), 95 - 100
The treatment of acute necrotizing ulcerative gingivitis; Hartnett AC et al.; The destruction of the interdental papillae and formation of permanent gingival craters are common sequelae of acute necrotizing ulcerative gingivitis . These craters can be disfiguring, especially in the anterior gingiva, and can act as a nidus for recurrent episodes . Traditional therapy has emphasized a surgical approach for elimination of these defects, often increasing the esthetic problems . The purpose of this paper is to review the treatment modalities of acute necrotizing ulcerative gingivitis and illustrate an alternative treatment approach of periodic scaling, root planing, and antimicrobial rinses with 0.12% chlorhexidine . With this therapeutic regimen, the disease process can be reversed and damaged papillae may regenerate.

Pediatr Infect Dis J, 1991 Feb, 10(2), 140 - 8
Antibiotic treatment of bacterial gastroenteritis; Ashkenazi S et al.; Antibiotic treatment is important in certain etiologies of bacterial gastroenteritis, both for clinical improvement and for eradication of the causative organism from stools, which is important epidemiologically . The etiology, however, is seldom known at presentation in sporadic cases of diarrhea . Thus the decision to initiate antibiotic therapy and the choice of the specific antimicrobial agents should be made on a clinical basis, before culture results are available.

J Med Assoc Thai, 1991 Feb, 74(2), 61 - 5
Treatment of community-acquired pneumonia with ofloxacin; Youngchaiyud P et al.; Our study of 28 carefully selected patients proved that ofloxacin is a safe and effective drug for mild to moderately severe community-acquired pneumonia . An effective oral antimicrobial drug such as ofloxacin can be used as an alternative to conventional therapy in community-acquired pneumonia.

J Antimicrob Chemother, 1991 Feb, 27(2), 185 - 90
Evaluation of the E test, a novel method of quantifying antimicrobial activity; Brown DF et al.; The 'E test' is a method for measuring MICs of antimicrobial agents against bacteria and is based on diffusion of a pre-formed antibiotic gradient from a plastic strip . The performance of the E test was evaluated by comparison with a conventional agar dilution MIC method in tests with ten agents and a variety of organisms . Correlation between MICs by the agar dilution and E test methods was good, 98.85% results were within 2 log2 dilution steps in a total of 1304 tests . The E test is technically straightforward as tests are set up in the same way as the disc diffusion method . The versatility and ease of use of the E test make the method an attractive alternative to conventional dilution tests.

Chem Pharm Bull (Tokyo), 1991 Feb, 39(2), 335 - 40
Syntheses and biological properties of new 8-fluorocarbapenem derivatives; Watanabe A et al.; 8-Fluorocarbapenem derivatives having various C-3 side chains were synthesized to study for the structure-activity relationship of carbapenems by in vitro biological evaluation . The introduction of fluorine at C-8 of racemic PS-5 led to slight improvements of the antimicrobial activity and the stability to renal dehydropeptidase-I . When D-cysteine was additionally introduced to the C-3 position of (+/-)-8-fluorocarbapenem, the diastereomeric separation of the 8-fluorocarbapenems became feasible . As expected from penicillins and cephalosporins, (+)-8-fluoro-3-D-cysteinylcarbapenem (+)-7a was antimicrobially active, whereas (-)-7b was inactive . It is worth noting, however, that (+)-7a was significantly more sensitive to renal dehydropeptidase-I than (-)-7b . Irrespective of the presence of fluorine at C-8, basic S-side chains at C-3, such as the pyridyl and pyrrolidyl groups, significantly improved in antimicrobial activity and dehydropeptidase-I stability . The combination of 8-fluorination with C-3 basic side chains in 7c--g resulted in a marked improvement of antimicrobial activity and dehydropeptidase-I stability.

Behring Inst Mitt, 1991 Feb, (88), 200 - 7
Mechanisms and modulation of macrophage activation; Nathan C; In the two decades following the discovery that macrophages can be activated by cytokines, there have been four major advances in our understanding of this phenomenon: (i) the identification of two biochemically defined, cytokine-inducible antimicrobial pathways, the enzymatic generation of superoxide and the enzymatic generation of nitric oxide; (ii) the identification of individual cytokines of known amino acid sequence capable of inducing these antimicrobial pathways and enhancing macrophage antimicrobial function; (iii) the demonstration of the utility of macrophage activating factors in the prevention and treatment of infectious diseases in man; and (iv) the discovery of the phenomenon of macrophage deactivation, together with the identification of several macrophage deactivating cytokines . This review briefly surveys each of these points, with emphasis on the regulation of production of the reactive oxygen intermediates and reactive nitrogen intermediates by two distinct but comparably suppressive cytokines, macrophage deactivation factor (MDF) and transforming growth factor-beta (TGF-beta).

Anaesthesist, 1991 Feb, 40(2), 100 - 4
{Sinusitis in long-term intubated, intensive care patients: nasal versus oral intubation}; Michelson A et al.; Discussion of paranasal sinusitis as a nosocomial infection in the mechanically ventilated intensive care (ICU) patient has recently been intensified . Some authors have emphasized nasotracheal intubation as a possible pathogenetic pathway . The aim of this study was to investigate the impact of nasotracheal or orotracheal intubation on the development of sinusitis in ICU patients . METHODS . In a prospective study, we followed 44 patients who required mechanical ventilation (greater than 24 h) in the ICU because of prolonged recovery from abdominal, thoracic, or posttraumatic surgery . Twenty patients were intubated nasotracheally and 24 orotracheally . Assignment to the groups was random . All were provided with a nasogastric tube and initially treated with systemic antibiotics . They received local antimicrobial prophylaxis of the nose, oropharynx, and stomach . Daily a-scan examinations of the maxillary sinuses were performed from the day of admission to the ICU until extubation, tracheotomy, death, or transfer . The average observation period was 6.9 days in the oral group and 7.1 days in the nasal group . In the case of a pathologic finding, aspiration of the antral sinus was carried out . In this study sinusitis indicated a sonographic finding; it did not necessarily imply a bacterial infection . RESULTS . At the beginning of the observation period, 6 patients in the oral group and 4 in the nasal group already had a pathologic maxillary sinus finding . At the end, in 15 of 24 in the oral group and 19 of 20 in the nasal group unilateral or bilateral sinusitis could be demonstrated . Development of bilateral sinusitis (13/20 in the nasotracheal group, 8/24 in the orotracheal group) was mainly observed after the appearance of unilateral sinusitis . The site corresponded to the site of the nasal tube in 65% . Unilateral paranasal infection was observed in nasotracheally and orotracheally intubated patients after an average of 2.8 and 2.6 days, respectively, whereas bilateral sinusitis had an average time delay of 4.5 and 5.7 days . Aspiration of the maxillary sinus was performed in 22 of 34 cases with sinusitis . Pathogenic organisms could be demonstrated in 7 of 13 nasotracheally intubated patients but only 2 of 9 with orotracheal tubes . CONCLUSION . We found that patients intubated orotracheally developed significantly less sinusitis than those intubated nasotracheally . Edema, local infection of the nasal mucosa, or mechanical obstruction of sinus drainage pathways by the tube are possible explanations . The fact that 63% of orally intubated patients had a pathologic maxillary sinus finding as well suggests that in addition to other reasons, an increased central venous pressure, positive pressure ventilation, and the supine position must be regarded as predisposing factors that increase the incidence of sinusitis . We conclude that the conditions of critically ill patients predispose to the development of sinusitis . Nasotracheal intubation is to be regarded as an additional risk, and therefore oral intubation should be preferred.

Arzneimittelforschung, 1991 Feb, 41(2), 151 - 4
Toxicological studies of the antimicrobial alkaloid juliflorine; Aqeel A et al.; Juliflorine (CAS 76202-00-1), an antibacterial and antidermatophytic alkaloid, was studied for its toxicity in mice, rabbits, chicks, chick embryos and vero cell line . In mice LD50 was determined as 17.46 mg/kg; in rabbits 33.11 mg/kg; in chicks 24.104 mg/kg; and in chick embryos 18.284 mg/kg . In rabbits the subsequent injection of non-lethal doses (10 mg/kg) through the same route induced swelling, induration, inflammation and tissue degeneration (around injected area) with sterile abcess . Topically 1% juliflorine in polyethylene glycol-400 was found non-toxic but higher concentrations (less than or equal to 2.5%) produced irritation and inflammation; the severity of reaction was dose dependent . In vero cell-line juliflorine was found toxic at greater than or equal to 5 micrograms/ml . Injected animals showed lethargy, prostration and weakness (dose dependent) but recovered after some days, while newly hatched chicks, from injected eggs with higher dose, did not survive after 48 to 72 h . Internal organs (liver, kidney, brain, etc.) of dead, sick and healthy animals were examined and found normal.

Rheum Dis Clin North Am, 1991 Feb, 17(1), 131 - 47
Vasculitis and infection with the human immunodeficiency virus; Calabrese LH; Vasculitic syndromes associated with infection with the human immunodeficiency virus (HIV) would appear to represent a microcosm of the vasculitic spectrum . Reported cases have included polyarteritis nodosa-like illnesses, hypersensitivity vasculitis, lymphomatoid granulomatosis, primary angiitis of the central nervous system, and a number of miscellaneous disorders . The pathogenesis of these conditions is unclear, but some appear to be mediated in part by the HIV itself . Therapeutically, little clinical data exist to guide clinicians in the management of such patients, but aggressive approaches combining immunosuppressive therapy with assertive antimicrobial prophylaxis may be warranted.

Aust N Z J Ophthalmol, 1991 Feb, 19(1), 9 - 20
The pathogenesis of Acanthamoeba keratitis; Badenoch PR; Most major eye centres in Australia have now seen patients with corneal infection due to Acanthamoeba . The medical treatment of this condition is difficult; Acanthamoeba isolates show wide variation in their susceptibility to antimicrobial agents and amoebicidal concentrations are difficult to achieve in the cornea . The recent development of animal models of Acanthamoeba keratitis will be important in understanding the pathogenic mechanisms involved . The key to improving the visual outcome for these patients may prove to be the manipulation of the host response.

Z Gesamte Hyg, 1991 Feb, 37(2), 84 - 7
{Rapid photometric method for determination of in vitro effectiveness of various antibiotic combinations}; Bretschneider M et al.; Combinations of antimicrobial agents are often used in medical practice . The combination therapy aims a broader spectrum of chemotherapy and/or synergistic effects . The effect of combination of chemotherapeutics on bacteria may be described as synergistic, indifferent or antagonistic . Therefore, it is essential to test the effectivity of antimicrobial combinations in vitro . The checker-board-technique is the most frequently used test to assess antibacterial combinations . For this standard test macroscopically read an incubation time of 18-24 hours is necessary . To reduce this incubation time to 4 hours a rapid nephelometric method was developed . The results of this method showed a good correlation with the standard test.

Antimicrob Agents Chemother, 1991 Feb, 35(2), 228 - 33
Comparison of methods for in vitro testing of susceptibility of porcine Mycoplasma species to antimicrobial agents; Ter Laak EA et al.; The MICs of 18 antimicrobial agents used against strains of three porcine Mycoplasma species were determined by a serial broth dilution method . Twenty field strains of M . hyorhinis, ten field strains of M . hyopneumoniae, six field strains of M . flocculare, and the type strains of these species were tested . Twelve field strains and the type strain of M . hyorhinis were also tested by an agar dilution method . Tests were read at various time points . When the broth dilution method was used, the final MIC had to be read 2 days after color changes had stopped . MICs of tetracycline, oxytetracycline, doxycycline, and minocycline were low for the three Mycoplasma species tested . MICs of chlortetracycline were 8 to 16 times higher than MICs of the other tetracyclines . Spiramycin, tylosin, kitasamycin, spectinomycin, tiamulin, lincomycin, and clindamycin were effective against all strains of M . hyorhinis and M . hyopneumoniae . The quinolones were highly effective against M . hyopneumoniae but less effective against M . hyorhinis . The susceptibility patterns for M . hyopneumoniae and M . flocculare were similar.

Infect Control Hosp Epidemiol, 1991 Feb, 12(2), 103 - 10
Diagnostic applications of DNA probes; Pfaller MA; This review has described several of the most common molecular biologic techniques that are, or will be, employed in the diagnostic laboratory . The potential advantages of these DNA probe assays in the diagnosis of infectious diseases include: rapid detection and identification of infectious agents; the ability to screen selected specimens using batteries of probes; and the detection of nonviable or difficult-to-culture organisms . The potential disadvantages of DNA probe assays include: the use of isotopic detection methods for optimum sensitivity; limited diagnostic sensitivity of current assays; slow turna-round time for some assay formats; expense of current reagents; limited availability of many probes; lack of technical expertise in most diagnostic laboratories; and the requirement for antimicrobial susceptibility testing (requires culture) . Given the above advantages and disadvantages, there are several key issues that must be considered before adopting DNA probe technology in the diagnostic laboratory; the cost of performing routine culture and identification versus the cost of screening with probes--both the number and type of specimens and the time savings that may be realized by eliminating routine cultures; the prevalence of the infectious agent--even the best DNA probe assay may not be useful or practical in a low-prevalence situation; the need for additional equipment and space; and the interpretation of false-positive and false-negative results--additional research is needed in this area . However, laboratories must consider these issues when using a test other than the current gold standard (i.e., culture) . DNA probe technology is with us and expanding rapidly . The intelligent application of this new technology will require communication between laboratorians and clinicians and careful consideration of the many advantages and disadvantages discussed above.

J Clin Periodontol, 1991 Feb, 18(2), 90 - 3
The effect of some chlorhexidine-containing mouthrinses on salivary bacterial counts; Addy M et al.; A number of chlorhexidine mouthwashes are available commercially which differ in formulation and regimen of use . As a comparative measure of antimicrobial persistence, this study evaluated the effect of 4 chlorhexidine mouthwash formulations on salivary bacterial counts after a single rinse . The study was a randomised single-examiner blind 5-way crossover investigation employing a panel of 10 young healthy human volunteers . The 0.12% and 0.2% commercial formulations when rinsed according to the respective manufacturers instructions produced similar large and prolonged reductions in salivary bacterial counts during the 7-h period . A 0.1% formulation also commercially available produced minimal effects on salivary bacterial counts and was little different to the saline rinse . A reformulated 0.1% rinse, not commercially available at the time of the study, produced significant salivary bacterial count reductions over the 7-h period albeit to a lesser degree of magnitude than to the 0.2% and 0.12% rinses . The results were consistent with comparative plaque inhibitory studies of the formulations and suggest that the method is a quick and simple way of screening products for antimicrobial and antiplaque potential.

J Clin Periodontol, 1991 Feb, 18(2), 140 - 4
Triclosan and sodium lauryl sulphate mouthwashes (I) . Effects on salivary bacterial counts; Jenkins S et al.; A number of commonly used toothpaste ingredients, such as detergents, possess not inconsiderable antimicrobial activity . Additionally, specific ingredients including triclosan are now added to toothpastes to enhance such activity and to improve plaque inhibition . To date, there have been few studies of the antimicrobial properties in vivo of individual toothpaste ingredients . Most investigations have evaluated the whole toothpaste product . Persistence of antimicrobial action in vivo has been shown to relate to potential plaque inhibitory action . The aim of this study was to compare the magnitude and duration of salivary bacterial count reductions produced by a single rinse of 0.2% triclosan, 1% sodium lauryl sulphate (SLS) and 0.2% chlorhexidine mouthwashes . 16 volunteers took part in a single-blind latin-square randomised crossover designed study with balanced residual effects . Before and for time periods up to 420 min following rinsing with the allocated mouthwashes, saliva samples were obtained and processed for total anaerobic counts . With the exception of the saline control rinse, the 3 test solutions produced considerable reductions in bacterial counts which remained significant to 3 h for triclosan and 7 h for SLS and chlorhexidine . However, at most time periods after baseline, the effects of chlorhexidine were significantly greater than triclosan and SLS . Overall, SLS had significantly greater effects than triclosan . Incremental values from 30 min post rinsing were always positive for SLS and triclosan, indicating bacterial recovery, whereas these values were negative for chlorhexidine . The results indicate that triclosan and SLS provide some persistence of antimicrobial activity in the oral cavity when used at relatively high dose compared to a toothpaste vehicle.

J Intern Med, 1991 Feb, 229(2), 189 - 92
Pneumothorax in a patient with Wegener's granulomatosis during treatment with immunosuppressive agents; Ogawa M et al.; We present the case of a 16-year-old woman with Wegener's granulomatosis, who developed a pneumothorax while receiving treatment with cyclophosphamide and glucocorticoids . The lung was re-expanded by tube drainage, and the patient recovered completely while the immunosuppressive treatment was continued in combination with sulphamethoxazole-trimethoprim . A possible role for this antimicrobial drug in the treatment of Wegener's granulomatosis is briefly discussed.

Epidemiol Infect, 1991 Feb, 106(1), 121 - 32
The changing ecology of hospital bacteria and the selective role of cephalosporins; Mulgrave L; More than 12,800 clinical isolates from 115,373 in-patient specimens obtained at the Sir Charles Gairdner Hospital, Perth, Western Australia, were identified and analysed statistically for relationships with usage of three generations of cephalosporins over the 5-year period from July 1984 to June 1989 . A positive relationship between cephalosporin usage and significantly increasing isolation rates for those species capable of producing chromosomal beta-lactamases was observed . Simultaneously, a small increase in the isolation frequency of non-chromosomal beta-lactamase-producing strains was noted and no correlation with cephalosporin usage was demonstrated . The trend toward predomination in the hospital environment of strains possessing substantial cephalosporin resistance has implications for future antimicrobial policy, choice of empiric therapy and the predictive value of standard antimicrobial susceptibility tests.

Curr Opin Dent, 1991 Feb, 1(1), 81 - 6
Chemotherapeutic agents as adjuncts in the treatment of periodontal disease; Howell TH; Periodontal disease is a broad term designating a number of infectious disease entities involving the supportive tooth structures . It has become clear that the various forms of periodontal disease are associated with specific groups of microorganisms . This evidence has led to treatment strategies that are primarily aimed at the suppression or elimination of specific periodontal pathogens . Until recently, surgical and mechanical intervention remained the principal methods for control of the multifactorial disease process . Recent advances in the development of chemotherapeutic agents have led to the increasing use of antimicrobials to suppress pathogenic flora . The use of antimetabolic agents to modulate host inflammatory response to the accumulation of bacterial plaque has also increased . Both types of chemotherapeutic agents can be used alone or in conjunction with traditional periodontal therapy to provide effective and predictable clinical improvement.

Behring Inst Mitt, 1991 Feb, (88), 230 - 8
Cytokine interactions in experimental cutaneous leishmaniasis; Solbach W et al.; Destruction of intracellularly living Leishmania major amastigotes is achieved by activated macrophages . In this report, we have investigated the contribution of IL-4, TNF-alpha and IFN-gamma to the induction of antileishmanial macrophage activation . It was found that as single lymphokine only IFN-gamma led to amastigote elimination by peritoneal exudate macrophages . Neither IL-4 nor TNF-alpha or the combination of both cytokines led to antimicrobial activation . When the macrophages were incubated with concentrations of IFN-gamma that by themselves were insufficient for maximum cell activation, it was found that both IL-4 and TNF-alpha very effectively synergized with IFN-gamma for induction of antiparasitic activity . The activation which was achieved when IFN-gamma was combined with IL-4 could be blocked not only with antibodies to either of the lymphokines, but also with an antiserum specific for TNF-alpha, suggesting the involvement of endogenously generated TNF-alpha in this synergism . Any of the synergistic activities observed presumably lead to the activation of the L-arginine dependent pathway used by the cell for the production of nitrogen oxides as effector molecules for parasite killing since NG-monomethyl-L-arginine (L-NMMA), a specific inhibitor of this pathway, completely blocked the killing of intracellular parasites . We conclude that macrophage activation for antiparasitic activity is directed by a complex network of cytokine-interactions, in which IL-4 and TNF-alpha very effectively synergize positively with low levels of IFN-gamma.

J Toxicol Sci, 1991 Feb, 16(1), 29 - 48
Four-week sub-acute toxicity study of S-(-)-9-fluoro-2,3-dihydro-3-methyl-10- (4-methyl-1-piperazinyl)-7-oxo-7H-pyrido-{1,2,3,-de} {1,4}benzoxazine-6- carboxylic acid hemihydrate (DR-3355) in CD rats and cynomolgus monkeys; Kato M et al.; S-(-)-9-Fluoro-2,3-dihydro-3-methyl-10-(4-methyl-1-piperazinyl)-7-oxo-7H -pyrido-{1,2,3,-de} {1,4}benzoxazine-6-carboxylic acid hemihydrate, DR-3355, a new quinolone antimicrobial agent, was administered by oral gavage to groups of ten male and ten female CD rats at dosages of 50, 200 or 800 mg/kg/day and to groups of three male and three female cynomolgus monkeys at dosages of 10, 30, or 100 mg/kg/day . Both species were treated for four weeks . The vehicle (0.5% sodium carboxymethyl cellulose)-treated group served as control . Rats at the high dose showed salivation, slight increases in total leucocyte and lymphocyte counts, slight changes in the plasma electrolyte balance, and minor reductions in urea concentration . The articular surfaces of the humerus and femur of rats at the high dose showed minor degenerative changes . Increased caecal weight occurred in rats at all the treatment groups . Monkeys at the high dose showed salivation, diarrhoea and lost weight . There was no microscopic change in the tissues examined . No effect levels under these conditions were established at 200 mg/kg/day in the rat, and 30 mg/kg/day in the monkey.

Eur J Clin Microbiol Infect Dis, 1991 Feb, 10(2), 68 - 70
In vitro susceptibility of Francisella tularensis to fluoroquinolones and treatment of tularemia with norfloxacin and ciprofloxacin; Syrjala H et al.; The in vitro susceptibility of ten strains of Francisella tularensis to four fluoroquinolones (ciprofloxacin, norfloxacin, ofloxacin and pefloxacin) was investigated by determining the MBCs of these quinolones . The results were as follows (mean +/- SE): ciprofloxacin 0.13 +/- 0.03 mg/l, norfloxacin 0.24 +/- 0.07 mg/l, ofloxacin 2.16 +/- 0.78 mg/l and pefloxacin 0.51 +/- 0.50 mg/l . These concentrations can be achieved in clinical practice . In addition, four tularemia patients were treated with an oral regimen of 750 mg ciprofloxacin b.i.d . and one patient with norfloxacin 400 mg b.i.d . The fever experienced by these volunteers vanished within a couple of days and they were able to resume normal work one week after receiving the antibiotics without any relapses later . These in vitro and in vivo results show that orally administered fluoroquinolones are promising antimicrobial agents for the treatment of human tularemia.

Am J Infect Control, 1991 Feb, 19(1), 19 - 35
National nosocomial infections surveillance system (NNIS): description of surveillance methods; Emori TG et al.; The National Nosocomial Infections Surveillance System (NNIS) is an ongoing collaborative surveillance system sponsored by the Centers for Disease Control (CDC) to obtain national data on nosocomial infections . The CDC uses the data that are reported voluntarily by participating hospitals to estimate the magnitude of the nosocomial infection problem in the United States and to monitor trends in infections and risk factors . Hospitals collect data by prospectively monitoring specific groups of patients for infections with the use of protocols called surveillance components . The surveillance components used by the NNIS are hospitalwide, intensive care unit, high-risk nursery, and surgical patient . Detailed information including demographic characteristics, infections and related risk factors, pathogens and their antimicrobial susceptibilities, and outcome, is collected on each infected patient . Data on risk factors in the population of patients being monitored are also collected; these permit the calculation of risk-specific rates . An infection risk index, which includes the traditional wound class, is being evaluated as a predictor of the likelihood that an infection will develop after an operation . A major goal of the NNIS is to use surveillance data to develop and evaluate strategies to prevent and control nosocomial infections . The data collected with the use of the surveillance components permit the calculation of risk-specific infection rates, which can be used by individual hospitals as well as national health-care planners to set priorities for their infection control programs and to evaluate the effectiveness of their efforts . The NNIS will continue to evolve in finding more effective and efficient ways to assess the influence of patient risk and changes in the financing of health care on the infection rate.

J Clin Periodontol, 1991 Feb, 18(2), 145 - 8
Triclosan and sodium lauryl sulphate mouthrinses . (II) . Effects of 4-day plaque regrowth; Jenkins S et al.; Toothpastes have been shown to exert some plaque inhibitory effects probably due to the action of detergents such as sodium lauryl sulphate (SLS) . Recently the antimicrobial, triclosan, has been added to experimental and commercial toothpaste products to enhance activity against plaque . There is, however, little information as to the plaque inhibitory effects alone of ingredients such as SLS and triclosan . This investigation compared the effects on 4-day plaque regrowth of a 1% SLS, 0.2% triclosan and 0.2% chlorhexidine rinse with a 0.9% saline rinse . The study was single blind, latin square, four-period crossover design, balanced for residual effects and employing 16 healthy dentate volunteers . During each period, normal oral hygiene ceased and plaque regrowth from a zero baseline was measured by score and area after 2 x daily rinses with 10 ml volumes of each rinse . Washout was a minimum of 60 h . Plaque scores and areas were significantly lower with chlorhexidine than the other preparations and significantly higher with saline . There were no significant differences between SLS and triclosan . The results were essentially consistent with the similar substantivity of SLS and triclosan demonstrated from the salivary bacterial count investigation . Taste acceptability may, however, explain the small reverse trends noted between the two studies . It is concluded that both SLS and triclosan would individually confer plaque inhibitory properties to toothpaste formulations . However, when combined in a single formulation, their effects may not be additive.

J In Vitro Fert Embryo Transf, 1991 Feb, 8(1), 24 - 32
Investigation of some antimicrobial procedures on the in vitro development of early murine embryos aimed toward developing methods for the disinfection of mammalian embryos prior to transfer; Bielanski A et al.; Eight-cell, zona pellucida-intact mouse embryos were exposed to the following substances or procedures that have been reported to have germicidal effects to determine if the embryos would survive and develop under in vitro conditions: the photosensitive substances hematoporphyrin, hematoporphyrin derivative, 8-methoxypsoralen, 4,5',8-trimethylpsoralen, and thiopyronine; the enzymes lipase (0.5%), phospholipase C (2 U/ml), chymotrypsin (0.5%), and trypsin (0.5%); pH 5.0; and helium/neon laser light, visible light, ultraviolet A light, and ultraviolet C light . Under the conditions used, embryos were not adversely affected by hematoporphyrin and/or helium/neon laser light; methoxypsoralen and/or ultraviolet A light; lipase; trypsin; pH 5.0 for 20 min; and visible light . Variable results were obtained from hematoporphyrin derivative with laser light . Thiopyronine, trimethylpsoralen in combination with ultraviolet A light, and ultraviolet C light killed embryos, and chymotrypsin and phospholipase C were harmful at 10- and 15-min exposure times, respectively.

Ann Neurol, 1991 Feb, 29(2), 202 - 9
Quinolinic acid in cerebrospinal fluid and serum in HIV-1 infection: relationship to clinical and neurological status; Heyes MP et al.; Quinolinic acid is an "excitotoxic" metabolite and an agonist of N-methyl-D-aspartate receptors . Of patients infected with human immunodeficiency virus type 1 (HIV-1) who were neurologically normal or exhibited only equivocal and subclinical signs of the acquired immunodeficiency syndrome (AIDS) dementia complex, concentrations of quinolinic acid in cerebrospinal fluid (CSF) were increased twofold in patients in the early stages of disease (Walter Reed stages 1 and 2) and averaged 3.8 times above normal in later-stage patients (Walter Reed stages 4 through 6) . However, in patients with either clinically overt AIDS dementia complex, aseptic meningitis, opportunistic infections, or neoplasms, CSF levels were elevated over 20-fold and generally paralleled the severity of cognitive and motor dysfunction . CSF concentrations of quinolinic acid were significantly correlated to the severity of the neuropsychological deficits . After treatment of AIDS dementia complex with zidovudine and treatment of the opportunistic infections with specific antimicrobial therapies, CSF levels of quinolinic acid decreased in parallel with clinical neurological improvement . By analysis of the relationship between levels of quinolinic acid in the CSF and serum and integrity of the blood-brain barrier, as measured by the CSF:serum albumin ratio, it appears that CSF levels of quinolinic acid may be derived predominantly from intracerebral sources and perhaps from the serum . While quinolinic acid may be another "marker" of host- and virus-mediated events in the brain, the established excitotoxic effects of quinolinic acid and the magnitude of the increases in CSF levels of the acid raise the possibility that quinolinic acid plays a direct role in the pathogenesis of brain dysfunction associated with HIV-1 infection.

Clin Pharmacokinet, 1991 Feb, 20(2), 135 - 50
Pharmacokinetic interactions between theophylline and other medication (Part II); Upton RA; Part I of this article, which appeared in the previous issue of the Journal, covered the effects or lack of effects on theophylline clearance of sympathomimetics, corticosteroids, antihistamines and other antiallergy drugs, antimicrobial agents, phenytoin, carbamazepine, barbiturates, antacids and activated charcoal . In Part II, this discussion is extended to the effects of other agents . Overall summaries, both textual and tabular, appear in Part I.

Antimicrob Agents Chemother, 1991 Feb, 35(2), 224 - 7
In vitro activities of lytic peptides against the sporozoites of Cryptosporidium parvum; Arrowood MJ et al.; Cryptosporidium parvum is a protozoan parasite that causes mild to severe diarrheal disease in animals and humans . There are currently no effective chemotherapeutic agents available for the treatment of cryptosporidiosis . Recent studies have described small, naturally occurring antimicrobial lytic peptides with antiprotozoal activities . In the present study, the anticryptosporidial activities of three synthetic lytic peptides were determined in an in vitro sporozoite susceptibility assay . Sporozoite viability was assessed microscopically by the uptake of the vital dyes fluorescein diacetate and propidium iodide . Sporozoite viability was reduced by 93.5% following a 60-min exposure to 10 microM Hecate-1 at 37 degrees C . Shiva-10 reduced sporozoite viability by approximately 74.0% after a 60-min exposure at 100 microM and 37 degrees C . The cecropin-b analog SB-37 reduced sporozoite viability by 6.0% following a 60-min exposure at 100 microM and 37 degrees C . A control peptide showed no anticryptosporidial activity.

Acta Trop, 1991 Feb, 48(4), 251 - 61
Constituents of Bidens pilosa L.: do the components found so far explain the use of this plant in traditional medicine?
Geissberger P, Sequin U.
The dried aerial parts of Bidens pilosa L . were extracted with petrol ether, chloroform, methanol, and methanol/water . The petrol ether and the methanol/water extracts showed some antimicrobial activity . Fractionation of the extracts yielded well known substances, most of which have, however, not yet been described as constituents of Bidens pilosa . Several of these substances have previously been shown to be biologically active . Thus, phenylheptatriyne, linolic acid and linolenic acid have antimicrobial activities . On the other hand, friedelin and friedelan-3 beta-ol, as well as several of the flavonoids found are anti-inflammatory agents . The detection of these compounds in extracts from B . pilosa may rationalize the use of this plant in traditional medicine in the treatment of wounds, against inflammations and against bacterial infections of the gastrointestinal tract.

J Antimicrob Chemother, 1991 Feb, 27(2), 171 - 6
Antimicrobial activity of rifabutin in combination with two and three other antimicrobial agents against strains of Mycobacterium paratuberculosis; Chiodini RJ; The inhibitory and bactericidal, synergistic, and antagonistic activities of rifabutin combined with ciprofloxacin, ethambutol, clofazimine, cefazolin, and amikacin in dual and triple combinations against various human and animal isolates of Mycobacterium paratuberculosis were determined . Synergism was observed when rifabutin was combined with either cefazolin or clofazimine in double combinations . The greatest amount of synergy occurred with the rifabutin-cefazolin combination in which bactericidal synergism was present with all strains . Of the triple combinations examined, only rifabutin in combination with ethambutol and cefazolin or streptomycin and cefazolin showed bactericidal synergism against most of the strains . Although antagonism was not observed in any double combination with rifabutin, antagonism was shown with several of the triple combinations . The rifabutin-cefazolin and rifabutin-streptomycin-cefazolin combinations were found to have the greatest bactericidal synergism at concentrations well within achievable serum and tissue levels and may be appropriate choices for chemotherapeutic use.

Schweiz Med Wochenschr, 1991 Jan 26, 121(4), 119 - 24
{Pneumonia: identification of respiratory pathogens}; Bille J; The etiological diagnosis of pneumonia is necessary because it will condition therapy . The broad spectrum of potential pathogens is reduced when the host's condition and the events around the pneumonia episode are taken in account . Community acquired pneumonia in an immunocompetent host most often is caused by bacteria (predominantly S . pneumoniae) or by mycoplasma or respiratory viruses . Microbiological diagnosis relies on direct sputum examination and culture (for bacterial agents) and on serology (for nonbacterial agents) . In a compromised host, the spectrum of etiological agents is broader; sputum examination often is unrewarding and invasive investigations are necessary . Bronchoscopy with bronchoalveolar lavage is increasingly used, allowing an abundant material to be analyzed with a battery of tests directed against the pathogens most probable in view of the clinical setting . Direct examinations with special stains for bacteria, fungi, parasites, and viruses offer a rapid diagnosis in some cases . Various cultural procedures for bacteria, viruses and fungi, particularly in the absence of previous antimicrobial therapy, will establish the etiological diagnosis in the majority of pneumonia cases and help to select specific therapy.

Cancer Res, 1991 Jan 15, 51(2), 672 - 5
Angiogenesis inhibition by minocycline; Tamargo RJ et al.; We describe a new inhibitor of angiogenesis, minocycline, a semisynthetic tetracycline antimicrobial with anticollagenase properties . Minocycline was incorporated into controlled release polymers and tested in the rabbit cornea against neovascularization in the presence of the VX2 carcinoma . Inhibition by minocycline was shown to be comparable to that of the combination of heparin and cortisone, a potent inhibitor of angiogenesis . Minocycline decreased tumor-induced angiogenesis by a factor of 4.5, 4.4, and 2.9 at 7, 14, and 21 days, respectively . At the end of the experiment, whereas the corneas with empty polymers had large, invasive, exophytic tumors, none of the corneas with minocycline had such vascular masses . Recently, studies of agents that disrupt collagen synthesis and deposition have yielded several new angiogenesis inhibitors . We suggest that investigation of agents that disrupt collagenolysis may similarly identify other angiogenesis inhibitors and further clarify the mechanisms of angiogenesis.

Klin Wochenschr, 1991 Jan 4, 69(1), 16 - 8
Pharmacokinetic interaction of antimicrobial agents with levomethadon in drug-addicted AIDS patients; Brockmeyer NH et al.; Morphine and its derivatives are metabolized by the liver microsomal enzyme system with a high first-pass effect after oral application . In four of 44 HIV-infected i.v . drug abusers who participated in a levomethadon maintenance program, we observed sustained symptoms of under-dosage and loss of effect of there to fore well-tolerated substitution therapy during rifampin treatment or therapy with zidovudine or fucidic acid . As a pharmacological model substance for cytochrome p 450 enzymes, measurement of antipyrine in serum by high pressure liquid chromatography revealed induction of cytochrome p 450 isoenzymes . The half-life of antipyrine decreased (patient 1 from 11.3 to 8.4 h and patient 2 from 10.7 to 7.6 h after rifampin, patient 3 from 12.2 to 8.6 h after fucidic acid, and patient 4 from 10.6 to 8.6 h after zidovudine) . In i.v . drug abusers on levomethadon maintenance programs, adjustment of the levomethadon dosage may be necessary when specific therapy for HIV infection and associated diseases requires the use of drugs known to be potent inducers of the liver microsomal enzyme system.

Kansenshogaku Zasshi, 1991 Jan, 65(1), 54 - 60
{Bacteriostatic activity of bovine colostrum}; Ushijima H et al.; Succeeding the previous report on antivirus activity of non immunized bovine colostrum immunoglobulin, we studied the bacteriostatic activity of the immunoglobulin, lactoferrin and lactoferrin Fe by using the automated antimicrobial susceptibility testing system . We have presented the representative positive and negative reactions . Then, we have reported that the immunoglobulin was effective in 10 of a total of 20 species which we examined . In some species, the lactoferrin was slightly more effective than the immunoglobulin was . These results indicated that the immunoglobulin, lactoferrin and lactoferrin Fe were useful for the bacteriostatic reaction.

Ann Dermatol Venereol, 1991, 118(3), 181 - 9
{Contact hypersensitivity to Kathon CG . Apropos of 35 cases among 977 tested subjects}; Ledieu G et al.; Kathon CG (Rohm and Haas) is a mixture of two isothiazolinones: chloromethylisothiazolinone and methylisothiazolinone . It is widely used in aqueous solution as antimicrobial agent in cosmetics (CG means cosmetic grade) instead of parabens . Routine testing is effected with Kathon CG in aqueous solution at 100 ppm (Trolab) in finn chamber tests on scanpor (ICDRG directives) . Between September 1987 and September 1989, 977 patients (538 women, 439 men) referred for suspected contact allergy were tested . Thirty-five patients (77 p . 100 of whom were young women) with a history of allergy to cosmetics were found to be positive . Face, hands or both were involved in 15, 7 and 9 cases respectively, and a lupus-like reaction was observed in one patient . Our results (frequency: 3.6 p . 100) were compared with previously published results ranging from 0.67 p . 100 to 16.1 p . 100 (tables IV and V) . Such wide variations can be explained by different selections of patients, different uses of cosmetics and lack of standardization in testing . Patch tests were strongly positive (quoted + +) in all cases . None of the irritant effects previously reported (3, 8, 28) was detected . In a control study carried out two months later, diluted patch tests (100, 50, 25, 15 and 7.5 ppm) were performed in 15 patients and were positive in 11 of them: 5 at 25 ppm, 1 at 15 ppm and 5 only at 100 ppm . Contrary to previous suggestions (7, 28, 36), there was no correlation between allergenic potential and minimal concentration, so that the "no response concentration" concept could not be confirmed.(ABSTRACT TRUNCATED AT 250 WORDS)

Rev Clin Esp, 1991 Jan, 188(1), 13 - 6
{The usefulness of the double-light telescopic catheter in the diagnosis of bacterial pneumonia in patients under mechanical ventilation}; Sole Violan J et al.; Fifty-eight patients who presented clinical criteria of pneumonia (fever, leukocytosis, purulent tracheo-bronchial secretions, and lung infiltrate of recent appearance in X-ray) were prospectively studied in order to determine the cost effectiveness {correction of rentability} of quantitative culture of bronchial secretions by means of a telescopic catheter (TC) in the diagnosis of bacterial pneumonia in patients under mechanical ventilation . In 25 patients (43%) a positive culture was obtained above 10(3) UFC/ml, confirming the pneumonia diagnosis in 17 cases and detecting a false positive result in one patient . In no case with a count less than 10(3) UFC/ml pneumonia diagnosis could be confirmed, being this diagnosis excluded in 24 of 33 patients with a count lower than 10(3) UFC/ml . These results suggest that the presence of fever, purulent tracheobronchial secretions and lung infiltrate in an intubated patient under mechanical ventilation does not indicate the presence of pneumonia in a high percentage of cases and that CT scan can identify those patients who require antimicrobial treatment, and this avoiding its use in patients who do not need it, with the resulting decrease in morbidity and high cost.

Infection, 1991, 19 Suppl 3, S150 - 3
A new method for assaying antimicrobials in the prostate; Philpott AC et al.; In this study we collected prostatectomy specimens from 20 men receiving selected preoperative antimicrobials: oral carbenicillin, norfloxacin, or ciprofloxacin . The prostatectomy specimens were then individually separated into stroma and epithelium . The intraprostatic differential concentrations were determined using High Performance Liquid Chromatography . The ratio of stromal to epithelial concentrations of the antimicrobials were calculated for carbenicillin (0.95), norfloxacin (1.28), and ciprofloxacin (1.1) . The quinolones tended to have higher stromal concentrations (although this was not statistically significant) . Carbenicillin was found in levels three times its MIC90 for Escherichia coli while the quinolones were detected in concentrations which greatly exceeded their E . coli MIC90S.

Infection, 1991, 19 Suppl 3, S126 - 30
Rat model of experimental bacterial prostatitis; Nickel JC et al.; A reproducible rat model of chronic bacterial prostatitis was developed employing a defined bacterial pathogen to study the pathophysiology of acute and chronic bacterial prostatitis . The progression of inflammation and its consequences following the retrograde introduction of bacteria through the acute and finally the chronic stages of prostatitis can be documented with microbiological, histological, ultrastructural and immunologic data . This model has many striking similarities to the natural history of human chronic bacterial prostatitis and further microbiological, antimicrobial and immune modulation or manipulation of this model should help us to further delineate the pathogenic mechanisms involved in this chronic infective disease.

Antibiot Khimioter, 1991 Jan, 36(1), 8 - 11
{Synthesis and properties of new rubomycin derivatives}; Olsuf'eva EN et al.; Condensation of rubomycin (daunorubicin) with respective hydrazides yielded novel substituted hydrazones: 13-cyanoacetyl hydrazone rubomycin, 13-L-phenylalanyl hydrazone rubomycin, 13-BOC-3-(uracilyl-1)-DL-alanyl hydrazone rubomycin and 13-BOC-3-(adenylyl-9)-DL-alanyl hydrazone rubomycin . With successive treatment of rubomycin with hydrazine hydrate and respective ketones novel asymmetric azines were prepared: 13-cyclopentylidene hydrazone rubomycin, 13-alpha,alpha'-dimethyl-cyclopentylidene hydrazone rubomycin and 13-(1-phenylethylidene-1) hydrazone rubomycin . 14-Adenylyl-N9-rubomycin was synthesized by interaction of 14-bromorubomycin with adenine and hydrogenation of its analog, 14-N-imidazolyl rubomycin by sodium borhydrite yielded 13-dihydro-14-N-imidazolyl rubomycin . There was observed correlation between the antimicrobial activity of the derivatives against B . mycoides and their cytostatic effect on the cells of murine leukemia NK/LI . The high in vitro activity of 13-cyclopentylidene hydrazone rubomycin showed satisfactory correlation with the results of the study on the antitumor effect in animals.

Pharmacotherapy, 1991, 11(2), 157 - 63
Antimicrobial prophylaxis for arthroplasty and total joint replacement: discussion and review of published clinical trials; Heath AF; Cephalosporins are often administered to prevent infections that can follow total joint replacements (TJR) and other arthroplastic procedures . However, recommendations contained within published guidelines and review articles vary greatly from those given by the manufacturer in product information circulars . Similarly, the results of published clinical trials vary substantially with regard to the choice of cephalosporin, the dose and dosing interval, and the duration of administration that should be used for antimicrobial prophylaxis in patients undergoing clean orthopedic procedures . Well-designed clinical trials provide data concerning the appropriate use of cephalosporins for preventing infections that may follow TJR or joint arthroplasty.

Chem Pharm Bull (Tokyo), 1991 Jan, 39(1), 218 - 20
Phytogrowth-inhibitory and antimicrobial activities of 3,4'-dihydroxy-alpha,beta-diethylstilbene, the isomer of diethylstilbestrol; Inamori Y et al.; 3,4'-Dihydroxy-alpha,beta-diethylstilbene (I), like diethylstilbestrol (II), showed phytogrowth-inhibitory and antimicrobial activities . First, compound I showed strong growth-inhibitory activity against the roots of two kinds of plants . The inhibitory activity of I was almost equal to that of sodium 2,4-dichlorophenoxyacetate used as a positive control . The phytogrowth-inhibitory activity of I was much higher than that of II . Next, unlike II, I had broad antifungal spectrum against phathogenic fungi . Compound I showed antifungal activity against six kinds of Fusarium oxysporum sp . This compound also had antibacterial activity against pathogenic and plant-pathogenic bacteria . These antibacterial activities of I were as high as those of II, the isomer of I . It should be emphasized that by shifting one of the phenolic hydroxyl groups of II to meta-position, phytogrowth-inhibitory activity was largely increased, while antimicrobial activity was unchanged.

Perit Dial Int, 1991, 11(1), 14 - 21
Host defense mechanisms in the peritoneal cavity of continuous ambulatory peritoneal dialysis patients . 1; Lewis S et al.; This article provides a review of studies on peritoneal white blood cells (WBC) in CAPD patients . To some extent these studies support the concept that the peritoneal cavity of these patients contains adequate-functioning WBC that can provide effective antimicrobial defenses when they are studied in dialysate-free media . Commercially available dialysis solutions significantly impair WBC function . In some patients with high incidences of peritonitis, there appears to be reduced bactericidal capacity of their peritoneal macrophages . CAPD seems to contribute to a state of both macrophage and lymphocyte activation in the peritoneal cavity . The clinical consequences of this chronic activation are not known.

Toxicon, 1991, 29(3), 321 - 8
A bactericidal protein in Bombina variegata pachypus skin venom; Mastromei G et al.; The skin venom of the yellow bellied toad Bombina variegata pachypus has an antimicrobial activity which seems to be correlated to the presence of a 6700 mol . wt polypeptide . This polypeptide was purified by electroelution from SDS-urea-polyacrylamide gels and characterized for its antimicrobial activity . A bactericidal action was detected at concentrations with little or no cytolytic effect . The determination of the Minimal Inhibitory Concentration showed that there was activity against gram positive and gram negative bacteria and also against yeasts . The skin secretions of three other anuran species (Bufo viridis, Hyla arborea and Discoglossus pictus) were examined for the presence of antimicrobial activities . Only the Hyla arborea secretion exhibited antimicrobial properties . A small amount of a 6700 mol . wt polypeptide was detected among the Hyla secreted products.

Arch Pharm (Weinheim), 1991 Jan, 324(1), 19 - 24
Synthesis of some thiazole-, 1,3,4-thiadiazole-, and 4H-1,2,4-triazole derivatives of pyrazolo{3,4-b}quinoline; Farghaly AM et al.; Three novel series of pyrazolo{3,4-b}quinolines were prepared, namely: 1-(3-substituted-4-phenylthiazolin-2-ylidene)hydrazinocarbonylm ethyl-1H-pyrazolo{3,4-b}quinolines 3a-d; 1-(5-substituted amino-1,3,4-thiadiazol-2-yl)methyl-1H-pyrazolo{3,4-b}quinolines 4b-d, and 1-(4-substituted-4H-5- thioxo-1,2,4-triazole-3-yl)methyl-1H-pyrazolo{3,4-b}quinolines 5a-d . These compounds were prepared by cyclization of the new key intermediates 1-(substituted thiocarbamoylhydrazinocarbonyl)methyl-1H- pyrazolo{3,4-b}quinolines 2a-d . The alkylthio, aralkylthio 6a-f as well as the Mannich bases 8a-f derived from compounds 5a-d were also prepared . The structures of the new compounds were elucidated by elemental analyses, IR, 1H-NMR-, and mass spectra . The antimicrobial as well as inotropic and chronotropic activities were studied.

J Ethnopharmacol, 1991 Jan, 31(1), 43 - 8
Traditional medicine of Baja California Sur (Mexico) . III . Carnosol: a diterpene antibiotic from Lepechinia hastata; Dimayuga RE et al.; The medicinal plant Lepechinia hastata, used as a remedy against uterine infections in Baja California Sur (Mexico), was shown to contain carnosol as the main diterpenoid secondary metabolite . Carnosol has potent in vitro antimicrobial activity . Detailed spectroscopical properties of carnosol are presented.

Clin Ther, 1991 Jan-Feb, 13(1), 189 - 93
The relationship of absorption characteristics and gastrointestinal side effects of oral antimicrobial agents; Grossman RF; Normal bowel flora play an important role in preserving gastrointestinal (GI) function . They inhibit colonization by pathogenic bacteria, help in the metabolism of by-products of drugs and endogenous substances, aid in the synthesis of vitamins, and stimulate nonspecific host immune systems that protect against potential pathogens . Antimicrobial agents that are poorly absorbed from the GI tract can substantially alter the bowel flora . Narrow-spectrum antimicrobial agents are less likely to disrupt the bowel flora than broad-spectrum agents . Drugs that undergo extensive enterohepatic circulation can also disrupt normal flora . Knowledge of the extent of GI absorption, bile excretion, and spectrum of activity allows prediction of the likelihood of GI side effects . For example, clindamycin, which is relatively poorly absorbed and has significant bile secretion, is associated with a high incidence of diarrhea . The use of an antibiotic with a relatively narrow spectrum, excellent GI absorption, and minimal bile excretion should reduce the incidence of GI side effects.

Scand J Infect Dis, 1991, 23(1), 89 - 95
Occurrence of doxycycline resistant bacteria in the oral cavity after local administration of doxycycline in patients with periodontal disease; Larsen T; Topical antimicrobial treatment is appearing as a means of therapy in patients with advanced periodontal disease . The purpose of the present study was to examine the occurrence of doxycycline resistant bacteria in subgingival plaque and oral cavity after local administration of doxycycline . Five patients with advanced marginal periodontitis were scaled, and one approximal pocket in each patient was additionally treated with locally delivered doxycycline . Microbiological samples were obtained from the test site, a contralateral control site and tongue and tonsils before treatment and 3, 13, 26 and 52 weeks after treatment . The occurrence and morphological distribution of doxycycline resistant bacteria was determined after anaerobic cultivation on enriched tryptic soy agar with and without doxycycline incorporated . At the test site and on tongue and tonsils the percentage of doxycycline resistant bacteria increased from less than 1% before treatment to 22% and 35%, respectively, immediately after treatment, but decreased again at week 13 . At the control site no increase was observed . Gram-positive cocci constituted the majority of doxycycline resistant bacteria at all 3 sampling sites (73-94%) . The morphological distribution of resistant bacteria was not affected by the doxycycline therapy . Thus, local doxycycline therapy resulted only in a transient increase in resistance in the oral microflora.

Surg Gynecol Obstet, 1991, 172 Suppl, 65 - 72
Design and evaluation of clinical trials of antimicrobial agents in surgery; Dellinger EP; Comparative trials of antibiotic therapy must be properly designed to produce meaningful results . Trials in the treatment of intra-abdominal infections are especially difficult to perform . Problems include finding adequate samples of comparable patients, establishing objective criteria by which to assess outcomes and controlling for the effects of nonexperimental factors . These difficulties are among the reasons many comparative trials of antibiotic therapy for intra-abdominal infection fail to find a difference in efficacy between the experimental regimens . Those trials that do demonstrate a therapeutic difference usually compare an adequate regimen against one that is clearly deficient; for example, one that lacks coverage of anaerobic organisms . For hospital acquired or surgical infections, the treatment regimen with the most extensive published support is the combination of an aminoglycoside and clindamycin . Single agent therapy for intra-abdominal infections may also be appropriate . Further clinical studies are needed, but two of the most promising agents are ticarcillin and clavulanic acid and imipenem and cilastatin.

Surg Gynecol Obstet, 1991, 172 Suppl, 36 - 41
Antibiotic therapy of intra-abdominal sepsis in the elderly: experience with ticarcillin and clavulanic acid; Fink MP; Age is a major factor in determining the outcome for older patients with intra-abdominal sepsis . Poor outcome in these patients may be related to a number of physiologic and immunologic changes associated with aging . The treatment of intra-abdominal sepsis can itself pose special risks for the elderly . Standard regimens containing aminoglycosides have a substantial risk of nephrotoxicity, which is magnified in elderly patients . Alternatives to standard aminoglycoside-containing regimens, therefore, are desirable . Most intra-abdominal infections involve multiple pathogens, usually both aerobic and anaerobic . The polymicrobial nature of intra-abdominal sepsis mandates antimicrobial chemotherapy effective against a broad range of organisms . In the past several years, a host of new antibiotics have been introduced that used alone or in combination with other drugs has the potential of safely avoiding aminoglycosides in many patients with intra-abdominal sepsis . One such agent, ticarcillin with clavulanate potassium, is active against a wide spectrum of aerobic and anaerobic pathogens . In a prospective, randomized, open label trial, ticarcillin and clavulanate was compared with gentamicin and clindamycin . Although the sample size was too small to allow meaningful statistical comparisons of efficacy and safety, both regimens were effective and well tolerated . In general, prolonged administration of aminoglycosides is rarely indicated for the treatment of intra-abdominal sepsis in the elderly, although initial empiric use of aminoglycosides may sometimes be warranted.

Mt Sinai J Med, 1991 Jan, 58(1), 19 - 27
Preoperative preventive antimicrobial therapy; Neibart E; Prophylactic antibiotics play a significant role in the management of the modern surgical patient . Guidelines for their use have been presented . Marked variations in nosocomial pathogens and their resistance patterns exist among institutions and surgical procedures are frequently far from routine owing to a variety of perioperative circumstances . A willingness to monitor and alter protocols based on local observations and newly published data remains imperative.

Aust Vet J, 1991 Jan, 68(1), 8 - 9
Chloramphenicol 4 . Responsible topical use in ophthalmology; Blogg JR; Chloramphenicol has gained widespread use in the topical treatment of ocular infections . The rationale for this use was based on the ability of chloramphenicol to penetrate the cornea and enter the anterior segment, together with its broad spectrum of antimicrobial activity . However, routine use in corneal ulceration or keratitis is not desirable . Hypopyon, when present, is usually sterile . Concerns about human exposure to chloramphenicol and its recent prohibition of use in food-producing animals, raise the need to review its indications and discuss alternatives . The role of chloramphenicol in ocular therapeutics is examined in this article.

Rev Infect Dis, 1991 Jan-Feb, 13 Suppl 2, S164 - 9
Characteristics of the ideal antibiotic for prevention of wound sepsis among military forces in the field; Hell K; Prompt administration of antibiotics is of the utmost importance in the treatment of wounds inflicted during a war or disaster . A single injection of a broad-spectrum drug with a long half-life should be given prophylactically to personnel on the battlefield to provide bactericidal coverage from the earliest possible moment after injury occurs . The antibiotic must remain effective at least throughout the period of transport to hospital and surgery . Use of antimicrobial agents will never replace careful surgical debridement, and these drugs should be used again later only if a bacterial infection develops . Other considerations include the choice of a drug that penetrates tissue thoroughly, is simple to store and administer, is easily available, and is cost effective.

Rev Infect Dis, 1991 Jan-Feb, 13(1), 120 - 6
Pericardial actinomycosis: case report and review; Fife TD et al.; Pericardial actinomycosis is rare and frequently goes unrecognized during life, a circumstance due in part to a paucity of clinical manifestations and to a low rate of positivity in cultures . We present a case report of pericardial actinomycosis and a review of 18 other cases reported in the literature since 1950 . Possible risk factors include aspiration pneumonia, alcohol abuse, and periodontal disease . Actinomyces may cause purulent pericarditis that evolves into cardiac tamponade or constrictive pericarditis . Clues to the identity of the causative organism (e.g., draining sinus tracts and the presence of sulfur granules) are frequently absent, and cultures often fail to yield the organism . Histologic examination of material obtained by biopsy is often necessary to make the diagnosis . Most cases originate from a thoracopulmonary site of actinomycosis and spread directly to the pericardium . Widespread dissemination to extrathoracic organs is uncommon . Treatment consists of high-dose, long-term antimicrobial therapy as well as drainage of the pericardial space.

Med Radiol (Mosk), 1991, 36(3), 29 - 32
{Experience in treating the victims of the accident at the Chernobyl Atomic Electric Power Station and the immediate disease outcomes}; Baranov AE et al.; The paper is concerned with the results of therapy of 115 patients with acute radiation syndrome after the Chernobyl accident . The chief methods of the effective therapy of bone marrow syndrome are antimicrobial drugs and fresh donor platelet mass transfusions . Hemopoietic stem cell transplantation (allogenic bone marrow or embryonic hepatocytes) is indicated and effective in a very limited number of patients in accident irradiation . Severe beta-burns of the skin remain an unsolved problem as a result of their spreading . Organizational principles of therapy of a great number of patients with acute radiation syndrome in a specialized hospital were described.

Antimicrob Agents Chemother, 1991 Jan, 35(1), 158 - 63
Furazolidone and nitrofurantoin in the treatment of experimental Pneumocystis carinii pneumonia; Walzer PD et al.; Furazolidone and nitrofurantoin, oral nitrofuran derivatives with broad-spectrum antimicrobial properties already in clinical use, were compared for activity against Pneumocystis carinii in an immunosuppressed rat model of P . carinii pneumonia . Furazolidone exhibited only slight activity as a prophylactic agent but was moderately effective in the therapy of pneumocystosis . The median histologic score and organism count fell from 4+ and 10(8) to 10(9) cysts per lung, respectively, in the controls to 1+ to 2+ and 10(7) to 10(8) cysts per lung, respectively, in the furazolidone-treated groups . However, these results were not as good as those obtained with the standard drug, trimethoprim-sulfamethoxazole (0+, 10(6) to 10(7) cysts per lung) . Nitrofurantoin showed little anti-P . carinii activity despite different doses or drug preparations . The high doses of furazolidone used here and their toxic effects on the rats will probably discourage investigation of this drug in the treatment of pneumocystosis in humans . Nevertheless, since many nitrofurans have been synthesized, further exploration of this class of compounds might be helpful in developing new anti-P . carinii agents or in studying structure-activity relationships.

J Biomater Appl, 1991 Jan, 5(3), 173 - 84
Antimicrobial activity of polymers coated with iodine-complexed polyvinylpyrrolidone; Kristinsson KG et al.; Polymer-associated infection is a problem of increasing importance in modern medicine . In a new approach to prevent such infections we have modified polyvinylfluoride (TEDLAR) films by graft copolymerization with N-vinylpyrrolidone to which iodine can be complexed . Grafting reaction was performed by the preirradiation technique using an electron accelerator . Grafted films were then treated in Lugol's solution for at least 24 h . Release of free iodine from the films was determined either by titration or using the agar disc diffusion test, showing an iodine release for up to 4-5 days . The antimicrobial activity of the films was tested in bacterial adhesion measurements . Bacterial and fungal cells in the range of 10(3) to 10(6) cfu/cm2 polymer were found on control samples without iodine, whereas on iodine-complexed films no viable cells could be detected at least for 5 days or even longer . Thus, microbial adhesion and growth can be inhibited by iodine-containing polymers.

Infection, 1991 Jan-Feb, 19(1), 44 - 5
Bilateral mammary abscess and uveitis caused by Brucella melitensis--report of a case; Gasser I et al.; Soft tissue locations of Brucella are a rare finding . We report the isolation of Brucella melitensis from a suspected breast tumour of a woman who also showed signs of uveitis . Three weeks after surgical drainage and despite antimicrobial therapy a new abscess developed on the other breast whose culture also yielded Brucella . As observed, unusual localization of brucellosis without previous penetrating injury may be the only manifestation of chronic infection.

Diagn Microbiol Infect Dis, 1991 Jan-Feb, 14(1), 7 - 10
Application of DNA probes to antimicrobial susceptibility testing of Legionella pneumophila; Reznicek M et al.; The commercial availability of a DNA probe assay for the detection of Legionella (Gen-Probe Incorporated, San Diego, CA) provides a unique opportunity to investigate the application of this technology to antibiotic susceptibility testing of L . pneumophila . We examined the ability of erythromycin, rifampin, and ciprofloxacin to kill L . pneumophila in buffered ACES-yeast extract broth (YEB) . The test organism was incubated for a total of 96 hr in the presence of 10 micrograms/ml erythromycin, 1 micrograms/ml rifampin, or 1 micrograms/ml ciprofloxacin . Growth was monitored at 24-hr intervals by quantitative plating and the DNA probe assay . The correlation between organism concentration {colony-forming units (CFU) per ml} and DNA probe activity (counts per min) was excellent (r = 0.97) . The percent decrease in CFU/ml at 96 hr relative to control counts was greater than 99% for erythromycin, rifampin, and ciprofloxacin . The percent decrease in CPM at 96 hr versus control was 87% for erythromycin, 89% for rifampin, and 93% for ciprofloxacin . This data documents a novel application of DNA probe technology, which may be useful in future studies of in vitro susceptibility of Legionella to various agents.

Pharmacotherapy, 1991, 11(1 ( Pt 2)), 6S - 13S
Antimicrobials and therapeutic decision making: an historical perspective; Quintiliani R et al.; In an effort to remedy inappropriate and excessive use of antimicrobials and to control costs, most hospitals have developed some type of antimicrobial management program . At Hartford Hospital, our most effective approaches have been those that reduce the chances for physician error, decrease the burden on ancillary services, and encourage short hospital stays . These include automatic correction of dose and dosing intervals of antimicrobials and, if possible, their conversion by pharmacy to cost-effective alternative agents; daily review of patients who are taking the drugs by an antimicrobial team; and replacement of parenteral with oral agents as soon as possible . Physician acceptance of these approaches will require significant changes in traditional prescribing styles and willingness to allow pharmacists to implement the recommendations of therapeutic and medical staff committees.

Pharmacotherapy, 1991, 11(1 ( Pt 2)), 4S - 5S
Antimicrobial cost and quality control: challenges in the 1990s; Barriere SL; Increasing constraints on health care reimbursement, competition among hospitals, and new high-cost technologies all contribute to escalation of costs in hospitals . The goal in the 1990s is to provide optimum, cost-effective care for patients without compromising quality . Among many proved methods is an effective formulary system with explicit criteria for use of medications, guidelines for use in specialized circumstances, and suggestions for therapeutic alternatives . This last method of cost control received endorsement from several organizations and offers an important function for hospital pharmacists . Hospital pharmacies can play a major role in minimizing antimicrobial costs and promoting optimum patient care.

Pharmacotherapy, 1991, 11(1 ( Pt 2)), 32S - 35S
Antimicrobial formulary management: meeting the challenge in a health maintenance organization; Carlson JA; Group Health Cooperative of Puget Sound is a consumer-governed health maintenance organization with approximately 380,000 enrollees . The enrollees are provided pharmacy services at 3 hospital locations, 28 primary care clinics, and 4 specialty care clinics . A Pharmacy and Therapeutics Committee (P&T) oversees cooperative-wide formulary management of all medications used for inpatients and outpatients, thus decreasing the stock of medications in all the pharmacy locations while providing representative drugs from all therapeutic classes . A subcommittee of the P&T committee, the Antibiotic Usage Review Group, manages the antimicrobial formulary . It consists of staff members from infectious disease, nursing, pulmonary medicine, family practice medicine, and pharmacy departments . The group provides recommendations based on seven specific areas; reviewing requests from prescribers for the addition of new antimicrobial agents to the formulary; evaluating antimicrobial agents by drug class; reviewing potential drugs for therapeutic interchange; developing use criteria for specific antimicrobial agents or classes; developing treatment algorithms for specific infectious diseases; performing drug use evaluations for antimicrobial agents; and approving the use of nonformulary antimicrobial agents . This approach has limited the inappropriate prescribing of antimicrobials and has increased the medical staff's knowledge on appropriate use of these agents.

Pharmacotherapy, 1991, 11(1 ( Pt 2)), 27S - 31S
Antimicrobial formulary management: a case study in a teaching hospital; Wright DB; The role of the formulary system for effective cost containment is becoming increasingly important . With antimicrobial agents taking up a large proportion of most pharmaceutical budgets, this group of agents is an obvious target for cost reduction . The responsible interchange of selected antimicrobial agents offers a promising method to achieve this goal . The Pharmacy and Therapeutics Committee at Henry Ford Hospital implemented the formulary replacement of cefoxitin with cefotetan on a cost basis after the agents were evaluated and considered to be therapeutically equivalent . Drug usage guidelines were developed to implement this change . Educational materials were distributed to the medical staff, and lectures on the appropriate use of cefotetan were given to the house staff . On implementation, all orders written for cefoxitin were automatically changed to cefotetan in the appropriate dosage . After the first 12 months of cefotetan usage no unanticipated problems with treatment failures or adverse effects were noted . Based on analysis of cefotetan use for the first year, a savings of +4F229,811 was achieved with this interchange.

Pharmacotherapy, 1991, 11(1 ( Pt 2)), 19S - 26S
Antimicrobial formulary management: meeting the challenge in the community hospital; Rush DR; We established a casework approach to develop an antibiotic formulary for a large community hospital . The program consists of a combination of comprehensive clinical and administrative strategies designed to reduce antimicrobial expenditures and improve the quality of antibiotic prescribing . Strategies included a background document summarizing each pharmacologic group of antimicrobial drugs and formulary preferences, presentations to medical and surgical departments, development of drug use evaluation strategies that complement the development of the formulary, and a monitoring program for nonformulary antibiotic use . The development of a customized microbiologic/antibiotic susceptibility report card specific to the institution's inpatient and outpatient microflora was an integral part of the program . This tool also allowed for the continuous compilation of comparison data and development of prescribing tips . Predetermined criteria were established providing physicians with microorganism susceptibility reports and preferred treatment alternatives linked to pharmacoeconomic concerns . These strategies can be implemented with or without direct clinical pharmacotherapy specialist involvement at the individual patient care level.

Pharmacotherapy, 1991, 11(1 ( Pt 2)), 14S - 18S
Antimicrobial formulary management: a consultant's perspective; Holzman MS; Health care administrators are concerned with the need for cost containment, including how pharmacies may contribute to cost savings . They also must be aware of how quality assurance activities and cost containment are related . Various techniques are available for reducing antibiotic costs, such as formulary alternatives, improving pricing, use of guidelines, controlling dosage frequency and strength, and converting from intravenous to oral route of administration . Two kinds of savings are involved: soft and hard . Soft savings are usually not real in the sense that overall hospital expenses will probably not be reduced as a result of implementing change . Hard savings will increase a hospital's profits and reduce expenses as a result of the intended change.

Vet Surg, 1991 Jan-Feb, 20(1), 21 - 9
Closed suction drainage in the treatment of infectious arthritis of the equine tarsocrural joint; Ross MW et al.; Infectious arthritis of the tarsocrural joint was treated in 13 horses with closed suction drainage through a flat, fenestrated, latex (Jackson-Pratt) drain, broad-spectrum antimicrobial agents, nonsteroidal anti-inflammatory drugs, and bandage immobilization . In 11 horses, arthroscopic lavage and debridement were also performed . Ingress drains were placed for lavage in six horses . Ten horses returned to their previous level of competition or were sound . One horse raced but had lameness of the affected tarsocrural joint and dropped in racing class; one horse was euthanatized because of laminitis in the supporting limb; and one horse was lame, but useful as a breeding animal . Closed suction drainage appeared to be a useful treatment in horses with infectious arthritis . Although arthroscopy was not necessary, it facilitated fibrin removal, lavage, and partial synovectomy . Because of the development of Pseudomonas superinfection in one horse, the use of simultaneous ingress catheters was not recommended.

JPEN J Parenter Enteral Nutr, 1991 Jan-Feb, 15(1), 60 - 4
Nonenzymatic glycosylation of immunoglobulin G impairs complement fixation; Hennessey PJ et al.; Transient hyperglycemia in patients receiving total parenteral nutrition may be associated with impaired immune function . The effects of short-term hyperglycemia on one aspect of antimicrobial immune function, ie, the ability of IgG to fix complement, were investigated . Aliquots of anti-human albumin, anti-horse ferritin, and anti-alkaline phosphatase were incubated for 0, 8, 16, 24, 48, and 96 hr with either 0 or 240 mg of glucose per deciliter of buffer . All samples were analyzed for the degree of glycation using a thiobarbituric acid assay, and for complement fixation ability using a microcomplement fixation assay . Significant increases in glycation over control samples were observed after only 16 hr (31 vs 15 mmol 5-hydroxymethylfurfural/mol IgG, p less than 0.01) . Complement fixation was significantly altered after 48 hr of incubation (76 +/- 5% vs 90 +/- 8% total serum complement fixed by albumin/anti-albumin complex, p less than 0.03) when four of the 84 (4.7%) IgG lysine residues were glycated . It is demonstrated that a significant reduction in complement fixation by immunoglobulin occurs with elevated glucose concentrations and that this may play a clinically significant role in transiently hyperglycemic patients.

Pediatr Infect Dis J, 1991 Jan, 10(1), 30 - 3
Antimicrobial drug suspensions: a blind comparison of taste of fourteen common pediatric drugs; Ruff ME et al.; Children of preschool age most often receive medications in liquid form, and smell and taste are major determinants in achieving compliance . We compared smell, taste and other characteristics of 14 commonly prescribed antimicrobial suspensions in a blind test in 30 adult volunteers to determine whether there was a difference in their acceptability . A significant difference was observed with cephalosporins ranking highest and penicillins ranking lowest . Our findings support anecdotal observations and claims often made by parents that cephalosporin antimicrobial suspensions taste good and are readily accepted by children and that penicillin suspensions have an unpleasant taste and aftertaste and are poorly accepted . Other drugs had intermediate scores . Of the two erythromycin suspensions evaluated, Ilosone tested superior to Erythromycin ES.

J Infect, 1991 Jan, 22(1), 37 - 40
Long-term antimicrobial therapy in the prevention of recurrent soft-tissue infections; Kremer M et al.; Thirty-six patients who had suffered two or more episodes of erysipelas or cellulitis during the previous year were randomly divided into two equal groups; one group received erythromycin base 250 mg b.i.d . for 18 months, while the other group received no prophylaxis for a similar period . No patients in the treated group developed infection during the 18 months' follow-up but eight of the control group (50%) relapsed and required antibiotic treatment . Prolonged antimicrobial prophylaxis is effective and safe in preventing recurrent episodes of soft-tissue infections.

Aust N Z J Surg, 1991 Jan, 61(1), 29 - 33
A survey of antimicrobial prophylaxis in elective colorectal surgery in New Zealand; Mercer PM et al.; In 1988 a survey of New Zealand general surgeons was conducted, by post, on the subject of routine antimicrobial prophylaxis for elective colorectal surgery . Surgeons who gave routine prophylaxis were asked for details of their regimens; those who did not were asked for their reasons . One hundred and seventy-five questionnaires were distributed and 167 were returned . Of these, 124 came from surgeons with a colorectal practice, and 118 of the 124 surgeons satisfactorily completed the questionnaire . Routine antimicrobial prophylaxis was given by 96.6% (114 of 118) . Of the 114 surgeons prescribing prophylaxis, one antimicrobial agent was used by 36.8%, two were employed by 53.5% and three or five were used by the remainder . The most commonly used (74.6%) antimicrobial agents were cephalosporins which were prescribed, alone or in combination with a nitroimidazole . The most frequent duration (46.4%) of antimicrobial administration was a combination of both the peri- and postoperative periods . When antimicrobial spectrum, route and duration of administration were all taken into account, 49.1% (56 of 114) were considered to give satisfactory regimens . Excessively protracted administration was the most frequent reason for unsatisfactory classification . The results of this survey demonstrate serious deficiencies in the practice of antimicrobial prophylaxis in elective colorectal surgery . These should be addressed through a programme of continuing education.

J Pediatr Health Care, 1991 Jan-Feb, 5(1), 24 - 30
Cystic fibrosis, intravenous antibiotics, and home therapy; Hammond LJ et al.; The survival rate of patients with cystic fibrosis has improved considerably in the last 20 years . Although not all of the factors accounting for this change are understood, aggressive nutritional management and treatment of pulmonary exacerbations certainly play a role . Home intravenous (IV) antibiotic delivery for pulmonary exacerbation has proved to be as effective as hospital treatment and offers significant advantages to the patient and family . This article examines the microbiology of pulmonary infections in patients with cystic fibrosis, as well as antimicrobial therapy, methods of IV administration, home IV therapy, and the nurse practitioner's role in this home program in the future.

Urology, 1991 Jan, 37(1), 61 - 4
Anal submucosal injection: a new route for drug administration . VI . Chronic prostatitis: a new modality of treatment with report of eleven cases; Shafik A; The anal submucosal route was used for the treatment of chronic bacterial prostatitis in 11 patients . Prior to presentation, the patients had received different antimicrobial agents; the symptoms disappeared only to recur whenever the drug was discontinued . After repeated failure, the patients were treated with gentamicin to which the organisms were sensitive, via the anal submucosal route . A daily injection was given for ten days on an outpatient basis . The technique of injection is described . The patients were followed up clinically and by segmented cultures for three years . No anorectal complications were encountered as had been demonstrated experimentally . The symptoms of chronic prostatitis disappeared, and culture was negative by the end of treatment and for two to three years thereafter in all patients . It appears that the antimicrobial agent, via anal route, reaches the prostatic tissues at a higher concentration than that of the serum . The route adopted by the drug to reach the prostate from the anal submucosa is presented.

Yao Xue Xue Bao, 1991, 26(3), 175 - 82
{Synthesis and antimicrobial activity of 7-acylamido-3-1, 2, 3-triazol-1-ylmethyl) cephalosporins}; Zhang CY et al.; In order to develop oral cephalosporin exhibiting broad-spectrum activity, a series of cephalosporin derivatives (VIII1-12) bearing 1, 2, 3-triazolymethyl substituents on the C3 position were synthesized . 7-Phenylacetamido-3-methyl-3-cephem-4-carboxylic acid (I) was employed as starting material and converted to VIII by procedures of esterification and oxidation, bromination, azido-substitution, dipolarcycloaddition, deprotection, cleavage, and condensation . Minimum inhibitory concentration (MIC) values in vitro showed that VIII2-4.9-11 had a wide antibacterial spectrum against Gram positive and Gram negative bacteria and possessed high activities . Further biological evaluation and the study of oral absorption for the six compounds will be performed.

Acta Paediatr Scand Suppl, 1991, 374, 151 - 9
Appropriate diets for the rehabilitation of malnourished children in the community setting; Brown KH; The treatment of severe PEM includes--as appropriate in individual patients--fluid and electrolyte therapy, antimicrobial drugs, dietary management, and social and behavioral counseling . Except in the case of severe anorexia or life-threatening infections or dehydration, nutritional rehabilitation can be completed in the community setting, using centrally-processed or locally-prepared food mixtures and, when necessary, supplemental vitamins, minerals, and trace elements . Energy intakes should be maximized to promote rapid recovery, and protein: energy ratios must be increased according to the expected rate of weight gain . Nutrient: energy densities should meet or exceed the RDAs . Cultural and economic factors must be considered in the formulation of mixed diets, and organoleptic characteristics of the enhanced recipe(s) must be appropriate for young children . Selected issues concerning implementation of a community-based rehabilitation program are discussed.

Nephron, 1991, 59(1), 80 - 3
Biochemical and pharmacodynamic studies of simple renal cyst fluids in relation to infection; Ohkawa M et al.; Biochemical analysis of renal cyst fluid was performed in 53 patients with simple renal cysts including 2 infected cases . The composition of noninfected cyst fluid tended to parallel that of serum . Additionally, the penetration of amikacin into cyst fluid was studied in 2 infected and in 11 noninfected patients following a single 200-mg intramuscular injection of amikacin . Drug levels in the fluid were below detection limit in the noninfected and approximately half or less of the serum values in the infected patients . These data may explain one of the reasons why infection of simple renal cysts is highly resistant to antimicrobial chemotherapy . The value of treatment by percutaneous aspiration and drainage of infected cysts is emphasized.

J Hyg Epidemiol Microbiol Immunol, 1991, 35(2), 157 - 61
In vitro antimicrobial efficacy of Centratherum anthelminticum seeds extracts; Sharma S et al.; The in vitro antimicrobial efficacy of different extracts of seeds of Centratherum anthelminticum was studied by the filter paper disk method against several human pathogenic bacteria and fungi . Some of the extracts showed significant effect over tested bacteria and fungi.

Ciba Found Symp, 1991, 158, 128 - 42; discussion 142-6, 204-12
Binding of antibiotics to DNA; Waring M; The DNA molecule can serve as host to numerous guest ligands, some of which are antibiotics, and almost all of which are endowed with anticancer or antimicrobial activity . Many guest ligands are quite large and complex in structure, and an array of intermolecular contacts underlie their complementarity to their macromolecular receptor . Often the process of molecular recognition involves conformational adjustments on the part of the interacting species, but the lion's share of the adjusting is demanded of the DNA helix which commonly ends up considerably distorted . Generally the lock must bend to accommodate the key . Two fundamentally different modes of binding can be identified: intercalation and minor groove-binding . The former mode is exemplified by daunomycin or actinomycin and the latter by netropsin or distamycin . Intercalation is associated with substantial extension and unwinding of the helix whereas groove binding is characterized by replacement of the spine of hydration and by lesser effects on helix geometry such as local bending . Bifunctional (or bis-) intercalation, as seen with echinomycin, causes the most far-reaching perturbations in the structure of DNA . It might even involve altered base pairing, which has been observed in complexes between echinomycin and oligonucleotides but has not yet been detected with macromolecular DNA in solution.

Pathobiology, 1991, 59(3), 182 - 4
Tumor necrosis factor-alpha: central regulatory cytokine in the induction of macrophage antimicrobial activities; Nacy CA et al.; Expression of activated macrophage resistance to infection requires the cooperative interaction of interferon-gamma (IFN-gamma) and either interleukin-2 (IL-2), interleukin-4 or granulocyte/macrophage-colony-stimulating factor: no single cytokine is effective . For IFN-gamma and IL-2, the effector activity can be suppressed by the presence of anti-tumor necrosis factor-alpha (TNF-alpha) antibodies in the reaction mixture . IFN-gamma and IL-2, only in combination, induce TNF-alpha-specific mRNA and secretion of this cytokine by macrophages . Development of intracellular killing activity by activated macrophages also requires the autocrine effects of TNF-alpha . IFN-gamma provides the first signal for the production of nitric oxide (NO), the effector molecule for intracellular destruction of parasites . When IFN-gamma-treated cells are infected with pathogens, they are stimulated to make TNF-alpha . Expression of intracellular killing, as well as production of NO, is inhibited by anti-TNF-alpha antibody.

Biotherapy, 1991, 3(3), 265 - 72
The synergistic effects of gamma interferon and clofazimine on phagocyte function: restoration of inhibition due to a 25 kilodalton fraction from Mycobacterium tuberculosis; Parak RB et al.; A 25 kDa glycolipoprotein from Mycobacterium tuberculosis has been shown to inhibit phagocyte functions associated with antimicrobial activity . These include the intracellular killing ability, reduction of nitro blue tetrazolium, hydrogen peroxide production and lysosyme release of polymorphonuclear leukocytes and peripheral blood monocytes . The present study undertook to investigate the synergistic effects of gamma interferon and clofazimine on restoring the inhibitory activities of the 25 kDa glycolipoprotein on these phagocyte functions . Gamma interferon and clofazimine at concentrations of 25 units/ml and 0.3 micrograms/ml acted synergistically by completely restoring all these systems . Independent use of these agents were unable to affect phagocyte functions or to restore the inhibition caused by the 25 kDa mycobacterial component . These studies indicate the possible use of these two phagocyte priming agents for the immunotherapy of tuberculosis.

J Nat Prod, 1991 Jan-Feb, 54(1), 213 - 7
Auranticins A and B: two new depsidones from a mangrove isolate of the fungus Preussia aurantiaca; Poch GK et al.; Auranticins A and B, two new antimicrobial depsidones, have been obtained from a mangrove isolate of the fungus Preussia aurantiaca . The structures were determined through analysis of selective INEPT, decoupling, COSY, and NOESY experiments.

Clin Ther, 1991 Jan-Feb, 13(1), 194 - 8
Microbial-host interactions in the airways in chronic respiratory infection; Cole PJ; The pathogenic events that take place in chronic respiratory infection highlight the successful microbial strategy of survival by persistence, or colonization . Microorganisms implement their strategy of persistence by two principal tactics: (1) sabotage of the host's bronchial defenses (ie, direct microbe-mediated damage to the host), and (2) subversion of the host's normally protective defenses into damaging host tissue itself (ie, indirect host-mediated damage provoked by the microbe) . Among the various ways in which microorganisms directly damage host defenses and facilitate their own persistence in the respiratory tract are inhibition of ciliary function, inhibition of mucociliary transport, alteration of ion transport in respiratory epithelium, stimulation of mucus production, and damage to respiratory epithelium . Patients with chronic respiratory infection suffer a vicious circle of events leading to progressive lung damage and cardio-respiratory failure . Treatments to break this circle include antimicrobial therapy to reduce microbial colonization and anti-inflammatory/immunosuppressive therapy to modulate damaging host responses.

J Am Vet Med Assoc, 1991 Jan 1, 198(1), 132 - 4
Neurologic manifestations of trypanosomiasis in a dog; Berger SL et al.; A 13-month-old Doberman Pinscher was evaluated because of slowly progressive paraparesis and signs of depression . The dog had temporal, supraspinatus, and infraspinatus muscle atrophy, bilateral enophthalmos, superficial inguinal lymphadenopathy, tachycardia with pulse deficits, and lesions of active and inactive chorioretinitis . Neurologic abnormalities included hyperreflexic patellar reflexes, lack of conscious proprioception, signs of superficial pain in the hind limbs, and depressed hopping reflexes in the forelimbs . Cranial nerve abnormalities included decreased sensation in the left nostril and a delayed gag reflex . Results of cerebrospinal fluid analysis were characteristic of nonsuppurative inflammation . A diagnosis of multifocal neurologic disease was made . The dog did not have serum titers for fungal diseases, canine distemper, Ehrlichia canis infection, borreliosis, Rocky Mountain spotted fever, or toxoplasmosis . The dog did not respond to various antimicrobial treatments, and only slightly responded to corticosteroid treatment . The dog died during an anesthetic procedure . The postmortem diagnosis of Trypanosoma cruzi infection (canine Chagas disease) was made on identification of the amastigote form of the organism in sections of brain, spinal cord, and myocardium.

J Pediatr, 1991 Jan, 118(1), 30 - 3
Role of Chlamydia pneumoniae in acute chest syndrome of sickle cell disease; Miller ST et al.; Children with sickle cell disease and acute chest syndrome were investigated for infection with Chlamydia pneumoniae and Mycoplasma pneumoniae . Of 30 patients who had 32 episodes of acute chest syndrome, four (13%) had C . pneumoniae isolated from the nasopharynx; two of these also had serologic evidence of acute infection, and one had positive nasopharyngeal isolates on two subsequent occasions during the course of 1 year with stable, elevated titers of anti-C . pneumoniae IgG, suggesting chronic infection . Two patients with negative cultures had serologic evidence of infection with C . pneumoniae . None of 32 cultures for M . pneumoniae were positive, and although anti-M . pneumoniae IgM developed in two patients, one of these patients had evidence of C . pneumoniae infection (positive culture and seroconversion) . We conclude that C . pneumoniae infection is prevalent in our sickle cell population with acute chest syndrome . Until further studies clarify the pathophysiologic significance of C . pneumoniae infection, we believe that early inclusion of erythromycin as antimicrobial therapy for acute chest syndrome seems reasonable.

Chemotherapy, 1991, 37(3), 206 - 11
Inhibitory effect of tachyplesin I on the proliferation of human immunodeficiency virus in vitro; Morimoto M et al.; An antimicrobial peptide, tachyplesin I, isolated from hemocytes of the Japanese horseshoe crab (Tachypleus tridentatus) was examined for its inhibitory effects on human immunodeficiency virus (HIV) infection in vitro . At a concentration of 7.5 micrograms/ml, tachyplesin I suppressed the development of cytopathic effects (CPE) by more than 70% in MT-4 cells infected with HIV (lymphadenopathy-associated virus) . This inhibitory effect was observed only when the drug was added during the adsorption period of the virus to the cells . In cocultures of MOLT-4 and persistently HIV-infected cells (MOLT-4/HIV), tachyplesin I at the same concentration completely inhibited multinucleated giant cell formation . Infectivity of HIV was reduced by 10(-2.5) in medium free from fetal calf serum containing tachyplesin I at a concentration of 200 micrograms/ml . Tachyplesin I did not show any inhibitory effect on reverse transcriptase activity of HIV at concentrations of 9-80 micrograms/ml at which tachyplesin I inhibited HIV infection . These results suggest that the anti-HIV action of tachyplesin I was due to the inhibition of virus adsorption.

Clin Rev Allergy, 1991 Spring-Summer, 9(1-2), 87 - 102
The impact of respiratory viral infections in patients with cystic fibrosis; Prober CG; Respiratory viruses have been implicated in pulmonary exacerbations of CF and in the long-term course of pulmonary dysfunction in these patients . However, the data are by no means complete and there is the clear need for more intensive evaluations of the role of viral pathogens in this population . Further controlled prospective studies assessing the impact of viral infections in large cohorts of patients with CF are still necessary . Placebo-controlled, antiviral treatment protocols also should be initiated . In clinical practice at the present time, patients with CF should be assessed for respiratory viral infections, at least at the time of hospitalizations for pulmonary deterioration . This assessment should include obtaining specimens from the respiratory tract for viral cultures and rapid respiratory viral antigen detection . Identifying a respiratory viral infection may alter clinical care . The patient can be isolated appropriately, and it may be possible to reduce the intensive use of expensive and potentially toxic parenteral antibiotics . The role of antiviral therapy in these patients must await further evaluations . The mechanisms of the short- and long-term effects of respiratory viruses in patients with CF have not been defined . However, pathophysiologic studies conducted in normal children and adults allow the development of several plausible hypotheses . The definition of mechanisms of injury in this population must be a priority, since it may influence clinical practice . If airway obstruction is the principal mechanism of viral-induced injury, therapeutic approaches designed to relieve the obstruction would be most appropriate . For example, if the obstruction resulted from induced or aggravated reactive airway disease, the current common practice of prescribing chronic bronchodilator therapy would be appropriate . This therapy might be especially suited to those experiencing frequent viral infections . In addition, the administration of bronchodilators to patients during acute exacerbations of pulmonary disease caused by viruses might be of clinical benefit . If, on the other hand, the principal mechanism of viral-induced injury is found to be through synergistic interaction with bacteria, the current practice of aggressive antimicrobial therapy would remain appropriate.

Zentralbl Mikrobiol, 1991, 146(4), 291 - 5
Antimicrobial activities on Mediterranean plants; March C et al.; Antimicrobial activities were tested for 22 plant species collected in the Valencian Community, using 9 different fungal and 6 bacterial strains which contaminate food and crops . Some of them showed fungizidal and bactericidal activity against some of the microorganisms tested.

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