Scand J Infect Dis, 1990, 22(5), 511 - 8 Microbiology, chemotherapy and mortality of brain abscess in Newcastle-upon-Tyne between 1979 and 1988; Richards J et al.; 71 patients admitted to Newcastle Regional Neurosurgical Centre between 1979 and 1988 with a diagnosis of brain abscess are reviewed . The overall mortality was 9.9%, with an operative mortality of 7% . The bacteriology of these abscesses is discussed in detail, together with the importance of effective standardized antimicrobial treatment regimens . The low mortality figures appeared to be in direct relationship to early recognition of this condition, prompt surgical intervention and effective chemotherapy. Ter Arkh, 1990, 62(7), 54 - 7 {Local immunity in pathology of the IgA system (IgA subclasses in the saliva of patients with A-paraproteinemia)}; German GP et al.; In 39 patients with A-paraproteinemia, the local immunity status was estimated according to the level of IgA subclasses in the saliva and antibody activity of secretory IgA to E . coli and S . Sonnei . Local production of normal IgA was undisturbed only in 12 patients with A-paraproteinemia, since in the saliva of those patients, there was a normal correlation of IgA subclasses and the level of antimicrobial IgA antibodies was the same as in healthy persons . The overwhelming majority of the patients with A-paraproteinemia and all the patients suffering from heavy alpha-chain disease manifested deficiency of local production of normal IgA, which consisted in the impairment of the normal correlation of IgA subclasses in the saliva and in the reduction of sIgA function . A-paraprotein was detected in many samples of the saliva using agar electrophoresis followed by immunoblotting . Secretion was shown to be mainly penetrated by the polymeric forms of A-paraprotein. Surg Gynecol Obstet, 1990, 171 Suppl, 31 - 4 Pathogenesis and treatment of intra-abdominal infection; Malangoni MA; Intra-abdominal infection is considered potentially life-threatening . Such infection is frequently secondary to perforated viscera, trauma or inflammatory disease . Simple abscesses may be drained percutaneously with roentgenologic guidance; complex abscesses often require open surgical drainage . Secondary peritonitis is usually polymicrobial; broad-spectrum antimicrobial therapy effective against aerobic and anaerobic gram-negative bacteria, as well as gram-positive organisms, is essential . Newer antibiotics, administered either singly or in combination, have been used successfully to treat intra-abdominal infection while avoiding the toxicity of aminoglycosides. Int J Technol Assess Health Care, 1990, 6(3), 403 - 17 Rationale for the use of antimicrobial agents in periodontal disease; Loesche WJ; The traditional approach to treating dental decay and periodontal disease has often focused on caries, neglecting periodontal infection . The past 15 years have seen significant advances in the treatment of periodontal disease with antimicrobial therapy, both with and without more traditional debridement or surgery . This article presents an overview of the use of antimicrobials, including an examination of treatment philosophies and the diagnosis of periodontal infection. Gynecol Obstet Invest, 1990, 30(1), 23 - 6 Amniotic fluid findings in women with high levels of chlamydial antibody; Cohen I et al.; A study was undertaken to examine possible transplacental passage of Chlamydia trachomatis from pregnant women who were seropositive for chlamydia, but with no cervical C . trachomatis infection . Forty asymptomatic pregnant women, scheduled for diagnostic amniocentesis at 15-19 weeks of gestation, were tested for the presence of high serum IgA and IgG chlamydial specific antibodies and for cervical chlamydia infection . Five (12.5%) had both high serum IgA and IgG antibody levels and 10 (25%) had high serum IgG antibody levels . Overall, 15 (37.5%) had high serum chlamydia specific antibody levels (all were free of cervical chlamydial infection) . The evaluation of the amniotic fluid specimens of these 15 seropositive pregnant women, who were free of cervical chlamydial infection, proved negative for direct C . trachomatis antigen detection and for chlamydial IgA and IgG specific antibodies . These negative results could be attributed to the lack of transplacental passage of C . trachomatis or to the antimicrobial activity of amniotic fluid against C . trachomatis, which has been previously described . The discrepancy between maternal infection and maternal serum antibody levels may suggest that the serologic test does not predict the presence of an antigen in the cervix. Br J Neurosurg, 1990, 4(4), 265 - 71 Brain abscess in the 1980s; Donald FE et al.; Brain abscess was reviewed in 24 patients admitted to University Hospital, Nottingham over a period of 3 years . Chronic ear infection was the most common predisposing factor, but in 11 patients the focus of infection remained unknown . CT scanning, carried out in all patients, was negative in one patient with clinical signs of meningitis . Polymicrobial and anaerobic infections were common . Actinomyces species were isolated in mixed culture from seven patients; in five the abscess was located in the cerebellum . Therapy was most often a combination of surgical drainage and antimicrobial therapy with beta-lactam agents and metronidazole . Evidence suggests that cefotaxime may offer a suitable alternative to chloramphenicol and benzylpenicillin in the treatment of brain abscess. Ann Urol (Paris), 1990, 24(4), 326 - 7 {Emphysematous pyelonephritis . Apropos of a case}; Ferriere X et al.; Emphysematous pyelonephritis is a rare form of pyelonephritis that carries a very poor prognosis . This article reports a review of the literature on this condition and describes the clinical and roentgenographic criteria for diagnosis . Diagnosis rests on the presence of clinical manifestations of pyelonephritis with intrarenal air-filled images on the roentgenograms . Both the author's personal experience and the data from the literature confirm the need for urgent treatment combining antimicrobial agents effective against Escherichia coli, the most common causative agent, and surgery, which usually consists in a nephrectomy. Scand J Infect Dis Suppl, 1990, 68, 7 - 13 Resistance situation of oral antibiotics in the Scandinavian countries with special reference to the fluoro-quinolones; Midtvedt T; In general, the Scandinavian countries have a rather conservative attitude towards new antimicrobial agents . Our antibiotic policies are based upon many years of clinical and laboratory experiences . It is generally believed, although not always satisfactorily proven, that our relatively restrictive attitude to the use of new as well as of older antimicrobial drugs by one mechanism or another, is a matter of some importance when explaining the relatively low antibiotic resistance profile (ARP) existing in most places in Scandinavia . When a new group of drugs, such as the quinolones, is going to be introduced in the therapeutic armamentarium, the existing ARPs of the microbes actually involved have to be taken into consideration. Int Urol Nephrol, 1990, 22(3), 257 - 62 Efficacy of prophylactic antimicrobial regimens in preventing infectious complications after transrectal biopsy of the prostate; Melekos MD; In a prospective study on 81 patients undergoing transrectal needle biopsy of the prostate, the efficacy of prophylaxis in preventing postbiopsy infectious complications was determined . The patients were divided randomly into four groups, and a comparison of the rate of postbiopsy complications in each group was made . In 11 and 17% of the patients in Group A (n = 18) who received povidone-iodine enema alone, bacteriuria and bacteraemia, respectively, occurred . When parenteral piperacillin alone in Group B (n = 22) was administered, the rates of the same complications were 9 and 14%, respectively, while both rates were as low as 4% in Group C (n = 25) when piperacillin in combination with povidone-iodine enema was given . On the other hand, in 31 and 37.5% of the patients in Group D (n = 16), who served as controls, bacteriuria and bacteraemia developed . The study has thus shown that parenteral piperacillin in combination with povidone-iodine enema significantly reduces the incidence of infectious complications associated with transrectal prostatic biopsy. J Can Dent Assoc, 1990, 56(7 Suppl), 37 - 9 The impact of chemotherapeutic agents on treatment planning; Ciancio SG; In this article the impact of chemotherapeutic agents on planning therapy for patients with plaque associated problems are reviewed . For special patients such as those receiving systemic medications which cause xerostomia or gingival hyperplasia, topical antimicrobials are of value for utilizing chemotherapeutic agents to teach patients a "clean mouth endpoint" . Once achieved, patients can use this as a goal to obtain without the use of an agent . Two mouthrinses have been clearly shown to be effective in reducing plaque and gingivitis; one contains chlorhexidine and the other essential oils . A third agent, sanguinarine, found in both a dentifrice and mouthrinse, appears to be effective when used as combined therapy and further studies of combined usage are warranted. Arch Oral Biol, 1990, 35(1), 79 - 80 The effect of stannous and sodium fluoride on coronal caries, root caries and bone loss in rice rats; Beiraghi S et al.; Sixty rice rats (Oryzomys palustris) were divided by littermate into 3 groups of 20 each . The 3 groups received either SnF2 (1000 parts/10(6) F), NaF (1000 parts/10(6} or double-distilled water (control) . Test solutions were topically applied to molar teeth, twice daily, for 7 days . All rats were also provided with double-distilled drinking water and diet 2000 ad libitum . Experiments ended after 9 weeks . Alveolar bone loss, root and coronal caries were recorded and scored . SnF2 significantly reduced bone loss (p less than 0.05), but NaF did not . Root caries was significantly different in all 3 groups (p less than 0.05) . SnF2 and NaF both reduced coronal caries significantly (p less than 0.05) in comparison to the control . However, the fluoride groups were not significantly different from each other . SnF2 may influence root caries via remineralization and an antimicrobial effect of the stannous ion. Clin Ther, 1990, 12 Suppl B, 34 - 42 Antimicrobial management of postoperative infections in abdominal surgery: single or combination regimen? Geroulanos S, Stern A, Christen D, Buchmann P. In a prospective, controlled, randomized study, the clinical and bacteriologic efficacy of imipenem/cilastatin was compared with that of a standard combination of an aminoglycoside, amoxicillin, and clindamycin in patients with serious postoperative infections . Doses used were imipenem/cilastatin 1 gm q 8 hr, amoxicillin 2 gm q 8 hr, and clindamycin 0.6 gm q 6 hr . Aminoglycoside doses were individualized and monitored six times weekly with serum concentration assays . Sixty-three patients were entered into the study: 31 in the imipenem/cilastatin group and 32 in the combination group . Diagnoses included pneumonia (ten in the imipenem/cilastatin group and seven in the combination group), peritonitis (eight in the imipenem/cilastatin group and 15 in the combination group), and septicemia (eight in the imipenem/cilastatin group and three in the combination group) . The two groups were comparable with respect to sex, age, underlying diseases, and duration of antibiotic therapy . In the imipenem/cilastatin group, 26 patients were cured and one improved (87%) . In the combination group, 21 were cured and five improved (81%) . Four patients receiving imipenem/cilastatin and six receiving the combination therapy failed to respond to treatment . Eighty percent of the bacterial isolates were eradicated, and 15% were suppressed in the imipenem/cilastatin group . Corresponding frequencies in the combination group were 84% and 11%, respectively . Isolated pathogens persisted in 5% of the patients in each group . It is concluded that imipenem/cilastatin appears to be an effective and well-tolerated alternative to a triple antibiotic combination in the treatment of serious postoperative infections.(ABSTRACT TRUNCATED AT 250 WORDS) Scand J Infect Dis, 1990, 22(2), 121 - 33 Epithelioid angiomatosis or cat scratch disease with splenic and hepatic abnormalities in AIDS: case report and review of the literature; Schwartzman WA et al.; Cat scratch disease (CSD) in the setting of HIV infection is associated with lesions of epithelioid angiomatosis but not with granulomatous lesions seen in the normal host . We report a case of CSD in a patient with AIDS and Kaposi's sarcoma with epithelioid angioma of skin, thrombocytopenia, and abnormalities of liver, spleen, lymph node, and pleura that responded to antimicrobial therapy . We also review reported cases of epithelioid angiomatosis in HIV infections . 12 of these resolved, including 3 without antimicrobial therapy; 18 demonstrated pleomorphic organisms with Warthin-Starry silver stain . Six involved visceral or bony as well as skin lesions . CSD should be considered in the setting of HIV infection with skin nodules even in the presence of biopsy-proven Kaposi's sarcoma . CSD may in these patients be responsible for a variety of disseminated lesions which respond to antimicrobial therapy. Caries Res, 1990, 24(2), 130 - 2 Effect of an antimicrobial-containing varnish on root demineralisation in situ; Huizinga ED et al.; The effect of an antimicrobial-containing varnish on root demineralisation was investigated . The in situ demineralisation effect on the varnish, with or without the active ingredients chlorhexidine and thymol, was measured by means of microradiography in comparison with no application after a 2-week period in vivo . Furthermore, the effect of one or two applications was investigated by the 10 participants who carried sound intact roots in an appliance for four consecutive 2-week periods . In each period, different roots were mounted in the buccal flanges of a lower prosthesis, the experiment being of a randomized cross-over design . The results show that: (1) A single varnish treatment with active ingredients reduced lesion depth and mineral loss by about 77 and 82%, respectively . (2) The control varnish had no effect, and it can be concluded that antimicrobial-releasing varnishes are promising materials for root caries prevention. Antibiot Khimioter, 1990 Jan, 35(1), 27 - 30 {Immobilization of antibiotics on a titanium surface}; Tikhonova LS et al.; Immobilization of antibiotics on the surface of electrolytically oxidated titanium was tried . Transfer of the immobilized ampicillin into hardly soluble calcium ampicillate resulted in providing the coating with antimicrobial activity for 5 days . The quantity of the immobilized antibiotic determined polarographically amounted to 6.4.10(-3) mol per 1 m2 of the surface. J Immunoassay, 1990, 11(1), 1 - 16 Development of a sensitive enzyme immunoassay for OPC-7251, a novel antimicrobial agent for percutaneous application; Muto N et al.; A sensitive enzyme immunoassay for OPC-7251, a novel pyridone carboxylic acid antimicrobial agent, was developed and applied for the determination of human plasma levels . OPC-7251 was coupled to bovine serum albumin through a formation of N-hydroxysuccinimide ester . By immunization of rabbits, highly specific antiserum was raised . Using the antiserum and beta-D-galactosidase-labeled hapten, the homologous assay system allowed the detection of 2 pg of this compound . Plasma samples were precisely analyzed down to the minimum value of 200 pg/ml after heat treatment . The system was further validated by the recovery test and correlation with the HPLC analyses . Percutaneous application of 10 g of 1% OPC-7251 cream to healthy volunteers resulted in the peak plasma value of 1.6 ng/ml about 8 hours after dosing, indicating extremely low absorption efficiency through a transdermal system. Annu Rev Med, 1990, 41, 393 - 400 Intestinal barriers to bacteria and their toxins; Walker RI et al.; Immunologic and nonimmunologic processes work together to protect the host from the multitude of microorganisms residing within the intestinal lumen . Mechanical integrity of the intestinal epithelium, mucus in combination with secretory antibody, antimicrobial metabolites of indigenous microorganisms, and peristalsis each limit proliferation and systemic dissemination of enteric pathogens . Uptake of microorganisms by Peyer's patches and other intestinal lymphoid structures and translocation circumvent the mucosal barrier, especially in immunosuppressed individuals . Improved understanding of the composition and limitation of the intestinal barrier, coupled with advances in genetic engineering of immunogenic bacteria, development of oral delivery systems, and immunomodulators, now make enhancement of mucosal barriers feasible. Adv Exp Med Biol, 1990, 262, 69 - 76 Anti-inflammatory systems in human milk; Goldman AS et al.; Human milk is characterized not only by a complex host defense system that prevents the colonization and proliferation of common microbial pathogens that may pervade the alimentary tract and respiratory tract of the infant but also by a paucity of inflammatory agents and an array of anti-phlogistic factors . Clinical observations support the notion that the protection provided by human milk involves not only antimicrobial factors, but also anti-inflammatory agents . The major anti-inflammatory agents include enzymes that degrade mediators of inflammation, anti-proteases, lysozyme, lactoferrin, secretory IgA and a number of antioxidants including cysteine, ascorbate, alpha-tocopherol, and beta-carotene . It is pertinent that most of these factors are either absent or poorly represented in cow's milk or other artificial feedings that substitute for breast feeding and that the attainment of adult serum levels of some of these antioxidants in early infancy is dependent upon breast feeding . It may be that the provision of these antioxidants may help to protect the recipient's developing immunologic system which is quite susceptible to oxidant damage . The absence of breast feeding will thus deprive the infant of valuable protection against common enteric-respiratory disorders and their inflammatory consequences . It should be pointed out that the protective systems in human milk including the anti-inflammatory components may not be completely delineated, and that little is known of the in vivo fate of the factors and precisely how they protect the recipient . Those questions should form the basis of important research in the next decades. J Burn Care Rehabil, 1990 Jan-Feb, 11(1), 35 - 41 Sildimac: a new delivery system for silver sulfadiazine in the treatment of full-thickness burn injuries; Miller L et al.; Wound care is painful for the patient with a burn injury and tedious for the burn unit staff but necessary to remove exudates and debris and to limit infections . In an effort to circumvent daily dressing changes while ensuring optimal wound protection, Sildimac (Marion Laboratories, Kansas City, Mo.), a new drug delivery system for silver sulfadiazine, was developed . When silver sulfadiazine, a topical antimicrobial commonly used for the treatment of burns, is incorporated into the delivery system, the drug is released in a sustained fashion . We report here the results of a multicenter evaluation of the safety and efficiency of Sildimac for treatment of full-thickness burn wounds . Sildimac, when left in place for up to 4 days, appears to be as effective as twice-daily wound cleansing and application of Silvadene cream 1% (Marion Laboratories, Kansas City, Mo.) for the treatment of full-thickness burns. Drugs, 1990 Jan, 39(1), 54 - 65 Pharmacological management of recurrent oral mucosal ulceration; Burgess JA et al.; A number of diseases can cause recurrent intraoral ulceration . This review focuses principally on drug management of intraoral ulceration associated with local and systemic conditions most likely to be observed on an outpatient basis by the general practitioner . These consist of recurrent aphthous stomatitis, erosive lichen planus, benign mucous membrane pemphigoid (BMMP), erythema multiforme . Behcet's disease, allergic stomatitis and infection . Information is provided on a spectrum of medication found useful in ulcer management, including topical antimicrobial and antifungal agents, topical and systemic corticosteroids, topical and systemic analgesics, and systemic immunosuppressive and anxiolytic drugs, plus details of dosage, important adverse reactions and interactions . A treatment guide for management of recurrent aphthae is presented . The reader is presumed to be familiar with differential diagnosis and the importance of establishing an accurate impression before starting drug therapy. Vestn Akad Med Nauk SSSR, 1990, (2), 58 - 61 {Mechanisms of the development of immunodependent inflammation in silicosis}; Grishina TI et al.; Patients with uncomplicated silicosis were found to develop chronic immunodependent inflammation caused by an adjuvant effect of silica and characterized by autoimmune, histamine- and complement-dependent components . Reduced specific and non-specific antimicrobial defence underlies frequent complication of silicosis by tuberculosis and nonspecific infectious diseases of the bronchopulmonary system . A diagram showing the development of immunodependent inflammation in silicosis is presented. Chemotherapy, 1990, 36(2), 85 - 90 Bioavailability of clindamycin during peritoneal dialysis; Eng RH et al.; Clindamycin phosphate becomes biologically active only with cleavage of the phosphate ester bond . A rat model was used to examine the amount of biologically active clindamycin attainable in the dialysate and in the blood during peritoneal dialysis . Intravenous administration of 10 mg/kg clindamycin phosphate alone without peritoneal dialysis produced peak blood levels of 15-20 micrograms/ml . With peritoneal dialysis, blood levels of less than 5 micrograms/ml were achieved . When clindamycin phosphate was added to the dialysis fluid at an initial concentration of 10 mg/ml, less than 5 micrograms/ml of the active antibiotic can be detected in the dialysis return fluids . Even in rats with induced peritonitis, less than 15 micrograms/ml could be found in the dialysis returns . With or without peritonitis, less than 5 micrograms/ml of active clindamycin was attained in blood from peritoneal installation alone . The conversion of the ester to the active compound appears to be the major problem . It is recommended that in those clinical situations in which the patient requires peritoneal dialysis, an alternate antimicrobial agent be used in place of clindamycin to avoid infections in the abdominal cavity or the blood while under therapy. J Antimicrob Chemother, 1990 Jan, 25 Suppl A, 39 - 47 Comparison of the acid stability of azithromycin and erythromycin A; Fiese EF et al.; In acidic aqueous media, erythromycin A is rapidly degraded via intramolecular dehydration to form erythromycin-6.9-hemiketal and then anhydroerythromycin, both of which possess little antimicrobial activity . Azithromycin, a new azalide antibiotic, has a methyl-substituted nitrogen in place of the carbonyl at the 9a position of the aglycone ring, thus blocking the internal dehydration pathway . As a result, azithromycin decomposition occurs primarily via acid-catalysed hydrolysis of the ether bond to the neutral cladinose sugar . Rate constants and the time for 10% decay (T1/10) were determined for both azithromycin and erythromycin A at pH2 using various levels of acetonitrile cosolvent and constant ionic strength . Semi-log plots of the decay rate constants versus the reciprocal of the solution dielectric constants were used to extrapolate to totally aqueous conditions . In solution at 37 degrees C and pH2 with ionic strength mu = 0.02, azithromycin was degraded with a T1/10 of 20.1 min while erythromycin underwent 10% decay in only 3.7 sec . The activation energy for hydrolysis of the ether bond connecting cladinose to azithromycin was 25.3 kcal/mol while the internal dehydration reaction of erythromycin had an activation energy of 15.6 kcal/mol . A solution stability profile was generated for azithromycin over the pH range of 1.0 to 4.1 at 30 degrees C . Stability was found to improve ten-fold for each unit increase in pH. J Antimicrob Chemother, 1990 Jan, 25 Suppl A, 33 - 8 In-vitro and in-vivo susceptibility of Borrelia burgdorferi to azithromycin; Johnson RC et al.; The in-vitro and in-vivo susceptibility of Borrelia burgdorferito tetracycline, erythromycin and azithromycin was investigated . A macrodilution broth technique was used to determine MBCs . B . burgdorferi was most susceptible to azithromycin (MBC 0.04 mg/l) followed by erythromycin (MBC 0.16 mg/l) and tetracycline (MBC 1.6 mg/l) . Syrian hamsters were used to determine ED50S for the three antimicrobials . Azithromycin was most effective in the elimination of spirochaetes from experimentally infected hamsters with an ED50 of 3.71 (+/- 1.9) mg/kg followed by tetracycline (ED50 15.6 (+/- 4.58) mg/kg) . Erythromycin possessed low activity, having an ED50 of 122.2 (+/- 51.9) mg/kg . Tissue concentrations of azithromycin exceeding the MBC were present 24 h after the final treatment. Scand J Infect Dis Suppl, 1990, 72, 54 - 60 Comparison of efficacy and safety of teicoplanin in gram-positive infections: a multicentre study; Lang E et al.; A multicentre open trial included 219 hospitalized patients suffering from various Gram-positive infections . Previous antimicrobial therapy had been carried out in 37% of patients . The initial teicoplanin dose was 400 mg for 77.6% and 800 mg for 12.6% of the patients, 9.8% received other initial doses . The dose on subsequent days was 200 mg or less for 63% of patients and 400 mg for the remaining 27% . The mean duration of treatment was 11 days . Concomitant antibiotic treatment was given in 35% of cases . The overall clinical success rate was 86.9% . Therapy failure or recurrence of infection was seen in 5% and 2%, respectively . Elimination of pathogens was seen in 85.1% of all evaluable cases . Adverse drug reactions were observed in 14 patients . From these results, we conclude that teicoplanin is safe and effective in the therapy of many different infections caused by Gram-positive bacteria. Eur J Cancer, 1990, 26(5), 569 - 74 Gram-positive bacteraemia in granulocytopenic cancer patients . EORTC International Antimicrobial Therapy Cooperative Group; Clinical features and management of severe dermatological reactions to drugs; Cabrini Medical Center, New York City, New YorkCutaneous adverse drug reactions are a frequent occurrence and have been reported in more than 2% of hospitalised patients . Among the most commonly involved drugs are sulphonamides, penicillins, anticonvulsants and non-steroidal anti-inflammatory drugs . Two groups of mechanisms are involved in the pathogenesis of drug reactions: immunological, with all 4 types of hypersensitivity reactions described; and non-immunological, accounting for at least 75% of all drug reactions . Besides minor skin reactions like urticaria, maculopapular rash, fixed eruptions or erythema nodosum, which are generally self-limited, severe life-threatening manifestations also occur . Erythema multiforme is secondary to drugs in half the cases; the minor form is characterised by typical target and iris lesions and is usually benign . However, a much more severe condition, erythema multiforme major or Stevens-Johnson syndrome, is associated with mucosal, ocular and visceral involvement, and carries a mortality of 5 to 15% if untreated . Toxic epidermal necrolysis, which could represent an even more dramatic form of the same disease, is characterised by severe widespread erythema, blisters and loss of skin in sheets, with denudation of more than 10% of the body surface area . This entity is frequently due to drugs . Mortality is 25 to 70%, and 90% of the survivors will have sequelae . Exfoliative dermatitis is an erythematous scaling disease often produced by drugs and carrying significant mortality . Photodermatitis may at times present with severe eczematous features . For clinical and epidemiological reasons it is important to try to identify the culprit drug following an approach based on previous experience with the drug, timing of events, patient reaction to dechallenge, patient reaction to rechallenge (if feasible), alternative aetiological candidates, and drug concentration or evidence of overdose . Management of severe skin reactions to drugs should require admission to a burn unit, where patients should be placed in warmed air-fluidised beds, receive excellent nursing care, analgesics and tranquillisers . Peeling necrotic epidermis should be removed and denuded dermis covered with biological grafts or synthetic dressings . Fluid balance must be adequately maintained; nutritional support and careful monitoring of early signs of skin infections is mandatory to ensure immediate antimicrobial treatment . Ocular care must be excellent to avoid serious sight-threatening sequelae . Steroids are presently not recommended . With these therapeutic modalities, morbidity and mortality can be markedly decreased. J Reprod Med, 1990 Jan, 35(1), 19 - 21 Laparoscopic diagnosis and treatment of acute pyosalpinx; Teisala K et al.; We diagnosed acute pyosalpinx in eight patients with laparoscopy . The pus was aspirated through the laparoscope in five cases, and antimicrobial treatment was started intravenously thereafter . The short-term recovery was uncomplicated . Laparoscopic treatment of acute pyosalpinx, in contrast to radical surgery, preserves reproductive potential and ovarian function. Andrologia, 1990, 22 Suppl 1, 74 - 82 Gene expression in bovine seminal vesicles; Scheit KH; Seminal vesicle secretion contributes significantly to the proteins of bovine seminal plasma . The following proteins from bull seminal vesicle were isolated and characterized: major protein (PDC 109), the basic proteins BUSI II, RNAse BS1, protein P6 and seminal antimicrobial protein (SAP) . Using antibodies against the proteins BUSI II, RNAse BS1, SAP and major protein, the seminal vesicle epithelium was identified as the source of the respective antigens . The biosynthesis of bovine seminal vesicle secretory proteins was studied by cell free translation of poly (A)-RNA from seminal vesicles and the respective mRNAs were characterized by cDNA cloning . Recombinant clones (103) of a cDNA library of bull seminal vesicle poly (A) + RNA were screened by colony hybridisation using radioactively labelled synthetic probes . The respective clone containing the longest cDNA insert was sequenced . In case of major protein the Mr of the 134 amino acid residue precursor polypeptide was 15,480 as deduced from direct mRNA sequencing . The precursor sequence of 25 amino acid residues has a hydrophobic character and very likely constitutes a signal peptide, directing the protein towards the secretory pathway . The deduced amino acid sequence contained no consensus sequence indicative of N-glycosylation. Acta Univ Carol {Med} (Praha), 1990, 36(1-4), 44 - 5 A more objective approach to the evaluation of antimicrobial therapy in cystic fibrosis; Valletta EA et al.; Thirteen biochemical markers of infection and inflammation were measured during anti-Pseudomonas therapy in cystic fibrosis (CF) patients with respiratory exacerbation . The assessment of some of these markers is thought to be helpful in the evaluation of efficacy of antibiotic therapy in CF. Drugs Exp Clin Res, 1990, 16(12), 621 - 8 Concentration-dependent bacterial killing, adaptive resistance and post-antibiotic effect of ciprofloxacin alone and in combination with gentamicin; Gould IM et al.; The clinical relevance of in vitro tests of antimicrobial activity, other than simple MIC and MBC observations, is increasingly recognised . Such tests include bacterial time-kill studies and post-antibiotic effect (PAE) . The authors have studied these parameters in 11 Gram-negative and Gram-positive strains, all clinical isolates . Viable counts were done at 0, 2, 4, 6 and 24 h by a new microtitre method, and PAE was studied by both conventional methodology and by use of the Malthus Microbial Growth Analyser . Bacterial kill was inoculum-dependent and kill at high inocula concentration-dependent . No paradoxical reduction in kill was seen at high concentrations of ciprofloxacin (200 x MBC) . PAE was concentration-dependent and addition of gentamicin can prolong PAE . Reduced sensitivity to further antibiotic exposure in the PAE period (adaptive resistance) was noticed and was dependent on antibiotic concentration in the first exposure . The significance of these findings to new dosage schemes is discussed . To optimise therapy in seriously ill patients, it may be relevant to increase the dose of ciprofloxacin currently used for treating serious infection. Perit Dial Int, 1990, 10(1), 49 - 52 Comparison of large volume culture to other methods for isolation of microorganisms from dialysate; Sewell DL et al.; Patients on continuous ambulatory peritoneal dialysis (CAPD) who reside long distances from a CAPD center often use community medical laboratories to document and manage episodes of peritonitis . We examined the feasibility of using large volume cultures as an alternative to more costly and labor intensive methods and to enhance earlier recovery of microorganisms from these patients . Three methods of processing dialysate from patients on CAPD were compared: (a) inoculation of 400 mL dialysate into a transfer bag (Baxter Healthcare, Inc., Round Lake, IL) containing 100 mL of 5-fold concentrate of trypticase-soy broth: (b) inoculation of 5 mL into each of two Bactec bottles (Johnston Laboratories, Towson, MD): and (c) centrifugation of 50 mL and culture of the sediment without white cell lysis on plated media and two Bactec bottles . Of the 58 specimens cultured, 34 (59%) were positive by one or more methods . Antimicrobial activity was detected in 20/58 (34%) dialysates, which represent 54% of all no-growth cultures . Of the 34 culture-positive specimens, microorganisms were recovered on plated media in 22 (65%); by the centrifugation system in 32 (94%); by the routine Bactec system in 28 (82%); and by large volume culture in 30 (88%) . The large volume culture system is an acceptable alternative to the more costly Bactec System and the labor intensive centrifugation method but does not significantly improve recovery of microorganisms. Drugs Exp Clin Res, 1990, 16(5), 237 - 42 In vitro antimicrobial activity of econazole and miconazole sulfosalicylate; Strippqli V et al.; The in vitro activities of new sulfosalicylic salts of econazole (E.SSA) and miconazole (M.SSA) have been investigated in comparison with the respective nitrate (NIT) salts and sulfosalicylic acid (SSA) alone . The results reveal good antimicrobial activity of M.SSA and E.SSA against different strains of Candida, dermatophytes, moulds, Gram-positive bacteria and Trichomonas vaginalis . The MIC values demonstrate that M.SSA is more active than M.NIT on Candida and T . vaginalis . E.SSA was also more active than E.NIT on T.vaginalis . Both SSA and sodium sulfosalicylate (NaSSA) were practically without activity by themselves . Finally, the pH variations did not significantly modify the activity of the SSA salts, suggesting that their greater activity could be due to better lipophilic activity of these compounds with respect to the nitrate salts. Drugs Exp Clin Res, 1990, 16(4), 157 - 65 In vitro antimicrobial activity of a novel aminothiazolylglycylcephalosporin, MT0703S, compared with that of ceftazidime, cefoperazone and aztreonam; Okamoto R et al.; The antibacterial activity of a novel aminothiazolylglycylcephalosporin, MT0703S, possessing a dihydroxypyridone moiety was compared in vitro with the activity of ceftazidime, cefoperazone, aztreonam and other beta-lactam antibiotics using seven bacterial species of a clinical origin . MT0703S showed the most potent activity against P . aeruginosa, including the ceftazidime-resistant strains, E . coli, K . pneumoniae and C . freundii . MT0703S was comparable to aztreonam but more active than ceftazidime and cefoperazone in its activity against K . oxytoca and E . cloacae, and comparable to ceftazidime against S . aureus and S . marcescens . MT0703S was more active than cefoperazone against S . marcescens but less active against S . aureus . The stability of MT0703S against various beta-lactamases appeared to be intermediate between the stability of ceftazidime and that of cefoperazone . The antimicrobial activity of MT0703S increased in a low-iron environment and decreased in a high ferric ion concentration. Scand J Infect Dis Suppl, 1990, 69, 125 - 36 Gonococci are survivors; Sparling PF et al.; Gonococci are capable of prolonged survival in untreated infection, and frequently reinfect persons with repeated and recent infection, despite considerable mucosal and systemic immune response to infection . Multiple mechanisms help to explain how this is achieved, including variations in surface antigen expression; production of an extracellular IgA protease; employment of antigens that preferentially stimulate host production of antibodies that block the killing activity of other antibodies; masking of critical epitopes by chemical modification of surface structures; molecular mimicry of host antigens; shedding of antigens in the form of outer membrane blebs; and, subverting certain nonimmunological antimicrobial defenses to the use of the bacterium . Moreover, gonococci are capable of considerable phenotypic adaptation to changing environmental conditions in vivo . This paper briefly reviews these concepts. Padiatr Grenzgeb, 1990, 29(5), 405 - 14 {Acute illness following admission to child day care centers and the use of antimicrobial agents}; Grimmer I et al.; 1 . During the first six months after the admission to day-care acute infections of children are very frequent . This gives rise to the question for the justification of the indication of antibacterial chemotherapy during this period . 2 . During the mentioned period all acute illnesses and the corresponding therapies of total 361 children in Berlin, the capital of the GDR, Leipzig and Schwedt are analysed . 3 . The local differences of the appearance of the antibacterial chemotherapy are not caused by the type and frequency of the diagnosis, but reflect the inadequate consideration for the therapy recommendations given by the Society of Padiatrics . 4 . The correlations between antibacterial chemotherapy and the appearance of acute respiration illnesses (ARI) suggest the influence of the bacteria on the origin of these illnesses of day-cared children. Lung, 1990, 168 Suppl, 1172 - 81 Life in the allogeneic environment after lung transplantation; Paradis I et al.; Because infection and rejection are the principal complications of any transplant procedure and because the alveolar macrophage is crucial to the defense of the lung from infection and may play a role in lung allograft rejection, we have begun to assess functions of this cell that are thought to be important in lung defense from infection and in transplant immunity . Antimicrobial functions include chemotaxis, which is a mechanism for recruiting macrophages to sites of inflammation and phagocytosis, and intracellular killing of microorganisms . As an accessory cell, the alveolar macrophage is necessary for an effective immune response to develop against either microorganisms or transplantation antigens . Our results indicate that the chemotactic, phagocytic but not the killing capability of alveolar macrophages from lung recipients is impaired . Alveolar macrophages and blood monocytes from lung recipients are also significantly impaired in their support for mitogen and antigen presentation to lymphocytes . Thus, the generation of an effective immune response to a microorganism may be impaired . Alveolar macrophages from lung recipients, however, function as well as those from normal subjects in stimulating lymphocyte proliferation in response to donor antigens (primed lymphocyte test) or unrelated allogeneic antigens (mixed lymphocyte reaction), while their respective blood monocytes function poorly in this regard . Our conclusions are that the antimicrobial functions of the alveolar macrophages are impaired after lung transplantation and this may be one mechanism to explain the unusual susceptibility of the lung allograft to infection . Those functions related to transplant immunity, however, are preserved and indicate that the alveolar macrophage may play a role in allograft rejection. Nahrung, 1990, 34(3), 273 - 7 Antagonistic action of lactic cultures toward spoilage and pathogenic microorganisms in food; Kivanc M; The antibacterial properties of cell-free filtrate from lactic cultures were assessed against 10 bacterial cultures . All the five species of lactic culture examined showed antimicrobial activity against tested bacteria . S . aureus was least sensitive of the tested bacteria, followed by E . coli and S . typhosa . E . aerogenes was the most sensitive one . L . casei had the greatest antimicrobial activity . Leu . mesenteroides weakly inhibited the growth of the tested bacteria . In general, inoculum density had little effect on inhibition. NCI Monogr, 1990, (9), 37 - 42 Oral complications of cancer therapies . Surveillance cultures; Schimpff SC; Surveillance cultures can be defined as an attempt to take microbiologic inventory, usually for bacteria and fungi, occasionally for viruses, at predetermined times during a patient's clinical course . They are useful in understanding the epidemiology of infection, evaluating techniques of infection prevention, assaying the effectiveness of preventive techniques, and guiding therapeutic decisions when empiric antimicrobial therapy is indicated . As such, they are most frequently used for patients at high risk of infection, such as those with acute leukemia receiving remission induction chemotherapy or bone marrow transplantation therapy . The sites sampled most frequently for surveillance cultures are the nose, oral cavity (pharynx or gingiva), and either the perianum or a stool specimen . Since hospital microbiology laboratories are not designed for the requirements of surveillance culturing, it is essential that such cultures only be obtained following appropriate communication and agreement with the laboratory directors. Antibiot Khimioter, 1990 Jan, 35(1), 37 - 40 {Bacteriocholia and cholic acid level in the bile in cholelithiasis}; Bekbergenov BM et al.; Infection of the biliferous system in patients with cholelithiasis was shown to be the most frequent when the levels of cholic acid in bile were low . Physiological concentrations of cholic and deoxycholic acids have antimicrobial activity against organisms not adapted to the presence in bile . Outer drainage of the bile ducts was accompanied by an increase in the levels of cholic acid when at the background of outer decompression bacteria were eliminated from the biliferous system . In vitro studies revealed a synergistic antibacterial effect of cholic and deoxycholic acid combinations with cefazolin. Ann Pediatr (Paris), 1990 Jan, 37(1), 44 - 7 {A review of four cases of Branhamella catarrhalis bacteremia in children}; Challier P et al.; Branhamella catarrhalis was recovered from one blood culture each from three infants and one neonate admitted to the Trousseau Hospital (Paris) between 1986 and 1988 . Clinical features included fever in every case, otitis in three cases, pneumonia in two cases, diarrhea in one case, and enterocolitis in one case . All the strains were beta-lactamase producers . Outcome was favorable in every case . The antimicrobial agent used was erythromycin in one case, amoxicillin in one case, and a third generation cephalosporin in two cases . We reviewed the pediatric literature for reports of Branhamella catarrhalis infections that seem more frequent or better detected than previously . The high prevalence of ampicillin-resistant strains is pointed out. Immunology, 1990 Jan, 69(1), 33 - 7 Role of TNF and IL-1 in infections with Toxoplasma gondii; Chang HR et al.; Mice lethally infected with the C56 strain of Toxoplasma gondii and treated with purified recombinant murine tumour necrosis factor (TNF, 1 microgram/day/mouse for 8 days), recombinant human interleukin-1 (IL-1 alpha or IL-1 beta, 100 ng/day/mouse for 5 days) or a single dose of a combination of TNF (1 microgram/mouse) and IL-1 alpha or IL-1 beta (100 ng/mouse) were significantly protected against death (P less than 0.05-0.001, as compared with untreated infected controls) . Mice infected with 100,000 tachyzoites of the highly virulent RH strain of T . gondii released serum TNF in relation to the time after infection and were primed to secrete an enhanced level of serum TNF upon stimulation with bacterial lipopolysaccharide (LPS) . In vitro studies showed that interferon-gamma (IFN-gamma) increased the antimicrobial activity of murine peritoneal macrophages whereas TNF, IL-1 alpha and IL-1 beta did not . TNF, however, synergized with the anti-toxoplasmic effect provided by IFN-gamma and this activity was blocked by anti-TNF antibodies . IFN-gamma induced the production of TNF and the anti-toxoplasmic effect provided by IFN-gamma seemed to be dependent partly on the production of TNF . We conclude that TNF and IL-1 may play a significant role in modulating the host's immune defence against T . gondii infection. Eur J Clin Microbiol Infect Dis, 1990 Jan, 9(1), 14 - 23 Prevention of infection and graft-versus-host disease by suppression of intestinal microflora in children treated with allogeneic bone marrow transplantation; Vossen JM et al.; The effect of suppression with antimicrobial agents of the intestinal microflora of paediatric bone marrow graft recipients on severe bacterial and fungal infections and on moderate to severe acute graft-versus-host disease was studied retrospectively . Data on 65 cases of bone marrow transplantation for either severe bone marrow failure or leukaemia, performed in a strict protective environment with either complete or selective gastrointestinal decontamination, were evaluated . All bone marrow grafts were from HLA-identical siblings and were not depleted of T-lymphocytes . Twenty percent of the recipients had one or more episodes of septicaemia during the granulocytopenic period after transplantation, mostly due to gram-positive bacteria . Only five children died due to infection, in each case caused by a microorganism originating from the endogenous flora . Complete gastrointestinal decontamination was superior to selective gastrointestinal decontamination in preventing infectious complications (p less than 0.001) . The same was the case for the prevention of acute graft-versus-host disease of grade II or higher, which was observed in 7 of 40 (17.5%) completely decontaminated children versus 9 of 18 (50%) selectively decontaminated children evaluable for graft-versus-host disease (p less than 0.01) . It is concluded that complete gastrointestinal decontamination in a strict protective environment is a feasible and very effective method for preventing severe infections and acute graft-versus-host disease after allogeneic bone marrow transplantation in children and adolescents; it resulted in a low transplantation-related mortality of 26% and a good quality of survival in 69% of the graft recipients. Oncol Nurs Forum, 1990 Jan-Feb, 17(1 Suppl), 4 - 8 Management of myelosuppression in the patient with cancer; Rostad ME; Bone marrow depression (myelosuppression) in the patient with cancer may result from the disease itself or from its treatment . The consequences of myelosuppression are numerous; the most critical problem that results from leukopenia is infection . Serious clinical consequences follow depression of normal leukocyte function . A clear understanding of the functioning of each type of leukocyte is essential for managing the various complications associated with leukopenia . The three components of myelosuppression management are: prevention of infection, frequent patient assessment for the early detection of infection, and aggressive management when such infection arises . The oncology nurse minimizes patient- and environment-related sources of infection and is aware that detection is complicated by the lack or diminution of signs and symptoms in a leukopenic patient . Infections that arise are managed in different ways, depending on the pathogen and on available therapy . In addition to conventional antimicrobial therapy, newer therapeutic modalities, such as colony-stimulating factors, may hold promise for the treatment of leukopenic patients . The nurse is responsible for many aspects of the care for these patients. J Immunol, 1990 Jan 1, 144(1), 278 - 83 Activated macrophages destroy intracellular Leishmania major amastigotes by an L-arginine-dependent killing mechanism; Green SJ et al.; Macrophages infected with amastigotes of Leishmania major and treated with IFN-gamma in vitro develop potent antimicrobial activities that eliminate the intracellular parasite . This antileishmanial activity was suppressed in a dose dependent fashion by NG-monomethyl-L-arginine (NGMMLA), a competitive inhibitor of nitrite, nitrate, nitric oxide and L-citrulline synthesis from L-arginine . Excess L-arginine added to infected macrophage cultures reversed the inhibitory effects of NGMMLA . Addition of arginase to culture media inhibited intracellular killing by IFN-gamma-treated cells . Similar effects were seen with macrophages obtained from BCG-infected C3H/HeN mice . Increased levels of nitrite, an oxidative product of the L-arginine-dependent effector mechanism, was measured in cultures of infected IFN gamma-treated macrophages as well as infected BCG-activated macrophages . Nitrite production correlated with development of antileishmanial activity . Nitrite production and microbicidal activity both decreased when in vivo or in vitro-activated macrophages were cultured in the presence of either arginase or NGMMLA . Nitric oxide synthesized from a terminal guanidino nitrogen atom of L-arginine and a precursor of the nitrite measured, may disrupt Fe-dependent enzymatic pathways vital to the survival of amastigotes within macrophages. Chin J Biotechnol, 1990, 6(2), 139 - 47 Interspecific protoplast fusion in Streptomyces--selection of thermotolerant antibiotic-producing recombinant; Qi HY et al.; The thermotolerant fusants were obtained after interspecific protoplast fusion between S . qingfengmyceticus M15S (SMr, stop growth at 39 degrees C, producing qingfingmycin with wide antimicrobial spectrum) and S . hygroscopicus var . jinggangensis *75 (SMs, grow well at 42 degrees C, producing jingganmycin of antifungus) by directly selecting from the regeneration plates containing SM 100 micrograms/ml and incubated at 42 degrees C . The fusion frequency was about 10(-5) -10(-4) . The stable thermotolerant recombinants with antimicrobial activity were obtained . The properties of their products were quite different from that of the parents (Qm, Jm) . The antimicrobial substance produced by recombinant F6-6 consists of two components: one has acid-alkaline indicator property; the other is fluorescent under UV light . The antimicrobial products of F1-16, F1-38 and FM3-32 have absorption peaks at 274nm, which suggests that a cytosine moiety may be present in their molecules. Lens Eye Toxic Res, 1990, 7(3-4), 693 - 704 Electroretinographical changes due to antimicrobials; Kawasaki K et al.; We evaluated the retinal toxicity of antimicrobials (sulbenicillin, cefazolin, flomoxef, gentamicin, sisomicin, netilmicin, tobramycin, amikacin, vancomycin, ofloxacin, lomefloxacin, and miconazole) by the electroretinogram, before and after a single-shot intravitreal injection in rabbits . The clinical dosage for single-shot intravitreal injections which we recommend are 2 mg for sulbenicillin, 0.25 mg for cefazolin, 0.2 to 0.4 mg for flomoxef, 0.1 mg for gentamicin, 0.1 to 0.2 mg for netilmicin, 0.2 to 0.4 mg for amikacin, 0.2 mg for tobramycin, 1 mg for vancomycin, 0.2 mg for ofloxacin, 0.2 mg for lomefloxacin, and 0.05 mg for miconazole. Lens Eye Toxic Res, 1990, 7(3-4), 469 - 80 In vitro toxicity of lomefloxacin in rabbit corneal epithelial cell cultures; Portoles M et al.; Lomefloxacin (NY-198) is a chemotherapic agent from the new 4-quinolone group, acting on DNA gyrase system . Lomefloxacin (LFLX), as some other new 4-quinolone compounds are antimicrobials of potential use for ophthalmic application . A first approach on the oculotoxicity of LFLX is the main purpose of this study . Four concentrations of LFLX (10, 30, 100 and 300 micrograms/ml) were tested on the first subculture of pigmented rabbit corneal epithelial cells . Cell number, protein contents, neutral red stain and wound healing were evaluated . The results showed that the lower concentrations (10 & 30 micrograms/ml) had no effect while the highest one had a remarkable cytotoxic effect . Pharmacokinetic data show that peak values achieved in the cornea and other ocular structures are lower than 40 micrograms/g (0.3% topical application) and, on another hand, MIC values range from less than or equal to 0.05 to 16 micrograms/ml . So, these "critical" concentrations have no cytotoxic effects according to our results . Then, it is concluded that Lomefloxacin could be a useful drug for topical ophthalmic development. Dev Pharmacol Ther, 1990, 15(3-4), 130 - 41 Ethical boundaries of medical research in infants and children in the 80s: analysis of rejected protocols and a new solution for drug studies; Koren G; To assess the difficulties in conducting pediatric research, we reviewed the 351 protocols dealing with research in infants and children in our institute between July 1982 and August 1988 . Of the 16 rejected protocols (4.5%), 12 were drug studies, 3 dealt with the nature of course of disease states and 1 was in the area of behavioral sciences . Drug studies were significantly more likely to be rejected than all other studies . The most common reason for rejection (n = 10) were major scientific flaws which, according to the committee, would result in inability of the study to answer the questions posed by the researchers . In 9 cases, the committee judged a study to be physically invasive without a direct benefit to the involved infant/child . In 3 cases, the committee rejected a study because patients with serious medical conditions might be randomized to receive placebo and not a drug which, based on current knowledge from adults, would possibly improve their condition . In 3 protocols current antimicrobial therapy covered all pathogens causing the infection and the proposed new therapy could not improve the prognosis further but only be equal or inferior . Researchers who had more than one protocol rejected had submitted significantly more protocols (7.17 +/- 1.35) than those who had only one rejection (1.86 +/- 0.36, p less than 0.0005) or than the 10 researchers with the highest number of studies without a single rejection (4.2 +/- 0.4, p less than 0.05) . In trying to solve the problem of invasiveness in drug studies in neonates, we have conducted a pharmacokinetic analysis and have documented that 3 samples for drug concentration are all that is needed for pharmacokinetic analysis, as values achieved with these data are not different from those calculated from 8 concentration-time points . In a prospective study in neonates, the validity of these assumptions was proven for the use of the antibiotic vancomycin . This model may be applicable to other areas of pediatric research where careful analysis of existing data may reveal that accurate information can be derived from much fewer samples than previously believed. Acta Microbiol Hung, 1990, 37(4), 379 - 92 Bacteriological proficiency testing in Hungarian clinical microbiology laboratories; Lanyi B et al.; In course of a proficiency testing programme carried out in 1989, a total of 47 clinical microbiology laboratories of public health stations and of hospitals received freeze-dried cultures for isolation, identification and antimicrobial susceptibility testing . The specimens contained bacteria that occur in everyday work, including those that require improved methods of cultivation and identification . Nine public health laboratories and one hospital laboratory achieved excellent results . Good results were attained by 11 public health and 6 hospital laboratories . Four public health and 10 hospital laboratories were on the medium level and 4 hospital laboratories did not reach even this degree . The main failures were due to an insufficient anaerobic cultivation, unreliable identification and negligation of controls for drug susceptibility tests. Scand J Infect Dis Suppl, 1990, 74, 42 - 8 Interactions between antibiotics and phagocytosis in bacterial killing; Van der Auwera P; The interaction between antimicrobial agents and phagocytic killing can be studied using three different approaches . The first approach, which is probably the most clinically relevant, is to study intracellular penetration and bioactivity against microorganisms relevant to a particular subcellular 'sequestration' site . The second approach, as yet of uncertain clinical relevance, is to study the toxicological impact of antimicrobial agents on phagocytic functions . This approach has shown that the cell membrane is the target for many enhancing or depressing effects associated with amphotericin B, antimalarials, coumarines, rifampicin and semi-synthetic cephalosporins . Of probable clinical relevance, the third approach is to study the effect on the phagocytic function of preincubating the microorganism . Modification of opsonisation has been the most frequently recognized mechanism, although the release of activating substances and sensitization of the microorganism to oxygen-dependent or -independent killing mechanisms have been described. Scand J Infect Dis Suppl, 1990, 74, 147 - 54 Impact of the antibiotic dosage schedule on efficacy in experimental soft tissue infections; Gerber AU; Soft tissue infection models have been used to study both the postantibiotic effect (PAE) and the effect of dosage intervals on antimicrobial efficacy . In vitro findings were mostly confirmed . For drug-organism combinations which showed a predominantly time-dependent killing pattern and absence of a PAE (beta-lactams vs Gram-negative organisms), frequent drug dosing was most efficacious . In contrast, a fast, predominantly concentration-dependent bactericidal effect followed by a PAE in vitro (e.g . aminoglycosides vs Gram-negative bacteria) correlated (though inconsistently) with superiority of bolus dosing over more continuous drug administration in vivo . Thus, the ratio of peak serum concentrations to MICs of target pathogens is possibly a valid predictor of efficacy for the aminoglycosides but not so for the activity of beta-lactam antibiotics where the duration of coverage at supra-MIC levels was clearly more important than the magnitude by which initial peaks exceeded the MIC of the target organism . It is not clear to what extent the results obtained in experimental soft tissue infections may hold true in man . Thus far, only a limited number of drug-organism combinations have been studied in well defined experimental settings using mostly small, granulocytopenic animals which differ pharmacokinetically from man . In addition, results are probably affected by the density of bacteria, their growth rate and metabolic activity, but also by the extent of inflammation at the site of infection. Med Microbiol Immunol (Berl), 1990, 179(6), 323 - 33 Interaction of lactoferrin with Escherichia coli cells and correlation with antibacterial activity; Visca P et al.; It has been established that the antimicrobial activity of lactoferrin towards Escherichia coli is enhanced by a direct contact between the protein and the microbial cell and that, in the case of E . coli K-12 strains, an antibacterial activity of lactoferrin unrelated to iron withdrawal is present . Evidence is now reported that lactoferrin binds to surface structures expressed in E . coli K-12 strains grown in either an "excess" or "stress" of iron . Under the experimental conditions used, lactoferrin binding both in the apo and in the iron-saturated form yields a maximum of 1.6 X 10(5) bound molecules/E . coli K-12 cell; the amount of lactoferrin bound does not depend on the expression of the iron-regulated outer membrane proteins . In contrast, lactoferrin does not bind to E . coli clinical isolates . Apo-lactoferrin (at 500 micrograms/ml in a chemically defined medium) inhibits the growth of E . coli K-12 strains but not of clinical isolates . These findings suggest that the antibacterial activity of the protein could be associated to its binding to the cell surface. Scand J Infect Dis Suppl, 1990, 73, 31 - 42 Delayed cerebrospinal fluid sterilization, in vitro bactericidal activities, and side effects of selected beta-lactams; Dajani AS et al.; Ampicillin (or penicillin G) plus chloramphenicol, cefuroxime, ceftriaxone, and cefotaxime have been used in the treatment of bacterial meningitis beyond the neonatal period . Review of recent data from the USA and Europe indicates that delayed CSF sterilization occurs significantly more often with ampicillin/chloramphenicol and cefuroxime than with ceftriaxone and cefotaxime . Delayed CSF sterilization is associated with an increased morbidity and neurological complications . Previously reported in vitro interactions between chloramphenicol and various beta-lactam antibiotics indicate that for bacteria where chloramphenicol is only bacteriostatic, the combination of chloramphenicol with beta-lactams is antagonistic . Killing rates of various beta-lactams were compared against a number of gram-positive and gram-negative bacteria . Cidal activity of some beta-lactams was inoculum dependent . There was a good correlation between in vitro activity and ability to sterilize CSF . Ceftriaxone is highly protein bound and its use in newborns is discouraged . Diarrhea occurs significantly more often after cefriaxone use than after the use of other agents . Ceftriaxone is uniquely associated with a high frequency of biliary pseudolithiasis which may be symptomatic and can cause measureable morbidity . In selecting the "proper" antimicrobial agent for the treatment of bacterial meningitis considerations should be given to proven clinical efficacy, prompt CSF sterilization, rapid in vitro cidal activity, safety and cost . We recommend cefotaxime as the agent of choice in the treatment of bacterial meningitis. Arch Oral Biol, 1990, 35 Suppl, 227S - 229S The long-term efficacy of systemic doxycycline medication in the treatment of localized juvenile periodontitis; Saxen L et al.; The presence of Actinobacillus actinomycetemcomitans in the deep periodontal pockets of patients with localized juvenile periodontitis has been causally associated with active periodontal destruction . Thus, eradication of this microorganism has become the goal of treatment . It has been postulated that such eradication cannot be achieved without systemic antimicrobial treatment . The efficacy of a semisynthetic tetracycline (doxycycline) in a double-blind follow-up study of 14 patients with localized juvenile periodontitis was evaluated . For assessment of the periodontal status, probing depth and bleeding after probing at 4 sites of all teeth were recorded . The treatment consisted of instruction in oral hygiene, scaling and root planing, periodontal surgery and systemic medication for 2 weeks with either doxycycline (Doximycin) or placebo . A . actinomycetemcomitans was cultivated from subgingival samples taken from 4 sites . The periodontal condition and the prevalence of A . actinomycetemcomitans were monitored at the baseline and at 2, 8 and 20 months . The periodontal condition improved in both groups; the only significant difference was a greater reduction in the prevalence of A . actinomycetemcomitans 8 months after treatment with doxycycline as compared with the placebo. Ciba Found Symp, 1990, 154, 213 - 24; discussion 224-8 Compounds from plants that regulate or participate in disease resistance; Kuc J; Disease resistance is multifactorial . The response phase includes: synthesis of phytoalexins, i.e . low molecular weight antimicrobial compounds which accumulate at sites of infection; systemically produced enzymes which degrade pathogens, e.g . chitinases, beta-1,3-glucanases and proteases; systemically produced enzymes which generate antimicrobial compounds and protective biopolymers, e.g . peroxidases and phenoloxidases; biopolymers which restrict the spread of pathogens, e.g . hydroxyproline-rich glycoproteins, lignin, callose; and compounds which regulate the induction and/or activity of the defence compounds, e.g . elicitors of plant and microbial origin, immunity signals from immunized plants and compounds which release immunity signals . Disease resistance in plants is not determined by the presence or absence of genes for resistance mechanisms, it is determined by the speed and degree of gene expression and the activity of the gene products . It is likely, therefore, that all plants have the genetic potential for resistance . This potential can be expressed systemically (immunization) after restricted inoculation with pathogens, attenuated pathogens or selected non-pathogens, or treatment with chemical substances that are produced by immunized plants or chemicals which release such signals . Immunization is effective against diseases caused by fungi, bacteria and viruses, and it has been successfully tested in the laboratory and field . Advances in science have provided information and technology to enhance resistance to plant pests . Pesticides are part of this technology, but they also contribute to a complex world problem which threatens our environment and hence our survival . The future will see the restriction of pesticide use and a greater reliance on resistant plants generated using immunization and other biological control technologies, genetic engineering and classical plant breeding . However, as with past and current technology, we will have created unique problems . The survival of our planet depends upon anticipating these problems and meeting the challenge of their solution. Ciba Found Symp, 1990, 154, 140 - 53; discussion 153-6 Phytoalexins as part of induced defence reactions in plants: their elicitation, function and metabolism; Barz W et al.; Microbial infection of plants or elicitation of cell cultures initiates substantial metabolic changes directed at the induction of defence reactions . The antimicrobial phytoalexins deserve special attention because they represent one essential component of plant resistance . The great structural diversity of phytoalexins and possible cellular sites for their toxic activity are discussed . Pterocarpan phytoalexin biosynthesis in Cicer arietinum is an example of the induction of extended biosynthetic pathways, their modes of regulation and metabolic links with constitutive secondary product formation . Elicitation of plant tissues represents a technique to induce simultaneously the formation of phytoalexins and increased levels of constitutive or other secondary products that do not normally accumulate . The biological function of phytoalexins and the pathways of their degradation by pathogenic fungi are outlined . Detoxification of phytoalexins by fungi may have important consequences for the practical application of these defence compounds and for the genetic transformation of fungi and plants . Phytoalexins accumulate in plants or cell cultures only transiently, because they are readily degraded or polymerized by extracellular peroxidases. Ann Rech Vet, 1990, 21 Suppl 1, 41S - 45S Pharmacokinetics and the dosage regimen of antimicrobial agents; Powers TE et al.; Some consider antimicrobial therapy an art rather than a science . The drug concentration at the site of infection is often assumed to be a major factor in predicting efficacy and high serum concentrations are assumed to have an advantage by increasing the amount of drug that diffuses into the various body tissues and fluids . Pharmacokinetic studies, along with pharmacodynamic studies, remain to be an important and essential portion of the data base needed for the determination of a proper dosage regimen for antimicrobial agents prior to clinical trials . Additional studies are needed to define the influence of the post antibiotic effect and post antibiotic leukocyte enhancement, as well as the subminimal and supraminimal inhibitory concentrations, on establishing the proper dosage regimen . It is recommended that the insert for a prescription antimicrobial agent should contain pharmacokinetic parameters, such as volume of distribution, t1/2 and body clearances. Drugs Exp Clin Res, 1990, 16(5), 231 - 5 Post-antibiotic effect of isepamicin compared to that of other aminoglycosides; Minguez F et al.; Isepamicin is a new aminoglycoside drug derived from gentamicin, which is more stable than other aminoglycosides to inactivating enzymes and experimentally is less nephrotoxic than gentamicin or amikacin . In this work a comparative study was carried out on the antibacterial activity (MIC and lethality curves) and the post-antibiotic effect (PAE) of different concentrations of isepamicin, netilmicin and gentamicin on pure cultures of S . aureus and E . coli . The MIC and curves of lethality were determined by conventional methods . The PAE was determined after exposure of the bacterial culture to the antimicrobial one for 1 h at 37 degrees C in a bath with stirring . Elimination of the drug was made by the dilution method . Isepamicin was found to have a MIC four times greater than netilmicin and gentamicin . Its activity over time was similar to that exhibited by other aminoglycosides . At concentrations higher than the MIC, a bactericidal effect was found with the three antibiotics, although isepamicin produced it at lower concentrations . The post-antibiotic effect induced by isepamicin, the same as that of netilmicin and gentamicin, was extensive and depended on the concentration and the strain used . Isepamicin shows antibiotic activity over time and a PAE similar to the other aminoglycosides tested but, unlike them, it has a faster activity, less toxicity and better resistance to inactivating enzymes . For this reason it makes a considerable contribution to antibacterial therapies in severe conditions, including immunodepressed patients who require long-term treatment. Drugs Exp Clin Res, 1990, 16(4), 181 - 6 Antimicrobial activity of a new derivative: N-(4-chlorobenzyl)-2-(1H-imidazol-1-ylmethyl)benzenamine; Panico S et al.; The activity of a new antifungal agent, an imidazolylmethylaniline derivative (XX H), synthesized by the authors, has been studied in vitro and in vivo . Antimicrobial data, in comparison with miconazole, ketoconazole and bifonazole, show antimicotic activity . The results are discussed on the basis of structure-activity relationships. Rev Med Chir Soc Med Nat Iasi, 1990 Jan-Mar, 94(1), 161 - 3 {The production and physicochemical characteristics of new pyridazinyl-3-methyl-4-phenylazo-5-pyrazolones}; Dorneanu M et al.; The synthesis of eight new 1-(R-pyridazinil)-3-methyl-4-(R-phenylazo)-5-pyrazolone, the structure of which was confirmed by the results of the physicochemical analysis, is presented . The preliminary tests for determining their biological action have revealed a moderate antimicrobial activity. Rev Med Chir Soc Med Nat Iasi, 1990 Jan-Mar, 94(1), 157 - 60 {Amphoteric ion intermediates in the pyrazine series . II . The action of p-nitrophenacyl bromide on pyrazine}; Ungureanu M et al.; Continuing to present the results of the investigations carried out on the amphoteric ions intermediates of the N-heteroatomic system with 2 natrium atoms in positions 1, 4, new pyrasine derivatives synthetized with p-nitro-phenacyl bromide are described . The observations on their antimicrobial and antiyeast activities is discussed. Toxicon, 1990, 28(10), 1221 - 7 Intracolonial variation in toxicity in scleractinian corals; Gunthorpe L et al.; Single colonies of the scleractinian corals Lobophyllia corymbosa, Favites abdita, Favia matthaii, Favia stelligera, Platygyra daedalea, Leptoria phrygia, Cyphastrea serailia, Hydnophora exesa and Astreopora myriophthalma were permanently marked with buoys on the reef flat at Heron Island . Great Barrier Reef . Portions of colonies were removed up to seven times at intervals of two or three months . Aqueous extracts of the colony portions were assayed using six bioassay regimes namely, toxicity to mice, toxicity to a coral and a hydroid, cytolytic activity on sheep erythrocytes and sea urchin ova and for antimicrobial activity on eight bacterial species . The incidence of one type of bioactivity in an extract was not correlated with the incidence of any other type of activity in that extract . Although each coral colony provided extracts that affected at least two of the bioassay systems, different activity profiles were obtained from successive extracts of each colony . Thus there is a temporal component to the idiosyncratic nature of bioactivity within a given colony of scleractinian coral. Toxicon, 1990, 28(10), 1199 - 219 Widespread but variable toxicity in scleractinian corals; Gunthorpe L et al.; Aqueous and/or aqueous ethanol extracts were made of 58 scleractinian species from 11 families, collected from Heron Island, Great Barrier Reef . At least one extract from each of 53 species (91%) exhibited activity against at least one bioassay system . Extracts from at least one colony of each of 41 species of the 58 tested were toxic to mice when injected i.p . Cytolysis of sheep red blood cells was produced by extracts from at least one colony of each of 49 species of the 57 species tested and antibacterial activity was present in extracts from at least one colony of each of 37 species of the 55 tested . Only four species from 45 species assayed yielded extracts toxic to mosquito fish . This is the first report of bioactivity in extracts of 46 species of coral and the first report of bioactivity of extracts of corals from the families Mussidae, Merulinidae, Siderastreidae, Oculinidae and Dendrophylliidae . Variable results on a particular bioassay exhibited by extracts from different colonies of a given species were analysed by the Generalized Linear Interactive Modelling system (GLIM) . Toxicity to mice, cytolytic and antimicrobial activity are not significantly correlated with each other . No model could be generated to explain the variation in the incidence of cytolytic activity nor of antimicrobial activity . However antimicrobial activity varied significantly between collection trips and was negatively associated with the presence of immature gonads in the colonies . The model predicts that toxicity to mice will be higher in extracts collected when average maximum monthly air temperature is high. Transplantation, 1990 Jan, 49(1), 126 - 30 Epstein-Barr virus-associated lymphoproliferative disease in a heart-lung allograft . Demonstration of host origin by restriction fragment-length polymorphism analysis; Randhawa PS et al.; An unusual posttransplant lymphoproliferative disorder is reported occurring within 6 weeks of a heart-lung transplantation, in a patient with primary exposure to the Epstein-Barr virus . The tumor presented primarily in the lung allograft as a rapidly fatal bronchopneumonia refractory to antimicrobial therapy . The viral genome was detected within the lesion by Southern blot analysis, and a primary infection was confirmed by serologic studies . Restriction fragment length polymorphism analysis using the LAM 4-1214 probe demonstrated that the tumor infiltrate in the allograft lung was derived not from the donor's bronchial-associated lymphoid tissue but from recipient lymphocytes trafficking through the allograft. Int J Cell Cloning, 1990 Jan, 8 Suppl 1, 347 - 54; discussion 354-5 The use of myeloid hematopoietic growth factors in patients with HIV infection; Mitsuyasu RT et al.; Hematologic abnormalities are frequent occurrences in patients with HIV infection . Myelosuppression in AIDS may be due to multiple factors and has significant impact on the treatment of HIV-infected individuals, as it is the major dose-limiting toxicity of a number of antimicrobial compounds and chemotherapy . Both granulocyte-macrophage colony-stimulating factor (GM-CSF) and granulocyte colony-stimulating factor (G-CSF) are hematopoietic hormones which effect myeloid progenitor cells and enhance the function of mature neutrophils . Clinical studies of the effects of these agents in patients with AIDS indicate that GM-CSF and G-CSF can increase the production of leukocytes in a dose-dependent fashion . This increase in leukocyte production may allow the continued administration of full doses of antiviral or other myelosuppressive medications in previously hematologically intolerant patients with AIDS . Investigations of the hematopoietic, virologic, and immunologic effects of these agents alone and in combination with other hematopoietins, cytokines, and chemotherapeutic agents will ultimately define their clinical utility in patients with HIV infection. Oncol Nurs Forum, 1990 Jan-Feb, 17(1 Suppl), 16 - 9 Infection prophylaxis for the patient with cancer; Cunningham R; Despite major advances in treatment, patients with cancer still are plagued by infections . Anti-infection prophylaxis begins with attempts to enhance host defenses, minimize natural barrier alterations, and reduce the number of pathogenic organisms in the patient's environment . Prevention of infection via immunomodulation also is effective to some extent . Immunoglobulin administration, leukocyte transfusion, vaccines, and lithium carbonate are integral parts of this approach to prophylaxis . Antimicrobial modulation also has been attempted . Oral nonabsorbable antibiotics have been used to reduce the number of potentially pathogenic gastrointestinal organisms . Systemic antibiotics have been evaluated for their prophylactic efficacy in patients with cancer . Obstacles to effective systemic prophylaxis include the risk of developing resistant populations of microorganisms and the inordinately large number of potentially pathogenic organisms . The oncology nurse must assume specific responsibilities when administrating prophylactic regimens . There are three crucial issues to be considered: risk factors, aspects of cost and reimbursement, and availability of the most recent treatment options. Proc Natl Acad Sci U S A, 1990 Jan, 87(1), 210 - 4 Antimicrobial defensin peptides form voltage-dependent ion-permeable channels in planar lipid bilayer membranes; Kagan BL et al.; Defensins are cationic, cysteine-rich peptides (Mr = 3500-4000) found in the cytoplasmic granules of neutrophils and macrophages . These peptides possess broad antimicrobial activity in vitro against bacteria, fungi, tumor cells, and enveloped viruses, and they are believed to contribute to the "oxygen-independent" antimicrobial defenses of neutrophils and macrophages . Pathophysiologic studies in vitro have pointed to the plasma membrane as a possible target for the cytotoxic action of defensins . We report here that defensins form voltage-dependent, weakly anion-selective channels in planar lipid bilayer membranes, and we suggest that this channel-forming ability contributes to their antimicrobial properties observed in vitro. Proc Soc Exp Biol Med, 1990 Jan, 193(1), 50 - 5 Magainin-2 releases histamine from rat mast cells; Hook WA et al.; The magainins are basic 23 amino acid peptides with a broad spectrum of antimicrobial activity . Their bactericidal effect has been attributed to their capacity to interact with lipid bilayer membranes . We observed histamine release by magainin-2 amide from rat peritoneal mast cells (ED50 = 13 micrograms/ml) but not from human basophils . This histamine-releasing reaction from peritoneal mast cells was due to a secretory rather than cytolytic effect, i.e., release occurred without concomitant liberation of lactic dehydrogenase . Furthermore, the pretreatment of mast cells with magainin-2 amide did not desensitize cells against subsequent challenge with other secretagogues . Maximum histamine release occurred in less than a minute at 25 and 37 degrees C . The addition of Ca2+ was not required for histamine release, although release was enhanced by the addition of 0.3-1 mM Ca2+ . The addition of 3 mM Ca2+ or Mg2+ was markedly inhibitory . The presence of Na+ or Cl- ions in the medium was not required for release . Therefore, histamine release is not due to the formation of anion-selective channels in the membrane of mast cells . The results indicated that the characteristics of histamine secretion induced by magainin-2 amide were unlike IgE-mediated release but were similar to the mechanism of release attributed to some other basic peptides and to compound 48/80. Am J Med, 1989 Dec 29, 87(6C), 78S - 81S The safety profile of ofloxacin; Tack KJ et al.; The safety profile of ofloxacin was evaluated on the basis of adverse reactions and abnormal laboratory values seen in United States clinical trials and phase I studies addressing specific issues . The most frequently reported adverse reactions occurring in 2,197 patients who received three to 10 days of ofloxacin in United States clinical trials were nausea (3.5 percent), insomnia (1.8 percent), headache (1.4 percent), and dizziness (1.2 percent) . Adverse reactions were not serious and usually rapidly reversible . The incidence of adverse reactions did not increase with increasing age . There is no clinically significant interaction with methylxanthines (caffeine or theophylline) . Crystalluria was not observed . Ofloxacin is a well-tolerated fluoroquinolone antimicrobial agent. J Immunol, 1989 Dec 15, 143(12), 4208 - 12 Macrophage cytotoxicity against schistosomula of Schistosoma mansoni involves arginine-dependent production of reactive nitrogen intermediates; James SL et al.; Lymphokine (LK)-activated macrophages are cytotoxic for multicellular larvae of the helminth parasite Schistosoma mansoni . Macrophage-mediated larval killing was found to be arginine dependent, as indicated by inhibition in the presence of exogenous arginase or the competitive inhibitor NG-monomethyl-L-arginine . Culture supernatant fluids from the larvicidal LK-activated macrophages contained nitrite, a product of activated macrophages derived by oxidation of arginine and implicated in the antitumor and antimicrobial effector function of these cells . Nitrite was not detectable in supernatant fluids obtained from nonactivated macrophages or from macrophages stimulated with LK in the presence of arginase or NG-monomethyl-L-arginine . Addition of excess iron or the reductant sodium dithionite to LK-activated macrophage cultures also inhibited larval killing in vitro, under conditions that have been shown by others to stabilize the activity of iron-containing enzymes involved in respiration . Nitrite production was not decreased under these conditions . These observations are consistent with the hypothesis that macrophage-mediated schistosomulum killing is caused, at least in part, by a mechanism proposed for tumor cytotoxicity, whereby production of reactive nitrogen intermediates triggers iron loss from critical target cell enzymes leading to lethal metabolic inhibition . In accordance, schistosomula were shown to be killed by inhibitors of mitochondrial respiration. Med Klin (Munich), 1989 Dec 15, 84(12), 578 - 83 {Fish breeder granuloma: infection caused by Mycobacterium marinum and other atypical mycobacteria in the human . Analysis of 8 cases and review of the literature}; Kern W et al.; Granulomatous lesions of the skin and tendon sheaths after exposure to fish tank or aquarium water are frequently caused by non-tuberculous so-called atypical mycobacteria . Mycobacterium marinum is the species most often isolated from such lesions . Rarely, other non-tuberculous species of mycobacteria may be isolated . In contrast to swimming-pool granuloma as the epidemic form of Mycobacterium marinum infection of man, fish tank granuloma seems to be a rare sporadic human disease that is often misdiagnosed . We report eight cases of fish tank granuloma . Five patients had sporotrichoid lesions, and one patient had a singular lesion . Three patients presented with tenosynovitis . Culture-proven Mycobacterium marinum infection was found in four patients, in one patient the causative organism isolated from the biopsy specimen was identified as Mycobacterium kansasii . In three patients with typical appearance of the lesions and exposure to fish tank water, biopsy specimens for culture were not available, and the diagnosis was histopathologically confirmed . Surgical treatment had an unfavourable outcome in two of three patients . Conservative antimicrobial therapy was evaluated in six patients . Similar to published reports, the treatment with rifampicin in combination with other agents seemed to be a useful therapy . Complete remission was, however, also achieved with doxycycline monotherapy . Microbiological diagnosis should be attempted in suspected cases of fish tank granuloma, and, if therapy is indicated, we strongly suggest primary medical treatment. Clin Mater, 1990, 6(1), 65 - 74 Bacterial adhesion to medical polymers--use of radiation techniques for the prevention of materials-associated infections; Jansen B; The basic principles of the adhesion of bacteria to polymer surfaces are discussed, as the first important step in the pathogenesis of foreign-body infections . Strategies for the prevention of foreign-body infections by polymer modification with ionizing radiation are presented . These include the modification of polymer surfaces by radiation or glow discharge techniques to obtain antiadhesive or antimicrobial surfaces, as well as the fixation or incorporation of antibiotic drugs to or into the polymer. Clin Mater, 1990, 6(2), 123 - 35 The use of antimicrobial acrylic strips in the nonsurgical management of chronic periodontitis; Moran J et al.; Evidence to date has demonstrated the potential value of acrylic strips to deliver antimicrobial compounds into periodontal pockets . The present study was designed to evaluate further the therapeutic effect of antimicrobial acrylic strips in the management of chronic periodontitis . A total of 101 pockets in 69 patients were randomly treated with (1) chlorhexidine strips, (2) metronidazole strips, (3) tetracycline strips, (4) root planing, and (5) combined root planing and metronidazole strips . Immediately before and after treatment clinical measurements of disease were recorded over a three-month period . For all treatment groups significant improvements in clinical parameters were seen compared to control untreated sites but the most effective treatment was combined root planing and metronidazole and the least effective chlorhexidine . Although not significant, combined root planing and metronidazole also appeared to produce some adjunctive effects on clinical parameters compared to root planing alone . Antimicrobial acrylic strips appear useful treatments for chronic periodontitis, but should be used primarily as an adjunct to conventional root planing. Orv Hetil, 1989 Dec 10, 130(50), 2671 - 5 {Antimicrobial chemotherapy--its clinico-pharmacologic significance}; Graber H; Remembering of Markusovszky, the outstanding Hungarian physician of the last century, author quotes Markusovszky's comments on perspectives of infectious diseases, then outlines the development of antibacterial chemotherapy . Some problems are discussed concerning the clinical pharmacology of the aminoglycoside and cephalosporin antibiotics and those of the new quinolones as well . Some results of author's and her coworker's researches are presented. Farmaco, 1989 Dec, 44(12), 1225 - 32 Synthesis of benzimidazole derivatives as potential antimicrobial agents; Habib NS et al.; Three novel series of benzimidazol derivatives were prepared . Namely; 2-alkyl-1-(4-substituted-4H-1,2,4-triazole-5-thion-3-yl)methylb enzimidazoles; 2-alkyl-1-(5-substituted amino-1,3,4-thiadiazol-2-yl)methylbenzimidazoles; and 2-alkyl-1-{(3,4-disubstituted thiazolin-2-ylidene)hydrazinocarbonyl} methylbenzimidazoles . The antimicrobial testing of the prepared compounds as well as of the key intermediate thiosemicarbazides was performed. Pathol Biol (Paris), 1989 Dec, 37(10), 1137 - 40 {Treatment of pneumonia caused by Legionella, Mycoplasma, Chlamydiae and Rickettsia using ofloxacin}; Leroy O et al.; To asses the efficacy and the safety of ofloxacin as therapy of pneumonia caused by intracellular pathogens, 35 patients were studied (26 male, 9 female, mean age: 52.5 +/- 16.6 years) . Causative pathogens were Chlamydia psittaci (n = 13), Legionella pneumophila (n = 10), Mycoplasma pneumoniae (n = 7) and Coxiella burnetii (n = 5) . Ofloxacin was administered orally in 32 cases (200 mg b.i.d . in 80% of cases) and by I.V . route in 3 cases . All patients were cured without any side effects . In conclusion, ofloxacin appears, in our study, as an efficient therapy for these pneumonias . It could be considered as a valuable alternative to other antimicrobial agents with intra-cellular activity. Vet Clin North Am Equine Pract, 1989 Dec, 5(3), 465 - 82 Antibiotics in the treatment of wounds; Spurlock SL et al.; In selecting an antibiotic, considerations include the sensitivity of the pathogen, drug distribution to the site of infection, bacteriostatic or bactericidal action under the existing tissue conditions, safety, and cost . Ideally, in vitro susceptibility of the pathogen can be obtained . In addition, cytologic evaluation, including a Gram stain, may be helpful in directing the initial course of therapy . Antibiotic sensitivity does not by itself guarantee satisfactory results . The terms "sensitive" and "resistant" are relative terms based on achievable blood levels of antimicrobial agents . The term "sensitive" implies that the level necessary to inhibit bacterial growth is achieved when an adequate dose is given at appropriate intervals . The distribution of the drug and, in turn, the level achieved at the site of infection depends on a number of factors, including molecular size, protein binding, and lipid solubility . Because, in most cases, specific tissue concentrations are not known, serum concentrations are used to represent the levels in the extracellular fluid space, which is the site of most bacterial infections . The local environment can further enhance or hinder antimicrobial penetration and activity . The antibiotic concentration achieved in the blood affects the concentration at the site of infection because simple passive diffusion appears to be the method of transport for most antibiotics . The antibiotic activity after reaching the site of infection is influenced by environmental conditions . Local production of enzymes, purulent and fibrinous exudate, and pH changes can adversely affect drug action . With many of these variables being difficult to predict, knowledge of etiologic agents is the cornerstone of rational use of the antimicrobial drugs . A reasonable suspicion based on clinical signs and knowledge of likely pathogens can guide the initial choice of antimicrobial therapy . Since both aerobic and anaerobic organisms may be involved in wound infections, and because antibiotic sensitivity of many of these pathogens is unpredictable, broad-spectrum antimicrobial therapy is often warranted initially. Clin Pharmacokinet, 1989 Dec, 17(6), 385 - 95 Clinical pharmacokinetics of antibacterial drugs in the elderly . Implications for selection and dosage; Meyers BR et al.; A review of the clinical pharmacokinetics of antibiotics in the healthy elderly reveals that for most compounds a decrease occurs in renal clearance (associated with age-related decreases in renal function), as well as a prolonged half-life and increased area under the plasma concentration-time curve . These changes are amplified in the sick infected elderly . It is important that the treating physician be aware of the potential side-effects of antimicrobial agents, and whenever possible choose those which are associated with the least adverse effects . Individual patient variability, including underlying diseases and other prescribed medications, must be taken into account when dosage is selected . beta-Lactam compounds have a remarkable safety record: specifically in the elderly, their therapeutic/toxic ratio is much higher than that observed with aminoglycosides . Regimens for this class of drugs in the elderly should maintain antibiotic concentrations above the minimum inhibitory concentrations for maximum efficacy . In the treatment of elderly patients, it is suggested that dosage and interval be based on estimated or measured creatinine clearance . Usually, for drugs that are excreted primarily by the kidney (i.e . amino-glycosides, beta-lactams and quinolones), dosage intervals must be increased when there is an associated fall in creatinine clearance . The pharmacokinetic parameters suggest that as an alternative to increasing dosage interval the usual dose may be decreased, but further studies are necessary for confirmation. Geriatrics, 1989 Dec, 44(12), 79 - 86 Reviewing geriatric concerns with commonly used drugs; Cooper JW; The most important special consideration for drug use in the last years of life is that the medications prescribed do what is intended and do not contribute to morbidity or premature mortality . Key factors in appropriate use are reviewed for analgesics, anti-inflammatories, corticosteroids, thyroid drugs, anti-diabetic agents, digoxin, newer antiarrhythmics, beta-blockers, diuretics and potassium supplements, sympatholytic and vasodilatory antihypertensives, warfarin and heparin, anxiolytics, neuroleptics, anticonvulsants, antidepressants, antimicrobials, laxatives, gastrointestinal and bronchodilatory agents, and nutritional supplements and vitamins. Pediatr Clin North Am, 1989 Dec, 36(6), 1371 - 87 Modern management of otitis media; Bluestone CD; In summary, infants and children who have acute otitis media should receive antimicrobial therapy . Amoxicillin is the standard of therapy for infants and children with acute otitis media, because it is safe and effective for most of the causative bacterial pathogens . Amoxicillin has also been shown to be effective for treatment of selected children with otitis media with effusion ("secretory" otitis media) and is the recommended prophylactic antimicrobial agent for prevention of frequently recurrent acute otitis media . During the past decade, however, an increasing rate of bacteria that are resistant to amoxicillin has occurred, primarily beta-lactamase-producing H . influenzae and B . catarrhalis . Because of the emergence of these bacteria, other antimicrobial agents, both old and new, have been advocated for treatment and prevention of otitis media; amoxicillin-clavulanate, cefuroxime axetil, and cefixime are the newer agents . These agents are indicated for selected infants and children; however, for most patients, amoxicillin remains a safe and relatively inexpensive effective drug . The common surgical procedures, such as myringotomy with tympanostomy tube insertion, and adenoidectomy with myringotomy with or without tympanostomy tube insertion, have now been shown to be effective for patients who have recurrent acute otitis media and chronic otitis media with effusion . The decision for or against these procedures should not only include consultation with an otolaryngologist but should also involve the parents and the child, if old enough . The risks, costs, and benefits of nonsurgical and surgical management should be discussed with all parties concerned. Rev Clin Esp, 1989 Dec, 185(9), 454 - 8 {Nocardiosis: clinical observations apropos of 9 cases}; Fontaneda Lopez D et al.; We have retrospectively analyzed 9 cases of nocardiosis that were studied in our hospital over the past 10 years . 66% of the patients had an associated disease and half of them were on steroid treatment . The clinical manifestations of the infection were pulmonary and cutaneous and in 44% of cases, it disseminated to the central nervous system . The diagnosis was made in all cases isolating the microorganism from pulmonary secretions, puss, spinal fluid and blood . Nocardia asteroides was isolated in 8 cases, and nocardia caviae in one case . There was a 55% mortality rate . The different clinical presentation and evolution are reviewed, as well as prognostic factors and antimicrobial treatment of nocardiosis. Arch Pharm (Weinheim), 1989 Dec, 322(12), 879 - 83 Antimicrobial activity of basic cholane derivatives, VIII; Bellini AM et al.; Two series of new compounds derived from deoxycholic acid have been synthesized: 3,12-dioxo-5 beta-cholan-24-N-substituted amides and their 3 beta-amino and 3 beta-N-alkylamino derivatives . The first series of five compounds 1-5 carries at C-24 the residue of benzylamine, morpholine, diethanolamine, N,N-diethyl-ethylenediamine, and N-methylpiperazine . The second series of twenty compounds 1A-D - 5A-D was prepared by means of reductive amination starting from the compounds of the first series . This reaction proved to be regioselective and stereospecific: it attacks only C-3 of the steroid moiety and introduces the following axial beta-oriented substituents: amino, methylamino, ethylamino, and benzylamino . The compounds of the first series showed moderate scattered antimicrobial activity; while introduction of the 3 beta-amino and 3 beta-N-alkylamino residue greatly increased activity towards Gram (+) strains; even yeast and fungi appear to be sensitive towards this last series of compounds . The results have been discussed with respect to the nature of the substituents both at C-3 and C-24, the highest activity being associated to the hydrophobicity of these residues. Antimicrob Agents Chemother, 1989 Dec, 33(12), 2132 - 6 WIN 57273 is bactericidal for Legionella pneumophila grown in alveolar macrophages; Edelstein PH et al.; The in vitro antimicrobial activity of WIN 57273, a new quinolone antimicrobial agent, was determined for 21 Legionella strains, using broth macrodilution and agar dilution testing methods; ciprofloxacin and erythromycin were tested as well . Three different buffered yeast extract media were used for the agar dilution studies, two of which were made with starch rather than charcoal . Broth macrodilution susceptibility testing was performed with buffered yeast extract broth and two Legionella pneumophila strains . Antimicrobial inhibition of L . pneumophila growth in guinea pig alveolar macrophages was also studied, using a method able to detect bacterial killing . The MICs for 90% of the 21 strains of Legionella spp . grown on buffered charcoal yeast extract medium were 0.125 microgram/ml for WIN 57273, 0.25 microgram/ml for ciprofloxacin, and 1.0 micrograms/ml for erythromycin . These MICs were falsely high, because of inhibition of drug activity by the medium used . Use of less drug-antagonistic, starch-containing media did not support good growth of the test strains . The broth macrodilution MICs for two strains of L . pneumophila serogroup 1 were less than or equal to 0.03 microgram/ml for WIN 57273 and ciprofloxacin and 0.125 microgram/ml for erythromycin . WIN 57273, ciprofloxacin, and erythromycin all inhibited growth of L . pneumophila in guinea pig alveolar macrophages at concentrations of 1 microgram/ml, but only WIN 57273 prevented regrowth or killed L . pneumophila after removal of extracellular antimicrobial agent. Antimicrob Agents Chemother, 1989 Dec, 33(12), 2034 - 6 Evaluation of an antimicrobial soap formula for virucidal efficacy in vitro against human immunodeficiency virus in a blood-virus mixture; Lavelle GC et al.; The virucidal efficacy of a health care personnel hand wash product containing 0.5% parachlorometaxylenol in a sodium C14-16 olefin sulfonate formula was evaluated in in vitro tests with human immunodeficiency virus type 1 (HIV-1) in the presence of 50% whole human blood . The HTLV-IIIRF strain of HIV-1 was suspended in 50% medium-50% whole human blood and exposed to various dilutions of the hand wash product for 30 or 60 s . Following detoxification, residual infectivity was determined by a lytic cytopathogenic assay in MT2 cell cultures . No infectious HIV could be detected after a 30-s exposure to the hand wash product at dilutions of 1:5 and 1:10 and after a 60-s exposure at dilutions of 1:5, 1:10, 1:20, and 1:30 . More than 99.9% of the virus was inactivated at these dilutions and exposure times. Xenobiotica, 1989 Dec, 19(12), 1349 - 54 The pharmacokinetics of pirtenidine in the rat and dog; Powles P et al.; 1 . Pharmacokinetic studies on the topical antimicrobial agent, pirtenidine, have been conducted in male Sprague-Dawley rats and beagle dogs, using a validated h.p.l.c . method with u.v . detection to measure the drug in plasma . 2 . Following a single i.v . bolus dose to the rat (equivalent to 1.35 mg base/kg) or dog (equivalent to 0.23 mg base/kg), the drug was extensively distributed with an apparent volume of distribution of 8.61/kg in rat and 3.31/kg in dog . Clearance was high (rat 2.71/h/kg; dog 1.51/kg) which resulted in a short terminal half-life in both species (2.2 and 1.5 h respectively) . 3 . Following a single oral dose to rats (equivalent to 4.5 mg base/kg) plasma pirtenidine concentrations were generally below the minimum quantifiable level of the analytical method (1 ng/ml) . A maximum possible bioavailability of 0.3% was estimated . 4 . After administering the same oral dose to dogs plasma concentrations rose slowly (t 1/2 abs = 1.2 h) to a peak (49.7 ng/ml) at 5.0 h post-dose . The terminal elimination half-life was 2.1 h . The absolute bioavailability was 10%. J Clin Pharm Ther, 1989 Dec, 14(6), 457 - 64 Disinfectants prepared in a hospital pharmacy--assessment of their microbiological purity and antimicrobial effectiveness; Nkibiasala SM et al.; The microbial contamination and antimicrobial effectiveness of seven topical disinfectants prepared at the hospital pharmacy were studied . These products were controlled throughout storage and use . The manufacturing routine investigated was able to deliver larger batch sizes and quality products that allowed increased storage time . The formulations chosen by the pharmacists were effective against bacteria for their intended uses . For chloramine only, loss of effectiveness required reduced storage time . No significant modification in the microbial quality of these products was observed during use in our hospital. Am J Hosp Pharm, 1989 Dec, 46(12), 2493 - 6 Effect of interventions on prescribing of antimicrobials for prophylaxis in obstetric and gynecologic surgery; Zhanel GG et al.; The effect of interventions on the conformity of physicians with guidelines for the appropriate use of antimicrobial prophylaxis in obstetric and gynecologic surgery is reported . Guidelines on the appropriate use of antimicrobial prophylaxis in common obstetric and gynecologic surgical procedures were developed in late 1986 by the antibiotic subcommittee at a 1100-bed tertiary-care teaching facility . The guidelines were not adopted immediately by the department of obstetrics and gynecology (OB-GYN) . An audit of the medical records of women who had received antimicrobial therapy for abdominal and vaginal hysterectomies and emergency cesarean sections during January through March 1987 showed that cefoxitin was used in 68% of the cases instead of the less expensive and equally efficacious cefazolin as recommended in the guidelines . The projected annual cost of this nonconformity was $26,500 . After the subcommittee informed the physicians about the guidelines and the audit results, the OB-GYN department adopted the guidelines . A second audit performed one year later showed that cefazolin was used in the recommended manner in 93% of cases; projected annual cost savings were $25,000 . Both audits showed that prophylactic treatment was inappropriately prolonged in 6% of cases . Substantial cost savings were realized by minimizing inappropriate antimicrobial drug use through efforts to promote rational and cost-effective therapy. DICP, 1989 Dec, 23(12), 1024 - 30 Formulary conversion of cefoxitin usage to cefotetan: experience at a large teaching hospital; Smith KS et al.; The pharmacy and therapeutics committee at Hartford Hospital recommended replacement of cefoxitin with cefotetan, based on data reported in the literature regarding antimicrobial activity, pharmacokinetic profile, and adverse reactions . Once the recommendation was approved by the medical staff, an intense educational program was instituted, and all orders for cefoxitin were converted to cefotetan with appropriate dosage modifications . A total of 960 patients were treated in the first year; no major patterns of ineffectual therapy or adverse events associated with cefotetan usage have emerged . The mean cost of cefotetan therapy was $180.59, which is $130.26 less per patient than a comparable regimen of cefoxitin (mean cost of therapy $310.85) . Based on the data analysis of cefotetan usage for a 12-month period, the actual annual savings due to therapeutic substitution of cefotetan for cefoxitin was $124.961 . To further evaluate the clinical efficacy, safety, and savings of this therapeutic interchange, two separate retrospective reviews of patient medical records were performed . The first audit has been previously published in its entirety . In the subsequent audit, 284 additional patient medical charts have been reviewed . These patients received either cefotetan therapy or concomitant therapy of an aminoglycoside combined with either clindamycin or mezlocillin . Clinical outcomes were classified as an empiric cure or improvement for 99.4, 98.5, and 92.9 percent of patients, respectively . In this audit, elevated prothrombin time/partial thromboplastin time values and bleeding episodes were noted infrequently, as were other adverse reactions.(ABSTRACT TRUNCATED AT 250 WORDS) J Allergy Clin Immunol, 1989 Dec, 84(6 Pt 1), 914 - 9 Glandular secretion of lactoferrin in a patient with neutrophil lactoferrin deficiency; Raphael GD et al.; Patients with specific granule deficiency (SGD) develop recurrent severe bacterial skin infections . Neutrophils from patients with SGD are deficient in lactoferrin (Lf), an antimicrobial protein commonly found in many mucosal secretions . Unstimulated and stimulated nasal secretions, saliva, and tears were collected from a patient with SGD and from normal control subjects and were analyzed for Lf . The secretions from the patient contained normal values of Lf, suggesting that the glands secrete Lf from a source other than neutrophils . Immunohistochemical staining of normal nasal mucosa demonstrated that Lf is localized within serous submucosal gland cells and that neutrophils are not normally observed in the nasal mucosa . These findings suggest that glandular tissues produce and locally secrete Lf by processes that are independent of neutrophil degranulation. J Am Vet Med Assoc, 1989 Dec 1, 195(11), 1606 - 8 Surgical excision of ectopic thyroid carcinoma involving the base of the tongue in dogs: three cases (1980-1987); Lantz GC et al.; Localized thyroid carcinoma involving the base of the tongue was diagnosed in 3 dogs examined because of a midline cervical mass rostroventral to the larynx . These masses had been present for 4 to 12 months and were firm, nonsensitive, and fixed in position . One dog had progressive dysphagia and dyspnea . Masses were surgically excised together with the base of the tongue and portions of the hyoid apparatus . Severe dyspnea that developed immediately after surgery in 1 dog was managed by tracheostomy intubation for 4 days . Transient dysphagia developed in all dogs . Hydration was maintained by IV fluid administration until water and food of gruel consistency could be swallowed 1 to 6 days after surgery . Consistency of food was gradually thickened to normal, as swallowing improved 6 days to 2 months after surgery . One dog developed aspiration pneumonia that resolved after antimicrobial administration and improved swallowing that prevented further aspiration . After 9 months, 3 years, and 6 years, the dogs were clinically normal. South Med J, 1989 Dec, 82(12), 1583 - 4 Lemierre's postanginal septicemia: internal jugular vein thrombosis related to pharyngeal infection; Shadowen RD et al.; We have described a case of septic thrombophlebitis of the internal jugular vein after an anaerobic pharyngeal infection . This and other septic thrombophlebitides are a part of Lemierre's postanginal septicemia . Early diagnosis and appropriate antimicrobial therapy are important to avoid sequelae. J Urol, 1989 Dec, 142(6), 1545 - 7 Nephrogenic adenoma of the bladder in children; Nold SR et al.; Nephrogenic adenoma is an uncommon entity, particularly in children . This benign lesion is believed to represent urothelial transformation in response to trauma or inflammation . Current treatment is local resection with fulguration of the base of the lesion, long-term antimicrobial therapy and periodic cystoscopy . Our 2 cases support not only the urothelial transformation theory but raise the possibility that immunosuppression may be a contributing factor in these lesions. Ann Emerg Med, 1989 Dec, 18(12), 1352 - 7 Plantar puncture wounds: controversies and treatment recommendations; Chisholm CD et al.; Future studies are needed to define the natural history of plantar puncture wounds; delineate optimal initial evaluation techniques; examine the role of broad-spectrum antimicrobials for proph