Antimicrobial

Farmaco {Sci}, 1988 Jun, 43(6), 489 - 99
Synthesis of some derivatives of 1-ethyl-6-fluoro-1,4-dihydro-4-oxo-7-(piperazin-1-yl)-3-quino linecarbo xylic acid (norfloxacin) as potential antibacterial agents; Pappalardo M et al.; Twelve new fluoroquinolones, structurally related to norfloxacin, have been synthesized in order to investigate the effect of substituents at the secondary nitrogen of the piperazine ring on antimicrobial activity . The new substances (carbamates, isoureas, guanidines, ureas and cyanamides) tested on a variety of gram-positive and gram-negative organisms showed lower activity than the model compound.

Oral Surg Oral Med Oral Pathol, 1988 Jun, 65(6), 757 - 62
Clinical and laboratory assessments of camphorated monochlorophenol in endodontic therapy; Koontongkaew S et al.; The purpose of this study was to evaluate the effect of camphorated monochlorophenol (CMCP) on bacterial status of root canals of nonvital teeth during treatments . The presence of bacteria in 15 single-rooted teeth with periapical lesions was studied throughout a whole period of treatment . Patients were randomly divided into three groups . In group 1, a control group, the intracanal medication was omitted . The teeth were enlarged under aseptic conditions in combination with the use of 3% H2O2 and 5.25% NaOCl as irrigants . In group 2, after chemomechanical preparation, the root canals were dressed with 2 microliter of 40% CMCP . The medicament was replaced on days 3 and 7 . In group 3, root canals were treated in a manner similar to those in group 2, except that the medicament was renewed on days 1 and 7 . The loss of CMCP was determined in groups 2 and 3 . The results showed that chemomechanical preparation could reduce bacteria in root canals to an uncultivable number . Approximately 62.5% of the original concentration of CMCP was lost after placement in root canals for 1 day . Intracanal dressing with CMCP between appointments induced a rapid decrease in number of bacteria in root canals within the first 1 to 3 days . However, compared to chemomechanical preparation, the antimicrobial effect of CMCP was not clinically impressive because negative cultures also could be observed despite the absence of intracanal medications.

Scand J Dent Res, 1988 Jun, 96(3), 212 - 7
Antiplaque effects and mode of action of a combination of zinc citrate and a nonionic antimicrobial agent; Saxton CA et al.; The effect upon plaque growth of adding a nonionic antimicrobial agent, triclosan, to a dentifrice containing zinc citrate was established in short-term in vivo studies . Plaque regrowth was inhibited by brushing with dentifrices which contained either zinc citrate or triclosan . When both were combined in the same dentifrice, the inhibition of overnight plaque regrowth was significantly greater . In two 4-day non-brushing studies, the dentifrices containing both zinc citrate and triclosan were applied either undiluted by the use of a cap splint or as 23% suspensions in water . Both methods resulted in significant reductions in plaque accumulation, with the greater activity being observed for the undiluted application of the dentifrice . Analysis of results of the overnight plaque studies for individual teeth revealed that the two agents had a complementary inhibitory action on plaque regrowth, zinc citrate being more effective on existing plaque whereas triclosan inhibited plaque formation on clean surfaces . The dentifrice containing both agents was effective against both existing plaque and new plaque formation . It is concluded that the addition of triclosan to a dentifrice containing zinc citrate improves its antiplaque potential.

Dan Med Bull, 1988 Jun, 35(3), 297 - 9
Changes in penicillin prescribing in general practice; Bro F et al.; In the present study, we have analysed changes from 1979 to 1983 in the use of phenoxymethyl penicillin and broad spectrum penicillin in the treatment of sinusitis in general practice . The changes are related to the doctors' seniority and to their practice conditions . All GPs in five counties were invited to register all prescriptions of antimicrobials during two periods, from 19 to 23 March 1979 and from 21 to 25 March 1983 . In 1979 and 1983, 574 and 625 GPs participated, constituting 67% and 66%, respectively, of all the GPs in the five counties . A total of 15,863 prescriptions of antimicrobials was registered . In all, 1,567 patients with sinusitis were included in the study . Log-linear analyses were performed in order to take into consideration covariation in the explanatory variables and changes in the composition of the material between 1979 and 1983 . The probability that a patient with sinusitis was treated with phenoxymethyl penicillin was reduced between 1979 and 1983 (odds ratio = 0.84), while the probability for treatment with broad spectrum penicillin was increased (odds ratio = 1.18) . The log-linear analyses revealed no relationship between the doctors' seniority, the practice form or localisation, and changes in use of phenoxymethyl penicillin or broad spectrum penicillin.

Antimicrob Agents Chemother, 1988 Jun, 32(6), 896 - 905
Cationic antitrypanosomal and other antimicrobial agents in the therapy of experimental Pneumocystis carinii pneumonia; Walzer PD et al.; Cationic compounds used in the treatment of veterinary African trypanosomiasis have structural properties similar to those of pentamidine, which has been used in the therapy of human trypanosomiasis and infection with Pneumocystis carinii . We have compared the activities of these drugs and other antimicrobial agents in an immunosuppressed rat model of P . carinii pneumonia . Diminazene, imidocarb, amicarbalide, quinapyramine, and isometamidium showed efficacy greater than or equal to that of pentamidine in the therapy of P . carinii infection, whereas ethidium and methylglyoxal bis(guanylhydrazone) were only slightly active against the organism . Diminazene and pentamidine also exhibited comparable efficacy in P . carinii prophylaxis, alpha-Difluoromethylornithine (DFMO), a polyamine inhibitor, was ineffective therapy when used alone and did not improve the effectiveness of pentamidine or diminazene . Quinine, quinidine, quinacrine, chlorpromazine, spiramycin, Pentostam, Astiban, dehydroemetine, ampicillin, gentamicin, chloramphenicol, and spectinomycin also showed little or no activity against the organism . Thus, in this model anti-P . carinii activity appears to be a common property of veterinary cationic trypanocidal compounds . This should be important in studying structure-activity relationships and in developing new drugs for the treatment of P . carinii infection in humans.

Am J Hosp Pharm, 1988 Jun, 45(6), 1346 - 9
Impact of home infusion therapy on the Colorado Medicaid program budget; Culbertson VL et al.; The impact of home infusion therapies on the pharmaceutical services drug budget of the Colorado Medicaid program was evaluated retrospectively . Pharmacy billing claims and prior authorization forms for home infusion therapies submitted to the Colorado Department of Social Services during a 26-month period were reviewed to determine the costs of the drug or hydration solutions and ancillary products necessary for the preparation and administration of the solutions . A dispensing fee of +3.40 per dose was figured into calculations of total costs of home infusion therapies, and an estimated cost of +100-+150 per day for follow-up care was added . Equivalent costs of hospitalization were calculated using an average per diem charge of +315 . A total of 61 patients received 1361 days of home infusion therapy during the study period . The majority of patients received home antimicrobial therapy; 752 days of hospitalization theoretically were avoided because of home administration of antimicrobial agents, which translates into a cost savings of +76,716-+114,316 . Patients also received home parenteral nutrition therapy, analgesic therapy, and rehydration therapy that yielded cost savings of +48,374-+78,824 but in some cases resulted in higher costs than hospitalization would have . Home infusion therapies increased pharmaceutical services costs by +99,475, representing an important shift of costs from the hospital services budget to the pharmaceutical services budget . Home infusion therapies generally incur lower costs than would be incurred during an equivalent hospital stay . The Colorado Medicaid budget should be adjusted to compensate for the shift of costs from hospital to pharmaceutical services.

Eur J Clin Microbiol Infect Dis, 1988 Jun, 7(3), 348 - 54
Etiological diagnosis of pneumonia in military conscripts by combined use of bacterial culture and serological methods; Lehtomaki K et al.; The combined use of microbiological, serological and clinical laboratory methods was evaluated for etiological diagnosis of pneumonia in 106 military conscripts . Special attention was paid to rapid diagnosis of pneumococcal pneumonia and its differentiation from viral and mycoplasmal pneumonia . The microbial etiology could be established in 91 (86%) of the pneumonia patients . Pneumococcal etiology was definitely established in 32 (30%) patients and considered probable in an additional 21 patients (20%) . Infection with Mycoplasma pneumoniae and adenovirus was confirmed in 23 (22%) of the patients . Mixed infections was observed in 28 (31%) of the patients with established etiology . Detection of pneumococcal antigen was the best rapid diagnostic method, being positive in 90% of the patients with purulent sputum samples in the group with a definite diagnosis of pneumococcal pneumonia prior to the start of antimicrobial treatment, while Gram stain was positive in only 65% of these patients . Sputum purulence could be used to differentiate very significantly pneumococcal from viral and mycoplasmal pneumonia (p less than 0.001) . These categories of pneumonia could also be successfully differentiated by clinical laboratory tests, of which the white blood cell count and C-reactive protein were most useful . The suggested cut-off value for the cell count was 10 X 10(9)/l, and for C-reactive protein 85 mg/l . These tests could not differentiate viral from mycoplasmal pneumonias.

J Immunol, 1988 Jun 1, 140(11), 3978 - 81
IFN-gamma-activated human alveolar macrophages inhibit the intracellular multiplication of Legionella pneumophila; Nash TW et al.; Human alveolar macrophages activated by human rIFN-gamma inhibit the intracellular multiplication of Legionella pneumophila, an intracellular bacterial pathogen and the agent of Legionnaires' disease . Activation of alveolar macrophages with IFN-gamma is dose dependent; significant inhibition of L . pneumophila multiplication (mean 1.60 +/- 0.20 logs) is achieved consistently with concentrations of IFN-gamma of greater than or equal to 2 x 10(-2) micrograms/ml (220 U/ml) . Activation of alveolar macrophages is also time dependent . In macrophages treated continuously after explantation, macrophages infected at 48 to 96 h after explantation are more inhibitory than macrophages infected at 24 h after explantation . In macrophages not treated continuously after explantation but treated for various lengths of time before infection, the longer their exposure to IFN-gamma before infection, the greater the inhibition of L . pneumophila multiplication (96 greater than 72 greater than 48 greater than 24 h) . IFN-gamma-activated alveolar macrophages exhibit morphologic signs of activation, including increased size, spreading, and aggregation . This paper demonstrates that a human resident macrophage can be activated with IFN-gamma such that it exhibits enhanced antimicrobial activity against a relevant pathogen.

Arch Fr Pediatr, 1988 Jun-Jul, 45(6), 393 - 7
{Infections and bone marrow autograft carried out for leukemias in children . Apropos of 47 cases}; Amsallem D et al.; This study included 44 children undergoing autologous marrow transplantation for leukemia between August 1979 and June 1987 . Three of them received a second transplant . In the phase of neutropenia, 38 children presented with fever . Nineteen septicemia occurred (13 Gram positive cocci, 6 Gram negative bacteria), and 2 interstitial pneumonitis were observed . All children with documented infection or a fever of unknown origin recovered after treatment, except 3, who died from infection . The latest antimicrobial therapy used was a combination of an aminoglycoside and a third generation cephalosporin . When necessary, vancomycin or amphotericin B were added . After engraftment (granulocyte count greater than 0.5 X 10(9)/l) 14 septicemia (which recovered) and 10 herpes zoster infections were observed . Only one patient died of infection (herpes zoster with encephalitis).

J Pediatr Surg, 1988 Jun, 23(6), 533 - 7
The usefulness of open-lung biopsy in the pediatric bone marrow transplant population; Shorter NA et al.; From October 1976 to October 1986, 126 children had bone marrow transplants at the Children's Hospital of Philadelphia . The indications were acute lymphocytic leukemia (ALL) (30), nonlymphocytic leukemia (24), aplastic anemia (15), solid tumors (47), and miscellaneous conditions (10) . Of these, 21 (17%) underwent 22 open-lung biopsies . Fourteen of these patients showed no causative microorganism . When a cause was found it was viral (usually cytomegalovirus {CMV}) in three, fungal in one, Pneumocystis carinii alone in two, both viral and pneumocystis in one, and a combination of viral, bacterial, and pneumocystis in one . Thirteen patients died due to continued deterioration after the biopsy . In only two patients was there a significant change in antimicrobial therapy as a result of the biopsy . Both had Pneumocystis (one in combination with virus and bacteria) . One patient with chronic infiltrates showed a lymphocytic interstitial pneumonia, which responded well to steroids . Open-lung biopsy is currently of limited value in this patient population . Survival is dismal unless the patient has Pneumocystis . We believe that prospective studies should be set up to compare open-lung biopsy with empiric antimicrobial therapy . A major emphasis must be on prevention.

Hautarzt, 1988 Jun, 39(6), 343 - 7
{Antimycotic susceptibility testing of yeasts important in dermato-venereology: methods, results and clinical relevance}; Korting HC et al.; During the last decades many different methods have been devised for testing the antimicrobial susceptibility of yeasts in vitro . These methods range from agar diffusion and agar dilution to macro- and micro-broth-dilution methods . Although the ideal method has not yet been found, interest is currently focussed on micro-dilution tests . Yeasts that cause disease in man are not generally susceptible to the most frequently used antimycotics . This is especially true of 5-fluorocytosine, but strains resistant to ketoconazole, nystatin and amphotericin B have also been found . So far, many of the data obtained from in vitro studies of the antimicrobial susceptibility of yeasts have been found not to be closely correlated with clinical outcome . Most recently this situation has changed greatly, however, and this seems to be due to a large extent to new test procedures.

Eur J Epidemiol, 1988 Jun, 4(2), 251 - 5
Comparison among enterotoxigenic strains of Escherichia coli isolated in Italy and Somalia; Caprioli A et al.; Nine strains of ETEC isolated in Italy have been compared with 13 isolates from Somalia with respect to toxin production, serotype and antimicrobial resistance pattern . None of the strains isolated from Italy belonged to any serotype or serogroups found among the strains from Somalia . Remarkable differences between the two groups of isolates were also observed with regard to the susceptibility to antimicrobials and the presence of R-plasmids . These findings suggest that ETEC strains isolated in Italy are not related to the strains widespread in Somalia and, generally, in developing countries.

Ann Plast Surg, 1988 Jun, 20(6), 573 - 5
Hypersensitivity dermatitis following suction-assisted lipectomy: a complication of local anesthetic; Fine PG et al.; We report a case of severe dermatitis involving the abdomen and thighs following suction-assisted lipectomy of these areas wherein local anesthetic containing the preservative methylparaben was used for infiltrative anesthesia . This use of local anesthetics with epinephrine can be of value in the performance of suction-assisted lipectomy to reduce blood loss, serve as an adjunct to other intraoperative anesthetic techniques, and for postoperative analgesia . Local anesthetic solutions commonly contain additives, which serve as antioxidants and antimicrobials . The most common of these preservatives is methylparaben, which can cause delayed hypersensitivity reactions . These reactions may be neither recognized nor clinically significant in small areas of infection, whereas in large body surface infiltrative procedures, such as suction-assisted lipectomy, these reactions may be of considerable consequence . This article reviews the pathophysiology and treatment of these reactions and gives recommendations for avoiding them.

Hematol Oncol Clin North Am, 1988 Jun, 2(2), 267 - 76
Cellular and molecular effects of recombinant interferon gamma in chronic granulomatous disease; Newburger PE et al.; We have examined the potential of IFN-gamma to ameliorate the physiologic defect of CGD by studying its effects on CGD phagocyte superoxide generation, NADPH-oxidase kinetics, and expression of the gene for the phagocyte cytochrome b heavy chain . In vitro treatment with IFN-gamma increased the respiratory burst activity of PMN and macrophages from three patients in two kindreds with type IA (variant, X-linked) . Phagocytes from type I (classic, X-linked) and types IIA and III (autosomal recessive) CGD did not respond to IFN-gamma in vitro . Preliminary studies of in vivo treatment of several of the same patients with subcutaneous IFN-gamma demonstrated similar responses . All subjects whose phagocytes had responded in vitro showed complete or partial correction of the CGD defect in superoxide generation for up to 1 month after IFN-gamma administration . One patient with type I CGD with no detectable in vitro response also showed improved phagocyte respiratory burst activity after in vivo IFN-gamma treatment . These studies establish the potential efficacy of IFN-gamma in the treatment of patients with X-linked CGD and provide an example of pharmacologic modulation of gene expression in human disease . The ease of administration and absence of toxicity suggest a place for IFN-gamma as an adjunct to more conventional antimicrobial therapy during acute infections in CGD and perhaps even other congenital and acquired immunodeficiency states.

Mayo Clin Proc, 1988 Jun, 63(6), 539 - 51
Whipple's disease: clinical, biochemical, and histopathologic features and assessment of treatment in 29 patients; Fleming JL et al.; Whipple's disease is a chronic systemic illness, the optimal treatment of which remains poorly defined . In our analysis of a 30-year, 29-patient experience with Whipple's disease at the Mayo Clinic, the frequent initial manifestations of diarrhea, weight loss, arthritis, and lymphadenopathy correlated with findings reported previously by other investigators . Antibiotic therapy yielded rapid symptomatic and biochemical improvement, and histologic changes in the small bowel occurred subsequently . Despite antimicrobial therapy, relapses in patients with Whipple's disease are common, and the central nervous system is considered the most serious site of involvement for recurrence . Administration of an antibiotic agent that is able to cross the blood-brain barrier may be more important in preventing relapse than prolonged duration of initial antimicrobial therapy.

Infect Immun, 1988 Jun, 56(6), 1464 - 9
Attempts to characterize the mechanisms involved in mycobacterial growth inhibition by gamma-interferon-activated bone marrow macrophages; Flesch IE et al.; Bone marrow-derived murine macrophages are able to inhibit the growth of Mycobacterium bovis and of some strains of M . tuberculosis after stimulation with either recombinant gamma interferon (rIFN-gamma) or lymphokines from antigen-specific T-cell clones . To elucidate the mechanism(s) involved in antimycobacterial activity, macrophages were infected with M . bovis in the presence of agents thought to influence the antimicrobial effects of phagocytes . Scavengers of toxic oxygen metabolites failed to influence the capacity of IFN-gamma-activated bone marrow macrophages to inhibit the growth of M . bovis . Suramin slightly affected mycobacterial growth in IFN-gamma-activated macrophages, and chloroquine markedly induced growth inhibition of M . bovis in unstimulated macrophages . We conclude that growth inhibition of M . bovis by IFN-gamma-activated macrophages is an oxygen-independent process.

Am J Surg, 1988 May 31, 155(5A), 52 - 5
Overview of cephalosporin prophylaxis; Kaiser AB; After an uncertain and highly controversial beginning, the use of antimicrobials for prophylaxis of surgical wound infection has evolved to represent state-of-the-art management of the surgical patient . Although a truly ideal prophylactic antimicrobial does not exist, the cephalosporins, particularly those of the first generation, have emerged as the mainstay of prophylaxis in surgery . However, new pathogens and newly recognized problems have necessitated a comparative evaluation of a wide variety of antibiotic regimens . The choice of an appropriate antibiotic is complicated by the lack of an adequate experimental model of infection in clean and clean-contaminated surgical procedures . Moreover, clinical trials have proved to be an inefficient method of comparing antibiotic regimens, as important variations in risk factors for infection cannot be reliably controlled . Significant differences exist among cephalosporins and between the cephalosporins and other classes of antimicrobials in several clinically important parameters: antimicrobial spectrum, serum half-life, ease of administration, tissue penetrability, cost, and incidence of allergy and toxicity . New generations of cephalosporins and new classes of antibiotics have demonstrated the potential to out-perform the first-generation cephalosporins in many of these areas . Although the first-generation cephalosporins were essential in establishing the efficacy of antibiotic prophylaxis in surgery, there are no guarantees that this class of cephalosporin, or that any cephalosporin, for that matter, will continue to dominate the prophylactic arena.

N Engl J Med, 1988 May 12, 318(19), 1240 - 3
Protection by milk immunoglobulin concentrate against oral challenge with enterotoxigenic Escherichia coli; Tacket CO et al.; Enterotoxigenic Escherichia coli is a common cause of traveler's diarrhea . Prophylaxis against traveler's diarrhea has been associated with side effects from bismuth subsalicylate and the development of resistance to antimicrobial agents . We undertook a double-blind controlled trial in which a bovine milk immunoglobulin concentrate with high titers of antibodies against enterotoxigenic E . coli was used as prophylaxis against E . coli challenge in volunteers . Lyophilized milk immunoglobulins were prepared from the colostrum of cows immunized with several enterotoxigenic E . coli serotypes and fimbria types, E . coli heat-labile enterotoxin, and cholera toxin . As a control, an immunoglobulin concentrate with no anti-E . coli activity was prepared . Ten volunteers received buffered immunoglobulin concentrate against enterotoxigenic E . coli, and 10 received the control immunoglobulin concentrate, dissolved in water, three times a day . No side effects were observed . On the third day of immunoglobulin prophylaxis, the volunteers were given 10(9) colony-forming units of enterotoxigenic E . coli H10407 (O78:H11) . This strain produces colonization factor antigen I and heat-labile and heat-stable enterotoxins . None of the 10 volunteers receiving the immunoglobulin concentrate against E . coli had diarrhea, but 9 of the 10 controls did (P less than 0.0001) . All volunteers excreted E . coli H10407 . We conclude from these preliminary results that milk immunoglobulin concentrate may be an effective prophylaxis against traveler's diarrhea.

Arzneimittelforschung, 1988 May, 38(5), 730 - 5
Penetration and permeation into human skin of fusidic acid in different galenical formulation; Stuttgen G et al.; The penetration into the horny layer and permeation through the skin of fusidic acid, incorporated in different bases, e.g., cream, ointment and a gel (Fucidine), was investigated in vitro in a penetration chamber, using human skin . Whereas the horny layer offers a marked barrier to penetration in normal skin, this barrier can be greatly reduced by damaging the horny layer by adhesive tape stripping . Fusidic acid showed penetration into the different layers of skin which was related to the duration of application, including the penetration chamber fluid, i.e., there was penetration of the entire skin thickness . In the presence of spontaneous changes in the horny layer, as in seborrhoeic warts and similar conditions, fusidic acid penetrated well into the deeper layers of the skin . Fusidic acid is thus a substance which permeates better in regions where the horny layer is damaged, and where it can attain high levels, which in practice are antimicrobial . Penetration into the skin is thus a function of damage to the horny layer and the quality of the horny layer itself . From this point of view the amount of absorption in dermatoses depends on the area of skin with damage to the horny layer . Penetration through normal skin can be disregarded.

Infection, 1988 May-Jun, 16(3), 189 - 93
Prolonged granulocytopenia due to selective antimicrobial modulation of the intestinal flora of irradiated mice: the impact on recovery from infection; Guiot HF et al.; In order to study the effect of modulation of the intestinal flora on granulopoiesis, conventional mice were given drinking water with or without a combination of antimicrobial drugs, i.e . neomycin, polymyxin B, amphotericin B and nalidixic acid . These antimicrobial drugs, which selectively eliminate the aerobic gram-negative rods and suppress yeasts, are currently administered to our patients to prevent infection during granulocytopenia (nalidixic acid has been replaced by pipemidinic acid) . After sublethal irradiation, mice on antimicrobial drugs were granulocytopenic longer than the controls . Although these differences were rather small, i.e . two days, the impact on the course of an experimental infection at the end of the period of granulocytopenia was substantial . After injection of 1 x 10(5) live bacteria into the thigh muscle, both groups of granulocytopenic mice exhibited an initial increase in the number of bacteria in the thigh muscle . After 18 h a further increase in the number of bacteria was found for 63% of the mice receiving antimicrobial drugs, whereas the number had dropped below the baseline in 77% of the controls . These differences were reflected in the incidence of bacteremia, i.e . positive blood cultures for the bacteria injected into the thigh muscle were found for 26% of the mice on antimicrobial prophylaxis versus only 2% of the control mice . Remarkably, the number of peripheral blood granulocytes correlated with the number of CFU isolated from the thigh 18 h after injection for the animals on prophylaxis but not for the controls . This might mean that modulation of the intestinal flora affects not only the number of circulating granulocytes, but also other host defense factors.

Antimicrob Agents Chemother, 1988 May, 32(5), 782 - 4
Synergistic interactions of ciprofloxacin and extended-spectrum beta-lactams or aminoglycosides against multiply drug-resistant Pseudomonas maltophilia; Chow AW et al.; The susceptibility of 28 clinical isolates of Pseudomonas maltophilia to 16 antimicrobial agents was determined in vitro by a standard agar dilution method with inoculum sizes of 10(4) and 10(6) CFU . All isolates exhibited multiple drug resistance . Nine isolates were selected for studies of combinations of ciprofloxacin with seven antipseudomonal beta-lactams and three aminoglycosides by a checkerboard agar dilution technique . Synergistic or additive combinations of ciprofloxacin in clinically achievable concentrations were most frequent with mezlocillin (89%), followed by cefoperazone (67%), piperacillin (56%), cefsulodin (56%), and ceftazidime (33%), and were infrequent with aztreonam (11%), the aminoglycosides (0 to 14%), or imipenem (0%) . Antagonism was not observed in any combination . These data suggest that combinations of ciprofloxacin with these agents may be useful for some nosocomial multiply drug-resistant P . maltophilia infections.

Food Chem Toxicol, 1988 May, 26(5), 441 - 6
Identification of spinacine as the principal reaction product of gamma-casein with formaldehyde in cheese; Restani P et al.; Formaldehyde is added to milk in the production of grana cheese as an antimicrobial agent . In order to study the fate of the formaldehyde, a grana cheese preparation was made using 14C-labelled formaldehyde . The 14C-activity in the cheese was found to be mainly associated with the caseins, but it was not uniformly distributed among the different fractions (alpha s, beta- and gamma-caseins) . gamma-Casein, separated by electrophoresis, was the most reactive component showing the highest specific activity . In the gamma-casein fractions, 99% of 14C-activity was associated with the basic amino acids . The only radioactive reaction product present in the gamma-casein fraction was identified by HPTLC and by an amino acid analyser to be spinacine, a condensation product of formaldehyde and histidine . Using the same method, other unknown radioactive products, of much less relevance, were detected in the total casein hydrolysate.

Br J Radiol, 1988 May, 61(725), 366 - 7
Radiological awareness of current recommendations on prophylaxis of infective endocarditis; Raby N; In 1982 the British Society for Antimicrobial Chemotherapy produced a report recommending that all patients with a prosthetic heart valve should receive prophylactic antibiotics prior to any procedure likely to cause a transient bacteraemia . This includes barium enema and genitourinary tract instrumentation . A postal survey of 38 radiology departments has shown that there is very poor awareness of this report and of its implications for radiology departments and suggestions are made as to how this may be improved.

Infect Immun, 1988 May, 56(5), 1194 - 202
A capsule-deficient mutant of Francisella tularensis LVS exhibits enhanced sensitivity to killing by serum but diminished sensitivity to killing by polymorphonuclear leukocytes; Sandstrom G et al.; The live vaccine strain (LVS) of Francisella tularensis is killed by human polymorphonuclear leukocytes as a result of strictly oxygen-dependent mechanisms (S . Lofgren, A . Tarnvik, M . Thore, and J . Carlsson, Infect . Immun . 43:730-734, 1984) . We now report that a capsule-deficient (Cap-) mutant of LVS survives in the leukocytes . In contrast to the encapsulated parent strain, the Cap- mutant was avirulent in mice and was susceptible to the bactericidal effect of nonimmune human serum . The mutant was killed by serum as a result of activation of the classical pathway of complement by naturally occurring immunoglobulin M . This killing by serum was mitigated by the presence of human polymorphonuclear leukocytes . After opsonization in complement component C5-deficient nonimmune serum, the Cap- mutant was ingested and survived in the leukocytes . Under these conditions, the parent strain was killed . The leukocytes responded to both the parent and the Cap- strain with a very low chemiluminescent response . Only the response to the parent strain was inhibited by superoxide dismutase . When the Cap- mutant was opsonized with immunoglobulin G, it induced a higher and superoxide dismutase-inhibitable chemiluminescent response and was killed by the leukocytes . In conclusion, the capsule of F . tularensis LVS seemed to protect this organism against the bactericidal effect of serum . When deprived of the capsule, the organism failed to induce an antimicrobial response in polymorphonuclear leukocytes and survived in the leukocytes . Survival in phagocytes is a key characteristic of intracellular parasites . The Cap- mutant of F . tularensis may become a useful tool in experiments to explain the differences between pathways of ingestion of intracellular parasites, evidenced by the death or survival of the parasite.

Arch Otolaryngol Head Neck Surg, 1988 May, 114(5), 531 - 3
Transtympanic iontophoresis of dexamethasone and fosfomycin; Sato H et al.; The effects of transtympanic iontophoresis of corticosteroids and antibiotics on otitis media with effusion (OME) were investigated . An experimental study using guinea pigs revealed that transtympanic passage of dexamethasone sodium phosphate and fosfomycin sodium by iontophoresis had sufficient anti-inflammatory and antimicrobial effects . Twenty children with OME (33 ears) who were treated by iontophoresis were compared with 28 untreated children with OME (35 ears) with respect to improvement assessed by tympanoaudiometry . After one month, tympanoaudiometry revealed improvement in 21 (63.6%) of the treated ears but in only 13 (37.1%) of the untreated ears, indicating the efficacy of this treatment for OME.

J Clin Microbiol, 1988 May, 26(5), 1047 - 9
Test-of-cure stool cultures for traveler's diarrhea; Ericsson CD et al.; Whether enteropathogens were eradicated or persisted in test-of-cure stool cultures from 251 patients with traveler's diarrhea, the durations of diarrhea were similar within the antimicrobial agent-treated (32 versus 33 h) and placebo-treated (82 versus 96 h) groups . Routine test-of-cure stool cultures can be useful for evaluating treatment failures and for assessing asymptomatic carriage of enteropathogens after treatment, but they are not mandated in the design of placebo-controlled antimicrobial treatment trials in traveler's diarrhea when the focus of the trial is clinical efficacy.

J Allergy Clin Immunol, 1988 May, 81(5 Pt 2), 1025 - 7
Sinusitis in children; Shapiro GG; Sinusitis is common in allergic children . We are now aware that the commonest presentation of this disorder in the pediatric age group is persistent cough and purulent rhinorrhea . Headache and facial tenderness, frequently noted in adults with sinusitis, are not common . Much remains to be learned about diagnostic techniques and therapy of sinusitis . Nasal cytology can be valuable for discriminating between allergic and infectious disease, but lacks both sensitivity and specificity . Although there is a high correlation between radiographs showing significant sinus membrane thickening or clouding and recovery of bacteria from antral taps, it is possible to see positive films in asymptomatic individuals . Similarly, films may be unremarkable, although the history and physical examination yield convincingly positive evidence for sinus infection . The clinician must sometimes decide on therapy when the diagnosis is not definitive . Antimicrobial therapy for sinusitis should be given for 3 to 4 weeks in many cases . Amoxicillin remains a good choice for therapy, but antibiotics capable of clearing infections by beta lactamase-producing bacteria should be considered in refractory situations . The value of antihistamines, decongestants, nasal steroids, and cromolyn sodium are unstudied at this time . If several antibiotic courses fail to alleviate the signs and symptoms of sinusitis, surgery is indicated . Antral lavage and creation of nasoantral windows is the usual approach in children . Patients with sinusitis often have concurrent middle ear disease . Patients with current sinusitis have a higher incidence of immunoglobulin disorders than found in a normal pediatric sample . It appears that patients with sinusitis are more often allergic than would be expected from 2 typical population distribution . More evaluation is needed to clarify these associations.

J Urol, 1988 May, 139(5), 967 - 70
Treatment of chronic prostatitis: intraprostatic antibiotic injections under echography control; Jimenez-Cruz JF et al.; We treated 51 patients diagnosed as having chronic bacterial prostatitis (gram-negative) with 2 ml . intraprostatic amikacin (500 mg.) or tobramycin (100 mg.) weekly for 2 to 4 weeks . Administration was perineal with echographic control and injection was done in the echogenic zone or external gland . In each case the diagnosis was obtained by fractioned microbiological study via the method of Meares and Stamey . This test was repeated 4, 12 and 24 weeks after the end of treatment . Of the patients 25 (49 per cent) were cured microbiologically, 11 (21.5 per cent) were cured after a second cycle of treatment and the remaining 15 (29.4 per cent) failed to respond . The clinical cure rate was 43.1 per cent and 41.1 per cent of the patients were improved . After 6 months 5 patients had relapse and 1 had reinfection . No differences were observed with both antimicrobials . The microbiological cure indexes of 70.5 and 58.8 per cent after 3 and 6 months, respectively, compared favorably with that obtained by oral therapy with antimicrobials that reach effective levels in the prostatic fluid . Transitory post-injection hemospermia was observed in 11 patients . Together with pain during or after injection (8 and 5 patients, respectively), these were the sole adverse effects observed with this therapy.

Med Clin North Am, 1988 May, 72(3), 717 - 22
Topical antimicrobial agents and antibiotics for the eye; McCloskey RV; Antibiotics for eye infection can be given topically, by subconjunctival or intravitreous injection, or systemically . The bacteria responsible are reviewed and pharmacokinetics influencing topical concentration are discussed . An approach to treatment by the primary care specialist is suggested.

Med Clin North Am, 1988 May, 72(3), 623 - 36
Quinolones: a new class of antimicrobial agents with wide potential uses; Neu HC; Quinolone antibiotics provide potentially important therapy for many infections that heretofore required extensive hospitalization . Improper use of these agents rapidly can lead to resistance and thereby remove them from the physician's arsenal of antimicrobial compounds . It also is possible that with more extensive use, these drugs will demonstrate adverse reactions that to date are unknown . Attention to how the agents are used can simultaneously avoid the problems of resistance and toxicity.

J Antimicrob Chemother, 1988 May, 21(5), 597 - 607
Interleukin-1 production by antibiotic-treated human monocytes; Roche Y et al.; The effects of penicillin, macrolides (spiramycin and erythromycin), cephalosporins (cefaclor and cefadroxil), tetracycline (doxycycline) and quinolones (pefloxacin, ciprofloxacin and ofloxacin) on extracellular and cell-associated interleukin 1 (IL-1) activity from human adherent mononuclear leucocyte cells were investigated in vitro . When cells were treated with an antibiotic concentration of 10 mg/l, no apparent effect could be detected for penicillin, erythromycin, cephalosporins or quinolones, while a slight increase of extracellular IL-1 activity associated with a decrease of intracellular IL-1 activity was observed with spiramycin and doxycycline . When high antibiotic concentration were used, extracellular IL-1 activity was increased by macrolides and tetracycline, while both cell-associated and class II human monocyte antigen expression were decreased . A toxic effect may have been exerted by these antimicrobial agents, since cell viability was altered when they were used at high concentrations . In contrast, extracellular IL-1 activity was found to be decreased by quinolones and cephalosporins . Intracellular IL-1 activity was also decreased by cephalosporins, while quinolones did not modify either cell-associated IL-1 activity or class II human monocyte antigen expression . The effect induced by quinolones and cephalosporins occurred without modification of cell viability . IL-1 activity was shown to be affected by antibiotics over the same range of concentrations which are known to inhibit mononuclear leucocyte proliferation . Our data may help in defining the mechanism by which the mitogen-induced mononuclear proliferative response is suppressed by antimicrobial agents since this appears to involve the inhibition of IL-1 production or of its release.

Age Ageing, 1988 May, 17(3), 187 - 92
Outcome following antimicrobial therapy for asymptomatic bacteriuria in elderly women resident in an institution; Nicolle LE et al.; Twenty-six elderly (mean age 83.3 +/- 8.7 years) institutionalized women with asymptomatic bacteriuria were treated with antibiotic therapy, including initial single-dose and subsequent 2 weeks' therapy, then 6 weeks' therapy if relapse occurred . Forty-seven courses of single-dose, 30 of 2 weeks', and 10 of 6 weeks' therapy were given during a 1-year period . At 8 weeks of follow-up, 57% of single-dose courses, 52% of 2-week, and 29% of 6-week had been followed by relapse, and 32%, 24%, and 29%, respectively, by reinfection . Outcome with single-dose therapy did not correlate with infecting organism, antimicrobial therapy, or presence of pyuria with the infection . However, residents who persistently relapsed following single-dose therapy appeared to be a less-well population, as evidenced by a significantly greater age, number of chronic disease diagnoses and medications, as compared to those who were cured by single-dose therapy . Thus, recurrent infection, including both relapse and reinfection is the usual short-term outcome following therapy for asymptomatic bacteriuria in this population . Differences in patient characteristics may prove useful in predicting which individuals may respond to minimal therapy.

Salud Publica Mex, 1988 May-Jun, 30(3), 362 - 9
{Magnitude and control of acute respiratory infections in children}; Benguigui Y; PIP: Acute respiratory infections of viral or bacterial origin represent 1 of the 3 main causes of morbidity and mortality in children of developing countries, where they typically are responsible for 15-20% of deaths in children under 5 . Mortality rates are higher in children under 1 year and decline with age . Fewer than 2% of children with pneumonia in developed countries die, vs . an estimated 10-20% in developing countries . Operational studies indicate that children dying of acute respiratory infections are those who do not receive health services or receive them too late, and those whose moderate infections are inadequately treated . Determining factors include inaccessibility of health services, socioeconomic problems, cultural factors limiting the frequency and acceptance of formal health services, and inadequate management of acute respiratory infections by the general health services . Immunizations, better case management and health education are 3 interventions for control of respirator infections that offer immediate potential benefits for primary health care in developing countries . Vaccinations against whooping cough, measles, and diphtheria are part of the Expanded Program of Immunization . Anti-pneumococcal vaccines and flu shots are not appropriate for use in children in developing countries . Health personnel should be trained to use antibiotics more rationally and efficiently and to make referrals to higher levels of care when needed . Oxygen treatment should be available in secondary and tertiary care centers . Health personnel should be trained to administer simple treatments for other possible complications of respiratory infections . Such measures have been applied sporadically in developing countries and data on their efficacy remain sparse . But mortality rates declined greatly in 1 rural community of India after introduction of the measures, and more proofs of their efficacy will become available as programs develop . It will be necessary to train health agents in differentiation of cases according to gravity, to recommend and apply treatment, to administer antimicrobial drugs, and to refer cases to hospitals . The main decision of the health agent concerns the gravity of the case and not the diagnosis of pneumonia or bronchitis . A classification based on the few most important signs and symptoms will facilitate the 2 principal decisions about treatment; whether to administer antimicrobial and whether to treat at home or refer to a higher level of care . A 3-part classification of acute respiratory infections if suggested for all outpatient care and community health agents: serious cases requiring hospitalization 2) moderate cases requiring antimicrobial but not hospitalization and 3) mild cases not requiring antimicrobial .

Diagn Microbiol Infect Dis, 1988 May, 10(1), 31 - 9
Comparison of the in vitro activity of ciprofloxacin and 24 other antimicrobial agents against clinical strains of Chromobacterium violaceum; Aldridge KE et al.; Eleven clinical strains of Chromobacterium violaceum were tested for their susceptibility to 25 antimicrobial agents . Ciprofloxacin was the most active of the compounds tested although norfloxacin and pefloxacin were highly active . No resistance was detected to mezlocillin, piperacillin, apalcillin, imipenem, and aztreonam while a single strain was resistant to ticarcillin . Among the cephalosporin/cephamycin group only cefotetan showed good in vitro activity . Gentamicin was more active than amikacin and tobramycin . Good in vitro activity was also noted for chloramphenicol, doxycycline, and trimethoprim-sulfamethoxazole while C . violaceum strains were highly resistant to rifampin and vancomycin . The bactericidal activity of selected agents was shown to be concentration dependent using time-kill kinetic studies . Addition of clavulanic acid did not increase the activity of ticarcillin and in one case was shown to induce beta-lactamase . High correlation was noted between the broth microdilution and disk diffusion susceptibility tests in predicting the susceptibility patterns of C . violaceum.

Zentralbl Bakteriol Mikrobiol Hyg {B}, 1988 May, 186(2), 166 - 79
{Microbial contamination of liquid-soap wall dispensers with one-way bottles}; Graf W et al.; Hygienic examinations were performed relating to microbial contaminations of different kinds of fluid soaps in relation to various systems of dispensers . Totally 492 specimens of fluid soap were examined comprising 14 different kinds of trade names (Code A-O), sampled in 14 different hospitals including 4 different systems of dispensers . Out of 14 trade name products--containing antimicrobial additives--8 proved to be sterile . The rest--declared as free from antimicrobial additives--showed bacterial contaminations of different grade . One of them (Code "O"), without antimicrobial additives) proved to be excessively contaminated with P . cepacia in 108 specimens out of 281, i.e . 38% in the range from 10(3)-10(6) CFU/ml . Further investigations on origin and mechanism of this alarming event revealed, that the cause for this dilemma was a failure in the dosing system of the one-way bottle dispensers used . This seems to be of fundamental importance for a great number of one-way-dispensers used at presence for fluid soaps or disinfectants: Changing only the emptied bottles out of the wall-attached device of dispenser causes inevitably a rapid recontamination of the new bottles, if not the dosing-device is as well removed and effectively cleaned and disinfected before reinserting.

Dent J Malays, 1988 May, 10(1), 9 - 16
Chlorhexidine mouthwash: a review of its pharmacological activity, clinical effects, uses and abuses; Yusof ZA; Chlorhexidine, an antiseptic with a wide antimicrobial spectrum, was first introduced as a general disinfectant in medical use . In dentistry, it was first used for disinfecting surgical sites and in endodontics . Its anti-plaque effect was later discovered and this lead to its widespread use as a plaque control agent available over-the-counter without prescription . The author reviews its pharmacological activity, clinical effects, uses and abuses in dentistry.

Infection, 1988 May-Jun, 16(3), 148 - 52
Treatment and prevention of pertussis by antimicrobial agents (Part II); Hoppe JE et al.; Suitable antimicrobials given during the catarrhal stage of whooping cough can attenuate the course of the disease . The efficacy of antibiotics administered prophylactically during the incubation period remains controversial but appears to be beneficial . Currently, erythromycin given for two weeks is the antibiotic of choice for pertussis . No treatment failures were observed with erythromycin estolate . Erythromycin ethylsuccinate and stearate must be given at high dosages (50-60 mg/kg/day) in order to achieve sufficient concentrations in the respiratory secretions . With ampicillin and amoxicillin treatment failures have been observed . The role of josamycin and co-trimoxazole in pertussis remains open.

J Biol Chem, 1988 Apr 25, 263(12), 5933 - 5
Characterization of two crystal forms of human defensin neutrophil cationic peptide 1, a naturally occurring antimicrobial peptide of leukocytes; Stanfield RL et al.; Two orthorhombic crystal forms (P2(1)2(1)2, a = 30.5 A, b = 44.5 A, c = 40.5 A; I2(1)2(1)2(1) (or I222), a = 30.1 A, b = 66.5 A, c = 35.5 A) of human neutrophil cationic peptide 1 have been characterized . The P2(1)2(1)2 form contains two peptides (Mr = 3425) per asymmetric unit; the I2(1)2(1)2(1) form contains one peptide per asymmetric unit . Both crystal forms diffract to beyond 1.8 A resolution.

J Biol Chem, 1988 Apr 25, 263(12), 5745 - 51
The cDNA sequence coding for prepro-PGS (prepro-magainins) and aspects of the processing of this prepro-polypeptide; Terry AS et al.; Amphibian skin is well known as a source of peptides homologous to bioactive peptides found in mammalian gut and brain . A systematic investigation of the skin secretions from Xenopus laevis revealed several peptides not derivable from known precursors . The sequence elucidation, utilizing fast atom bombardment/mass spectrometry, of two peptides, PGS and PGS Gly-10;Lys-22, is reported . These have been independently characterized and named magainins and found to have antimicrobial activity . A mixed sequence oligonucleotide probe complementary to the mRNA sequence coding for PGS was synthesized and used to screen a Xenopus skin cDNA library . A full length cDNA species encoding prepro-PGS was isolated and characterized, and its sequence is reported . The deduced precursor sequence was found to contain one copy of PGS Gly-10;Lys-22 and five copies of PGS . The proteolytic processing of this prepro-polypeptide is discussed.

Pharm Weekbl Sci, 1988 Apr 22, 10(2), 80 - 5
Formation and antimicrobial activity of complexes of beta-cyclodextrin and some antimycotic imidazole derivatives; Van Doorne H et al.; Complex formation between beta-cyclodextrin and six antimycotic imidazole derivatives has been studied . The solubility of all drugs was increased in the presence of beta-cyclodextrin . The smallest increase (approx . 5-fold) was observed for miconazol, and the largest increase (approx . 160-fold) was observed for bifonazol . Apparent 1:1-complex constants were measured and found to decrease in the order: bifonazol greater than ketoconazol greater than tioconazol greater than miconazol greater than itraconazol greater than clotrimazol . The complexes appeared to possess a low, if any, antimicrobial activity . Measurement of inhibition zone sizes, with four test organisms was used to study the release of the antimycotic drugs from topical preparations . The antimycotic drugs were more readily released from topical preparations containing beta-cyclodextrin than from the same vehicles without beta-cyclodextrin . The rationale of beta-cyclodextrin addition to antimycotic topical preparations is discussed.

J Am Vet Med Assoc, 1988 Apr 15, 192(8), 1081 - 2
Consolidating pneumonia and pneumothorax in a horse; Spurlock SL et al.; A 3-year-old Thoroughbred mare with signs of acute abdominal pain and chronic pneumonia was found to have pneumothorax . A single application of suction was successful in resolving the pneumothorax . The underlying pneumonia was treated with long-term antibiotic administration selected on the basis of results of bacteriologic culture and antimicrobial susceptibility testing of a transtracheal aspirate . The pneumonia resolved, and the mare returned to competition as a show hunter.

Tijdschr Kindergeneeskd, 1988 Apr, 56(2), 86 - 90
{Current aspects of the prevention and treatment of infections during treatment with cytostatics}; Postma A et al.; Due to intensive cytostatic therapy of childhood leukemia there is a continuing improvement of treatment results . However the resulting immunosuppression increases the risk of (opportunistic) infections . Several measures for prevention and treatment are discussed e.g . oral care varicella vaccination, antimicrobial therapy.

J Antibiot (Tokyo), 1988 Apr, 41(4), 425 - 32
SF2446, new benzo{a}naphthacene quinone antibiotics . II . The structural elucidation; Gomi S et al.; Structures of new antibiotics SF2446A1, A2, A3, B1, B2 and B3 have been deduced by means of spectral analyses and chemical studies . The structure of SF2446A1 which is a main product of fermentation and has the strongest antimicrobial activity, has been proposed to be 11-(2,4-di-O-methyl-beta-L-rhamnopyranosyl)amino-5,6,6a,14a-tetrah ydro- 1,6,8,14a-tetrahydroxy-6a-methoxy-2-methoxycarbonyl-3-methyl- benzo{a}naphthacene-7,9,12,14-tetra-one . All of antibiotics have a novel benzo{a}naphthacene quinone skeleton and SF2446A1, A2, B1 and B2 have an N-glycosidic linkage with 2,4-di-O-methyl-L-rhamnose.

Can J Vet Res, 1988 Apr, 52(2), 286 - 7
Antimicrobial drug susceptibility of Leptospira interrogans serovar hardjo isolated from cattle; Prescott JF et al.; The susceptibility to commonly used drugs of 18 isolates of Leptospira hardjo from the kidneys of feedlot cattle from different sources was determined quantitatively . All isolates were susceptible to penicillin G, ampicillin, tetracycline, erythromycin and streptomycin . Susceptibility to sulphamethazine was ambiguous . No drug resistance was detected and the results were similar to those described for other serovars.

J Bone Joint Surg Am, 1988 Apr, 70(4), 536 - 9
Prevention of infection after total joint replacement . Experiments with a canine model; Petty W et al.; An experiment was done in dogs to evaluate how efficient each of several techniques was in preventing infection after a total joint arthroplasty . The techniques that were studied were intraoperative irrigation with saline solution or with antimicrobial solution, perioperative systemic administration of antibiotics, and the addition of an antibiotic to bone cement . Irrigation with saline solution did not reduce the incidence of infection . A slight reduction was found after irrigation with neomycin solution and after systemic administration of cefazolin solution . The use of bone cement containing gentamicin caused a statistically significant reduction in the rate of infection; in fact, no infection developed in any animal that was treated with bone cement containing gentamicin . There was excellent but not absolute correlation between findings on culture that indicated the presence of infection and histological evidence of inflammation.

Vet Clin North Am Equine Pract, 1988 Apr, 4(1), 145 - 56
Prevention and management of peritonitis in horses; Markel MD; Peritonitis and adhesions in the horse are best managed through prevention . Perioperative antimicrobial therapy, nonsteroidal anti-inflammatory therapy, experienced personnel, and good surgical techniques should minimize complications after surgery . Despite preventative measures, some horses still develop peritonitis after surgery . Immediate, intensive treatment is necessary to enhance their chances for survival.

Dent Clin North Am, 1988 Apr, 32(2), 217 - 41
Antimicrobial agents in the prevention and treatment of periodontal diseases; Bral M et al.; It has been estimated that there are more than 400 diseases affecting the oral cavity . In terms of prevalence, however, the major public health problems are caries and periodontal disease . Although these two destructive entities are completely different in many respects, they share a common denominator: the initial lesions are brought about by an aggregate of bacteria known as plaque . This article discusses chemical control of plaque in the treatment of gingivitis and antimicrobial control of subgingival plaque in the treatment of periodontitis . The authors address the use of antibiotics in the treatment of localized juvenile periodontitis, the ideal properties of antiplaque agents, and adjunctive subgingival application of antimicrobial agents.

Acta Chir Scand, 1988 Apr, 154(4), 305 - 9
Failure of single-dose metronidazole prophylaxis in colorectal surgery . No benefit from high dosage or combination with nalidixic acid; Kling PA et al.; In an open prospective study of postoperative infectious complications, patients undergoing elective colorectal surgery were randomly allocated to one of three groups receiving parenteral single-dose antimicrobial prophylaxis (1 g or 3 g metronidazole or 1 g metronidazole + 3 g nalidixic acid) . Because of an unacceptably high rate of surgical infection in all three groups (36%, 29% and 39%, p greater than 0.1) among the first 103 evaluable patients, the study was discontinued . Nalidixic acid--though effective in in vitro tests of bacterial susceptibility--thus was found to be of little or no value as prophylaxis against Gram-negative infection . As the observed infection rate when metronidazole was given at the start of operation was seven-fold that previously found in the same department when 1 g metronidazole was administered 3-4 hours preoperatively (28/103 vs . 2/50, p less than 0.01), the timing of metronidazole prophylaxis was assumed to be potentially important for its ability to protect also against aerobic postoperative infection.

Surg Clin North Am, 1988 Apr, 68(2), 431 - 43
The biology of peritonitis and implications for treatment; Maddaus MA et al.; Peritonitis continues to be one of the major infectious problems confronting surgeons . Despite the many advances in antimicrobial agents and supportive care, mortality from diffuse suppurative peritonitis remains unacceptably high . The authors review the anatomy and defense capabilities of the peritoneal cavity and then focus on the polymicrobial nature of peritonitis and how, through microbial interactions with host defenses, there is either resolution or persistent infection . They also consider possible infection-potentiating agents in the peritoneal cavity and experimental modes of therapy.

Infect Immun, 1988 Apr, 56(4), 779 - 84
Lipid X protects mice against fatal Escherichia coli infection; Golenbock DT et al.; Lipid X, the major monosaccharide precursor of lipid A, is nontoxic and has previously been shown to protect mice and sheep from the harmful effects of endotoxin . To test the hypothesis that lipid X could be therapeutic against infections with gram-negative organisms, neutropenic ICR mice were infected by intramuscular inoculation of Escherichia coli and subsequently treated with lipid X alone or in combination with the antibiotic ticarcillin . Lipid X slightly prolonged survival; treated mice had a significantly improved rate of survival 18 h after intramuscular inoculation as compared with controls (P less than 0.025) . By 24 h, however, this difference disappeared . When lipid X was combined with ticarcillin, survival differences were both significant and prolonged . Treatment of mice with one to two doses of lipid X for a total dose of 1 mg intravenously and with 1,200 mg of ticarcillin per kg every 6 h improved survival over a 48-h treatment period from 5 to 23% (P less than 0.0025) . Treatment with lipid X and ticarcillin over a broad range of antibiotic dosages in 362 mice demonstrated improved survival of two- to fourfold (P less than 0.0001 at 24 h after inoculation, P less than or equal to 0.0005 at 48 h, and P less than or equal to 0.0001 at 5 days) . Lipid X enabled the dose of ticarcillin necessary to protect 50% of mice from death to be reduced by two- to fivefold . Pretreatment with lipid X was not necessary to improve survival: 16 of 17 (94%) infected and visibly ill animals that received lipid X and ticarcillin 6 h after thigh inoculation survived versus 30 of 44 (68%) control animals treated with ticarcillin alone (P less than 0.0001) . Lipid X had no antimicrobial activity in vitro . Lipid X is a novel agent that enhances survival in an animal model of severe infection with gram-negative organisms.

Mikrobiyol Bul, 1988 Apr, 22(2), 120 - 5
{The importance of tetracycline treatment of cervical Chlamydia trachomatis infections: control with cervical smears}; Demirezen S et al.; Cervical Chlamydia trachomatis infection is extremely common, crucial and sexually transmitted disease . In order to prevent from this disease an effective treatment is necessary . Tetracycline is an effective antimicrobial medicine for treatment of cervical Chlamydia trachomatis infection . In our study, after we had established the diagnosis of Chlamydia trachomatis on the patient's cervical smear, Tetracycline was used for treatment . In control smear after treatment . Chlamydial intracytoplasmic inclusion bodies and atypical cellular changes which we observed in the first smear were not seen.

Semin Hematol, 1988 Apr, 25(2), 101 - 11
Survival of intracellular pathogens within human mononuclear phagocytes; Murray HW; The preceding discussion makes it clear that there are multiple determinants, related to the microorganism, the host defense cell, and the presence of activating T cell stimuli that must be considered when examining at the cellular level how and why intracellular pathogens are able to cause infection . From the standpoint of the interaction of the mononuclear phagocyte's antimicrobial mechanisms with T gondii, L donovani, and C psittaci, the determinants which appear to influence directly the outcome of intracellular infection include: a . the magnitude of the phagocyte's respiratory burst capacity; b . the ability to respond specifically and effectively to microbial ingestion with the generation of O2- and H2O2; c . susceptibility to H2O2; and d . the presence of and susceptibility to oxygen-independent mechanisms . T cell dependent enhancement of the mononuclear phagocyte's antimicrobial mechanisms is a particularly critical element in cellular resistance to infection, and thus, host defense . If the activated state is not properly achieved, the macrophage remains susceptible to and perpetuates intracellular infections.

Am J Hosp Pharm, 1988 Apr, 45(4), 819 - 23
Association of length of stay and total hospital charges with antimicrobial regimen changes; Raisch DW et al.; The association of changes in antimicrobial therapy with length of stay and total hospital charges in a 600-bed general medical hospital was studied . Changes in antimicrobial regimens were examined in three diagnosis-related groups (DRGs): DRG 79 (respiratory infections and inflammations, age greater than 69 years, and/or secondary diagnosis), DRG 89 (simple pneumonia and pleurisy, age greater than 69 years, and/or secondary diagnosis), and DRG 416 (septicemia, age greater than 17 years) . These changes were defined as follows: (1) switching from one drug or drug combination to another, (2) adding one or more drugs to a regimen, or (3) discontinuing one drug of a multiple-drug regimen . Variables examined for association with these changes were length of hospital stay and pharmacy, antimicrobial, intravenous therapy, and hospital charges . In DRGs 79 and 89, changes in antimicrobial regimens were associated with significantly longer hospital stay and significantly higher pharmacy, antimicrobial, intravenous therapy, and total hospital charges . In DRG 416, changes in antimicrobial regimens were not associated with higher charges or longer stay . Significant differences among DRGs were found with respect to the types of changes, with more changes from broad- to narrow-spectrum coverage occurring in DRGs 89 and 416 than in DRG 79 . At this institution, patients whose antimicrobial regimens were changed had significantly longer hospital stays and higher charges in two of three DRGs.

Clin Microbiol Rev, 1988 Apr, 1(2), 139 - 56
Antibiotic combinations: should they be tested?
Eliopoulos GM, Eliopoulos CT.
When antibiotic combinations are used to provide a broader spectrum of antimicrobial activity or in an attempt to prevent the emergence of resistant organisms, it is rarely necessary or practical to perform tests of drug interactions in vitro . In vitro testing of combinations may be useful when combinations are used in an attempt to attain synergistic interactions . In some cases, screening methods can be used as substitutes for formal synergy testing . This paper examines the mechanisms of antibiotic interaction leading to synergism or antagonism, surveys attempts to correlate in vitro observations with efficacy in animal models, and reviews clinical data providing evidence for or against a useful role of synergistic antibiotic interactions in the treatment of human infections.

Farmaco {Sci}, 1988 Apr, 43(4), 319 - 31
Synthesis and antimicrobial activity of some pyrrole derivatives . II: 2-(2'-acylhydrazino)-3-ethoxycarbonyl-5-aryl (or alkyl)- pyrrole derivatives; Cocco MT et al.; A series of 2-(2'-acylhydrazino)-3-ethoxycarbonyl-3-aryl (or alkyl)-pyrrole derivatives was synthesized and submitted to in vitro microbiological screening . Most derivatives showed considerable antibacterial and antifungal activities.

J Appl Bacteriol, 1988 Apr, 64(4), 311 - 27
Monitoring for the development of antimicrobial resistance during the use of olaquindox as a feed additive on commercial pig farms; Linton AH et al.; Since 1982, when olaquindox was introduced as a pig-feed additive in the UK, about 12 commercial farms in Suffolk have been monitored annually to check for the possible emergence of resistance to olaquindox and chloramphenicol among the coliform flora of the pigs and their environment . In spite of the sampling variability and the impossibility of controlling the use of feed additives and management on the farms, the overall results obtained were consistent and, it is suggested, the method is widely applicable . A steady, albeit low, increasing incidence and level of resistance to olaquindox was recorded (1982-1984) on farms using it and, to a lesser degree, on neighbouring farms that did not . No significant increase in the level of chloramphenicol resistance was observed . Genetical studies on a selection of olaquindox-resistant isolates suggested that the genes determining resistance were likely to be borne on the chromosome.

Crit Care Clin, 1988 Apr, 4(2), 299 - 324
Antibiotic selection and pharmacokinetics in the critically ill; Bush LM et al.; In critically ill patients, a good outcome of an infection episode often requires early institution of appropriate antimicrobial therapy . The choice of one specific antimicrobial agent or combination of agents over another requires consideration of the nature of the etiologic organism, the host, and the drug(s).

Crit Care Clin, 1988 Apr, 4(2), 245 - 57
Nosocomial pneumonia; Hessen MT et al.; Nosocomial pneumonia remains a challenging problem in critically ill patients in terms of both diagnosis and therapy . The clinical picture is often confusing; confounding factors such as congestive heart failure, ARDS, and interstitial lung disease may obscure the presence of pneumonia . Previous antimicrobial therapy or the presence of large numbers of colonizing organisms contribute to the difficulty of diagnosis . The use of sheathed fiberoptic bronchoscopy with quantitative culture and biopsy is probably the best initial invasive test when routine diagnostic methods fail; open lung biopsy remains the ultimate standard for diagnosis . Empiric therapy is often necessary and should be designed to treat organisms suspected of being the etiologic pathogens either on the basis of preliminary laboratory results (gram and acid-fast stains) or the clinical setting.

J Hosp Infect, 1988 Apr, 11(3), 253 - 62
Bacteriuria during indwelling urethral catheterization; Mulhall AB et al.; The incidence of bacteriuria and the risk factors related to its acquisition were determined in a prospective study of 220 hospitalized patients . Bacteriuria was recorded in 97/220 (44%) of patients, in 42 cases within 48 h (Group A) and in 55 cases more than 48 h (Group B) after catheterization . The results of a multivariate analysis of Group A demonstrated that the reason for catheterization, the use of antimicrobial chemotherapy and the medical specialty of care were the only variables of those assessed associated with the acquisition of bacteriuria . In a similar analysis of Group B the number of days the catheter was in situ and the use of antimicrobial chemotherapy were the only factors which achieved statistical significance.

Antibiot Khimioter, 1988 Apr, 33(4), 262 - 6
{Structural and functional study of polymyxins . Isolation and properties of individual components of polymyxin M}; Trakhanova MN et al.; LPCC and HPLC revealed that polymyxin M was a mixture of five components of the polymyxin nature: PM1, PM2, PMx, PMy and PMz . The individual compounds PM1, PM2 and PMz were isolated . Their physicochemical properties and data on antimicrobial activity are presented.

Am J Ophthalmol, 1988 Mar 15, 105(3), 239 - 43
Fortified antibiotic ointment in bacterial keratitis; Hyndiuk RA et al.; We conducted experiments to determine the effectiveness of fortified antibiotic ointment in the treatment of Pseudomonas keratitis in rabbits . We evaluated gentamicin ointment (3, 10, 20, and 40 mg/g), gentamicin solution (3 and 10 mg/ml), and placebo, each given every 30 minutes . We also examined the effectiveness of fortified ointment given in extended treatment intervals . In short-term trials, commercial-strength gentamicin solution (3 mg/ml) was therapeutically superior (P less than .001) to commercial-strength gentamicin ointment (3 mg/g) in reducing corneal bacterial colony counts . No significant difference in antimicrobial effect was noted between fortified gentamicin ointment and fortified gentamicin solution at 30-minute treatment intervals . Fortified gentamicin ointment reduced colony counts even at extended treatment intervals of up to four hours in a severe keratitis model.

Vet Rec, 1988 Mar 12, 122(11), 249 - 51
Antibiotic resistance: an overview; Walton JR; The results of large scale surveys have indicated that in general terms antibiotic resistance in bacteria has not increased, especially in Europe and North America . When the prevalence of resistance in specific bacteria has increased the increase has usually been associated with the introduction of a novel antimicrobial agent, whether in human or veterinary clinical practice, but the prevalence of resistance that is recognised may be very small . It would appear that the use of antibiotics in livestock farming during the past 20 years has not compromised public health . Any problems in human medicine which are due to bacterial resistance have resulted from the use of antibiotics in man and not from their use in agriculture . Similarly, any problems in veterinary medicine which are due to bacterial resistance have resulted from the use of antibiotics in animals and not from their use in man.

Farmaco {Sci}, 1988 Mar, 43(3), 239 - 50
Studies on isoquinoline derivatives . IV . Synthesis and evaluation of the antimicrobial and antifungal activities of N2-arylidene-substituted 3-carbazoyl-isoquinolines; Vittorio F et al.; 2,4-Dimethyl-1-oxo-1,2-dihydro-3-carbazoyl-isoquinoline (II), 1-chloro-, 1-methoxy-3-carbazoyl-4-methylisoquinoline (VI, X) and a series of their hydrazonic derivatives have been synthesized and tested in vitro for antibacterial and antifungal activities . 1-(1-Chloro-4-methyl-3-isoquinolinoyl)-2-(5-nitro-2-furfurylide ne) hydrazine (VII h) proved to be the most effective in the series (MIC 0.78 micrograms/ml) and was more potent than furazolidone against several strains of S.aureus; the same compound also showed a moderate antifungal activity.

Can J Microbiol, 1988 Mar, 34(3), 323 - 6
Antibiotic efficacy in intraabdominal sepsis: a clinically relevant model; Bohnen JM et al.; We present preliminary data on the role of antibiotics in intraabdominal sepsis using a new, clinically relevant animal model . Peritoneal cavity infection was induced by ligation and perforation of the cecum in adult rats . Surviving rats were randomized to receive either saline or cefoxitin at the time of cecal excision and peritoneal lavage, 18 h after the onset of infection . This is different from previous models of abdominal sepsis (in which antibiotics are given within 4 h of peritoneal contamination) and mimics the clinical setting in which antibiotics are initiated much later, at the time of operation . Antibiotic-treated rats received 20 mg cefoxitin i.m . every 8 h for 7 days; controls received saline at similar times . Thirty-nine of 67 control rats died (58%) versus 20 of 64 (31%) that received cefoxitin (p less than 0.005) . We conclude that even with delayed administration, antibiotics appear to improve the outcome of intraabdominal sepsis . With further characterization of this model we plan to use it as an in vivo assay to compare the efficacy of different antimicrobial agents in intraabdominal sepsis.

Z Naturforsch {C}, 1988 Mar-Apr, 43(3-4), 177 - 83
Lentinellic acid, a biologically active protoilludane derivative from Lentinellus species (Basidiomycetes); Stark A et al.; A new antimicrobial and cytotoxic sesquiterpenoid, lentinellic acid, has been isolated from submerged cultures of Lentinellus ursinus and L . omphalodes . The structure of the antibiotic was elucidated by spectroscopic methods and a single crystal X-ray analysis . 1 may be formed biogenetically by condensation of a protoilludane aldehyde 4 with a malonate unit.

Zentralbl Bakteriol Mikrobiol Hyg {A}, 1988 Mar, 267(4), 537 - 40
Concentration of azlocillin in human chondral tissue; Schonfeld W et al.; The concentration of azlocillin was determined using high performance liquid chromatography in serum and chondral tissue after intravenous infusion of azlocillin (75 mg/kg body weight) . In serum the levels of ten patients (2 to 27 years of age, body weight 12 to 69 kg) decreased from 478 (30 min post infusion) to 120 micrograms/ml (120 min) . In contrast, the concentrations in chondral tissue ranged between 24 and 35 mg/g tissue at the corresponding times . Although the mean levels suggest a remarkable penetration of azlocillin into chondral tissue, the high individual differences observed in the tissue levels (2.1 to 138 micrograms/g tissue) require a higher dosage to ensure sufficient antimicrobial therapy in all patients.

Hautarzt, 1988 Mar, 39(3), 161 - 5
{Minimum inhibitory concentration and minimum bactericidal concentration of tetracycline and erythromycin in 35 recent Munich isolates of Chlamydia trachomatis}; Korting HC et al.; Thirty-five recent clinical isolates of Chlamydia trachomatis were subcultured and subjected to antimicrobial susceptibility testing with tetracycline and erythromycin . Detection of typical chlamydial inclusion bodies and elementary bodies was based on the use of fluorescence-labelled monoclonal antibodies . Minimum inhibitory concentration being defined as the lowest concentration suppressing all inclusion body formation and minimum bactericidal concentration as the lowest concentration preventing all detectable chlamydial growth, both these parameters were studied . With tetracycline the minimum inhibitory concentrations ranged from 0.03 to 0.08 microgram/ml, with erythromycin from 0.04 to 0.2 microgram/ml . The corresponding data for the minimum bactericidal concentrations were less than 0.2 to 1.0 and 0.2 to 2.0 respectively . Thus, at present, there still seems to be no major resistance problem with genital Chlamydia trachomatis isolates in the Federal Republic of Germany.

J Gen Intern Med, 1988 Mar-Apr, 3(2), 144 - 9
Does physician uncertainty affect patient satisfaction?
Johnson CG, Levenkron JC, Suchman AL, Manchester R.
Physicians may choose one of several strategies when initially uncertain about making a specific therapeutic recommendation . The authors investigated how patients' satisfaction is affected by disclosure of uncertainty and its attempted resolution during a clinical encounter . Three hundred and four patients awaiting appointments at a university hospital's ambulatory medical clinic were randomized to view one of five videotapes (VTs) of a patient seeking advice about antimicrobial prophylaxis for a heart murmur . In VT-1 and VT-2, the physician disclosed no uncertainty and prescribed therapy . In VT-3, VT-4, and VT-5, the physician openly conveyed uncertainty but then: (VT-3) prescribed antibiotics without resolving his uncertainty; (VT-4) consulted a reference book with the patient present, then prescribed; or (VT-5) checked a computer with the patient present, then prescribed . Patients rated their satisfaction with the physician on a standardized questionnaire . Differences in satisfaction between the five VTs were significant (p = 0.001), with the highest ratings found for VT-1 and VT-2, where no uncertainty was disclosed . The lowest ratings in satisfaction were found when the physician expressed but then ignored uncertainty (VT-3) or examined a textbook (VT-4) . Global satisfaction was inversely and significantly correlated (r = -0.47) with the patients' perception of uncertainty in the physician . The manner in which clinical uncertainty is disclosed to patients and then resolved by the physician appears to affect patients' satisfaction.

Am J Med, 1988 Mar, 84(3 Pt 2), 617 - 21
Hospital survey of antimicrobial prophylaxis to prevent endocarditis in patients with prosthetic heart valves; Brooks RG et al.; The American Heart Association (AHA) has published guidelines for use of prophylactic antibiotics to prevent bacterial endocarditis, but few data are available about physician compliance with these guidelines . A retrospective review was conducted of the use of prophylactic antibiotics in patients with prosthetic heart valves who were undergoing diagnostic or operative procedures or heart catheterization at three hospitals . Compliance with AHA recommendations was only 30 percent (14 of 46) for procedures considered high risk for patients with prosthetic heart valves . Six (23 percent) of 26 patients who underwent right or left heart catheterization received prophylactic antibiotics (not recommended by AHA) . Antibiotics were given to 42 (74 percent) of 57 patients who underwent surgical procedures considered at low risk of bacteremia, but only 33 (58 percent) received antibiotics that cover organisms commonly present at the site of the procedure . The results indicate that clinicians frequently do not administer prophylactic antibiotics in patients with prosthetic heart valves who are undergoing invasive procedures or do not follow published AHA guidelines when antibiotics are administered.

Biochem Pharmacol, 1988 Mar 1, 37(5), 951 - 6
Inhibition of protein kinase C by defensins, antibiotic peptides from human neutrophils; Charp PA et al.; Defensins, human neutrophil peptide (HNP) antibiotics, potently inhibited phospholipid/Ca2+ protein kinase (protein kinase C, PKC) and phosphorylation of endogenous proteins from rat brains catalyzed by the enzyme . Of the three defensin peptides, HNP-2 appeared to be more potent than HNP-1 and HNP-3 . Kinetic studies indicated that defensins inhibited PKC noncompetitively with respect to phosphatidylserine (a phospholipid cofactor), Ca2+ (an activator), ATP (a phosphoryl donor) and histone H1 (a substrate protein) with Ki values ranging from 1.2 to 1.7 microM . Defensins, unlike polymyxin B (another peptide inhibitor of PKC), did not inhibit the binding of {3H}phorbol 12,13-dibutyrate to PKC; however, defensins, like polymyxin B, inhibited the PKC activity stimulated by 12-O-tetradecanoylphorbol-13-acetate . Defensins had little or no effect on myosin light chain kinase (a calmodulin/Ca2+-dependent protein kinase) and the holoenzyme or catalytic subunit of cyclic AMP-dependent protein kinase, indicating a specificity of action of defensins . It is suggested that defensins, among the most potent peptide inhibitors of PKC so far identified, may have profound effects on functions of neutrophils and other mammalian cells, in addition to their well-recognized antimicrobial activities.

Arch Ophthalmol, 1988 Mar, 106(3), 404 - 5
Aqueous humor penetration of ciprofloxacin in the human eye; Skoutelis AT et al.; Two doses of ciprofloxacin were administered intravenously, 200 mg every 12 hours, to 25 patients undergoing cataract surgery . Plasma and aqueous humor were obtained at 1, 3, 5, 7, and 9 hours after the administration of the second dose of the drug . Peak intraocular concentrations (mean +/- SD), 0.21 +/- 0.1 mg/L, were detected at one hour following ciprofloxacin administration . A time-dependent decrease of the penetration was observed, and by nine hours after the administration, ciprofloxacin levels were 0.05 mg/L . These results illustrate that ciprofloxacin may be an effective antimicrobial agent for prophylactic use in ophthalmologic surgery and also for the treatment of intraocular infections due to susceptible organisms.

Clin Orthop, 1988 Mar, (228), 307 - 8
Retrospective evaluation of an iodophor-incorporated antimicrobial plastic adhesive wound drape; Ritter MA et al.; The incidence of postoperative wound infection following the use of an iodophor-incorporated adhesive wound drape with a preliminary one-minute alcohol cleanse was observed in 649 total arthroplasties . The patients were followed for a minimum of one year to detect signs of infection . An infection rate of 0.46% was comparable to the incidence previously observed for conventional methods using an iodine spray as a skin preparation.

Diagn Microbiol Infect Dis, 1988 Mar, 9(3), 155 - 66
Susceptibility testing of Nocardia species for the clinical laboratory; Wallace RJ Jr et al.; Not all patients are able to tolerate or show a favorable response to the treatment of choice for Nocardia, the sulfonamides . Many new drugs are available with good activity against N . asteroides, the most common pathogenic species, although susceptibility to these agents, including amikacin, amoxicillin/clavulanic acid, and the third generation cephalosporins, is variable . For these and other reasons, we recommend routine susceptibility testing of Nocardia . Disk diffusion testing on Mueller Hinton agar is the best currently available clinical method . A suggested control strain and tentative susceptible and resistant breakpoints for 12 antimicrobial agents are provided . This includes agents not previously evaluated, including cefotaxime, amikacin, ciprofloxacin, and doxycycline . The zones of inhibition were all larger than those currently used by the NCCLS for rapidly growing bacteria, and the disk breakpoints generally fit best with the MIC breakpoints used with the dilution susceptibility method (M7-T) . A broth microdilution MIC method is described that showed good correlation with disk diffusion results, but need additional study . Because of limited experience in most laboratories with this species, reliance on a good reference laboratory for confirmatory susceptibility testing is recommended . Beta-lactamase testing is not helpful, as almost all Nocardia produce beta-lactamase, although many isolates retain susceptibility to selected beta-lactams.

Antimicrob Agents Chemother, 1988 Mar, 32(3), 303 - 7
Enzyme immunoassay to assess effect of antimicrobial agents on Toxoplasma gondii in tissue culture; Derouin F et al.; Toxoplasma gondii grown on MRC5 fibroblasts in 96-well tissue culture plates was tested for susceptibility to five antimicrobial agents . T . gondii growth was quantitated by an enzyme-linked immunosorbent assay, which was performed directly on the fixed cultures, using a rabbit anti-T . gondii immunoglobulin G as the first antibody and a phosphatase-labeled anti-rabbit immunoglobulin G as the second antibody . Optical density values were highly correlated with the number of T . gondii organisms in the Giemsa-stained cultures (r = 0.89), and an enzyme-linked immunosorbent assay was used to assess the effect of antimicrobial agents at various concentrations . For each drug, regression models were used to quantify the relationship between optical density values and antimicrobial agent concentrations in the cultures . A significant inhibitory effect was found with pyrimethamine and sulfadoxine for concentrations greater than or equal to 0.05 and 30 micrograms/ml, respectively . With spiramycin, a progressive increase in inhibition of T . gondii was observed for increasing concentrations from 1 to 100 micrograms/ml . Ornidyl (difluoromethylornithine) and (2R,5R)-6-heptyne-2,5-diamine, which are ornithine decarboxylase inhibitors, were found to have a marked inhibitory effect for concentrations greater than or equal to 25 and 2 mM, respectively . This proposed method was sensitive and easy to perform and does not require the use of radiolabeled compounds; since it allows experimental design on replicate cultures and can be partially automated, it thus may prove useful for the systematic screening of the activity of new compounds against T . gondii.

J Antimicrob Chemother, 1988 Mar, 21(3), 281 - 300
Antibiotic-associated hypoprothrombinaemia; Lipsky JJ; Hypoprothrombinaemia is regarded as a serious adverse effect of antimicrobial therapy . This effect has commonly been attributed to the potential of these drugs to kill intestinal bacteria, a possible source of vitamin K, which is a necessary co-factor in the synthesis of four of the clotting factors . This review examines the evidence for and against this hypothesis, first in experimental animals, then in humans, and assesses the reports of antibiotic associated hypoprothrombinaemia in man, with particular attention to information about the mechanism . The hypothesis that it is the destruction of intestinal bacteria that ultimately results in hypoprothrombinaemia may not be justified . Certain antibiotics, which contain thiol-leaving groups, may produce hypoprothrombinaemia because the thiol group inhibits the vitamin K-dependent step in clotting factor synthesis.

Am J Obstet Gynecol, 1988 Mar, 158(3 Pt 2), 722 - 7
Multicenter comparison of cefotetan and cefoxitin in the treatment of acute obstetric and gynecologic infections; Hemsell DL et al.; Two hundred eighty-seven women were treated in a multicenter, randomized, comparative study to compare the safety and efficacy of cefotetan every 12 hours with that of cefoxitin every 6 or 8 hours in the treatment of acute obstetric and gynecologic pelvic infections . The most frequent primary diagnoses in both groups were endometritis and pelvic inflammatory disease; 24 of these patients were also bacteremic . The mean duration of treatment was 5.2 and 5.4 days for the cefotetan and cefoxitin groups, respectively, and the total doses administered were 18.1 and 32.1 gm, respectively . The rate of clinical failure for the cefotetan group was 8.5% and 12.2% for the cefoxitin group . Laboratory and clinical adverse reactions were infrequent and none was serious; both antimicrobials were well tolerated . These results suggest the administration of cefotetan provided adequate clinical and bacteriologic effectiveness in the treatment of hospital- and community-acquired, polymicrobial obstetric and gynecologic pelvic infections.

J Am Optom Assoc, 1988 Mar, 59(3), 184 - 8
Microbiologic characteristics of unpreserved saline; Houlsby RD et al.; This study was designed to assess the microbiological risk associated with using unpreserved saline buffered with either borate or phosphate salts . The results indicate that borate buffer has measurable antimicrobial activity and can control some microbiological contamination . However, phosphate-buffered saline can become easily contaminated and usually promotes growth or maintains viability of adventitious contaminants.

Obstet Gynecol, 1988 Mar, 71(3 Pt 2), 510 - 1
Acute focal pyelonephritis (lobar nephronia) complicating pregnancy; Cox SM et al.; Lobar nephronia, although initially indistinguishable from acute pyelonephritis, is characterized by a prolonged febrile course . The diagnosis is established radiographically using computed tomography . Treatment involves continuation of antimicrobials until the patient has been afebrile for 48 hours . Lobar nephronia has not been previously reported with pregnancy.

Clin Pediatr (Phila), 1988 Mar, 27(3), 127 - 9
Randomized study of six umbilical cord care regimens . Comparing length of attachment, microbial control, and satisfaction; Gladstone IM et al.; Two hundred and seventy one infants were enrolled in a study to compare six different methods of treating the umbilical cord . Antimicrobial control was equal for all methods . Repeated triple dye application was considered least acceptable by staff and parents and had the longest attachment time . Povidone-iodine was associated with the shortest attachment time and was most liked . If there is no special need to treat a specific nosocomial outbreak, duration of cord attachment and satisfaction of staff and parents can help clinicians decide on a cord care regimen.

J Assoc Off Anal Chem, 1988 Mar-Apr, 71(2), 304 - 16
Microbial receptor assay for rapid detection and identification of seven families of antimicrobial drugs in milk: collaborative study; Charm SE et al.; A microbial competitive receptor assay for detecting residues of antibiotic families in milk was studied collaboratively by 13 laboratories . The drugs and levels (ppb) tested in this study include penicillin G, 4.8; cephapirin, 5.0; cloxacillin, 100; tetracycline, 2000; chlortetracycline, 2000; oxytetracycline, 2000; erythromycin, 200; lincomycin, 400; clindamycin, 400; sulfamethazine, 75; sulfamethoxazole, 50; sulfisoxazole, 50; streptomycin, 1000; novobiocin, 50; and chloramphenicol, 800 . In this method, microbial cells added to a milk sample provide specific binding sites for which 14C or 3H labeled drug competes with drug residues in the sample . The 14C or 3H binding to the specific binding sites is measured in a scintillation counter and compared with a zero standard milk . If the sample is statistically different from the zero standard, it is positive . The assay takes about 15 min . The binding reaction occurs between the receptor site and the drug functional group, so all members of a drug family are detected . In this case, beta-lactams, tetracyclines, macrolides, aminoglycosides, novobiocin, chloramphenicol, and sulfonamides, including p-aminobenzoic acid (PABA) and its other analogs, are detectable . The incidence of false negative determinations among samples is about 1%; the incidence of false positives is about 3% . For negative cases, the relative standard deviations for repeatability ranged from 0 to 5% and for reproducibility from 0 to 6% . For positive cases, relative standard deviations ranged from 0 to 13% for repeatability and from 0 to 14% for reproducibility . The method has been adopted official first action.

J Infect, 1988 Mar, 16(2), 129 - 34
Assessment of antimicrobial treatment of acute typhoid and paratyphoid fevers in Britain and The Netherlands 1971-1980; Fallon RJ et al.; The response of 310 patients with typhoid or paratyphoid fevers to current antibiotic therapy was studied retrospectively . Most patients were of Asian or European origin, thus reflecting the areas in which they were infected . Of the 244 patients with well-recorded therapy 63% were treated with chloramphenicol, 22% with co-trimoxazole and the remainder with various penicillins . There was little difference in response in terms of resolution of fever . Symptoms persisted in only two of 153 (1.3%) patients given chloramphenicol but side-effects led to a change of treatment in nine of these patients . Co-trimoxazole was not significantly inferior and amoxycillin performed well, but the small number of cases treated with ampicillin or mecillinam did not respond as well as those treated with the other drugs.

Infect Dis Clin North Am, 1988 Mar, 2(1), 57 - 83
Principles of antimicrobial therapy for head and neck infections; Hill MK et al.; The physician should take a logical, systematic approach when choosing antimicrobial therapy . The recent proliferation of antimicrobial agents and changing susceptibility patterns amongst bacterial pathogens have made this a more arduous task . Classifying antibiotics according to their spectrum of activity, tissue penetration and potential side effects will aid in choosing empiric therapy for serious head and neck infections.

Prim Care, 1988 Mar, 15(1), 125 - 45
Bacterial diseases of the colon; Sawyer MK et al.; Acute diarrhea of bacterial origin is discussed for seven enteric pathogens, and specific antimicrobial therapy based on positive identification is stressed . Selection of patients with self-limited disease not requiring antimicrobial therapy is emphasized in order to avoid costly laboratory tests . The role of daycare facilities in the spread of enteric pathogens in this country is discussed . This article includes a review of newer methods for treating infants and children with oral rehydration and rapid refeeding.

J Antibiot (Tokyo), 1988 Mar, 41(3), 302 - 7
Identification of fluorescent glycopeptide derivatives by two consecutive high pressure liquid chromatographic procedures; Joos B et al.; Reversed phase high pressure liquid chromatography (HPLC) was used to separate individual components of the complex glycopeptide antibiotic teicoplanin in microgram quantities with gradient elution . Each of eight different fractions was then subjected to a specific and highly sensitive HPLC method, which has been developed for the determination of teicoplanin concentrations in biological specimens . This analytical procedure includes precolumn derivatization with fluorescamine and isocratic elution . The fluorescent teicoplanin derivatives were identified by comparing their retention times in both HPLC procedures . Derivatization resulted in increased hydrophobicity and improved chromatographic separation, but the order of elution of the different compounds was not changed . The antimicrobial activity of the individual underivatized fractions correlated with their respective contents of total teicoplanin A2, whereas the pseudo-aglycone A3 appeared less active . Similar techniques have the potential to be applied to other complex glycopeptide antibiotics.

Allergol Immunopathol (Madr), 1988 Mar-Apr, 16(2), 127 - 38
Pulmonary reactions induced by drugs: a clinical compendium; Sastre J et al.; With the increasing number of drugs, the list of agents which are capable of inducing pulmonary reactions continues to lengthen . This article is a compendium of presently available information on drug induced pulmonary reactions which we have found clinically useful . We have divided the drugs in groups on the basis of two features, pharmacologic actions and type of pulmonary reactions . A total of 109 drugs are cited . Categories of pharmacologic actions include cytotoxic drugs, analgesic and antirheumatic drugs, antimicrobial agents, vasoactive drugs, tranquilizers, anticonvulsants, antidepressants, antiarrhythmics, oral antidiabetics and a group of miscellaneous drugs . Type of pulmonary reactions include pulmonary eosinophilia, bronchoconstriction, acute interstitial pulmonary disease, mediastinic involvement, pleural effusion, pulmonary hypertension, pulmonary calcifications, pulmonary infections and drugs reported to cause drug-induced Systemic Lupus Erythematosus.

Infection, 1988 Mar-Apr, 16(2), 126 - 30
Antimicrobial susceptibility of Bordetella pertussis (Part I); Hoppe JE et al.; In this review of the literature data are collected from the more recent studies on the susceptibility of Bordetella pertussis to penicillins, cephalosporins, other beta-lactam antibiotics, aminoglycosides, tetracyclines, erythromycin, josamycin, co-trimoxazole and various other antibiotics . The methods of susceptibility testing of B . pertussis are discussed and suggestions for standardization are made.

Arch Surg, 1988 Mar, 123(3), 360 - 4
Infectious complications in liver transplantation; Colonna JO 2nd et al.; Thirty-five patients received 42 liver homografts between February 1984 and August 1985 . One or more infections developed in 23 patients (66%) some time after transplantation . An average of 2.5 infections per infected patient occurred . Of 37 bacterial infections, two thirds were either bacteremias or localized intra-abdominal infections . The median onset was 29 days after operation . Thirteen viral infections were identified, with a median onset of 18 days after operation . Nine fungal infections, six disseminated and three localized, were identified, with a median onset of nine days after operation . Infection was the primary cause of death in five (14%) of 35 patients . Fatal infections were evenly distributed among bacterial (two), fungal (three), and viral (two) pathogens . Despite advances in surgical techniques and the use of cyclosporine, infection after orthotopic liver transplantation is a serious problem . Certain patients can be identified as high risks for infection and require an aggressive diagnostic workup followed by early institution of antimicrobial therapy.

Ann Intern Med, 1988 Mar, 108(3), 328 - 33
Intestinal infections in patients with the acquired immunodeficiency syndrome (AIDS) . Etiology and response to therapy; Smith PD et al.; STUDY OBJECTIVE: To determine the frequency of pathogenic gastrointestinal microorganisms in patients with the acquired immunodeficiency syndrome (AIDS) and diarrhea, and to determine if treatment for identifiable microorganisms improves symptoms . DESIGN: Prospective, consecutive sample study . Setting: Referral-based clinic and wards, National Institutes of Health . PATIENTS: Twenty of twenty-two consecutive homosexual males with AIDS and diarrhea, and 10 homosexual males with AIDS without diarrhea . INTERVENTIONS: All patients had a complete physical examination; serial stool examinations for viral, bacterial, fungal, and protozoan pathogens; and esophagogastroduodenoscopy and colonoscopy to obtain duodenal fluid and mucosal tissue to analyze for enteric pathogens or histopathology . Patients with diarrhea had a malabsorption evaluation . Patients with treatable pathogenic microorganisms received standard antimicrobial therapy . MEASUREMENTS and MAIN RESULTS: The 20 patients with AIDS and diarrhea had greater weight loss, lower mean numbers of helper-inducer (OKT4) lymphocytes, and a higher incidence of extraintestinal opportunistic infections than the 10 patients without diarrhea . One or more enteric pathogen was identified in 17 of 20 patients (85%; 95% confidence interval {CI}, 65% to 96%) with diarrhea . Only 1 patient without diarrhea was infected with an enteric pathogen . Nineteen of twenty patients with diarrhea and all 10 patients without diarrhea had chronic inflammatory changes in their intestinal biopsy specimens . Sixteen patients with identifiable enteric pathogens and diarrhea were treated; 11 (69%; 95% CI, 43% to 87%) showed microbiologic, histologic, or clinical improvement . CONCLUSIONS: Thorough diagnostic evaluation can lead to the identification of enteric pathogens in a high percentage of patients with AIDS and diarrhea . Specific therapy can lead to symptomatic improvement.

Hinyokika Kiyo, 1988 Mar, 34(3), 551 - 4
{Clinical studies on Suncefal (cefpiramide) concentration in prostatic tissue and bladder wall}; Okishio N et al.; The cefpiramide (CPM) concentration in prostatic tissue of 19 patients with benign prostatic hypertrophy and bladder wall of 2 patients with bladder tumors was measured, after 2 g of CPM was administered intravenously by bolus technique prior to operation . Prostatic tissue level was 28.4 to 131 micrograms/g and tissue to serum ratio 0.15 to 0.63 at 12 min . to 220 min . after administration . The T1/2 of CPM in prostatic tissue was 3.29 hours . The bladder wall level was high at both determinations . CPM level in prostatic tissue and bladder wall covered the minimum inhibitory concentration of many bacteria detected from the infected sites . Therefore, CPM which has a strong antimicrobial activity can be considered as a highly useful antibiotic for the treatment of postoperative infections.

FEBS Lett, 1988 Feb 15, 228(2), 337 - 40
Antimicrobial properties of peptides from Xenopus granular gland secretions; Soravia E et al.; Previously, we described a family of novel broad spectrum antimicrobial peptides, magainins, from the skin of Xenopus laevis . In this report we show that at least two other Xenopus peptides, present in the skin and its secretions, PGLa and a peptide released from the xenopsin precursor, exhibit antimicrobial properties comparable to the magainins . The identification of these newer members provides insight into the structural diversity of vertebrate antimicrobial peptides.

South Med J, 1988 Feb, 81(2), 185 - 8
Cefotetan: comparative and noncomparative studies in obstetric and gynecologic infections; Knuppel RA et al.; Cefotetan is a recently introduced cephamycin antibiotic for parenteral administration, with a broad spectrum of antibacterial activity . Its elimination half-life of three hours or more allows a twice-daily dosage schedule . A noncomparative trial of cefotetan yielded a satisfactory clinical response in the treatment of all of ten patients with pelvic infection . Subsequently, we did a prospective, randomized comparative study of 53 patients with pelvic infections treated with either cefotetan (2 gm IV every 12 hours) or cefoxitin (2 gm IV every six to eight hours) . Both drugs showed similar clinical efficacy and antimicrobial activity (100% {n = 36} with cefotetan and 94% {n = 17} with cefoxitin, the difference not statistically significant) . A mean of 21.3 gm of cefotetan was required, as compared with 34.4 gm of cefoxitin, a statistically significant difference (P less than .001) . Use of cefotetan is therefore more cost effective.

Int J Clin Pharmacol Ther Toxicol, 1988 Feb, 26(2), 69 - 74
Drug prescribing patterns: a study of four institutions in Sri Lanka; Angunawela II et al.; Drug prescribing patterns were studied retrospectively in 600 patients admitted to the medical wards of three Government hospitals and one private nursing home in the Kandy area of Sri Lanka . The mean drug exposure in the governmental institutions varied between 3.6 and 3.7, whereas at the private institution, patients were exposed to an average of 7.2 drugs . The three Government institutions used 87, 91 and 107 drugs . The private institution 201 . There was no difference in drug exposure in relation to sex, but a tendency towards increased drug exposure was noted with increasing age and longer duration of stay . Antimicrobial agents were the most frequently prescribed class of drugs and diazepam the most prescribed single drug . The reasons for the extensive use of diazepam observed in this study are not clear.

Vestn Khir Im I I Grek, 1988 Feb, 140(2), 131 - 5
{Treatment of complicated forms of paronychia by using the electrophoresis of anti-inflammatory and antimicrobial preparations}; Alekseenko AV et al.; The work presents an analysis of treatment of patients with complicated forms of panaritium . To increase the efficiency of treatment the authors used certain physical factors, in particular, direct electric current--interstitial (intracavitary) electrophoresis of antimicrobial and antiinflammatory agents in complex therapy . The investigation of results of the treatment shows sufficiently high efficiency of the interstitial (intracavitary) electrophoresis . The time of treatment of patients with complicated forms of panaritium became 2 times shorter.

J Comp Pathol, 1988 Feb, 98(2), 167 - 76
Pneumonia following experimental bronchial obstruction in sheep; Pfeffer A; Five of 7 sheep in which the bronchi supplying the right apical lobe of the lung were obstructed with a cottonwool plug developed pneumonia . Large numbers of bacteria were isolated from 4 of the 5 pneumonic lungs . Only minor pulmonary lesions, which are common in sheep on pasture, were observed in 5 sham operation and 5 control sheep . These results support a role for airway obstruction in compromising the antimicrobial defences of the lungs in naturally occurring bacterial pneumonias of sheep.

J Antibiot (Tokyo), 1988 Feb, 41(2), 212 - 9
A simple screening method for insecticidal substances from actinomycetes; Fabre B et al.; A simple and selective assay system was developed in the search for new insecticidal substances from Actinomycetales strains propagated on solid culture media . The strains were first tested for their ability to produce antimicrobial compounds . Only strains displaying weak or no activity were retained and screened in the insecticidal bioassay . Microbial solid cultures were given as food to larvae and to adults of Musca domestica to detect insecticide producers . A second phase, after extraction of the active compounds, consisted of an evaluation of the insecticidal potency and a primarily biological identification of the products synthesized by the selected strain . Of 6,280 actinomycete strains which were screened, 47 were active but only 30 of these were finally chosen in the second phase of screening . All these strains, except one, produced known metabolites such as piericidins, avermectins or valinomycin . The one strain, CL307-24, and its insecticide products appeared novel and will be the topic of further study.

J Antibiot (Tokyo), 1988 Feb, 41(2), 149 - 56
Crisamicin C, a new isochromanequinone antibiotic . Isolation, structure determination, and biosynthesis; Russell WL et al.; Micromonospora purpureochromogenes subsp . halotolerans was found to produce crisamicin C, a novel antibiotic, together with crisamicin A . Crisamicin C was purified by silica gel column chromatography and its physico-chemical properties, structure and biosynthesis were studied . Crisamicin C, mp 260 degrees C (dec), showed UV maxima at 392 (epsilon 9,497), 261 (epsilon 32,959) and 232 nm (epsilon 24,623) in CH3CN, and gave an IR spectrum with absorbances at 1782 (lactone), 1705 and 1655 (quinone) cm-1 . Crisamicin C plasma desorption mass spectrometry (PD-MS) m/z 615.9 {M + H)+, hydroquinone) was 16 amu higher than crisamicin A PD-MS m/z 600 {M + H)+, hydroquinone) suggesting that the two antibiotics differ by one additional oxygen in crisamicin C . Analysis of 1H and 13C NMR spectra, in comparison with those of crisamicin A, indicated that crisamicin C was the 4'a, 10'a epoxide derivative of crisamicin A . Carbon-thirteen labeled acetate feeding experiments were used to confirm the positions of the epoxide and other structural features . Crisamicin C was a more potent antibiotic than crisamicin A, but shared the same spectrum of antimicrobial activity (Gram-positive only).

J Am Vet Med Assoc, 1988 Feb 1, 192(3), 377 - 8
Near drowning of a gelding; Humber KA; After becoming entangled in safety lines and being submerged in a chlorinated swimming pool, a 2-year-old Thoroughbred gelding was evaluated and treated successfully . Treatment included antimicrobial agents, anti-inflammatory drugs, bronchodilators, diuretics, humidified oxygen, and surfactant transplant . The results of follow-up examination of the gelding 120 days after hospitalization were normal.

Ann Plast Surg, 1988 Feb, 20(2), 146 - 7
Survival after a second episode of toxic epidermal necrolysis; Dreyfuss DA et al.; Toxic epidermal necrolysis resulting from severe hypersensitivity to medication has a reported mortality of up to 66% . A patient surviving two episodes with more than a 50% skin loss is unprecedented in the medical literature . Mortality has been associated with many factors, including delayed reepithelialization, persistent skin slough, coagulopathy, severe hypoproteinemia, and sepsis . It may be possible to decrease morbidity and mortality by preventing the shearing of epidermis, thereby limiting the denuded areas . This case report describes the successful management of our patient's second episode of toxic epidermal necrolysis . The treatment of this patient in our specialized burn center consisted of careful fluid and electrolyte management, nutritional support, standard topical antimicrobials, and new modalities of local wound management.

J Reprod Med, 1988 Feb, 33(2), 202 - 4
Skin preparation methods before cesarean section . A comparative study; Lorenz RP et al.; Preoperative skin preparation before cesarean section using a one-minute alcohol wash followed by application of an iodophor-impregnated adhesive film was evaluated in a prospective, randomized, controlled study of 79 patients . The iodophor film was as effective as the five-minute iodophor scrub followed by an iodophor wash, as determined by a reduction in skin bacterial counts . Clinical infectious morbidity was no different between the treatment and control groups, although the study was too small to draw statistically significant conclusions in this respect . This study demonstrated the antimicrobial effectiveness of a new, more rapid method of pre-operative skin preparation before cesarean section as compared to a longer, traditional method . This new, rapid method offers advantages for many patients undergoing abdominal delivery.

J Clin Pathol, 1988 Feb, 41(2), 211 - 4
Incidence of vaginal Weeksella virosa (formerly group IIf); Mardy C et al.; The antimicrobial susceptibilities, biochemical properties, and cultural characteristics of six strains of Weeksella virosa (formerly group IIf) were determined . The main characteristics of this non-fermentative organism were production of cytochrome oxidase, gelatinase, and indole, but a lack of saccharolytic activity . A study was then made of the isolation rates of Weeksella virosa from high vaginal swabs from 300 women: a healthy control group (n = 100), a general group with symptoms of vaginal infection (n = 100), and 100 women from a remand centre, where likelihood of exposure to sexually transmitted disease might be expected to be higher . The incidence of Weeksella virosa was found to be 2% in the first two groups . This suggests that, irrespective of the presence of pathogens, the incidence of the species in the general female population is around 2% . A much higher incidence (15%) was found in the third group, suggesting sexual transmission of the organism.

Neurology, 1988 Feb, 38(2), 322 - 3
Idiopathic CSF pleocytosis in relapsing polychondritis; Brod S et al.; The association of relapsing polychondritis with CSF pleocytosis is reported for the first time . Three cases are described in which infectious etiologies of the pleocytosis were excluded by appropriate cultures and serologic studies . We suggest that the finding of CSF pleocytosis in relapsing polychondritis does not merit empiric antimicrobial therapy in the absence of demonstrated infection.

Eur Respir J, 1988 Feb, 1(2), 161 - 7
The clinical effect and the effect on the ciliary motility of oral N-acetylcysteine in patients with cystic fibrosis and primary ciliary dyskinesia; Stafanger G et al.; The effect of peroral N-acetylcysteine (NAC) in patients with cystic fibrosis (CF) and primary ciliary dyskinesia (PCD) was investigated . 41 CF patients and 13 PCD patients completed the study which was a double-blind, placebo-controlled, cross-over trial . The patients received either NAC or placebo for two periods of three months followed by a three month follow-up period . Active treatment consisted of NAC, either 200 mg x 3 daily (patients weighing less than 30 kg) or 400 mg x 2 daily (greater than 30 kg) . The effect was evaluated in terms of a subjective clinical score, weight, sputum bacteriology, blood leucocyte count, sedimentation rate, titres of specific antimicrobial antibodies, lung function parameters and measurement of the ciliary function . No effect was seen in PCD patients, but in CF patients an improved lung function was seen in the period when the patients suffer most from lower airway infections.

Drugs, 1988 Feb, 35(2), 143 - 53
Sulconazole . A review of its antimicrobial activity and therapeutic use in superficial dermatomycoses; Benfield P et al.; Sulconazole is a substituted imidazole antimicrobial agent structurally related to other drugs in this group . It possesses a broad spectrum of activity in vitro against dermatophytes, yeasts and some Gram-positive bacteria . The efficacy and safety of sulconazole 1% cream has been demonstrated in controlled clinical studies in patients with superficial dermatophyte or yeast infections . In these trials, sulconazole generally displayed similar efficacy to clotrimazole, econazole and miconazole, although in a few studies sulconazole produced better and/or quicker improvement than clotrimazole or miconazole in small numbers of patients with tinea pedis . Further studies in larger groups of patients are needed to confirm these encouraging preliminary findings . Thus, sulconazole is an effective and well tolerated alternative to other topical imidazole drugs in the treatment of superficial fungal infections of the skin.

Ann Plast Surg, 1988 Feb, 20(2), 124 - 7
Chronic extensive necrotizing abscess of the scalp; Razzouk A et al.; Chronic subgaleal abscesses have been extremely rare since the advent of antimicrobial therapy . The majority of reported cases have occurred as acute infections following traumatic scalp lacerations or needle electrode insertion for fetal monitoring . The rich blood supply of the head makes widespread infection from a scalp surgical wound a very unlikely occurrence . Most acute infections of the scalp result in complete resolution with adequate early treatment . However, extensive purulent fibrosis of the scalp remains a potentially serious surgical complication . We report 2 cases of chronic necrotizing abscess of the scalp associated with a postsurgical scalp ulcer . The inflammatory process caused extensive necrotizing fibrosis (up to 2.5 cm thick) of the entire undersurface of the scalp and involved both the galea aponeurotica and the periosteum . We discuss the unique pathological features of this entity along with recommendations for its operative management and suggestions for flap design.

Clin Geriatr Med, 1988 Feb, 4(1), 57 - 70
Asymptomatic bacteriuria in the elderly; Boscia JA et al.; Bacteriuria in the elderly is common and usually asymptomatic . In the absence of symptoms or obstructive uropathy (which is rare in women), bacteriuria in the elderly appears to be a benign disease, and therefore antimicrobial therapy is probably not warranted.

Proc Natl Acad Sci U S A, 1988 Feb, 85(3), 910 - 3
Antimicrobial activity of synthetic magainin peptides and several analogues; Zasloff M et al.; We have previously reported the isolation of two broad-spectrum antimicrobial peptides ("magainins") from the skin of the African clawed frog Xenopus laevis . These natural peptides are active against many species of bacteria and fungi and also induce osmotic lysis of protozoa . In this report we demonstrate that synthetic magainin peptides appear to be indistinguishable from the natural products with respect to chromatographic properties and biological activity . These studies demonstrate conclusively that the magainin peptides are potent antimicrobial substances.

Mayo Clin Proc, 1988 Feb, 63(2), 161 - 74
Immunoglobulin G and its function in the human respiratory tract; Reynolds HY; Immunoglobulin G--which can be subdivided into four classes, each with different functional characteristics--is an important component of the host defense system of the respiratory tract . An excessive amount can be produced or can accumulate after airway irritation (exposure to cigarette smoke) or from immunologic stimulus of B-lymphocyte-plasma cells in types of hypersensitivity and interstitial lung diseases . Specific antibody activity can be identified in organic dust-induced hypersensitivity pneumonitis and asthma that contributes to disease pathogenesis . The availability of opsonic antimicrobial antibodies is essential for optimal function of phagocytes in uptake and containment of bacteria . With an absolute or functional deficiency of IgG, recurrent and chronic types of sinopulmonary infections occur . These extremes of IgG availability, either high levels (presumably excessive) or deficient, are discussed in this review.

J Ethnopharmacol, 1988 Feb-Mar, 22(2), 211 - 21
Ethnopharmacology of Calotropis procera flowers; Mascolo N et al.; An ethanolic extract of the flowers of Calotropis procera was investigated for anti-inflammatory, antipyretic, analgesic and antimicrobial activities . The plant extract reduced the paw swelling induced by carrageenan by 37%, fever in rats by 40% and showed some weak effect in rats on the writhing induced by acetic acid . The growth of both gram-positive and gram-negative bacteria was significantly inhibited . A dose-dependent effect on prostaglandin release was also observed.

J Antimicrob Chemother, 1988 Feb, 21(2), 171 - 5
Susceptibility of Pseudomonas pseudomallei to new beta-lactam and aminoglycoside antibiotics; McEniry DW et al.; Pseudomonas pseudomallei is resistant to many antimicrobial agents . We determined the susceptibility to twelve beta-lactams and six aminoglycosides of twelve isolates of P . pseudomallei . Imipenem (MIC range 0.5-1.0 mg/l; MIC90 1.0 mg/l), ceftazidime (MIC range 1-8 mg/l; MIC90 8.0 mg/l), amoxycillin/clavulanate (MIC range 4-8 mg/l; MIC90 8.0 mg/l), piperacillin (MIC range 4-16 mg/l; MIC90 8.0 mg/l), and carumonam (MIC range 4-16 mg/l; MIC90 8.0 mg/l) were the most active . Aminoglycosides were relatively inactive, for example, gentamicin (MIC range 16-64 mg/l; MIC90 64 mg/l), netilmicin (MIC range 16-128 mg/l; MIC90 128 mg/l) and amikacin (MIC range 32-64 mg/l; MIC90 64 mg/l).

Antimicrob Agents Chemother, 1988 Feb, 32(2), 259 - 61
In vitro activities of 39 antimicrobial agents for Branhamella catarrhalis and comparison of results with different quantitative susceptibility test methods; Doern GV et al.; The in vitro activities of 39 antimicrobial agents were assessed versus 74 clinical isolates of Branhamella catarrhalis . Resistance was observed only with penicillin and ampicillin and then only with beta-lactamase-producing strains . The results of in vitro susceptibility tests with agar dilution and broth microdilution procedures were found to be comparable . The results of broth tube macrodilution tests were, in general, one twofold-concentration increment higher.

Antimicrob Agents Chemother, 1988 Feb, 32(2), 255 - 6
In vitro evaluation of josamycin, spiramycin, and erythromycin against Rickettsia rickettsii and R . conorii; Raoult D et al.; The antimicrobial activities of josamycin, erythromycin, and spiramycin against Rickettsia conorii and R . rickettsii were evaluated in two tests: a dye-uptake assay and a plaque assay . The MIC of josamycin was 1 microgram/ml for both species; the MICs of erythromycin and spiramycin were 4 to 8 and 16 to 32 micrograms/ml, respectively, for both species . Only josamycin may be of clinical use in treating spotted fever rickettsiosis . It may be useful in treating pregnant women and young children.

Microbiol Sci, 1988 Feb, 5(2), 42 - 6
Microbial contaminants and antimicrobial properties of human milk; May JT; A review and listing of antibacterial, antiviral and antiparasite factors in human breast milk is presented . Also reviewed are the microbial contaminants such as cytomegalovirus and rubella virus, which have recently been shown to infect infants via breast milk, without adverse effects . The retroviruses, human immunodeficiency virus and human T-lymphotropic virus type 1 have been detected in human milk, with the latter virus probably being transmitted through the milk . These virus contaminants can be destroyed by pasteurization of the human milk.

Antimicrob Agents Chemother, 1988 Feb, 32(2), 257 - 8
In vitro drug susceptibility of Chlamydia sp . strain TWAR; Kuo CC et al.; The in vitro susceptibilities of eight Chlamydia sp . strain TWAR isolates were tested against tetracycline, erythromycin, penicillin, ampicillin, sulfisoxazole, and a new drug, trospectomycin . The ranges of inhibitory concentrations of these antimicrobial agents, except for sulfonamide, were similar to those for Chlamydia trachomatis . Sulfisoxazole was not inhibitory at the highest nontoxic concentration tested.

J Hosp Infect, 1988 Feb, 11 Suppl A, 7 - 14
Infection control during neutropenia; van den Broek PJ; The first principle of infection prevention in neutropenic patients is to ensure that every effort is made to prevent impairment of the host's defences or any disturbance of the ecological balance of the patient's microbial flora . The second principle is that potential or established sources of infection should be sought and ideally treated before any immunosuppressive therapy is instituted . The third principle is to define the extent to which a particular patient can be expected to benefit from special measures such as protective isolation, sterile or low-pathogen food, decontamination, granulocyte transfusions, passive or active immunization, or antimicrobial prophylaxis aimed at a specific micro-organism such as Pneumocystis carinii or Mycobacterium tuberculosis . A programme for the prevention of infections in neutropenic patients will fail if any of these three principles is ignored.

J Hosp Infect, 1988 Feb, 11 Suppl A, 259 - 64
Effects of antimicrobial prophylaxis on colonization resistance; Nord CE et al.; The effect of antimicrobial agents on the intestinal microflora of patients undergoing colorectal surgery was examined . Two narrow spectrum agents, clindamycin and aztreonam, disturbed colonization resistance . This was preserved with the broad spectrum compound, imipenem . Ecological effects are difficult to predict and clinical studies of new antibiotics should include investigations of their impact on the normal human intestinal flora.

J Pharmacobiodyn, 1988 Feb, 11(2), 131 - 6
Studies on iridoid-related compounds . V . Antitumor activity of iridoid dervs . periodate oxidation products; Ishiguro K et al.; In the course of a modification study of iridoid glucosides to investigate their antitumor and antimicrobial activity, we found that about all metaperiodate oxidation products of iridoid glucosides which had no antitumor activity showed potent activity against the leukemia P388 in mice . They were found to be more active than the corresponding aglycones obtained by enzymic hydrolysis of iridoid glucosides . Among them, periodate oxidation product of sweroside showed the most potent activity, of which the maximum total/control (T/C) value was 198% at 200 mg/kg.

FEBS Lett, 1988 Jan 18, 227(1), 21 - 6
A two-dimensional NMR study of the antimicrobial peptide magainin 2; Marion D et al.; Using two-dimensional NMR spectroscopy, a complete 1H resonance assignment has been obtained for the peptide magainin 2 recently isolated from Xenopus laevis . It is demonstrated that this peptide adopts an alpha-helical structure with amphiphilic character when dissolved in a mixture of trifluoroethanol (TFE) and H2O . The transition to the alpha-helical conformation occurs at very low concentrations of TFE.

Chemotherapy, 1988, 34(3), 185 - 90
Plasma and tissue concentrations of ceforanide and cefazolin in women undergoing hysterectomy; Souney PF et al.; Thirty-four women who underwent vaginal hysterectomy received either ceforanide or cefazolin as perioperative antimicrobial prophylaxis . Samples of plasma, myometrium, endometrium and fallopian tubes were obtained at various intervals after injection and were assayed for cephalosporin concentration . Following intramuscular injection approximately 1 h prior to surgery, both drugs provided adequate tissue levels at the time of the procedure . Although both antimicrobials achieved similar tissue concentrations, all tissue samples for ceforanide exceeded the MIC90 for Escherichia coli while in the cefazolin group 9/18 myometrial samples and 10/15 endometrial samples fell below the MIC90 for this organism.

Drugs, 1988, 35 Suppl 2, 133 - 8
Comparison of the antimicrobial prophylactic efficacy of cefotaxime and cephazolin in obstetric and gynaecological surgery . A randomised multicentre study; Periti P et al.; A prospective randomised multicentre study was designed to assess the efficacy of 2 different cephalosporins as short term prophylactic treatment in obstetric and gynaecological surgery . A single dose of cefotaxime (2g IV before surgery) was compared with 2 doses of cephazolin (2g IV before surgery and after 8 hours) . Patients exposed to antibacterial drugs within 7 days, who had preoperative infections, or with known beta-lactam hypersensitivity were excluded . 612 patients entered the study, of whom 552 were evaluable . 276 were given cephazolin (group A) and 276 cefotaxime (group B) . Groups A and B were similar for mean age, obesity, diabetes, types of diseases and obstetric history . No significant differences were observed in type of surgery (vaginal hysterectomy, abdominal hysterectomy, myomectomy and caesarean section) between 2 groups . The mean duration of surgery was 89 and 85 minutes in group A and B, respectively . 25 patients (9.1%) in group A and 20 (7.2%) in group B developed wound infections (not statistically significantly different) . The percentages of patients with infections other than surgical infections were similar (i.e . 13.0 and 11.2 for the cefotaxime and the cephazolin groups, respectively) . These preliminary data show that a single 2g IV dose of cefotaxime and two 2g IV doses of cephazolin have equal antimicrobial prophylactic activity in obstetric and gynaecological surgery.

Drugs, 1988, 35 Suppl 2, 116 - 23
Cefotaxime single-dose surgical prophylaxis in a prepaid group practice . Comparisons with other cephalosporins and ticarcillin/clavulanic acid; Jones RN et al.; The prophylactic efficacy of a single 1g dose of cefotaxime for a wide variety of clean and clean-contaminated surgical procedures was studied in a large prepaid medical practice setting . Regimens were evaluated in 3 successive prospective, randomised comparative trials involving 1950 evaluable patients between November 1983 and March 1986 . Single-dose cefotaxime was initially compared with standard multiple-dose regimens of cephazolin and cefoxitin, and subsequently used as the control regimen for comparisons with single-dose cefoperazone and ticarcillin/clavulanic acid . Patients were observed for the development of wound infection, non-wound morbidity, and adverse reactions . The single-dose prophylaxis regimens resulted in fewer surgical wound infections (p less than 0.05) compared with multi-dose prophylaxis if colorectal procedures were excluded from the analyses . The limited effectiveness of single-dose prophylaxis in colorectal surgery occurred despite the co-administration of erythromycin and neomycin . More than half the infections in all groups were discovered after hospital discharge and were inconsequential . Organisms isolated from the various infections generally remained susceptible to the administered antimicrobial agents . Adverse reactions occurred significantly (p less than 0.001) less often in the patients receiving single-dose prophylaxis . Non-wound morbidity was comparable in all trial groups . The costs associated with single-dose regimens were much lower than those of the FDA-approved multiple-dose regimens . These data confirm that single-dose, broad spectrum beta-lactam agents such as cefotaxime provide safe, effective and economical prophylaxis for a wide variety of surgical procedures.

Pediatr Pulmonol, 1988, 4(4), 201 - 4
Comparison of piperacillin alone versus piperacillin plus tobramycin for treatment of respiratory infections in children with cystic fibrosis; McCarty JM et al.; Seventeen patients with cystic fibrosis (CF) and pulmonary exacerbations were randomly assigned to two treatment groups: piperacillin 600 mg/kg/day (P), and piperacillin 600 mg/kg/day plus tobramycin (PT), in order to determine the safety and pharmacokinetics of high-dose piperacillin and whether piperacillin alone was effective for the treatment of Pseudomonas infections . The mean half-life of piperacillin was 0.54 hours, with a peak concentration of 232 micrograms/ml . No differences between P and PT groups were noted in clinical assessment, as judged by Shwachman scores, pulmonary function testing, or weight gain . However, during the course of treatment, quantitative sputum cultures decreased by greater than 10(2) colony-forming units in only 5 out of 19 Pseudomonas isolates from the P group, compared with 12 of 19 isolates from the PT group (P less than 0.03, Chi-square) . Although emergence of resistance was not seen, one isolate had an increase in minimum inhibitory concentration from 8 to 128 micrograms/ml . There were no serious adverse reactions to piperacillin; only one patient developed fever possibly related to piperacillin . Therapy with high-dose piperacillin was safe in children with CF . Treatment with piperacillin alone was less effective than combination therapy with gentamicin for reduction in titer of Pseudomonas in sputum . However, the role of antimicrobial agents in the treatment of CF remains undefined . A double-blind placebo-controlled trial is indicated.

Pharmazie, 1988 Jan, 43(1), 29 - 31
Structure-release relationships of physically based polymer-biocide combinations . Part 3: Effect of the environment on the release of 3(5)-methylpyrazole from monolithic matrix systems; Schulz B et al.; The release behaviour of the antimicrobially active 3(5)-methylpyrazole from matrix systems prepared from maleic anhydride copolymers as well as from copolymers of maleic esters and maleic amides was studied . Under alkaline conditions erosion is the predominant release mechanism compared to the release of the agent by diffusion into neutral or acid media . The presence of potassium and calcium salts influences the release rate under aquatic conditions in a different way . The diffusion rate of the active ingredient through membranes of maleic anhydride copolymers also depends on interactions with the surrounding media as well as on the hydrophilicity of the matrix.

Infection, 1988, 16 Suppl 1, S24 - 8
Single and multiple dose pharmacokinetics of ciprofloxacin in gynecological tissues; Gerstner GJ et al.; In a prospective pharmacokinetic study the serum and tissue concentrations of ciprofloxacin (Bay O9867), a new carboxyquinolone antimicrobial agent were studied . 22 patients were given 300 mg ciprofloxacin i . v . before the operation (group A), and 19 patients were premedicated with 500 mg ciprofloxacin orally twice daily for three days followed by 300 mg i . v . preoperatively . Tissue samples weighing approximately 2 g were taken from the fallopian tubes, the ovaries, the fundus myometrium and the cervix . Ciprofloxacin concentrations were measured biologically by the cup plate agar diffusion method . Ciprofloxacin concentrations in serum and gynecological tissues were within the same range in both groups . Maximal serum concentrations of 6 and 4 mg/l, respectively, were recorded immediately after infusion . After 2 h serum concentrations ranged from 0.6 to 1.3 mg/l in both groups . At the same time, the tissue concentrations ranged from 0.62 to 3.3 mg/kg, indicating that tissue levels exceed corresponding serum concentrations . On average ciprofloxacin is concentrated in the extravascular space two-fold, as compared to the corresponding serum concentrations . There is no drug accumulation . The tissue concentrations obtained provide a full antibacterial coverage for gynecological infections, since the MIC for the most pathogenic bacteria is less than 1 mg/l.

Rev Mal Respir, 1988, 5(1), 31 - 5
{Prevention of infections in chronic bronchitis using vaccination and/or immunomodulation}; Latil F et al.; Polyvalent antimicrobial vaccines have been widely used in chronic bronchitis for nearly fifty years without their effect or mechanism of action always being well understood . The polysaccharide vaccines, in particular pneumococcal, are better defined chemically and in their mode of action . However, it does not seem that ordinary chronic bronchitis is a good indication for these vaccines . The immunomodulators, extracts of the cell wall of certain bacteria, are aimed at increasing the host's defence capacity in a non-specific manner . The addition of ribosomes may favour specific and non-specific immunomodulation . Certain vaccines have shown their efficacy in reduction of infective episodes in chronic bronchitis . However, other studies ought to be undertaken to obtain purified products which are not toxic and are yet more effective . Finally, it is necessary to have better knowledge of the mode of administration and of the doses administered corresponding to the optimal efficacy of the vaccines.

Comput Methods Programs Biomed, 1988 Jan-Feb, 26(1), 97 - 9
BASIC programs to analyse minimal inhibitory concentration (MIC) antimicrobial susceptibility results; Ling J et al.; BASIC programs have been written to analyse minimal inhibitory concentration (MIC) antimicrobial susceptibility results for large numbers of organisms and a wide variety of antimicrobials . The output of the programs lists the numbers, percentages, cumulative numbers and cumulative percentages of organisms inhibited at different concentrations . The distribution of MICs are additionally printed as a histogram . The range, MIC for 50% and 90% of organisms (MIC50 and MIC90 respectively), and the geometric mean MIC of each drug are also calculated.

Antimicrob Agents Chemother, 1988 Jan, 32(1), 78 - 80
Susceptibility of dysgonic fermenter 2 to antimicrobial agents in vitro; Verghese A et al.; Dysgonic fermenter 2 (DF-2) is a fastidious, gram-negative organism well recognized as a cause of fulminant septicemia in patients without spleens or patients with alcoholic cirrhosis . In vitro antibiotic susceptibility testing of eight strains with a Schaedler broth dilution technique revealed DF-2 to be susceptible to all of the antibiotics tested except aztreonam . Previous reports that DF-2 is aminoglycoside resistant were based on disk diffusion or agar dilution assays that may be less reliable given the slow growth of the organism and its requirement for CO2 incubation . Penicillin is commonly used as prophylaxis after dog bites and has excellent activity against DF-2.

J Clin Pathol, 1988 Jan, 41(1), 44 - 8
Serum C reactive protein in infective endocarditis; McCartney AC et al.; C reactive protein (CRP) was measured serially in 29 patients with infective endocarditis . Twenty one patients were initially treated with antimicrobial drugs . In 13, serial measurement of CRP concentrations showed a progressive return to normal (less than 10 mg/l), which correlated with a satisfactory recovery . Of the remainder (eight patients), five had persistently high concentrations of CRP, indicating a failure to respond to antimicrobial treatment alone . Two of these five patients died and three underwent valve replacement . Of 11 patients treated with antibiotics and valve replacement, CRP concentrations returned to normal in nine . Two patients had infective complications and the CRP concentration did not return to normal . A transient rise in CRP concentration during an otherwise uneventful fall to normal was a sign of allergic reaction in two and of intercurrent infection in three more patients . Serial measurements of CRP concentrations in patients with infective endocarditis may be useful to monitor treatment and also to detect other infections and complications.

J Clin Microbiol, 1988 Jan, 26(1), 161 - 3
Analysis of antimicrobial susceptibility results using microcomputers; Chan KW et al.; A computer program has been developed on an IBM-PC-compatible microcomputer to analyze antimicrobial susceptibility results of large numbers of organisms tested against a variety of antimicrobial agents . For each species, the output includes the numbers, percentages, cumulative numbers, and cumulative percentages of organisms inhibited at different concentrations of each drug, the MICs for 50 and 90% of organisms tested, MIC ranges, and geometric mean MICs . The distributions of MICs are also plotted as histograms . The program was written in dBASE III command language, but a compiled version allows rapid program execution independently of the dBASE III package.

Arch Biochem Biophys, 1988 Jan, 260(1), 85 - 93
The essential role of cobalt in the inhibition of the cytosolic isozyme of 3-deoxy-D-arabino-heptulosonate-7-phosphate synthase from Nicotiana silvestris by glyphosate; Ganson RJ et al.; The prime molecular target of glyphosate (N-{phosphonomethyl}glycine), a potent herbicidal and antimicrobial agent, is known to be the shikimate-pathway enzyme, 5-enol-pyruvylshikimate-3-phosphate synthase . Inhibition by glyphosate of an earlier pathway enzyme that is located in the cytosol of higher plants, 3-deoxy-D-arabino-heptulosonate-7-phosphate synthase (DS-Co), has raised the possibility of dual enzyme targets in vivo . With the recent appreciation that magnesium (and manganese) can replace cobalt as the divalent-metal activator of DS-Co, it has now been possible to show that sensitivity of DS-Co to inhibition by glyphosate is obligately dependent upon the presence of cobalt . Evidence for a cobalt(II):glyphosate complex with octahedral coordination was obtained through examination of the effect of glyphosate upon the visible electronic spectrum of aqueous solutions of cobalt(II) chloride . The presence of glyphosate increased the concentration of cobalt(II) chloride required for enzyme activity, and the concentration of cobalt(II) chloride markedly affected the concentration of glyphosate required for inhibition of DS-Co activity . The extent to which DS-Co is vulnerable to inhibition by glyphosate in vivo depends, therefore, upon the unknown extent to which DS-Co molecules in the cytosol might be associated with cobalt.

Am J Obstet Gynecol, 1988 Jan, 158(1), 16 - 22
Antimicrobial activity of amniotic fluid against Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum; Thomas GB et al.; Amniotic fluids obtained by amniocentesis at 16 weeks to term were examined for the presence of Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum . Of 140 fluids tested, none harbored chlamydiae, and only one harbored mycoplasma, M . hominis . A number of amniotic fluids were subsequently tested for their ability to inhibit the growth of these microorganisms . Amniotic fluids and chlamydial suspensions in a 2:1 ratio were incubated 30 to 90 minutes before their inoculation in McCoy cells . Procedures were followed for chlamydial isolation . Genital mycoplasmas were incubated with amniotic fluid samples for 24 or 48 hours at 35 degrees C . Growth in amniotic fluid specimens was compared with growth in pseudoamniotic fluid and broth controls . Fourteen amniotic fluid specimens collected from gestations of 16 to 40 weeks, were found to be inhibitory to the formation of inclusions of C . trachomatis in McCoy cells . Ten amniotic fluid specimens (16 to 39 weeks, gestation) demonstrated various degrees of inhibition against M . hominis, and three fluids were inhibitory to the growth of Ureaplasma . The inhibitor was heat and protease resistant and activity was proportional to concentration . The molecular weight of the inhibitor was probably greater than 10,000 daltons, and pH, although perhaps a contributing factor, was not the cause of the inhibition.

South Med J, 1988 Jan, 81(1), 95 - 6
Toxoplasmosis associated with nephrotic syndrome in an adult; Oseroff A; Symptomatic generalized toxoplasmosis is uncommon in an immunocompetent host . Even more unusual is the association of nephrotic syndrome with toxoplasmosis, which has previously been reported only in congenital or pediatric cases . This is the first reported case of generalized toxoplasmosis with nephrotic syndrome in an immunocompetent adult . This case should serve to alert the clinician to the possibility of toxoplasmosis in the diagnosis of FUO and adult nephrotic syndrome, and it demonstrates resolution without antimicrobial agents.

Farmaco {Sci}, 1988 Jan, 43(1), 15 - 28
Chemotherapeutic agents with an imidazole moiety . II . Synthesis and biological activities of new 1,4-diarylimidazoles; Porretta GC et al.; The synthesis, antifungal and pharmacological activities of new 1,4-diarylimidazoles are reported . Antimicrobial data in comparison with antifungal antibiotic pyrrolnitrin pointed out that the 1,4-diaryl-2-mercaptoimidazole derivatives were inactive and all 1,4-diarylimidazoles exhibited a weak antifungal activity . Some compounds showed a selective activity against strains of Candida sp . Instead pharmacological data did not evidence any significant antiinflammatory activity . The tested compounds were prepared by reacting appropriate phenacylanilines with potassium thiocyanate in acidic medium to afford 1,4-diaryl-2-mercapto imidazoles which were then transformed into title compounds by treatment with nitric acid.

Farmaco {Sci}, 1988 Jan, 43(1), 103 - 12
Synthesis and biological activity of some pyrrole derivatives . I; Cocco MT et al.; The synthesis of some 5-substituted 2-amino-3-cyano (and 3-carboethoxy)pyrroles is described starting from the cyano- and carboethoxyacetomidines and the alpha-halogeno ketones . The compounds tested in vitro as antimicrobial agents did not show any significative activity.

Drugs, 1988, 35 Suppl 2, 221 - 30
Cefotaxime optimal dosage in adult patients . A reappraisal; Simon A et al.; Cefotaxime, a third generation cephalosporin, is used throughout the world over a wide range of doses . The purpose of this paper is to discuss the rationale for determination of the optimal dosage and of adequate modes of administration . Among the factors determining in vivo activity, the most important are: (1) the time dependence of the antibacterial effect of cephalosporins, (2) the limited effect of increasing the drug concentration in contact with the bacteria and (3) the absence of a significant post-antibiotic effect . Combined with the rather short elimination half-life of cefotaxime, these factors argue for the use of a unitary dose of 1g in adult patients and for a 6- or 8-hour interval between doses . Information obtained from various animal models of infection are discussed . Clinical and bacteriological studies published in the international literature report a high rate of cure (between 80 and 100%) according to the type of infection and to the criteria of efficacy, with daily doses ranging from 2 to 4g bid or qid . The results obtained with the lowest doses are detailed, particularly for infections permitting the use of a low dosage . The necessity for increasing the dose is discussed in the following situations: (1) in specific infections requiring high local drug concentrations such as meningitis and endocarditis, (2) against micro-organisms exhibiting moderate susceptibility to cefotaxime (MIC greater than or equal to 1 mg/L) and (3) in immunocompromised patients . It is now well established that third generation cephalosporins have to be combined with other antimicrobial agents (e.g . aminoglycosides) for the treatment of patients with infections caused by bacteria able to become resistant . For susceptible strains, it has not been established that a synergistic effect of cefotaxime with another agent allows a reduction of the dosage of each member of the combination.

Crit Rev Microbiol, 1988, 15 Suppl 1, S1 - 31
Preparation and use of liposomes in the treatment of microbial infections; Swenson CE et al.; The potential application of liposomes to drug delivery has been apparent since 1965, when these phospholipid vesicles were first described by Bangham . Since then, experiments on animals have shown that liposome encapsulation can dramatically alter the distribution of drugs in the body and their rate of clearance . These pharmacokinetic differences, as well as other less well-understood effects, can result in reduced toxicity and enhanced efficacy of the encapsulated drug . The vast majority of studies on the therapeutic use of liposomes have involved the delivery of drugs used in cancer chemotherapy and metabolic storage diseases, but there is now more literature on the use of liposomes for the delivery of antimicrobial drugs and immunomodulating agents . This review briefly discusses the general properties of liposomes and the rationale for their use in antimicrobial drug delivery and immunomodulation, as well as the encapsulation of specific agents and the effect of encapsulation on the treatment of infectious diseases.

Infection, 1988, 16(1), 69 - 74
New developments in medical microbiology: computer-assisted diagnosis and automated instruments; Heizmann W et al.; Time and accuracy required for diagnosis are two of the most important factors in medical microbiology . Computer-assisted diagnosis is one tool to overcome these problems . The software of such systems, much more than the hardware, is of utmost importance and both have to fulfill several items . 1) High flexibility and integration within the already existing working schemes of the laboratory . 2) Terminals in every laboratory . 3) High speed of calculation . 4) Online data transfer from automated instruments . 5) External terminals on intensive care units . 6) Epidemiological and etiopathological investigations have to be possible at any time . In the laboratory the burden of simple, repeating tasks is diminished, inquiries can be made in a minute and precise information about the epidemiological situation can be gained within a few hours . Thus, calculated antimicrobial therapy depending on the incidence of certain pathogens in given specimens in different departments is possible . In the case of fast-growing bacteria, preliminary reports, including susceptibility testing available within the first 24 h, are possible and will be of great help to the clinician in monitoring the calculated antimicrobial regimen . External terminals will allow continuous flow of data from the laboratory to wards and vice versa.

Eur J Cancer Clin Oncol, 1988, 24 Suppl 1, S35 - 45
Empiric antimicrobial therapy for febrile granulocytopenic cancer patients: lessons from four EORTC trials; Klastersky J et al.; The results of the four EORTC trials conducted over the past 15 years suggest: (1) early empiric therapy with broad spectrum antibiotics directed against gram-negative bacterial bacteremia (GNBB) is a reasonable approach in febrile granulocytopenic patients (GCP); (2) the level and dynamics of the granulocyte count are extremely important in determining the outcome of bacteremia; severely and/or persistently neutropenic patients are the true tests of antibiotic efficacy and they benefit from antimicrobial synergism; (3) mortality from GNBB in GCP is not related directly to a given empiric antimicrobial regimen which may 'buy time' and allow appropriate therapeutic alterations; (4) only microbiologically documented infections and especially bacteremias are useful to compare responses to antimicrobial regimens; (5) the response rate of GNBB is clearly influenced by the susceptibility of the causative pathogen to the beta-lactam component of the empiric regimen and emergence of resistance to some antibiotics (cephalothin, carbenicillin, ticarcillin, azlocillin) has rendered some combinations less effective . The combination of an anti-Pseudomonas beta-lactam plus an aminoglycoside is recommended as the 'standard' for empiric therapy in febrile GCP; (6) gram-positive pathogens have become a common cause of bacteremia in GCP and although the response rate to empiric regimens may be marginal, the associated mortality is low . A general conclusion from these trials is that studies of the management of infection in GCP should include sufficient numbers of eligible patients to allow for evaluation of bacteremic patients at highest risk of death . The need for large collaborative studies stems directly from these considerations.

Rev Infect Dis, 1988 Jan-Feb, 10 Suppl 1, S258 - 61
Adverse effects of the fluoroquinolones; Halkin H; Data on adverse reactions due to the quinolone antibacterial agents--ciprofloxacin, ofloxacin, pefloxacin, norfloxacin, and enoxacin--observed in a patient sample of approximately 30,000 are reviewed . Overall rates of adverse reactions were 4.0%-8.0%, and adverse reactions necessitated discontinuation of therapy in 1.0%-2.6% of patients . Patterns of organ-system involvement and of signs and symptoms were quite similar, with gastrointestinal effects predominating (nausea, vomiting, diarrhea, or abdominal pain in 1.0%-5.0% of the patients), followed by effects on the central nervous system (dizziness, headache, and/or insomnia in 0.1%-0.3% of the patients) and skin (0.5%-2.2% of the patients) . Elevation in levels of hepatic enzymes occurred in 1.8%-2.5% of the patients, azotemia in 0.2%-1.3%, and eosinophilia in 0.2%-2.0% . These adverse effects were reversible after drug withdrawal and were generally not dose-dependent . Within the constraints of the relatively small number of well-documented patients and the unique mechanism of action of these antimicrobial agents, the safety profile of these drugs seems to make them acceptable for use when their administration is well directed and specific . In addition, close surveillance for new phenomena should be maintained.

Rev Infect Dis, 1988 Jan-Feb, 10 Suppl 1, S225 - 33
Quinolones in the treatment of serious infections; Webster A et al.; The new 4-quinolones have excellent broad-spectrum antibacterial activity . Pharmacokinetic studies show that they are reliably absorbed when given orally and reach high tissue levels . They are effective in animal models of systemic infections, with activity comparable to that of current antimicrobial regimens . Their use to date in systemic infections in humans has not been extensive, but results in the treatment of severe infections, including bacteremia, osteomyelitis, and pneumonia have been encouraging . The few comparative studies that have been undertaken confirm the efficacy of these agents . The limited experience with these drugs in the treatment of infection in the immunosuppressed host is largely favorable . Emergence of resistance, although demonstrable in vitro, does not appear to pose a clinical problem, although addition of a second agent may be advantageous . These drugs appear to be well tolerated, with gastrointestinal disturbance being the most commonly reported adverse effect.

Rev Infect Dis, 1988 Jan-Feb, 10 Suppl 1, S132 - 6
Drug interactions with quinolones; Lode H; The mechanisms involved in drug interactions may be either pharmacokinetic or pharmacodynamic . Pharmacokinetic interactions are the leading events and are caused by alterations in absorption, distribution, metabolism, and elimination of one drug by another . The reported interactions of new quinolones are due to a decrease in antimicrobial activity at low pH, a Mg++-dependent reduction in efficacy, and a probenecid-induced decrease in tubular secretion of ciprofloxacin . The reduction of theophylline clearance by those quinolones that are metabolized primarily in the liver (enoxacin and ciprofloxacin) is of clinical relevance; also, the interactions of quinolones with Mg++-containing antacids, which result in tremendous loss of bioavailability, are of therapeutic importance.

J Reprod Med, 1988 Jan, 33(1 Suppl), 154 - 8
Prevention of infections after obstetric and gynecologic surgery; Faro S; The need for antimicrobial prophylaxis in patients undergoing vaginal hysterectomy is well recognized, and the benefits of prophylaxis in cesarean section are relatively clear-cut . In contrast, only those patients at risk of serious complications from postoperative infection are considered candidates for prophylaxis after abdominal hysterectomy . This paper addresses the following questions: Does the patient need prophylaxis? If so, how should the most suitable antibiotic be selected?

J Reprod Med, 1988 Jan, 33(1 Suppl), 135 - 41
Pelvic inflammatory disease . Decision making in the pharmacy and therapeutics committee; Mercer LJ; In today's environment of cost containment, the pharmacy and therapeutics committee plays an increasingly important role in determining the availability of antibiotics for the treatment of specific diseases . However, if the drug is not optimal for treatment and sequelae of a disease process develop, no true savings are gained . The goal of treating pelvic inflammatory disease should not be just reduction of morbidity but preservation of fertility and reduction of surgery after therapy . Multiple factors must be considered when choosing antibiotic therapy for pelvic inflammatory disease, including the spectrum of pathogenic organisms involved, the efficacy of the antibiotic chosen, the safety profile of the antibiotic, the pattern of resistance to the antibiotic in both the hospital and the community, the cost of administering the antibiotic and management of its side effects . This paper reviews the concepts used at the Chicago Lying-in Hospital, University of Chicago, in choosing the primary antibiotic, ceftizoxime, for the treatment of pelvic inflammatory disease . This antibiotic offers a broad spectrum of antimicrobial activity with little resistance, few side effects, evidence of penetration into the infected tissues and prolonged dosing intervals, which allow substantial cost savings as well as efficacious treatment of acute pelvic inflammatory disease.

J Reprod Med, 1988 Jan, 33(1 Suppl), 119 - 23
Acute pelvic inflammatory disease . Etiologic and therapeutic considerations; Hemsell DL; Acute pelvic inflammatory disease (PID) is a community-acquired bacterial infection presumed to be initiated by sexual activity . The therapeutic goals in its treatment are to treat the symptoms, preserve fertility when desired and prevent the development of sequelae . PID should be diagnosed early and accurately, and appropriate antimicrobial therapy should be initiated immediately . Cost-effective parenteral therapy should include antibiotics that can be administered in as few daily doses as possible without sacrificing efficacy.

Surgery, 1988 Jan, 103(1), 32 - 8
Complications in cardiac transplant patients requiring general surgery; Colon R et al.; With the advent of cyclosporine A, heart transplantation has become a widely accepted treatment for patients with end-stage cardiac disease that is not amenable to medical or surgical treatment . Between July 1982 and December 1985, 86 heart transplantations were performed at the Texas Heart Institute with cyclosporine A and prednisone used for immunosuppression . Thirty patients had complications requiring general surgical consultation . The pancreas and biliary tracts were most commonly affected . Pancreatitis developed in sixteen patients; five patients required operative intervention, resulting in a 40% mortality rate . Five of nine patients with cholecystitis required cholecystectomy . All patients survived the procedures . Other gastrointestinal complications included colonic ileus, bowel perforation, gastrointestinal bleeding, gastric outlet obstruction, and perirectal abscess . Patients who have undergone cardiac transplantation are susceptible to life-threatening infections and are at risk of serious complications requiring general surgical intervention . Better results can be obtained in these complex clinical situations when complications are identified early and managed aggressively through the adjustment of immunosuppression, adequate selection of antimicrobial agents, and proper timing of surgical intervention.

Mayo Clin Proc, 1988 Jan, 63(1), 72 - 6
Legionella bozemanii pneumonia in an immunocompromised patient; Jaeger TM et al.; Legionella bozemanii, a rare cause of pneumonia, has a predilection for patients with impaired cellular immunity and underlying disease . We report the 12th culture-proven case of this infection, acquired in the community by a patient undergoing chemotherapy for chronic lymphocytic leukemia . The diagnosis was established when studies of bronchoalveolar lavage fluid produced a positive reaction with species-specific fluorescent antibody and growth on selective culture media . Although erythromycin was administered within 48 hours after the initial examination, the clinical condition did not improve substantially until rifampin was added to the antimicrobial regimen.

J Med Chem, 1988 Jan, 31(1), 221 - 5
Studies on prodrugs . 7 . Synthesis and antimicrobial activity of 3-formylquinolone derivatives; Kondo H et al.; Several 3-formylquinolone derivatives (8a-c) were synthesized to assay the antibacterial activity both in vitro and in vivo . In vitro, all of the compounds 8a-c showed lower activity than that of the corresponding 3-carboxyl compounds 1a-c, and in vivo, they showed higher activity than that of compounds 1a-c . After oral administration of 3-formyl compounds 8a-c to mice, the compounds were rapidly metabolized into 3-carboxyl compounds 1a-c . In particular, the 3-formyl derivative (8a) of norfloxacin (NFLX, 1a) gave a 2-fold higher serum level than that of NFLX and functioned as a prodrug of NFLX.

Antimicrob Agents Chemother, 1988 Jan, 32(1), 144 - 6
In vitro susceptibility of Trichomonas vaginalis to 50 antimicrobial agents; Sears SD et al.; We determined the susceptibilities of five strains of Trichomonas vaginalis, one of which was metronidazole resistant, to 50 antimicrobial agents . For the metronidazole-susceptible strains, the most active agents were metronidazole, tinidazole, mebendazole, furazolidone, and anisomycin . Against the resistant strain mebendazole, furazolidone, and anisomycin were the most active . Antifungal agents, beta-lactams, macrolides, aminoglycosides, and folic acid antagonists were ineffective against all strains.

J Ocul Pharmacol, 1988 Winter, 4(4), 351 - 8
Polyvinylpyrrolidone iodine: corneal toxicology and epithelial healing in a rabbit model; York KK et al.; Polyvinylpyrrolidone-iodine (PVP-I) is a biocompatible broad spectrum antimicrobial that is widely used as an ophthalmic pre-operative prepping agent . In order to determine if PVP-I is safe for treating corneal ulcers and conjunctivitis, we evaluated the ocular toxicity of frequent dosing in a rabbit model . We evaluated ocular irritation in 18 rabbits according to the McDonald-Shadduck method . Concentrations of 0.5% PVP-I or less were practically non-irritating when administered six times per day . We evaluated corneal epithelial wound healing in 16 rabbits with standardized abrasions . Concentrations of 0.33% PVP-I showed epithelial healing comparable to gentamicin treated eyes and untreated controls . Concentrations of 0.5% PVP-I delayed epithelial healing by one day . Because of its broad spectrum and apparently low toxicity, PVP-I may be a useful treatment for corneal ulcers, keratitis and conjunctivitis.

Drugs Exp Clin Res, 1988, 14(10), 649 - 54
A micromethod for determination of antimicrobial agents in bone; Heimdahl A et al.; A microtechnique, requiring very small amounts of tissue material, was developed for assay of antimicrobial agents in bone . Without previous homogenization or extraction, small bone pieces (mean weight 0.014 g) from human subjects and pigs were placed into wells in agar plates preinoculated with the test strain . Round and distinct zones of inhibition were formed around the pieces . Standards for ampicillin and flucloxacillin were prepared from freeze-dried bone pieces from human subjects and pigs with known amounts of antibiotics as well as in human plasma and phosphate-buffered saline (PBS) . Curves obtained from these standards were linear . Bone pieces from human and pig maxilla gave superimposable curves, but differed from curves obtained in plasma or PBS . The method was used in a pharmacokinetic study of bacampicillin in human maxillary bone and plasma . Bacampicillin tablets (2 X 400 mg) were given to patients before oral surgery . Standardized bone pieces and plasma samples were obtained at different times during surgery . The peak ampicillin concentrations estimated from the population curves were 8.0 mg/l in plasma and 1.1 mg/l in maxillary bone . The elimination half-life of ampicillin was similar in plasma and maxillary bone.

Drugs Exp Clin Res, 1988, 14(10), 645 - 8
A high performance liquid chromatography method for the determination of FCE 22101, a novel penem antimicrobial, in serum; Baskerville AJ et al.; FCE 22101 (sodium {5R, 6S, 8R}-6-alpha-hydroxyethyl-2-carbamoyloxymethyl-2- penem-3-carboxylate) is a new penem antimicrobial with a broad spectrum of activity . In order to investigate the pharmacokinetics of FCE 22101 in human volunteers, a high performance liquid chromatographic assay has been developed for determining concentrations of FCE 22101 in serum . Serum samples were deproteinised with an equal volume of acetonitrile followed by centrifugation . The supernatant was then diluted with an equal volume of 0.05 M phosphate buffer (pH 7.0) and 50 microliters was applied to the separation column . Chromatographic separation of FCE 22101 was achieved using an SP8700 solvent delivery system (Spectra-Physics), an SP8780XR autosampler (Spectra-Physics) and a reverse-phase C18 mu-BondaPak column (8 X 100 mm) radially compressed in a Z module (Millipore, UK) . The mobile phase consisted of a water, methanol and orthophosphoric acid mixture (74:25:1), which was filtered through a 0.22 micron filter and de-gassed under vacuum prior to use . The flow rate was 1.4 ml/min and FCE 22101 was detected in the column eluant using an LC871 UV-Vis detector set at 318 nm . The data were analysed using an SP4270 integrator (Spectra-Physics) . The lower limit of sensitivity of the assay method was 0.8 mg/l and recovery from deproteinised serum was of the order of 70% . Intra-assay variation was less than 5% and inter-assay variation was less than 10%.

Chemotherapy, 1988, 34 Suppl 1, 30 - 3
Comparative study of ceftriaxone and cefoperazone in the treatment of acute cholecystitis; Friedlender J et al.; Forty patients with acute cholecystitis were divided into two randomized groups on the basis of the emergency antimicrobial therapy received, and were treated for a period of 5 days . The first group was given ceftriaxone (Rocephin), the second cefoperazone (Cefobis) . This concomitant antimicrobial treatment of acute cholecystitis proved to be effective in 85% of the patients; 15% underwent 'a chaud' surgery on the 6th day because of a lack of response to the treatment . Ceftriaxone and cefoperazone proved to be equally effective . Use of ceftriaxone, however, was simpler (one injection a day) and the cost of treatment substantially lower.

Microbios, 1988, 56(228-229), 177 - 80
Glaucium flavum Crantz . IV.Antimicrobial activity; Cabo J et al.; The extracts obtained from root, stem, leaf and fruit pericarps of Glaucium flavum showed antibacterial activity in an in vitro assay . The root extract was the most active against the Gram-positive bacteria which were investigated.

Pharmacotherapy, 1988, 8(6), 324 - 33
Imipenem monotherapy versus combination therapy in the management of mixed bacterial infection: a critical appraisal; Jaresko GS et al.; There has been a great deal of interest in the use of imipenem monotherapy rather than combinations of antimicrobials for mixed bacterial infections . A review of the published comparative studies of imipenem versus combinations in serious mixed bacterial infections indicated that, overall, imipenem is at least as effective as, and maybe less expensive than, the combinations tested . Several studies suggest that clinical response to imipenem is more rapid than to the comparison regimens; however, other factors may have influenced these values, and the numbers of patients in these reports were small . Imipenem is devoid of the adverse effects associated with aminoglycosides . Other adverse effects, including superinfection and central nervous system toxicity, were similar for imipenem and the comparison regimens . Meta-analysis of the published reports and abstracts revealed that imipenem is as effective as combination regimens for the treatment of serious mixed bacterial infection.

Zentralbl Chir, 1988, 113(19), 1273 - 9
{Experiences with the use of cerium nitrate silver sulfadiazine in the local treatment of thermal injuries in childhood}; Lorenz C et al.; Ointment containing cerium nitrate and silver sulphadiazine (Flammacerium) was applied to 47 children with second-degree to third-degree thermal injuries, with something between five and 60 per cent of the body surface being affected, as had been reported in a one-year prospective study . This ointment proved to be superior to several alternative approaches with regard to local properties, antimicrobial effectiveness, and applicability to several degree of burns . The process of treatment can be optimised due to unproblematic applicability in open and closed variants under both hospitalised and outpatient conditions . This assessment has been underlined by good to very good therapeutic results.

Zentralbl Gynakol, 1988, 110(15), 953 - 6
{Chlorhexidine as a vaginal antiseptic in obstetrics}; Ketscher KD et al.; The antimicrobial efficiency of a chlorhexidine containing emulsion which is used as gliding or antiseptic remedy is examined . The killer-time for germs within the suspension test as well as the testing in clinical use confirm the efficiency known from literature . The use of chlorhexidine containing emulsions serving as antiseptic gliding remedy is recommended.

Int J Clin Pharmacol Res, 1988, 8(4), 267 - 9
The effect of antimicrobial prophylaxis for thoracic noncardiac surgery: thienamycin versus cefazolin; Perlikova I et al.; A comparison was made of the use of thienamycin and cefazolin in antimicrobial prophylaxis of patients undergoing major thoracic noncardiac surgery . Fever and failure or success of prophylaxis were used as criteria . Both cefazolin and thienamycin were of the same value in cases of lung resections, while thienamycin was clearly superior in resections of thoracic oesophagus.

APMIS Suppl, 1988, 3, 59 - 62
A comparison of antibiotics consumption and bacterial resistance patterns in Kuwait and Sweden; Shihab Eldeen A et al.; The total utilization of antimicrobial drugs, expressed as DDD/1000 inhibitants/day, was 19 in Kuwait and 15 in Sweden . Aminoglycosides, tetracyclines and trimethoprim/sulphonamide were used more in Kuwait than in Sweden . The utilization of cephalosporins, however, was more prevalent in Sweden than in Kuwait . Hospital use of aminoglycosides was more pronounced in Kuwait than in Sweden, whereas trimethoprim/sulphonamide was less utilized in Kuwait . The overall consumption of antimicrobial drugs expressed as DDD/500 hospital beds, was highest in one of the Swedish hospitals where, for example, the consumption of tetracyclines was 15-fold higher than that in the comparable Kuwaiti hospital . Regarding bacterial resistance patterns, the large use of aminoglycosides and ampicillin was reflected in a higher resistance frequency among the Kuwaiti isolates . Resistance frequencies for trimethoprim/sulphonamide was also relatively much higher in Kuwait than in Sweden . In this case there was, however, no simple correlation to utilization figures, which are lower for the Kuwaiti hospital than for the Swedish . Resistance to chloramphenicol was prevalent in both countries, in spite of the very limited use of this drug.

J Rheumatol, 1988, 15(5), 840 - 4
Serious bacterial cellulitis of the periorbital area in two patients with systemic lupus erythematosus; Derksen RH et al.; We describe the occurrence of bacterial cellulitis in the periorbital area of 2 patients with systemic lupus erythematosus (SLE) . In both patients the antibacterial activity of polymorphonuclear leucocytes was normal . The opsonic capacity of serum was defective in one patient (corresponding to decreased levels of the 4th component of complement) and normal in the other . Seemingly minor bacterial infections of the skin in patients with SLE should warrant aggressive antimicrobial treatment.

Scand J Infect Dis Suppl, 1988, 53, 50 - 8
Impact of different antimicrobial agents on the colonisation resistance in the intestinal tract with special reference to doxycycline; Nord CE et al.; The administration of antimicrobial agents has a number of effects on the intestinal microflora . One is the reduction of colonisation resistance, i.e., the resistance displayed by the host to implantation of new microorganisms in the intestinal microflora . In the present investigation, the impact of three antimicrobial agents--clindamycin, doxycycline and erythromycin--on the colonisation resistance in the intestinal human microflora was examined . Two of the agents--clindamycin and erythromycin--disturbed the colonisation resistance and caused ecological changes, while the third agent--doxycycline--better preserved the colonisation resistance . Ecological effects are difficult to foresee and clinical studies of antimicrobial agents should include investigations of the impact on the normal human intestinal microflora.

Drugs Exp Clin Res, 1988, 14(12), 741 - 5
In vitro activity of antimicrobial agents against mycobacteria; Casal M et al.; The aims of this study were to investigate the possible effects of new antimicrobial agents, the conventional antituberculosis drugs and several combinations of these agents against 190 clinical isolates of Mycobacterium tuberculosis and 30 of M . avium.

Rev Epidemiol Sante Publique, 1988, 36(6), 451 - 6
{Infections and utilization of antibiotics in the hospital, results from a prevalence survey in 1986}; Avril JL et al.; To estimate the rate of infectious diseases and the efficiency of medical care in our hospital, we conducted a prevalence survey of both infections and antibiotic use on 588 inpatients . Results showed that 125 patients (21% of the total) had infections; of these, 56 had nosocomial infections . A third of the patients had been receiving antimicrobial drugs; among them, 30% were receiving the drugs for prophylactic reasons . A misuse in the prophylaxis of infections was determined, particularly in the duration of treatment . The study demonstrated that an effective infection-control program and an antibiotic policy are required in our hospital.

Pharmacotherapy, 1988, 8(6), 334 - 50
Aminoglycosides: current role in antimicrobial therapy; Cunha BA; Aminoglycosides remain the cornerstone of antibiotic therapy for nosocomial, gram-negative bacillary infections despite the recent introduction of broad-spectrum beta-lactam antibiotics and quinolones with antipseudomonal activity . Initially, aminoglycosides were used as antiaerobic gram-negative antimicrobial therapy . Currently, they have a key role in many types of infections, such as gram-negative urosepsis and in febrile granulocytopenic patients, because of their established antipseudomonal activity . Empiric treatment of febrile episodes in granulocytopenic cancer patients with an aminoglycoside, in combination with an anti-pseudomonal beta-lactam, accounts for much of the aminoglycoside use . Amikacin is emerging as one of the most effective aminoglycosides on the basis of resistance rates, pharmacokinetic factors likely to affect clinical efficacy, safety, and overall cost of therapy.

Acta Haematol, 1988, 80(3), 159 - 61
Atypical mycobacterial infection in alpha interferon-treated hairy cell leukaemia; Giles FJ et al.; A patient whose hairy cell leukaemia had begun to respond to alpha interferon therapy developed overt atypical mycobacterial infection . This eventually responded to combination antimicrobial therapy . The clinical difficulties involved in this unique case included difficulty in isolation of the organism, failure of an empirical trial of antituberculous therapy and false attribution of the patient's infective symptoms to alpha interferon.

Int J Immunopharmacol, 1988, 10(2), 161 - 7
Enhancement of interleukin 2 production by quinolone-treated human mononuclear leukocytes; Roche Y et al.; Previous studies have shown that lectin-induced human mononuclear leukocyte (MNL) proliferation was influenced by quinoline derivative antibiotics (quinolones), depending on both the dose and the antimicrobial agent used . Since the production of interleukin-2 (IL-2) is known to be involved in the proliferation of immune cells, we investigated the effects of three quinolones: ciprofloxacin (Cip), ofloxacin (Ofl) and pefloxacin (Pef) on IL-2 production in vitro by phytohemagglutinin (PHA)-stimulated human MNL . IL-2 activity in the supernatants of PHA-stimulated MNL was found to be enhanced by quinolones in a dose- and time-dependent manner . Increased IL-2 activity was observed using Cip, Ofl or Pef at therapeutically achievable blood concentrations (5-10 micrograms/ml) . Since at these concentrations the PHA-induced proliferative response of MNL was not impaired by quinolones, the increased recovered IL-2 activity was not related to a decreased absorption of IL-2 by activated MNL . At high antibiotic concentrations (25 micrograms/ml), the enhanced IL-2 activity might be related (i) to increased accumulation resulting from the decreased proliferation induced by the quinolones at these concentrations, and (ii) to a true increased IL-2 production by the cells . In fact, an increased IL-2 recovery in presence of quinolones was always observed after blocking the cell cycle by mitomycin C, and was therefore independent of DNA-synthesis . Furthermore, the expression of IL-2 receptors was not modified by Cip, Ofl or Pef . These data show that quinolones increased IL-2 synthesis by MNL and suggest the potential usefulness of these antibiotics, not only as antimicrobial agents, but also as modulators of immune responses.

J Antimicrob Chemother, 1988 Jan, 21(1), 65 - 74
Clofazimine reverses the inhibitory effect of Mycobacterium tuberculosis derived factors on phagocyte intracellular killing mechanisms; Wadee AA et al.; The effects of clofazimine on phagocyte functions associated with antimicrobial activity have been investigated . Clofazimine at a variety of concentrations was capable of enhancing the spontaneous production of hydrogen peroxide and the intracellular killing ability of phagocytes; but had no effect on resting phagocyte lysozyme release, or hexose monophosphate shunt (HMPS) activity . However, when these latter functions were assessed in the presence of a phagocytic stimulus, clofazimine moderately increased both lysozyme release and HMPS activity . A 25 Kd glyco-lipoprotein derived from Mycobacterium tuberculosis has been shown to inhibit these antimicrobial functions . Clofazimine was capable of partially reversing the inhibitory effect of the mycobacterial component in all of the systems assessed . Partial restoration was observed at concentrations of 0.5 mg/l and was maximal at 2 mg/l . These studies indicate important mechanisms operative in the pathogenesis of tuberculosis and suggest that clofazimine may have clinical relevance in the treatment of mycobacterial diseases.

J Infect Dis, 1988 Jan, 157(1), 14 - 22
In vitro assessment of antimicrobial agents against Toxoplasma gondii; Harris C et al.; We have modified a method of quantitating growth of Toxoplasma organisms by measuring incorporation of {3H}uracil into Toxoplasma-infected, differentiated L6E9 rat myocytes and have found that low-dose pyrimethamine (0.1 microgram/ml) and sulfadiazine (25 micrograms/ml) are synergistic . Pyrimethamine at higher concentrations (0.5 and 1.0 micrograms/ml) inhibits uptake to the same degree as the low-dose pyrimethamine-sulfadiazine combination . Spiramycin was effective only at high concentrations (200 micrograms/ml) and with prolonged incubation of greater than 72 h . Clindamycin and several of its analogues, methotrexate and difluoromethylornithine, were all ineffective and showed no additive effect with either pyrimethamine or sulfadiazine . Spirogermanium, an experimental antineoplastic and antiprotozoan agent, was effective only at concentrations close to those toxic to the system . 5-Fluorouracil was effective even at 0.1 microgram/ml . At 0.01 microgram/ml it was synergistic with pyrimethamine (0.1 microgram/ml), and the combination was as effective as high-dose pyrimethamine (1.0 microgram/ml).

Magnesium, 1988, 7(5-6), 281 - 9
Phagocytes and monokines: perspectives on metabolic regulation in sepsis; Sacco NA et al.; The importance of monocytes and macrophages in antimicrobial host defense physiology has long been recognized . The mononuclear phagocyte system includes the precursor cells in bone marrow, or promonocytes, circulating peripheral blood monocytes, and the resident tissue macrophages of both fixed and free types . This review focuses on the pathophysiological role of the monokines, especially interleukin-1 in metabolic regulation during sepsis.

Scand J Infect Dis Suppl, 1988, 57, 20 - 3
Management of upper respiratory tract infections in Japan; Kitahara M; This brief review on the management of upper respiratory tract infections in Japan encompasses antimicrobial treatment of otitis media, sinusitis and tonsillitis.

Med Cutan Ibero Lat Am, 1988, 16(5), 427 - 9
{Benzoyl peroxide in the treatment of decubitus ulcers}; Fernandez Vozmediano JM et al.; We communicate a case of pressure sore (decubitus ulcer) treated with 20% topic benzoyl peroxide in O/W emulsion with very satisfactory results . This substance feeds hyperbaric oxygen . Benzoyl peroxide also has antimicrobial, antipruriginous and antifungal properties all of them contributing to shorten the evolution of the lesions.

Drugs, 1988, 36 Suppl 4, 18 - 25
Current management of acute diarrhoeas . Use and abuse of drug therapy; Ludan AC; Acute diarrhoeas in infants and children should be regarded as a protective physiological response of the gastrointestinal tract to flush out harmful organisms and toxins, thus limiting the morbidity from this illness . The approach to therapy of acute diarrhoeas must be physiological rather than pharmacological . Prevention and early correction of acute dehydration with oral rehydration is the most physiological approach to the successful management of acute diarrhoeas, which generally have a self-limited course . The use of antidiarrhoeal drugs is limited to a few isolated cases . These may include the short term administration of antimicrobials in selected cases of acute diarrhoea caused by entero-pathogens where antimicrobials are proven to be efficacious . Antisecretory drugs which are devoid of unwanted side effects may be tried in persistent cases of acute diarrhoeas, but kaolin-pectin mixtures and antimotility drugs should be avoided for infants and children . Generally, the management of acute diarrhoea is simply to stop the dehydration rather than the diarrhoea, not with drug therapy but with oral rehydration therapy.

Clin Exp Obstet Gynecol, 1988, 15(4), 174 - 7
Antimicrobial prophylaxis for vaginal hysterectomy: comparison of two regimens; Mele G et al.; A randomized trial has been performed to evaluate the efficacy of two antibiotic regimens as a prophylaxis for vaginal hysterectomy . The results, especially in terms of microbiological characteristics of the local population, are then discussed.

Ann N Y Acad Sci, 1988, 549, 56 - 64
Mycoplasma hominis in maternal and fetal infections; Embree J; Although prevalence of M . hominis colonization during pregnancy varies from 12-50%, its role in infections of the mother and newborn infants is unclear . Definite correlations exist with chorioamnionitis and amniotic fluid infections, but as it is rarely isolated alone during these infections, its pathogenic role is uncertain . Its association with septic abortion is similarly questioned . Prevalence and antibody titers to M . hominis increase with increasing parity . Transient bacteremia occurs in approximately 2.5% of normal deliveries . M . hominis does have a significant role in postpartum fever . Women harboring the organism during labor with low predelivery antibody titers are at risk . Approximately 30% of exposed infants are colonized (4% of all infants) but there are only a few reports of neonatal meningitis, pneumonia, or skin abscesses due to M . hominis . Most recover without specific therapy . The role of antimicrobial therapy of M . hominis in pregnancy and the neonatal period is unclear . Further studies of these issues should simultaneously consider all potential genital tract pathogens.

Drugs, 1988, 35 Suppl 7, 12 - 6
Beta-lactamases in clinical isolates . Spectrum implications of sulbactam/ampicillin; Acar JF et al.; Combining ampicillin with an irreversible beta-lactamase inhibitor such as sulbactam is a promising technique for controlling infections due to resistant organisms . The combination not only restores the effectiveness of ampicillin against species that have acquired resistance to it, but it can extend the antimicrobial spectrum to species that have never exhibited susceptibility to ampicillin . However, the inhibition of beta-lactamases and the evaluation of inhibitors are still complicated by numerous factors known collectively as 'the epidemiology of beta-lactamases' . This refers to the distribution of enzymes in different bacterial species and in different geographical locations, the numerous types of enzymes, the variable number and amount of beta-lactamases that may exist in the same cell, and, of course, the potential for transfer of beta-lactamase resistance from one species to another.

Curr Med Res Opin, 1988, 11(3), 196 - 204
Critical care requirements after elective surgery of the alimentary tract . The Norwegian Gastro-Intestinal Group (NORGAS); Serum bactericidal test; Department of Pathology, Vanderbilt University School of Medicine, Nashville, Tennessee 37232The serum bactericidal test represents one of the few in vitro tests performed in the clinical microbiology laboratory that combines the interaction of the pathogen, the antimicrobial agent, and the patient . Although the use of such a test antedates the antimicrobial era, its performance, results, and interpretation have been subject to question and controversy . Much of the confusion concerning the serum bactericidal test can be avoided by an understanding of the various factors which influence bactericidal testing . In addition, the methodologic aspects of the serum bactericidal test have recently been addressed and should place this test on firmer ground . New information on the clinical utility of this test is becoming available; additional data are needed to establish more clearly the usefulness of the serum bactericidal test in specific infections . Such clinical trials from multiple centers will enable firmer recommendations for the future use of the serum bactericidal test.

Acta Oncol, 1988, 27(5), 497 - 502
Empiric antimicrobial therapy for febrile granulocytopenic cancer patients . Lessons from four EORTC trials; Klastersky J; The experience from four EORTC trials on antimicrobial therapy for febrile granulocytopenic cancer patients (GCP) is reviewed . A general conclusion from these trials is that studies of the management of infection in GCP should include sufficient numbers of eligible patients to allow for evaluation of bacteremic patients at highest risk of death . The need for large collaborative studies stems directly from these considerations.

Tierarztl Prax, 1988, 16(2), 113 - 8
{The pharmacokinetics of common chemotherapeutic drugs used in veterinary medicine}; Lutz F; The present paper summarizes the pharmacokinetics of chemotherapeutic agents commonly used in controlling bacterial disease in animals . Data on absorption, distribution and excretion of chemotherapeutic agents are given in form of tables . It is explained that pharmacokinetic parameters of antimicrobial chemotherapy among others are influenced by the drug's pharmaceutical formulation, its route of administration, its biotransformation and also by the age of the patients . There are given hints for handling the drug in order to achieve optimal effects.

Tierarztl Prax, 1988, 16(2), 103 - 7
{General and special problems concerning the approval and re-evaluation of antimicrobial agents for use in agriculturally useful animals}; Hoffmann B; Problems associated with registration and reevaluation of drugs are discussed in this paper . In particular it deals with difficulties resulting from toleration of residue concentrations in edible tissues and from the deduction of withdrawal periods . Possible consequences when applying identical criteria for registration and reevaluation are outlined . The necessity to involve the whole veterinary profession, when setting criteria for determination, presentation and evaluation of clinical efficacy, is stressed.

Scand J Infect Dis Suppl, 1988, 53, 22 - 8
Comparative trials of doxycycline versus amoxicillin, cephalexin and enoxacin in bacterial infections in chronic bronchitis and asthma; Chodosh S et al.; The comparative efficacy of doxycycline versus amoxicillin, cephalexin, cefaclor and enoxacin was examined in four separate cross-over and blinded studies of acute bacterial bronchitis in chronic bronchitis and asthma . The efficacy of doxycycline over the eleven-year period (1975-1986) covered by these studies also was examined . Patients with acute bacterial exacerbations, defined by increased chest symptoms, increased bacteria and sputum neutrophilia, were randomly entered . When a new acute infection occurred, they were re-entered and received the other antibacterial . Response was recorded as successful or not; early rebound infections and the periods free of infection were noted . A total of 136 exacerbations were evaluated in the comparison of doxycycline with the other 4 antibacterials, and 93 exacerbations in the long-term efficacy of doxycycline . The acute success was similar for doxycycline with the other antibacterials and was superior to cefaclor . Early rebound infections occurred less frequently with doxycycline as compared to the cephalosporins and was similar versus amoxicillin and enoxacin . The infection-free period was longer after doxycycline than with the other four antimicrobials . Doxycycline maintained its efficacy to elicit a prompt response and provide a long infection-free period, but an increase of early rebound infections was noted over the eleven-year period.

Chronobiologia, 1988 Jan-Jun, 15(1-2), 25 - 39
Antimicrobial agents as biological response modifiers (BRM) and chrono-immunomodulation: an emerging relationship; Dammacco F et al.; Immune defense mechanisms play an essential protective role against infections caused by a wide array of pathogenic microorganisms . Although the growing number of the available antimicrobial agents has certainly improved the overall clinical outcome of such infections, antimicrobial therapy not rarely fails whenever the host's immune function is depressed . On the other hand, recently introduced therapeutic and diagnostic procedures (antineoplastic chemotherapy causing severe neutropenia and mucositis; organ transplantation requiring conditioning regimens; the widespread use of intravascular catheters and prosthetic devices; administration of adrenal corticosteroids and/or other immunosuppressive agents) have resulted in an unprecedented number of immunocompromised hosts . In addition, a variety of antibiotics have been found to display adverse effects on specific and non-specific immune functions, thus further impairing the already depressed immune system of the host . Antibiotic-mediated immunomodulation hence is explored with the introduction of a third-generation cephalosporin, namely cefodizime (CDZ), which has been shown to possess immunostimulating properties in preliminary in vitro and ex vivo studies as well as in a few experimental animal models . A chronoimmunopharmacological approach to CDZ-induced immunomodulation has been started by ourselves . The study, which is still in progress, includes patients with multiple myeloma (MM), selective IgA deficiency and chronic uremia, and matched healthy subjects . A number of immunological parameters are being assessed on blood samples drawn every 6h in the 24-h span prior to CDZ administration (a single 2 g daily dose i.v . for 6 days to the patients and for 4 days to healthy subjects), and in the 24h following the last CDZ injection . Healthy subjects and patients are randomly assigned to two groups, depending on whether they are given the antibiotic at 0800 or at 1800 . Although a full evaluation of the results will be reported elsewhere, the group of MM now includes 24 patients . A circadian stage-dependent chronoimmunomodulating effect has been unequivocally shown for the monocytic chemotactic responsiveness to CDZ in MM . Immunostimulating 'side-effects' suggest that CDZ should possibly be regarded as a prototype antimicrobial agent for patients with impaired immune functions . Conceivably, a better knowledge of such properties will help synthesize new antibiotics with specific immunomodulating effects.

Pediatr Cardiol, 1988, 9(2), 103 - 8
The association between immunodeficiency and congenital heart disease; Radford DJ et al.; The predilection of children with congenital heart disease (CHD) to infection may be explained in part by an underlying immunodeficiency disorder . Some 13 syndromes in which immunodeficiency and CHD may coexist have been reported in the medical literature . In addition, immunoglobulin and T-cell deficiencies have been found in nonsyndromal patients with CHD . The diagnosis of immunodeficiency should be entertained in such children, as early recognition of an immunodeficiency disorder can result in improved antimicrobial and immunological management.

Chemotherapy, 1988, 34(3), 248 - 55
High teicoplanin uptake by human neutrophils; Maderazo EG et al.; The cellular/extracellular (C/E) concentration ratio of teicoplanin in polymorphonuclear leukocytes (PMNs) increased rapidly with time (C/E 60 +/- 13 at 20 min) . The C/E ratio was time- and concentration-dependent . At 20 min and an initial concentration of 75 +/- 16 micrograms/ml the cellular drug concentration was 4,700 +/- 1,300 micrograms/ml . The mechanism of drug uptake was by an active process and transported (cellular) drug retained its antimicrobial activity . Washing removed 42% of cellular drug . Teicoplanin inhibited PMN chemotaxis at very high concentrations and PMN microbicidal activity at lower concentrations.

Arch Inst Cardiol Mex, 1988 Jan-Feb, 58(1), 57 - 9
{Infectious Brucella endocarditis in a case of corrected transposition of the great arteries}; Garcia Urruticoechea P et al.; We describe a case of a 14 year old male who developed infections endocarditis due to Brucella sp . He had a corrected transposition of great vessels with valvular pulmonary stenosis and mitral insufficiency . Vegetations were demonstrated by echocardiogram on the pulmonary valve as well as on left atrioventricular valve . He had also proliferative nephritis . Prolonged antimicrobial treatment results in complete healing . Because the rarity of this association we inform this observation.

Antimicrob Agents Chemother, 1988 Jan, 32(1), 68 - 74
In vitro culture system to determine MICs and MBCs of antimicrobial agents against Treponema pallidum subsp . pallidum (Nichols strain); Norris SJ et al.; A new procedure for determining the susceptibility of Treponema pallidum subsp . pallidum to antimicrobial agents was developed, utilizing a tissue culture system which promotes the in vitro multiplication of this organism . In the absence of antibiotics, T . pallidum (Nichols virulent strain) multiplied an average of 10-fold when incubated for 7 days in the presence of Sf1Ep cottontail rabbit epithelial cell cultures . Varied concentrations of penicillin G, tetracycline, erythromycin, and spectinomycin were added to triplicate cultures to determine their effects on treponemal multiplication, motility, and virulence . The MIC of each antibiotic was defined as the lowest concentration which prevented treponemal multiplication, whereas the MBC was defined as the lowest concentration which abrogated the ability of the cultured treponemes to multiply and cause lesions in rabbits . The in vitro culture technique provided highly reproducible MICs and (in parentheses) MBCs of each of the antibiotics tested: aqueous penicillin G, 0.0005 (0.0025) microgram/ml; tetracycline, 0.2 (0.5) microgram/ml; erythromycin, 0.005 (0.005) microgram/ml; and spectinomycin, 0.5 (0.5) microgram/ml . The significance of these results in light of the in vivo activities and the previous in vitro evaluations of these antibiotics is discussed . The T . pallidum in vitro cultivation system shows promise as a method for studying the interaction between T . pallidum and antimicrobial agents and for screening new antibiotics for syphilis therapy.

Oral Surg Oral Med Oral Pathol, 1988 Jan, 65(1), 116 - 21
The patient with chronic renal failure who is undergoing dialysis or renal transplantation: another consideration for antimicrobial prophylaxis; Naylor GD et al.; A patient with chronic renal failure who is undergoing dialysis or renal transplantation is susceptible to a number of infections . Transient, usually asymptomatic bacteremias occur in a wide variety of dental manipulations, particularly those involving the mucous membranes . Certain bacteremias may cause serious complications in these already compromised patients . Therefore, antimicrobial prophylaxis is essential when these patients undergo bacteremia-causing dental procedures.

Drugs Exp Clin Res, 1988, 14(10), 629 - 34
Effect of subminimal inhibitory concentrations of pefloxacin on the piliation and adherence of E . coli; Desnottes JF et al.; Several recent reports have shown that sub-lethal concentrations of antibiotics may decrease the adhesive ability of bacteria to epithelial cells; however, the mechanism by which the antimicrobial agents reduce adherence has remained unknown . The effect of sub-MICs of pefloxacin, a new broad-spectrum antibacterial quinolone, was studied on: haemagglutination, adherence, outer membrane and fimbriae of a pyelonephritogenic E . coli strain . The strain agglutinated in a mannose-resistant way human P1 but not p erythrocytes . After purification, the fractions containing outer membrane and fimbriae proteins were studied using electron microscopy and sodium dodecyl sulfate-polyacrylamide gel electrophoresis . The E . coli strain, grown in the presence of sub-MICs of pefloxacin, exhibited: (i) abnormal forms with filament formation; (ii) a markedly altered capacity of haemagglutination (human P1 erythrocytes) and adherence to uroepithelial cells . The inhibition of haemagglutination and adherence corresponded to a decrease in P-fimbriae production . These results were also associated with changes in the extraction of the outer membrane proteins of pefloxacin-treated bacteria . No major qualitative difference could be seen in outer membrane and P-fimbriae protein profiles after growth with sub-MICs of pefloxacin . This study has demonstrated that sub-lethal concentrations of pefloxacin alter piliation and the outer membrane of E . coli . These changes are associated with reduced bacterial haemagglutination and adherence.

J Burn Care Rehabil, 1988 Jan-Feb, 9(1), 92 - 5
Comparison of complications during rehabilitation between conservative and early surgical management in thermal burns involving the feet of children and adolescents; Gore D et al.; To evaluate the long-term sequelae of early surgical management compared with conservative therapy, a retrospective review from January 1976 to December 1984 was undertaken . Through inspection of burn diagrams, 395 patients were identified with burns involving the foot . From 1976 through 1980, 109 patients were managed in a conservative fashion with topical antimicrobial therapy and delayed debridement and grafting; 36 of these patients with severe burns were managed with skeletal suspension . Between 1981 and 1984, 136 patients were treated with earlier surgical debridement and grafting; during this period, skeletal suspension was rarely used . No statistical difference was found in mortality, amputations, incidence of open wounds, development of contractures, or number of patients requiring reconstructive procedures between conservative and early excision therapy except in those children treated with skeletal suspension . Thus in burns involving the feet in children, early excision and grafting does not alter the resultant morbidity compared with conservative burn management.

Antimicrob Agents Chemother, 1988 Jan, 32(1), 137 - 40
Antimicrobial susceptibilities of Bordetella species isolated in a Multicenter Pertussis Surveillance Project; Kurzynski TA et al.; MICs for 90% (MIC90s) of 75 Bordetella pertussis strains for amoxicillin, erythromycin, rifampin, and sulfamethoxazole-trimethoprim were 1, less than or equal to 0.12, 1, and 4 micrograms/ml, respectively . Susceptibility rates were all greater than or equal to 93% . Only 17% of the strains were susceptible to tetracycline . The MIC90s of ciprofloxacin, enoxacin, norfloxacin, ofloxacin, and roxithromycin were less than or equal to 0.06, 0.5, 0.25, 0.12, and 0.5 micrograms/ml, respectively . For B . parapertussis, the MIC90s were 16-fold higher with amoxicillin and rifampin and 2- to 4-fold higher with the fluoroquinolones and roxithromycin.

J Clin Microbiol, 1988 Jan, 26(1), 25 - 30
Quantitation of effects of subinhibitory concentrations of trimethoprim on P fimbria expression and in vitro adhesiveness of uropathogenic Escherichia coli; Dean EA et al.; The ability to adhere to and colonize urogenital mucosa is an important virulence attribute of uropathogenic Escherichia coli . This adherence, which appears to be mediated by P fimbriae, may be affected by antibiotics or other agents that affect fimbrial expression . We describe here an enzyme immunofiltration assay to quantitate fimbriation and the application of that technique to measurement of the effects of sublethal doses of trimethoprim on P fimbrial expression . Effects on P fimbriation correlated with effects on the adherence of treated bacteria to cultured T24 bladder carcinoma epithelial cells; i.e., trimethoprim treatment decreased both P fimbriation and bacterial adherence . It was possible to quantitate effects on P fimbriation when type 1 fimbriae were also present . The enzyme immunofiltration assay may be useful for studies on the role of fimbriae in the pathogenesis of bacterial infections, and it may facilitate identification of antimicrobial agents that interfere with bacterial adherence to mucosal surfaces.

Pharmacotherapy, 1988, 8(6), 301 - 14
The 4-quinolone antibiotics: past, present, and future; Stein GE; During the past 5 years the 4-quinolone antibiotics have progressed from relative obscurity to a highly visible and intensely studied class of compounds . The zeal for developing and marketing newer fluoroquinolones closely parallels that of the cephalosporins for the last 10 years . All of these newer agents appear to have similar mechanisms of action, but numerous derivatives of the basic 4-quinolone structure have been synthesized in an effort to enhance the antimicrobial spectrum and pharmacologic properties of these antibiotics.

Dermatologica, 1988, 176(5), 234 - 42
Clofazimine-mediated enhancement of reactive oxidant production by human phagocytes as a possible therapeutic mechanism; Anderson R et al.; Clofazimine, at concentrations within the therapeutic range (0.01-5 micrograms/ml), stimulated human polymorphonuclear leucocytes (PMNL) to generate increased amounts of reactive oxidants (RO) when activated with the tripeptide leucoattractant N-formyl-L-methionyl-L-leucyl-L-phenylalanine (FMLP), calcium ionophore, phorbol myristate acetate and opsonised zymosan . Clofazimine per se did not activate the membrane-associated oxidative metabolism of PMNL, but rather primed these cells to hyperreact to the various stimuli . To investigate the therapeutic significance of these observations clofazimine was administered to patients with various chronic inflammatory diseases (lichen planus, discoid lupus erythematosus and rheumatoid arthritis) and generation of RO by FMLP-activated phagocytes was measured before and during clofazimine administration . A statistically significant potentiation of RO generation by FMLP-activated phagocytes was observed during clofazimine administration . Since RO are immunosuppressive and antimicrobial the therapeutic mechanisms of clofazimine may be related to pro-oxidative interactions of this agent with phagocytes.

Rev Infect Dis, 1988 Jan-Feb, 10 Suppl 1, S14 - 21
Mode of action of the quinolone antimicrobial agents; Hooper DC et al.; The newer quinolone antimicrobial agents are more potent antibacterial agents than is the older analog nalidixic acid . For many of the quinolone agents, increased antibacterial potency correlates with increased potency in inhibiting the essential bacterial enzyme DNA gyrase . Studies with mutants resistant to drug action have identified the A subunit of this enzyme as a drug target . Other drug-resistance mutations are associated with pleiotropic drug resistance and decreased amounts of porin outer-membrane proteins and appear to involve alterations in permeability of the bacterium to the drug . Structure-activity studies of a large number of quinolone analogs have identified the importance to drug action of substituents at positions 1, 3, 4, 6, and 7 of the quinolone ring . Uncertainties remain, however, about the details of the molecular interactions of quinolones, DNA gyrase, and DNA and about the specific events that lead to quinolone-mediated bacterial killing.

Arch Otolaryngol Head Neck Surg, 1988 Jan, 114(1), 52 - 5
Hydrolase activity in middle ear effusions . Effect of antibiotic therapy; Diven WF et al.; Hydrolytic enzymes have been shown to be present in middle ear effusions recovered from children with both persistent and acute otitis media . In the present study, we investigated the effect of ampicillin therapy on the expression of hydrolytic enzyme activity in acute middle ear effusions using the chinchilla animal model . The median values of enzyme activities were lower for the ampicillin-treated animals when compared with the nontreated control animals . For the ampicillin-treated animals, eight of 12 assayed activities were characterized by a time-dependent decay of enzymatic activity . For the untreated animals, the majority of assayed activities (seven of 12) showed an increase in activity with time . These results show that sterilization of the middle ear cleft and elimination of the hydrolytic enzyme activity may be benefits of antimicrobial therapy and prerequisite to the healing of the inflamed mucosa.

N Engl J Med, 1987 Dec 31, 317(27), 1692 - 8
Ceftazidime combined with a short or long course of amikacin for empirical therapy of gram-negative bacteremia in cancer patients with granulocytopenia . The EORTC International Antimicrobial Therapy Cooperative Group; Splenic reticuloendothelial function after splenectomy et al.; Department of Surgery, St . Paul Ramsey Medical Center, MinnOverwhelming infection after splenectomy remains a problem despite the introduction of vaccine and antimicrobial prophylaxis . To evaluate prospectively various procedures proposed for salvage of the spleen, we measured reticuloendothelial function for two to five years in 51 patients who had initially presented with abdominal trauma and suspected splenic rupture . The mean percentage of pocked erythrocytes and the clearance of antibody-coated autologous erythrocytes in 8 patients who had splenic repair and in 6 who had partial splenectomy were the same as in 11 controls with intraabdominal injury that did not involve the spleen . The mean percentage of pocked erythrocytes remained significantly elevated in 19 patients who had undergone total splenectomy without autotransplantation of splenic tissue . One of seven patients who underwent splenic autotransplantation had a normal level of pocked erythrocytes 18 months after surgery, and a second patient had only a slight elevation at 24 months . The mean (+/- SEM) half-time clearance of labeled erythrocytes was significantly longer in the group that had total splenectomy without autotransplantation (421.1 +/- 74.5 hours) than in the autotransplantation group (91.6 +/- 20.0) or in the controls (5.4 +/- 2.0) . We conclude that reticuloendothelial function was better preserved after partial splenectomy and splenic repair than after splenic autotransplantation, but that autotransplantation was superior to total splenectomy and appeared to be safe . Splenic autotransplantation deserves further study in patients who have had splenic trauma when other surgical maneuvers to save the spleen are not possible.

J Am Vet Med Assoc, 1987 Dec 1, 191(11), 1462 - 4
Pancytopenia caused by bone marrow aplasia in a horse; Lavoie JP et al.; Pancytopenia was evaluated in a mature Quarter Horse gelding . A diagnosis of bone marrow aplasia was made on the basis of bone marrow hypocellularity . History of drugs administered included penicillin, oxytetracycline, trimethoprim-sulfadiazine, phenylbutazone, dipyrone, flunixin meglumine, and isoxsuprine . Clinical remission was observed after treatment with glucocorticoids, androgens, and broad-spectrum antimicrobials.

Mayo Clin Proc, 1987 Dec, 62(12), 1142 - 5
Antimicrobial agents in adult patients with renal insufficiency: initial dosage and general recommendations; Van Scoy RE et al.; The dosage or the time interval of administration (or both) of many antimicrobial agents must be adjusted in anephric patients or those with compromised renal function . Antimicrobial agents that must have adjustment of dosages include most, but not all, of the penicillins and cephalosporins, the aminoglycosides, vancomycin, and trimethoprim-sulfamethoxazole . The maximal doses of these agents generally should be decreased in proportion with the extent of reduction in renal function . The dosage of chloramphenicol, clindamycin, rifampin, nafcillin, and ceftriaxone probably need not be adjusted if hepatic function is essentially normal . The suggested doses are relatively crude guidelines to initial antimicrobial therapy . Serum antimicrobial assays are frequently indicated for accurate adjustment of the dosage, especially with the amino-glycosides . The efficacy of therapy and the possible occurrence of toxicity should be monitored in all patients but particularly in those with renal insufficiency . Recommendations for patients undergoing peritoneal dialysis are not included in this article.

J Med Chem, 1987 Dec, 30(12), 2163 - 9
Synthesis of antimicrobial agents . 1 . Syntheses and antibacterial activities of 7-(azole substituted)quinolones; Uno T et al.; A series of 6-fluoro- and 6,8-difluoro-7-(azole substituted)-1,4-dihydro-4-oxo-3-quinolinecarboxylic acids were prepared . Structure-activity relationship studies indicated that the antibacterial potency was better when the 6,8-substituents were fluorine atoms and the 7-substituent was either 1-imidazolyl, 20, or 4-methyl-1-imidazolyl, 25 . From the results of studies on pharmacokinetic profile and toxicity, 20 and 25 were found to possess excellent antibacterial activities and to show high blood levels after oral administration to mice with low toxicity.

Chemioterapia, 1987 Dec, 6(6), 431 - 3
In vitro susceptibility of Mycobacterium fortuitum, Mycobacterium chelonae and Mycobacterium avium against some quinolones; Casal M et al.; The in vitro susceptibility of Mycobacterium fortuitum, Mycobacterium chelonae and Mycobacterium avium to ciprofloxacin, norfloxacin and ofloxacin was studied by the agar dilution method . All strains of Mycobacterium fortuitum were inhibited by 2 mg/ml or less of these antimicrobial agents . Concentrations higher than achievable blood levels were necessary to inhibit Mycobacterium chelonae and Mycobacterium avium.

Biochem Cell Biol, 1987 Dec, 65(12), 1049 - 56
Biochemical and morphological effects of gentamicin in human proximal tubular cells: effects on lipid and lipoprotein metabolism; Chatterjee S et al.; The effects of gentamicin, an antibiotic used extensively for antimicrobial therapy on the ultrastructure, binding, internalization, degradation, and cholesterol esterification of low-density lipoproteins, were investigated in cultured human proximal tubular cells . Cells were incubated with 0.3 mM gentamicin for 21 days with the following observations . Cells treated with gentamicin contained numerous "myeloid bodies." The binding, internalization, and degradation of 125I-labeled low-density lipoproteins ({125I}LDL) in cells treated with gentamicin was twofold lower than control cells . Pulse-chase experiments demonstrated that gentamicin did not impair the internalization of receptor-bound LDL and their subsequent transport to the lysosome . The relative amounts of {125I}LDL displaced by increasing concentrations of unlabeled LDL were the same in both gentamicin-treated and control cells . This pattern was reflected in the cell surface binding, internalization, and degradation of {125I}LDL . Gentamicin did not alter the degradation of {125I}LDL in cell homogenates at 4.0 . The data suggest that gentamicin decreases the receptor-mediated endocytosis of LDL and subsequent lipid metabolism.

Farmaco {Sci}, 1987 Dec, 42(12), 973 - 8
Synthesis of thiadiazol derivatives of 4(3H)-quinazolinone as potential antimicrobial agents; Khalil MA et al.; Three series of quinazolinone derivatives were synthesised namely: 3-{4-(2-substituted amino-1,3,4-thiadiazol-5-yl)phenyl}-2-methyl-4-(3H)- quinazolinones; 3-{4-(2-substituted amino-1,3,4-thiadiazol-5-yl)anilino}-2-methyl-4-(3H)- quinazolinones and 3-{(2-substituted amino-1,3,4-thiadiazol-5-yl)methyl}-2-methyl-4(3H)-quinazolinones . The antimicrobial activity of representative compounds of these series as well as of the starting quinazolinone acids was studied.

J Dairy Sci, 1987 Dec, 70(12), 2486 - 92
Isolation of bovine immunoglobulins and lactoferrin from whey proteins by gel filtration techniques; Al-Mashikhi SA et al.; Whey is a suitable source of immunoglobulins and lactoferrin to enrich infant formulas . Gel filtration on Sephacryl S-300 and on Fractogel TSK HW-55 was used to isolate immunoglobulins from colostral whey, acid whey, and Cheddar cheese whey . The SDS-PAGE and immunoelectrophoresis techniques indicated that the purity of the fractions from fractionation on Sephacryl S-300 was better than that by fractionation on TSK HW-55 column . Biological activity of fractions from the Sephacryl S-300 column as assessed by immunochemical analysis was 99, 83.3, and 92% for colostral, acid, and sweet wheys . The well-proven antimicrobial agent, lactoferrin, was isolated from sweet whey by heparin-attached Sepharose . Lactoferrin selectively adsorbed to the column was subsequently eluted with 5 mM Veronal-HCl containing .5 M NaCl, pH 7.4 . Purity of the isolated protein was confirmed by SDS-PAGE and immunoelectrophoresis.

Immunobiology, 1987 Dec, 176(1-2), 108 - 24
The course of Legionella pneumonia in guinea pigs after inhalation of various quantities of L . pneumophila; Twisk-Meijssen MJ et al.; The course of legionella pneumonia in guinea pigs after infection with various quantities of virulent L . pneumophila serogroup 1 organisms by aerosol exposure was investigated . The clinical course, histopathological characteristics, manifestations in the lungs and clearance of the legionella organisms from the lungs and spleen were followed . Four groups were exposed to 4.3 X 10(4), 4.7 X 10(5), 5.0 X 10(6) and 1.0 X 10(8) aerosolized legionellae, respectively . The most striking clinical symptoms were fever and weight loss, which were found in 67-94% and 33-100% of the animals, depending on the dose of L . pneumophila organisms administered . Spontaneous death occurred only in animals receiving the highest dose and always within 10 days . All animals exhibited exponential growth of legionella organisms in the lungs . Maximal growth occurred 5 to 7 days after exposure and varied from 9.3 X 10(7) to 7.4 X 10(8) organisms/both lungs . Twenty-two days after exposure, legionellae could still be cultured from lung tissue . Between 2 and 7 days after exposure, the spleen cultures were positive for legionellae in 41% of the animals receiving the lowest dose and in 83% of all other animals; legionellae could no longer be cultured from spleen tissue after day 7 . Depending on the dose, peripherally localized areas of bronchopneumonia increased in size with time, tending to become confluent lobar pneumonia . The microscopic changes were not related to the number of inhaled organisms . In the cellular infiltrate, PMN predominated until day 7 and macrophages thereafter . Seroconversion was found in all animals that survived greater than 7 days . The present animal model closely mimics the course of events in human legionella pneumonia, thus enabling us to further study the factors involved in host resistance against legionella as well as the efficacy of various antimicrobial agents in normal and immunosuppressed animals.

Antimicrob Agents Chemother, 1987 Dec, 31(12), 1935 - 8
In vitro antimicrobial activity against reference strains and field isolates of Treponema hyodysenteriae; Kitai K et al.; The in vitro susceptibilities of eight isolates of Treponema hyodysenteriae from pigs naturally infected with swine dysentery between 1976 and 1983 were determined by an agar dilution technique . Carbadox, olaquindox, tiamulin, metronidazole, furazolidone, and monensin were the most active against these field isolates regardless of the year of recovery . The influence of inoculum size on the MICs against four reference strains of T . hyodysenteriae was studied . Various degrees of activities of ampicillin and lincomycin were found, depending on the inoculum size . The effect of successive in vitro subcultures on the susceptibility of a reference strain of T . hyodysenteriae was examined . The strain resistant to tylosin became susceptible to the drug.

Antimicrob Agents Chemother, 1987 Dec, 31(12), 1904 - 8
High-performance liquid chromatography measurement of antimicrobial concentrations in polymorphonuclear leukocytes; Koga H; High-performance liquid chromatography was used to determine the penetration of 19 antimicrobial agents into human polymorphonuclear leukocytes . The ratios of the intracellular concentration to the extracellular concentration of ampicillin, piperacillin, cefazolin, ceftizoxime, cefpimizole, and ceftazidime were all less than 0.6 . Lincomycin showed a high intracellular-to-extracellular ratio (3.0), while clindamycin achieved a ratio of 15.5, which was the highest ratio of all of the 19 tested antibiotics . Ratios for rifampin, isoniazid, chloramphenicol, and trimethoprim were 8.2, 1.1, 9.6, and 6.1, respectively . Six quinolone-class antimicrobial agents had ratios from 2.2 to 8.2 . Flucytosine showed a penetration ratio of 4.6 . Clindamycin uptake was temperature dependent and occurred best with live polymorphonuclear leukocytes; sodium fluoride, adenosine, and puromycin were inhibitory . The results obtained in this study correlate well with the results of other studies involving radioisotopic methods . This indicates that high-performance liquid chromatography is a useful method for determining the intracellular penetration of antimicrobial agents.

J Parasitol, 1987 Dec, 73(6), 1152 - 7
Unique differences in infectivity and seroreactivity of Toxoplasma harvested from mice infected for different lengths of time; McCabe RE et al.; For use in experiments, Toxoplasma of the RH strain are usually harvested from mouse peritoneal cavities 48 hr (2-day Toxoplasma) or more after intraperitoneal inoculation . In this report we show that Toxoplasma harvested at 24 hr (1-day Toxoplasma) after inoculation are much more infective for and replicate to a greater degree within mouse resident peritoneal macrophages in vitro and are much more resistant to the cidal activity of activated mouse peritoneal macrophages and resident rat peritoneal macrophages than are 2-day Toxoplasma . Ingestion of 1-day Toxoplasma by macrophages did not trigger the respiratory burst as measured by reduction of nitroblue tetrazolium (NBT), but coating 1-day Toxoplasma with specific antibody did result in reduced NBT . However, coating 1-day Toxoplasma with specific antibody did not markedly decrease infectivity for macrophages in vitro, unlike decreased infectivity observed when 2-day Toxoplasma are coated with specific antibody . Use of 1-day Toxoplasma in the dye test resulted in a 5-fold decrease in titer of specific antibody in human sera . Use of Toxoplasma harvested 24 hr after infection may serve as a new tool to probe virulence factors of Toxoplasma and of host cells' antimicrobial mechanisms.

Carbohydr Res, 1987 Dec 1, 170(1), 47 - 55
Synthesis of 7'-(3-hydroxypropyl)fortimicin A and 6'-epifortimicin A; Kanai K et al.; 1,10-Di-0-acetyl-2,3,4,6,7,8,9-heptadeoxy-2,6-bis(2, 4-dinitrophenylamino)-L-lyxo-decopyranose (7) and -D-ribo-decopyranose (8) have been prepared from methyl 2-acetamido-2,3,4,6-tetradeoxy-6-nitro-alpha-D-erythro-hexopyranoside via a nitro aldol reaction with 4-{(tetrahydropyranyl)oxy}butanal in the presence of cesium fluoride, and their configurations at C-6 have been established by conversion of the precursor of 8, namely, methyl 2,6-diacetamido-10-O-acetyl-2,3,4,6,7,8,9-heptadeoxy-alpha-D - ribo-decopyranoside, into the known methyl 2,6-diacetamido-2,3,4,6,7,8,9,10-octadeoxy-alpha-D-ribo-d ecopyranoside . The title fortimicin A derivatives, 7'-(3-hydroxypropyl)fortimicin A and 6'-epifortimicin A, have been synthesized by condensation of compound 7 and 8, respectively, with 2,5-di-O-benzoyl-1,4-bis{N-(methoxycarbonyl)}fortamine B, followed by deprotection and introduction of a glycyl group . Their antimicrobial activities have been found to be weak compared to that of fortimicin A.

J Clin Microbiol, 1987 Dec, 25(12), 2413 - 4
Collaborative clinical laboratory evaluation of an individual MIC strip system; Isenberg HD et al.; Susceptibility results obtained with individualized MIC strips (MICRO-MIC) agreed with the standard microdilution broth method at a level of 96% or greater for each of the 10 antimicrobial agents tested.

Infect Dis Clin North Am, 1987 Dec, 1(4), 893 - 905
Asymptomatic bacteriuria in the elderly; Boscia JA et al.; Bacteriuria in the elderly is common and usually asymptomatic . In the absence of symptoms and/or obstructive uropathy (which is rare in women), bacteriuria in the elderly appears to be a benign disease and therefore antimicrobial therapy is probably not warranted.

Hinyokika Kiyo, 1987 Dec, 33(12), 2127 - 33
{A case of retrovesical abscess due to Crohn's disease}; Tanaka N et al.; A 29-year-old man was admitted with pain on urination and high grade fever-up . Mass was palpated above the right lobe of prostate . Cystoscopy revealed an edematous region in the upward to the right ureteral orifice . CT revealed the retrovesical mass in the same region . The surgical specimen obtained by transurethral resection showed severe inflammatory changes, but no malignancy was found . Antimicrobial chemotherapy had been continued, but the mass did not disappear on palpation and computed tomography and cystoscopy revealed pus-discharge from the center of the edematous region was found . An operation was performed under the diagnosis of retrovesical abscess . The terminal ileum had formed adhesion to the posterior bladder wall . Segmental resection of the ileum and partial resection of involved segment of the bladder were performed . The pathological diagnosis was Crohn's disease . Inflammation of ileum seemed to infiltrate the bladder wall and formed an abscess . After the operation symptoms disappeared.

Semin Respir Infect, 1987 Dec, 2(4), 255 - 61
Nosocomial Legionnaires' disease; Kirby BD et al.; Members of the family Legionellaceae have emerged as important nosocomial pathogens . Bronchopneumonia is the typical illness and mimics other nosocomial pneumonias . On rare occasion, surgical wound infections may be due to legionellae . Legionella pneumophila is the species causing most human illness, but other species may predominate in individual institutions . Pneumonia is acquired by inhalation of environmental aerosols from water sources contaminated by Legionella sp . In the hospital setting contaminated water sources include potable water, heat-exchange systems, and cooling towers . Water temperature control and maintenance programs may prevent colonization of water systems . Should clinical cases and water colonization occur, aggressive suppression/eradication programs--by chlorination or heat/flush--must be instituted . Surveillance of pneumonias in high-risk patient groups is essential for early detection of a nosocomial outbreak . There has been no evidence of person-to-person transmission . Familiarity with diagnostic techniques and their pitfalls will permit institution of effective antimicrobial therapy.

Pathol Biol (Paris), 1987 Dec, 35(10 Pt 2), 1422 - 5
{Effect of antibiotics on IL-1 in vitro production by human monocytes}; Roche Y et al.; The effects of penicillin, macrolides (spiramycin and erythromycin), cephalosporins (cefaclor and cefadroxil), cycline (doxycycline) and quinolones (pefloxacin, ciprofloxacin and ofloxacin) on extracellular and cell-associated interleukin-1 activity from human monocytes were investigated in vitro . When cells were treated with 10 micrograms/ml of quinolones, cephalosporins or penicillin, no effect on IL-1 production could be detected . Using 100 micrograms/ml, extracellular IL-1 activity was found to be decreased by quinolones (about 35% of the control without antibiotic) without modification of the cell-associated IL-1 activity . Extra and intracellular IL-1 was only slightly decreased by cephalosporins, while penicillin did not alter the IL-1 activities . Spiramycin and doxycycline using 100 micrograms/ml increased extracellular IL-1 while cell-associated was decreased . A toxic effect may have been exerted by these antimicrobial agents.

Pathol Biol (Paris), 1987 Dec, 35(10 Pt 2), 1418 - 21
{Interactions between macrophages and anti-infective agents}; Vilde JL et al.; Direct effects of antimicrobial agents on macrophages functions are not well precised . However, antimicrobials can enhance phagocytosis of bacteria by macrophages in vitro, at subinhibitory concentrations . This enhancement is related to the antibiotic effect . It is dependent of the nature of the antimicrobial agent, of the experimental procedure and some discrepancies appeared in the results . The precise mechanism, effect on the bacterial wall, or on the bacterial protein synthesis is uncertain . The third type of interaction concerns the intracellular penetration and activity of antimicrobial agents within macrophages . In a human monocyte-derived macrophage model, the intracellular growth of Legionella pneumophila was inhibited by erythromycin, rifampicin and fluoroquinolones at concentrations clearly lower than their MICs; doxycycline and cotrimoxazole were inhibitory at concentrations closed to their MICs . Cefoxitin was not inhibitory even at high concentrations despite a low MIC value . This confirms the good intracellular activity of macrolides and fluoroquinolones and the low intracellular activity of beta-lactams.

Pathol Biol (Paris), 1987 Dec, 35(10 Pt 2), 1412 - 7
{Alveolar macrophages and antibiotics . Review}; Voisin C et al.; Although alveolar macrophages play a key role in pulmonary defence against infections, little is known about interactions of these cells with antibiotics . In vitro, some drugs fail to enter alveolar macrophages readily; in contrast, other antimicrobial agents (clindamycin, erythromycin, ethambutol) are highly concentrated by these cells, as well as josamycin, erythromycin and spiramycin in vivo . Moreover, clindamycin, erythromycin, chloramphenicol, rifampin and pefloxacin lead to an increased phagocytosis by alveolar macrophages, either by compromising bacterial antiphagocytic components or stimulating proper phagocytic activity of the cell . The influence of antibiotics upon mechanisms of microorganisms destruction (production of oxygen metabolites, oxygen independent system), upon regulation of lymphocyte functions (interleukin 1, prostaglandin E2) or other secretory activities (enzymes, modulators of cell activities, various bioactive products) have not been extensively studied and require further investigations.

Hematol Oncol Clin North Am, 1987 Dec, 1(4), 801 - 39
Management of infections in children with cancer; Barson WJ et al.; Infectious complications remain a frequent cause of morbidity and mortality in children with cancer, especially in those who are granulocytopenic . Physicians caring for these children must approach each new febrile episode as if it were life threatening . Questions concerning the present illness must be comprehensive . The physical examination should be done in a compulsive manner because the more obvious signs of inflammation are often absent because of granulocytopenia . Immediate initiation of broad-spectrum intravenous antibiotic coverage is required once the appropriate specimens for diagnostic microbiology studies have been obtained . Because these patients may exhibit either dramatic or, more often, only subtle clinical findings, they must be monitored closely and have a complete physical examination at least daily . The laboratory studies frequently determine the etiology of the fever . Therapy can then be modified, based upon the particular pathogen isolated or the type of infection identified . Because bacterial infections are responsible for most infectious febrile episodes in the granulocytopenic child with cancer, appropriate antibiotic therapy usually is curative . However, some patients remain febrile and granulocytopenic without explanation . These patients frequently have a fungal infection and respond to amphotericin B therapy . Our present armamentarium of antimicrobial agents against the common pathogens encountered in cancer patients, except for cytomegalovirus, is adequate . Future advances in therapy of infections in children with cancer will probably be in the area of immunotherapy . This would include both passive administration of products to strengthen a debilitated immune system, together with active immunization with the aim to prevent infectious complications . Prevention of infection in the cancer population may be one of the keys to producing longer remissions and prolonged overall survival, by enabling pediatric oncologists to administer more intensive induction chemotherapy.

Epidemiol Infect, 1987 Dec, 99(3), 613 - 24
Properties of strains of Escherichia coli belonging to serogroup O157 with special reference to production of Vero cytotoxins VT1 and VT2; Scotland SM et al.; Fifty-four strains of Escherichia coli belonging to serogroup O157 were examined for the production of Vero cytotoxins VT1 and VT2, and for other properties such as plasmid content, resistance to antimicrobial agents and colicin production . Twenty-six strains from cases of diarrhoea, haemorrhagic colitis and haemolytic uraemic syndrome in humans produced VT . By serum neutralization tests and hybridization with DNA probes for VT1 or VT2, three classes were recognized which produced either VT1 alone or VT2 alone or both VT1 and VT2 . These strains were of H type 7 or non-motile . The strains producing VT were sensitive to all the antimicrobial agents tested, and all carried at least one plasmid which had a molecular weight of c . 60 X 10(6) . Seven strains of porcine origin and 21 strains of human origin did not produce VT or hybridize with either DNA probe . None of these strains was of H type 7 . Of the 21 human VT- strains, 17 were of extra-intestinal origin and 18 were of H type 45 . Twenty-three of the 28 VT-strains were resistant to at least one antimicrobial agent.

Drugs, 1987 Dec, 34(6), 695 - 701
Serous and recurrent otitis media . Pharmacological or surgical management?
Marchant CD, Collison LM.
The management of recurrent acute otitis media and serous otitis media is both challenging and controversial . The efficacy of antimicrobial prophylaxis of children at high risk for recurrent acute otitis media is established, but the indications for such therapy are controversial . Tympanostomy tube insertion also decreases the frequency of recurrent otitis media . High-risk children can be successfully managed with chemoprophylaxis from autumn through to spring . If this fails, then tympanostomy tube insertion should be considered . Serous otitis media that follows acute otitis media resolves spontaneously in more than 90% of cases . Serous otitis media of unknown onset also has a strong tendency to resolve without treatment . Antihistamines and decongestants, although popular, have no significant effect on the course of serous otitis media . Antimicrobial therapy has a modest effect on the resolution of serous otitis media . Tympanostomy tubes usually improve the conductive hearing loss associated with serous otitis media and should be used when bilateral serous otitis media fails to resolve spontaneously . If repeated tympanostomy tube insertion fails, then adenoidectomy should be considered . With the course of management outlined, most children will have a successful outcome with conservative therapy and the need for surgery will be minimised.

J Infect Dis, 1987 Dec, 156(6), 934 - 41
Guidelines for evaluating new antimicrobial agents; Gilbert DN; Evaluating new antimicrobial agents is governed mostly by interaction between the pharmaceutical industry and the Food and Drug Administration (FDA) . Clinical trials are designed to comply with FDA guidelines published in 1977 . Basic principles of the 1977 guidelines remain valid; however, changes in the clinical application of anti-infective agents and in the accepted design of clinical trials have occurred . Some changes are inconsistent with the requirements of the 1977 documents . Members of the Infectious Diseases Society of America (IDSA) have the perspective and knowledge needed to assist in updating the 1977 guidelines . It is proposed that the IDSA establish a formal working relationship with the FDA to review and modernize the 1977 guidelines . Industry participation in this process is desirable . If the IDSA can help orchestrate guideline revision in an environment of mutual respect and cooperation, the result may be a more efficient drug-evaluation process that continues to protect the public interest and is more consistent with contemporary concepts of treatment for infectious disease.

Vet Med (Praha), 1987 Dec, 32(12), 721 - 30
{Foreign substances in the meat and organs of bulls and pigs fed with pastes made from household and food industry waste in addition to pastes made from poultry droppings}; Gilka J et al.; The residues of antimicrobial substances, some chlorinated and organophosphate pesticides and chemical elements were studied in the meat and organs of a group of bulls fed food-waste paste for 240 days and a group of bulls fed the same paste with an addition of poultry waste . These residues were also studied in the tissues of pigs fed the food-waste paste for 135 and 151 days until slaughter . The feed ingredients were also examined during the feeding trials . Although some of the residues under study were found in the tissues of the test animals at increased amounts, their concentrations were diluted in the tissues in the majority of cases when the feed pastes were administered . All residue contents recorded in the tissues remained below the permissible limits as given in valid instructions and directives so that the products, i . e . meat and organs, could be deemed digestible on the basis of hygienic evaluation . Hence, from the point of view of the occurrence of residues of foreign substances in edible tissues, the administration of food-waste pastes to farm animals can be considered as admissible.

Cell Immunol, 1987 Dec, 110(2), 391 - 9
Stimulation of macrophage H2O2 release by resident thymocytes: effect of a soluble factor distinct from interferon-gamma; Mellors JW et al.; Activated T cells are known to stimulate macrophage oxidative metabolism and antimicrobial activity through release of interferon-gamma (IFN-gamma) . In contrast, the role of nonactivated T cells in regulating macrophage effector functions is less well defined . We have previously reported that a low molecular weight soluble factor derived from resident (nonactivated) thymocytes enhances macrophage receptor-mediated phagocytosis . In the present study, we examined the capacity of resident murine thymocytes to stimulate the respiratory burst and microbicidal activity of peritoneal macrophages . Macrophages cultured for 1-2 days with cell-free thymocyte supernatant (TS) released two to three times more H2O2 in response to PMA or opsonized zymosan than did control macrophages . The H2O2-stimulating factor in TS was distinguished from IFN-gamma by its heat stability (100 degrees C, 20 min), approximate MW of 2400 Da (gel filtration high-pressure liquid chromatography), and absence of interferon activity in both antiviral and enzyme-linked immunosorbent assays . TS-treated macrophages, however, did not exhibit a greater capacity to kill or inhibit the intracellular growth of Toxoplasma gondii, indicating that the thymocyte factor did not fully activate macrophage microbicidal mechanisms . These data suggest that thymocytes can increase the respiratory burst capacity of macrophages in the absence of antigen-specific immune responses.

J Exp Med, 1987 Dec 1, 166(6), 1734 - 46
Recombinant granulocyte/macrophage colony-stimulating factor activates macrophages to inhibit Trypanosoma cruzi and release hydrogen peroxide . Comparison with interferon gamma; Reed SG et al.; Recombinant granulocyte/macrophage colony-stimulating factors (rGM-CSF) of mouse and human origins activated macrophages of the homologous species to inhibit the replication of the protozoan parasite T . cruzi . Activation could be induced with 10-100 ng/ml of rMu-GM-CSF, whether it was added before or after uptake of the parasite, in either adherent or suspension cultures . However, the degree of inhibition of parasite replication after exposure to rMu-GM-CSF was not as great as after treatment with rMu-IFN-gamma, and much more rMu-GM-CSF than rMu-IFN-gamma was required to achieve an equivalent antimicrobial effect . These results were mirrored by effects of the cytokines on enhancement of H2O2-releasing capacity in resident mouse peritoneal macrophages . In the latter tests, rMu-IFN-gamma and rHu-TNF-alpha afforded a 44-51-fold enhancement over the untreated control, with a 50% effective concentration (EC50) for rMu-IFN-gamma of approximately 0.05 ng/ml . Using rMu-GM-CSF or rM-CSF, enhancement of H2O2-releasing capacity was 14-15-fold over control, with EC50s of 1 and 14 ng/ml, respectively . However, peak enhancement of macrophage H2O2-releasing capacity was seen at least 24 h earlier with rMu-GM-CSF or rHu-M-CSF than with r-Mu-IFN-gamma or rHu-TNF-alpha . Thus, rMu-GM-CSF and rHu-GM-CSF displayed clear-cut macrophage-activating activity in vitro, but rMu-GM-CSF was less potent and less effective than rMu-IFN-gamma in the tests used.

J Clin Oncol, 1987 Dec, 5(12), 2032 - 40
Trimetrexate: a second generation folate antagonist in clinical trial; Lin JT et al.; Trimetrexate is a promising new lipophilic antifolate with antitumor and antimicrobial activity, which is currently undergoing clinical trials . It differs from methotrexate in its transport and intracellular retention, and may be useful against tumors resistant to methotrexate because of impaired transport or deficient polyglutamylation . In preclinical studies, it has demonstrated a broader spectrum of antitumor activity than methotrexate, and appears to have synergistic antitumor activity when combined with a number of other agents . In clinical trials, the primary toxicity has been hematologic, with rapid recovery and no evidence of cumulative dose effect . Nonhematologic toxicity has been sporadic . Preliminary results of phase II trials indicate activity against breast, non-small-cell lung, and head and neck tumors . In addition, trimetrexate with simultaneous leucovorin rescue appears to be a promising new treatment for pneumocystis pneumonia in AIDS patients, with minimal toxic side effects.

Neurol Res, 1987 Dec, 9(4), 270 - 4
Stereotactic drainage of brain abscesses; Lunsford LD; Between 1981 and 1986, 16 patients with brain abscesses underwent computed tomography (CT) guided stereotactic aspiration with (n = 5) or without (n = 11), catheter drainage . Infectious sources were found in 11 patients; 6 patients had concomitant immune suppression . Bacterial or mixed toxoplasmic-fungal or toxoplasmic-viral abscesses were diagnosed in 14 patients . After prolonged antimicrobial treatment, follow-up clinical and radiological evaluations confirmed abscess resolution in 12 patients . The abscess size was smaller in four patients, three of whom died 30-60 days after surgery due to overwhelming systemic opportunistic infections . One patient with a tuberculous brain abscess continued to exhibit gradual abscess regression one year after beginning three-drug antituberculous therapy . No surgical mortality occurred but two patients required evacuation of post-operative intracerebral haematomas that resulted from over-vigorous abscess aspiration . CT stereotactic drainage is a safe and effective technique to diagnose and treat brain abscesses and is mandatory for small or deep-seated lesions . Empirical therapy of suspected brain abscesses is rarely warranted in the era of CT stereotactic surgery.

Diagn Microbiol Infect Dis, 1987 Dec, 8(4), 245 - 9
In vitro evaluations of U-76,252 (CS-807): antimicrobial spectrum, beta-lactamase stability, and enzyme inhibition; Jones RN et al.; Compound U-76,252 (Upjohn) is a cephalosporin ester that enhances oral absorption of the active free acid cephem, U-76,253 . The active form structurally resembles parenteral aminothiazolyl-methoxyimino cephalosporins such as cefotaxime and its desacetyl metabolite . The g-negative antimicrobial activity of U-76,253 A (sodium salt of U-76,253) was most similar to that of cefixime and more potent than that of cefaclor or cefuroxime among the orally administered cephalosporins . Against g-positive bacteria, U-76,253 A was more active than cefixime . U-76,253 A was relatively stable to hydrolysis by five beta-lactamases (Type Ia, TEM-1, K1, CARB-2, and OXA-1), a stability most similar to cefotaxime and superior to that of cefaclor . Only the Type Ia (P99) enzyme was significantly inhibited by U-76,253 (IC 50 = 2.0 microM).

J Med Chem, 1987 Dec, 30(12), 2283 - 6
Chiral DNA gyrase inhibitors . 2 . Asymmetric synthesis and biological activity of the enantiomers of 9-fluoro-3-methyl-10-(4-methyl-1-piperazinyl)-7-oxo-2,3-dihydro-7H- pyrido{1,2,3-de}-1,4-benzoxazine-6-carboxylic acid (ofloxacin); Mitscher LA et al.; A short and efficient synthesis, starting with (R)- and (S)-alaninol, of the two optical antipodes of the quinolone antimicrobial agent ofloxacin has been devised . Testing in vitro of the products against a range of bacteria and in an assay system incorporating purified DNA gyrase from different bacterial species demonstrates that the S-(-) enantiomer is substantially the more active.

J Biol Chem, 1987 Nov 5, 262(31), 15004 - 10
Myeloperoxidase-mediated damage to the succinate oxidase system of Escherichia coli . Evidence for selective inactivation of the dehydrogenase component; Rosen H et al.; Myeloperoxidase, a granule-associated enzyme of neutrophils and monocytes, combines with H2O2 and chloride to form a potent microbicidal system that contributes to phagocyte antimicrobial activity . The nature of the lesion or lesions induced by the myeloperoxidase system which are responsible for the loss of microbial replicative activity (viability) remains unknown . Using Escherichia coli grown to late log or stationary phase under conditions of low aeration with succinate as the sole carbon source, we found that myeloperoxidase-induced loss of microbial viability could be correlated with a decrease in succinate-dependent respiration (succinate oxidase activity) . Succinate dehydrogenase activity fell rapidly to undetectable levels during incubation with the myeloperoxidase system, suggesting that damage to the dehydrogenase was a major factor in the loss of oxidase activity . Other components of the succinate oxidase system were resistant to the actions of myeloperoxidase . The ubiquinone-8 and cytochrome components of the respiratory chain remained nearly constant in amount despite reduction of respiration to undetectable levels . However, as expected from the loss of succinate dehydrogenase activity, succinate-ubiquinone reductase and succinate-cytochrome reductase activities were markedly impaired . We propose that the loss of E . coli viability induced by the myeloperoxidase-H2O2-chloride system is due in part to the loss of electron transport function consequent to the oxidation of critical catalytic centers in susceptible dehydrogenases.

J Antibiot (Tokyo), 1987 Nov, 40(11), 1475 - 82
Okilactomycin, a novel antibiotic produced by a Streptomyces species . I . Taxonomy, fermentation, isolation and characterization; Imai H et al.; Okilactomycin, a novel antibiotic, was isolated from the culture filtrate of a strain of actinomycetes . The producing organism, strain YP-02908L, was identified as Streptomyces griseoflavus subsp . zamamiensis subsp . nov . The antibiotic was extracted with ethyl acetate and purified by silica gel column chromatography . It was obtained as colorless prisms from a dichloromethane solution . It exhibited weak antimicrobial activity against Ehrlich ascites carcinoma in vivo . The apparent molecular formula of okilactomycin was determined as C24H32O6 . It is a new member of the lactone group antibiotics.

Tijdschr Diergeneeskd, 1987 Nov 1, 112(21), 1243 - 5
{Waiting periods in the New Netherlands Kidney Test}; Nouws JF et al.; The New Netherlands Kidney Test used in monitoring slaughtered animals for antimicrobial residues will be legalised in the near future . With regard to this new test, minimum pre-slaughter withdrawal periods required to obtain negative results of the test are roughly indicated . The problem of establishing reliable withdrawal periods is briefly discussed.

J Fam Pract, 1987 Nov, 25(5), 497 - 503
Cat-scratch disease; Hainer BL; Cat-scratch disease is a self-limited disease associated with contact with cats that causes regional lymphadenopathy in children and young adults . Recently identification of the probable causative organism, a gram-negative, non-acid-fast coccobacillus, has been achieved through special staining techniques from skin inoculation sites and involved lymph tissue . Differential diagnosis includes a variety of other infectious diseases and neoplasms . Diagnosis of cat-scratch disease can be made by presence of typical clinical findings, history of exposure to cats, results of skin testing to cat-scratch antigen, and in some circumstances, biopsy or fine-needle aspiration from skin inoculation site or involved lymph nodes . Future developments awaiting culture of the suspected bacterium include a vaccine for prevention, rapid diagnostic methods, and antimicrobial testing.

Drug Intell Clin Pharm, 1987 Nov, 21(11), 909 - 14
A clinical pharmacy-oriented drug surveillance network: II . Results of a pilot project; Grasela TH Jr et al.; A nationwide network of clinical pharmacists has been organized for the purpose of collecting drug experience data generated during the routine clinical care of patients . In order to assess the utility of this network a pilot project was performed to obtain a cross-sectional view of antibiotic utilization in the U.S . and to identify potential problems with a more widespread implementation of this program . One hundred eleven pharmacists enrolled in the drug surveillance network participated in this survey and collected information on more than 2000 patients treated with antimicrobial agents over approximately a three-month period (February-April 1987) . The most common sites of infection were the lung, genitourinary tract, skin and soft tissue, and the abdomen, and accounted for approximately 75 percent of infections . Overall, the aminoglycosides, the first-generation cephalosporins, and the aminopenicillins remain the most commonly used antibiotics and represent approximately 50 percent of antimicrobials used in the surveyed population . The results of this pilot project suggest that the use of a nationwide network of clinical pharmacists is a promising source of clinically relevant drug experience data . The ability to concurrently evaluate patients and link information regarding patient demographics, drug therapy regimens, diagnosis, and clinical outcomes fills an important gap in our knowledge of clinical drug utilization.

Am J Gastroenterol, 1987 Nov, 82(11), 1193 - 5
Localized pseudomembranous colitis simulating carcinoma of the cecum; Arber N et al.; A 76-yr-old woman complained of right lower quadrant abdominal pain, nausea, and fever . There was no history of antibiotic therapy or preceding diarrhea . At laparotomy, a cecal lesion simulating a tumor was found with an otherwise normal colon . Right hemicolectomy was performed . Pathological examination showed pseudomembranous colitis confined to the cecum . It is suggested that pseudomembranous colitis unrelated to prior exposure to antimicrobial agents can occur without diarrhea, and may be a localized process mimicking colonic carcinoma.

Rev Med Interne, 1987 Nov-Dec, 8(5), 487 - 92
{Biliary excretion of cefotaxime and desacetylcefotaxime}; Jehl F et al.; The biliary excretion of cefotaxime (CTX) and its metabolite desacetylcefotaxime (DSCTX) was measured by HPLC in 9 recently cholecystectomized-patients following the IV injection of 15 mg/kg body weight of CTX . The totality of bile was collected by an original procedure: the inflated balloon of a Fogarty catheter was introduced into the distal branch of a Kehr drain T-tube . Biliary clearance of CTX and DSCTX was measured for 8 h . Cefotaxime peaked at 90 min . after injection at 34.5 +/- 15.3 micrograms/ml; in the 7-8 h sample it was 2.7 +/- 1.7 micrograms/ml . DSCTX peaked at the same time at 49.3 +/- 17.0 micrograms/ml, and was 4.6 +/- 3.2 micrograms/ml at 8 h . The bile/serum ratio of CTX and DSCTX concentration was 1 from the 1st to the 8th hours (range: 1.35 +/- 1.08 to 11.0 +/- 3.1) . The biliary clearance of CTX was 0.190 ml/min . The total amounts of CTX and DSCTX eliminated in bile were respectively 1050 +/- 472.8 micrograms and 1902.7 +/- 804.1 micrograms (0.093 +/- 0.041 p . 100 of the dose and 0.186 +/- 0.077 p . 100 of the dose) . Considering the minimum inhibitory concentration of the pathogens currently encountered in the biliary sepsis, CTX should be a suitable antimicrobial agent for the treatment of biliary infections.

J Nat Prod, 1987 Nov-Dec, 50(6), 1025 - 40
A modern look at folkloric use of anti-infective agents; Mitscher LA et al.; Infectious diseases are of ancient origin, and mankind has a venerable history of use of higher plant extracts for the therapy of such infections . Some such agents survive in use from earlier times--quinine, emetine, and sanguinarine, for example--but the modern use of fermentation-based antibiotics has greatly overshadowed work on agents from other sources . After a brief review of the present status of the field of antibiotics, this review focuses upon the present status of antimicrobial agents from higher plants with particular reference to agents from plants with a folkloric reputation for treatment of infections . In particular, recent work on the tropical genus Erythrina is emphasized . The use of modern microbiological techniques demonstrates that higher plants frequently exhibit significant potency against human bacterial and fungal pathogens, that many genera are involved, that many folkloric uses can be rationalized on this basis, that the active constituents are readily isolated by bioassay-directed techniques, that their chemical structures are types uncommon amongst fermentation-based agents but are familiar to natural product chemists, that their antimicrobial spectra are comparatively narrow but that their potency is often reasonable, that they are comparatively easy to synthesize and the unnatural analogues so produced can possess enhanced therapeutic potential and, thus, it is concluded that such work generates a gratifying number of novel lead structures and that the possibility of finding additional agents for human or agricultural use based upon higher plant agents is realistic.

Diagn Microbiol Infect Dis, 1987 Nov, 8(3), 149 - 55
In vitro susceptibility of Mycobacterium avium complex to antibacterial agents; Davis CE Jr et al.; In vitro agar dilution susceptibility studies were performed utilizing 20 isolates (24 against rifamycin) of Mycobacterium avium complex against several antimicrobial agents not routinely tested in the mycobacteriology laboratory . Thirteen strains were susceptible to gentamicin at 4 micrograms/ml, 20 to amikacin at 8 micrograms/ml, 18 to streptomycin at 8 micrograms/ml, 20 to kanamycin at 8 micrograms/ml, 20 to trimethoprim/sulfamethoxazole at 2 micrograms/ml, 12 to sulfisoxazole at 10 micrograms/ml, 14 to rifabutin at 1 microgram/ml . No activity was found with penicillin G, cephapirin, moxalactam, vancomycin, clindamycin, erythromycin, trimethoprim, or minocycline . This data suggests a potential use of trimethoprim/sulfamethoxazole, sulfisoxazole, amikacin, gentamicin, and kanamycin in the treatment of infections caused by this group of organisms.

Antibiot Med Biotekhnol, 1987 Nov, 32(11), 817 - 9
{Antibiotic properties of cultures of the Streptomyces coelicolor group that suppress the growth of strains of the same species}; Mukasheva TD et al.; Antimicrobial spectrum of 45 cultures of the S . coelicolor group with respect to closely related strains and other streptomycete species was studied . The spectrum of 7 cultures was narrow and they inhibited closely related strains and certain streptomycete species . These cultures produced antibiotic substances of bacteriocin-like nature . The bacteriocin-like substances of the cultures differed in sensitivity to temperature and proteolytic enzymes and capacity for dialysis through cellophane membranes . Biosynthesis of the antibiotic substances increased after exposure to UV light.

J Assoc Off Anal Chem, 1987 Nov-Dec, 70(6), 979 - 80
Colorimetric determination of a polymeric quaternary ammonium antimicrobial preservative in an ophthalmic solution; Good RM Jr et al.; A simple colorimetric method is presented for the determination of Polyquad, a polymeric quaternary ammonium antimicrobial preservative, in an ophthalmic solution . Polyquad and magnesium are coprecipitated by ion pairing with Ponceau S, a highly colored sulfonate dye, at an acidic pH . The sample is centrifuged and the supernate analyzed spectrophotometrically . The concentration of Polyquad is determined by the decrease in dye concentration . Formulation excipients such as disodium edetate, dextran, and hydroxypropylmethylcellulose did not interfere with the quantitation . The method is specific, accurate, precise, and stability-indicating for the quantitation of 10 ppm Polyquad.

Infection, 1987 Nov-Dec, 15(6), 450 - 4
Investigation of the biliary clearances of cefotaxime and desacetylcefotaxime by an original procedure in cholecystectomised patients; Jehl F et al.; The biliary elimination of cefotaxime (CTX) and its metabolite desacetylcefotaxime (DSCTX) were measured by HPLC in nine recently cholecystectomised patients following the i . v . injection of 15 mg/kg body weight of CTX . All of the bile was collected by an original procedure: the inflated balloon of a Fogarty catheter was introduced into the distal branch of a Kehr drain T-tube . Biliary clearance of CTX and DSCTX was measured for 8 h . Cefotaxime peaked at 90 min after injection at 34.5 +/- 15.3 mg/l; in the 7-8 h sample it was 2.7 +/- 1.7 mg/l . DSCTX peaked at the same time at 49.3 +/- 17.0 mg/l, and was 4.6 +/- 3.2 mg/l at 8 h . The bile/serum ratio of CTX and DSCTX concentrations was above 1 from the first to the eighth hours (range: 1.35 +/- 1.08 to 11.0 +/- 3.1) . The biliary clearance of CTX was 0.190 ml/min . The total amounts of CTX and DSCTX eliminated in bile were respectively 1050 +/- 472.8 micrograms and 1902.7 +/- 804.1 micrograms (0.093 +/- 0.041% of the dose and 0.186 +/- 0.077% of the dose) . Considering the minimum inhibitory concentration of the pathogens currently encountered in biliary sepsis, CTX should be a suitable antimicrobial agent for the treatment of biliary infections.

Zh Mikrobiol Epidemiol Immunobiol, 1987 Nov, (11), 84 - 8
{Changes in the antimicrobial potential of the phagocytosing cells of great gerbils in experimental plague}; Isin ZhM et al.; The work deals with the results obtained in the study of the activity of the cytocidal systems of phagocytes in great gerbils under normal conditions and during the plague infectious process . The data have been analyzed in comparison with the corresponding characteristics of phagocytic activity in mice . Changes in the oxygen-dependent metabolism (ODM) of neutrophils and macrophages, responsible for the functioning of their oxygen-dependent cytocidal systems, in plague show features characteristic of the nonspecific systemic postaggression reaction (SPAR) . In Y . pestis-sensitive animals (mice), changes in the ODM activity of phagocytes are manifested as shock of different severity . In great gerbils, these changes present as true SPAR . The degree of the sensitivity of animals to Y . pestis infection is mainly determined by the initial level of the activity of oxygen-sensitive cytocidal systems of neutrophils (determined in the nitro blue tetrazolium spontaneous reduction test) . In great gerbils this level exceeds the corresponding characteristics in mice 2.6- to 8.7-fold.

J Antimicrob Chemother, 1987 Nov, 20 Suppl B, 47 - 56
Cellular uptake and subcellular distribution of roxithromycin and erythromycin in phagocytic cells; Carlier MB et al.; The intracellular accumulation and subcellular distribution of 14C-labelled roxithromycin and erythromycin has been studied in macrophages and polymorphonuclear neutrophils of both human and animal origin . Roxithromycin was consistently and significantly more accumulated than erythromycin, reaching intracellular/extracellular concentration ratios between 14 (in polymorphonuclear neutrophils) and 190 (in alveolar macrophages from smokers) . Uptake was reversible, insensitive to anaerobiosis and to the presence of an aminoglycoside, but inhibited by acid pH . Upon subcellular fractionation by isopycnic centrifugation in sucrose gradients., half the roxithromycin or erythromycin recovered in cell homogenates was found associated with the lysosomes in macrophages, and about one third with azurophil granules in polymorphonuclear leucocytes . Inasmuch as cellular uptake is a necessary, albeit not sufficient, condition for antimicrobials to kill or inhibit the growth of intracellular bacteria the properties of roxithromycin may give it a distinct advantage over other antimicrobial agents.

Am J Optom Physiol Opt, 1987 Nov, 64(11), 824 - 8
Antimicrobial effectiveness of some soft contact lens care systems; Tse LS et al.; A study of the antimicrobial effectiveness of three soft contact lens care systems, In-A-Wink, Oxysept, and Hydrocare revealed that viable microorganisms are less likely to be present in the storage solution of the Hydrocare system than in either the Oxysept or In-A-Wink systems after lenses are removed by patients . The limited antimicrobial activity of sorbic acid in the In-A-Wink neutralizing solution could be attributed to the pH of the formulation . It is recommended that the neutralizing solution be discarded after the lenses are removed from the case, as microorganisms transferred by the hands to the solution in the case could remain viable, thus increasing the risk of eye contamination.

Acta Paediatr Scand, 1987 Nov, 76(6), 944 - 9
A prospective study of respiratory infections in 12-year-old children actively engaged in sports; Osterback L et al.; Data on the incidence of respiratory tract infections, antimicrobial treatment, days with fever and absence from school on account of these infections were studied in children participating in extracurricular sports activities with regular supervised training and competitive events . Swimmers, ice-hockey players and apparatus gymnasts were compared to a control group of children . Their mean age was 12.7 years at the end of the one year study . The children were examined three times during the year . More information was collected by a nurse who contacted the mothers of the children every two months . The girls had contracted more respiratory tract infections than the boys during the study . This difference was only seen regarding common colds, not regarding major bacterial respiratory infections, i.e . otitis media, tonsillitis, sinusitis and pneumonia . Because of this difference the results were analysed separately for the sexes . No differences between the sports and the control groups were seen in any respect regarding respiratory infections . Contrary to general opinion, sports participation does not seem to have a preventive effect on the occurrence of respiratory infections in children.

J Ethnopharmacol, 1987 Nov, 21(2), 139 - 52
Antimicrobial activity of selected plants employed in the Spanish Mediterranean area; Rios JL et al.; Eighty-one plants from the Spanish Mediterranean area employed as antimicrobial agents in folk medicine have been identified . The in vitro antimicrobial activity of chloroform and methanol extracts of the plants were studied using the agar dilution method against six selected microorganisms . Thirty extracts had activity against some of the microorganisms tested . Bioautography showed that the antimicrobial activity is probably due to flavonoids, terpenoids and phenolic acids.

J Antimicrob Chemother, 1987 Nov, 20 Suppl B, 113 - 20
Tissue distribution of roxithromycin; Bergogne-Berezin E; As tissue distribution studies have become increasingly important aspects of the assessment of new antimicrobials, roxithromycin distribution has been evaluated in experimental models and in human tissues and body fluids . High levels were achieved in respiratory tract tissues and fluids and in the male and female genital tract . In most experiments the local concentrations of roxithromycin were as high as that in serum, reaching 4-6 mg/l (or mg/kg) or more . These high levels were generally stable and an equilibrium was reached between central and extra-vascular compartments . These data provide important information which may be clinically relevant.

J Antimicrob Chemother, 1987 Nov, 20(5), 677 - 84
Enzyme-linked immunosorbent assay for the in-vitro detection of sensitivity of Chlamydia trachomatis to antimicrobial drugs; Cevenini R et al.; A new method of testing antimicrobial activity in vitro against Chlamydia trachomatis by enzyme-linked immunosorbent assay (ELISA) was developed by using a monoclonal antibody reacting with the major outer membrane protein of C . trachomatis LGV2 serotype . ELISA was compared with standard iodine stain, with immunofluorescence assay (IFA) and immunoperoxidase assay (IPA) performed with the same monoclonal antibody as in the ELISA . The MICs and MBCs of rifampicin, oxytetracycline, erythromycin, chloramphenicol and cefazolin detected by ELISA were higher than those determined by iodine stain and slightly lower than those determined by IFA and IPA . Since ELISA was at least as informative as the previously described techniques, but more rapid and standardizable and easier to perform, the assay may be useful in measuring the antimicrobial drug susceptibility of C . trachomatis.

Rev Infect Dis, 1987 Nov-Dec, 9(6), 1065 - 78
Health and economic impacts of antimicrobial resistance; Holmberg SD et al.; For comparison of the impacts of infections due to antimicrobial-resistant bacteria with those of infections due to antimicrobial-susceptible strains of the same bacteria, data were evaluated from 175 published and unpublished reports of investigations of nosocomial and community-acquired infections with selected bacteria . The evaluation of outcomes of hospital-acquired infections with resistant organisms was often confounded by risk factors also associated with poor outcomes . Nevertheless, for both nosocomial and community-acquired infections, the mortality, the likelihood of hospitalization, and the length of hospital stay were usually at least twice as great for patients infected with drug-resistant strains as for those infected with drug-susceptible strains of the same bacteria . Poor outcomes could be attributed both to the expected effects of ineffective antimicrobial therapy and to the unexpected occurrence of drug-resistant infections complicated by prior antimicrobial therapy for other medical problems . Although the adverse economic and health effects of drug-resistant bacterial infections can only be roughly quantified, it is concluded that antimicrobial resistance is an important health problem and an economic burden to society.

Pediatr Infect Dis J, 1987 Nov, 6(11), 1040 - 2
Bacterial meningitis presenting with normal cerebrospinal fluid; Polk DB et al.; At a large children's hospital cases of bacterial meningitis with normal initial cerebrospinal fluid determinations other than culture or antigen detection assays were reviewed in an attempt to determine clinical or other laboratory findings accompanying this presentation . During a 5-year period from January, 1980, through December, 1985, 7 of 261 pediatric meningitis patients (2.7%) fulfilled these criteria . Ages ranged from 3 weeks to 18 months . All 7 patients were hospitalized for observation with all but 1 begun on empiric antibiotic therapy . Laboratory parameters such as a complete blood count, sedimentation rate or C-reactive protein did not influence decisions for management . Cerebrospinal fluid antigen detection assays were negative in all but one patient with pneumococcal meningitis . Review of these cases did not reveal unique indicators for bacterial meningitis . The results emphasize that the physician must rely on clinical judgment in initiating empiric antimicrobial therapy once apparently normal cerebrospinal fluid parameters are observed.

Med Clin North Am, 1987 Nov, 71(6), 1155 - 68
Chloramphenicol and tetracyclines; Francke EL et al.; Tetracyclines have a broad range of clinical usefulness because of their broad antimicrobial spectrum of activity . For most routine gram positive and gram negative infections, alternative agents are available, but for Chlamydiae, Rickettsiae, Brucella, and Borrelia they still remain agents of choice . To some extent, gastrointestinal intolerance and inability to use these agents in patients with renal dysfunction have been overcome by the availability of doxycycline . Phototoxicity is a problem with this agent, however . Tetracycline is still useful as a sclerogenic agent for malignant effusions, and demeclocycline often is an agent of choice in therapy of inappropriate antidiuretic hormone secretion.

Med Clin North Am, 1987 Nov, 71(6), 1147 - 54
Erythromycin; Brittain DC; Erythromycin is the only macrolide antibiotic to have gained widespread use in the United States . Introduced in 1952, it rapidly gained a popularity that it enjoys to this day . Numerous other antimicrobial agents have been marketed since that time: Whole new classes of antibiotics, both natural and synthetic, have been discovered, studied, and released for general use . Many of these newer agents boast a broader spectrum of antimicrobial activity, yet erythromycin's place in the clinician's arsenal is unthreatened because erythromycin remains the drug of first choice for a number of pathogens against which the new drugs are inactive . It is one of the safest antibiotics available for use today and when used against susceptible organisms and in indicated clinical situations, its effectiveness is unquestioned.

Med Clin North Am, 1987 Nov, 71(6), 1079 - 91
Antibiotic combinations; Allan JD Jr; Combinations of antimicrobial agents are most often used to provide empiric broad spectrum coverage . Other potential reasons for combination therapy include treatment of polymicrobial infections, to enhance killing or inhibition (synergism), to reduce the potential for developing resistance, and less commonly to allow reduction in the dose of a toxic agent . However, combination regimens are often used unnecessarily and can result in increased side effects, costs, and other undesirable effectsPublication Types:

	Review
	Review, Tutorial

What Is Bioengineering?, What Is Biotechnology?, What Is Bioremediation?, What Is Rhizobia?, What Is Genome?, c, Microbe, c, Microbiology, e, Bacteriology, s, Microbes, r, Microorganism, c, Escherichia coli, n, Staphylococcus aureus, n, Growth media, s, Klebsiella, e, Gram negative, i, Meningococcus, o, Escherichia coli, s, Bactericidal, e, Bacillus, n, S. cerevisiae, a, Proteus, r, Yeasts, c, Campylobacter, e, Haemophilus, n, Gram negative, e, Escherichia coli, a, S. cerevisiae, c, Pseudomonas aeruginosa, e, Vibriosis, a, Escherichia coli, i, Streptococcal

Scientific Publications - Work Done by Microbiology Reader Bioscreen C
Agricultural Microbiology Anaerobic Microbiology Antimicrobial Susceptibility Artificial Atmosphere Bioassay of Antibiotics Biofilm Microbiology Bioreactor Technology Biotechnology Cell Biology Clinical Microbiology Environmental Microbiology Experiments with Yeast	Fermentation Food Microbiology Functional Genomics Gene Technology Growth Media Development Growth Rate and Lag Time Industrial Microbiology Medical/Pharmaceutical Field Microbiological Assay Microbiological Research Microbiology of Cosmetics go to a specific theme...	Military Microbiology Molecular Microbiology Mutagenicity and Genotoxicity Oral Microbiology Patents Postantibiotic Studies Soil Microbiology Spore Microbiology Veterinary Microbiology Waste/Wastewater Treatment Water Microbiology Wine Microbiology

� 2005 Transgalactic Ltd (manufacturer of Bioscreen C software) | Privacy Statement | P.O. Box 1393, 00101 Helsinki, Finland, phone: +358 9 85172920, fax: +358 9 8749481, e-mail: microbiology@bionewsonline.com

Last modified: May 25, 2005