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 strai