Med Clin North Am, 1987 Nov, 71(6), 1051 - 64 General concepts on the chemotherapy of infectious diseases; Neu HC; Chemotherapy affects both the host and the microorganism . Antimicrobial agents have a profoundly adverse influence on the surrounding environment if they are improperly employed . In all chemotherapy, it is critical to know what the infecting organisms are, and if that information is not immediately available, to base chemotherapy on those organisms that characteristically produce the infection . It also is critical to have an understanding of the distribution of antibiotic-resistant microorganisms in one's community if the proper antimicrobial agent is to be selected . The host's status and site of the infection will impact upon the choice of drug . Infection in sites in which phagocytic function is poor, such as in heart valves or in the spinal fluid, or in individuals lacking complement, white blood cells, or immunoglobulins, must be treated with bactericidal agents . An understanding of the pathogenesis of infection caused by different microorganisms will provide insights into the type of therapy, duration, and amount of drug that must be used . Ultimately, the chemotherapy of infection should be based on integration of the activity of antimicrobial agents with their pharmacologic properties. J Clin Periodontol, 1987 Nov, 14(10), 573 - 80 Periodic subgingival antimicrobial irrigation of periodontal pockets . II . Microbiological and radiographical observations; Wennstrom JL et al.; The purpose of this study was to evaluate the microbiological effects of repeated subgingival irrigation of deep periodontal pockets as a single measure of treatment as well as combined with mechanical debridement, and to study the concomitant radiographical changes of the alveolar bone . 2-3 interproximal sites per jaw quadrant in 10 patients showing a probing depth of greater than or equal to 6 mm and bleeding on pocket probing were selected for the study . The pockets in the various quadrants were randomly assigned to professionally performed subgingival irrigation with 0.2% chlorhexidine gluconate, 3% hydrogen peroxide or saline or to non-irrigation . During a first phase of treatment, the pockets were periodically irrigated (every 2nd-3rd day during weeks 1-2 and 5-6) and no subgingival mechanical debridement was performed . During a second phase, subgingival scaling and root planning were carried out with adjunctive subgingival irrigation of the pockets . During the entire trial, the patients' plaque control was carefully supervised . Sampling of the subgingival microflora was performed before and after the first and second treatment phases and 3 months after the termination of the active treatment . Dark-field assessment and cultivation of the bacterial samples were performed . The radiographical examination was carried out at the start of each treatment phase and 3 months after the termination of phase II and the radiographs were analysed by the use of a subtraction technique . The results demonstrated that periodic subgingival antimicrobial irrigation per se had only limited and transient effects on the subgingival microflora.(ABSTRACT TRUNCATED AT 250 WORDS) HNO, 1987 Nov, 35(11), 475 - 7 {Current significance of Gram's stain in the treatment of ENT infections in the clinic and general practice}; Feidt H et al.; The aim of our investigations was to evaluate the current importance of Gram's stain in ENT infections . This long established easy microbiological method was compared with culture and sensitivity tests . For this purpose 549 Gram's stains were performed on 384 patients . In 88.8% of the cases Gram's stains gave reliable information in a few minutes so that a correct and effective antimicrobial treatment could be started . In 5.7% no pathogen could be found using a Gram's stain, probably because the concentration was too low (10(5)/ml) whereas a pathogen could be cultured in these cases . However culture revealed microbiological information in 11.5% of the cases that was unreliable or even misleading in deciding treatment . In conclusion, Gram's stain is a very cheap, quick and easy method which has been forgotten by many clinicians but which is sufficient as the only microbiological method in uncomplicated ENT infections and is of great importance for a correct interpretation of the results of culture in severe infections . In life-threatening cases it may even be of a crucial value. Emerg Med Clin North Am, 1987 Nov, 5(4), 807 - 26 The patient with suspected meningitis; Keroack MA; When meningitis presents acutely, therapy should be instituted within 1 hour, based on the patient's age and risk factors . When the presentation is subacute, clinical assessment, with analysis of the cerebrospinal fluid, allows the physician to decide among empiric antimicrobial therapy, observation, or further diagnostic studies. Antibiot Med Biotekhnol, 1987 Nov, 32(11), 841 - 3 {Use of different nutrient medium variants in determining the antimicrobial activity of neomycin}; Ermolova OB et al.; Gel diffusion regularities with respect to neomycin sulfate substances differing in their composition and the antibiotic separate components were studied on nutrient media of diverse composition . Optimal conditions for standardization of neomycin sulfate antimicrobial activity with using the agar diffusion method and synthetic medium are determined. Antimicrob Agents Chemother, 1987 Nov, 31(11), 1697 - 702 Determination of in vitro susceptibility of Mycobacterium avium complex isolates to antimycobacterial agents by various methods; Inderlied CB et al.; Various methods were used to determine the in vitro susceptibility of Mycobacterium avium complex strains isolated from patients with acquired immunodeficiency syndrome . Our results confirm the noted resistance of the M . avium complex to conventional antituberculosis agents . The procedures used were both agar dilution and broth dilution, including a commercially available radiometric system (BACTEC; Johnston Laboratories, Towson, Md.) . In general, all strains were more resistant by an agar dilution procedure than by a broth dilution procedure . Radiometric data were analyzed by defining a value, termed T100, which provides a discrete MIC . The broth (radiometric) procedure is reproducible and convenient for screening antimicrobial agents for in vitro activity and assessing potential therapeutic efficacy . Nevertheless, there is no standard procedure for determining the in vitro susceptibility of the M . avium complex, and appropriate clinical correlation studies are needed to accurately assess the clinical relevance of any in vitro result. J Anim Sci, 1987 Nov, 65(5), 1243 - 8 Effect of neomycin, carbadox and length of adaptation to calorimeter on performance, fasting metabolism and gastrointestinal tract of young pigs; Yen JT et al.; Five sets of littermate gilts (8.2 +/- .19 kg average initial weight) were randomly assigned within litter to a 16% protein corn-soybean meal basal diet (B), B + .308% neomycin, or B + 55 ppm carbadox . Each set was equally-fed individually once daily for 16 d in metabolism cages and 5 d in calorimeters . The average daily feed intake for 21 d was 276 g . Oxygen consumption and CO2 production were measured during an 8- to 24-h postprandial period on d 16, 19, 20 and 21, and during a 32- to 48-h postprandial period after the d 21 feeding . Pigs were killed 50 h postprandially for gastrointestinal tract measurements . Dietary supplementation of antimicrobial agents (neomycin and carbadox) resulted in improvements (P less than .01) in daily gain and efficiency of feed utilization and lower (P less than .05) small intestinal mass in pigs . There was no difference (P greater than .05) in daily gain, feed efficiency or small intestinal mass between pigs fed neomycin- or carbadox-supplemented diets . Whole-animal fasting O2 consumption and CO2 production measured during the 8- to 24-h or 32- to 48-h postprandial period were not affected (P greater than .05) by the supplementation or the source of dietary antimicrobial agents . There were no differences (P greater than .05) in 8- to 24-h fasting O2 and CO2 measurements determined on d 16, 19, 20 and 21, indicating that adaptation to calorimeters was not needed by the pigs.(ABSTRACT TRUNCATED AT 250 WORDS) J Hosp Infect, 1987 Nov, 10(3), 305 - 7 The antimicrobial activity of protamine and polybrene; Mulholland B et al.; Polybrene and protamine have broad antimicrobial activity and may be useful as topical agents. J Leukoc Biol, 1987 Nov, 42(5), 463 - 73 Murine glia cells in culture can be stimulated to generate reactive oxygen; Sonderer B et al.; Induction of luminol-enhanced chemiluminescence (CL) indicative of reactive oxygen formation was studied in glia cell cultures from newborn mice . A burst of CL could be induced by phorbol myristate acetate, zymosan, and antibody-coated bovine red blood cells, whereas Sendai virus and several other agents known to induce CL in myeloid cells were ineffective . Sodium azide failed to inhibit CL, indicating a myeloperoxidase-independent mechanism of light emission . In parallel experiments we identified the cells binding antibody-coated erythrocytes as macrophages characterized by the reduction of nitroblue tetrazolium and phagocytosis of zymosan and latex particles . Brain macrophages may use reactive oxygen intermediates (ROI) as a mechanism of antimicrobial defence; and, on the other hand, ROI formed by these cells may contribute to immuno-pathology in the brain. J Leukoc Biol, 1987 Nov, 42(5), 447 - 54 Activation of rat alveolar macrophages by gamma interferon to inhibit Toxoplasma gondii in vitro; Badger AM et al.; We have investigated the effects of murine interferons on the ability of rat alveolar macrophages (AM) to inhibit the proliferation of the intracellular protozoan Toxoplasma gondii . This activity was determined by measuring suppression of 3H-uracil uptake into the Toxoplasma and by microscopic enumeration of the intracellular organisms . Recombinant gamma interferon (rMulFN-gamma), but not alpha/beta interferon (IFN-alpha/beta) was able to activate AM for antimicrobial activity in vitro . Maximum activation was achieved by incubation with 50-200 units/ml rMulFN-gamma and the activity was lost at one unit/ml . The highest levels of activation were obtained when macrophages were incubated with interferon for 48-72 h prior to the challenge with Toxoplasma organisms . Activation could still be obtained, however, when the interferon was added to the cultures as late as 2 h after the phagocytosis of Toxoplasma . Neither MDP nor low concentrations (1-1-ng/ml) of S . typhosa lipopolysaccharide (LPS) were able to activate these cells to inhibit the growth of Toxoplasma . Phagocytosis of Toxoplasma by AM did not result in the release of O2-, in fact the spontaneous release of O2- by these cells was inhibited by Toxoplasma . This inhibition was reversed by preincubation of the cells with rMulFN-gamma. J Appl Bacteriol, 1987 Nov, 63(5), 401 - 7 The effect of incubation time and temperature on growth of Escherichia coli on gradient plates containing sodium chloride and sodium nitrite; McClure PJ et al.; Two-dimensional gradient plates are a convenient way of screening antimicrobial effects of preservative factors acting in combination across a broad range of physical and chemical conditions . We report the effects of sodium chloride, sodium nitrite and incubation temperature on the growth of Escherichia coli by staining, laser densitometry and computer graphics . Staining not only more easily distinguished the growth area but also gave an indication of the viability of cells present . 2-(p-iodophenyl)-3(p-nitrophenyl)-5-phenyl tetrazolium chloride was the more useful of the two stains used . Inhibitory concentrations of sodium chloride decreased with reduced incubation temperature . The response of E . coli to combinations of salt and nitrite on gradient plates was very similar to its response in liquid medium. Vet Rec, 1987 Oct 31, 121(18), 416 - 9 Swine dysentery control in the German Democratic Republic and the suitability of injections of tiamulin for the programme; Blaha T et al.; In 1977 swine dysentery was made a notifiable disease in the German Democratic Republic, with the intention of eradicating it by the systematic treatment of clinically affected herds using intensive medication and hygiene control programmes . On individual farms the scheme appeared to be successful, but the national incidence of the disease did not decline, owing to the continuous presence of latently infected herds and the movement of carrier pigs to uninfected farms . In 1981 the scheme was re-appraised and a new scheme was introduced in one region where all the breeding herds were screened for the presence of Treponema hyodysenteriae; all positive herds were treated with either metronidazole or tylosin, and the movement of pigs into the region was controlled . This programme effectively eradicated the disease from the region and is being introduced to the rest of the country . Owing to concern about the safety of metronidazole and the development of resistance to tylosin, alternative antimicrobials were examined and tiamulin was selected to assess its suitability for inclusion in the programme . A 560 sow breeding herd and progeny were treated for five days with tiamulin at 10 mg/kg bodyweight . This was coupled with extensive cleaning, disinfection and rodent control programmes . The results of the trial showed that the clinical disease stopped in two days and that no further clinical signs were seen in the subsequent two-and-a-half years . Bacterial monitoring of faeces samples and colonic scrapings from dead pigs failed to identify viable T hyodysenteriae . There was a significant increase of 0.6 piglets weaned per litter and improvements in weaning weights and growth rates . It was concluded that tiamulin was suitable for inclusion in the swine dysentery eradication programme in the GDR. Schweiz Med Wochenschr, 1987 Oct 24, 117(43), 1661 - 5 {Current perspectives in the treatment of infectious endocarditis of a natural heart valve}; Delaye J et al.; In view of the severity of infective endocarditis, which is due to local and general infectious processes and the hemodynamic consequences of valvular destruction, a policy of earlier valve replacement has been adopted . Clinical, bacteriologic and pathologic data collected over two years suggest that early surgery can be recommended in the following cases: congestive heart failure, inadequate results of antimicrobial therapy, and multiple emboli . Further studies should validate this policy, but the necessity of general prophylaxis for infective endocarditis must always be borne in mind. Tijdschr Diergeneeskd, 1987 Oct 15, 112(20), 1172 - 6 {Lethal effects of various antimicrobial agents and clinically usable alternatives in rabbits and rodents}; Lumeij JT et al.; The lethal effects of antibiotics which may be observed in rabbits and some rodent species are reviewed . A selection of antibiotics and chemotherapeutic agents and their respective dosages are referred to, which may be used therapeutically in these animals . Suggestions are made for the treatment of enterocolitis induced by antibiotics in rabbits. FEBS Lett, 1987 Oct 5, 222(2), 251 - 5 {4,4'-(Z)-dehydrophenylalanine}gramicidin S with stabilized bioactive conformation and strong antimicrobial activity; Shimohigashi Y et al.; Dehydrophenylalanine (delta Phe) was incorporated into an antibiotic peptide gramicidin S (GS) in place of D-Phe4,4' to prepare an unsaturated analog . Conformational analysis with 1H-NMR indicated that the unsaturated analog has much the same backbone conformation as that of natural gramicidin S as shown by NOE experiments . Studies on temperature dependences and on the chemical shift differences showed that the hydrogen bonds between Val-NH and Leu-CO in the unsaturated analog are strengthened by the incorporation of delta Phe4,4' . This resulted in the reinforcement of the beta-sheet structure which is the most important structural element for GS bioactivity . {delta Phe4,4'}gramicidin S exhibited indeed very strong antimicrobial activities against Gram-positive bacteria as well as the natural peptide. Pediatr Infect Dis J, 1987 Oct, 6(10), 907 - 11 Chronic recurrent multifocal osteomyelitis: a noninfectious inflammatory process; King SM et al.; We report seven patients with chronic recurrent multifocal osteomyelitis, an uncommon childhood disease of unknown etiology . These patients presented with insidious onset of bone pain at one or more sites associated with erythema, swelling and tenderness . Scintigraphy and radiography were consistent with osteomyelitis at multiple sites . Bone biopsies confirmed osteomyelitis but no organisms were consistently isolated . During a 1- to 3-year follow-up, most patients developed new symptomatic lesions . The disease was unaffected by antimicrobial therapy . Two of our patients had psoriasis and all were rheumatoid factor-, antinuclear factor- and HLA-B27-negative . We speculate that chronic recurrent osteomyelitis is a noninfectious inflammatory condition, a seronegative spondyloarthropathy . Chronic recurrent osteomyelitis is a clinical entity that should be recognized so that invasive diagnostic procedures and antimicrobial therapy are appropriately used . The patient may be reassured that this is not a malignant condition although there may be exacerbations over many years. Mycopathologia, 1987 Oct, 100(1), 3 - 5 Mycotoxins, mycotoxicoses, mycotoxicology and Mycopathologia; Bennett JW; Mycotoxins are fungal poisons . This definition does not stipulate whether fungi are the targets of poisoning or are the producers of the poisons . The following is suggested as a useful working definition: Mycotoxins are natural products produced by fungi that evoke a toxic response when introduced in low concentration to higher vertebrates and other animals by a natural route . Some mycotoxins have multiple effects, and may cause phytotoxic and antimicrobial syndromes in addition to animal toxicity . By convention, mushroom and yeast poisons are usually excluded from discussions of mycotoxins . The eclectic nature of the discipline and the international scope of the problem has attracted scientists from many different backgrounds . The publishers and editors of Mycopathologia intend for this journal to become a major forum for mycotoxin research. J Am Vet Med Assoc, 1987 Oct 1, 191(7), 847 - 8 Conservative treatment of a minimally displaced fracture of the radius of a horse; Martin BB et al.; The successful conservative treatment of an open, displaced fracture of the radius of a horse suggests that conservative treatment should not be ignored when surgery is not an option . The importance of proper soft-tissue management and the use of broad-spectrum antimicrobial treatment in the management of orthopedic injuries is emphasized. J Anim Sci, 1987 Oct, 65(4), 1064 - 76 In vitro lactic acid inhibition and alterations in volatile fatty acid production by antimicrobial feed additives; Nagaraja TG et al.; Batch culture fermentations were used to determine the effects of avoparcin, lasalocid, monensin, narasin, salinomycin, thiopeptin, tylosin, virginiamycin, monensin + tylosin combination, and two new ionophore compounds (RO22-6924/004 and RO21-6447/009) on lactic acid and volatile fatty acid (VFA) production . Ruminal fluid from cattle fed a high alfalfa hay diet was incubated with glucose for 12 h in a buffered medium to determine the effect of antimicrobial compounds on lactic acid concentration . Fermentations treated with antimicrobial compounds had higher final pH and lower L(+) lactic acid concentration . Narasin and salinomycin were more inhibitory than other ionophore compounds . Monensin and tylosin in combination was more effective than monensin alone . Among the nonionophore compounds, avoparcin was the least effective and thiopeptin, tylosin and virginiamycin were extremely effective in reducing lactic acid concentration . Ruminal fluid from cattle fed a diet of alfalfa hay and grain (50:50) was incubated with a mixture of sugars, casein and urea for 12 h in a buffered medium to determine the effect of antimicrobial compounds on VFA production . Generally, total VFA concentration was not affected by antimicrobial compounds except RO22-6924/004, tylosin and virginiamycin, which caused a reduction at high concentrations . Tylosin, monensin and tylosin mixture, thiopeptin and virginiamycin at high concentrations (greater than 6.0 micrograms/ml) increased the acetate proportion . All compounds increased the molar proportion of propionate . Tylosin and virginiamycin at high concentrations (greater than 6.0 micrograms/ml) decreased the proportion of propionate . Monensin and tylosin in combination had no effect on propionate proportion . Among the compounds tested, narasin and salinomycin were the most effective in enhancing propionate proportion . Ionophore compounds were more inhibitory to butyrate production than the nonionophore compounds . Batch culture fermentations may be used to quantitate the relative efficacy of antimicrobial compounds to alter ruminal fermentation characteristics. J Anim Sci, 1987 Oct, 65(4), 1013 - 8 Effects of a dietary antimicrobial (carbadox) on liver cholesterol 7 alpha-hydroxylase activity and bile acid patterns in the young pig; Tracy JD et al.; Two experiments were conducted to investigate the effects of the antimicrobial carbadox (CX) on bile acid metabolism in the young pig . The pigs were fed a fortified, 19.5% crude protein, corn-soybean meal diet without or with 55 ppm CX . In Exp . I pigs were fed the diets for 28 d, then the level of activity of hepatic cholesterol 7 alpha-hydroxylase (CH-7 alpha), the rate-limiting enzyme of bile acid metabolism, was measured . The CX-fed pigs gained faster (P less than .05) and more efficiently (P less than .05) and had lower (P less than .02) CH-7 alpha activity than the control pigs . In Exp . II, pigs ranging in weight from 12 to 15 kg were fitted with indwelling catheters in the hepatic portal (HP) and anterior vena cava (VC) veins . Radiolabeled chenodeoxycholic acid (CDC) was infused into the HP and blood samples from both veins were taken at meal time and hourly for 6 h following six meals over 3 d . Bile was collected 14 d after infusion . Concentrations of lithocholic acid (LC) in the bile and hyodeoxycholic acid (HDC) in the plasma were reduced by dietary CX . Dietary CX did not significantly affect metabolism of plasma CDC or hyocholic acid (HC) as measured by radioactivity . Meal time (0800 vs 1600) affected (P less than .05) plasma CDC radioactivity at all times and the level of HDC radioactivity 2 h post-prandial . There was a meal time X dietary treatment interaction (P less than .02) on plasma HC radioactivity 2 h post-prandial . These data suggest that dietary CX inhibited intestinal microbial degradation of CDC and HC. Arch Dermatol, 1987 Oct, 123(10), 1346 - 50 Subcutaneous phaeohyphomycosis caused by Exserohilum rostratum in an immunocompetent host; Burges GE et al.; A healthy, 55-year-old woman developed a subcutaneous abscess and systemic symptoms of nausea, dizziness, and chills following minor trauma to her leg . Histopathologic examination of a skin biopsy specimen revealed golden-brown colored mycelial elements, and culture resulted in growth of a dematiaceous fungus identified as Exserohilum rostratum . Surgical excision of the abscess and concomitant oral therapy with ketoconazole resulted in resolution of symptoms . In previously reported cases of human phaeohyphomycosis caused by Exserohilum and related Bipolaris species in both immunocompromised and immunocompetent hosts, treatment has varied from topical antimicrobial therapy to combined surgery and intravenous antifungal chemotherapy . Our experience leads us to believe that surgical debridement of an accessible focus of infection along with orally administered ketoconazole may provide adequate therapy in an immunocompetent host. J Med Chem, 1987 Oct, 30(10), 1918 - 28 Streptonigrin and lavendamycin partial structures . Probes for the minimum, potent pharmacophore of streptonigrin, lavendamycin, and synthetic quinoline-5,8-diones; Boger DL et al.; The preparation and evaluation of 7-amino-5,8-dioxo-2-(2'-pyridyl)quinoline-6'-carboxylic acid (5a) and 7-amino-2-(2'-aminophenyl)-5,8-dioxoquinoline-5'-carboxylic acid (6a) constituting potential minimum, potent pharmacophores of streptonigrin (1a) and lavendamycin (2a), two structurally related naturally occurring antitumor antibiotics, are detailed . In contrast to observations associated with streptonigrin and lavendamycin in which the C-ring C-6' carboxylic acid potentiates the antitumor, antimicrobial, and cytotoxic properties of the naturally occurring, substituted 7-aminoquinoline-5,8-dione AB ring systems, the C-6'/C-5' carboxylic acid of 5a/6a diminishes the observed antimicrobial and cytotoxic properties of the 2-(2'-pyridyl)- and 2-(2'-aminophenyl)-7-aminoquinoline-5,8-diones . A direct comparison of the antimicrobial and cytotoxic properties of a complete set of streptonigrin and lavendamycin partial structures is detailed in efforts to define the role peripheral substituents play in potentiating the biological properties of the naturally occurring and synthetic agents bearing the 7-aminoquinoline-5,8-dione AB ring system and in efforts to define the minimum, potent pharmacophore of the naturally occurring antitumor antibiotics . The relationship of these observations to a chemical mechanism of cellular toxicity is discussed. Infect Immun, 1987 Oct, 55(10), 2420 - 7 Nonoxidative antimicrobial effects of human polymorphonuclear leukocyte granule proteins on Chlamydia spp . in vitro; Register KB et al.; Proteins from isolated granules of human polymorphonuclear leukocytes were assessed for their nonoxidative microbicidal effect on chlamydiae by two different methods: a radioisotope assay for elementary body integrity and a biological assay for inclusion development . Crude granule extract, which consisted of a mixture of all granule proteins, caused a 20 to 30% decrease in infectivity and a 52% decrease in infectivity when incubated with Chlamydia psittaci CAL-10 and Chlamydia trachomatis serovar E, respectively . To define more specifically the components that were damaging to chlamydiae, crude granule extract was subjected to Sephadex G-75 column chromatography and isolated granule fractions were obtained . Only fractions containing lysozyme as the major component consistently caused reductions in infectivity of C . trachomatis elementary bodies . In contrast, fractions collected after the lysozyme fraction, containing proteins with molecular masses of 13,000 daltons or less, had detrimental effects on C . psittaci infectivity . Additional experiments using highly purified human polymorphonuclear leukocyte lysozyme confirmed its infectivity-reducing action upon C . trachomatis but not upon C . psittaci. J Vet Intern Med, 1987 Oct-Dec, 1(4), 175 - 82 Therapy of suspected septicemia in neonatal foals using plasma-containing antibodies to core lipopolysaccharide (LPS); Morris DD et al.; Equine antiserum to core lipopolysaccharide (LPS) was evaluated in a double-blind prospective study for therapeutic benefit in suspected septicemia in neonatal foals . Forty foals younger than 7 days of age were included in the study by satisfaction of clinical and laboratory criteria, suggestive of gram-negative septicemia . Twenty-two foals were treated with core LPS antiserum (plasma produced from horses which were hyperimmunized with rough gram-negative mutant bacterin) and 18 foals received "nonimmune" plasma (from horses prior to immunization against core LPS) . All foals received antimicrobials, fluids, and other supportive care measures, depending on clinical signs and according to accepted current practice . The clinical and laboratory data of each foal were monitored and recorded daily for 14 days after plasma treatment or until death . The overall survival rate of these 40 foals with septicemia was 52.5% . The most prevalent diagnoses in addition to septicemia were enteritis and pneumonia . Of 30 positive bacterial cultures, 93% were due to gram-negative organisms . There was no statistically significant increase in survival rate in the 22 foals given core LPS antiserum (P greater than 0.05). Antimicrob Agents Chemother, 1987 Oct, 31(10), 1579 - 84 Broth microdilution testing of susceptibilities to 30 antimicrobial agents of Mycobacterium avium strains from patients with acquired immune deficiency syndrome; Yajko DM et al.; A total of 31 strains of Mycobacterium avium complex isolated from patients with acquired immune deficiency syndrome were tested for susceptibility to 30 antimicrobial agents by using microdilution trays containing dried antimicrobial agents . MICs were determined over a period of 7 days of growth in a broth medium (7HSF) that is equivalent to 7H11 agar . MICs obtained by this method showed good agreement with MICs determined by the agar dilution method . Strains could be divided into two groups by their antimicrobial susceptibility patterns . All group 1 strains (8 of the 31 strains tested) were at least moderately susceptible to inhibition by a variety of beta-lactam antimicrobial agents, including amoxicillin-clavulanic acid and cefmenoxime . Group 2 strains (23 of 31) were susceptible only to amikacin (22 of 23 strains) . All 31 strains were resistant to oxacillin, clindamycin, erythromycin, tetracycline, chloramphenicol, vancomycin, nitrofurantoin, and aztreonam at the highest concentration of antimicrobial agent present in the microdilution trays . The addition of Tween 80 to 7HSF broth increased the susceptibility of M . avium complex to many of the antimicrobial agents tested . Killing of M . avium complex (i.e., less than or equal to 1% survival after 7 days) was found to vary for different strains and antimicrobial agents . Killing of some strains by amoxicillin-clavulanic acid, carbenicillin, azlocillin, cefmenoxime, cefotaxime, amikacin, and ampicillin occurred at concentrations of antimicrobial agent that are achievable in serum . Further studies are needed to determine whether any of these antimicrobial agents has activity against M . avium complex cells that have been ingested by macrophages. Am J Med, 1987 Oct, 83(4), 653 - 60 Osteomyelitis in the feet of diabetic patients . Long-term results, prognostic factors, and the role of antimicrobial and surgical therapy; Bamberger DM et al.; Fifty-one diabetic patients with osteomyelitis of the foot were studied to determine potential prognostic factors and the role of antimicrobial therapy . Most of the patients were elderly, with diminished pulses, a sensory neuropathy, and a polymicrobial infection . Twenty-seven patients had a good outcome, defined as clinical resolution at the time of the last follow-up examination, without the need for amputation . The mean duration of follow-up for these patients was 19 months . Fifteen patients had a below-knee amputation, and nine had a toe amputation . The absence of necrosis and/or gangrene, the presence of swelling, and the use of antimicrobial therapy active against the isolated pathogens for at least four weeks intravenously, or combined intravenously and orally for 10 weeks, predicted a good outcome . Diabetic foot osteomyelitis, in the absence of extensive necrosis or gangrene, usually responds to antimicrobial therapy without the need for an ablative surgical procedure. Am J Optom Physiol Opt, 1987 Oct, 64(10), 739 - 48 Surface interactions on hydrogel extended wear contact lenses: microflora and microfauna; Hart DE et al.; The microbial flora and fauna of 25 high water content nonionic "soft" contact lenses worn by patients on an extended wear basis, 4 hand-cleaned patient-worn lenses, and 4 improperly maintained lenses were compared . Almost all the patient-worn lenses (24 of 25) were free of viable microorganisms, whereas all the hand-cleaned lenses (4 of 4) were contaminated with different microorganisms . This study showed that hand contact is a major source of microbial contamination of a lens and that usually the hand-transported microorganisms do not survive permanently on the lens in a healthy, normal eye . Improperly maintained lenses demonstrated pathogenic microbial associations . Proof of the eye's potent antimicrobial environment was demonstrated . Thus, microorganism-lens associations are largely due to lens handling and inappropriate maintenance regimens . Typically there are few microorganisms on an extended wear soft lens while it is being worn. J Clin Periodontol, 1987 Oct, 14(9), 541 - 50 Periodic subgingival antimicrobial irrigation of periodontal pockets (I) . Clinical observations; Wennstrom JL et al.; The present investigation was undertaken to study the clinical effect of professionally performed periodic subgingival irrigation per se and as an adjunct to scaling and root planing . 10 patients suffering from moderate-severe periodontal disease participated in the study . Following an initial 3-month period of supervised supragingival plaque control, a total of 102 periodontal sites with probing pocket depth greater than or equal to 6 mm and "bleeding on probing" were selected and subjected to a Baseline examination comprising assessments of oral hygiene and gingival conditions, probing depths and probing attachment levels . The pockets in the various jaw quadrants were randomly assigned to one of the following treatment groups: (1) periodic subgingival irrigation with hydrogen peroxide, (2) periodic subgingival irrigation with chlorhexidine, (3) periodic subgingival irrigation with saline and (4) no subgingival treatment . During the first part of the study (baseline-32 weeks), no mechanical debridement of the subgingival area was performed . The irrigation treatment was carried out by the operator 3 times per week during weeks 1 + 2 and 5 + 6 of the trial . In the 2nd part of the trial (32-52 weeks), the sites were subjected to scaling and root planing combined with professional irrigation during weeks 32-38 . The previously non-irrigated control sites were not subjected to adjunctive irrigation when mechanically debrided . During the entire study, the patients were recalled for professional tooth cleaning once every 4 weeks . Re-examinations were carried out at 4, 6, 32, 40 and 52 weeks . The results revealed that repeated professional irrigation of unscaled periodontal pockets with chlorhexidine or hydrogen peroxide resulted in a temporarily reduced frequency of bleeding sites, but not in any clinically significant changes in probing assessments . A similar improvement of bleeding scores was observed in the saline-irrigated control group . Scaling and root planing, in combination with an optimal supragingival plaque control, resulted in a marked resolution of the clinical symptoms of periodontal disease . Adjunctive irrigation with chlorhexidine or hydrogen peroxide did not improve the healing result above and beyond that obtained after mechanical debridement alone or in combination with saline irrigation . Hence, the study failed to demonstrate that professionally performed periodic subgingival irrigation with chlorhexidine or hydrogen peroxide, used alone or in combination with thorough mechanical debridement, has a significant therapeutic effect. Trop Geogr Med, 1987 Oct, 39(4), 345 - 9 Negative cultures of cerebrospinal fluid in partially treated bacterial meningitis; Kilpatrick ME et al.; Admission cerebrospinal fluid and serum were examined for antimicrobial activity in 296 Egyptian patients hospitalized with signs of meningitis . Assays were positive in 92%; 60% had large levels of antimicrobial activity in cerebrospinal fluid . Bacterial meningitis was diagnosed in 102 patients . The negative cerebrospinal fluid cultures in 58 of these patients were in part due to the antimicrobial activity in the cerebrospinal fluid . Mortality in patients with bacterial meningitis was greatest when cultures were positive and moderate levels of antimicrobial activity were present in the cerebrospinal fluid . Survival in these patients appeared to be enhanced if their prehospitalization antimicrobial use suppressed bacterial growth in the cerebrospinal fluid. Jpn J Antibiot, 1987 Oct, 40(10), 1787 - 93 {Flomoxef treatment of patients with respiratory tract infections}; Takagi K et al.; Flomoxef (FMOX, 6315-S) was administered to 22 patients with respiratory tract infections . The patients consisted of 13 patients with pneumonia, 7 with bronchitis, 1 with bronchiectasis and 1 with pyothorax . The drug was administered by intravenous injection or intravenous drip infusion twice a day with doses of 1 to 2 g and total doses ranged from 17 to 64 g . The following results were obtained . 1 . Clinical responses to the therapy were excellent in 1 case, good in 10 cases, fair in 4 cases, poor in 4 cases and not determined in 3 cases . Efficacy ratio was 57.9% . 2 . As for adverse reactions, exanthema in 1 patient and stomatitis and numbness of tongue in another patient were observed, but these symptoms improved with cessation of the therapy . Abnormal laboratory test values were observed in 5 cases . From these results it appears that FMOX is a valuable antimicrobial agent against patients with respiratory tract infections. Farmaco {Sci}, 1987 Oct, 42(10), 735 - 45 Piperazin-2,5-diones N,N'-substituted . III . Synthesis and pharmacological activities of some 1-aryl-4-arylidene (or heteroarylidene)aminopiperazin-2,5-dione derivatives; Previtera T et al.; The synthesis, antimicrobial and antitumor activities of new N,N'-substituted-2,5-dioxopiperazine derivatives are reported . The biological investigation showed that only the compounds containing the 5-nitrofurylidene moiety were active against some bacteria . All tested compounds showed no significant antitumor activity against lymphocytic murine leukemia P 388. Antimicrob Agents Chemother, 1987 Oct, 31(10), 1529 - 34 Effect of quinolones and other antimicrobial agents on cell-associated Legionella pneumophila; Havlichek D et al.; We evaluated the in vitro susceptibility of Legionella pneumophila ATCC 33152 (serogroup I) to 13 antibiotics alone and in combination with rifampin (0.1 mg/liter) by three methods . Extracellular susceptibility was determined by MIC determinations and time kill curves in buffered yeast extract broth, while intracellular susceptibility was determined by peripheral human monocytes in RPMI 1640 culture medium . Antibiotic concentrations equal to or greater than the broth dilution MIC inhibited or killed L . pneumophila by the time kill method, except this was not the case for trimethoprim-sulfamethoxazole . Antibiotic concentrations below the broth dilution MIC did not inhibit Legionella growth . The only antibiotic-rifampin combinations which produced improved killing of L . pneumophila by the time kill method were those in which the logarithmic growth of L . pneumophila occurred during the experiment (rosoxacin, amifloxacin, cinoxacin, trimethoprim-sulfamethoxazole, clindamycin, and doxycycline) . Neither direct MICs nor time kill curve assays accurately predicted intracellular L . pneumophila susceptibility . Rifampin, erythromycin, ciprofloxacin, rosoxacin, enoxacin, amifloxacin, gentamicin, clindamycin, and doxycycline all inhibited intracellular L . pneumophila growth at readily achievable concentrations in serum . Cefoxitin and thienamycin showed no inhibition of growth, although they were present extracellularly at concentrations that were 20 to 1,000 times their broth dilution MICs . Clindamycin was the only antibiotic that was able to inhibit intracellular L . pneumophila growth at an extracellular concentration below its MIC . The gentamicin (5 mg/liter)-rifampin combination was the only antibiotic-rifampin combination which demonstrated decreased cell-associated Legionella survival in this model of in vitro susceptibility. Diagn Microbiol Infect Dis, 1987 Oct, 8(2), 119 - 22 Susceptibility in vitro of Nocardia species to antimicrobial agents; Southern PM Jr et al.; Fifty-four clinical isolates of Nocardia spp . were tested in vitro for susceptibility to several antimicrobial agents . Of these, 89% were susceptible to ciprofloxacin, 86% to imipenem, 85% to fusidic acid, and 71% to cefotaxime . Some of the agents may be suitable alternative or adjunctive drugs to sulfonamides and aminoglycosides for chemotherapy of Nocardial infections. Pediatr Infect Dis J, 1987 Oct, 6(10), 985 - 8 Selection of antimicrobial agents for treatment of acute otitis media with effusion; McCracken GH Jr; Although a few studies suggest that symptomatic treatment alone may be sufficient for many children with acute otitis media with effusion, most investigators believe that clinical response is improved with antibiotic therapy . The first step in selecting an antimicrobial agent for treatment of acute otitis media with effusion is to determine in vitro susceptibilities of the most frequently isolated pathogens to commonly used antibiotics . Another important variable to consider is the degree to which the prospective agent penetrates and is concentrated in middle ear fluid . Although bacteriologic eradication of causative pathogens remains an objective of therapy, the desired result of any treatment regimen for both physician and patient is a satisfactory clinical response . Knowledge of geographic bacterial resistance patterns is essential to effective antibiotic therapy and continued successful clinical outcomes . The ideal antimicrobial agent for treatment of acute otitis media with effusion is safe, well-tolerated by infants and young children, is effective against the most frequently encountered pathogens and is affordable. Orthopedics, 1987 Oct, 10(10), 1405 - 9 Antimicrobial prophylaxis for arthroplasty: a comparative study of cefonicid and cefazolin; Davis WA et al.; A double-blind, multicenter trial compared cefonicid and cefazolin for prophylaxis against postoperative infection in 117 patients undergoing joint replacement . Cefonicid, which has an extended serum half-life, was administered once daily, while cefazolin was given every eight hours . The drug was administered one half to one hour before surgery and continued for up to 72 hours . Patients were observed throughout their hospitalization period and followed for 30 days after discharge . No evidence of wound or joint infection was observed in any of the patients who met the criteria for evaluation . Adverse reactions consisted mainly of infrequent gastrointestinal symptoms and laboratory abnormalities . Three patients died from causes unrelated to study medication . No differences between the two regimens were found with respect to safety or efficacy in the prevention of postoperative infection after arthroplasty . The effectiveness of once-daily administration should make cefonicid a highly cost-effective alternative to many of the more expensive first- and second-generation cephalosporin antibiotics currently used in hospital practice. Mikrobiyol Bul, 1987 Oct, 21(4), 289 - 95 {An evaluation of the antibacterial effectiveness of bisdequalinium acetate and sodium hypochlorite}; Gorgul G et al.; The antimicrobial effectiveness of sodium hypochlorite and bis-dequalinium acetate was evaluated in vitro using three different microorganisms . The solutions were prepared in various concentrations and microorganisms were exposed to these solutions for 5, 10, 15 min . then placed into a culture medium, incubated and determined the presence or absence of growth . These results were compared with those obtained with phenol . The following conclusions were drawn from this study: 1 . Of the solutions tested Bis-dequalinium acetate was the most effective antimicrobial agent . And 1.25/1000 Bis-dequalinium acetate is appropriate for the clinical use . 2 . Sodium Hypochlorite is the least effective compared with Bis-dequalinium acetate and phenol . 2/100 NaOCl is agreeable for the clinical use . 3 . Normal saline exhibits no antimicrobial properties. Antimicrob Agents Chemother, 1987 Oct, 31(10), 1519 - 23 Disk diffusion susceptibility testing of Branhamella catarrhalis with ampicillin and seven other antimicrobial agents; Doern GV et al.; A total of 74 clinical isolates of Branhamella catarrhalis were characterized with respect to their ampicillin, amoxicillin-clavulanate, cephalothin, cefaclor, erythromycin, tetracycline, chloramphenicol, and trimethoprim-sulfamethoxazole MICs and zones of inhibition . Disk diffusion tests were performed according to the guidelines of the National Committee for Clinical Laboratory Standards with two different media (Mueller-Hinton agar and chocolate Mueller-Hinton agar) and plates incubated under two atmospheric conditions (ambient air and 5 to 7% CO2) . Optimum disk diffusion test results were obtained with Mueller-Hinton agar plates incubated in ambient air with all eight antimicrobial agents . On the basis of comparisons of MICs versus zones of inhibition, the following zone diameter interpretive criteria were defined for testing B . catarrhalis with disks containing 10 micrograms of ampicillin: greater than or equal to 38 mm, susceptible; 20 to 37 mm, moderately susceptible; less than or equal to 19 mm, resistant . The respective MIC correlates were less than or equal to 0.06, 0.125 to 0.5, and greater than or equal to 1.0 micrograms/ml . Because of the absence of frankly resistant test organisms, it was not possible to make definitive recommendations pertaining to disk diffusion tests with amoxicillin-clavulanate, cephalothin, cefaclor, erythromycin, tetracycline, chloramphenicol, and trimethoprim-sulfamethoxazole . Evidence is presented, however, which suggests that the current National Committee for Clinical Laboratory Standards disk diffusion interpretive criteria for nonfastidious bacteria can be applied to B . catarrhalis, at least as they pertain to the susceptible category with cephalothin, amoxicillin-clavulanate, erythromycin, tetracycline, chloramphenicol, and trimethoprim-sulfamethoxazole . With cefaclor, a zone diameter of greater than or equal to 21 mm was determined to adequately define the susceptible category. Antimicrob Agents Chemother, 1987 Oct, 31(10), 1497 - 501 Biosynthetic studies on antibiotic A47934; Zmijewski MJ Jr et al.; A47934, a peptide antibiotic produced by Streptomyces toyocaensis, belongs to the glycopeptide class of compounds which includes ristocetin and vancomycin . Incorporation studies with radioisotope-labeled substrates indicated that tyrosine, p-hydroxyphenylglycine, p-hydroxyphenylglyoxylate, acetate, and sulfate were efficiently incorporated into A47934 . This is consistent with the reported biosynthesis of other glycopeptide antibiotics . Prototrophic mutants blocked in antibiotic biosynthesis were isolated at a low frequency (0.4%) after mutagenesis . Secretor-convertor pairings of the 36 mutants obtained demonstrated that they belonged to three classes: two groups of secretor-convertor pairs and a larger group of mutants that did not make antibiotic under any condition tested . Neither the secretor-convertor studies not supplementation of the cultures with putative biosynthetic intermediates was useful in identifying the location of the biosynthetic blocks . All studies to determine the timing of the sulfate addition step in the biosynthesis indicated that the sulfate is added prior to the formation of intermediates that possess antimicrobial activity. J Clin Pharm Ther, 1987 Oct, 12(5), 273 - 91 Clinical pharmacokinetics, toxicity and cost effectiveness analysis of aminoglycosides and aminoglycoside dosing services; Mathews A et al.; This article reviews the clinical pharmacokinetics, clinical toxicity and cost-effectiveness analysis of aminoglycosides and of dosing services for aminoglycosides . The reader is referred elsewhere for a review of the pharmacology, antimicrobial spectrum of activity and clinical use of these drugs . A critique of the more commonly used methods of aminoglycoside dosage determinations is included, based on the inter-individual variation in aminoglycoside disposition parameters . The advantages and disadvantages of arbitrary, predictive, and pharmacokinetic methods of dosing determination are summarized . Justification for the routine determination of serum aminoglycoside concentrations is reviewed . We review the lack of standardization of definitions for aminoglycoside-associated nephrotoxicity in published studies, and studies which illustrate these differences are highlighted . Evidence for the association between serum aminoglycoside concentrations and nephrotoxicity is examined . Ototoxicity is similarly reviewed . The concept of cost-effectiveness analysis is examined extensively in this review . We discuss the literature concerning the cost benefit analysis of drug dosing services. Epidemiol Infect, 1987 Oct, 99(2), 445 - 53 Respiratory tract infections due to Branhamella catarrhalis: epidemiological data from Western Australia; DiGiovanni C et al.; During a 3-year period Branhamella catarrhalis was isolated in significant numbers from 239 (1.3%) of 19,488 specimens of sputum sent for routine microbiological examination at a 700-bed general hospital . The majority of patients (83%) were over 60 years of age and 65% were male . There was a distinct seasonal variation in isolations with a peak incidence during the winter and early spring, a pattern not found with other pathogens . Susceptibility to amoxycillin decreased by approximately 50% over the 3 years, corresponding to an increased incidence of beta-lactamase-producing strains . There were minimal changes in susceptibility to other antimicrobial agents . Underlying pulmonary disease was the major factor predisposing to B . catarrhalis infection, and 71% of patients were smokers or ex-smokers. Farmaco {Sci}, 1987 Oct, 42(10), 767 - 86 Teicoplanin: chemical, physico-chemical and biological aspects; Coronelli C et al.; The structure determination and the physico-chemical properties of teicoplanin, a new glycopeptide antibiotic of the vancomycin-ristocetin family are presented . Some biological studies and the mechanism of action at the molecular level are discussed . Analytical test methods, such as HPLC assay, bioassay and enzymatic assay are described . The antimicrobial activity of teicoplanin and of some relevant acid and basic hydrolysis products are also discussed. Eur J Clin Microbiol, 1987 Oct, 6(5), 587 - 9 Commercially available fluorescein-conjugated monoclonal antibody for determining the in vitro activity of antimicrobial agents against Chlamydia trachomatis; Webberley JM et al.; A simple, reproducible method for determining the antibiotic susceptibility of chlamydial isolates is described . Minimum inhibitory and lethal concentrations (MICs and MLCs) were determined for tetracycline and erythromycin titrated against a recent clinical isolate of Chlamydia trachomatis in McCoy cell cultures . A fluorescent antibody stain was found to be more sensitive than giemsa staining, generally giving two-fold higher values for both MICs and MLCs. J Interferon Res, 1987 Oct, 7(5), 591 - 6 Interferons: from virus inhibitor to modulator of amino acid and lipid metabolism; Borden EC et al.; Purity of interferons has facilitated definition of pleiotropic biological effects . Alterations that might be suspect with use of impure interferons, such as those occurring in tryptophan and lipoprotein metabolism, have been defined both in vitro and in humans . Reduction in tryptophan contributes to antimicrobial effects for intracellular pathogens and may explain some clinical observations . Decreases in plasma lipoproteins occur rapidly and are of a magnitude similar to cholesterol-lowering drugs used clinically . Alteration in metabolism of amino acids and fats substantially extends the biological effects of a virus-inhibitory protein. J Immunol, 1987 Sep 15, 139(6), 1971 - 7 Trace levels of bacterial lipopolysaccharide prevent interferon-gamma or tumor necrosis factor-alpha from enhancing mouse peritoneal macrophage respiratory burst capacity; Ding AH et al.; Preexposure of resident mouse peritoneal macrophages for 1 hr to traces of bacterial lipopolysaccharide (LPS) (less than or equal to 1 ng/ml) rendered the cells refractory to activation by recombinant interferon-gamma (rIFN gamma) or recombinant tumor necrosis factor-alpha (rTNF alpha), as evaluated by release of H2O2 upon stimulation with phorbol myristate acetate . Inhibition persisted for at least 4 days . Fifty percent inhibition of activation mediated by rIFN gamma followed 1 hr exposure to 10 pg/ml LPS . Fifty percent inhibition of activation mediated by rTNF alpha was achieved with 1 hr exposure to 1 pg/ml LPS . Such low levels LPS exposures (concentration X time) are far below those reported for many other actions of LPS on host cells . Inhibition was partially prevented by the cyclooxygenase inhibitors indomethacin, ibuprofen, and acetylsalicylic acid . Exogenous prostaglandins PGE1 and PGE2, and the 3',5'-cyclic adenosine monophosphate analog dibutyryl cyclic adenosine monophosphate (cAMP), mimicked the inhibitory effect of LPS in a dose-dependent manner, consistent with the hypothesis that formation of endogenous cyclooxygenase products in response to LPS may elevate intracellular cAMP and that the latter may mediate the observed inhibition . In addition, neutralizing antibody against IFN alpha and IFN beta selectively prevented LPS inhibition of activation mediated by rIFN gamma, but not by rTNF alpha . This suggests that IFN alpha and/or IFN beta induced by LPS also contributed to inhibition of activation by rIFN gamma . Thus, release of LPS may afford microorganisms a means by which to interfere with immunologically mediated enhancement of the respiratory burst-dependent antimicrobial capacity of macrophages. Hosp Formul, 1987 Oct, 22(10), 852 - 7, 860-3 Antibiotic resistance in the hospital setting: extent of the problem and possible solutions; Hoffmann SA et al.; The advent of effective antimicrobial agents has been justifiably hailed as one of the most significant medical advances . However, as experience with older agents has grown and as newer compounds have been added to the clinician's armamentarium, certain disadvantages associated with the use of antimicrobials have become increasingly apparent . Toxicity and cost are among the disadvantages, but drug resistance is probably the major adverse consequence of widespread antimicrobial use . This article reviews the extent, mechanisms, and consequences of antimicrobial resistance--particularly in the hospital environment--and offers strategies for minimizing both its emergence and its spread. Farmaco {Sci}, 1987 Sep, 42(9), 629 - 39 Research on antibacterial and antifungal agents . III . Synthesis and antimicrobial activity of 2-methyl-5-aryl-3-furoic acids and 2-methyl-3-imidazolylmethyl-5-aryl furans; Porretta GC et al.; The synthesis and microbiological activities of 2-methyl-5-aryl-3-furoic acids and 2-methyl-3-imidazolyl-methyl-5-aryl-3-furans are reported . Antimicrobial data in comparison with pyrrolnitrin showed an interesting antifungal activity but a very poor antibacterial activity . The presence of an imidazole nucleus does not increase antifungal activity . The introduction of a substituent in the para position of the aryl at a C5 of the furan ring affects antifungal activity. Farmakol Toksikol, 1987 Sep-Oct, 50(5), 57 - 9 {Pharmacokinetic characteristics of the antibiotics comprising antimicrobial biocompatible conjunctive elements for the internal organs}; Sidorova IS et al.; It was found during the study of pharmacokinetics of gentamycin and cephamesine being constituents of antimicrobial conjunctive elements for the internal organs that in the process of diffusion of the antibiotics from the polymer film gentamycin level in the organism increased by the 1st day of observation and cephamesine level by the 3rd day . Thereafter their concentrations decreased by the 7th and 10th days, respectively . The depot of the antibiotics is created at the site of the film application, and their highest concentrations occurring in the periods dangerous for the development of postoperative inflammatory complications exceed the minimal suppressive concentrations with regard to their main causative agents . It is advisable to use antimicrobial conjunctive elements with the given antibiotics for prevention of postoperative inflammatory complications following cesarean section. J Pediatr Surg, 1987 Sep, 22(9), 839 - 42 Antimicrobial therapy of Broviac catheter infections in pediatric hematology oncology patients; Olson TA et al.; Long-term therapy of pediatric oncology patients has been facilitated by permanent indwelling venous catheters . Over a 3-year period, 54 Broviac catheters were placed in 43 oncology patients and two hemophiliacs . There were 20 episodes of sepsis in 14 patients and the most common bacteria were S epidermidis (4), S aureus (4), and K pneumoniae (3) . Catheter exit site infections occurred ten times in six patients; S aureus eight of ten . Antibiotic therapy without catheter removal was successful in 18 of 20 children with catheter sepsis and 8 of 10 patients with exit site infections . These data strongly suggest that although catheter-related infections are common, removal of Broviac catheters is not required for successful treatment of the infection. J Clin Microbiol, 1987 Sep, 25(9), 1730 - 4 Selective and differential medium for recovery of Pseudomonas cepacia from the respiratory tracts of patients with cystic fibrosis; Welch DF et al.; A selective and differential medium, OFPBL (oxidation-fermentation base supplemented with agar, lactose, and two antimicrobial agents), for the isolation of Pseudomonas cepacia from respiratory specimens of patients with cystic fibrosis was developed and tested . Among 725 specimens submitted from seven centers over a 4- to 6-month period, 58 (8%) yielded P . cepacia on OFPBL; only 19 of these were recovered on MacConkey or sheep blood agar (P less than 0.001) . No isolate was recovered on MacConkey or sheep blood agar alone . Ranges of recovery rates among centers were 0 to 15% on OFPBL and 0 to 10% on MacConkey or sheep blood agar . Ninety percent of P . cepacia isolates were detected on OFPBL in less than or equal to 3 days . Other nonfermenters and yeasts isolated on OFPBL were distinguished from P . cepacia by failure to acidify the medium . The new medium was clearly superior to MacConkey and sheep blood agars for the isolation of P . cepacia from the respiratory secretions of patients with cystic fibrosis. South Med J, 1987 Sep, 80(9), 1187 - 9 Bordetella bronchiseptica pneumonia in a patient with chronic lymphocytic leukemia; Buggy BP et al.; This case report describes two episodes of pneumonia caused by Bordetella bronchiseptica in a patient with chronic lymphocytic leukemia . There was discrepancy between the in vitro sensitivity testing of the organism and subsequent clinical response to several antimicrobial agents . Human infection with B bronchiseptica is almost always associated with severe underlying disease and contact with an appropriate animal reservoir. Mayo Clin Proc, 1987 Sep, 62(9), 789 - 98 General principles of antimicrobial therapy; Wilkowske CJ et al.; Use of antimicrobial agents must be tailored to the individual patient, site of infection, and etiologic organism . The choice of drug should be based on efficacy, safety, low toxicity, and acceptable cost . Empiric therapy should be broad enough to cover the pathogens that are suspected of causing the infection, based on the site of infection and the type of host . Definitive therapy may differ from initial therapy and should be started as soon as specific laboratory and clinical data are available . Cautious conservatism is advocated with regard to the use of new antimicrobial agents . The effects of the agents on the microbial ecology and hospital environment should be considered . Judicious use is necessary to prevent antimicrobial pollution. J Med Chem, 1987 Sep, 30(9), 1674 - 7 3-Carbonylacrylic derivatives as potential antimicrobial agents . Correlations between activity and reactivity toward cysteine; Dal Pozzo A et al.; A number of 3-carbonylacrylic acid derivatives were prepared, with a view to varying systematically the stereoelectronic environment of the conjugated double bond . The rates of reaction with cysteine were measured spectrophotometrically when possible or by stopped flow when very fast . Some of the final reaction products were isolated . Other properties examined were partition substituent constants and antimicrobial activity . On the basis of published data and these studies, the activity appears to be the combined effect of at least two mechanisms, one probably related to the effect of these structures on surface tension, the other to the electrophilic properties of the unsaturated system. J Gerontol, 1987 Sep, 42(5), 466 - 9 Secretion of antimicrobial proteins from the parotid glands of different aged healthy persons; Fox PC et al.; The secretion of three antimicrobial proteins from the parotid glands of 82 generally healthy men and women, 22 to 81 years in age, was examined . No change was observed in the levels of secretory IgA, but statistically significant, modest elevations (approximately 50 to 100%) of lactoferrin, in both unstimulated and stimulated secretions, and lysozyme, in unstimulated secretions, were detected when results were expressed as mg antimicrobial protein/100 ml saliva . However, these alterations were not observed if data were expressed as mg antimicrobial protein/g total protein . Also, no change was detected in an acinar cell exocrine product, the anionic proline-rich proteins, as reported previously by our laboratory . The data are consistent with a maintenance of protective functions in parotid saliva during aging. Infect Immun, 1987 Sep, 55(9), 2281 - 6 Purification, primary structure, and antimicrobial activities of a guinea pig neutrophil defensin; Selsted ME et al.; A broad-spectrum antimicrobial peptide present in guinea pig neutrophils was isolated, characterized biochemically, and assessed for microbicidal range and potency in vitro . The guinea pig neutrophil peptide (GPNP) was purified to homogeneity from a granule-rich subcellular fraction of peritoneal exudate neutrophils by gel filtration and reversed-phase high-performance liquid chromatography . GPNP was microbicidal for selected bacterial, fungal, and viral test organisms at concentrations in the microgram per milliliter range . Composition and primary structure analyses revealed that GPNP was homologous to a recently characterized family of antimicrobial peptides, termed defensins, isolated from rabbit and human neutrophils . The entire amino acid sequence of GPNP was determined, revealing that 8 of 31 residues were among those invariant in six rabbit and three human defensin peptides . The conserved sequence included six disulfide-linked cysteine residues, a common structural feature of defensins . The sequence of GPNP also included three nonconservative substitutions in positions otherwise invariant in the human and rabbit peptides . Characterization of GPNP provides new insight into structural features which may be essential for the broad-spectrum antimicrobial activities of defensins. Am J Clin Pathol, 1987 Sep, 88(3), 361 - 5 Evaluation of Hemophilus type B systemic isolates for beta-lactamase and non-beta-lactamase mediated ampicillin resistance and for susceptibility to other antimicrobial agents; Woolfrey BF et al.; Of 175 recent Minnesota Hemophilus influenzae type b isolates from systemic disease, 43 were found to be resistant to ampicillin (greater than or equal to 4 micrograms/mL {mg/L}), each of which produced beta-lactamase . Of the 132 ampicillin-susceptible isolates, 68 (52%), all beta-lactamase negative, had minimum inhibitory concentrations (MICs) of either 1 or 2 micrograms/mL (mg/L), indicating relative resistance if derived from cerebrospinal fluid (CSF) infections . From a review of the literature, and in agreement with the authors findings, ampicillin-resistant beta-lactamase-negative isolates are rare and are likely to be nontypeable, of respiratory origin, and with MICs in the low resistance range . For the 43 ampicillin-resistant isolates, percentages resistant to other agents were as follows: 0% chloramphenicol, 0% rifampin, 6% tetracycline, 0% trimeprim-sulfamethoxazole, 2% cefamandole, 5% cefaclor, 2% moxalactam, and 0% for the remaining third-generation cephalosporins cefotaxime, ceftazidime, and ceftizoxime . Unlike ampicillin-resistant isolates, 100% of ampicillin-susceptible isolates had relatively low cefaclor MICs of less than or equal to 4 micrograms/mL (mg/L), suggesting a relatively increased H . influenzae beta-lactamase effect on cefaclor in comparison with the other cephalosporins tested. J Clin Endocrinol Metab, 1987 Sep, 65(3), 551 - 4 Kinetic analysis of inhibition of human adrenal steroidogenesis by ketoconazole; Couch RM et al.; The kinetics of the inhibitory effects of the imidazole antimicrobial ketoconazole on the activities of the steroidogenic enzymes distal to cholesterol side-chain cleavage were studied in human adrenal microsomal and mitochondrial suspensions . Although ketoconazole was a competitive inhibitor of all five enzyme reactions, the effects on 17-hydroxylase, 17,20-desmolase, and 11-hydroxylase activities (Ki = 10(-8) M) were considerably greater than those on 21-hydroxylase and 3 beta-hydroxysteroid dehydrogenase/isomerase activities (Ki = 10(-4) M) . These findings explain the clinical endocrine effects of ketoconazole in the usual therapeutic doses, which include inhibition of cortisol and androgen secretion, compensatory ACTH-mediated secretion of 17-desoxysteroids such as progesterone and aldosterone, and suppression of PRA. J Antibiot (Tokyo), 1987 Sep, 40(9), 1292 - 302 Modification of the cysteamine side chain of thienamycin . III; Sato M et al.; Thienamycin derivatives (4) having a cyclic amidine moiety at the C-2 position were prepared . The susceptibility to renal dehydropeptidase-1 and the antimicrobial activity of these compounds were determined . Their structure-activity relationships are also discussed. J Periodontol, 1987 Sep, 58(9), 622 - 7 Viadent, ethanol, and pH effects upon gingival epithelial-like cells, in vitro; Barczynski JL et al.; Interest has recently been directed towards the use of antiplaque mouthrinses . Most published material concerns the antimicrobial effects of these agents rather than their effects upon oral tissue . This study was conducted to evaluate the effect of a sanguinarine-containing mouthrinse called Viadent upon epithelial-like gingival cells . The cells were grown for 24 hours in supplemented Earle's medium, with and without different Viadent dilutions . Cell counts were made with a hematocytometer . It was found that 50% of the cells were inhibited at 1.2% Viadent . In similar studies, it was found that 70% ethanol and two pH buffers were less toxic than Viadent . Exposure of preformed cell monolayers to Viadent also showed significant inhibition . The relative toxicity of different antiplaque agents may be compared using such cells as a model system . In conclusion, it was observed that Viadent significantly affected gingival cell growth in vitro, that viable cell numbers were greatly reduced by short time exposure, and that the toxic effect of Viadent could only partially be accounted for by ethanol content and/or pH. Z Lebensm Unters Forsch, 1987 Sep, 185(3), 202 - 7 An enzyme-linked immunosorbent assay for the determination of chloramphenicol using a monoclonal antibody . Application to residues in swine muscle tissue; van de Water C et al.; A competitive enzyme-linked immunosorbent assay (ELISA) using a monoclonal antibody is described for the determination of chloramphenicol (CAP) residues in swine muscle tissue . The limit of detection of standard solutions is established to be 25 ng ml-1 = 2.0 ng CAP per well) . The very high specificity of the monoclonal antibody for CAP is expressed by the insignificant cross-reactivity with other antimicrobial agents and with structurally related compounds . By means of the rapid sample preparation method described earlier for the CAP determination using high-performance liquid chromatography (HPLC), residue levels of CAP in swine muscle tissue above 5 micrograms kg-1 can be easily quantitated . The muscle samples show good recovery percentages at 10-50 micrograms kg-1 spiking levels . The results obtained by the ELISA method were confirmed by HPLC. Vopr Med Khim, 1987 Sep-Oct, 33(5), 43 - 8 {Lysosomal proteins of neutrophils--factors of antimicrobial protection of cells}; Lyzlova SN; Lysosomal antimicrobial factors in neutrophilic granulocytes, components of oxygen-dependent and oxygen-independent mechanisms are considered . Physico-chemical and biological properties om myeloperoxidase, cooperative effect of myeloperoxidase and other cation proteins in neutrophilic lysosomes, interrelation and interaction between various antimicrobial factors in phagocytosis are discussed . Inhibition of the oxygen active forms by means of blood serum proteins is considered. Rev Infect Dis, 1987 Sep-Oct, 9 Suppl 5, S620 - 9 Glucocorticoid-induced impairment of macrophage antimicrobial activity: mechanisms and dependence on the state of activation; Schaffner A et al.; Experimental observations indicate that tissue macrophages deployed in great numbers at critical anatomic sites such as the liver, spleen, and lung are major targets for glucocorticoids compromising natural resistance of the host . Therapeutic concentrations of glucocorticoids appear to prevent destruction of microorganisms ingested by macrophages without interfering with phagocytosis, phagolysosomal fusion, and/or secretion of reactive oxygen intermediates . These findings indicate that at the cellular level the glucocorticoid target should be sought for in the nonoxidative armature of the phagocyte and that nonoxidative killing systems of resident tissue macrophages play an important role in natural resistance to opportunistic pathogens . Glucocorticoids do not prevent lymphokine-induced activation of oxidative killing systems . Thus, lymphokines such as interferon-gamma can restore the microbicidal activity of macrophages functionally impaired by glucocorticoids . Counterbalance of the suppressive effect of glucocorticoids by lymphokines might only be possible, however, for pathogens susceptible to oxidative killing and not for microorganisms that are more resistant to reactive oxygen intermediates such as Aspergillus spores and Nocardia, opportunists that appear to be particularly associated with hypercortisolism. Rev Infect Dis, 1987 Sep-Oct, 9(5), 855 - 65 Actinomycosis of the central nervous system; Smego RA Jr; Actinomyces species are rare but treatable causes of CNS infection . Differentiation of actinomycosis from nocardiosis is crucial to the selection of appropriate antimicrobial therapy . A review of 70 cases of CNS actinomycosis was conducted in an effort to characterize clinicopathologic features and identify patients with a high risk of death from infection . Types of lesions included brain abscess (67%), meningitis or meningoencephalitis (13%), actinomycoma (7%), subdural empyema (6%), and epidural abscess (6%) . Most infections developed from distant sites (lung, 19 cases; abdomen, four; pelvis, three) or contiguous foci (ear, sinus, and cervicofacial region, 21 cases) . For nonmeningitic infection, signs and symptoms were generally those of a space-occupying lesion and were indistinguishable from the manifestations of other pyogenic infections except for a longer interval before diagnosis . Risk factors included dental caries; dental infection; recent tooth extraction; head trauma; gastrointestinal tract surgery; chronic otitis, mastoiditis, or sinusitis; chronic osteomyelitis; tetralogy of Fallot; and actinomyces infection of an intrauterine device . Optimal management combined adequate surgical drainage with prolonged antibiotic therapy (mean duration, 5 months) . Overall mortality from treated infection was 28%; 54% of survivors had neurologic sequelae . Features correlated with a poor prognosis were disease onset greater than 2 months before diagnosis and treatment, no antibiotic treatment, no surgery, and needle aspiration drainage of abscess lesions. J Clin Pharmacol, 1987 Sep, 27(9), 673 - 7 A comparative trial of moxalactam plus ticarcillin and clavulanic acid or piperacillin as empiric antibiotic therapy for febrile cancer patients; D'Olimpio JT et al.; Resistance of bacteria to beta-lactam antibiotics remains a difficult clinical problem that can be compounded in infected patients with serious underlying illness, especially those who are immunocompromised . In a prospective randomized safety and efficacy trial, febrile cancer patients received either ticarcillin disodium combined with the beta-lactamase inhibitor clavulante potassium (Timentin, Beecham Laboratories, Bristol, TN) plus moxalactam (T+M), or piperacillin plus moxalactam (P+M) as initial empiric antimicrobial therapy . Sixty-six febrile episodes in 53 patients were studied . In the T+M group, 14 (78%) of 18 clinically evaluable infections in patients with profound granulocytopenia improved as did all 14 (100%) such infections in the P+M group . In the T+M group 17 of 21 (81%) similarly evaluable infections improved irrespective of granulocyte count, as did 14 (88%) of 16 of such infections in the P+M group . These results are not statistically significantly different . Serious side effects were infrequent and comparable with both regimens . There was one antibiotic related hemorrhage in the P+M group and a serious episode of nephrotoxicity in a patient who died without recovering renal function in the T+M group . These results suggest that the overall safety and efficacy of Timentin plus moxalactam, and piperacillin plus moxalactam are comparable and similar to previous empiric antibiotic trials. J Antimicrob Chemother, 1987 Sep, 20 Suppl A, 41 - 9 The role of the microbiology laboratory in the treatment of infective endocarditis; Stratton CW; The antibiotic era has greatly improved the prognosis for patients with infective endocarditis . The need for bactericidal activity against the infecting organism has created an additional role for the clinical microbiology laboratory . This role involves the selection and performance of the proper in-vitro susceptible tests in order to ensure bactericidal activity . However, there are problems in both the performance and the interpretation of bactericidal tests; these include persisters, the 'paradoxical effect', tolerance and the development of resistance . Technical factors include inoculum size, growth phase of the inoculum, insufficient contact between the test organism and the antimicrobial agent, and the volume of transfer for the count of survivors . Appreciation of these factors is important for the laboratory performing bactericidal tests, which include time-kill curves, minimal bactericidal concentrations and the serum bactericidal test . Of these tests, the serum bactericidal test offers the most logical approach . However, the performance of this test and the interpretation of the results has been controversial . Recent attempts at standardization should allow better utilization . In addition to the serum bactericidal test, the clinical microbiology laboratory can offer time-kill curves and minimal bactericidal activity and can offer serum assays of antibiotics to ensure adequate levels without toxicity . The use of any or all of these methods must be tempered by clinical judgement in each individual case . Application of the proper tests can assist in the optimal therapy of infective endocarditis. J Antimicrob Chemother, 1987 Sep, 20 Suppl A, 29 - 39 The microbiological diagnosis of infective endocarditis; Washington JA; Variables affecting the isolation of microorganisms causing endocarditis include the volume of blood cultured, the number of blood cultures obtained, prior antimicrobial therapy, the type of microorganism involved, and blood culture technique . Culture-negative infective endocarditis is most frequently associated with prior antimicrobial therapy and nonbacterial agents, such as fungi, chlamydiae, and rickettsiae . For the diagnosis of bacterial endocarditis, culture of two to three separately collected blood samples of at least 10 ml, and preferably 20 ml, each generally suffices; however, in cases who have recently received antibiotics it may be necessary to culture an additional two to three blood samples or to consider use of beta-lactamase, antimicrobial adsorbent resins, or lysis-concentration, the last of which is also the most effective method for recovering mycobacteria and fungi from blood. Clin Chest Med, 1987 Sep, 8(3), 467 - 79 Nosocomial pneumonia; Toews GB; Nosocomial pneumonias are a particularly problematic group of infections . The pathogenesis of these pneumonias, including mechanisms of colonization and pulmonary defense mechanisms, is discussed . An approach to the hospitalized patient with fever and infiltrates, based on the clinical setting, the nature of the host defense defect, the radiographic findings, and the results of invasive diagnostic procedures, is presented . Antimicrobial agents available to treat patients with nosocomial pneumonia are reviewed. Clin Chest Med, 1987 Sep, 8(3), 373 - 80 The effect of common pharmacologic agents on pulmonary antibacterial defenses: implications for the geriatric patient; Esposito AL; Clinical and laboratory observations have raised the possibility that common pharmacologic agents disrupt lung host defense and predispose to bacterial infection of the lower respiratory tract . Epidemiologic data suggest that the potential for an impairment in pulmonary antibacterial mechanisms is greatest among individuals of advanced age . However, lung antimicrobial systems are extremely complex, and patients with pulmonary infections characteristically have a variety of predisposing conditions . Thus, it remains very difficult to assess the relative impact of drug-related derangements on lung antimicrobial systems . Indeed, it is likely that multiple intrinsic and extrinsic factors contribute to the evolution of most bacterial pneumonias . Thus, while medications may not represent major risk factors, they may act in an additive or synergistic manner with other predisposing conditions, such as age-associated changes in immunologic activity and underlying disease, to enhance susceptibility to infectious illnesses of the lung . Clearly, substantial clinical and laboratory study will be required in order to define the role that common pharmacologic agents play in predisposing to bacterial infection of the lower respiratory tract. J Clin Periodontol, 1987 Sep, 14(8), 457 - 61 The influence of a dentifrice containing a zinc salt and a nonionic antimicrobial agent on the maintenance of gingival health; Svatun B et al.; The purpose of the present investigation was to test the concept that a dentifrice containing zinc citrate and Triclosan could maintain gingival health . The gingival health of 101 young predominately female student nurses in Oslo was brought to a high level by professional cleaning supported by oral hygiene instruction . The criterion of gingival health was less than or equal to 5 elicited bleeding sites from a full mouth assessment . The mean bleeding value attained for the whole group was 3.5 . 2 balanced groups were formed, based on the initial number of elicited bleeding sites and plaque values . One group used the test dentifrice and the other group the placebo for 6 months, with an intermediate assessment after 3 months . The placebo group failed to maintain the standard of oral hygiene and gingival health that had been achieved by professional care . In contrast, the group using the test dentifrice for 6 months exhibited similar levels of plaque and gingival health to that observed at baseline following oral hygiene instruction . After 6 months, less than 7% of the subjects in the placebo group possessed healthy gingivae in contrast to 60% of the test group . Thus a dentifrice containing a zinc salt and nonionic germicide had successfully maintained gingival health in a group of young adults. J Clin Microbiol, 1987 Sep, 25(9), 1774 - 5 Test-of-cure analysis by direct immunofluorescence for Chlamydia trachomatis after antimicrobial therapy; Nachamkin I et al.; The direct immunofluorescence assay (DFA) was compared with culture for test-of-cure analysis for Chlamydia trachomatis in patients 7 to 10 days after antimicrobial therapy was given . DFA test-of-cure results correlated with culture results in 79.5% of 39 patients . Of DFA-negative patients, 97% had negative cultures . Six of seven patients with borderline DFA results had negative culture results. Eur J Epidemiol, 1987 Sep, 3(3), 222 - 32 The epidemiology of nosocomial epidemic Pseudomonas cepacia infections; Martone WJ et al.; Pseudomonas cepacia has occasionally been identified as an epidemic and endemic nosocomial pathogen . In outbreaks, usually one clinical site predominates but many may be involved . Detailed investigations have usually implicated a contaminated liquid reservoir or moist environmental surface as the source . Liquid sources have included a number of different classes of antiseptics and disinfectants such as quaternary ammonium chlorides, biguanides, hexachlorophene, and iodophors . Environmental and patient isolates have had multiply resistant antimicrobial susceptibility patterns . The clinical distinction between colonization and infection may be difficult and may challenge the skills of the clinician . Expenditure of resources needed to solve epidemics is justified in view of the potential virulence of this organism and the high likelihood that an unrecognized but easily eliminated liquid environmental reservoir may be the source. Drug Intell Clin Pharm, 1987 Sep, 21(9), 687 - 93 Bismuth subsalicylate in the treatment and prevention of diarrheal disease; DuPont HL; Bismuth subsalicylate (BSS) has been used for more than 80 years to treat gastrointestinal symptoms although little clinical evidence was available until recently to substantiate its value and possible mechanisms of action . BSS 4.2 g given over 3 1/2 hours was shown to reduce the number of stools passed and favorably alter subjective symptoms in patients with traveler's diarrhea . BSS has also been shown to have beneficial effects on chronic infantile diarrhea . A small but discernible effect has been shown on selected symptoms associated with Norwalk virus-induced gastroenteritis . A liquid preparation, in a dose of 60 ml qid (4.2 g/d), was 62 percent effective in preventing traveler's diarrhea during a three-week period of risk and a tablet formulation (BSS 600 mg qid) was 76 percent effective in preventing experimentally induced enterotoxigenic Escherichia coli diarrhea in volunteers . A tablet formulation (2.1 g/d) was recently shown to be 65 percent effective in preventing traveler's diarrhea during a three-week clinical trial in Mexico . Preliminary evidence suggests that the salicylate moiety exerts antisecretory effects in patients with diarrhea and the bismuth and intestinal hydrolysis products of BSS have direct antimicrobial effects. Clin Lab Med, 1987 Sep, 7(3), 499 - 512 Antimicrobial susceptibility tests and their role in therapeutic drug monitoring; DeGirolami PC et al.; Principles and techniques of routine and special in vitro antimicrobial susceptibility testing of bacteria are reviewed with emphasis on the advantages, limitations, and potential problems of each method . The utilities of MBC testing and of serum bactericidal titer determination are discussed in the clinical context . The use of testing for possible antibiotic interactions is examined in light of potential benefits and risks of combination antimicrobial therapy. J Oral Maxillofac Surg, 1987 Sep, 45(9), 779 - 84 Inhibitory and cidal antimicrobial actions of electrically generated silver ions; Hall RE et al.; One promising alternative to antibiotics in the treatment of localized infections is the generation of antimicrobial silver ions by the use of low intensity direct current from a pure silver anode implanted at the site of an infection . This study investigates the in vitro bacteriostatic and bactericidal properties of this system on a variety of organisms. Semin Respir Infect, 1987 Sep, 2(3), 152 - 8 Chlamydial and mycoplasmal pneumonias; Leigh MW et al.; Chlamydia species and Mycoplasma pneumoniae are among the most common agents of community-acquired pneumonia, as well as causes of various nonpneumonic syndromes . Both can be considered "exotic" bacteria: Chlamydiae because they depend on host cell energy, hence their obligate intracellular replication; and M pneumoniae because it is an extracellular parasite that lacks the standard protective bacterial cell wall . The unusual biology of these organisms complicates laboratory diagnosis, but because both are susceptible to selective antimicrobials, therapy often proceeds empirically on clinical suspicion . Generally the respiratory diseases produced are self-limited without significant complications or known sequelae. Infect Immun, 1987 Sep, 55(9), 2017 - 20 Influence of 1,25-(OH)2 vitamin D3 and gamma interferon on the phenotype of human peripheral blood monocyte-derived macrophages; Poulter LW et al.; The effects of 1,25-dihydroxy vitamin D3 and gamma interferon on the phenotypic changes associated with monocyte maturation in vitro were investigated . Human monocytes separated from peripheral blood mononuclear cell populations by adherence to plastic were cultured for 7 days on glass . Immunocytological analysis was performed on monolayers fixed at various times by using monoclonal antibodies specific for mature macrophages (RFD7), interdigitating (dendritic) cells (RFD1), and class II major histocompatibility complex antigen (RFDR1) . Without any addition to the culture medium, proportions of these monocytes (normally RFD1 and RFD7 negative) developed either RFD1 positivity (23%) or RFD7 positivity (49%) over 7 days of culturing . The addition of gamma interferon to these cultures markedly reduced the proportion of RFD7-positive cells (less than 10%) but increased the proportion of RFD1-positive cells (40 to 60%) . In contrast, 1,25-dihydroxy vitamin D3 reduced the expression of both RFD1 and RFD7 . Both of these effects were dose dependent and required at least 3 days of contact with the cells . The possibility that RFD1- and RFD7-positive cells represent functionally distinct subsets makes these effects of significance in our understanding of the role of these mediators in controlling the immunocompetence of nonlymphoid accessory cell populations and in macrophage-associated antimicrobial activity. J Pharm Pharmacol, 1987 Sep, 39(9), 685 - 90 Antimicrobial activity of n-alkyltrimethylammonium bromides: influence of specific growth rate and nutrient limitation; Wright NE et al.; The antimicrobial activity of an homologous series of n-alkyltrimethylammonium bromides has been assessed towards Escherichia coli grown at a variety of specific growth rates and under various conditions of nutrient limitation . For each individual set of growth conditions activity was parabolically related to the n-alkyl chain length of the compounds and thus to compound lipophilicity (log P) . The compound that showed optimal activity and thereby optimal lipophilicity (log Po) changed according to growth rate and nutrient limitation . Such changes are related to variations in the gross cell envelope composition of the cultures (phospholipid, lipopolysaccharide, neutral lipids, proteins) . The data therefore support the hypothesis that changes in growth rate and nutrient limitation alter the overall lipophilicity of the cell envelope and thereby the optimal value of log P for compounds to traverse it . Additionally, the data suggest that for the compounds examined, the neutral acidic:neutral phospholipid ratios of the cell envelope, also influence the permeation of it. Jpn J Antibiot, 1987 Sep, 40(9), 1639 - 43 {Clinical studies on cefoperazone and polymyxin B for the treatment of infections in patients with hematological malignancies}; Hara M; Cefoperazone (CPZ) was used for the treatment of 20 febrile episodes in 18 patients with hematological malignancies and polymyxin B (PL) was applied to the antimicrobial decontamination of the digestive tract in 9 patients with acute leukemia during remission induction therapy . The clinical evaluation of effectiveness was as follows: Excellent in 9 patients (45%), good in 6 patients (30%) and poor in 5 patients (25%) . In neutropenic patients the overall efficacy rate was 70% . Side effects were recognized in 3 patients . Allergic reactions such as eruption and eosinophilia were seen and transient liver dysfunction was recognized . This study indicates that CPZ is effective for the treatment of infections in patients with hematological malignancies. Pharm Weekbl Sci, 1987 Aug 21, 9(4), 193 - 7 Antimicrobial activities of essential oils . A 1976-1986 literature review on possible applications; Janssen AM et al.; The testing of essential oils for antimicrobial activities is reviewed with respect to various possible applications . Consideration is given to the screening for antimicrobially active oils or constituents, for disinfecting or antiseptic properties and for food conserving properties . The role of essential oils in biological interactions and their potential as therapeutic agents are also discussed. FEBS Lett, 1987 Aug 17, 220(2), 332 - 6 Environment-dependent conformation and antimicrobial activity of a gramicidin S analog containing leucine and lysine residues; Ono S et al.; An analog of gramicidin S, cyclo(-L-Leu-L-Lys-L-Leu-D-Leu-L-Leu-)2, in which four out of five amino acid components of gramicidin S were substituted, has been synthesized . This analog assumes a conformation similar to that of gramicidin S in acidic liposomes and a random conformation in neutral liposomes . The antimicrobial activity of this analog corresponded to one-fourth of that of gramicidin S . A possible mechanism for conformational changes in acidic liposomes is discussed. J Immunol, 1987 Aug 15, 139(4), 1291 - 6 A monoclonal antibody that inhibits the antimicrobial action of a 57 KD cationic protein of human polymorphonuclear leukocytes; Spitznagel JK et al.; Two monoclonal antibodies (mAb) specific for epitopes of a 57,000 m.w., cationic antimicrobial protein (CAP57) purified from granules of human polymorphonuclear leukocytes (PMN) have been produced . Both were IgG1 mouse antibodies with typical heavy and light chain structure . The mAb reactive with CAP57 failed to react specifically with other heretofore defined PMN or serum proteins as shown by ELISA . Both mAb showed specific reactivity in Western blots with CAP57 . One of these mAb (P1G8) inhibited the antimicrobial action of CAP57 by 50% at a ratio of 62.5 micrograms antibody per microgram CAP57 . The other mAb, P2A5, had no inhibitory capacity for CAP57 . Binding constants of the two mAb for the antigen were determined and were found to be virtually identical . Thus, the greater inhibitory capacity of P1G8 for bacterial killing by CAP57 was not directly related to binding strength of the mAb . Competition experiments showed that unlabeled P1G8 could compete as well against radiolabeled P2A5 as could unlabeled P2A5 . In the reverse experiment, it was seen that P1G8 competed with radiolabeled P1G8 for CAP57 better than unlabeled P2A5 . These findings could be due to two antibodies that recognize different but adjacent epitopes on CAP57, one of the epitopes (P1G8) being closer to structure(s) of the protein essential to its antimicrobial action . Immunocytochemical studies showed positive staining with both mAb . The reaction was restricted to the cytoplasm of peripheral blood PMN and was of a granular pattern . Other peripheral blood cells (which included red blood cells, eosinophils, monocytes, and lymphocytes) failed to bind either mAb. J Immunol, 1987 Aug 15, 139(4), 1297 - 302 Differential antimicrobial activity of human mononuclear phagocytes against the human biovars of Chlamydia trachomatis; Yong EC et al.; The antimicrobial activities of human mononuclear phagocytes against Chlamydia trachomatis were investigated . Phagocytes cultured for 7 days or less were efficiently microbicidal . Almost complete inactivation of organisms from both human biovars was observed after 48 hr of incubation . However, organisms from the lymphogranuloma venereum (LGV) biovar survived in mononuclear phagocytes infected after 8 days or more in culture, whereas those from the trachoma biovar continued to be killed by such cells . Phagocytes cultured as long as 21 days killed the trachoma organisms with the same effectiveness as those cultured for 7 days or less . An ultrastructural study of inoculated phagocytes illustrated phagolysosomal fusion with degradation of organisms from either biovar in phagocytes which had been cultured for 24 hr before infection . Phagolysosomal fusion was not observed in cells which had been cultured for 8 days or more and then infected with LGV . The addition of interferon-gamma to these macrophages partially restored the phagocytes' microbicidal activity for LGV . Furthermore, a synergistic effect was observed when eosinophil peroxidase was added with interferon . Specific antibody failed to neutralize the infectivity of LGV organisms in 8-day or older mononuclear phagocytes . The findings may reflect the differences in disease syndromes between the two biovars, with the trachoma biovar causing more peripheral diseases and the LGV biovar causing a more systemic disease, with lymph node involvement as its main syndrome. Hosp Pharm, 1987 Sep, 22(9), 877 - 83 A comprehensive system for antimicrobial monitoring and review using a mandatory antimicrobial ordering sheet; Jeffrey LP et al.; A comprehensive antimicrobial monitoring and review program using computer screening of information provided by antimicrobial order sheets (AOS) is needed to meet increasing pressures for ongoing review of all antibiotic use by indication . This article describes a program that has been successful in rapidly identifying areas of concern for further review and resolution . These multi-faceted programs passed JCAH scrutiny . Based on the authors experience, a system incorporating mandatory use of an AOS was preferred to a voluntary system . When used voluntarily, compliance to the use of an AOS was 84% . Compliance to use of parts of the form were stronger where check-off boxes were used instead of fill-in blanks . Surgical services personnel and first year residents were the most noncompliant . Admission orders lended themselves to noncompliance . Pharmacists using the forms were less compliant than physicians using them voluntarily, and gave different indications for use than did the physicians . Data documented on the AOS were verifiable with notes in the patient's medical record 92% of the time . Pharmacy coding and collection methods for AOS data presented problems in accurately determining compliance . When the use of the AOS became "mandatory," compliance increased to 97% . Trends in antimicrobial use were reported by an array of computer-generated reports of which several are illustrated . The system described here allows for the identification and monitoring of areas of concern in antimicrobial use, improves the efficiency of quality assurance activities, and can assess the effectiveness of a corrective action. Med J Aust, 1987 Aug 3, 147(3), 132 - 6 Atypical pneumonia: recognition and treatment; Yung AP et al.; While the term "atypical pneumonia" has been in use for many years, it cannot in fact be defined . However, there is a persuasive reason to retain the clinical use of the term, and that is to provide a guide for the clinician in the choice of empirical antibiotic therapy for patients with acute pneumonia . Atypical pneumonia, then, is a descriptive term for a common clinical syndrome . Provided certain clinicoepidemiological groups are excluded, the most common infectious causes of this syndrome are Mycoplasma pneumoniae, Chlamydia psittaci, Coxiella burneti, and Legionella species, but it should be stressed that the syndrome may occasionally be produced by other infectious and non-infectious diseases . Conversely, the atypical pneumonia syndrome occupies only one part of the clinical spectrum of disease that is caused by these organisms . This becomes important when one is selecting antibiotic therapy for patients with other respiratory syndromes, especially those with life-threatening disease . The antimicrobial therapy of the three common causes of atypical pneumonia is discussed in detail. Diagn Microbiol Infect Dis, 1987 Aug, 7(4), 283 - 6 In vitro activity in deptomycin (LY-146032) compared with other antimicrobial agents against gram-positive cocci; Wright DN et al.; A comparison was made of the activity of deptomycin (LY-146032) with that of ampicillin, cephalexin, cefamandole, cephalothin, erythromycin, teicoplanin, tetracycline, and vancomycin . The minimal inhibitory concentration (MICs) for greater than or equal to 90% of 356 Gram-positive cocci, against deptomycin, were less than or equal to 2 micrograms/ml . The MICs for the other antimicrobials varied greatly depending on the compound . A slight and unexplained inoculum effect was observed for LY-146032. J Clin Microbiol, 1987 Aug, 25(8), 1576 - 8 Effect of inoculum size on results of macrotube broth dilution susceptibility tests with Branhamella catarrhalis; Doern GV et al.; The effect of inoculum size on the results of macrotube broth dilution MICs was assessed with 15 strains of Branhamella catarrhalis versus 22 antimicrobial agents . The study isolates included five beta-lactamase-negative strains, five strains that produced beta-lactamase and for which ampicillin MICs were high, and five beta-lactamase-producing strains for which ampicillin MICs were low . An inoculum effect was observed only with strains in the last group when tested versus the following antimicrobial agents: penicillin G, ampicillin, cephalothin, cefamandole, cefuroxime, and cefaclor. Am J Obstet Gynecol, 1987 Aug, 157(2), 485 - 8 Treatment and prevention of female pelvic infection: the quest for single-agent therapy; Cunningham FG; The advantages of a single-agent regimen for prevention or treatment of female pelvic infections are outlined, and the characteristics of an "ideal" single agent are described . Indications for antimicrobial use in obstetrics and gynecology as well as the pathogens most likely to cause infection are reviewed . Empirical treatment regimens are assessed not only for efficacy but also for safety, simplicity, cost, and potential for inducing bacterial resistance . Piperacillin, as an example of an antimicrobial that may be appropriate for single-agent use in female pelvic infections, is evaluated in depth. Laryngoscope, 1987 Aug, 97(8 Pt 1), 978 - 80 Use of human amniotic membrane in otolaryngologic practice; Zohar Y et al.; Human amnion is a readily available allograft with low antigenicity, high antimicrobial potential, and the ability to foster epithelialization . We have used human amniotic membrane in our department for replacing nasal mucosa in Rendu-Osler-Weber disease, as tympanic membrane grafts, and for covering head and neck sites after flap necrosis . Our experience shows moderate success for management of severe epistaxis and excellent results in covering surfaces after flap necrosis . Use of amnion in eardrum perforations was unsuccessful and was discontinued . Properties of human amniotic membrane are listed and its application in the otolaryngologic practice is reviewed. J Pediatr, 1987 Aug, 111(2), 206 - 11 Granulocyte elastase-alpha 1-antiproteinase complex in cystic fibrosis: sensitive plasma assay for monitoring pulmonary infections; Hollsing AE et al.; Elastase in plasma was determined as a complex of granulocyte elastase and alpha 1-antiproteinase (GEC) by an enzyme-linked immunosorbent assay in 67 patients with cystic fibrosis . The patients were observed for 1 years, when clinically infected and noninfected . Although noninfected patients had GEC levels within the normal range, the mean value was significantly higher than the mean values in patients in an optimal noninfectious state (P less than 0.01) and in healthy controls (P less than 0.001) . Clinical signs of (in most cases) low-grade infection were paralleled by significant increases in GEC levels (P less than 0.001) . There was no correlation with different types of bacteria or age of patients . No cross reaction to Pseudomonas elastase could be found in vitro or in vivo . Significant decreases of GEC values were seen after intravenously administered antimicrobial therapy (P less than 0.001), and although the white blood cell count and erythrocyte sedimentation rate were rarely increased above the normal range, they decreased congruently (P less than 0.001), and lung function improved (P less than 0.001) . The sensitivity of GEC was significantly higher than that for erythrocyte sedimentation rate (P less than 0.01) and white blood cell count (P less than 0.05) . Determination of GEC values seems to be a simple and sensitive measurement for monitoring treatment in cystic fibrosis, especially of low-grade infections in patients with normal standard blood tests. J Dent Res, 1987 Aug, 66(8), 1315 - 20 A mixed-culture chemostat system to predict the effect of anti-microbial agents on the oral flora: preliminary studies using chlorhexidine; McDermid AS et al.; A mixed-culture chemostat system, composed of nine bacterial species representative of plaque in health and disease, has been assessed as an improved laboratory method of evaluating the likely in vivo effects of antimicrobial agents used in dentistry . The advantages of the system include reproducibility, the long-term stable cultivation of bacteria under controllable conditions, and repeated sampling, for bacteriological and biochemical studies, without disrupting the stability of the community . The effects of (i) the continuous provision of chlorhexidine (CHX) and (ii) three pulses of CHX (final concentration in both experiments = 0.24 mmol/L) on the composition of the chemostat communities were monitored . Only L . casei survived the continuous provision of CHX; the other bacteria were killed and were lost at different rates which generally corresponded to their known sensitivities to CHX . After each CHX pulse, the numbers of bacteria fell markedly . Again, L . casei was least affected, while A . viscosus, B . intermedius, and F . nucleatum were temporarily undetectable but returned to their original levels within 2-4 generation times . Counts of S . mutans were affected more by CHX than those of S . sanguis or S . mitior . The effect of successive pulses of CHX on the viability of some bacteria and on acid production (as measured by pH-fall experiments) decreased, suggesting that adaptation to CHX had occurred . The fact that the in vitro observations paralleled previous clinical findings suggests that the mixed-culture system could be used as a predictive model of the probable effect on the oral flora of new anti-microbial agents prior to expensive trials in animals or human volunteers. Proc Natl Acad Sci U S A, 1987 Aug, 84(15), 5444 - 8 Dequalinium, a topical antimicrobial agent, displays anticarcinoma activity based on selective mitochondrial accumulation; Weiss MJ et al.; Positively charged lipophilic compounds, such as rhodamine 123, localize in mitochondria and are selectively accumulated and retained by carcinoma cells . It has been suggested that this phenotype may be exploited for selective killing of carcinoma cells by lipophilic cations . Here we report that doubly positively charged dequalinium, which has been used for 30 years as an antimicrobial agent in over-the-counter mouthwashes, lozenges, ointments, and paints, exhibits significant anticarcinoma activity . Dequalinium is more effective than seven of eight established anticancer drugs in prolonging the survival of mice with intraperitoneally implanted mouse bladder carcinoma MB49 . Dequalinium also inhibits the growth of subcutaneously implanted human colon carcinoma CX-1 in nude mice and recurrent rat colon carcinoma W163 in rats . Lipophilic cationic compounds, such as dequalinium, could comprise a unique class of anticarcinoma agents. J Ethnopharmacol, 1987 Aug, 20(3), 191 - 207 An integrated approach to the pharmacological evaluation of traditional materia medica; Kyerematen GA et al.; A triple-tiered working model is projected for the pharmacological evaluation of crude drugs prescribed in traditional medical practices . Of the proposed component tests and procedures, the majority have had their usefulness already validated in natural product pharmacological research . First-level investigations (herbalist consultations/professional attestations, hippocratic screening and literature surveys) provide first-hand pharmacological information about traditional materia medica . Second-level investigation comprising bioassay-modelled tests (brine shrimp toxicity test, opiate receptor-binding studies, fertilized sea urchin egg test, platelet adenyl cyclase/phosphodiesterase assays, hexobarbital-induced sleeping time test, antimicrobial assays, isolated guinea pig ileum test and pharmacodynamic screening) are designed to extend the mode(s) of drug action suggested by the first-level procedures . Based on data from Level 1 and Level 2 findings, third-level experiments are specific tests tailored to confirm the pharmacodynamic/kinetic properties and clinical efficacy of traditional drugs . Level 2 and Level 3 tests may be combined in monitoring fractionations and subsequent isolation of unique crude drug constituents with potential application in conventional therapeutics. J Appl Bacteriol, 1987 Aug, 63(2), 147 - 51 On the statistical evaluation of adherence assays; Woolfson AD et al.; Parametric (unpaired t-test) and non-parametric (Mann-Whitney U-test) methods have been used in the evaluation of adherence assays on the non-antibiotic antimicrobial agent, Taurolin . In all but one case, where the anti-adherence effect was known to be marginal, both statistical methods gave similar results although there were some minor differences in the levels of significance achieved . The effect of the agent on the deviation of adherence data from normality was quantified by calculation of the skewness coefficient for each data set . A significant anti-adherence effect appears to result in a decrease in the skewness of the adherence assay data . It was concluded that either parametric or non-parametric statistical evaluation of adherence assay data is valid for large numbers of observations . In future studies of this type it is suggested that attention should also be given to the effect of the anti-adherence agent on the deviation of adherence data from normality as denoted by the skewness coefficient. J Clin Microbiol, 1987 Aug, 25(8), 1486 - 9 Unusual verotoxin-producing Escherichia coli associated with hemorrhagic colitis; Bopp CA et al.; All strains of Escherichia coli isolated from cases of hemorrhagic colitis and sent to the Centers for Disease Control, Atlanta, Ga., over a 3-year period were assayed for toxicity in Vero cell cultures . Strains that produced moderate or high levels of verotoxin were characterized by serotype, biotype, antimicrobial resistance, plasmid profile, and adherence to HeLa cells . Over 200 isolates were typical O157:H7 strains . Six isolates were atypical O157:H7 strains; two were resistant to antimicrobial agents; one was indole negative, two were citrate positive, and one was urea positive . Six isolates were nonmotile O157 strains . All of these isolates were similar to typical O157:H7 strains by plasmid profile and negative or slow sorbitol fermentation . Eleven other verotoxigenic isolates did not possess the O157 antigen, had a variety of plasmid profiles, and were sorbitol positive . Two of the eleven were enteropathogenic serotypes (O111:NM and O26:H11), yet none were adherent to HeLa cells . We conclude that verotoxigenic E . coli associated with hemorrhagic colitis includes atypical O157 strains and other serotypes . Hence, investigators should use current screening methods with caution. Am J Obstet Gynecol, 1987 Aug, 157(2), 498 - 501 Single-dose prophylaxis for vaginal and abdominal hysterectomy; Hemsell DL et al.; The practice of administering perioperative antimicrobials to uninfected patients undergoing elective surgical procedures has been subjected to careful prospective investigative scrutiny during the past two decades . A wound classification system was developed, helping to identify procedures for which prophylaxis did not provide benefit to the patient . Guidelines for prophylaxis in hysterectomy were proposed and risk factors were sought . Pharmacokinetics and spectrum of antibacterial activity, although variables of paramount importance in predicting success in the treatment of established infections, were discovered to have questionable impact on prophylactic efficacy . Duration of antimicrobial administration has gradually diminished fro