Antimicrobial

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 from the total length of hospital stay to a single preoperative dose without increased risk of infection; efficacy may be related to route of administration . The wisdom of using newer agents for prophylaxis is addressed and questioned.

Am J Obstet Gynecol, 1987 Aug, 157(2), 488 - 90
Single-agent therapy for women with acute polymicrobial pelvic infections; Hemsell DL et al.; Pathogens that cause acute polymicrobial female pelvic infections usually do not differ from those that compose the normal flora of the lower reproductive tract . Accurate identification of these bacteria is difficult because cultures obtained via the lower tract can easily be contaminated . Although use of a double-lumen catheter-protected brush culture cannot completely eliminate the risk of contamination, it is the least invasive method for obtaining culture material from the upper reproductive tract . Compounding the problem of accurately identifying pathogens that cause acute upper tract infections is the fact that bacteria appear to be present in the upper tracts of asymptomatic women with normal examinations . Because of these problems and because of the polymicrobial nature of these infections, empiric therapy frequently includes more than one antimicrobial agent . Newer, semisynthetic penicillins and cephalosporins have expanded spectrums of in vitro activity against most of the bacteria frequently recovered from pelvic infection sites . Comparative clinical trials have shown these agents to be as effective when used alone as is combination therapy . With few exceptions, empiric monotherapy with one of these newer antimicrobials will be curative for women with acute upper tract infection, will have less potential toxicity, will require less space, materials, and manpower to administer, and will be less expensive.

Proc Natl Acad Sci U S A, 1987 Aug, 84(15), 5449 - 53
Magainins, a class of antimicrobial peptides from Xenopus skin: isolation, characterization of two active forms, and partial cDNA sequence of a precursor; Zasloff M; A family of peptides with broad-spectrum antimicrobial activity has been isolated from the skin of the African clawed frog Xenopus laevis . It consists of two closely related peptides that are each 23 amino acids and differ by two substitutions . These peptides are water soluble, nonhemolytic at their effective antimicrobial concentrations, and potentially amphiphilic . At low concentrations they inhibit growth of numerous species of bacteria and fungi and induce osmotic lysis of protozoa . The sequence of a partial cDNA of the precursor reveals that both peptides derive from a common larger protein . These peptides appear to represent a previously unrecognized class of vertebrate antimicrobial activities.

Arch Surg, 1987 Aug, 122(8), 918 - 22
Single-dose antibiotic prophylaxis for biliary surgery . Cefazolin vs moxalactam; Kellum JM et al.; Cefazolin was compared with moxalactam for single-dose prophylaxis against infection in a double-blind, prospective, randomized trial of 90 patients undergoing cholecystectomy . Risk factors for infection were present in 65 (72%) of the 90 patients and were evenly distributed . Antibiotic levels in plasma, bile, and tissue measured when the cystic duct was divided were similar for both drugs . Age greater than 65 years but not recent cholecystitis or type of antibiotic was predictive of recovery of bacteria from bile cultures . Wound infections occurred in two patients receiving cefazolin and one patient receiving moxalactam for an overall infection rate of 3% . No toxic reactions to antibiotics, including bleeding disorders, were observed . In conclusion, no significant difference in prophylactic efficacy was detected in this comparison of a first-generation with a third-generation cephalosporin . Because of its lower cost and narrower antimicrobial spectrum, however, cefazolin should remain the agent of choice.

Postgrad Med, 1987 Aug, 82(2), 149 - 56
Pneumonias acquired from others . 2 . Radiographic findings, treatment; Cunha BA; Although patterns found on the chest film of a patient suspected to have pneumonia are usually nonspecific by themselves, they are useful in eliminating or narrowing diagnostic possibilities . For example, a miliary pattern suggests miliary tuberculosis, but it may also be caused by several noninfectious diseases (table 1) . Other clues, such as the presence or absence of fever, must also be considered to arrive at a likely diagnosis . Cavitary lesions, bilateral hilar adenopathy, pleural effusions, and pulmonary nodules are other findings that are commonly seen on the chest film of these patients . Possible infectious and noninfectious causes are listed in tables 2 through 5 . Antimicrobial therapy that is appropriate, free from side effects, and cost-effective must be chosen . The frequency of administration of a drug can make a great difference in the total cost of treatment, since hospitals charge for each intravenous dose . The clinician should consider which drug is effective against the infective organism and also the least expensive to administer (table 6).

J Dent Res, 1987 Aug, 66(8), 1310 - 4
A non-antibacterial chemically-modified tetracycline inhibits mammalian collagenase activity; Golub LM et al.; Tetracyclines (including the semi-synthetic analogues, minocycline and doxycycline) are considered useful adjuncts in periodontal therapy because they suppress Gram-negative periodontopathogens . Recently, these antibiotics were found to inhibit mammalian collagenase activity, a property which may also be of therapeutic value . It has been suggested that the anti-collagenase properties of the tetracyclines are independent of their antibiotic efficacy . To advance this hypothesis further, we chemically converted tetracycline hydrochloride to its non-antimicrobial analogue, de-dimethylaminotetracycline . This chemically-modified tetracycline (CMT), although no longer an effective antibiotic, was found to inhibit the in vitro activity of collagenase from partially purified extracts of human rheumatoid synovial tissue and rachitic rat epiphysis . In a preliminary in vivo study, pathologically-excessive collagenase in skin and gingiva was induced by rendering adult male rats diabetic, and the oral administration of CMT to these rats significantly reduced the excessive collagenase activity in both tissues . Moreover, CMT administration did not affect the severe hyperglycemia in these rats but did prevent, at least in part, the diabetes-induced loss of body weight, skin weight, and skin collagen mass; these effects suggest a lack of toxicity in this animal model . A proposed clinical advantage of CMT over conventional tetracyclines, in the treatment of diseases characterized by excessive collagenolytic activity, is the lack of development of antibiotic-resistant micro-organisms during prolonged use . However, the consideration of clinical trials to support this hypothesis must await further laboratory and extensive toxicity tests.

Thorac Cardiovasc Surg, 1987 Aug, 35(4), 199 - 205
Antimicrobial prophylaxis in cardiovascular surgery; Geroulanos S et al.; In the past five years three prospective randomized studies compared five different prophylactic antimicrobial regimens in major cardiovascular surgery . In 1980/81 a 4 d cefazolin (CFZ) prophylaxis (16 X 0.5 g) was compared with a 2 d cefuroxime (CFX) administration (4 X 1.5 g) . Of the 566 patients who entered the study 281 received CFZ and 285 were given CFX . In 1982/83 a 2 d CFX prophylaxis (4 X 1.5 g) was compared with a two shot ceftriaxone (CRO) prophylaxis (2 g i.v., + 1 g 24 h later) . Of the 512 patients enrolled 258 received CFX and 254 CRO . In 1984/85 a 1 d CFZ prophylaxis (4 X 0.5 g) was compared with a single shot prophylaxis of CRO (1 X 2 g) . Of the 541 patients who entered the study 272 received CFZ and 269 CRO . All patients of age 16 y or older who were undergoing open heart surgery (n = 1384) and surgery of the major arteries (n = 235) were eligible for trial entry with the following exceptions: patients with preoperative infections, those who had received an antibiotic within 48 h of operation, and any with known allergies to cephalosporins or who had suffered an anaphylactic reaction to any penicillin . The patients were allocated to one of the two treatments by means of a randomized code, stratified for cardiac and major vascular operations . The first dosis was always given prior to surgery at the beginning of anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)

Cancer Res, 1987 Jul 15, 47(14), 3895 - 900
Phase I clinical trial and pharmacokinetic evaluation of acodazole (NSC 305884), an imidazoquinoline derivative with electrophysiological effects on the heart; Trump DL et al.; Acodazole (NSC 305884) is a synthetic imidazoquinoline which has antimicrobial as well as antineoplastic properties . A Phase I trial of acodazole administered as a 1-h i.v . infusion once weekly X 4 was conducted . Mild to moderate nausea and vomiting and moderate burning and erythema at the infusion site were the only toxicities seen among 33 patients treated over 51 courses at doses between 20 mg/m2/week and 888 mg/m2 . The first patient treated at 1184 mg/m2 developed an irregular pulse and was found to have a prolonged cardiac output interval (Q-Ti) on electrocardiogram and polymorphic ventricular tachycardia ("torsades des pointes") . Careful study of five additional patients treated according to a modified schedule (340 mg/m2 week one, 500 mg/m2 week 2, 666 mg/m2 week 3, and 888 mg/m2 week 4) revealed 20% or greater Q-Ti prolongation after 20 of 27 treatments; Q-Ti prolongation had resolved 24-36 h after each infusion . Q-Ti prolongation occurred at all dose levels; no ventricular arrhythmias occurred . Acodazole was cleared with a long t1/2 (20.7 h) primarily by nonrenal mechanisms . No alterations in peak plasma levels or excretion were seen in the patients in whom Q-Ti prolongation was detected . No antitumor activity was seen . Further development of acodazole will require delineation of pharmacological means of surppressing this Q-Ti prolongation.

Biochemistry, 1987 Jul 14, 26(14), 4389 - 97
Two-dimensional NMR studies of the antimicrobial peptide NP-5; Bach AC 2nd et al.; Nearly complete proton resonance assignment of the rabbit antimicrobial peptide NP-5 has been made from two-dimensional NMR data taken at a single temperature . The assignment procedure involved acquisition of phase-sensitive double-quantum-filtered correlation spectra, relayed coherence-transfer spectra, total correlation (homonuclear Hartmann-Hahn) spectra, double- and triple-quantum spectra, and nuclear Overhauser effect spectra . The combination of these complementary experiments simplified and accelerated resonance assignment of the peptide . Individual assignments were made at 20 degrees C for all amide and C alpha protons in the peptide, and for all nonlabile side-chain protons on 26 of the 33 amino acid residues in NP-5 . Analysis of the proton-proton nuclear Overhauser effect connectivities, the slowly exchanging amide protons, and the proton chemical shifts in NP-5 indicates that the peptide has a stable, ordered structure in solution . These data also indicate that residues 19-29 in NP-5 are involved in an antiparallel beta-sheet that has a hairpin conformation.

Methods Find Exp Clin Pharmacol, 1987 Jul, 9(7), 445 - 7
The value of comparative bioavailability studies of marketed drugs in drug control . An example with erythromycin stearate; Venho VM et al.; As a part of the quality control of drugs The National Medicine Control Laboratory in Finland has started comparative bioavailability studies of synonym preparations in human volunteers by taking all the products containing the same active ingredients for absorption studies at the same time . The first study, which is presented as an example of the importance of these studies, covered three erythromycin stearate preparations containing 250 mg of erythromycin . 12 volunteers took 2 tablets of every product at one week intervals in a cross-over fashion, and the serum erythromycin levels were measured microbiologically for 12 hr . Disintegration and dissolution tests were also performed . One of the products was coated with an acid-resistant film and was not dissolved in pH 1.2, whereas the conventional tablets lost all antimicrobial activity after 15 min in pH 1.2 . In phosphate buffer, pH 6.6, all the tablets dissolved rapidly and retained antimicrobial activity . One of the conventional tablets showed only a 50% bioavailability as compared to the two others and was subsequently withdrawn from the market . Thus, it is important to conduct comparative post-marketing bioavailability studies with drugs which earlier have shown good bioavailability.

Antibiot Med Biotekhnol, 1987 Jul, 32(7), 484 - 8
{The main trends in the area of the pharmacokinetic study of chemotherapeutic agents}; Firsov AA; Development of rational antibiotic dosing is mainly limited by the absence of a clear conception of the minimum efficient concentration . Studies on antimicrobial effect kinetics in dynamic models in vitro simulating pharmacokinetic profiles observed in humans markedly promote the problem solution . Such an approach enabled one to reveal a relationship between duration or intensity of the antibiotic effect and the area under the concentration/time curve . This relationship depends on the antibiotic pharmacokinetic profile . It is advisable to evaluate antibiotic efficacy against microorganisms by the minimum efficient area under the concentration/time curve and not by the antibiotic minimum efficient concentration . Thus, it is possible to estimate simultaneous contribution of two factors to the antimicrobial effect: drug concentration and exposure time.

Br Heart J, 1987 Jul, 58(1), 66 - 71
Fifty cases of late prosthetic valve endocarditis: improvement in prognosis over a 15 year period; Leport C et al.; The clinical course, prognostic factors, and management of 50 cases of late prosthetic valve endocarditis, occurring more than two months after valve replacement, were reviewed . Twenty nine cases that presented from 1971 to 1980 were compared with 21 cases that presented from 1981 to 1985 . Apart from an appreciable decrease in the frequency of neurological complications between the first period (38%) and the second period (10%) no differences in clinical or bacteriological features were seen . Seventeen (59%) of the 29 cases in the earlier period and four (19%) of the 21 cases in the later period died . The rationale for antimicrobial treatment was similar during both periods . Cardiac surgery was performed in eight of 29 cases between 1971 and 1980 and in 11 of 21 between 1981 and 1985; the mean (SD) time between diagnosis of endocarditis and operation was 28 (19) days and 43 (44) days respectively . Six of the eight cases operated on in the first period died as did two of the 11 operated on in the second period . Twenty seven of the 29 cases presenting between 1971 and 1980 were treated with anticoagulants--either warfarin (15 of 27) or heparin sodium (12 of 27) . Sixteen of the 21 cases presenting later were given anticoagulants and 15 of these cases were given heparin sodium . Control of anticoagulation was inadequate in nine of the 27 cases treated with anticoagulants during the first period and in only two of 16 treated during the second period . During the first treatment period neurological complications were more frequent when control of anticoagulation was inadequate.

Tijdschr Kindergeneeskd, 1987 Jul, 55(3), 81 - 6
{Cephalosporins: microbiological and pharmacokinetic properties, application to pediatrics}; Geelen SP et al.; Many cephalosporins are presently available for clinical use . Although the cephalosporins are excellent antimicrobial agents for many infectious diseases in childhood, they have not replaced the older antibiotic regiments . In fact they offer the pediatrician a broader range of choices in treatment . This article gives a review on microbiological and pharmacokinetic properties of cephalosporins and an indication for the use of cephalosporins in pediatric therapy.

Photochem Photobiol, 1987 Jul, 46(1), 61 - 6
Potentially useful antimicrobial and antiviral phototoxins from plants; Towers GH et al.; The wide range of naturally occurring compounds from microorganisms and plants which are phototoxic in UV-A light (320-400 nm) includes cinnamyl esters, coumarins and furanocoumarins, furanochromones, benzofurans, alkaloids, based on tryptophan or phenylalanine, extended naptho-and anthraquinones, polyacetylenes and their thiophene derivatives . The cellular targets are cell membranes, e.g., acetylenes, or the nucleus, e.g., furanocoumarins . Compounds reacting with cell membranes in light either generate singlet oxygen, e.g., alpha-terthienyl, or react by a free radical mechanism, e.g., phenylheptatriyne, or do both . Those that react with nucleic acids intercalate with these macromolecules forming photoadducts, e.g., furanocoumarins, furanochromones and furanoquinolines . With others, such as the beta-carbolines, the explanation for their photogenotoxicity is unknown . A number of these natural photosensitizers have been examined with bacteria, yeasts, and viruses and the mechanisms of phototoxicity have been elucidated . Some of the sulfur-containing acetylenes may be useful in photochemotherapy.

Rev Infect Dis, 1987 Jul-Aug, 9(4), 693 - 703
Mixed bacterial meningitis; Downs NJ et al.; Two recent cases of mixed bacterial meningitis at the Kansas City Veterans Administration Medical Center were studied . A review of the literature suggests that 1% of all cases of meningitis are caused by more than one bacterial species . Before 1950 such cases occurred predominantly in children and were caused by combinations of bacteria commonly associated with meningitis . Since 1950 a largely adult population has been affected by mixed bacterial meningitis, with a higher incidence of gram-negative bacillary organisms cultured from the cerebrospinal fluid . Common predisposing factors in this older group of patients include infection at contiguous foci, tumors in close proximity to the central nervous system, or fistulous communications with the central nervous system . Mortality was 26% for cases occurring before 1950 and 63% for those occurring after 1950 . Failure to recognize one of the organisms present in the cerebrospinal fluid may result in the initiation of inadequate therapy in as many as 67% of cases . Empiric broad-spectrum antimicrobial therapy is indicated in symptomatic patients predisposed to mixed bacterial meningitis until culture results become available.

Z Lebensm Unters Forsch, 1987 Jul, 185(1), 10 - 3
Inhibitory effects of essential oil components on growth of food-contaminating fungi; Pauli A et al.; The antifungal activity of several components of essential oils were evaluated using a paper-disk method . The substances investigated are structurally related to eugenol . Equimolar amounts were tested on more than ten fungal strains known to contaminate food . Iso-eugenol, cinnamaldehyde, carvacrol, eugenol and thymol revealed the strongest antifungal activity . The most resistant strain appeared to be Penicillium verrucosum var . cyclopium, and the most sensitive was P . viridicatum . Some of the structural effects were considered, including a free hydroxyl group in connection with an alkyl substituent which seemed to represent an especially active configuration of phenolic compounds and which rendered antimicrobial activity.

Am J Med, 1987 Jul, 83(1), 27 - 33
Prospective randomized comparison of therapy and no therapy for asymptomatic bacteriuria in institutionalized elderly women; Nicolle LE et al.; Fifty elderly (mean age, 83.4 +/- 8.8 years) institutionalized women with asymptomatic bacteriuria were randomly assigned either to receive therapy for treatment of all episodes of bacteriuria identified on monthly culture or to receive no therapy unless symptoms developed . Subjects were followed for one year . The therapy group had a mean monthly prevalence of bacteriuria 31 +/- 15 percent lower than those in the no-therapy group, but periods free of bacteriuria lasting six months or longer were documented for only five (24 percent) subjects . For residents receiving no therapy, 71 percent showed persistent infection with the same organism(s) . Antimicrobial therapy was associated with an increased incidence of reinfection (1.67 versus 0.87 per patient-year) and adverse antimicrobial drug effects (0.51 versus 0.046 per patient-year) as well as isolation of increasingly resistant organisms in recurrent infection when compared with no therapy . No differences in genitourinary morbidity or mortality were observed between the groups . Thus, despite a lowered prevalence of bacteriuria, no short-term benefits were identified and some harmful effects were observed with treatment of asymptomatic bacteriuria . These data support current recommendations of no therapy for asymptomatic bacteriuria in this population.

Oral Surg Oral Med Oral Pathol, 1987 Jul, 64(1), 30 - 4
Systemic lupus erythematosus: a consideration for antimicrobial prophylaxis; Zysset MK et al.; Endothelial damage to heart valves, similar to that seen with rheumatic heart disease, occurs in 50% of all patients with systemic lupus erythematosus . Bacterial endocarditis is a consequence in 1% to 4% of these patients . This rate is greater than the incidence of endocarditis after rheumatic heart disease and compares favorably with the incidence of endocarditis in patients with prosthetic heart valves . At present, it is not possible to accurately delineate the subpopulation of patients with SLE that is at risk for this disease; hence, it is recommended that antibiotic prophylaxis (standard regimen suggested by the American Heart Association) be considered for all patients with systemic lupus erythematosus undergoing dental procedures associated with transient bacteremias.

Antimicrob Agents Chemother, 1987 Jun, 31(6), 925 - 9
Pharmacokinetics of cefoperazone in ambulatory elderly volunteers compared with young adults; Meyers BR et al.; Two groups of 10 healthy ambulatory subjects, i.e., a group of 10 persons less than or equal to 30 years of age (mean age, 27.6 years) and a group of 10 persons greater than or equal to 65 years of age (mean age, 70 years), were randomized in a single-trial crossover design to receive 1 and 2 g of cefoperazone with a 1-week washout between doses . The elderly subjects had both decreased estimated creatinine clearances and decreased albumin concentrations in serum . Cefoperazone concentrations in serum of elderly persons were significantly higher at each interval from 30 min to 6 h for the 2-g dose . Compared with that in younger persons, the total clearance in elderly subjects was significantly lower for both the 1- and 2-g doses, the renal clearance was significantly lower for the 2-g dose, and the area under the curve was significantly higher for the 2-g dose in the elderly persons . The half-life at beta phase was higher in the elderly persons at both the 1- and 2-g doses but not significantly so . Changes in total clearance and area under the curve and higher levels in serum in the elderly persons suggest a longer duration of antimicrobial activity in this age group.

Am J Hosp Pharm, 1987 Jun, 44(6), 1353 - 7
Retrospective review of amphotericin B use in a tertiary-care medical center; Gross MH et al.; A retrospective review of amphotericin B use in a tertiary-care medical center was conducted, and use patterns were evaluated . The pharmacy department audited the medical records of all patients who received amphotericin B during 1983 . Of 179 patients who received amphotericin B, the medical records of 140 patients were suitable for review . Amphotericin B use increased almost tenfold over a six-year period . Medical services used approximately two thirds of the total drug, while surgery used one fourth . Amphotericin B was used systemically in 98 patients and as a bladder irrigant in 42 patients . In a third of cases, the drug was used when a fungal infection was not documented . Daily dosages of less than 25 mg and total dosages of 500 mg were commonly administered . Amphotericin B was frequently administered with other antimicrobial agents in patients with serious underlying diseases; therefore, evaluation of its efficacy in all patients was difficult . Clinical nephrotoxicity was detected during treatment in approximately 15% of patients . Amphotericin B is no longer used exclusively for classical deep-seated mycoses; frequently, the drug is used as empiric treatment for candida and aspergillus infections . Amphotericin B use has risen because of the difficulty in diagnosing deep-seated mycoses and because of the frequent isolation of yeasts from seriously ill patients . Prospective studies are needed to guide clinicians in determining indications for amphotericin B use and the proper dosage and length of treatment for the drug.

J Antimicrob Chemother, 1987 Jun, 19(6), 795 - 7
Serum concentrations of amoxycillin in children following an oral loading dose prior to general anaesthesia: relevance for the prophylaxis of infective endocarditis; Cannon PD et al.; A Working Party of the British Society for Antimicrobial Chemotherapy has recommended an oral regimen for adult patients at risk from infective endocarditis who require dental treatment under a general anaesthesia . The Working Party recommends oral amoxycillin 3 g 4 hours prior to general anaesthesia . This study shows that doses of amoxycillin previously recommended for the prophylaxis of infective endocarditis in children having treatment under local anaesthesia also result in adequate serum concentrations at the time of operation (14.34 mg/l +/- (1 S.D.) 8.64).

Epidemiol Infect, 1987 Jun, 98(3), 241 - 52
Restriction enzyme fingerprinting of trimethoprim resistance plasmids; Kraft CA et al.; Restriction enzyme fingerprinting was applied to 72 transferable trimethoprim resistance plasmids to examine aspects of their epidemiology and molecular relatedness . These plasmids had previously been divided into 25 groups according to differences in mol . wts and in antimicrobial resistance determinants . Restriction enzyme fingerprinting allowed the plasmids to be further divided into 44 different groups . The groups based on molecular weight and resistance patterns often, but not invariably, corresponded with those based on restriction enzyme fingerprints . Some plasmids with the same mol . wt and resistance pattern had different digest fingerprints and conversely, although more rarely, plasmids which differed in molecular weight by as much as 10 MDa or in resistance pattern by one resistance marker, had indistinguishable fingerprints . The plasmids were initially divided into three broad categories according to which restriction enzymes gave fingerprints of 6-20 fragments . These categories differed in the molecular weights of the plasmids contained, the numbers of resistance markers, and the proportions of the plasmids which carried transposon Tn7 . Some plasmids were more widespread and persistent than others with the same mol . wt and resistance pattern but with a different restriction enzyme fingerprint . Thus, application of this technique has shown the trimethoprim resistance plasmids studied to be more diverse than was indicated by determination of mol . wt and resistance pattern, and has indicated changes in the plasmid pool over the 3 years during which they were collected.

Arch Intern Med, 1987 Jun, 147(6), 1141 - 3
Prosthetic valve endocarditis caused by Brucella melitensis . A report of four cases successfully treated with tetracycline, streptomycin, and sulfamethoxazole and trimethoprim plus valve replacement; Fernandez-Guerrero ML et al.; Optimal treatment of prosthetic valve endocarditis due to Brucella melitensis is unknown . The presence of ring abscess makes extensive surgical debridement and valve replacement essential steps of management . Antimicrobial therapy with tetracycline hydrochloride plus streptomycin sulfate or sulfamethoxazole and trimethoprim can achieve the sterilization of infected cardiac tissue . Late bland periprosthetic leaks occur frequently . Reoperation can be safely performed after a period of antimicrobial therapy . Prolonged treatment with doxycycline hyclate seems advisable.

Am J Clin Pathol, 1987 Jun, 87(6), 770 - 2
The association of antimicrobial therapy with postmortem spleen culture in bacteremic patients; Roberts FJ; A difficulty encountered during antimicrobial clinical trials is to determine whether a patient's death was related to uncontrolled bacteremia or other factors . Because the postmortem spleen culture correlates with untreated antemortem bacteremia, a study was performed to determine the association of the duration of appropriate antimicrobial therapy with the recovery of the blood culture organism from the postmortem spleen . During the last 10 days of life, blood cultures from 79 patients yielded 85 organisms . The spleen yielded 96%, 55%, 41%, and 35% of the blood culture organisms in patients receiving appropriate antibiotics for 0, less than 2, 2-4, and greater than 4 days, respectively . Statistical analysis with the use of chi-square test for stratified data showed this to be a significant trend . This correlation suggests that postmortem spleen cultures may be of value in assessing antimicrobial therapy in patients dying within ten days of proven bacteremia.

South Med J, 1987 Jun, 80(6), 774 - 7
Occult pneumococcal bacteremia and empyema without preceding pulmonary parenchymal involvement; Bennett MR et al.; We have presented a case of pneumococcal empyema without evidence of pulmonary parenchymal infection . We postulate that the pleural space was hematogenously seeded from an unexplained pneumococcemia . This manifestation of pneumococcal infection is unusual, particularly since the patient was receiving adequate antibiotic therapy before the radiologic or clinical appearance of the empyema . This emphasizes the need for diagnostic thoracentesis when the clinical situation changes, even after appropriate antimicrobial therapy is begun.

Infect Immun, 1987 Jun, 55(6), 1536 - 9
Antimicrobial binding of a radiolabeled cationic neutrophil granule protein; Farley MM et al.; A 57,000-dalton protein (CAP57) purified from human polymorphonuclear leukocytes has antimicrobial activity against a number of gram-negative bacteria . We developed a procedure using solid-phase Iodo-gen to radiolabel CAP57 without destroying its antibacterial activity . Iodinated and native CAP57 were electrophoretically identical . Autoradiographs of sodium dodecyl sulfate-polyacrylamide gels revealed greater than 95% of the 125I in a single heavy band in the 57,000-molecular-weight region . The quantity of {125I}CAP57 bound to bacterial test strains was directly proportional to the sensitivity to CAP57.

Acta Odontol Scand, 1987 Jun, 45(3), 141 - 6
Topical application of tetracycline in regenerative periodontal surgery in beagles; Claffey N et al.; This study was designed to test the effect of tetracycline on healing subsequent to periodontal surgery . Aqueous solutions of tetracyclines are highly acidic and may therefore represent a suitable substitute for citric acid . Furthermore, tetracyclines react with dental hard tissues to from long-lasting antimicrobial compounds, and they have a retarding effect on pellicle and plaque formation and an antienzymatic effect . The alveolar bone around mandibular premolars was surgically reduced up to 6 mm from the cementoenamel junction in two beagles . The denuded root surfaces were exposed to the oral environment during 3 months without plaque control . Regenerative surgery was then carried out, using root surface conditioning with 1% tetracycline and coronally repositioned flaps . Six months later, histologic evaluation showed connective tissue attachment extending to the cementoenamel junction in most of the specimens . Superficial root resorption was prevalent in the cervical region, below which a collar of replacement resorption partly surrounded the roots in a characteristic manner . Morphometric analysis showed that attachment gain was similar to that obtained with citric acid in a preceding series of seven dogs . These preliminary results indicate that connective tissue attachment gain after topical use of tetracycline is similar to that obtained with citric acid . In addition, the antibacterial capacity and biological effects of tetracycline warrant further study of its possible clinical use in periodontal reconstructive surgery.

Mol Gen Mikrobiol Virusol, 1987 Jun, (6), 3 - 9
{The "side-effects" of plasmids (R-plasmids and virulence)}; Domaradskii IV; Many plasmids affect the host cells . Their effects cannot be explained only by the expression of the well-known genes coding for antibioticresistance, bacteriocinogeny and hemolysis or the analogous genes (side-effects) . The side effects are not characteristic of all plasmids operating under similar conditions . Forecasting of the side-effects inducikility by any definite plasmid is impossible now . Sometimes the same functions exert the contrary effects on the bacterial cell . The connection between the presence of plasmids, especially R-plasmids and the complex cellular property, virulence, is of great interest . Often, bacteria become less virulent obtaining the plasmids . Two possible reasons causing such an effect are discussed . The first one is a direct effect of plasmids on cellular physiology . The second reason is connected with population shifts caused by the fact that the cells with initial low virulence possess the recipient ability predominantly . The decreased virulence of bacteria harbouring R-plasmids, in authors opinion, is quite a natural phenomenon based on plasmid host cells adaptation to the existence in "the realm of antimicrobial agents".

Chemioterapia, 1987 Jun, 6(3), 202 - 7
Controversies in antimicrobial prophylaxis; Hirschmann JV; This paper examines four controversies in antimicrobial prophylaxis . Duration of prophylaxis: Antimicrobial agents must be present in the tissues throughout the operation . Usually, a single preoperative or intraoperative dose will suffice; postoperative doses are unnecessary . Third-generation cephalosporins: no clinical evidence supports their use for surgical prophylaxis . Optimal prophylaxis for colorectal surgery: the information is conflicting, but oral agents combined with a parenteral antibiotic may be optimal . Prophylaxis for patients with indwelling prosthetic joints or vascular grafts: prophylaxis is unnecessary for procedures like dental work that cause transient bacteremia, but established infections should receive prompt, vigorous antimicrobial therapy.

Chemioterapia, 1987 Jun, 6(3), 196 - 201
Principles of antimicrobial chemoprophylaxis in surgery; Periti P et al.; In the last fifteen years great efforts have been made to establish the appropriate use of antimicrobial agents in surgery . The most common error in the use of prophylactic antibiotics is to continue the drugs beyond the time necessary for maximal benefit: the smallest dose of the drug should be given over the shortest period of time which results in a low rate of postoperative septic complications . In the selection of appropriate antimicrobial drugs for prevention or therapy of surgical infections the most important pharmacological and clinical factors affecting the choice are considered.

Burns Incl Therm Inj, 1987 Jun, 13(3), 204 - 7
A laboratory method to evaluate formulation effects on the in vitro antimicrobial activity of topical creams and ointments; Love D et al.; A simple and reproducible method is described to assess the effect of formulation on the bactericidal and fungicidal activity of topical antimicrobial agents . The technique involves direct inoculation of test and control articles followed by aliquot sampling, neutralization of active antimicrobial ingredients and enumeration of viable microorganisms by standard methods . Two silver sulphadiazine cream formulations, differing in their aliphatic alcohol content, were evaluated as manufactured and in diluted forms in this manner using three bacterial and one fungal burn wound isolates . Results were analysed by a multivariate analysis of variance to test formulation effects, concentration effects and their interaction over time . The results demonstrate that the antimicrobial activity of both creams is equivalent.

Am J Kidney Dis, 1987 Jun, 9(6), 476 - 84
Cyclosporine toxicity: the effect of combined therapy using cyclosporine, azathioprine, and prednisone; Lorber MI et al.; Forty-nine patients among 360 who received renal transplants under cyclosporine (CsA)/prednisone (Pred) immunosuppression required alteration of the immunosuppressive regimen because of intractable nephrotoxicity . Twenty-five patients, converted totally to azathioprine (Aza)/Pred, suffered intractable nephrotoxicity with no associated evidence suggesting ongoing rejection . The results with Aza/Pred conversion were disappointing because of an unacceptably high incidence of rejection and allograft loss . Twenty-four patients with intractable CsA nephrotoxicity were, therefore, treated using an alternative approach combining Aza with aggressive CsA dose reduction, and continued Pred therapy . All patients tolerated initiation of Aza without complication; allograft rejection was not common . Renal function improved for 23 of the 24 (96%) CsA/Aza/Pred patients with mean serum creatinine levels falling from 3.5 +/- 0.5 mg/dL to 2.2 +/- 0.4 mg/dL after a mean follow-up of 14 months (P less than .001) . Among 18 patients observed at least 12 months, seven (39%) enjoyed serum creatinine values less than or equal to 2 mg/dL . Nine CsA/Aza/Pred-treated patients (37.5%) required hospitalization because of infectious complications, all of which resolved with temporary reduction of immunosuppression and specific antimicrobial therapy when indicated . One patient sustained acute allograft rejection as a result of patient noncompliance, and one patient on a seemingly appropriate CsA/Aza/Pred dose responded initially to steroid pulse antirejection therapy; however, renal function again worsened . Two patients developed progressive renal dysfunction due to chronic rejection, and returned to dialysis 13 and 17 months, respectively, following initiation of CsA/Aza/Pred . Overall, the actuarial graft survival for CsA/Aza/Pred-treated patients was 100% at 1 year, and 84% at 2 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Oral Surg Oral Med Oral Pathol, 1987 Jun, 63(6), 683 - 7
Therapeutic use of chlorhexidine in bone marrow transplant patients: case studies; Ferretti GA et al.; Patients undergoing cytotoxic chemotherapy and radiation therapy often experience severe oral complications during and after treatment despite supervised oral hygiene and conventional antimicrobial regimens . The antimicrobial compound chlorhexidine is an effective topical prophylactic agent against oral mucositis and candidiasis . Oral mucositis developed in four patients who underwent bone marrow transplantation; the condition was severe enough to prompt use of chlorhexidine . In each case, there was clinical resolution of mucositis and a concomitant decrease in the oral microbial burden 1 week after chlorhexidine use began . This strongly suggests that, in addition to its value in protecting these severely immunocompromised patients from oral infection, chlorhexidine also offers a therapeutic benefit in the resolution of existing oral infections and of mucositis.

Farmaco {Sci}, 1987 Jun, 42(6), 457 - 63
Synthesis and antimicrobial activity of some new 2-chloro-4-nitrobenzoylamino acid and dipeptide derivatives; el-Naggar AM et al.; The synthesis of a series of 2-chloro-4-nitrobenzoylamino acid methyl esters (II-VIII), corresponding hydrazides (IX-XV), dipeptide methyl esters (XVI-XXII) and dipeptide hydrazides (XXIII-XXIX) was achieved employing the carbodiimide and azide methods . The derivatives containing the residues of Phe and Tyr were found to be active against several microorganisms.

HNO, 1987 Jun, 35(6), 262 - 4
{Antimicrobial action of rolitetracycline in gelatin sponge packs (Marbagelan) in tympanoplasty}; Mertens J et al.; Gelatine sponge packs (Marbagelan) saturated in rolitetracycline (Reverin) were evaluated . The antimicrobiotic efficacy of the substance was determined in 26 packs before insertion and in 20 packs removed from the external ear meatus after varying periods . High concentrations of rolitetracycline were found independent of saturation grade in the packs before insertion . In the packs removed from the external meatus acceptable antimicrobial activity was found independent of the time the packs remained in the ear . An efficient prophylaxis against infection in ear surgery is guaranteed.

Nature, 1987 Jun 25-Jul 1, 327(6124), 730 - 2
A new class of synthetic antibacterials acting on lipopolysaccharide biosynthesis; Hammond SM et al.; Although there is a need for antibacterial agents that act only on Gram-negative bacteria, there are at present few such compounds . The 2-deoxy analogue of beta-KDO (3-deoxy-beta-D-manno-2-octulopyranosonic acid) is a potent inhibitor of a key enzyme (CMP-KDO synthetase) in lipopolysaccharide biosynthesis of Gram-negative bacteria, but it fails to penetrate intact bacteria . Coupling an L-L-dipeptide to the 8-amino-2,8-dideoxy analogue of beta-KDO enabled it to be recognized and actively accumulated by certain peptide permeases of the cytoplasmic membrane . The dipeptide was hydrolysed in the cell and the inhibitor released . Subsequent inhibition of CMP-KDO synthetase led to the accumulation of large amounts of lipid A precursor and bacterial death . These compounds represent a new class of synthetic antimicrobials with a novel mechanism of action and considerable potential as chemotherapeutic agents.

J Clin Microbiol, 1987 Jun, 25(6), 1079 - 82
Regression analysis, proposed interpretative zone size standards, and quality control guidelines for a new macrolide antimicrobial agent, A-56268 (TE-031); Hanson CW et al.; A-56268 is a 6-O-methyl derivative of erythromycin A which has a spectrum of activity similar to that of erythromycin and is 1 log2 dilution more potent than erythromycin against most organisms that have been tested . The correlation of zone size diameters and MICs of A-56268 for 461 strains of bacteria isolated from clinical specimens was investigated . Based on anticipated levels in human serum of 2 micrograms/ml, 15-microgram disks have been recommended with zone size standards of greater than or equal to 15 mm for susceptibility (MIC correlate, less than or equal to 2.0 micrograms/ml) and less than or equal to 11 mm for resistance (MIC correlate, greater than or equal to 8 micrograms/ml) . Selection of these tentative breakpoints resulted in no very major errors (false susceptible), a major error (false resistant) rate of 0.22%, and an acceptable minor error (intermediate) rate of 2.82% . MIC ranges and zone diameter limits for quality control organisms used in the standardized agar dilution and disk diffusion susceptibility tests with A-56268 are given.

J Pharm Pharmacol, 1987 Jun, 39(6), 477 - 9
The differential cytotoxicity of antiseptic agents; Blenkharn JI; The cytotoxicity of the antiseptic agents noxythiolin and chlorhexidine has been evaluated in-vitro using a range of tissue culture cell lines of differing degrees of neoplasticity . Noxythiolin appeared more cytotoxic than did chlorhexidine when tested against established neoplastic cell lines . By contrast, noxythiolin was not cytotoxic to normal control (non-neoplastic) cells . For chlorhexidine, the cytotoxic activity against control cells was similar to that observed for neoplastic cell lines . The results confirm an earlier observation of limited antitumour activity of noxythiolin solutions and, on the basis of differential cytotoxicity, confirm that noxythiolin is free from adverse effects against normal tissues and is safe for use as an antimicrobial agent applied to peritoneal surfaces and the healing wound.

Vet Rec, 1987 May 23, 120(21), 495 - 9
Future developments in the manipulation of growth in farm animals; Lamming GE et al.; The anabolic steroid and antimicrobial growth promoters may be regarded as the first generation of animal growth promoters or performance enhancers . There is major investment in the development of new techniques to improve the efficiency of farm animal production . These techniques are reviewed under the headings of growth hormone (somatotrophin) and related techniques, immunological techniques, the beta-adrenergic agonists and the direct genetic manipulation of farm animals.

Pharmazie, 1987 May, 42(5), 327 - 9
Influence of vehicle on antimicrobial efficiency of topical dosage forms of chloramphenicol; Cajkovac M et al.; Antimicrobial efficiency of chloramphenicol incorporated into ambiphilic emulsion bases was investigated, and it was shown that the efficiency was several times greater than the efficiency of a comercially available lipophilic dosage form . The efficiency was especially pronounced when the samples with a higher aqueous-phase content and of a lower viscosity were used . All ambiphilic preparations were stable when stored at 4 degrees C for 6 months, and when storage time was prolonged up to 1 year the most stable formulations were those which were prepared with a mixture of Tagat S and Tegin M.

J Ethnopharmacol, 1987 May, 19(3), 319 - 25
Chemistry and pharmacology of a tertiary alkaloid from Strychnos trinervis root bark; Melo MF et al.; Bisnordihydrotoxiferine has been isolated as the major alkaloid from the root bark of Strychnos trinervis . This compound shows a wide antimicrobial spectrum against gram-positive, gram-negative and acid-fast microorganisms, filamentous and yeast-like fungi and also phytopathogenic microorganisms . Preliminary studies also reveal some cytotoxic activity in KB cells which was confirmed by tests against sarcoma 180 tumors.

J Nat Prod, 1987 May-Jun, 50(3), 418 - 21
Constituents of Tritonia crocosmaeflora, I . Tricrozarin A, a novel antimicrobial naphthazarin derivative; Masuda K et al.; A novel naphthazarin derivative, tricrozarin A, has been isolated from the fresh bulbs of Tritonia crocosmaeflora and was characterized as 5,8-dihydroxy-2,3-dimethoxy-6,7-methylenedioxy-1,4-naphthoquinone (2,3-dimethoxy-6,7-methylenedioxynaphthazarin) . Tricrozarin A exhibits antimicrobial activity against gram-positive bacteria, fungi, and yeast in vitro and is the first tetra-oxygenated naphthazarin derivative isolated from higher plants.

J Nat Prod, 1987 May-Jun, 50(3), 368 - 74
5'-Hydroxyisoavrainvilleol, a new diphenylmethane derivative from the tropical green alga Avrainvillea nigricans; Colon M et al.; A new brominated diphenylmethane, 5'-hydroxyisoavrainvilleol, was isolated from the tropical green macrophyte, Avrainvillea nigricans, using conventional chromatographic techniques . The structure is based on a combination of spectrochemical arguments, including a detailed analysis of the long range 1H-13C coupling constants . The natural product shows gram-positive antimicrobial activity.

Am J Otolaryngol, 1987 May-Jun, 8(3), 175 - 8
Acute pseudomonas mastoiditis in children; Leiberman A et al.; Five children with acute pseudomonas mastoiditis were treated and followed up in our medical center during a period of three years . The main clinical features of the disease include predilection for young male infants, a high rate of local aggressiveness, prolonged hospitalization for repeated surgical procedures, and the need for several courses of intravenous specific antimicrobial therapy . Although correctly diagnosed and promptly treated, these patients may be destined to chronic ear disorders.

J Antibiot (Tokyo), 1987 May, 40(5), 594 - 9
A new antitumor antibiotic, FR-900482 . II . Production, isolation, characterization and biological activity; Kiyoto S et al.; FR-900482 is a new antitumor antibiotic produced by a new actinomyces named Streptomyces sandaensis No . 6897 . It exhibits potent cytotoxic activity against various tumor cells in vitro . Furthermore, it has weak antimicrobial activity against some Gram-positive or Gram-negative bacteria.

Antimicrob Agents Chemother, 1987 May, 31(5), 763 - 7
Influence of antibiotics on formylmethionyl-leucyl-phenylalanine-induced leukocyte chemiluminescence; Briheim G et al.; The effect of three antimicrobial agents, penicillin G, ampicillin, and chloramphenicol, on luminol-enhanced chemiluminescence of polymorphonuclear leukocytes stimulated by the chemoattractant formylmethionyl-leucyl-phenylalanine was studied . An inhibitory effect of penicillin G and of ampicillin was demonstrated, whereas chloramphenicol gave rise to an enhancement of the chemiluminescence response from polymorphonuclear leukocytes . These effects could be due to interaction between the drugs and the polymorphonuclear leukocytes, but they could also be the result of interference with the generation of light without any effect on the cells . Therefore, the effects of the same antimicrobial agents on the chemiluminescence generated from a cell-free system consisting of myeloperoxidase and hydrogen peroxide were investigated in parallel . The results obtained in the cell-free system were almost identical to those obtained in the cell system; i.e., penicillin G and ampicillin caused an inhibition and chloramphenicol caused an enhancement of the light emission . These results indicate that observed effects induced by drugs in a chemiluminescence assay are not necessarily due to interaction between the drug and polymorphonuclear leukocytes but may be caused by interference with other components of the assay . In view of these findings, the conflicting data reported in the literature on the effects of antimicrobial agents on phagocyte function are discussed.

Rev Infect Dis, 1987 May-Jun, 9(3), 595 - 603
Treatment of infections of cerebrospinal fluid shunts; McLaurin RL et al.; There is no unanimity at present concerning the best method of treatment of cerebrospinal fluid shunt-related infections . The most frequently used method includes removal of the shunt followed by antibiotic therapy and later replacement of the shunt . The experience at the University of Cincinnati during the past 15 years indicates that many shunt infections can be effectively treated without shunt removal . This report summarizes experiences with 11 consecutive ventriculoperitoneal shunt infections . These were treated by externalization of the peritoneal catheter followed by intraventricular and systemic antimicrobial therapy and by later replacement of the peritoneal catheter . The advantages of this method include the avoidance of two major operative procedures and the elimination of a period in which the intracranial pressure is not controlled . The need for externalization of the peritoneal catheter relates to the occurrence of localized peritoneal infection and pseudocyst formation, which prevents cure of the infection in many instances if the catheter is left in place . After follow-up periods of four months to five years, 10 of the 11 patients have apparently been cured of their infection.

J Med Microbiol, 1987 May, 23(3), 279 - 88
Characterisation of anaerobic curved rods (Mobiluncus spp.) isolated from the urogenital tract; Vetere A et al.; Thirty-two strains of anaerobic curved rods isolated from vaginal secretions and one isolated from seminal fluid were examined . Growth of all strains on solid media was superior to growth in liquid media, and at 37 degrees C they grew both anaerobically and in O2 5% in N2; they also grew anaerobically at 33 degrees C but not at 42 degrees C . No growth factors were identified, but strains grew more profusely at pH values above 5 X 0 . The strains were screened in 80 biochemical tests, and for their susceptibility to 30 different antimicrobial agents . Most of the tests did not differentiate between the strains, but they were divided into four groups on the basis of cell morphology, metronidazole susceptibility, beta-galactosidase activity and arginine and hippurate hydrolysis . Group 1 consisted of 19 strains conforming to the species M . curtisi; group 2 consisted of five strains conforming to the species M . mulieris; group 3 consisted of five strains that resembled M . curtisi morphologically, and group 4 consisted of four strains that resembled M . mulieris morphologically, but the strains in the latter two groups reacted differently in at least one of the three major differential biochemical tests . Of three strains of M . curtisi and three of M . mulieris chosen at random, one of M . mulieris had a SDS-PAGE and fast-protein liquid chromatography protein profile indistinguishable from that of M . curtisi . We conclude that further efforts are required to clarify the taxonomic status of the genus Mobiluncus.

Br J Obstet Gynaecol, 1987 May, 94(5), 454 - 60
Microbiological and histopathological findings in acute pelvic inflammatory disease; Paavonen J et al.; Upper genital tract infection was investigated in 45 women admitted to hospital for suspected acute pelvic inflammatory disease (PID) . Salpingitis was diagnosed by laparoscopy in 30 (67%) women . Histopathological evidence of endometritis was found significantly more often in the 30 women with salpingitis (87%) than in the other 15 women without salpingitis (33%) . C . trachomatis or N . gonorrhoeae, or both, were isolated from the upper genital tract in 14 of the 31 women who had both salpingitis and endometritis or endometritis only but in none of the four women who had salpingitis alone and in none of the 10 women who had no evidence of PID . Bacterial vaginosis was associated with histopathological evidence of upper tract infection . Non-chlamydial non-gonococcal organisms were frequently isolated from the upper genital tract . No organisms were isolated from the upper genital tract from 9 of 35 women with laparoscopic or histopathological evidence of PID compared with 7 of 10 women without evidence of PID . C . trachomatis or N . gonorrhoeae in the endometrium was associated with lymphoid follicles comprising transformed lymphocytes, and correlated with the density of plasma cells on biopsy . The microbiological results support the recommendations of broad spectrum antimicrobial therapy for PID.

Am J Clin Pathol, 1987 May, 87(5), 669 - 72
The pathology of fatal Mediterranean spotted fever; Walker DH et al.; A 77-year-old woman from rural Spain had a febrile summertime disease develop with rash, eschar, and pulmonary, abdominal, and neurologic signs and symptoms . Mediterranean spotted fever (MSF) was diagnosed late in the course, and antirickettsial treatment was given only during the last 30 hours of life . Clinical manifestations of severe disseminated vascular injury included thrombocytopenia, hypoalbuminemia, edema of the lungs and legs, and severe prerenal azotemia . The diagnosis was documented by specific serology . Necropsy revealed vascular injury with perivascular lymphohistiocytic infiltrates suggestive of rickettsiosis in the central nervous system, lung, heart, kidneys, esophagus, stomach, colon, pancreas, spleen, and thyroid . Gastric hemorrhage and acute pneumonia contributed to the patient's death on day 18 of illness . Antimicrobial treatment and host defenses apparently reduced rickettsiae to an undetectable quantity . MSF has increased in incidence in the Mediterranean basin and has been reported in travelers returning to the United States.

J Med Chem, 1987 May, 30(5), 871 - 80
Structure-activity relationships in the 2-arylcarbapenem series: synthesis of 1-methyl-2-arylcarbapenems; Guthikonda RN et al.; The labile tert-butyldimethylsilyl esters of the azetidinones 6-8b served as the crucial synthons in the preparation of the potentially useful ylide pyridyl thio esters 18-20 . These intermediates were utilized to synthesize a host of title carbapenems 25-30d, 32, and 49-53 . The antimicrobial properties and DHP-I susceptibility of these carbapenems were studied with reference to thienamycin.

J Infect Dis, 1987 May, 155(5), 855 - 61
Bronchoalveolar lavage for diagnosing acute bacterial pneumonia; Thorpe JE et al.; The utility of gram stain and semiquantitative culture of the fluid retrieved by bronchoalveolar lavage (BAL) in identifying the causative agent in acute bacterial pneumonia was initially assessed in 92 patients . Fifteen of these patients presented with clinically active bacterial pneumonia; the remaining patients underwent bronchoscopy to evaluate other processes in the lung . Thirteen of the 15 patients with clinically active bacterial pneumonia had a BAL culture greater than or equal to 10(5) colony-forming units per milliliter of BAL fluid, whereas none of the other groups had a positive culture (chi 2 = 70.7, P less than .001) . Gram stain of cytocentrifuged BAL fluid was positive (one or more organisms seen per 1,000 X field) only in those patients with an active bacterial pneumonia . Applying this technique, we studied 59 immunocompromised patients presenting with pulmonary infiltrates . Eight (21%) of the 39 patients presenting with microbial-related infiltrates proved to have acute bacterial pneumonia by BAL culture; the pneumonia resolved with appropriate antimicrobial therapy.

Am J Obstet Gynecol, 1987 May, 156(5), 1201 - 5
Single-dose cephalosporin for prevention of major pelvic infection after vaginal hysterectomy: cefazolin versus cefoxitin versus cefotaxime; Hemsell DL et al.; Antimicrobial overutilization accelerates the development of bacterial resistance . A prospective, randomized, blinded clinical trial of vaginal hysterectomy prophylaxis was designed to compare the efficacy, safety, and costs of cefazolin with those of cefoxitin and cefotaxime . Sixteen women (7.5%) developed febrile morbidity only, 10 (4.7%) developed major pelvic infection requiring parenteral antimicrobial therapy, and neither clinical nor laboratory adverse reactions of significance were observed . Anemia, diabetes, and additional surgical procedures were associated with a significantly increased incidence of postoperative infection; no regimen was more protective for women with or without these risk factors . Infections almost doubled hospital stay and the charges for health care . Diagnosis-related group reimbursement would have been more than $1,300 less than the mean hospital charge for women who developed infection . Utilizing cefazolin for prophylaxis and reserving cefoxitin and cefotaxime for therapy is cost and antimicrobial efficient.

Am J Obstet Gynecol, 1987 May, 156(5), 1148 - 52
Single-dose antimicrobial therapy in the treatment of asymptomatic bacteriuria in pregnancy; Jakobi P et al.; Fifty obstetric patients with asymptomatic bacteriuria were treated by single-dose antimicrobial therapy . The immediate cure rate was 84% and the recurrence rate was 12% . Seven of the eight patients in whom single-dose treatment failed responded to subsequent 7-day therapy with the same drug, indicating renal involvement . A 50% recurrence rate in the group of patients in whom single-dose treatment failed was compared with a 5% recurrence rate in the group cured by single-dose therapy, which indicates that failure with single-dose antimicrobial therapy can serve as a therapeutic test to identify patients at high risk for recurrent bacteriuria and its sequelae during pregnancy . It is concluded that single-dose antimicrobial therapy is a safe and effective way to treat asymptomatic bacteriuria in pregnant patients without urologic problems in their history.

Urol Clin North Am, 1987 May, 14(2), 307 - 22
Medical treatment of male infertility; Hirsch IH et al.; After an appropriate clinical and laboratory assessment of a patient's fertility status, the clinician must often decide whether specific and empiric treatment is indicated . Specific treatment may take the form of replacement therapy (exogenous gonadotropins or GnRH) for pituitary or hypothalamic failure, inhibition of prolactin secretion, antimicrobial therapy, or immunosuppressive therapy for demonstrable immunologic infertility . Finally, ejaculatory dysfunction often requires sympathomimetic agents . Alternatively, in the normogonadotropic oligospermic patient, the major form of empiric therapy relies on the enhancement of physiologic hormone levels that influence spermatogenesis . Such "stimulation" therapy may be achieved by GnRH analogues, antiestrogens, exogenous gonadotropins, or androgens.

Ann Intern Med, 1987 May, 106(5), 745 - 56
History of the specialty of infectious diseases in the United States; Kass EH; Infectious diseases in the United States were for generations so integral to health and medicine that a special interest in the field, except for investigative purposes, could hardly be contemplated . With declining mortality and morbidity from infections, and the advent of major antimicrobial drugs, interest in infectious disease flagged in clinical and microbiological departments . Several factors have caused a new interest in infectious disease, including the appearance of newly recognized infectious disease syndromes; advances in microbiologic, immunologic, virologic, and epidemiologic understanding; increased societal interest; proliferation of effective therapeutic and preventive agents; and the general thrust toward specialization . This interest led to the formation of societies, subspecialty boards, and journals, and accounts for the prominence of infectious disease in clinical departments and in national thought . Similar developments are taking place at various rates in other countries, with renewed attention to the toll of infectious diseases in developing countries.

Vet Clin North Am Small Anim Pract, 1987 May, 17(3), 577 - 602
Special considerations for appropriate antimicrobial therapy in neonates; Jones RL; Guidelines for the use of antibiotics in puppies and kittens must take into account drug absorption, distribution, metabolism, and excretion . In the neonate, these factors may differ considerably from those in the adult; thus, there are differences in therapeutic efficacy and adverse effects . This article discusses the special considerations for antimicrobial therapy in neonates and presents a rational approach to selecting antimicrobial therapy that improves the use of antibiotics.

Am J Clin Pathol, 1987 May, 87(5), 640 - 1
Susceptibility of Gardnerella vaginalis to metronidazole, its bioactive metabolites, and tinidazole; Bannatyne RM et al.; The susceptibilities of 510 clinical isolates of Gardnerella vaginalis to metronidazole, its principal oxidative metabolites, and tinidazole were determined by an agar dilution method . The hydroxy metabolite was the most active, with an MIC90 value (minimum concentration that inhibited 90% of the strains) of 1.12 mg/L (5.51 mumol/L) . Tinidazole and metronidazole were somewhat less active, with MIC90s of 4.09 mg/L (23.9 mumol/L) and 4.44 mg/L (18.0 mumol/L), respectively . The acid metabolite was inactive, with an MIC90 value of 226.55 mg/L (1.22 mmol/L) . These results suggest that the hydroxy metabolite of metronidazole may contribute significantly to the antimicrobial effect of the parent drug in G . vaginalis-associated infections.

J Infect Dis, 1987 May, 155(5), 968 - 72
Oral antimicrobial therapy for adults with osteomyelitis or septic arthritis; Black J et al.; We conducted a retrospective review of 21 adult patients with osteomyelitis and septic arthritis who were treated with high doses of oral antimicrobial agents, usually after an initial course of intravenous therapy . The mean duration of parenteral and oral therapy was 3.6 days and 43.0 days, respectively . Absorption of oral antibiotics was assessed by determining the trough serum bactericidal titers for the infecting organism; whenever feasible, the dosages were adjusted to achieve trough titers greater than or equal to 1:8 . The follow-up period ranged from six to 66 months (mean, 42.4 months) . Eighteen of 21 patients had no clinical signs of recurrence after initial therapy . One patient with an infected joint prosthesis developed recurrent infection, and two patients had recurrences accompanied by sequestra . The mean duration of hospitalization was 13.4 days, and the mean duration of outpatient treatment was 31.9 days.

Diagn Microbiol Infect Dis, 1987 May, 7(1), 45 - 50
Mechanism of aminoglycoside resistance among beta-lactam-resistant Escherichia coli in the United States; Gaynes RP et al.; We examined aminoglycoside (AG) resistance in ampicillin-resistant Escherichia coli obtained from nine hospitals participating in the National Nosocomial Infections Study . The isolates were tested to 25 antimicrobials using broth microdilution methods . If the organism was intermediate or resistant to gentamicin, tobramycin, netilmicin, or amikacin, we determined the class of aminoglycoside-modifying enzyme (AME) using the phosphocellulose paper binding assay . Of 423 E . coli, 21 (5%) were intermediate or resistant to one or more of the AGs . All but two of these E . coli isolates had at least one AME . Twelve isolates had phosphotransferase (APH) enzymes; seven had adenyltransferase (ANT) enzymes (all ANT{2"}); and four had acetyltransferase (AAC) enzymes . The seven ANT{2"}-producing isolates were more likely to be acquired in the community than in the hospital (4/7 ANT{2"}-producing E . coli versus one of 14 of the other AG-resistant E . coli, p = 0.03, Fisher's exact test) . These findings suggest that for E . coli resistant to both ampicillin and an AG, APH enzymes are the predominant AME class . Additionally, isolates with certain AMEs may be acquired both in the community and in the hospital.

Ann Inst Pasteur Microbiol, 1987 May-Jun, 138(3), 349 - 58
Evaluation of a standard scrubbing method for the recovery of aerobic skin flora; Chevalier J et al.; The most reliable method for sampling skin flora is still a matter of debate, although the subject is of importance in many fields ranging from clinical to basic research . For the evaluation of normal skin flora, Williamson and Kligman's scrub method is the most commonly used . In order to determine the value of this method, standardized for the evaluation of topical antimicrobial agents on aerobic skin flora, we compared its results to those obtained both from bacterial counts and from microscopic studies on biopsies performed at the same site . After different experiments had established the optimal experimental conditions on human and pig skin, a comparative study on six healthy subjects was carried out in the peri-umbilical area . The mean log numbers of aerobic bacteria in the scrub samples and in the biopsies were respectively, 3.1 and 2.9, which were not statistically significant . These numerical results were similar to those obtained by electron microscopy . Hence, the standard scrub method may be considered satisfactory for the recovery of aerobic bacteria from healthy human skin.

Biol Chem Hoppe Seyler, 1987 May, 368(5), 501 - 6
Molecular cloning and expression of a synthetic DNA coding for the antimicrobial protein of bull seminal plasma; Preuss KD et al.; A DNA carrying the coding sequence for the antimicrobial protein from bull seminal plasma (SAP) was obtained by enzymic ligation of six synthetic oligonucleotides . The 162 bp synthetic DNA fragment was cloned into the C-terminal part of the lacZ-gene employing the vector pUR289 . Expression in E . coli in the presence of the inducer isopropylthiogalactoside (IPTG) led to the formation of a fusion protein, which was shown by immuno-blotting to contain immuno-reactive antimicrobial protein . Approximately 90 min after induction, the cells stopped growing and the culture was found to contain no viable cells 3 h after induction . We conclude from this observation that the beta-galactosidase-antimicrobial protein fusion product was toxic for the E . coli cell and that the SAP-residue attached to beta-galactosidase was responsible for the cytotoxicity.

J Burn Care Rehabil, 1987 May-Jun, 8(3), 206 - 9
Prospective clinical study of Hydron, a synthetic dressing, in delivery of an antimicrobial drug to second-degree burns; Fang CH et al.; This clinical trial prospectively evaluates the potential beneficial effects of antimicrobial drug delivery from a synthetic dressing (Hydron-AgSD) formed on second-degree burn wounds . A paste composed of polyethylene glycol-400, poly 2-OH ethylmethacrylate, and silver sulfadiazine (AgSD 1%-3%) matured within one hour to form a solid dressing . In 27 patients, comparable areas of second-degree wounds on the same patient were selected at random for test and control (silver sulfadiazine 1% only) sites . The mean total time of the synthetic dressing application per patient was about nine days, and each dressing remained in place for nearly four days . During this interval the control sites required four dressings changes . In 17 tests for infections, the control areas were contaminated but no bacteria were detected under the synthetic dressing; in three tests, the controls had no bacteria, whereas the synthetic dressing did . Healing of burns was similar under both types of dressing . Benefits of Hydron treatment included increased patient comfort because of the reduced number of dressing changes and, in some cases, greater freedom from contaminating bacteria.

Antimicrob Agents Chemother, 1987 May, 31(5), 780 - 3
Rapid in vitro metabolic screen for antileprosy compounds; Franzblau SG et al.; Measurement of intracellular ATP of Mycobacterium leprae after direct in vitro exposure to antimicrobial agents was evaluated as a rapid means of identifying potentially useful therapeutic agents . Nude mouse-derived M . leprae was incubated in an axenic modified Dubos medium in the presence or absence of antimicrobial agents for up to 3 weeks . ATP was then assayed by using the firefly bioluminescence technique . Rifampin, clofazimine, and ethionamide each effected a significantly accelerated rate of ATP decay compared with controls . Dapsone appeared inactive, possibly reflecting a general insensitivity of this system to compounds acting at certain loci . The system appeared suitable for assessing comparative activity of new structural analogs of clofazimine . Other active compounds included erythromycin, minocycline, chloramphenicol, gramicidin, and, to a lesser extent, cycloserine, cephalothin, ciprofloxacin, tetracycline, and gramicidin S . The penicillins, bacitracin, isoniazid, nalidixic acid, trimethoprim, polymyxin B, and griseofulvin were all inactive . The system appears sensitive to agents with various modes of action and may prove useful as a primary screen for antileprosy drugs.

Rev Infect Dis, 1987 May-Jun, 9 Suppl 3, S297 - 312
Economic evaluations of antibiotic use and resistance--a perspective: report of Task Force 6; Liss RH et al.; The economic consequences of antibiotic prophylaxis and therapy for bacterial infections in humans are profound . The reduction in real-dollar terms in the amount of illness and disability resulting from the use of developed and marketed antibiotics far outweighs costs of adverse effects, including resistance . Although bacterial infections continue to cause substantial mortality and morbidity worldwide, standard criteria for assessing the relation of infection to death or the contribution of resistance to mortality and morbidity do not exist . While local outbreaks of resistance may have serious consequences, bacterial susceptibility to antimicrobial therapy has remained virtually unchanged nationally where studied . Nevertheless, discriminating use of antimicrobial agents is held widely to be the keystone for minimizing resistance . It is not clear whether risk of selecting resistance is lowered by current community or clinical practices . Some analysts concentrate on the "problem" and "cost" of resistance and forget the benefits of the use of antibiotics . Development of resistance is a natural consequence of antibiotic use, but further quantification of this relation is required . Reports that resistance is increasing worldwide have presented a scientific challenge and economic opportunity to the pharmaceutical industry for the development of new antimicrobial agents . However, if a reasonable rate of return cannot be foreseen, capital for research and development is likely to be invested in areas that appear more financially attractive.

Rev Infect Dis, 1987 May-Jun, 9 Suppl 3, S270 - 85
Social, behavioral, and practical factors affecting antibiotic use worldwide: report of Task Force 4; Kunin CM et al.; In addressing its charge from the General Chairperson of this study, Task Force 4 decided to direct special attention to antibiotic use in developing nations because of the critical importance of the disease burden of bacterial infections in these regions of the world . The task force recognized the impact of respiratory and diarrheal diseases on morbidity and mortality among young children in developing nations . Another major concern was the potential for global spread of resistant strains . Emergence and spread of antibiotic-resistant bacteria is augmented in settings in which treatment may be inadequate because of socioeconomic constraints and where there is crowding and poor sanitation . Much of the information concerning the factors that govern antibiotic use in these countries is anecdotal . No two countries are identical in their use of antimicrobial agents, and patterns of use may differ greatly in regions within the same country . Efforts to improve the usage of antibiotics in developing countries must take into consideration the perception of health and disease of the populations, the availability of antibiotics, and the characteristics of the established systems of medical care.

Eur J Pediatr, 1987 May, 146(3), 216 - 20
Bacterial meningitis: is there a "best" antimicrobial therapy?
Eichenwald HF.
The introduction of several cephalosporins into pediatric practice has provided the physician with a number of choices in the treatment of neonatal and childhood meningitis . Adequate studies are available to indicate that these new drugs are as effective as traditional treatments in terms of survival and major neurologic sequelae but it is not known whether the results are worse or better as far as the incidence of more subtle neurologic changes is concerned . The advantages of the cephalosporins in treatment of childhood meningitis are that they permit single drug therapy, the risks of drug toxicity are reduced, and the problems of penicillin-tolerant pneumococci and ampicillin/chloramphenicol-resistant H . influenzae are avoided . When used in the treatment of neonatal disease, the cephalosporins have the advantage of lower toxicity than the aminoglycosides, generally making blood drug level determinations unnecessary, and are effective against strains of bacteria that have become resistant to the latter drugs.

Sci Total Environ, 1987 May, 63, 191 - 7
Antimicrobial activity of electrolyzed saline solutions; Wilk IJ et al.; Electrolysis of solutions containing certain electrolytes, through the use of novel electrodes, produces significant levels of ozone, oxygen, and chlorine at the anode . The process works at ordinary temperatures, and with dilute solutions . These solutions, after electrolysis, can be much more effective, by a factor of several hundred, against microorganisms than solutions containing comparable hypochlorite solutions.

J Clin Microbiol, 1987 May, 25(5), 819 - 23
Yield, clinical significance, and cost of a combination BACTEC plus Septi-Chek blood culture system; Thomson RB Jr et al.; A blood culture was performed by adding a vented Septi-Chek bottle (Roche Diagnostics, Div . Hoffmann-LaRoche Inc., Nutley, N.J.) to a standard BACTEC system (Johnston Laboratories, Inc., Towson, Md.) blood culture . The yield of bacteremic patients, the clinical significance of organisms detected, and the cost of the combination system were compared with those of the standard BACTEC system alone . Each culture included 20 ml of blood divided among a BACTEC 6B aerobic bottle (5 ml), a BACTEC 7D anaerobic bottle (5 ml), and a Septi-Chek bottle equipped with a slide subculture attachment (10 ml) . Significant isolates grew in 9.6% of the 2,269 cultures evaluated . The combination BACTEC plus Septi-Chek system detected 25% more bacteremic patients than the BACTEC system alone, 129 patients versus 103 . The 26 bacteremic patients detected by only the added Septi-Chek bottle included 7 whose organism was isolated from blood alone and 19 whose organism was in mixed or pure culture from a second source . Detection of the organism resulted in alteration of antimicrobial therapy in 17 of these 26 patients . The combination system, which cultured a 20-ml blood volume, cost $11,000 more during the study period than the BACTEC system alone, which cultured a 10-ml volume . Reimbursement under the diagnosis-related group system was increased by $23,000 as a result of documentation of sepsis in these 26 patients . Blood volume and, possibly, the use of multiple blood culture systems are important factors when selecting a blood culture procedure for routine use.

Antimicrob Agents Chemother, 1987 May, 31(5), 811 - 2
In vitro evaluation of CP-62,993, erythromycin, clindamycin, and tetracycline against Chlamydia trachomatis; Walsh M et al.; The antimicrobial activity of CP-62,993 against four Chlamydia trachomatis isolates was compared with those of erythromycin, clindamycin, and tetracycline . The MIC of CP-62,993 was 0.26 to 1.02 micrograms/ml for 100% inclusion inhibition and 0.031 to 0.063 microgram/ml for 50% inclusion inhibition . With pharmacokinetic and antimicrobial studies demonstrating prolonged half-life and in vitro effectiveness, CP-62,993 may make possible a single, short-course treatment regimen for C . trachomatis infection.

Am J Trop Med Hyg, 1987 May, 36(3), 541 - 8
Loss of granule myeloperoxidase during in vitro culture of human monocytes correlates with decay in antiprotozoa activity; Locksley RM et al.; Human monocytes maintained in culture lose microbicidal activity against intracellular protozoa which has been correlated with attenuation of the respiratory burst . The granule enzyme myeloperoxidase, which can markedly amplify hydrogen peroxide-dependent antimicrobial activity, is also lost in vitro . Adherent monocytes were examined immediately, 3 and 10-14 days following explantation, for the magnitude of the stimulated respiratory burst and for cellular myeloperoxidase . Fresh cells generated 254 +/- 38 nmol O2-/mg protein as compared to a peak of 782 +/- 45 nmol O2-/mg at 3 days and less than 100 nmol O2-/mg after 10-14 days . The myeloperoxidase content of the cells also decreased; over 85% was lost after 3 days . Fresh monocytes killed over 90% of ingested Toxoplasma gondii or Leishmania major . In contrast, 10-14 day explanted monocytes killed only 12% of ingested Toxoplasma and 33% of Leishmania, and surviving organisms replicated readily . The 3-day monocytes were significantly less able to kill protozoa than were fresh cells despite their nearly 3-fold greater generation of O2- . If peroxidase was reintroduced into 3-day monocytes by coating organisms with eosinophil peroxidase prior to phagocytosis, their antiprotozoa activity was nearly restored to that of freshly explanted cells.

Arch Inst Cardiol Mex, 1987 May-Jun, 57(3), 229 - 33
{Infectious endocarditis caused by Candida . Presentation of 3 cases and review of the literature}; Palacios Hernandez HJ et al.; We present 3 patients with infective endocarditis due to Candida sp . They were not immunodeficient subjects, but they had major surgery, longterm antimicrobial therapy and prosthetic implants . Candida endocarditis is a difficult diagnosis for biological and technical . There is also poor results with and therapeutic reasons . The combined treatment with amphotericin B and 5-fluorocytosine, plus surgical removal of the infected tissue is recommended widely in the literature.

Contact Dermatitis, 1987 May, 16(5), 260 - 2
Dodecyl gallate, permitted in food, is a strong sensitizer; van der Meeren HL; Additives are now an established part of our packaged food . Some, like colouring agents and flavouring compounds are hardly necessary or even redundant . Others, mainly antimicrobials and antioxidants, are very important . Antioxidants are not only added to food, but also to cosmetics, pharmaceuticals and industrial products . Dodecyl gallate belongs with propyl- and octyl-gallate to the synthetic esters of gallic acid . These lipid-soluble phenols are very effective antioxidants . We found contact allergy in 4 of 10 workers having only limited contact with dodecyl gallate in the very low concentration of 0.05% . It is important to recognize its strong sensitizing capacity . Workers working with dodecyl gallate should avoid direct skin contact.

Am J Med, 1987 Apr 27, 82(4A), 387 - 90
Economic impact of oral ciprofloxacin . A pharmacist's perspective; Barriere SL; With increasing numbers of patients covered under diagnostic-related group or prospective payment systems, there is mounting pressure to reduce the costs associated with caring for patients while maintaining the quality of care . New, broad-spectrum, parenteral antimicrobial agents are a prime target for cost control . The availability of an orally administered drug that is effective in a variety of serious infections would have a significant impact on cost reduction in hospitals . A significant proportion of the cost of parenteral drug therapy is associated with labor, supplies, and equipment . An orally administered drug would obviate these costs . Additionally, iatrogenic problems associated with parenteral therapy (e.g., phlebitis) would be avoided, the quantities of expensive parenteral drugs purchased might be reduced, and the duration of hospitalization for selected diseases such as osteomyelitis would probably decrease . Finally, the ease of oral administration may allow longer courses of therapy for resistant infections than have heretofore been possible . Oral ciprofloxacin and similar compounds present both opportunities and challenges for pharmacists . The fiscal impact may be beneficial for the hospital in terms of cost reductions for drug purchases and in expediting discharge for prolonged courses of outpatient therapy . The magnitude of cost reductions will vary substantially depending upon the types of patients and infections managed in a given institution . The challenge for pharmacists is to assure that these valuable compounds, as well as all antimicrobial agents, are appropriately utilized to avoid the offsetting costs of adverse effects, superinfection, unnecessary use, and the development of resistance.

Am J Med, 1987 Apr 27, 82(4A), 317 - 20
Treatment of chancroid with ciprofloxacin . A prospective, randomized clinical trial; Naamara W et al.; Chancroid is a major sexually transmitted disease in many developing countries . Although single-dose and short-course treatment of chancroid have been described, the increasing resistance of Hemophilus ducreyi to antimicrobial agents requires continuing evaluation of new therapies . Ciprofloxacin is a new quinolone antimicrobial agent with excellent in vitro efficacy against H . ducreyi . A double-blind, randomized clinical trial was conducted comparing a single-dose ciprofloxacin regimen (500 mg) and a three-day regimen of ciprofloxacin (500 mg twice daily) with a three-day regimen of trimethoprim-sulfamethoxazole (160 and 800 mg, respectively, twice daily) for the treatment of chancroid . The three-day ciprofloxacin regimen successfully eradicated H . ducreyi, and resulted in rapid clinical improvement in all 40 patients followed, with no failures . The other two regimens were also effective, but bacteriologic and clinical failure occurred in two and three patients following treatment with single-dose ciprofloxacin and three days of trimethoprim-sulfamethoxazole, respectively . All patients with buboes had resolution of lesions . There were no significant adverse effects associated with ciprofloxacin or trimethoprim-sulfamethoxazole . All three regimens are effective therapy for chancroid and H . ducreyi infections . If resistance to trimethoprim-sulfamethoxazole becomes widespread, ciprofloxacin may become a first-line therapy for chancroid . This study also demonstrates the efficacy of ciprofloxacin in soft tissue infection.

Am J Med, 1987 Apr 27, 82(4A), 12 - 20
Mechanisms of action of and resistance to ciprofloxacin; Hooper DC et al.; Ciprofloxacin and other newer quinolone antimicrobial agents exhibit increased potency and decreased frequency of spontaneous bacterial resistance in comparison with older analogues such as nalidixic acid . New and published observations on the mechanisms of action of and resistance to ciprofloxacin in Escherichia coli are presented and discussed . Genetic and biochemical studies have identified the A subunit of the essential bacterial enzyme DNA gyrase as a target of ciprofloxacin and other quinolones . For a series of quinolones, inhibition of purified DNA gyrase correlated with antibacterial activity . The bactericidal activity of ciprofloxacin and ofloxacin is, in contrast to that of certain other quinolones, somewhat less affected by rifampin and cell starvation, suggesting the existence of a site of drug action in addition to DNA gyrase . The frequency of selection of spontaneous single-step resistance mutants of E . coli was more than 100-fold lower with ciprofloxacin than with nalidixic acid . Strains highly resistant to ciprofloxacin could, nevertheless, be selected by serial passage on drug-containing agar . Two mutations contributing to this high level of resistance were analyzed . One, designated cfxA, conferred a 16-fold increase in drug resistance and mapped in a location consistent with a gyrA mutation; similar increases in resistance to ciprofloxacin were seen with gyrA mutations selected for resistance to other quinolones . The other mutation, cfxB, conferred pleiotropic resistance to ciprofloxacin, tetracycline, and chloramphenicol and appeared to be an allele of the multiple antibiotic resistance gene marA . The mutation cfxB was associated with a decreased amount of porin outer membrane protein OmpF, suggesting that drug permeation may occur in part through this channel . In summary, the A subunit of DNA gyrase is a target of ciprofloxacin and other quinolones . Ciprofloxacin resistance appears to occur both by mutation in this target and by alteration of drug permeation through the outer membrane of the cell.

Tijdschr Diergeneeskd, 1987 Apr 15, 112(8), 486 - 90
{The importance of health protection of the consumer in relation to veterinary drugs}; Peters PW et al.; The responsibility of the Ministry of Welfare, Health and Cultural Affairs (WVC) and especially the task of the Veterinary Public Health Inspectorate (VI), and the research and advice of the National Institute of Public Health and Environmental Hygiene (RIVM) are described with regard to the Netherlands Veterinary Medicinal Products Act, now and in the future . The registration of these medicines is also necessary for the safety of the consumer; this holds both for the problems related to residues in products of animal origin, and for the problems with respect to bacterial resistance to antimicrobial drugs, because of therapeutic prescription of the same type of drugs in human patients . The admittance to the market of a veterinary drug will only take place after an adequate risk-evaluation with respect to human health, followed by risk-management; the latter implies the admittance policy and its control . The authors have the opinion that the internal quality control and quality assurance during the meat production chain has to be conducted by the producers themselves . The monitoring of this surveillance, and hence the external quality assurance, will remain a governmental responsibility to safeguard products of animal origin.

Klin Wochenschr, 1987 Apr 15, 65(8), 380 - 6
Intralymphatic interleukin-2 treatment of a hemophiliac AIDS patient with defective interleukin-2 production; Gramatzki M et al.; To improve immune functions in an interleukin-2 (IL-2) deficient hemophiliac AIDS patient suffering from severe Pneumocystis carinii pneumonia, treatment with IL-2 was started in addition to standard antimicrobial therapy . Highly purified IL-2 was administered subcutaneously and then repeatedly intralymphatically in a manner similar to pedal lymphography . No toxicity was observed . The patient temporarily improved clinically as well as with regard to immunological functions . Particularly the in vitro response to phytohemagglutinin (PHA) could partly be restored, and skin tests revealed improved response to recall antigens . These findings indicate that IL-2 can be administered safely and effectively by the intralymphatic route and may--in addition to antibiotics--be of value in AIDS patients with severe opportunistic infections.

Arch Intern Med, 1987 Apr, 147(4), 666 - 71
A simple index to identify occult bacterial infection in adults with acute unexplained fever; Mellors JW et al.; Patients with acute fever (less than three weeks' duration) and no localizing symptoms or physical findings to suggest a source (unexplained fever) may have self-limited illness or occult bacterial infection requiring prompt treatment . To develop a management strategy for patients with unexplained fever, we studied 880 adults who were evaluated for acute fever in an emergency room . At presentation, 135 (15%) patients had unexplained fever . Occult bacterial infection was found in 48 (35%) of these 135 patients, and 21 (44%) of 48 infected patients had bacteremia . Four bacteremic patients were incorrectly discharged from the emergency room without antimicrobial therapy . Neither a "toxic" appearance of the patient nor an initial temperature of greater than or equal to 39.4 degrees C (103 degrees F) were predictive of occult bacterial infection . An index of predictive features was developed that included: age 50 years or older; diabetes mellitus; a white blood cell count greater than or equal to 15,000/mm3 (15 X 10(9)/L); a neutrophil band cell count greater than or equal to 1500/mm3 (1.5 X 10(9)/L); and a Wintrobe erythrocyte sedimentation rate greater than or equal to 30 mm/h . In patients with 0, 1, 2, or 3 or more index features present, the proportions having occult bacterial infection were 5% (1/21), 33% (15/45), 39% (15/38), and 55% (17/31), respectively . All four bacteremic patients incorrectly discharged had two or more of the index features . Adults presenting with acute unexplained fever often have life-threatening bacterial infection . A simple clinical index can be used to estimate the likelihood of occult infection and may reduce the frequency of diagnostic error.

Antimicrob Agents Chemother, 1987 Apr, 31(4), 650 - 2
In vitro activity of paldimycin (U-70138F) against gram-positive bacteria isolated from patients with cancer; Rolston KV et al.; The in vitro activity of paldimycin, a novel antimicrobial agent, was compared with that of vancomycin against 306 gram-positive isolates (representing 12 bacterial species) obtained from patients with cancer . Paldimycin had lower MICs for 90% of isolates than vancomycin did against most isolates tested . Its activity, however, was medium and pH dependent, being greatest in Nutrient broth at a pH of 6.8.

Lab Anim, 1987 Apr, 21(2), 118 - 20
Effect of mucin on the pharmacokinetics of antibiotics in the rat; Mordenti JJ et al.; The intramuscular pharmacokinetics of ticarcillin and amikacin in rats receiving 1 ml of 5% mucin suspension (equivalent to 250 mg/kg) administered intraperitoneally were not altered compared with the control animals . However, it is important to investigate the effect of mucin on the pharmacokinetics of antimicrobial agents in animals which are used to evaluate the efficacy of the agents.

Hepatogastroenterology, 1987 Apr, 34(2), 90 - 3
Crohn's disease . Rifampin treatment of the ocular and gut disease; Wirostko E et al.; Idiopathic Uveitis (IU) may occur as either an isolated ocular disease or with other systemic diseases such as Crohn's Disease (CD) . As many as 33% of CD patients demonstrate IU, and frequently their gut and IU course and severity are similar . Rifampin produces remissions of isolated IU, and Rifampin has been used to treat gut CD with varying success . In this investigation 4 CD patients, whose gut but not IU had partially responded to corticosteroids, the addition of Rifampin was associated with improvement in both their CD Activity Index and IU, allowing steroid discontinuation; Rifampin withdrawal was associated with exacerbations of both gut disease and IU; and re-institution of Rifampin was associated with another gut and IU disease remission . Since mouse ocular and systemic inflammatory disease producing non-cultivatable ultrastructurally unusual bacteria are commonly found within isolated chronic IU vitreous polymorphonuclear (PMN) leukocytes, a search for these bacteria in CD eye and gut disease seems justified, as the beneficial results of Rifampin in this study may have been an antimicrobial action on these bacteria.

Farmaco {Sci}, 1987 Apr, 42(4), 299 - 306
{Synthesis and antimicrobial activity of 3-nitroisoxazole derivatives}; Duranti E et al.; Some azomethine type compounds from 3-nitroisoxazole-5-carboxy-aldehyde were synthesized; among these the most active, oxime (III a), shows bacteriostatic activity in vitro against gram--comparable to that of nitrofurantoin.

Chemioterapia, 1987 Apr, 6(2), 95 - 8
Microbiological and pharmacokinetic evaluation of cefonicid, a long-acting cephalosporin; Mini E et al.; The in vitro antimicrobial activity of cefonicid has been tested against 27 recent clinical isolates of 7 different species (S . aureus, E . coli, K . pneumoniae, P . mirabilis, S . marcescens, E . cloacae and P . aeruginosa) using the MS-2 Research System, contrast phase microscopy and the colony forming unit assay . With the exception of P . aeruginosa, S . marcescens and E . cloacae, cefonicid showed excellent activity against the different bacterial species tested (i.e . S . aureus, E . coli, K . pneumoniae and P . mirabilis) . Tissue penetration of cefonicid after a single i.m . or i.v . dose (1 or 2 g, respectively) was also studied using the suction blister method . In 14 adult subjects with normal renal and liver functions, cefonicid plasma half-life was 5.1 and 5.4 h following i.v . and i.m . administration . Drug concentrations achieved at peak in plasma and suction blister fluid were higher than the minimum inhibitory concentrations for most sensitive pathogens and remained above these values for 24 h . These data support the use of a single daily dose regimen of cefonicid, both i.v . and i.m., for the treatment of most common infections caused by sensitive pathogens in blood and tissues.

J Antimicrob Chemother, 1987 Apr, 19(4), 521 - 6
Antimicrobial prophylaxis of infective endocarditis: effect of BSAC recommendations on compliance in general practice; Scully CM et al.; General dental practitioners in the South West Region of the U.K . were surveyed to assess compliance with the recently published recommendations of the British Society for Antimicrobial Chemotherapy on the antimicrobial prophylaxis of infective endocarditis . For the majority of dental patients, the level of prophylaxis had improved compared with previous reports: 75% of practitioners organized the prophylaxis themselves, 80% gave oral amoxycillin to penicillin non-allergic patients, and 86% gave erythromycin to penicillin-allergic patients . Some 51% complied to an acceptable level with recommended amoxycillin schedules but only 2% complied with erythromycin schedules . The BSAC recommended prophylactic regimens have certainly improved compliance although they are not yet universally accepted.

J Antibiot (Tokyo), 1987 Apr, 40(4), 483 - 95
Modification of the cysteamine side chain of thienamycin . II; Sato M et al.; A new type of thienamycin derivatives (3a-3j, 4a, 4b), having a monothioacetal or a thioacetal side chain at the C-2 position was prepared, and the susceptibility to renal dehydropeptidase-1 (DHP-1) and the antimicrobial activity of these compounds were determined . The structure-activity relationships of these derivatives are also discussed.

Vet Clin North Am Equine Pract, 1987 Apr, 3(1), 59 - 80
Drug therapy of respiratory disorders; Beech J; The emphasis of this article is on the clinical application of drugs in therapy for treatment of disorders of the lower respiratory tract . Medications discussed include those used to enhance clearance of secretions and those employed to prevent and/or alleviate bronchoconstriction . Antimicrobial agents and respiratory stimulants are briefly mentioned.

Vet Clin North Am Equine Pract, 1987 Apr, 3(1), 191 - 220
Rational selection of antimicrobial drugs for treatment of infections of horses; Brumbaugh GW; The goal of antimicrobial drug use is quite specific . Consideration of many microbe-related, host-related, and drug-related factors is necessary for appropriate selection and use of antimicrobial drugs in equine patients . The concepts and data presented in this article demonstrate that fact . At the risk of oversimplification, "The bug denotes the drug, and the horse directs the course."

Vet Clin North Am Equine Pract, 1987 Apr, 3(1), 181 - 90
Antimicrobic susceptibility of bacterial pathogens from horses; Hirsh DC et al.; Rational choice of an antimicrobial agent requires that the condition for which the drug is prescribed contain an infectious agent and, if so, knowledge of the susceptibility of the microorganism to antimicrobial drugs . Unfortunately, most infectious conditions necessitate the use of an antimicrobic drug before data from the microbiology laboratory are available . The data presented are meant to serve as a guide in the choice of antimicrobic drugs for treatment of infectious processes of the horse before knowledge of the nature of the microorganism isolated as well as its susceptibility to antimicrobic agents . What has been presented are the most commonly isolated microorganisms together with their susceptibility to antimicrobic drugs.

Vet Clin North Am Equine Pract, 1987 Apr, 3(1), 145 - 51
Drug interactions and incompatibilities; Paul JW; The clinical significance of drug interactions in animals is often minor, but, in some cases, they may result in a fatal outcome . In the critically ill patient, the temptation to employ relatively large doses, particularly of antimicrobials or corticosteroids, or to use multiple-drug therapy is enhanced . These two factors, combined with a debilitated state of the patient, increase the probability of severe drug interactions that could mean the difference between recovery or death . It would be prudent to consider the possibility of drug interactions when selecting drugs for concomitant use, evaluating adverse reactions, evaluating laboratory test results, or mixing drugs in vitro.

Vet Clin North Am Equine Pract, 1987 Apr, 3(1), 123 - 44
Pharmacologic considerations in drug therapy in foals; Caprile KA et al.; Rational drug therapy in the foal requires a sound knowledge of the pharmacodynamics and pharmacokinetics of various drugs as well as a thorough understanding of the physiologic differences that exist between the neonate and the adult and that may serve to alter drug disposition and, therefore, drug response . A summary of these physiologic factors with emphasis on the foal is presented and is followed by recommendations regarding the applied therapeutics of various antimicrobial agents.

Vet Clin North Am Equine Pract, 1987 Apr, 3(1), 101 - 22
Clinical pharmacology of the gastrointestinal tract; Clark ES et al.; This article discusses the various drugs that affect the equine gastrointestinal tract . Drugs that alter intestinal motility, that protect the gastrointestinal tract, and that alter secretions, as well as analgesics, appetite stimulants, and orally administered antimicrobial agents are reviewed.

Microb Pathog, 1987 Apr, 2(4), 269 - 82
Role of the alveolar macrophage in host defense and immunity to Legionella micdadei pneumonia in the guinea pig; Levi MH et al.; Guinea pigs develop a lethal pneumonia after intratracheal infection with Legionella micdadei, and the lung displays pathological changes similar to those observed in humans . To investigate the role of the resident alveolar macrophage in the pathogenesis of L . micdadei pneumonia, guinea pig alveolar macrophages obtained by bronchoalveolar lavage were cultured in vitro and infected with L . micdadei . In the absence of opsonins L . micdadei was phagocytized by, and multiplied within, alveolar macrophages with greater than a 100-fold increase in cell-associated colony forming units over 20 h . L . micdadei opsonized with complement or antibody multiplied within alveolar macrophages at the same rate as unopsonized bacteria . Guinea pigs which were treated with antimicrobials after infection with L . micdadei and recovered from the pneumonia were immune to challenge with an otherwise lethal inoculum of L . micdadei . However, the growth curve of both unopsonized and opsonized L . micdadei in the alveolar macrophages from immune animals was essentially identical to that in macrophages from susceptible animals . Thus, the resident alveolar macrophage is not capable of limiting the growth of Legionella . Rather, the alveolar macrophages appear to be the primary site of Legionella multiplication within the lung . Although alveolar macrophages may participate in other aspects of pulmonary immunity to the legionellae, these data indicate that the alveolar macrophage alone does not act as an effector cell in cell-mediated immunity to Legionella.

Eur J Clin Microbiol, 1987 Apr, 6(2), 179 - 82
Comparative in vitro activity of amifloxacin and five other fluoroquinolone antimicrobial agents and preliminary criteria for the disk susceptibility test; Barry AL et al.; Amifloxacin is a fluoroquinolone with a spectrum of activity similar to that of ofloxacin, pefloxacin, enoxacin, norfloxacin and ciprofloxacin . For disk susceptibility tests, 10 micrograms amifloxacin disks are recommended with zone size interpretive standards of less than or equal to 16 mm and greater than or equal to 20 mm for the resistant and susceptible categories respectively.

Chemioterapia, 1987 Apr, 6(2), 75 - 8
Comparative in vitro activity of ciprofloxacin, ofloxacin and pefloxacin against resistant clinical isolates; Periti P et al.; The in-vitro antimicrobial activity of three new quinolones, ciprofloxacin, ofloxacin and pefloxacin, was compared against 194 recent clinical isolates, 50 S . aureus, 50 E . coli, 45 E . cloacae and 49 P . aeruginosa . About half of the strains were resistant to a standard reference antibiotic like oxacillin (S . aureus), ampicillin (E . coli), gentamicin (E . cloacae) and amikacin (P . aeruginosa) . The resistant selected strains were less susceptible to the three fluoroquinolones tested than the parent isolates, but, except for pefloxacin against E . cloacae and P . aeruginosa, the decrease in susceptibility was relatively low and MICs remained below the resistance break-point.

Diagn Microbiol Infect Dis, 1987 Apr, 6(4), 307 - 9
Antimicrobial activity of imipenem and SCH34343 against Legionella species; Jones RN et al.; Twenty-seven Legionella spp . strains were tested against four beta-lactams, erythromycin and rifampin by a buffered ACES-yeast extract broth microdilution method . The minimum concentrations inhibiting 90% of strains were imipenem 0.06 micrograms/ml, SCH34343 0.25 micrograms/ml, amoxicillin 0.5 micrograms/ml, cefotaxime less than or equal to 0.12 micrograms/ml, erythromycin 0.25 micrograms/ml, and rifampin less than or equal to 0.008 micrograms/ml.

Mol Gen Mikrobiol Virusol, 1987 Apr, (4), 35 - 9
{The nature of DNA damage and its repair after treatment of bacteria with dioxidine}; Bakai TS et al.; The nature of the lethal effect of antimicrobial drug dioxidin was studied . The treatment of bacterial cells by dioxidin results in an instant repression of DNA synthesis and formation of single strand gaps in DNA molecule . The repair of single strand gaps in polA+ cells involves the DNA polymerase I . The deficit of this enzyme leads to the increased degradation of DNA . The products of the recA, polA1, lexA, recB are relevant for bacterial resistance to dioxidin while the products of uvrA, uvrE and recF genes are not . On the basis of the obtained data dioxidin may be defined as a "gamma-type" agent due to the nature of dioxidin-induced lesions in DNA and their repair.

Drugs, 1987 Apr, 33(4), 413 - 21
Management of bacteriuria in pregnancy; Pedler SJ et al.; Bacteriuria of pregnancy is a common condition which, although usually asymptomatic, may give rise to potentially serious sequelae . All pregnant women should therefore be screened for the presence of bacteriuria, which if detected should be treated with an antimicrobial agent believed to be safe for use in pregnancy . Appropriate antimicrobial drugs include penicillins, cephalosporins and nitrofurantoin . Nalidixic acid, aminoglycosides and sulphonamides may be used under certain circumstances and with some precautions . Tetracyclines, trimethoprim and co-trimoxazole (trimethoprim-sulphamethoxazole) should be avoided . There is some evidence that short-course therapy in pregnant women is less effective than longer courses, and we continue to recommend a 7-day course . Follow-up after completing a treatment course is an essential part of managing bacteriuria of pregnancy.

Am J Vet Res, 1987 Apr, 48(4), 703 - 11
Antimicrobial alternatives for calf diarrhea: sera trace element responses to Escherichia coli-, deferoxamine-, or gallium-induced diarrhea; Fettman MJ et al.; Aseptic and septic inflammatory diseases often are associated with marked changes in tissue and sera trace element kinetics . Iron and zinc sequestration by the host may serve as a protective effect against microbial proliferation, but may deprive host tissues of these necessary elements as well . Conversely, systemic iron administration has been shown to increase susceptibility to, and severity of, infectious diseases, although deficient iron stores may be repleted . Escherichia coli enteritis in calves provides a model wherein the effects of enteric iron antagonism and parenteral iron supplementation may be studied simultaneously . Male calves (n = 12) were given (IM injection) 300 mg of iron-dextran after base-line blood samples were obtained, then the calves were allotted to 4 groups (each of 3 calves): group 1 (control)--orally given nonpathogenic E coli; group 2--orally given enterotoxigenic B44 E coli; group 3--orally given deferoxamine (50 mg/kg, twice a day); group 4--orally given gallium (4 mg/kg; twice a day) . Calves were studied for 8 days; blood samples were obtained each day (day 1 through day 8) for hematologic and serum biochemical analyses . There were significant increases in serum iron concentration and % saturation in all calves within 24 hours of iron-dextran administration, which returned to base-line values in all but group 4 (given gallium) within 3 days . In the exceptional group (4), total iron-binding capacity decreased with time, as in the other groups, but serum iron concentration remained significantly increased, implying gallium interference with systemic iron assimilation.(ABSTRACT TRUNCATED AT 250 WORDS)

Sex Transm Dis, 1987 Apr-Jun, 14(2), 88 - 91
Suboptimal efficacy of erythromycin and tetracycline against vaginal Ureaplasma urealyticum; Bowie WR et al.; Female sexual contacts of men with nongonococcal urethritis (NGU) are often treated with either tetracycline or erythromycin because these antimicrobial agents are active in vitro against most strains of both Chlamydia trachomatis and Ureaplasma urealyticum, the major identified causes of NGU . Both drugs are known to be active against genital C . trachomatis infections in women . In this study, tetracycline and erythromycin base were evaluated for efficacy against U . urealyticum in the vagina . U . urealyticum was isolated from 400 (85%) of 473 women . Among women whose cultures for U . urealyticum were initially positive, cultures were negative at follow-up for one (1%) of 95 receiving no treatment, four (6%) of 71 receiving erythromycin base (250 mg four times daily for seven to ten days), and 59 (42%) of 142 receiving tetracycline (500 mg four times daily for five to ten days) . Thus, none of the regimens is reliable for eradication of U . urealyticum from the vagina.

Eur J Clin Microbiol, 1987 Apr, 6(2), 165 - 6
Effect of Ro 23-6240 on sensitive and resistant intracellular mycobacteria; Easmon C et al.; The activity of Ro 23-6240 and rifampicin against intracellular Mycobacterium fortuitum and Mycobacterium chelonei was assessed in vitro over a 48-hour period . Both agents, at an extracellular concentration of 2.0 mg/l (Ro 23-6240) and 1.0 mg/l (rifampicin), produced a significant intracellular killing of the sensitive Mycobacterium fortuitum at both 20 and 48 hours . However, neither agent was effective against the resistant Mycobacterium chelonei . It was concluded that Ro 23-6240 has a direct antimicrobial effect against sensitive intracellular mycobacteria.

Burns Incl Therm Inj, 1987 Apr, 13(2), 123 - 30
Release and antimicrobial activity of silver sulphadiazine from different creams; van Saene JJ et al.; The release and antimicrobial activity of silver sulphadiazine from five different creams were studied: unguentum emulsificans aquosum, unguentum hydrophylicum non ionogenicum, paraffin cream (15 per cent), a homemade preparation and a commercially available preparation (Flamazine) . A diffusion cell was used to measure the release and the agar well diffusion technique to determine the antibacterial activity of the silver sulphadiazine released . The paraffin cream (15 per cent) preparation had the highest release rate, followed by the homemade cream and the commercially available cream . The antibacterial activity ran parallel with the release results . This study shows the silver sulphadiazine paraffin cream to be superior to the other four preparations, including the commercially available silver sulphadiazine cream, using release and antibacterial activity as criteria.

Drug Intell Clin Pharm, 1987 Apr, 21(4), 373 - 9
Economic examination of cefoperazone therapy; Jacobs J et al.; Medical records of 1137 patients from 35 hospitals were reviewed to examine the total cost of care for patients receiving cefoperazone as initial therapy compared to a control group receiving alternative agents . The direct costs of care measurable through a retrospective review of patient records were examined, including the cost of antibiotic acquisition, drug administration, laboratory testing, and room and board . Results of a regression analysis show that cefoperazone as initial therapy is associated with lower costs for all factors studied except acquisition cost . Antibiotic acquisition averaged $24 per patient more for the cefoperazone group (p less than 0.01) . However, for cefoperazone patients drug administration was $63 less (p less than 0.0001), laboratory testing costs averaged $9 less (p = 0.22), and costs associated with room and board charges were $80 less (p = 0.40) . Total costs averaged $3073 per cefoperazone patient and $3228 per control patient (p = 0.20) . These data suggest that the previously accepted definitions of antimicrobial costs (i.e., cost per gram, cost per dose, cost per day) may no longer be adequate in this era of cost containment . In order to make sound clinical decisions with lowest total costs, practitioners should identify how and where costs are incurred.

J Neurosci Nurs, 1987 Apr, 19(2), 95 - 9
Bacterial meningitis update; Prendergast V; Meningitis can result from an invasion of the central nervous system (CNS) by bacteria, fungi, viruses, or parasites . While a diagnosis differentiating the types of meningitis may be difficult in the early stages, it is imperative that treatment be instituted as soon as possible . Bacterial meningitis can have a mortality rate of 100% if left untreated . Through a combination of early recognition, prompt institution of antimicrobial treatment, and effective nursing support the management of these patients is greatly enhanced . This article contrasts bacterial with other types of meningitis; presents the physical examination, diagnostic work-up, treatment, and complications; and explores nursing considerations.

Can J Hosp Pharm, 1987 Apr, 40(2), 51 - 6
The effect of pharmacy intervention on aminoglycoside costs; Tsuyuki RT et al.; Antibiotics constitute a large percentage of every hospital's drug budget . In an effort to control the escalating costs of antimicrobial therapy, we focused on the usage of aminoglycosides at our institution . The aminoglycosides, gentamicin and tobramycin, are similar in terms of antimicrobial spectra and toxicities . Since gentamicin is much less expensive, it was felt that significant cost savings would be realized if gentamicin were to be used preferentially over tobramycin . Specific criteria for the use of tobramycin were developed and approved by the Pharmacy and Therapeutics Committee . All patients prescribed parenteral tobramycin during the five week data collection period were entered into the study . We chose to use direct verbal intervention as our method for altering physician's prescribing patterns . An educational program of intervention was set up such that when a physician prescribed tobramycin, the patient's chart was immediately reviewed . If tobramycin was prescribed for a purpose other than those in the approved criteria for tobramycin use, the physician was contacted personally to discuss the cost-effectiveness of gentamicin use . Utilization figures from the previous six months showed that our interventions would save approximately $32,000 over a one year period . Our interventions on aminoglycoside prescribing represents a highly successful, cost-effective and educational method for altering physician's prescribing patterns.

Hosp Pharm . 1987 Apr;22(4):354, 356.
Medication use and potential drug interactions in pediatric patients with infectious diseases; Lisby SM et al.; Infectious diseases are the most common type of illness in pediatric patients . Limited data are available, however, about the most frequently prescribed drugs for children in pediatric infectious diseases units . The authors prospectively evaluated medication records of 493 children over a 5-month period to determine the pattern of drug prescribing and incidence of potential drug interactions in children admitted to the infectious diseases unit in a pediatric hospital . Antimicrobial agents were the most frequently prescribed class of drugs, comprising 60% of all drug orders . Of all antibiotics used during this period, ampicillin was the most common (24% of antibiotic orders) . Ceftriaxone, cefuroxime, and gentamicin were also used frequently and consisted of 15%, 10%, and 14% of all orders for anti-infective agents, respectively . Other classes of drugs frequently given to patients on the infectious disease unit were antipyretics (14%), bronchodilators (10%), and anticonvulsants (7%) . The incidence of potential drug interactions was 3.5%, the majority involving anticonvulsants . A clinically significant drug interaction was not documented in any of these cases . Observations made from this study may assist in developing clinical pharmacy services and educational programs for pharmacy students . In addition, knowledge of drug use patterns may aid in conducting antibiotic use reviews.

Laryngoscope, 1987 Mar, 97(3 Pt 1), 271 - 4
Fulminant infections of odontogenic origin; Dierks EJ et al.; The dentition is a common source of infection in the head and neck and most odontogenic infections respond uneventfully to proper dental therapy . Some more fulminant odontogenic infections can produce complications including airway obstruction, necrotizing fasciitis, and extension of the infection to the orbits, intracranial structures, and thorax . Six such cases treated by the authors are presented and recommendations for management including aggressive antimicrobial, therapy-based bacteriology and surgical drainage and debridement are made.

J Am Geriatr Soc, 1987 Mar, 35(3), 213 - 8
Gram-negative bacillary bacteremia in the elderly: incidence, ecology, etiology, and mortality; McCue JD; The incidence, ecology, and mortality of gram-negative bacillary bacteremia in elderly patients were studied in an analysis of 334 episodes over a four-year-period in a 489-bed North Carolina community teaching hospital, 135 (40.4%) of which occurred in patients 70 years of age or older . The bacteremia rate per 1000 hospital admissions increased sharply with increasing age . The ecology and in vitro antimicrobial susceptibilities of the bacterial isolates were strongly influenced by community v hospital acquisition, but not by age . Urosepsis was significantly more likely to be the underlying source of hospital-acquired bacteremia in patients 70 years or older (P less than 0.01) . Total bacteremia-related mortality did not increase with increasing age; in the group of patients aged 70 years or older with nonfatal/ultimately fatal underlying diseases (NF/UFUD), however, mortality was 9.1% compared to 2.9% in the younger age group (P less than 0.001) . Significantly increased bacteremia-related mortality was also noted in the older patients with NF/UFUD admitted from nursing homes (P less than 0.05) and those not treated with an appropriate antimicrobial agent within 24 hours (P less than 0.01) . Overall, the older patients with hospital-acquired bacteremia, neutropenia-associated infection, those bacteremic from a nonurinary source of infection, and those treated with multiple-drug regimens had higher mortality (P less than 0.05) . Gram-negative bacteremia is much more common in patients 70 years of age or older and compared with younger patients mortality appears to be significantly increased for the important subgroup of older patients with nonfatal or ultimately fatal underlying diseases.

J Allergy Clin Immunol, 1987 Mar, 79(3), 484 - 8
Management of drug allergy in patients with acquired immunodeficiency syndrome; Greenberger PA et al.; Management of patients with acquired immunodeficiency syndrome (AIDS) is complicated by a high frequency of adverse drug reactions to trimethoprim-sulfamethoxazole and pentamidine . Because of the lack of suitable alternative antiparasitic drugs, some patients who have experienced previous allergic-type reactions to antimicrobial agents may require readministration with incriminated drugs . We report the outcome of seven drug-allergic patients with AIDS evaluated from 1982 to 85 . Readministration of pentamidine was carried out without repeated reactions in three patients, and sulfadiazine and sulfamethoxazole-trimethoprim were readministered after very cautious test dosing in two other patients . A generalized maculopapular rash developed after 10 days of sulfadiazine therapy for Toxoplasma chorioretinitis but has been managed with prednisone, 20 to 30 mg/day for 3 months, and sulfadiazine has been continued . The administration of prednisone, 100 to 200 mg daily for treatment of severe cutaneous vasculitis from azulfidine in another patient, did not result in suprainfection . The complexities and potential legal risk of readministration of drugs in the drug-allergic patient with AIDS are emphasized in that coincidental deaths occurred in two patients 48 and 96 hours after readministration of pentamidine.

Farmaco {Sci}, 1987 Mar, 42(3), 159 - 74
{Quinolizidine derivatives with antimicrobial activity}; Sparatore A et al.; Thirty quinolizidinyl derivatives, together with two dialkylaminoalkyl analogues, were tested at concentration up to 160 mg/l for antimicrobial activity against 17 microrganisms, including gram-positive and gram-negative strains, Mycobac, tuberculosis, Trichom, vaginalis, fungi and yeasts . The most common activity found is that against Mycobac, tuberculosis, followed by that against gram-positive strains; several compounds {(I a), (I b), (I c), (II a), (III a), (VIII e), (XIX e), (XXI e)} exhibit a good or a very high level of activity . Concerning the gram-negative bacteria, activity is found only against Escherichia coli and is random and usually slight, as is that against fungi, yeasts and protozoa . Compounds (I a), (III a) and (XXI e) are of interest for their high activity and for their broad spectrum of activity, while compound (X e) is peculiar for its selectivity against Mycobac . tuberculosis.

Infect Immun, 1987 Mar, 55(3), 568 - 71
Extracellular release of antimicrobial defensins by human polymorphonuclear leukocytes; Ganz T; Human polymorphonuclear leukocytes (PMN) contain three antimicrobial and cytotoxic peptides which belong to a family of mammalian granulocyte peptides named defensins . To determine their potential availability for extracellular microbicidal or cytotoxic events, we quantified the extracellular release of defensins after stimulation of human PMN with phorbol myristate acetate and opsonized zymosan . As determined by enzyme immunoassay and confirmed by polyacrylamide gel electrophoresis and densitometry, 10(6) human PMN contained 4 to 5 micrograms of defensins . After stimulation with a high concentration of phorbol myristate acetate (1 microgram/ml), about 8% of PMN defensins were found in the media . Release of defensins correlated best with the release of azurophil granule marker beta-glucuronidase or elastase and poorly with the release of either the specific granule marker lactoferrin or cytoplasmic lactate dehydrogenase . Phagocytosis of opsonized zymosan resulted in the extracellular release of less than 3% of PMN defensins . The factors responsible for less release of defensins into media relative to the release of other azurophil granule proteins may include heterogeneity of azurophil granules and the affinity of defensins for cellular surfaces and opsonized particles . In vivo, defensins are most likely to reach effective microbicidal or cytotoxic concentrations in PMN-rich exudates (pus), in confined environments of the phagolysosomes, or in intercellular clefts between PMN and their targets.

Rev Infect Dis, 1987 Mar-Apr, 9(2), 388 - 91
Infectious diseases fellowship training: another viewpoint; Kaye D et al.; According to some observers, an oversupply of physicians in general, and of infectious disease (ID) specialists in particular, already exists; if not, oversupply may be imminent . More stringent licensing requirements, mandatory accreditation for specialty programs, and legislation restricting Medicare expenditure on direct education may help to keep the numbers of specialists down . However, once saturation is reached, it will persist longer in ID than in other, older subspecialties . In the future, many ID specialists may spend much of their time evaluating conditions that have no obvious relation to an infectious disease . Rather than an unfortunate waste, however, ID training will be advantageous in these circumstances because of the excellent background acquired in evaluating histories and performing thorough physical examinations and the emphasis placed on cost-effective use of antimicrobial agents . Physicians well trained in ID are likely to be cost conscious in the use of the laboratory as well as parsimonious in the use of drugs . A further lowering of costs probably results from contributions of these physicians to hospital formulary committees and infection control programs . Thus, residents in internal medicine who wish ID training should be given the opportunity; they will be better internists for the experience.

Antibiot Med Biotekhnol, 1987 Mar, 32(3), 202 - 6
{Evaluation of the antimicrobial action of substances for the setting of hygienic standards}; Prokhorova II et al.; The notion of antimicrobial effect threshold as an index of hygienic importance for toxicological estimation of chemotherapeutic agents is grounded by the generally accepted conception of thresholds of substances harmful effect . The methodical means used in determining the antimicrobial effect threshold including the recommended set of the measurable indices of intestinal microflora are discussed.

J Clin Microbiol, 1987 Mar, 25(3), 575 - 7
Bordetella bronchiseptica bronchitis; Papasian CJ et al.; The clinical course of a patient with bronchitis caused by Bordetella bronchiseptica is described . The organism was recovered on one occasion from a protected catheter brush specimen obtained at bronchoscopy and on two occasions from expectorated sputum specimens . The infection was eradicated with antimicrobial therapy.

J Clin Microbiol, 1987 Mar, 25(3), 522 - 5
Isolation of Simonsiella sp . from a neonate; Whitehouse RL et al.; A member of the genus Simonsiella, presumptively identified as S . muelleri, was isolated from a gastric aspirate taken from a neonate 15 min postpartum . The neonate showed a dental cyst and early eruption of teeth, confirmed by mandibular X ray . The morphological features, cultural characteristics, and antimicrobial susceptibility of the isolate are presented.

J Clin Microbiol, 1987 Mar, 25(3), 501 - 3
Plasmids of Ewingella americana: supplementary epidemiologic markers in an outbreak of pseudobacteremia; Clark N et al.; During an outbreak of pseudobacteremia in a children's hospital, Ewingella americana was found in blood cultures from 20 patients . E . americana was inoculated into blood culture bottles at the time of specimen collection due to cross contamination from nonsterile, citrated blood collection tubes used for coagulation studies . Antimicrobial susceptibility testing and plasmid profiling were used to assess the association between patient isolates and isolates from unused blood collection tubes . All E . americana isolates had similar antibiograms (i.e., resistance only to cephalothin) when tested at 37 degrees C . However, when the same isolates were tested for antimicrobial susceptibility at 25 degrees C, a different antibiogram (i.e., resistance to chloramphenicol, ampicillin, and cephalothin) was found . The majority of these isolates also demonstrated a unique four-plasmid profile (130, 56, 4.6, and 3.1 megadaltons), and two of these plasmids (130 and 56 megadaltons) were characterized as temperature-sensitive plasmids . An epidemiologic link between outbreak-associated isolates obtained from different time periods in the outbreak was supported by evidence of a significant trend in the ability of the outbreak-associated isolates to reduce nitrate, together with the presence of the resistance antibiogram at 25 degrees C and the demonstration of the unique four-plasmid profile.

J Clin Microbiol, 1987 Mar, 25(3), 498 - 500
Ewingella americana: recurrent pseudobacteremia from a persistent environmental reservoir; McNeil MM et al.; From September 1981 through April 1984, 20 patients at one hospital were identified with Ewingella americana pseudobacteremia . Case-control studies demonstrated an association between having a positive blood culture for E . americana and having blood for culture obtained simultaneously with blood obtained for coagulation studies (15 of 19 case patients versus 4 of 38 controls; P = 4.5 X 10(-7)) . Review of blood-drawing procedures showed that blood for coagulation studies and culture was drawn with the same syringe, and coagulation tubes were filled before blood culture tubes . Some phlebotomists were not using new sterile needles to inoculate blood culture bottles . Collection tubes for coagulation studies were prepared in the hospital, and E . americana was isolated from all 52 unused coagulation tubes tested . Solutions prepared in the hospital may constitute a persistent inanimate environmental reservoir for this uncommon microorganism . Pseudobacteremia can result in unnecessary antimicrobial therapy for some patients, incurring the risks of adverse drug reactions, selection of drug-resistant bacteria, and increased health care costs.

Equine Vet J, 1987 Mar, 19(2), 92 - 6
Antimicrobial selection and dosage in the treatment of equine bacterial infections; Baggot JD et al.; The success of antimicrobial therapy depends on administration of an agent to which the pathogenic microorganisms are susceptible at the concentrations attained at the site of infection . The route of administration, size of the dose and dosing interval must be appropriate for the drug preparation selected . With penicillins in particular, dosage can be tailored to the severity of the infection and quantitative susceptibility of the microorganism . This approach cannot be applied to aminoglycosides because their relatively narrow margin of safety limits the amount which can be administered . In severe infections it is important quickly to establish effective antimicrobial concentrations, which means that the choice of drug must be based on experience in treating the particular type of infection (empiric selection) and its dosage be adequate to produce a high peak concentration in the plasma . In treating septicaemic conditions of neonatal foals the deficit in serum immunoglobulins should be corrected, and it is advisable to administer antimicrobial agents or combinations that produce a bactericidal effect at dosages modified for immature physiological processes.

Toxicol Lett, 1987 Mar, 36(1), 23 - 35
Safety evaluation of Streptomyces murinus glucose isomerase; Ashby R et al.; A glucose isomerase enzyme, obtained from Streptomyces murinus, was produced by a fermentation process and subjected to a series of tests to investigate its safety in use and manufacture . It was not mutagenic (Ames test, using liquid culture) nor did it provoke chromosomal damage (rat bone marrow cytogenetics test) . It did not contain (nor did the organism produce) antimicrobial activity or macrolidpolyene antibiotics . It had no teratogenic activity when administered to pregnant rats at 100,000 ppm in the diet . It was without effect upon rats when administered at this dietary concentration for 4 weeks . Dietary administration at 5000, 15,000 or 50,000 ppm to rats for 13 weeks resulted in nephrocalcinosis in females at all dosages (probably a physiological response to the altered calcium:phosphate ratio in the admixed diet) and status spongiosus in the brains of males receiving 50,000 ppm . As the finding of nephrocalcinosis in rats is generally agreed to be of no toxicological importance with regard to the use in man, the dietary concentration of 15,000 ppm was considered to be highest no-effect level . This level corresponds to an intake of some 1000 mg/kg/day, which represents approximately 8000 times the human intake based on a conservative estimation.

J Trauma, 1987 Mar, 27(3), 301 - 4
Silver nylon cloth: in vitro and in vivo evaluation of antimicrobial activity; Deitch EA et al.; The topical agents used in burn care today, although beneficial, do have limitations, the most important of which is the failure to prevent or treat burn wound infections in patients with extensive injuries . Therefore, we evaluated the antimicrobial activity of two silver nylon fabrics (SN and HRS) on the growth of S . aureus, P . aeruginosa, and C . albicans . The theoretical advantages of these nylon fabrics over presently available silver compounds is their ability to continuously release silver ions into the burn wound as long as the material is in contact with the wound . Additionally, the release of silver from these fabrics can be augmented electrolytically . The results of these experiments indicated that both materials were microbicidal in vitro for all three test organisms . Furthermore, the antimicrobial activity could be significantly augmented by passing a weak DC current through the material, which increased the rate of release of silver ions from the fabrics . In vivo, HRS was as effective as silver sulfadiazine in preventing colonization of the burn wound . The use of silver nylon fabrics thus appears to be a promising way of delivering large quantities of silver ions into the burn wound without the potential side effects of a carrier molecule or cream.

Pediatr Infect Dis J, 1987 Mar, 6(3), 328 - 31
Penicillins and macrolides in the treatment of community-acquired respiratory tract infections; Kernbaum S; The use of penicillins and macrolides in the management of community-acquired respiratory tract infections is evaluated in relation to such factors as antimicrobial activity, stability, pharmacokinetics and adverse reactions . Attention is directed to the side effects of drugs, e.g . to the clear advantages of 16 (e.g . spiramycin) vs . 14 (e.g . erythromycin)-membered ring macrolides, and examples are drawn to illustrate the tactics of antimicrobial therapy in the management of pneumonias.

Drugs, 1987 Mar, 33(3), 242 - 58
Pentamidine isethionate . A review of its antiprotozoal activity, pharmacokinetic properties and therapeutic use in Pneumocystis carinii pneumonia; Goa KL et al.; Pentamidine isethionate, an aromatic diamidine, is an antiprotozoal agent proven to decrease mortality from Pneumocystis carinii pneumonia in debilitated infants and immunodeficient adults and children . Like the combination antimicrobial agent co-trimoxazole, pentamidine has been shown in retrospective studies to resolve episodes of pneumonia in approximately 41 to 87% of patients, including those with the acquired immunodeficiency syndrome (AIDS), when used alone or as sequential therapy . Although about 45% of all patients given pentamidine experience side effects--which may include nephrotoxicity, hypotension, hypoglycaemia or local reactions--in patients with AIDS the incidence of side effects is less with pentamidine than with co-trimoxazole . Thus, despite its profile of potentially severe side effects, pentamidine isethionate is a proven antimicrobial agent with a distinct place in the treatment of Pneumocystis carinii pneumonia in the growing population of AIDS patients.

J Fam Pract, 1987 Mar, 24(3), 289 - 95
Infective endocarditis; Birrer RB et al.; Despite major changes in the epidemiology, microbiology, and prognosis over the last 50 years, the diagnosis of infective endocarditis is still difficult, and serious complications including death are not uncommon . Prosthetic and right-sided valvular infections are more common and require longer periods of vigorous antimicrobial therapy than in the past . An effective short-course antibiotic regimen has been designed for sensitive microorganisms, and protocols have been established for culture-negative cases (15 percent) and empiric situations . Finally, cardiac surgery should be considered as an important modality, especially in cases of congestive heart failure.

J Infect Dis, 1987 Mar, 155(3), 403 - 17
New antibiotics: areas of appropriate use; Neu HC; This has been an analysis of a number of agents whose clinical use has been approved in the past five years and of several agents that will undoubtedly be available within the next year . By the very nature of time alotted, the analysis had to be superficial . I believe that it is important to view all the agents because they cross each other in uses . I believe that areas of appropriate use exist for all of the compounds that I have discussed, and I also believe that cost and convenience will play increasingly important roles in the selection of what agent is most fitting, the definition of appropriate . In many infections it will not be possible to show a significant difference among drugs in a class, unless extremely large studies are undertaken . From my review of the literature in preparation for this meeting, I doubt these studies will be mounted . The infectious disease clinician must be familiar with all of the agents so that he or she can make judgments about which agent(s) make(s) the most sense for his/her hospital . I believe that it is fitting and proper for the infectious disease physician to appropriate the correct selection, methods of administration, and dose of antibiotic in many clinical situations, particularly ones in which parenteral agents are used . I hope the IDSA will have an impact on the proper use of the quinolones, monobactams, penems, and carbapenems . Our goal in the use of antimicrobial agents should be the selection of agents for prophylaxis, empiric therapy, and therapy for defined infections in a manner that results in cure, with reasonable cost and minimal damage to the microbial ecology.

Infection . 1987 Mar-Apr;15(2):128.
Antimicrobial effects of niridazole on Gardnerella vaginalis; Bannatyne RM et al.; Niridazole, a nitrothiazole derivative, demonstrated powerful antimicrobial activity against 510 clinical isolates of Gardnerella vaginalis tested . MIC's ranged from 0.002 to 1.0 mg/l with MIC50 and MIC90 values of 0.02 and 0.067 mg/l respectively.

J Clin Microbiol, 1987 Mar, 25(3), 476 - 9
Factors affecting antimicrobial susceptibility of Fusobacterium species; Rowland MD et al.; Fifteen clinical isolates of Fusobacterium species were studied to determine their quality of growth on five agar media, their susceptibility to penicillin, cephalothin, cefoxitin, and cefotaxime, the inoculum effect, and the presence of L forms and beta-lactamase . Wilkins-Chalgren agar supported confluent growth best, but Fusobacterium nucleatum exhibited poor growth on all agar media . Most isolates exhibited poor reproducibility of MIC results with repeated agar dilution testing . However, most isolates were susceptible to all antibiotics at the breakpoint concentrations . No inoculum effect was observed, but preparation of an inoculum at a 0.5 McFarland nephelometric standard produced a lower than expected number of CFU (10(6) CFU) in some isolates . L forms were frequently seen . No beta-lactamase was found . The variability in MICs seen with beta-lactam antibiotics was not found when clindamycin was tested . MIC studies with Fusobacterium spp . may be complicated by poor growth on agar media, poor reproducibility, and small inoculum size.

J Clin Periodontol, 1987 Mar, 14(3), 144 - 8
The effects of a dentifrice containing a zinc salt and a non-cationic antimicrobial agent on plaque and gingivitis; Saxton CA et al.; The antiplaque potential of metal salts in mouthwashes or dentifrices has been previously demonstrated . The purpose of the present investigation was to establish the effects on plaque and gingival health of a dentifrice which contained a combination of the metal salt, zinc citrate, and the anti-microbial agent, Triclosan . Plaque growth was reduced by a dentifrice which contained either zinc citrate or triclosan, but greater inhibition was achieved with dentifrices which contained both agents . A 4-day non-brushing study in which slurries of the dentifrice were used, confirmed that the test dentifrice which contained 1% zinc citrate and 0.5% Triclosan reduced the accumulation of plaque by 50% . In a double-blind crossover study of 28 days duration, a significant reduction in plaque accumulation and an improvement in gingival health was demonstrated for the test dentifrice compared to the placebo . Further analysis of the data indicated that the dentifrice was most efficacious for participants who brushed ineffectively . Also, the greatest benefit was obtained by subjects that used the largest amount of dentifrice.

Infect Dis Clin North Am, 1987 Mar, 1(1), 25 - 54
Gonococcal infections; Dallabetta G et al.; Although gonorrhea rates for the 1980s appear to have plateaued or even declined slightly in developed nations, in the developing world rates appear to be continuing to increase . In recent years, worldwide gonorrhea control efforts have been compromised by the continuing emergence of antimicrobial resistance resulting from plasmid-mediated beta-lactamase production, plasmid-mediated tetracycline resistance, and chromosomally mediated resistance to many antimicrobial agents . Intensive investigation of gonococcal physiology and structure has provided insights into gonococcal pathogenesis and epidemiology . Application of knowledge gained through basic research is being used to provide improved methods of gonorrhea diagnosis and to identify components of potential gonococcal vaccines.

Semin Respir Infect, 1987 Mar, 2(1), 74 - 81
Prophylactic strategies for hospitalized patients at risk for pneumonia; Altman FM Jr; Thirty-five years ago pneumonia prophylaxis failed because the agents available then did not have the antibacterial spectrum necessary to prevent colonization and infection with multiple gram-negative bacteria . Combinations of the newer antibiotics delivered intratracheally do cover most common organisms and they may be sufficient for prophylaxis . Careful monitoring is necessary because a number of unusual pathogens have the potential to circumvent the prophylactic regimen . Widespread use of topical antibiotics may result in the emergence of antimicrobial resistance in intensive care unit areas . The magnitude of this risk is difficult to calculate and some maneuvers are available to decrease the likelihood that this will occur . Nevertheless, at present these uncertainties are sufficient to prevent the routine clinical use of antibiotics for pneumonia prophylaxis . There are now eight studies showing that prophylaxis can decrease the incidence of pneumonia by greater than 50% . These should stimulate further clinical research designed to minimize the problems with bacterial resistance.

Acta Chir Scand, 1987 Mar, 153(3), 185 - 92
Stratified duration of prophylactic antimicrobial treatment in emergency abdominal surgery . Metronidazole-fosfomycin vs . metronidazole-gentamicin in 381 patients; Andaker L et al.; Consecutive adult patients requiring emergency abdominal surgery were randomly allocated to preoperative treatment with metronidazole-gentamicin (M-G) or metronidazole-fosfomycin (M-F) . Postoperative continuation of antibiotics depended on the estimated risk of septic complications . Peroperatively the cases were stratified as group A, acute inflamed appendicitis, or absence of septic disorder--no postoperative antibiotics, group B, gangrenous appendicitis or cholecystitis or intestinal obstruction without resection, or operations with contamination regarded as minor (gastrotomy or enterotomy)--three further doses of antibiotics, or group C, perforated appendicitis, perforation of the alimentary tract, generalized peritonitis or gross contamination--antibiotics continued for 5 days . Assessment for septic complications was made in 381 patients (191 M-G, 190 M-F) . The total incidence was 4.8% (M-G 7.8%, M-F 1.6%, p less than 0.01) . The difference was mainly due to higher infection rate in patients stratified to group C and randomized to M-G . Stratification thus permitted restricted duration of antibiotic treatment with a low septic complication rate, significantly less with M-F than with M-G regimen.

J Appl Bacteriol, 1987 Mar, 62(3), 227 - 9
Incidence of infantile diarrhoea due to enteropathogenic Escherichia coli in Port Harcourt metropolis; Antai SP et al.; Five hundred diarrhoeal stool samples from the University of Port Harcourt Teaching Hospital were investigated for enteropathogenic Escherichia coli . Results showed that the organism was endemic in Port Harcourt metropolis and was responsible for about 15% of the incidence of infantile diarrhoea in the community . Detailed analysis revealed that 13 serotypes were involved . It was also observed that babies aged between 0 and 18 months were more susceptible than those aged between 19 and 36 months . Male infants were also shown to be more at risk than females . Antibiotic sensitivity tests showed that the enteropathogenic E . coli isolated were highly resistant to most common antimicrobial drugs but were highly sensitive to genticin and cefotaxime.

Rev Infect Dis, 1987 Mar-Apr, 9(2), 295 - 328
Long-term prophylaxis of infection by selective decontamination in leukopenia and in mechanical ventilation; Clasener HA et al.; The autochthonous anaerobic bacterial flora in the mucosal layer of the gastrointestinal tract limits colonization by aerobic potential pathogens . This effect is called colonization resistance . Colonization of the digestive tract by potentially pathogenic microorganisms precedes infection in patients with leukopenia and in cases of mechanical ventilation and can be prevented by long-term administration of antimicrobial agents that spare the autochthonous anaerobic bacterial flora of the mucous membranes, a concept known as selective decontamination . Antimicrobial agents active against anaerobic flora reduce colonization resistance, permitting colonization by and overgrowth of potentially pathogenic microorganisms and possibly leading to infections with resistant microorganisms . A distinction can be made between antimicrobial agents that reduce colonization resistance and those that leave it intact by examining the effect of antimicrobial agents on aerobic intestinal flora of mice and humans.

Rev Infect Dis, 1987 Mar-Apr, 9(2), 250 - 64
Pharmacokinetics of antimicrobial agents in the elderly; Ljungberg B et al.; Many elderly individuals are treated with antibiotics, but knowledge of the pharmacokinetic performance of the compounds in these patients is limited . Advanced age is accompanied by many physiologic alterations that may have secondary effects on absorption, distribution, metabolism, and excretion of drugs . Information on absorption and metabolism in the elderly is scarce and conflicting . Because renal excretion of penicillins and cephalosporins decreases with the physiologic signs of the kidneys, dose reduction is advisable in elderly patients . Monitoring of serum drug levels is recommended for the selection of correct dosages of renally eliminated antibiotics with a narrow therapeutic range--e.g., aminoglycosides and vancomycin . There is a considerable need for additional studies of the influence of age on the kinetics of antimicrobial agents.

Int J Dermatol, 1987 Mar, 26(2), 123 - 7
Outpatient therapy of bite wounds . Demographic data, bacteriology, and a prospective, randomized trial of amoxicillin/clavulanic acid versus penicillin +/- dicloxacillin; Goldstein EJ et al.; Thirty patients received penicillin (17 of these also received dicloxacillin) and 31 received amoxicillin/clavulanic acid in a randomized study of the outpatient management of bite wounds . A wide variety of aerobic (185 strains) and anaerobic (47 strains) bacteria were isolated from these wounds . The control and study regimens were equally effective . There were four therapeutic failures in all . Aggressive wound management along with antimicrobial therapy led to a 87-96% cure rate . Loose stools or diarrhea was a more frequent side effect with amoxicillin/clavulanic acid than with penicillin +/- dicloxacillin.

J Clin Microbiol, 1987 Mar, 25(3), 536 - 9
Serotype, antimicrobial susceptibility, and pathogenicity of Erysipelothrix rhusiopathiae isolates from tonsils of apparently healthy slaughter pigs; Takahashi T et al.; Erysipelothrix rhusiopathiae was isolated from tonsils of 63 (10.5%) of 600 apparently healthy slaughter pigs in the Kanto area of Japan in February and July 1984 . The isolation rate was significantly higher during July than in February . Of these 63 isolates, 34 isolates (54.0%) were serotype 7, 20 isolates (31.7%) were serotype 2, 6 isolates (9.5%) were serotype 6, and 1 isolate (1.6%) each was serotype 11, 12, or 16 . All isolates of serotypes 2, 6, 11, 12, and 16 were highly virulent for mice, whereas most isolates of serotype 7 were weakly virulent . In swine, all isolates of serotype 2 were highly virulent, capable of inducing generalized urticarial lesions with depression and anorexia . On the other hand, 37 of 43 isolates of serotypes other than 2 induced no clinical signs, and the remaining 6 isolates induced local urticarial lesions at the site of inoculation in swine . The MIC of dihydrostreptomycin ranged from 1.56 to 100 micrograms/ml . All of the dihydrostreptomycin-resistant strains belonged to serotype 2 . The high virulence of E . rhusiopathiae strains of serotype 2 harbored in the tonsils suggests a possible role of such strains in the cause of swine erysipelas . In contrast, members of the other nonvirulent or weakly virulent group, mainly serotype 7 strains, were considered to be resident in porcine tonsils.

Ann Otol Rhinol Laryngol Suppl, 1987 Mar-Apr, 129, 1 - 19
Finnish approach to the treatment of acute otitis media . Report of the Finnish Consensus Conference; Karma P et al.; The theme of the first consensus conference to be held in Finland was the treatment of acute otitis media . The statements and recommendations accepted by the conference, which was organized according to the National Institutes of Health model, are presented in this report . On the basis of scientific knowledge, clinical experience, and conditions in Finland, the conference delegates concluded that penicillin V, in large doses, is still the drug of first choice in this disease . The importance of surgical drainage of the middle ear was stressed, as was the necessity of careful follow-up of the patient until the condition is completely healed . Decongestants were considered rather useless . In the prevention of recurrent attacks, adenoidectomy but not tonsillectomy was regarded as being of help, tympanostomy of probable benefit, antimicrobial (sulfonamide) prophylaxis worth considering in selected cases, but the effect of pneumococcal vaccination poor . The conference delegates agreed that uncomplicated acute otitis media should, as before, usually be treated by physicians taking care of children at the primary health care level.

J Chromatogr, 1987 Feb 27, 389(1), 139 - 53
Chlorination of Irgasan DP300 and formation of dioxins from its chlorinated derivatives; Kanetoshi A et al.; Irgasan DP300 (2,4,4'-trichloro-2'-hydroxydiphenyl ether) (I), an antimicrobial agent for use with fabrics, was easily chlorinated with sodium hypochlorite to give 2',3,4,4'-tetrachloro-2-hydroxydiphenyl ether (II), 2',4,4',5-tetrachloro-2-hydroxydiphenyl ether (III) and 2',3,4,4',5-pentachloro-2-hydroxydiphenyl ether (IV) . Irgasan DP300 and its chlorinated derivatives were readily converted into polychlorinated dibenzo-p-dioxins (PCDDs) by heating: Irgasan DP300 was converted into dichlorodibenzo-p-dioxin(s) (di-CDD, 42%); II into two trichlorodibenzo-p-dioxins (tri-CDDs, 22%) and three tetrachlorodibenzo-p-dioxins (tetra-CDDs, 46%); III into two tri-CDDs (44%), more than two tetra-CDDs (25%) and pentachlorodibenzo-p-dioxin(s) (penta-CDD, 1%); and IV into two tetra-CDDs (16%), trace amounts of penta-CDD(s) and four hexachlorodibenzo-p-dioxins (hexa-CDDs, 40%) . Although UV irradiation of Irgasan DP300, II and III gave PCDDs, the amounts of PCDDs formed were much smaller than those obtained by heating . Moreover, PCDD was not detected in the UV irradiation of IV . The identified products suggested that disproportionation of chlorine atom(s) occurred in the photolysis.

Cancer, 1987 Feb 15, 59(4), 844 - 9
Differences between first and subsequent fevers during prolonged neutropenia; Wingard JR et al.; Fever during neutropenia before engraftment was studied in 86 consecutively treated patients undergoing allogeneic bone marrow transplantation . Eighty-four of the 86 patients experienced 132 febrile episodes . Only 26% of the patients had one fever which resolved with antibiotics . The rest required modification of antimicrobial therapy because of refractory fever (32%) or recurrent fevers (42%) . The 121 fevers which occurred during neutropenia were analyzed to determine differences between first and subsequent fevers (79 and 42 episodes, respectively) . The frequency of sepsis (23%) and defervescence (64%) did not differ between first and subsequent fevers . Presumed localized infection (PLI) was identified in 75% of first fever but in only 28% of subsequent fevers (P = 0.000002) . Of the PLI identified, oropharyngeal mucosal disease accounted for 68% during first fever but only 38% during subsequent fevers (P = 0.02) . Although sepsis in first fever was more frequently associated with PLI than sepsis in subsequent fevers (61% versus 10%, P = 0.01), overall, patients with PLI had a lower frequency of sepsis than those without (17% versus 32%, P = 0.04) . Gram-negative pathogens were uniformly gentamicin sensitive in sepsis during first fever but were mostly gentamicin-resistant in sepsis during subsequent fevers (P = 0.01).

J Immunol, 1987 Feb 15, 138(4), 1246 - 9
Macrophage activation for antileishmanial defense by an apparently novel mechanism; Wyler DJ et al.; Activation of macrophages by lymphokines (including interferon-gamma; IFN-gamma) is presently considered to be a major host defense mechanism against a number of intracellular microorganisms . In a series of earlier studies that made use of mice undergoing spontaneous resolution of footpad infections with Leishmania major, we obtained evidence suggesting that a subpopulation of Leishmania-sensitized lymph node T lymphocytes could activate antimicrobial effects in Leishmania-infected macrophages by an apparently lymphokine-independent mechanism . These effector lymphocytes are not cytotoxic to host cells, and their effects are antigen specific and genetically restricted . To more rigorously investigate this apparently novel mechanism of macrophage activation, we examined the effect of blocking lymphokine production with cyclosporin A (CSA) on the capacity of these effector lymphocytes to exert macrophage activating function . Although CSA blocked lymphokines that activate antileishmanial effects, it did not inhibit the antimicrobial capacity of the effector lymphocytes . We also confirmed that IFN-gamma is the major macrophage-activating lymphokine that induces antileishmanial effects; treatment of lymphokine-containing supernatants with anti-IFN-gamma antibody markedly reduced their antimicrobial effects . In contrast, treatment of effector lymphocytes with this antibody failed to reduce their macrophage-activating capacity . We conclude that there exists an apparently novel macrophage-activating mechanism for antimicrobial defense that is independent of soluble lymphokine mediators.

Hosp Pharm, 1987 Mar, 22(3), 267 - 72
An aminoglycoside monitoring service in a community hospital using a microcomputer; Voytovich RM et al.; A pharmacy-based aminoglycoside dosing and monitoring service using a microcomputer is described . The service was developed after an audit of aminoglycoside use and serum drug sampling revealed existence of several deficiencies in areas related to aminoglycoside antimicrobial therapy . A protocol was proposed by the pharmacy department and accepted by the Pharmacy and Therapeutics Committee whereby the departments of pharmacy, laboratory, and nursing would initiate a protocol for aminoglycoside dosing and serum drug sampling . The program has been operational for 36 months . The author's experience indicated that a pharmacy-based aminoglycoside dosing and monitoring service can be effectively conducted by baccalaureate-level pharmacists.

Am J Obstet Gynecol, 1987 Feb, 156(2), 513 - 20
Infectious morbidity in gynecologic cancer; Brooker DC et al.; A retrospective investigation of infectious morbidity in gynecologic oncology patients documented that 54 (11%) of 494 patients and 68 (6%) of 1204 patient admissions were complicated by a serious infection . The highest rate of infectious morbidity by admission was 21%, occurring in patients admitted for cancer of the vulva . The highest surgical infectious morbidity, 22%, occurred in patients admitted for cervical cancer . Important factors in determining infection risk include multiple host factors, radical surgical procedures, factors inherent in the tumor itself, and additional irradiation and chemotherapy . These serious polymicrobial infections dictate intelligent selection of antimicrobials and appropriate monitoring to anticipate complications inherent in antimicrobial therapy . beta-Lactamase induction, superinfection, nephrotoxicity, and necrotizing enterocolitis are documented problems in these patients.

Br J Rheumatol, 1987 Feb, 26(1), 24 - 7
Brucella arthritis among Iraqi patients; Al-Rawi ZS et al.; The clinical features of acute Brucella arthritis were reported in a prospective study of 58 patients (29 male, 29 female) . Polyarthritis occurred in 33, was migratory in ten, additive in 23 and symmetrical in ten . Monoarthritis of knee or hip joints occurred in ten patients, whilst the spine alone was involved in 15 . Hip and spinal involvement was more destructive than peripheral joint involvement . Hotness, redness and joint effusions were not prominent features . Tissue-typing did not show any association with Brucella arthritis . Treatment with various antimicrobials was followed by recovery, but the relapse rate was lowest with combined tetracycline and streptomycin . Brucella arthritis is frequently seen in Iraq, and dairy products prepared locally from unpasteurized milk should be controlled by local health authorities.

Arch Surg, 1987 Feb, 122(2), 158 - 64
Design and conduct of antibiotic trials . A report of the Scientific Studies Committee of the Surgical Infection Society; Solomkin JS et al.; Several recent publications have identified important methodologic problems in the design and conduct of antimicrobial trials in surgery . Developed by consensus of the members of the Scientific Studies Committee of the Surgical Infection Society, this report provides broad guidelines for the construction of antimicrobial trials . The central issues identified include pretrial definition of study purpose, entry criteria, assignment device, and statistical analysis . These issues are fundamental in designing studies with an acceptable likelihood of finding differences among those antimicrobial regimens at least risk to the study subjects . The importance of stratifying patients on the basis of background condition, disease, and severity of illness is stressed . The inclusion in a study of variables that enhance the statistical power and, therefore, the believability of this study is stressed as an important means of clarifying substantial differences between therapies.

Acta Pathol Microbiol Immunol Scand {C}, 1987 Feb, 95(1), 35 - 40
Immunoglobulins and innate factors of immunity in saliva of children prone to respiratory infections; Lehtonen OP et al.; Serum and salivary total IgA, IgG and IgM as well as salivary innate non-immunoglobulin antimicrobial factors (lysozyme, lactoferrin, salivary and leukocyte peroxidase systems) were measured in 13 children prone to recurrent respiratory infections and compared to their age-matched healthy controls . Serum IgG and IgM levels were significantly elevated and salivary IgA remarkably low in infection-prone children as compared to the controls . However, the levels of secretory piece-bearing IgA were about the same in both groups . There were no significant differences between the two groups in serum IgA levels or in any of the non-immunoglobulin factors . The results indicate that low salivary IgA is associated with recurrent respiratory infections.

J Antibiot (Tokyo), 1987 Feb, 40(2), 157 - 64
Carbazomycins C, D, E and F, minor components of the carbazomycin complex; Naid T et al.; Carbazomycins C (III), D (IV), E (V) and F (VI), the minor components of the carbazomycin complex, were isolated from the cultured broth of Streptoverticillium ehimense together with carbazomycins A (II) and B (I) . Among them, III and IV were shown to be new substances and their structures were elucidated as 4-hydroxy-3,6-dimethoxy-1,2-dimethylcarbazole and 3,4,6-trimethoxy-12-dimethylcarbazole, respectively, by spectroscopic and chemical means . The other components, V and VI, were found to contain an aldehyde function and were identified as carbazomycinal and 6-methoxycarbazomycinal, respectively . The antimicrobial activity of III and IV are also reported.

J Antibiot (Tokyo), 1987 Feb, 40(2), 149 - 56
New piericidin glucosides, glucopiericidins A and B; Matsumoto M et al.; The new piericidin group antibiotics, glucopiericidins A and B were isolated from the culture broth of Streptomyces pactum S48727 (FERM P-8117) as co-metabolite of piericidin A1 . The structures of glucopiericidins A and B were determined as piericidin A1, 10-O-beta-D-glucoside and piericidin A1, 3'-O-D-glucoside on the basis of their spectral and chemical properties, respectively . Glucopiericidins were more potent in inhibiting antibody formation than piericidin A1 in vitro . In addition, these substances showed better antimicrobial activities than piericidin A1 . Acute toxicities of these substances in mice were lower than that of piericidin A1 . This indicates that D-glucose in glucopiericidin molecules is important in modulating their physiological activities.

Eur J Clin Microbiol, 1987 Feb, 6(1), 11 - 7
Controlled trial of a short and a prolonged course with ciprofloxacin in patients undergoing transurethral prostatic surgery; Grabe M et al.; The efficacy of a short (Group I) and a prolonged (Group II) course with ciprofloxacin was assessed in patients undergoing transurethral prostatic resection for benign hyperplasia or cancer of the prostate and compared with that of controls without antibiotic (Group III) . Both regiments significantly reduced the frequency of postoperative bacteriuria (p less than 0.01) and of severe infectious complications (p = 0.004) as compared to the controls . Both regimens were equally effective in preventing perioperative and postoperative acquisition of bacteriuria in patients without bacteriuria at surgery . In patients with bacteriuria before surgery, bacteriuria was found postoperatively in 35% in Group I and 10% in Group II (p = 0.012), but in 82% of the patients in Group III . Ciprofloxacin inhibited all but 7 of 176 bacterial strains at an MIC of less than or equal to 1 microgram/ml . Given orally ciprofloxacin is a valuable alternative antimicrobial for use in conjunction with transurethral prostatic resection . A short course is sufficient for prophylaxis, and adequate therapy is achieved with a prolonged regimen.

Antimicrob Agents Chemother, 1987 Feb, 31(2), 331 - 2
In vitro susceptibility of Capnocytophaga species to antimicrobial agents; Hawkey PM et al.; A total of 33 clinical isolates of Capnocytophaga spp . were susceptible to 4-quinolone antimicrobial agents . The antipseudomonal penicillins tested were equally active against all isolates, as were cefuroxime, ceftriaxone, ceftizoxime, cefotaxime, latamoxef, and ceftazidime . Most isolates were resistant to trimethoprim, and some were resistant to aztreonam . Most regimens for the empirical treatment of septic episodes in immunocompromised patients are suitable for the treatment of Capnocytophaga spp . infections.

Antimicrob Agents Chemother, 1987 Feb, 31(2), 249 - 52
Susceptibility of Mobiluncus species to 23 antimicrobial agents and 15 other compounds; Spiegel CA; The susceptibility of 12 strains of Mobiluncus curtisii and 10 strains of M . mulieris to 23 antimicrobial agents and 15 other compounds was determined . All strains were susceptible to chloramphenicol, clindamycin, rifampin, tobramycin, vancomycin, virginiamycin, and all beta-lactam antibiotics tested, including imipenem . One strain of M . mulieris was resistant to erythromycin and josamycin . All were resistant to colistin, cycloserine, nalidixic acid, and neomycin . Tetracycline had variable activity . All M . curtisii strains were resistant to metronidazole and its hydroxy metabolite . Of 10 M . mulieris strains, 5 were resistant to metronidazole and 2 were resistant to its hydroxy metabolite . All 12 M . curtisii and 1 of 10 M . mulieris strains were resistant to tinidazole . M . curtisii and M . mulieris produced two mutually exclusive clusters of MICs when tested against ampicillin, cefoxitin, cephalothin, moxalactam, alizarin red, Evans blue, and sodium fluoride . Gardnerella vaginalis was more susceptible to Nile blue A than was either M . curtisii or M . mulieris . Clindamycin and imipenem may be useful agents in the therapy of metronidazole-resistant bacterial vaginosis . Metronidazole, tinidazole, and Nile blue A may be of value in the development of a selective agar for Mobiluncus species.

Antimicrob Agents Chemother, 1987 Feb, 31(2), 164 - 7
In vitro and in vivo susceptibility of the Lyme disease spirochete, Borrelia burgdorferi, to four antimicrobial agents; Johnson RC et al.; The antimicrobial susceptibility of Borrelia burgdorferi isolated from human spinal fluid was determined in vitro and in vivo . A broth dilution technique was used to determine the MBCs of four antimicrobial agents . The Lyme disease spirochete was most susceptible to ceftriaxone (MBC, 0.04 microgram/ml) and erythromycin (MBC, 0.05 microgram/ml), then tetracycline (MBC, 0.8 microgram/ml), and finally penicillin G (MBC, 6.4 micrograms/ml) . Syrian hamsters were used to determine the 50% curative doses (CD50s) of the four antimicrobial agents . Ceftriaxone and tetracycline had the highest activities, with CD50s of 24.0 and 28.7 mg/kg {corrected}, respectively . Both erythromycin and penicillin G possessed low activities . The CD50 of erythromycin was 235.3 mg/kg {corrected}, and the CD50 of penicillin G was greater than 197.5 mg/kg {corrected}.

J Antimicrob Chemother, 1987 Feb, 19(2), 211 - 20
The use of a tissue culture model to assess the penetration of antibiotics into epithelial cells; Chadwick PR et al.; A tissue culture model was developed in which enteroinvasive Escherichia coli invaded and survived within HEp-2 epithelial cells . The bacteria were shown to be intracellular by light and electron microscopy and immunofluorescence . The model was then used to assess the ability of antimicrobial agents to penetrate into cells and alter the morphology of the bacteria . Chloramphenicol, tetracycline, trimethoprim and ciprofloxacin penetrated more easily than beta-lactam antibiotics . Ampicillin and its derivatives penetrated more easily than cephalosporins, latamoxef or aztreonam . Only ciprofloxacin was able to kill intracellular bacteria.

J Clin Periodontol, 1987 Feb, 14(2), 74 - 9
Examiner agreement in estimating changes in periodontal bone from conventional and subtraction radiographs; Grondahl K et al.; It has previously been shown that computer-assisted subtraction of serially-obtained radiographs yields a higher degree of accuracy in the detection of small changes in the marginal periodontal bone than conventional radiographs . This study concerns another important aspect of such diagnostic methods, namely the intra- and inter-examiner agreement rates . On 10 patients with moderate to severe periodontal bone loss involved in a clinical trial to evaluate the effectiveness of subgingival antimicrobial irrigation, conventional radiographs were taken at baseline and after 32 and 52 weeks . The changes in terms of gain or loss of bone occurring between the examination at baseline and that after 32 weeks, as well as those occurring between the examination performed after 32 weeks and that made after 52 weeks, were evaluated by means of conventional radiographs and by subtraction images . Both types of image were interpreted by each of 4 observers . The images were read a 2nd time after a period of at least 2 weeks . The inter-observer as well as the intra-observer agreement were assessed by calculating 3 different measures of agreement: the overall agreement, the specific agreement and the kappa value . Regardless of measure, higher inter-observer agreement rates were found for all observers when the subtraction technique was employed . A similar pattern was found with respect to the intra-observer agreement rates.

Surg Clin North Am, 1987 Feb, 67(1), 133 - 45
Topical therapy for burns; Monafo WW et al.; Topical antimicrobial agents can prevent or minimize burn infections and should be used from the outset in all patients who are at significant risk from sepsis--either because of their wound severity or associated comorbid factors . All of the currently available topical agents have shortcomings; some of them have appreciable toxicity . The recent shift in emphasis toward early surgical closure of extensive deep burns in great part has resulted from appreciation of the inadequacies of currently available topical agents . Topical agents cannot substitute for timely and comprehensive physiologic support of burned patients.

Ann Intern Med, 1987 Feb, 106(2), 216 - 20
Ciprofloxacin or trimethoprim-sulfamethoxazole as initial therapy for travelers' diarrhea . A placebo-controlled, randomized trial; Ericsson CD et al.; The efficacy of ciprofloxacin was compared with that of trimethoprim-sulfamethoxazole in a placebo-controlled trial of the 5-day treatment of acute diarrhea among 181 adults recently arrived in Guadalajara, Mexico . Both antimicrobial agents were significantly (p less than 0.0001) more efficacious than placebo in the treatment of diarrhea, with the average duration of diarrhea being 29, 20, and 81 hours, respectively, in the ciprofloxacin, trimethoprim-sulfamethoxazole, and placebo treatment groups . The antimicrobial agents were also more efficacious than placebo in treating diarrhea caused by enterotoxigenic Escherichia coli, invasive enteropathogens, and unknown pathogens . Both antimicrobials were effective in treating mild-to-moderate and moderate-to-severe disease, and both were well tolerated . Ciprofloxacin appears to be a logical alternative to trimethoprim-sulfamethoxazole in the initial treatment of acute travelers' diarrhea.

Antimicrob Agents Chemother, 1987 Feb, 31(2), 197 - 201
Comparison of histologic and quantitative techniques in evaluation of therapy for experimental Pneumocystis carinii pneumonia; Kim CK et al.; Pneumocystis carinii pneumonia was induced in rats by the administration of corticosteroids, and histologic and quantitative techniques were compared in the evaluation of the severity of the disease and response to therapy . A highly significant correlation was found between the histologic score of the extent of alveolar involvement (the standard method of assessment) and the number of P . carinii cysts and nuclei in lung homogenates, lung weight, and lung weight/body weight ratio . Clear differences were noted between rats which responded well and rats which responded poorly to therapy by all techniques . Quantitation of P . carinii cysts and nuclei revealed a 10(4)-fold reduction in organism burden with successful treatment . Thus, these techniques should be helpful in the development of testing of new antimicrobial agents in the rat model of pneumocystosis.

J Trauma, 1987 Feb, 27(2), 176 - 9
Control of burn wound sepsis: a comparison of in vitro topical antimicrobial assays; Heggers JP et al.; The Minimal Inhibitory Concentration (MIC) and the Nathan's Agar Well Diffusion (NAWD) tests are bacterial antimicrobial susceptibility predictors . Some suggest that the NAWD is not as reliable as the MIC test . We compared the MIC and NAWD tests as to how well they agree to bacterial sensitivity or resistance and predicted clinical outcome of burn wound infections . Using 65 bacterial isolates from burned patients, the MIC and NAWD tests agreed in 60.0% of the isolates (vs . a perfect agreement of 100%, p less than 0.001), implying that these tests are not interchangeable . From 18 burned patients treated with nitrofurazone or mafenide acetate, 28 infectious isolates were evaluated . The outcome of these infections was correctly predicted by NAWD in 92.8% and the MIC in 72.0% of the cases (p less than 0.05) . It seems that for burns treated with topical antimicrobials, the NAWD is a more reliable predictor of bacterial susceptibility.

Jpn J Antibiot, 1987 Feb, 40(2), 295 - 302
{Prophylactic effects of cefmenoxime against postoperative infections after thoracotomy . Studies of cefmenoxime transfer from serum to pleural fluid and of clinical effects of cefmenoxime}; Matsuura Y et al.; Cefmenoxime (CMX) at a dose of 1 g was administered intravenously to each of 10 patients undergoing thoracotomy, and concentrations of CMX in the serum and pleural fluid were measured . Serum concentration of CMX reached its peak of 43.71 micrograms/ml at 1 hour and decreased to 4.15 micrograms/ml at 3 hours after the administration . The concentration of CMX in the pleural fluid reached its peak of 7.61 micrograms/ml at 3 hours and decreased slowly 5.26 micrograms/ml at 7 hours after the administration . A clinical study with 21 patients was performed to evaluate the effect of CMX as a prophylactic antimicrobial agent in thoracotomy . Patients received intravenous administration of 4 g/day of CMX for 7-10 days following operations . Each patient was evaluated daily for fever, sign of allergic reaction, and wound infection and other symptoms . No apparent infection occurred in those clinical patients except 1 patient with a suspected infection, and 1 case of allergic reaction as exanthema was observed during this study . Prophylactic effect of CMX against postoperative infection after thoracotomy was good.

J Anat, 1987 Feb, 150, 43 - 8
Immunohistochemistry of secretory proteins in the bull seminal vesicle; Aumuller G et al.; Antibodies against several proteins isolated from bovine seminal fluid (ribonucleases, bull seminal proteinase inhibitor BUSI II, seminal antimicrobial protein SAP) were used to identify the secretion sites of the respective proteins within the genital tract of the bull . Consistent positive immunoreactions were achieved with most of the antisera in the seminal vesicle epithelium, while only weak or dispersed immunoreactions were found in the epididymis, ductus deferens or the prostate . Comparison of serial sections of bull seminal vesicle stained with different antisera gave incongruous distribution patterns of positively reacting cells . This was interpreted as a sign of either a differential secretion cycle for different proteins in these cells or, more likely, a fixation or processing artifact . There was no clear cut evidence for secretion of seminal antimicrobial protein by seminal vesicle epithelium, but rather a resorption of intraluminally concentrated SAP . The secretion site of this important protein remains obscure, unless cRNA probes for in situ hybridisation studies are available.

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