Antimicrobials

Onkologie, 1987 Feb, 10(1), 57 - 8
Chemoprophylaxis of bacterial infections in granulocytopenic patients with ciprofloxacin; Dennig D et al.; The trial was conducted to evaluate the antimicrobial prophylactic efficacy of ciprofloxacin in reducing the frequency of infections in granulocytopenic patients . The frequency of infections was evaluated in 34 patients with acute non-lymphoblastic leukemia, acute lymphoblastic leukemia, blast crisis of chronic myelogenous leukemia and other malignancies . 46 courses of oral prophylactic treatment with 500 mg ciprofloxacin twice daily were administered . While there was no infection in 61% of treatment courses, fever over 38 degrees C (axillary) occurred in 39% . 6 patients had a fungal pulmonary infection, one patient a supposed viral pneumonia, and only two patients had a documented bacterial infection . There were no severe side effects . We conclude that ciprofloxacin is a potent drug in prophylaxis of bacterial infections in cancer patients with therapy-induced granulocytopenia.

J Clin Pharm Ther, 1987 Feb, 12(1), 59 - 63
Drug prescribing for TPN patients at a teaching hospital serving a developing community; Bertram T et al.; Drug prescribing for TPN patients at Ga-Rankuwa Hospital was investigated as part of a larger retrospective survey of TPN products and practices . The medical records of 45 patients who received parenteral nutrition over the period April-August 1985 were examined . Relevant information was transcribed onto survey forms, classified and analysed . The major defined complaints were gastrointestinal (50%) and perinatal (34.5%) . Twelve patients had more than one major complaint . Seventy-three per cent of the patients were admitted to paediatric wards and over 24% to (adult) surgical wards . There was one medical patient in the group . The only drug categories that were prescribed in more than 10% of cases were antimicrobial agents (64.9%) and analgesics (10.4%) . The most frequently used individual drugs were gentamicin (17.5%), penicillin G (14.3%), piperacillin (17%) and aminophylline (11%) . The implications of this pattern of drug use for TPN patient monitoring are discussed.

J Antimicrob Chemother, 1987 Feb, 19(2), 193 - 6
In-vitro susceptibility of Pseudomonas species to fifteen antimicrobial agents; Rolston KV et al.; The in-vitro susceptibility of four Pseudomonas spp . (P . aeruginosa, P . fluorescens, P . maltophilia and P . putida) to 15 antimicrobials was determined . Ciprofloxacin had the greatest in-vitro activity . Although the susceptibility of the different species to individual agents was quite variable, they tended to be less susceptible to agents such as amikacin, aztreonam, cefoperazone, ceftazidime and piperacillin, already in clinical use at our institution, than to newer agents, not currently in clinical use.

Antibiot Med Biotekhnol, 1987 Feb, 32(2), 122 - 9
{Principles for analyzing the kinetic curves of the antimicrobial effect in dynamic systems simulating the pharmacokinetic profiles of antibiotics}; Firsov AA et al.; Alternative variants of the available methods for estimating the antimicrobial effect kinetics in the in vitro dynamic systems were analyzed . For defining and analyzing the concentration-effect relations in the in vitro dynamic systems it was recommended that two integral parameters characterizing the antimicrobial effect duration (TE) and intensity (IE) irrespective of the recording means be used . TE is defined by the time from the moment of antibiotic administration into the dynamic system till the moment when the count of the microorganisms reaches again its initial level . IE is defined by the area between the curves of the microbial growth kinetics in the presence and absence of an antibiotic . The possible application of TE and IE is exemplified by relation between the sisomicin antimicrobial effect on P . aeruginosa 58, E . coli 93 and K . pneumoniae 5056 and the antibiotic concentration under conditions of sisomicin pharmacokinetic profiles reproduction after intramuscular administration within the levels of the therapeutic doses with an account of individual variability of the aminoglycoside concentration in the blood of humans.

Comput Methods Programs Biomed, 1987 Feb, 24(1), 47 - 62
Choice of antimicrobial drugs by the site of infection; Chung SJ et al.; Microcomputer programs are designed in BASIC for the analysis of 1209 positive cultures and 1056 antimicrobial susceptibility tests on clinical specimens from various sites of infection . A list of antimicrobial drugs of choice by the site of infection is determined on the basis of the computer analysis of the data . The list may be useful to clinicians for initial therapy in critically ill patients and for preoperative prophylaxis before the results of cultures and susceptibility tests are reported.

Surg Clin North Am, 1987 Feb, 67(1), 57 - 68
Systemic antibiotic treatment in burned patients; Dacso CC et al.; Systemic antibiotics are a valuable therapeutic modality in the burned patient when properly used . Injudicious use, however, may not only fail to be beneficial to the patient but also may produce harmful effects--either through direct toxicity or by contributing to the emergence of resistant strains of micro-organisms . General guidelines and principles for systemic antibiotic use include the following: The burned patient, despite all efforts, will be exposed to microorganisms . No single agent or combination of agents can destroy all the organisms to which the burned patient is exposed . Treatment involves first identifying the organism responsible for clinical sepsis, then choosing appropriate agents . Combinations of antibiotics are not always synergistic or even additive in effect . Multiagent therapy may have the untoward effect of predisposing to superinfection by yeast, fungi, or resistant organisms . Antibiotics should be used for a long enough period to produce an effect, but not long enough to allow for emergence of opportunistic or resistant organisms . Dosages must be adjusted based on serum concentrations when serum assays are available . In general prophylactic systemic antibiotics are indicated in only a few clinical situations including the immediate preoperative and postoperative periods associated with excision and autografting, and possibly in the early phases of burns in children . The penetration of systemic antibiotics into burn eschar remains an area not fully studied; hence, they cannot be the only therapeutic modality used to treat burn wound infection . Systemic dosages of antibiotics in burns will require alteration depending on the clinical status of the patient . The choice of agent requires a thorough knowledge of side effects, toxicity, and potential benefit . Above all, active surveillance and monitoring of the burned patient and the environment in which he or she is being treated is mandatory for effective treatment . The increasing number of new antimicrobial agents has presented a new dilemma to the practicing clinician because many of these agents have not been evaluated thoroughly in the burned population . With further studies, the armamentarium of the burn treatment team will inevitably increase . It is in this manner only that so many of the unanswered questions will be solved, and that infection will start to decline as the major cause of death in the burned population.

J Dent Res, 1987 Feb, 66(2), 475 - 9
Antimicrobial factors in saliva: ontogeny and relation to oral health; Tenovuo J et al.; Antimicrobial agents (antibody and non-antibody) present in human saliva protect oral tissues by a variety of mechanisms, such as prevention of bacterial adhesion, agglutination of micro-organisms, and inhibition of multiplication and metabolism . However, studies in which the concentrations of various salivary antimicrobial agents have been correlated to the presence and severity of oral diseases--of dental caries, in particular--have produced controversial data, and it seems evident, also on the basis of the present study, that no single salivary antimicrobial factor (except flow rate) affects oral health to a significant degree . In the present study, we report the levels of some selected salivary antimicrobial agents in predentate and dentate human infants, with a comparison to the levels found in young adults' saliva . Salivary lysozyme, peroxidase, and hypothiocyanite concentrations were already at the adult level at the time when the primary teeth erupt, whereas immunoglobulin (IgA, IgG, and IgM), lactoferrin, myeloperoxidase, and thiocyanate concentrations were significantly lower in children than in adults . Dentate children had more IgG, thiocyanate, and protein in whole saliva than did predentate children.

Agents Actions, 1987 Feb, 20(1-2), 77 - 86
Ascorbate and cysteine-mediated selective neutralisation of extracellular oxidants during N-formyl peptide activation of human phagocytes; Anderson R et al.; The effects of sodium ascorbate and cysteine (2.5 X 10(-5) M-2.5 X 10(-4) M) on the intensity and profile of luminol-enhanced chemiluminescence, superoxide generation, extracellular myeloperoxidase (MPO) activity and auto-iodination were measured in purified human polymorphonuclear leukocytes activated by the leukoattractant FMLP in vitro . Chemiluminescence studies were also performed using a whole-blood method . Cysteine (10(-4) M-2.5 X 10(-4) M) and ascorbate (2.5 X 10(-5) M-2.5 X 10(-4) M) caused significant inhibition of the early extracellular peak of FMLP-activated chemiluminescence and increased the intensity of the later occurring intracellular peak in both PMNL and blood . At the same concentrations both agents scavenged superoxide released by FMLP-activated PMNL, inhibited oxidant generation by extracellular MPO and decreased FMLP-induced auto-oxidation of PMNL . Administration of a single 1 gram oral dose of ascorbate to adult human volunteers was associated with significant reduction and enhancement respectively of the extracellular and intracellular luminol-enhanced chemiluminescence responses of FMLP-activated blood . These results show that the water soluble anti-oxidants cysteine and especially ascorbate selectively neutralise the reactivity of harmful reactive oxidants released by phagocytes, whilst the intracellular generation of antimicrobial oxidants remains intact.

J Am Dent Assoc, 1987 Feb, 114(2), 217 - 21
The use of sodium bicarbonate and hydrogen peroxide in periodontal therapy: a review; Amigoni NA et al.; The comparative benefits from the use of sodium bicarbonate and hydrogen peroxide over the use of a commercial dentifrice in periodontal therapy is controversial . The consensus of the clinical research indicates that application by patients of sodium bicarbonate and hydrogen peroxide offers no advantage over the preestablished, properly performed home oral hygiene procedures . Any improvements in clinical and microbial parameters generally were attributed to scaling and root planing . The studies that have reported beneficial results with sodium bicarbonate and hydrogen peroxide have used additional antimicrobial agents, concomitant professional application of these substances, and scaling and root planing . In one of these reports, inorganic salts and chloramine-T were delivered subgingivally throughout root-planing procedures, in addition to home application of inorganic salts . Most of these patients also received at least one course of systemic tetracycline therapy . Because this study had no control group, it is impossible to determine whether this program is more effective than are other periodontal therapy programs . A more controlled clinical study involving professional application of sodium bicarbonate, sodium chloride, hydrogen peroxide, and povidone-iodine has shown greater gains in clinical attachment and bone mass than has brushing with toothpaste and water . Again, subgingival scaling and root planing were necessary to attain these results . Because multiple topical agents were applied in both of these reports and systemic antimicrobial agents were used by the Keyes group, it is impossible to determine which agent was responsible for the improvements . Further, professional application may be the crucial factor.(ABSTRACT TRUNCATED AT 250 WORDS)

Arch Surg, 1987 Feb, 122(2), 197 - 203
Neutrophil function in a rat model of endotoxin-induced lung injury; Simons RK et al.; Polymorphonuclear neutrophil leukocytes (PMNs) are known to cross the alveolar-capillary barrier and enter the alveolus in acute adult respiratory distress syndrome (ARDS) . The pathogenic role of PMNs in both the acute lung injury and subsequent infectious susceptibility in ARDS is not clear . In the present study we investigated the functional status of various neutrophil populations using a chronic, endotoxemia-induced ARDS model . Rats infused with Escherichia coli endotoxin for three days develop an acute lung injury with a histologic picture closely resembling human ARDS . The PMNs recovered from the circulation and by bronchoalveolar lavage were compared with normal rat PMNs . In endotoxemic animals, superoxide production was markedly enhanced in circulating PMNs, indicating production of high levels of potentially cytotoxic oxygen intermediates, while myeloperoxidase activity was decreased in both circulating and lavage PMNs, indicating depressed myeloperoxidase-dependent antimicrobial activity.

Pharmacol Toxicol, 1987 Feb, 60(2), 100 - 3
Antibacterial effect of four phenothiazines; Kristiansen JE et al.; Various types of phenothiazines were examined for antibacterial effect on 61 Gram-positive and Gram-negative bacterial strains in vitro . The investigated phenothiazines were two neuroleptic drugs, fluphenazine and chlorpromazine, and two antihistaminic drugs, alimemazine and promethazine . All four drugs have antibacterial effects in vitro, the phenothiazines being more potent against the Gram-positive microorganisms . The antibacterial potency of the drugs was measured as IC50: Fluphenazine 29 microM (15 micrograms/ml), alimemzaine 49 microM (37 micrograms/ml), promethazine 88 microM (28 micrograms/ml) and chlorpromazine 92 microM (29 micrograms/ml) . The antibacterial potency of the drugs was linked neither to the neuroleptic nor the antihistaminic potency of the drugs, which is in agreement with results of earlier stereoisomeric investigations . Thus, the known phenothiazines may represent a pool of potentially new antimicrobial drugs . A therapeutic application of these results, however, requires additional in vitro an in vivo testing in an animal model . The bacterial model might be of value as a model system in the study of the interaction of neuropharmacological agents and other membrane active compounds on biological membranes.

J Immunol, 1987 Jan 15, 138(2), 491 - 5
In vivo and in vitro activation of alveolar macrophages by recombinant interferon-gamma; Black CM et al.; In vivo administration of recombinant interferon-gamma (rIFN-gamma) was previously shown to result in activation of the microbicidal activities of peritoneal macrophages (PM phi) . Because macrophages at different anatomical sites vary in their functional capacities, we considered it of interest to determine whether administration of murine rIFN-gamma, either in vitro or in vivo, can enhance the microbicidal activity of resident alveolar macrophages (AM phi) and to compare the effects of rIFN-gamma on AM phi and PM phi . After incubation in vitro with rIFN-gamma, the antimicrobial activities of both murine AM phi and PM phi were enhanced, as assessed by their ability to inhibit replication of the intracellular parasite, Toxoplasma gondii . This effect was dose dependent for AM phi over a range of 0.1 to 1 U/ml and for PM phi over a range of 0.5 to 1000 U/ml . In this assay, the minimum dosage required for in vitro activation of AM phi was one-half that required for activation of PM phi, suggesting a greater sensitivity of AM phi to the in vitro activity of rIFN-gamma . Macrophages from both anatomical sites were also activated when rIFN-gamma was administered in vivo . This effect was dose dependent over a range of 10(3) to 10(5) U/mouse . Freshly harvested AM phi and PM phi from mice injected 24 hr earlier with 10(4) U rIFN-gamma by either the i.v . or i.p . routes markedly inhibited intracellular multiplication of Toxoplasma . In contrast, AM phi and PM phi from control mice permitted fourfold to ninefold increases in numbers of intracellular Toxoplasma . The anti-toxoplasma activity of AM phi and PM phi gradually diminished over a period of 3 days when assayed at successive 24 hr periods after a single i.v . injection of rIFN-gamma . At 3 days after injection, a substantial loss of anti-toxoplasma activity was observed with PM phi as compared with controls; residual anti-toxoplasma activity was still demonstrable in AM phi at 3 days . These results demonstrate that in vitro as well as in vivo treatment with rIFN-gamma confers on AM phi an enhanced antimicrobial activity . These findings provide a rationale for evaluating rIFN-gamma in the treatment of pulmonary infections, especially those due to opportunistic pathogens against which AM phi play a major role in host defense.

Z Hautkr, 1987 Jan 15, 62(2), 125 - 35
{Therapy of chronic venous insufficiency--the domain of dermatologic ambulatory care}; Lohfink HD; By means of a graded test system for external medicaments, we optimized and standardized the local therapy of chronic venous insufficiency (CVI) in our out-patient department: allergological tests; subjective sensitivity tests of ulcus cruris venosum; comparison of ointments with powder in the therapy of ulcus cruris venosum, objective findings, applicability of the dry therapy (Heede); comparison of external drugs containing antimicrobial chemotherapeutics with those not containing these additives in the therapy of ulcus cruris venosum; comparison of ointments containing heparinoid with lipoid-in-water emulsions without admixtures in plebological therapy . We report on the therapeutic standard . Clinically 63,8% of all patients attending our dermatologic out-patient department showed CVI (stages I to IV); 38,7% were graded "venously ill" (stages III and IV) . Stage I of CVI is characterized by varicous veius without discomfort . Problems of eczema are both dermatological and phlebological problems . The therapy of CVI, however, is the dermatologist's business.

Can J Hosp Pharm, 1987 Feb, 40(1), 6 - 11
Intravenous metronidazole: a drug utilization review in a community hospital; Nessim D; The recent release, relatively high cost and extensive usage of intravenous metronidazole, in a 690-bed community hospital, prompted a drug utilization review of this antimicrobial agent . The review was retrospective and occurred over the period of October 25, 1984, to April 10, 1985 . All patients started on intravenous metronidazole were assessed . The quality of use of intravenous metronidazole was determined on the basis of pre-established criteria, which were developed from the literature and in consultation with the hospital's Medical Microbiologist . These criteria were approved by a peer review committee of medical staff . Drug utilization was assessed as either appropriate or inappropriate . Appropriate therapy implied compliance with all of the criteria for appropriate intravenous metronidazole use with respect to indication, dose, dosage frequency, timing of perioperative prophylaxis, duration of use, and concurrent antimicrobial drug use, when metronidazole was prescribed for prophylaxis, empiric treatment or treatment of a documented infection (documented treatment) . Inappropriate use implied non-compliance with one or more of the criteria . Fifty-four courses of intravenous metronidazole in fifty in-patients were reviewed . Of the total usage of intravenous metronidazole, 50%, was judged to be inappropriate . Although the Surgical Services accounted for 56% of the total usage, only 13% of the total intravenous metronidazole use was for surgical prophylaxis . Of these cases, 57% were inappropriate . Seventy percent of the total intravenous metronidazole use was for empiric treatment; 53% of these cases were considered inappropriate . The reasons cited most frequently for inappropriate prophylactic or empiric use were inappropriate indication and inappropriate dosage frequency.(ABSTRACT TRUNCATED AT 250 WORDS)

Gan No Rinsho, 1987 Jan, 33(1), 89 - 96
{Acute squamous metaplasia of the whole lung after combined radiation and chemotherapy in advanced lung cancer}; Miyamoto T et al.; Two patients with advanced lung cancer, histologically diagnosed as adenocarcinoma and squamous cell carcinoma, respectively, were treated with a combination of radiation and anticancer drugs (aclacinomycin-A, bleomycin, mitomycin) . The lung tumors responded remarkably to this combined modality . However, the patients succumbed to pneumonia-like disease, being refractory to various antimicrobial treatments . Histologic examination revealed that the outstanding squamous metaplasia developed diffusely in the terminal bronchioles and the alveoli in all lobes of the lungs . Compared with their clinical courses and the resultant detailed pathological findings, the pathogenesis of the conditions was discussed.

J Am Acad Dermatol, 1987 Jan, 16(1 Pt 2), 238 - 42
Cutaneous botryomycosis in a patient with acquired immunodeficiency syndrome; Patterson JW et al.; A patient with acquired immunodeficiency syndrome presented with multiple pruritic papules and nodules over the trunk and extremities . Biopsy specimens from two of these lesions contained granules within abscesses of the papillary dermis . There were numerous gram-positive cocci within the granules . Culture of one lesion failed to produce growth . A mouse inoculated with tissue from a lesion revealed no evidence of sepsis or organ involvement . The skin lesions showed no obvious response to systemic antimicrobial therapy but gradually resolved after treatment had been discontinued . Such lesions should be clinically distinguished from other cutaneous manifestations of acquired immunodeficiency syndrome, such as Kaposi's sarcoma.

J Trauma, 1987 Jan, 27(1), 45 - 8
Natural course of the human bite wound: incidence of infection and complications in 434 bites and 803 lacerations in the same group of patients; Lindsey D et al.; Human bites and common lacerations are frequent in certain residential groups in institutions for the care of developmentally disabled individuals . We screened the records of such an institution and studied the course and outcome of 434 human bite wounds and 803 lacerations in the same group of clients . Infection developed in 13.4% of the lacerations, and 17.7% of the bite wounds (chi 2 = 3.474; p greater than 0.06) . Prophylactic antibiotics were administered after 14.0% of the bite wounds, and 3.2% of the lacerations . Infection supervened after prophylactic antibiotics in 29.5% of the bites and 34.6% of the lacerations . No patient with a bite wound required debridement, initial or subsequent surgical intervention other than wound closure, admission to hospital, or intravenous antibiotics . There is no recorded instance of a bite wound complication other than immediate loss of tissue . These data substantiate a higher incidence of infection in human bite wounds, but they are scant support for admonition that such wounds are indication for routine antimicrobial prophylaxis or aggressive surgical intervention.

Obstet Gynecol, 1987 Jan, 69(1), 127 - 30
Abbreviated antibiotic therapy for the treatment of postpartum endometritis; Soper DE et al.; Standard antimicrobial therapy for postpartum endometritis usually consists of several days of intravenous antibiotics followed by up to ten days of oral therapy . In an effort to decrease the length of hospitalization and duration of antibiotic use, 54 patients were placed on an abbreviated antibiotic protocol . Therapy consisted of intravenous gentamicin and clindamycin until the patient's temperature remained lower than 99.5F for 24 hours, at which time intravenous antibiotics were discontinued and the patient was discharged immediately without oral medication . No morbidity secondary to the abbreviated regimen was observed . Further, the duration of hospitalization and antibiotic therapy of the study group were significantly shorter than similar data from a group of historic controls . These observations suggest that an abbreviated course of antibiotics, based upon the patient's "therapeutic response," may be a safe and cost-effective alternative to the currently practiced therapeutic regimen.

Rev Argent Microbiol, 1987 Jan-Mar, 19(1), 27 - 31
{Resistance to antibiotics in strains of Azospirillum sp.}; Alonso M et al.; A total of 32 strains of Azospirillum mainly isolated from rhizosphere of grasses and soils of Argentina were examined for susceptibility to 9 antimicrobial agents (trimethoprim, ampicillin, carbenicillin, streptomycin, spectinomycin, chloramphenicol, kanamycin, nalidixic acid and tetracycline) . Many of the strains were sensitive to tetracycline, kanamycin, chloramphenicol and nalidixic acid, and resistant to ampicillin (more than 50 mg/l) and carbenicillin (more than 200 mg/l) . In spite of this general pattern, for most of the strains it was possible to obtain an antibiotype . Such antibiotype could be useful for identification of the strains in field experiments or in genetic transfer experiments.

J Hyg Epidemiol Microbiol Immunol, 1987, 31(3), 335 - 41
Drug resistance and pathogenicity of S . aureus isolated from patients; Vymola F et al.; Over the period 1983-1985, investigators from the Institute of Hygiene and Epidemiology, Prague, and the Central Research Institute of Epidemiology, USSR Ministry of Public Health, Moscow, carried out a joint study of drug resistance in S . aureus strains in relation to their enterotoxigenic properties and phage group specificity . Altogether 277 strains were explored which had been isolated at random from the clinical material from infant and adult inpatients . Most of the isolated strains featured multiple resistance to antibiotics: PNC (77.9%), CMP (52.7%), TET (21.6%), ERY (17.6%) and LIN (11.9%) . The strains isolated from infants were most frequently resistant to TET and ERY . No correlation was found between the incidence of antimicrobial drugs resistance and toxigenic properties of the isolated strains.

Toxicon, 1987, 25(8), 899 - 909
A low molecular weight protein with antimicrobial activity in the cutaneous 'venom' of the yellow-bellied toad (Bombina variegata pachypus); Barberio C et al.; The cutaneous 'venom' was collected from dorsal skin fragments of the yellow-bellied toad Bombina variegata pachypus by means of stimulation with noradrenaline . Light and electron microscope observations gave evidence that the 'venom' corresponds to the secretory products of both serous gland types (i.e . with small or large granules) characteristic of this genus, which had discharged their contents upon stimulation . The serous 'venom', when tested for antimicrobial activity, inhibited the growth of several bacterial strains . Heat treatment, dialysis, protease digestion and SDS-PAGE electrophoresis showed that the antimicrobial activity was thermostable and associated with a low molecular weight protein . This protein was purified and homogeneity determined by CM-cellulose chromatography and SDS-PAGE electrophoresis . The purified protein has a molecular weight of 6700, displays antibacterial properties and appears different from the antimicrobially active peptides previously isolated from the 'venom' of the toad.

Scand J Infect Dis, 1987, 19(4), 483 - 4
Infective aortitis due to Brucella melitensis; Aguado JM et al.; Infective aneurysms caused by Brucella sp . are extremely rare . B . suis and B . abortus have been implicated in a few cases but to our knowledge, B . melitensis has not been reported as a cause of mycotic aneurysm of the abdominal aorta . We here report the first case of this described in the English literature . The patient was successfully treated with resection of the infected aneurysm, placement of an axillo-bifemoral graft, and prolonged antibiotic treatment (doxycycline and streptomycin) . Extended antimicrobial therapy and extra-anatomical bypass grafting procedures are advisable in the management of brucella infections of the abdominal aorta.

J Arthroplasty, 1987, 2(3), 215 - 7
Triple antibiotics for the treatment of infected joint replacements . Case report and commentary; Shaw JA; Combination antibiotics are frequently used in the treatment of infected joint arthroplasties to achieve synergistic activity against the infecting organisms . A case is presented in which triple antibiotic therapy was used in the treatment of an infected hip arthroplasty . The antibiotic combination proved to have an antagonistic effect despite documented sensitivities to the individual drugs . Serum antimicrobial assays are recommended in the treatment of all prosthetic joint infections.

Respiration, 1987, 51(4), 285 - 91
Mycobacterium malmoense--report of a case in Switzerland; Leuenberger P et al.; Mycobacterium malmoense was isolated in four different sputum samples of a 45-year-old alcoholic smoker . The biochemical and culture characteristics of this species are described and compared with a reference strain (ATCC 29571) . The isolated strain was sensitive in vitro to rifampicine, ethionamide, kanamycine and erythromycin . Therapy consisted of right-upper-lobe lobectomy and a two-year antimicrobial therapy . There was no sign of relapse at the end of the treatment period.

Nahrung, 1987, 31(5-6), 507 - 17
Colonization resistance of the digestive tract--mechanism and clinical consequences; van der Waaij D; Potentially pathogenic bacteria and yeasts meet a number of resistance factors . These colonization resistance (CR) determining factors control the growth density of potentially pathogenic microorganisms in the various parts of the alimentary canal . The CR of the digestive tract is to be seen partially of host origin but to a greater extent due to direct and indirect activity of the (anaerobic) indigenous microflora . This implies that the CR mechanism is vulnerable to antibiotics which affect the indigenous flora during treatment . A decreased CR enhances colonization by microorganisms that are resistant to the antibiotic(s) used for therapy . Increased population densities of potentially pathogenic bacteria ("overgrowth") may correlate with invasion of the mucosal tissues often followed by translocation to remote lymphatic organs . Overgrowth also may correlate with development or acquisition of resistance to the antibiotic applied . By screening in experimental animals antibiotics have been selected which do not affect the CR . Such antimicrobial drugs have successfully been used to selectively eliminate potentially pathogenic bacteria and yeast in neutropenic patients.

Ann Med Interne (Paris), 1987, 138(4), 296 - 7
{Severe pneumopathy and acute renal insufficiency disclosing Chlamydia psittaci infection: resistance to the treatment with erythromycin}; Garo B et al.; The authors report one case of psittacosis with acute respiratory distress syndrome, acute tubulo-interstitial nephropathy and jaundice . Erythromycin therapy was uneffective but recovery was obtained with minocycline and rifampicin treatment . Early diagnosis of Chlamydia psittaci infection is mandatory in order to prevent severe complications and to institute appropriate antimicrobial therapy.

Ann Med Interne (Paris), 1987, 138(4), 287 - 8
{Legionnaires' disease in hairy cell leukemia . 2 new cases}; Voiriot P et al.; We report the cases of two patients who developed legionnaires' disease during the course of hairy cell leukaemia . The clinical features are described with special emphasis on the severity of illness in one patient and marked jaundice in both . These cases demonstrate the enhanced susceptibility to Legionella pneumophila infections in patients with hairy cell leukaemia . We therefore suggest a reevaluation of empiric antimicrobial treatment of pneumonia in such patients.

Drugs Exp Clin Res, 1987, 13(3), 161 - 6
Enhancement of antibiotic antibacterial activity by experimental pleural exudates; Miglioli PA et al.; The aim of this research was to study the synergistic effect of experimental pleural exudates and antimicrobial drugs on various microorganisms . The antibacterial activity of different pleural exudates alone and in the presence of sub-MIC amounts of antibiotics was studied by a continuous recording turbidimetric method . Synergistic action between the antibiotics and the exudates was demonstrated . This phenomenon can be explained by the presence of heat-labile substances that themselves possess only slight antibacterial activity but are able to increase the effect of sub-MIC antibacterial drugs.

Zentralbl Gynakol, 1987, 109(7), 450 - 8
{Choriocarcinoma: neutropenia--acute emergency}; Briese V et al.; A patient aged 21 with metastatic choriocarcinoma was treated with Methotrexate . After twice application a severe neutropenia developed . The treatment of the febrile granulocytopenic cancer patient receiving antineoplastic therapy was performed by human gammaglobulin, transfer factor, leucocyte transfusion and selective antimicrobial modulation.

Vet Hum Toxicol, 1987, 29 Suppl 1, 54 - 7
Aquaculture in Europe; Brown LA; The major aquatic species farmed in Europe are Atlantic salmon, rainbow trout and carp . Eels, flat-fish, mussels, oysters and crayfish are also produced . Northern Europe, with more temperate climates, centers its production around the salmonidae; further south and east eels and various species of carp are farmed . Farm systems vary from extensive fishing lakes to highly intensive tank units . Drugs and chemicals appear to be reasonably available in Europe to fish farmers . Three antimicrobials are currently licensed for use in food fish . Current legislation on the use of chemicals on fish farms does not adequately cover the present situation and so, almost any chemical which does not have to be given by a veterinarians prescription is available for a fish farmer . The constraints on future development of medicines for aquaculture industry are discussed together with the problems of generic prescribing.

Dev Pharmacol Ther, 1987, 10(4), 278 - 91
Epidemiological evaluation of anti-infective drug prescribing for children in outpatient practice; Stanulovic M et al.; In comparison with other regions in Yugoslavia, in the District of Novi Sad a high prescribing rate for antimicrobial drug were previously found . The aim of this study was to determine whether this high rate applies also to pediatric patients up to the age of 7 years, to define the prescribing pattern of physicians, and ultimately, to direct educational and other measures toward improving the therapeutic practices . The sample consisted of all prescriptions for 1 month for 26,652 children, comprising 8.9% of the total population . The method was based on a drug dose statistics concept, where the most frequently prescribed amount of the active substance, determined by convention as the defined daily dose (DDD), was used as a unit of measurement . The number of such statistical or average doses were expressed per 1,000 children per day . It was found that the prescribing rate in the District exceeds all other regions for which comparable data exist . In the prescribing pattern, the high usage of tetracyclines contributed to final removal of tetracyclines in syrup formulation from the market in Yugoslavia.

Clin Ther, 1987, 9(4), 420 - 8
Antimicrobial management of surgically treated gangrenous or perforated appendicitis: comparison of cefoxitin and clindamycin-gentamicin; Sirinek KR et al.; Patients with gangrenous or perforated appendicitis were treated with cefoxitin or a combination of clindamycin and gentamicin for a minimum of five post-operative days . Septic complications developed in four of the 54 patients receiving cefoxitin: one was an intraabdominal abscess requiring surgery and three were wound infections . Of the 51 patients receiving clindamycin-gentamicin, two had septic complications: one was an intra-abdominal abscess requiring surgery and one was a wound abscess requiring drainage . The differences in the septic complications in the two treatment groups were not statistically significant . The cost to the patient of combined therapy with clindamycin and gentamicin was 36% higher than the cost of cefoxitin alone . The results demonstrate that cefoxitin alone is comparable to the "gold standard" of clindamycin-gentamicin in the treatment of patients with gangrenous or perforated appendicitis.

Zentralbl Mikrobiol, 1987, 142(2), 175 - 8
Characterization of an antimicrobial substance, produced by Streptomyces violaceorectus; el-Gammal AA; Streptomyces violaceorectus produces a yellow-brown antimicrobial substance when cultivated on starch-potassium nitrate medium . The purified antimicrobial substance was active against Gram-positive, Gram-negative bacteria, and fungi . The solubility, characteristics, Rf values, minimum inhibiting concentrations, UV and IR spectra were studied . Elemental analysis was: carbon 37.94%, hydrogen 6.97%, nitrogen 7.50%, and oxygen 47.58%.

Neurochirurgie, 1987, 33(2), 142 - 7
{Cerebral aspergillosis . Apropos of 4 cases}; Hajjar J et al.; Four patients with aspergillosis of the central nervous system collected in less than two years are reported . Three patients had hematologic malignancies (acute myelogenous leukemia, Hodgkin's disease) and were treated with corticosteroids and chemotherapy . One patient received antimicrobial agents fort a post operative meningitis (after acoustic neuroma surgery) . Analysis of these cases and review of literature available us to point out the increased frequency of invasive and cerebral aspergillosis particularly in immunocompromised hosts treated by cytotoxic drugs or broad spectrum antibiotic therapy . Diagnosis is very difficult because: --there are non specific radiologic features for aspergillus granuloma, abscess, aneurysm or meningitis, --blood and cerebrospinal fluid cultures are invariably negative, --serologic tests have limited value in immunosuppressed patients (poor capacity to elaborate antibodies) . Diagnosis can be made only by surgical biopsy who isolate fungal elements . However diagnosis in greatest cases is only made at autopsy . Treatment consist by antifungal drugs administered intravenously and surgery when it is possible . Prognosis of cerebral aspergillosis is very poor and mortality rate very high about 70%.

Acta Anaesthesiol Belg, 1987, 38(1), 117 - 22
Bronchopulmonary superinfections in the critically ill; Vincent JL et al.; Bacterial colonization of the airways can lead to nosocomial respiratory infections . The emergence of Gram-negative bacteria in the upper airways is usual in critical conditions . Antimicrobial therapy and especially bacterial adherence to the airways mucosa have been incriminated in the selection of Gram-negative bacteria becoming ultimately multiresistant . Transmission of bacteria by the hands of the ICU-personnel and aspiration of bacteria represent two important factors in the airway colonization . Bacterial clearance can simultaneously be impaired by debility and altered mental state . Pulmonary infections are especially common in peritonitis or after abdominal surgery . In a series of 30 patients who had a complicated course after abdominal surgery, we observed that in all patients with acute respiratory failure, sputum cultus yielded at least one microorganism also recovered from cultus of the abdominal secretions . Acute respiratory failure was most commonly due to respiratory infection and carried a worse prognosis . Aspiration of bacteria from the gastrointestinal tract appears to represent the most common source of nosocomial bronchopulmonary superinfection in the critically ill.

Clin Ther, 1987, 9(2), 167 - 73
Effective perioperative prophylaxis with a single dose of cefotaxime in transurethral prostatectomy; Nielsen PB et al.; In a prospective, observer-blind study, the authors assessed the efficacy of cefotaxime (2 gm IV) as auxiliary therapy to the currently used antimicrobial prophylaxis in transurethral prostatectomy . Cefotaxime was administered to 48 patients . From these, 188 blood specimens were drawn and eight blood cultures from eight patients were positive . From an untreated control group of 50 patients 196 specimens were drawn . Thirty-one of these specimens (from 17 patients) were positive (P less than 0.05) . This significant reduction was due mainly to fewer pathogen isolates (1 versus 16) . The number of postoperative complications was reduced from 21 in 15 patients to 12 in 10 patients (P less than 0.05) . It is concluded that a single IV dose of 2 gm of cefotaxime protects against the immediate perioperative complications.

Med Pediatr Oncol, 1987, 15(1), 7 - 13
Randomised study of ticarcillin, cefamandole with or without tobramycin in febrile, neutropenic patients with solid tumors; Page JP et al.; A prospective randomised study was conducted comparing the efficacy and toxicity of the antibiotics ticarcillin and cefamandole (TC) with or without tobramycin (TCT) in 100 febrile neutropenic patients with solid tumours undergoing conventional chemotherapy . In this study, neutropenia less than 100/microliter was noted in 31% of 106 evaluable infectious episodes and neutrophil counts less than 1,000/microliter persisted for a median 4 days . Infection was microbiologically documented in 42% of episodes (bacteremia 24%) with gram-negative organisms responsible for 63% of bacterial isolates . Overall, 65% of episodes responded to TC and 76% to TCT (p greater than 0.05) . Patients with initial shock bacteremia, pulmonary infection, or gram-negative sepsis responded relatively poorly . Neutrophil nadir and pathogen susceptibility did not influence outcome . Antibiotic toxicity was minimal with no tobramycin-related nephrotoxicity . These results are broadly comparable to those observed with leukemic patients, but the relatively short duration of neutropenia in the solid-tumour patients appears to minimize the need for additional antibiotics provided there is adequate antimicrobial coverage with the initial choice of antibiotics.

J Antibiot (Tokyo), 1987 Jan, 40(1), 1 - 6
Identification of novel erythromycin derivatives in mother liquor concentrates of Streptomyces erythraeus; Kibwage IO et al.; The identification of five novel compounds, pseudo-erythromycin A-6,9-hemiketal, 8,9-anhydro-pseudo-erythromycin A-6,9-hemiketal, 8,9-anhydro-pseudo-N-demethylerythromycin A-6,9-hemiketal, 5-O-beta-D-desosaminylerythronolide A and 15-nor-erythromycin C, in mother liquor concentrates of Streptomyces erythraeus is described . The pseudo-erythromycin derivatives are characterized by a 12-membered macrocyclic ring as a result of C13----C11 trans-lactonization . The five compounds have very little antimicrobial activity.

Stat Med, 1987 Jan-Feb, 6(1), 91 - 7
Maximum likelihood estimation and likelihood ratio test for square tables with missing data; Shih WJ; Missing data complicate the analysis of paired categorical data . This paper considers with the use of the EM algorithm, the maximum likelihood estimation and likelihood ratio test for incomplete square tables with missing data . An example involving the susceptibility of micro-organisms to antimicrobial drugs illustrates the procedure.

Rev Infect Dis, 1987 Jan-Feb, 9(1), 214 - 9
After empiric therapy: what to do until the granulocyte comes back; Pizzo PA; The prompt initiation of empiric broad-spectrum antibiotic therapy when a granulocytopenic patient becomes febrile has become standard practice and has resulted in a significant reduction in the early morbidity and mortality associated with infection . Granulocytopenic patients, however, are at risk for multiple infectious episodes, particularly when the duration of neutropenia is prolonged . Accordingly, the addition of one or more antimicrobial agents to the initial empiric antibiotic regimen is often necessary to deal effectively with these second infections and to help maximize the patient's chance for survival . An organized plan that incorporates modifications of the primary antibiotic regimen (e.g., the addition of another antibiotic or an antifungal agent) into the overall management of the febrile neutropenic patient is important, especially when neutropenia lasts for more than a week.

Rev Infect Dis, 1987 Jan-Feb, 9(1), 189 - 93
The white cells: use of granulocyte transfusions; Quie PG; Since serious infections are major complications in patients with fewer than 200 phagocytic cells per microliter or in patients with dysfunctional phagocytes, granulocyte transfusions have been used in an attempt to improve clinical outcome . After two decades of trial and clinical use, the role of granulocyte transfusions for therapy of serious infections has not been clearly established . The methods of harvest, storage, and transfusion of granulocytes are acceptable; however, the quantities that are obtained from donors restrict numbers of cells that may be transfused . Limited clinical response has diminished enthusiasm for the use of granulocyte transfusions as therapy, and their use as prophylaxis has been ineffective . Reported clinical data suggest that patients with persisting granulocytopenia with sepsis due to gram-negative bacteria and patients with chronic granulomatous disease with life-threatening infections unresponsive to aggressive antimicrobial therapy may benefit from granulocyte transfusions.

Drugs, 1987, 34 Suppl 1, 56 - 61
A preliminary report on the pharmacokinetics of ofloxacin, desmethyl ofloxacin and ofloxacin N-oxide in patients with chronic renal failure; White LO et al.; The in vitro activities of ofloxacin, desmethyl ofloxacin and ofloxacin N-oxide were determined and a specific high performance liquid chromatography (HPLC) assay for these 3 compounds was devised as part of a study of the pharmacokinetics of ofloxacin and its metabolites in patients with impaired renal function . Desmethyl ofloxacin had significant antimicrobial activity but less than that of the parent drug . In 2 patients with chronic renal failure, specific HPLC assay indicated an extended half-life for ofloxacin (approximately 13 hours) and the appearance in serum of low concentrations of both metabolites after 10 hours, persisting until the last blood sample was taken (32 hours) . Further studies using specific assays are needed, particularly in patients undergoing haemodialysis and after administration of multiple doses.

Arch Inst Pasteur Madagascar, 1987, 53(1), 217 - 26
{Antibacterial action of essential oils extracted from Madagascar plants}; Ramanoelina AR et al.; The following aromatherapy study reports the antimicrobial activity of eight Malagasy essential oils by the determination of their respective M.I.C . (Minimal Inhibitory Concentration) on enteropathogenic and spoilage bacteria strains . The aromatic plants used were taken from the Labiatae family (Thymus vulgaris, Ocimum gratissimum), the Myrtaceae family (Eugenia caryophyllata, Melaleuca viridiflora) and the Compositae (Helichrysum lavanduloides, H . bracteiferum, H . gymnocephalum, Psiadia altissima) . Their inhibitory effect were tested on eight referied strains commonly used for antibiotic measurements and also on twelve others enteropathogenic bacteria strains . The results showed that three oils from Thymus vulgaris, Ocimum gratissimum and Eugenia caryophyllata were particularly efficient with a large spectra action . We noticed that the essential oil of Melaleuca viridiflora had also a high inhibitory effect especially on Gram positive bacteria.

Vet Med Nauki, 1987, 24(10), 21 - 7
{Preclinical research on drug forms containing rifamycin SV intended for intramammary use}; Pashov D et al.; It was established, that LD50 of rifamycin SV--sodium salt, produced by the Research Institute on Microbiological Industry--Razgrad (People's Republic of Bulgaria)--RM, at p.o . applying on albino mice, albino rats and broilers is correspondingly greater than 4100.0 mg/kg m., greater than 5740.0 mg/kg m . and 1951.6 (1355.5 divided by 2810.1) mg/kg m . and at s . c . introducing into albino mice--815.9 (756.9 divided by 879.9) mg/kg m . From the prepared on the basis of RM-4 intramammary medicaments--RM-1, RM-2 and RM-3 for lactating cows and RM-4 for cows in the dry period, a good bearing have RM-1, RM-3 and RM-4 . RM-1, RM-2 and RM-3, applied intracisternally a single time on lactating cows, and RM-4 on cows in the dry period, create antimicrobial levels with duration correspondingly 168, 72 and 48 h, and 35 days . RM almost does not penetrate in the neighbouring not treated quarters . Appropriate medicament for the lactating cows with average duration of emission is RM-3 (term of action 96 h) and for cows in the dry period RM-4 when applied 35 days before the calving.

Arch Immunol Ther Exp (Warsz), 1987, 35(2), 97 - 101
Microbial transformation of azacarbazoles . II . Conversion of methyl-substituted alpha-carbolines to corresponding alpha-iso-carbolines by Kitasatosporia setae strain; Peczynska-Czoch W; alpha-Carboline derivatives substituted with methyl groups at C-2, C-4, C-2,4, C-6 and C-8 position were subjected to N-1 methylation performed by Kitasatosporia setae . The yield of formed corresponding alpha-iso-carbolines varied, depending on the position of methyl substituent . It has been observed that the methyl group introduced in position C-2 and C-6 of alpha-carboline molecule markedly diminishes the susceptibility of nitrogen for enzymic attack in comparison with methylation reaction performed with methyl iodide . On the contrary, derivatives possessing methyl groups in positions C-4 and C-8 are methylated by chemical and microbial means with approximately the same yield . The obtained alpha-iso-carbolines appeared to be toxic to the transforming Kitasatosporia setae strain at the concentration range of 0.2-2.5 microM/ml . Taking into account that the MIC values of parent alpha-carbolines estimated for Kitasatosporia setae were much higher than 2.5 microM/ml, this finding seems to be out of the accordance with the general belief that the microbial conversion of xenobiotics is only a detoxification process . Apparently, 4-methyl and 2 -dimethyl substituted alpha-iso-carbolines besides of their antimicrobial properties, displayed strong cytotoxic activity against KB cells line at the concentration range 0.03-0.05 microM/ml.

Arch Immunol Ther Exp (Warsz), 1987, 35(2), 129 - 37
Microbial transformation of azacarbazoles . VII . Antitumor properties of benzo-alpha-iso-carbolines formed by Kitasatosporia setae strain from corresponding benzo-alpha-carbolines; Peczynska-Czoch W; 2,3-Benzo-alpha-carboline, 7,8-benzo-alpha-carboline and their 4-methyl derivatives were subjected to microbial conversion yielding corresponding benzo-alpha-iso-carbolines . All obtained products showed significant antimicrobial and cytotoxic properties . ID50 values were found to be at range 0.01-0.001 microM/ml, regarding in vitro KB tumor cells system data . It has been found that introduction of methyl group at para-position to the nitrogen of pyridine nucleus strongly increases cytotoxic and microbial activity of benzo-alpha-iso-carbolines . Apparently it has been indicated that antitumor activity of benzo-alpha-iso-carbolines is strongly dependent on shape and size of the molecule . Of all the compounds tested only 2,3-benzo-1,4-dimethyl-alpha-iso-carboline increases life span of leukemia P388 bearing mice up to 160%.

Acta Med Austriaca, 1987, 14(5), 112 - 4
{Possibilities and limits of the H2 breath test}; Hay U et al.; The hydrogen breath test has been introduced as a non-invasive and reproducible test for the detection of milk intolerance, bacterial overgrowth and intestinal motility disorders . In our hands the semiquantitative assessment of mucosal lactase activity and the non-invasive monitoring of antimicrobial treatment in bacterial overgrowth were further attractive facettes of this test.

Fundam Clin Pharmacol, 1987, 1(4), 283 - 96
Immunopharmacology of the immunotherapy of cancer, infection, and autoimmunity; Hadden JW; The current status and future prospects of the immunotherapy of cancer, infection, and autoimmunity are reviewed briefly . Progress in treating the immunodeficiency of cancer with thymic hormones and drugs such as levamisole and lentinan has produced some degree of remission stabilization . Interferon, interleukin II, and LAK cells have inhibited active, progressive cancer . New approaches with monoclonal antibodies, immunotoxins, tumor necrosis factors, and so on are under rapid development . Future prospects focus on combined approaches yielding synergy . Treatment of infections in animals and man either prophylactically or therapeutically, with thymic hormones, interferons, and thymomimetic drugs such as levamisole and isoprinosine, demonstrate the efficacy of this approach . The use of these agents in conjunction with antimicrobial therapy in immunosuppressed hosts is warranted . In immunodeficiency associated with AIDS virus infection, interleukin II, thymic hormones, isoprinosine, and imuthiol have shown effect in partially restoring immune function, although with little clinical benefit . Their use with antiviral therapy is advocated . Finally, thymic hormones, isoprinosine, levamisole, and other sulfur-containing compounds have ameliorated murine and human autoimmune disease presumably through effects in improving cellular immune function . Continued development of this type of therapy is warranted . The continued progress of immunopharmacology as the science of immunotherapy portends the future successful development of many therapeutic approaches to these diseases.

Acta Neurochir (Wien), 1987, 89(3-4), 112 - 6
Post-operative aseptic meningitis; Blomstedt GC; Neurosurgical patients with post-operative meningitis often present with negative bacterial cultures . The symptoms and signs as well as laboratory findings are identical to those with verified bacterial meningitis . The aim of this study was to find out whether we are dealing with a sterile reaction, and antimicrobial treatment can safely be stopped . 24 patients with post-operative meningitis with negative bacterial cultures were randomized into two groups . Both were initially treated with chloramphenicol until the results of the bacterial cultures were available . Treatment was then withdrawn in one group and continued in the other . Chloramphenicol had no effect on the outcome and can therefore safely be stopped when adequate bacterial cultures are reported negative.

Chemotherapy, 1987, 33(6), 419 - 27
In vitro evaluation of difloxacin (A-56619), A-56620, and other 4-quinolones against isolates from cancer patients; Rolston KV et al.; The in vitro activity of two new quinolones, difloxacin and A-56620, was compared with that of other quinolones against isolates obtained from bacteremic cancer patients . Both agents had a broad antimicrobial spectrum which included both gram-positive and gram-negative organisms . A-56620 had lower MIC values against most organisms tested than difloxacin, and its activity was comparable to that of ciprofloxacin.

Nephrologie, 1987, 8(6), 287 - 92
{Functions and metabolism of polynuclear neutrophils in patients under chronic hemodialysis}; Paul JL et al.; Clinical evidence indicates that infection is still a cause of morbidity and mortality in patients undergoing hemodialysis . The major role played by the polymorphonuclear cells in antimicrobial response by the host explained considerable study of several aspects of granulocyte functions in chronic hemodialysis patients . It is now well documented that hemodialysis induces the sequential activation of the complement components of the alternative pathway and may provide a mechanism for initiating leukoaggregation and sequestration of granulocytes . This complement activation could also explain the profound leukopenia observed shortly after the initiation of hemodialysis . It has been also assumed that the sequestration of granulocytes is dependent on a temporarily altered cell function and leads to a depressed chemotaxis, an impairment of phagocytic and bactericidal capacities . Moreover, a significant defect in the oxidative metabolism was observed before and during the course of the dialysis session . This article summarizes research that has been done on the function of neutrophils from chronic hemodialysis patients.

Drugs, 1987, 34 Suppl 1, 131 - 3
Antimicrobial prophylaxis in immunocompromised patients; Hartlapp JH; The results of a randomised, prospective trial to investigate the efficacy of prophylactic treatment with ofloxacin during granulocytopenia after cytostatic treatment are presented . 42 patients with metastasised testicular germ-cell tumours entered the study . Cytostatic treatment consisted of at least 4 courses, 2 of which were succeeded by prophylactic treatment with ofloxacin . Three patients undergoing prophylactic treatment developed fever . Fever occurred in 16 patients during control phases (no ofloxacin prophylaxis) of cytostatic treatment . Seven of the 19 infections could be documented microbiologically . No side effects that related to ofloxacin were noted . In conclusion, ofloxacin was highly effective in the prevention of infection and, therefore, should be given prophylactically to patients with granulocytopenia.

ORL J Otorhinolaryngol Relat Spec, 1987, 49(3), 152 - 6
Antimicrobial prophylaxis in head and neck surgery; Panosetti E et al.; In this random study, 60 patients were given either cefotaxime, or ceftriaxone as a prophylactic measure in cervicofacial surgery . Each antibiotic was administered during a 48-hour period starting 1 h before the operation . Twenty-three patients underwent major cervicofacial surgery including opening of the pharynx or the buccal cavity by the cervical route . Only a single postoperative infection was observed as a result of a salivary fistula on the 2nd postoperative day . The two antibiotics have turned out to be very efficient as short-term prophylactic treatment in cervicofacial surgery . In other respects, the much longer half-life of ceftriaxone means that a single daily dose can be given . Finally, the cost of the prophylactic treatment is smaller using ceftriaxone than cefotaxime.

J Exp Zool Suppl, 1987, 1, 53 - 63
Vitamin-binding proteins in the nutrition of the avian embryo; White HB 3rd; Nutrients required for the growth and development of an avian embryo must be present when the egg is laid . Many, if not most, of the nutrients in eggs are transferred from the blood plasma of the hen into the yolk of the oocyte as specific nutrient-protein complexes . Egg yolk contains vitamin-binding proteins for thiamin, riboflavin, biotin, cobalamin, retinol, and cholecalciferol . The biochemical details of how these plasma vitamin-protein complexes are recognized by and deposited in the oocyte and subsequently dissociated for use by the embryo are not known . Niacin and ascorbic acid are synthesized by the embryo from other compounds deposited in the egg . Pantothenic acid, which is abundant in the egg, is not bound tightly to a specific protein . Binding proteins for thiamin, riboflavin, biotin, and cobalamin are also present in egg white . Because they are usually not saturated with respect to their ligand, these binding proteins are able to scavenge nutrients and thereby are thought to protect the embryo from infection by microbes that require the ligands . In the albumen of a few species, nutritionally significant amounts of bound riboflavin or biotin are present, suggesting both nutritional and antimicrobial functions for their binding proteins . It is postulated that differences in the amounts of various nutrient-binding proteins correspond to differences in the nutrient contents among the eggs of various species and reflect differences in the nutrient needs of the contained embryos . Mutations that inactivate nutrient-binding proteins arrest development before hatching and are dependent solely on the maternal genotype.

Int J Clin Pharmacol Res, 1987, 7(3), 215 - 7
Cefoperazone therapy of bacterial meningitis: a preliminary report; Cristiano P et al.; Eleven hospitalized patients with bacterial meningitis were treated with cefoperazone at daily dosage ranging between 3 and 8 g intravenously . Seven patients had proven Gram-negative bacterial infections, but in four patients the aetiological agent remained unknown . Eight patients completely recovered from infection and the pathogens were eradicated, in one patient the treatment failed and in two patients only some improvement was registered . Furthermore in five patients cefoperazone serum and cerebrospinal fluid levels were determined four times in the first week of treatment (1st, 3rd, 5th and 7th day) . No side-effects were recorded . Cefoperazone can be considered as effective antimicrobial agent in the therapy of bacterial meningitis.

Immunopharmacol Immunotoxicol, 1987, 9(4), 489 - 510
Halothane anesthesia decreases human monocyte hydrogen peroxide generation . Protection of monocytes by activation with gamma interferon; Stevenson GW et al.; In an effort to determine the impact of halothane anesthesia on certain human cell-mediated immune functions, normal, purified human monocytes and lymphocytes were exposed to halothane in vitro at varying concentrations for up to 8 hours . Subsequently, these human effector cells were analyzed for their ability to function in several cell-mediated immunologic assays . Natural killer cell activity against K-562 was unaffected by halothane in most of the donors tested . Similarly, the ability of purified monocytes to inhibit MBL-2 tumor cell growth was unchanged . Halothane appeared to decrease the proliferative response of lymphocytes to phytohemagglutinin (PHA) in approximately 50% of the normal donors tested . In contrast, the ability of monocytes to lyse antibody-coated red cell targets (ADCC) was unaffected by even maximal exposure to halothane . Of interest was the finding that human monocytes exposed to as low as 2% halothane anesthesia for 4 hours displayed a dramatic down-regulation of hydrogen peroxide (H2O2) release . Since it is known that hydrogen peroxide and other incompletely reduced forms of oxygen secreted by monocytes can play a major role in the antimicrobial, antitumor, and inflammatory functions of these cells, this finding may help explain the enhanced susceptibility of post-operative patients to infections.

Folia Microbiol (Praha), 1987, 32(5), 421 - 5
Antimicrobial properties of aromatic compounds of plant origin; Zemek J et al.; The antimicrobial action of 11 compounds involving guaiacyl- and syringyl-like structures (low-molecular-weight part of lignin), gallic acid and its derivatives, cinnamic acid and its derivatives, veratric acid, anisic acid and crotonic acid (a total of 25 compounds) against bacteria, yeast-like organisms and protozoa was examined . Aromatic compounds modified in the C-side chain and aldehydes were effective preferentially against Trichomonas vaginalis, whereas against bacteria and yeast-like organisms eugenol was the most effective inhibitor.

Toxicol Pathol, 1987, 15(3), 333 - 7
Interleukin 1 and interferon-gamma: cytokines that provide reciprocal regulation of macrophage and T cell function; Schultz RM; Interactions between macrophages and T cells are symbiotic, since optimal functions of both cell types require interchange of soluble mediators . Upon activation, macrophages release interleukin-1 (alias lymphocyte activating factor, leukocytic endogenous mediator, and endogenous pyrogen), a family of molecules with multivarious biological effects, ranging from induction of fever and the acute phase response to lymphocyte activation and concomitant release of interleukin-2 . Interleukin-2 induces activation and replication of several subsets of precursor lymphocytes, including cytotoxic T cells, lymphokine-activated killer (LAK) cells, and natural killer (NK) cells, and enhances their cytotoxic activity for tumor cells . Both interleukin-2 and leukotrienes enhance production of immune interferon (interferon-gamma) by activated T cells . Aside from antiviral activity, interferon-gamma produces a number of immunomodulatory effects, including macrophage activation (Ia induction, antimicrobial effector function, and activation of oxidative metabolism) and augmentation of NK function . Expression of Ia on accessory cell membranes is required for the initiation of many antigen-specific, T-dependent immune responses . Interferon-gamma also synergizes with a variety of microbial agents to augment macrophage tumoricidal function and enhance interleukin-1 secretion . The production of interferon-gamma appears to have a critical role in feeding back the cascade of interleukins in a loop of amplification . Both interleukin-1 and interferon-gamma modulate release of arachidonate metabolites in various cells . This cascade of cytokines, in collaboration with arachidonate oxygenation products, regulates immunity and sets the stage for many of the events underlying inflammation . Various anti-inflammatory drugs and immunopotentiators appear to act by modulating cytokine pathways.

J Toxicol Clin Toxicol, 1987, 25(4), 255 - 72
Properties of the extract and spicules of the dermatitis inducing sponge Neofibularia mordens Hartman; Flachsenberger W et al.; Skeletal components and the exudate of the sponge Neofibularia mordens, as well as four fractions of the extract were investigated . Possible causes, and management, of the contact dermatitis resulting from application of extract fractions were studied . Antimicrobial activity of the sponge extract fractions, together with their effect on small crustaceans, was determined . Two fractions exhibited strong neuroactivity on guinea-pig isolated intestine, octopus-arm nerve-muscle and crustacean cheliped nerve-muscle preparations.

Folia Microbiol (Praha), 1987, 32(4), 329 - 33
Antimicrobial effects of some mono- and bishydrazones; Valent M et al.; Antibacterial, antifungal and antiprotozoal effects of nine mono- and bishydrazones of glycolaldehyde, glyoxal, methoxyacetaldehyde and glutaraldehyde were studied using eight model organisms . It was found that bishydrazones are much more efficient antimicrobial agents than monohydrazones in the case of all model microorganisms.

Pediatr Infect Dis J, 1987 Jan, 6(1), 24 - 8
Review of 59 patients hospitalized with animal bites; Feder HM Jr et al.; We reviewed the charts of 59 pediatric and adult patients hospitalized because of animal bites (46 dog bites, 10 cat bites, 3 monkey bites) . The bites of 40 of the 59 patients were infected at the time of admission . Gram-stained specimens correctly predicted the infecting bacteria in only 5 of 20 cases . Eighty-three percent of the bacterial isolates were penicillin-susceptible . Before admission 14 patients had received outpatient antibiotic prophylaxis and the infections in 11 of these 14 patients were caused by bacteria susceptible to the prophylactic antibiotic . Complications were more common if antimicrobial therapy had not been altered according to susceptibility testing results . Of the 59 patients 19 were admitted immediately after being bitten because of severe uninfected bites . Of these 19 patients 18 received prophylactic antibiotics and none developed a serious complication.

Intensive Care Med, 1987, 13(2), 106 - 13
Prevention of colonization and respiratory infections in long-term ventilated patients by local antimicrobial prophylaxis; Unertl K et al.; In a randomized clinical trial the prophylactic effects of locally administered antimicrobials on quantitative colonization and respiratory infections were studied in intubated patients with an expected period of mechanical ventilation of greater than 6 days . Nineteen patients received 50 mg of polymyxin B and 80 mg of gentamicin distributed among nose, oropharynx and stomach at 6-h intervals, as well as 300 mg of amphotericin B in the oropharynx . Twenty untreated patients served as controls . In the control group colonization by respiratory pathogens was more common (oropharynx 19 vs 6 patients (p less than 0.001); trachea 19 vs 11 (p less than 0.01)), and the number as well as the count of the colonizing species was usually higher . Fourteen patients of the control group developed respiratory infections, including nine cases of pneumonia, as compared to four patients with prophylaxis, including one case of pneumonia (p less than 0.01) . Pneumonia-associated deaths were prevented with prophylaxis; however, the overall mortality remained unchanged . Respiratory infections in the prophylaxis group were associated with organisms resistant to the agents used, but the overall occurrence of resistance was not increased, as compared to the control group . We conclude that unrestrained upper airway colonization by respiratory pathogens and respiratory tract infection were causally related . Local antimicrobial prophylaxis proved to be a highly effective strategy for the prevention of potentially life-threatening pneumonias in critically ill patients, but in the present study the host setting appeared to be the major determinant of outcome.

Antimicrob Agents Chemother, 1987 Jan, 31(1), 27 - 31
Inactivation of enveloped viruses and killing of cells by fatty acids and monoglycerides; Thormar H et al.; Lipids in fresh human milk do not inactivate viruses but become antiviral after storage of the milk for a few days at 4 or 23 degrees C . The appearance of antiviral activity depends on active milk lipases and correlates with the release of free fatty acids in the milk . A number of fatty acids which are normal components of milk lipids were tested against enveloped viruses, i.e., vesicular stomatitis virus, herpes simplex virus, and visna virus, and against a nonenveloped virus, poliovirus . Short-chain and long-chain saturated fatty acids had no or a very small antiviral effect at the highest concentrations tested . Medium-chain saturated and long-chain unsaturated fatty acids, on the other hand, were all highly active against the enveloped viruses, although the fatty acid concentration required for maximum viral inactivation varied by as much as 20-fold . Monoglycerides of these fatty acids were also highly antiviral, in some instances at a concentration 10 times lower than that of the free fatty acids . None of the fatty acids inactivated poliovirus . Antiviral fatty acids were found to affect the viral envelope, causing leakage and at higher concentrations, a complete disintegration of the envelope and the viral particles . They also caused disintegration of the plasma membranes of tissue culture cells resulting in cell lysis and death . The same phenomenon occurred in cell cultures incubated with stored antiviral human milk . The antimicrobial effect of human milk lipids in vitro is therefore most likely caused by disintegration of cellular and viral membranes by fatty acids . Studies are needed to establish whether human milk lipids have an antimicrobial effect in the stomach and intestines of infants and to determine what role, if any, they play in protecting infants against gastrointestinal infections.

Antimicrob Agents Chemother, 1987 Jan, 31(1), 117 - 20
Therapeutic implications of inhibition versus killing of Mycobacterium avium complex by antimicrobial agents; Yajko DM et al.; Patients with the acquired immune deficiency syndrome (AIDS) with disseminated Mycobacterium avium infection have responded poorly to treatment with rifabutine (Ansamycin) and clofazimine, in spite of the good in vitro response of M . avium to these antimicrobial agents . We compared the ability of these and other antimicrobial agents to kill versus the ability to inhibit the growth of strains of the M . avium complex isolated from patients with AIDS . Killing curve experiments showed that the concentrations of rifabutine and clofazimine needed to kill two log units of M . avium are at least 32 times greater than the concentrations needed to inhibit growth . Little or no killing occurred at concentrations of these antimicrobial agents that are achievable in serum . In contrast, five of seven strains tested were killed by ciprofloxacin at concentrations that can be achieved in serum . Ciprofloxacin should be studied further for possible use in the treatment of M . avium infections.

Clin Ther, 1987, 9(3), 273 - 80
Clinical and bacteriological evaluation of tetracycline and erythromycin in acne vulgaris; Al-Mishari MA; A clinical and bacteriological comparison of tetracycline and erythromycin was carried out in 40 patients with papulopustular acne vulgaris . Twenty patients received 250 mg of tetracycline BID and 20 received 250 mg of erythromycin BID for four months . Clinically, 19 (95%) of patients treated with tetracycline and 17 (85%) of those treated with erythromycin had improvement ranging from moderate to very good . Both drugs also reduced the microflora both in the pustules and on normal skin from the same patients . Three patients given tetracycline and one given erythromycin reported mild side effects . Thus both antimicrobial agents were effective and safe in treating acne vulgaris.

Antimicrob Agents Chemother, 1987 Jan, 31(1), 100 - 1
In vitro activity of A-56268 (TE-031) and four other antimicrobial agents against Chlamydia trachomatis; Segreti J et al.; The in vitro activity of A-56268 (TE-031), a new macrolide antibiotic, against 11 strains of Chlamydia trachomatis was determined and compared with that of four other antibiotics . A-56268 was the most active drug tested . Doxycycline, trimethoprim-sulfamethoxazole, and erythromycin had good activity but were less active in vitro than A-56268.

Sex Transm Dis, 1987 Jan-Mar, 14(1), 37 - 40
Symptomatic response to therapy of men with gonococcal urethritis: do all need posttreatment cultures?
Schmid GP, Johnson RE, Brenner ER.
Because the large majority of men with gonorrhea respond to antimicrobial therapy with the rapid disappearance of signs and symptoms, it was hypothesized that a symptomatic response to therapy would predict successful treatment . The records of 4897 men with gonorrhea, of whom 183 (3.7%) were treatment failures on days 3-7 after treatment were studied, and the clinical response to therapy with microbiologic outcome was correlated . Before therapy, 4662 men (95.2%) had dysuria and/or urethral discharge . Of the 582 men who remained symptomatic, 103 (17.7%) had a positive culture after treatment, as compared with only 78 (1.9%) of 4080 men who became asymptomatic (P less than .01) . The conclusion was that men who are initially symptomatic and become asymptomatic after therapy have a small chance (one of 50) of being infected at the posttreatment visit . However, because of its very large size, this group contributed almost one-half of all treatment failures (78 of 183; 42.6%).

Br J Neurosurg, 1987, 1(2), 179 - 83
Subdural empyema: a rational management plan . The case against craniotomy; Shearman CP et al.; A review of the management of 34 patients with subdural empyema treated at the Derbyshire Royal Infirmary has been undertaken . It is concluded that craniotomy has little part to play in the management of patients with this condition . With modern, improved antimicrobials and prompt burr hole lavage complete recovery should be obtained in the majority of cases . The treatment of the severely ill patient is discussed.

J Infect, 1987 Jan, 14(1), 71 - 8
Cutaneous infection with Mycobacterium gordonae; McIntyre P et al.; A case of cutaneous infection with Mycobacterium gordonae and other reports of extrapulmonary infection due to this organism are reviewed . This case confirms the pathogenic potential of M . gordonae which must now be included among the scotochromogens capable of causing cutaneous disease . Isolates of this organism should be tested against a full range of antimicrobial agents since traditional antituberculous therapy may be of limited efficacy . Pending the results of in vitro susceptibility testing, amikacin, ethambutol, rifampicin and co-trimoxazole are suggested as empirical therapy for infections caused by this organism.

J Hyg Epidemiol Microbiol Immunol, 1987, 31(3), 307 - 12
Comparative investigation of PMN leucocyte antimicrobial potential in animals of different species susceptibility to the plague agent; Isin ZhM et al.; The present work was aimed at a comparative study of oxygen-dependent metabolism (OM) and myeloperoxidase (MPO) activities as well as the content of bactericidal cationic proteins (BCP) in polymorphonuclear leucocytes (PMNL) from mammals and birds with different susceptibility to plague (mice, guinea pigs, rats, great and miday gerbils, rabbits, dogs, pigeons and man) . The experimental finding of an association between infectious susceptibility and functioning of the major PMNL bactericidal systems (OM activity and BCP content) indicates that the magnitude of antimicrobial potential of professional phagocytes is a factor determining species susceptibility to plague . The intermediate and high levels of MPO activity detected in all the species studied except in pigeons suggest involvement of the MPO-H2O2-halide cytocidal system of PMNL in destroying Y . pestis.

J Antibiot (Tokyo), 1986 Dec, 39(12), 1724 - 35
Preparation and evaluation of 3,4''-ester derivatives of 16-membered macrolide antibiotics related to tylosin; Kirst HA et al.; A large group of ester derivatives of tylosin-related macrolides was prepared in which the hydroxyl groups at C-3 and C-4'' were acylated by either chemical or biochemical methods . Most of the derivatives exhibited excellent in vitro antimicrobial activity . However, only the 3,4''-diacyl derivatives of tylosin and macrocin showed any significant improvements of in vivo efficacy against experimental infections in rodents.

Antimicrob Agents Chemother, 1986 Dec, 30(6), 958 - 60
Relevance of in vitro antimicrobial susceptibility of Brucella melitensis to relapse rate in human brucellosis; Ariza J et al.; The in vitro susceptibility of Brucella melitensis was examined vis-a-vis the clinical outcome in 75 patients with brucellosis . The initial MICs for Brucella isolates from patients who relapsed and from those who did not were similar . Furthermore, the MICs for isolates from patients whose infections relapsed were no different from those for original isolates . Our results clearly showed that neither initial nor subsequent antibiotic susceptibility plays a role in the likelihood of relapse of patients with brucellosis.

Antimicrob Agents Chemother, 1986 Dec, 30(6), 874 - 6
Pharmacokinetics of cefoperazone in the parturient; Gonik B et al.; Limited pharmacokinetic data for cefoperazone are available from the parturient . Because cefoperazone has a dual excretory pattern, primarily via the biliary system and secondarily via the kidney, pregnancy-induced physiologic alterations can influence its deposition and clearance . Twelve term parturients receiving cefoperazone prophylaxis after cesarean section were selected for study . After 2 g of cefoperazone was administered for 1 h intravenously, serial blood samples were assayed by high-pressure liquid chromatography . Plasma protein binding of cefoperazone was studied in vitro . The mean peak cefoperazone concentration +/- standard deviation was 169.9 +/- 60.4 micrograms/ml . The mean half-life was 152 min . Total serum clearance was 80.8 +/- 30.8 ml/min . The steady-state volume of distribution was 14.2 +/- 6.0 liters . All subjects had detectable trough levels at the end of the dosage interval, with a mean value of 6.5 +/- 5.2 micrograms/ml . Protein binding of cefoperazone for parturients was 74.3 +/- 10.9%, compared with 87.7 +/- 3.2% in nonpregnant controls (P less than 0.05) . These data suggest that cefoperazone deposition can be greatly influenced by pregnancy . However, unlike several other new antimicrobial agents whose excretions are mainly renal, the cefoperazone half-life and thus trough concentration for the parturient more closely resemble that for the nonpregnant subject.

Am J Hosp Pharm, 1986 Dec, 43(12), 3008 - 13
Effect of pharmacist interventions on drug therapy costs in a surgical intensive-care unit; Miyagawa CI et al.; The effect of interventions by a clinical pharmacist on the cost of drug therapy in a 14-bed surgical intensive-care unit (SICU) was evaluated . The SICU pharmacist provides both distributive and clinical services from a modified satellite pharmacy five days each week . During a 13-week study period that comprised 65 days, the pharmacist documented all interventions that resulted in a discontinuation of or change in drug therapy, all nonformulary-drug requests, the detection and avoidance of problems related to drug therapy, and the enrollment of patients in investigational drug studies (for which the pharmacy department received monetary remuneration) . The effect of these interventions on the costs of drug therapy was calculated using drug acquisition costs and, for i.v . preparations, the cost of the i.v . fluid and the cost of preparing and checking the product . A total of 332 interventions during the study period represented $18,030 in potential cost avoidance, which would extrapolate to an annual cost avoidance of $72,122 . The majority of interventions involved discontinuations of or changes in drug therapy, most often involving antimicrobials . This pharmacist had a positive impact on the cost of drug therapy in the SICU.

Chemioterapia, 1986 Dec, 5(6), 385 - 7
In vitro antimicrobial activity in comparison with tonsillar tissue penetration of mezlocillin; Martinetto P et al.; The aim of this study was to determine the role of mezlocillin, a new acylureidopenicillin, in otorhinolaryngology . One hundred and forty-four bacterial strains were isolated from 100 patients suffering from infections of the oropharyngeal tract . Among the isolates only 10 (6.9%) resulted in being mezlocillin-resistant by the agar diffusion method . Minimum inhibitory and minimum bactericidal concentrations were also determined . Pharmacokinetic parameters e.g., diffusion in tonsillar tissue and serum concentrations, were studied . Mean mezlocillin tonsillar levels of 3.5 micrograms/g and 1.8 micrograms/g and serum concentrations of 60.2 micrograms/ml and 10.6 micrograms/ml, 1 h and 4 h respectively after administration, were found.

Obstet Gynecol, 1986 Dec, 68(6), 789 - 94
Puerperal pelvic thrombophlebitis: impact on diagnosis and treatment using x-ray computed tomography and magnetic resonance imaging; Brown CE et al.; The clinical diagnosis of puerperal pelvic thrombophlebitis was confirmed by x-ray computed tomography in 11 women, and further documented in six by magnetic resonance imaging . Venous thrombi were demonstrated in ovarian, iliofemoral, and inferior vena caval vessels . In six women with ovarian vein involvement and no evidence of iliofemoral thrombophlebitis, resolution followed intravenous antimicrobial therapy alone, and in three of these, resolution was confirmed by x-ray tomography . In contrast, three of five women with symptomatic iliofemoral thrombophlebitis had a prolonged febrile course despite antimicrobial and heparin therapy . The clinical courses of these 11 women were consistent with the observation that pelvic thrombophlebitis is associated with pelvic infection . Disease manifested within a few days after parturition was more likely due to ovarian vein involvement, whereas disease with later onset of symptoms was more likely due to iliofemoral thrombosis, with or without vena caval extension . Through the use of x-ray computed tomography and magnetic resonance imaging, the natural course of pelvic thrombophlebitis can be better elucidated and therapeutic regimens more clearly evaluated.

J Clin Microbiol, 1986 Dec, 24(6), 1100 - 1
Isolation of two strains of Kingella kingae associated with septic arthritis; Raymond J et al.; Two new cases of infection, a presternal abscess and a spondylodiscitis caused by the recently classified bacterium Kingella kingae, are reported . The main bacteriological characteristics and the susceptibility of the two isolates to antimicrobial agents are described . The pathology of K . kingae, particularly among children, is reviewed.

Antibiot Med Biotekhnol, 1986 Dec, 31(12), 917 - 20
{Experimental and clinical study of the use of lysozyme in combination with chemotherapeutic agents}; Bukharin OV et al.; Antimicrobial effect of lysozyme in combination with a wide set of antimicrobial drugs (38) was studied with respect to 74 bacterial cultures . It was shown that synergism of the antimicrobial effect in the presence of lysozyme was variable for drugs differing in the mechanism of their action and depended on the pathogen species . The most pronounced synergistic effect was observed with respect to grampositive bacteria with the use of many drugs such as benzylpenicillin, ampiox, morphocycline, erythromycin and others . The potentiation effect of lysozyme was less pronounced with respect to Coli bacteria and Pseudomonas . Combination of lysozyme with aminoglycosides such as gentamicin, tobramycin, sisomicin and amikacin resulted in increasing antimicrobial effect with respect to practically all the microbial cultures tested . The clinical trials of the efficient combinations of the antibiotics and lysozyme studied experimentally proved their high efficacy in combined therapy of patients with pneumonia and pyelonephritis of bacterial genesis . Thus, in children with acute pneumonia (92 observations) it resulted in more rapid elimination of the temperature reaction, toxic and cardiorespiratiry syndromes, cough and physical signs of the disease . In treatment of 83 children with pyelonephritis complete clinico-laboratory remission was observed in 81 per cent of the cases against 56.4 per cent in the patients treated with the antibiotics without lysozyme.

Comput Methods Programs Biomed, 1986 Dec, 23(3), 217 - 23
A microcomputer-assisted analysis of drug resistance in bacteria; Moller JK; A software package for analysis of antimicrobial drug resistance traits has been developed . It is written in PASCAL and implemented on a microcomputer . The microbiological data to be analysed is reduced to the different patterns of drug resistance found and the associated numbers of isolates . Based upon these patterns of drug resistance, the incidence of resistance to individual drugs and combinations is calculated . Furthermore, the extent and nature of the multiple drug resistance within a group of microorganisms is examined by looking at various aspects of the statistical association of drug resistance traits.

Clin Perinatol, 1986 Dec, 13(4), 741 - 54
Septic shock in obstetrics; Gonik B; Septic shock in the obstetric population remains an uncommon yet potentially lethal complication of infection . Effective therapy mandates early recognition and aggressive intervention . Although numerous similarities exist in comparison to the nonobstetric patient, differences in potential pathogens and alterations in physiologic parameters should be kept in mind . In addition, the antepartum subject carries with her another potentially viable human being who deserves consideration . Optimal therapy should be directed at reestablishing an effective intravascular volume, maintaining adequate oxygen delivery to peripheral and central tissues, and the initiation of appropriate broad-spectrum antimicrobial agents to eradicate the causative pathogens.

J Urol, 1986 Dec, 136(6), 1290 - 1
Acute renal failure in a solitary kidney due to bacterial pyelonephritis; Weinstein T et al.; Deterioration of renal function after acute bacterial pyelonephritis is rare . We report on 2 patients with a solitary functioning kidney in whom acute renal failure developed in the setting of acute bacterial pyelonephritis . Following antimicrobial treatment kidney function returned to baseline values . This finding suggests that patients with a solitary functioning kidney are more prone to have renal dysfunction after acute bacterial pyelonephritis.

Eur J Clin Microbiol, 1986 Dec, 5(6), 634 - 8
Influence of antibiotics on intestinal mucin in healthy subjects; Carlstedt-Duke B et al.; To determine the effect on microbial breakdown of intestinal mucin healthy volunteers were treated orally with ten different antibiotics . The most pronounced effects were seen after administration of bacitracin, clindamycin or vancomycin: the electrophoretic mucin pattern in faeces changed from a normal conventional pattern to a specific pattern similar to that found in germ-free rats . Disturbed patterns were also observed in some of the subjects treated with ampicillin, doxycycline, erythromycin, metronidazole or nalidixic acid . In most cases the electrophoretic mucin pattern normalized within five weeks after the end of treatment . There were no effects on the microbial breakdown of intestinal mucin in the groups treated with ofloxacin or trimethoprim/sulfamethoxazole . Thus, administration of antimicrobial drugs in clinically recommended doses may cause long-term disturbances in one microflora-associated characteristic, the breakdown of intestinal mucin.

Aust N Z J Med, 1986 Dec, 16(6), 761 - 5
Serological investigations in the diagnosis and management of infective endocarditis; Roberts-Thomson PJ et al.; In a retrospective study of 39 patients with infective endocarditis (IE) all had elevated concentrations of C reactive protein (CRP) at presentation, patients with the acute variety having significantly higher values than patients with the subacute variety . In addition, the majority of patients with subacute bacterial endocarditis had elevated concentrations of circulating immune complexes (CICs) and rheumatoid factor (RF), both of which were absent in all but one of nine patients with acute bacterial endocarditis . Two patients with subacute and one with acute bacterial endocarditis had low values of C3 and C4 . Measurement of CRP, CICs, and RF did not distinguish between patients with and without extracardiac manifestations . Sequential analysis of patients revealed that a successful response to antimicrobial treatment was indicated by a striking and rapid decline in CRP, with less striking declines in CICs, RF, and IgM . Antibiotic failure was indicated by the persistence of high concentrations of CRP and CICs . We conclude that the measurement of C reactive protein is of some value in the diagnosis and management of infective endocarditis . A normal CRP concentration excludes this diagnosis . The measurement of CRP alone appears sufficient for monitoring most cases of infective endocarditis with the sequential measurement of rheumatoid factor and circulating immune complexes adding no useful information except where the CRP remains elevated despite treatment . In this latter instance, persisting high levels of CRP and circulating immune complexes together herald an ominous course.

Arch Latinoam Nutr, 1986 Dec, 36(4), 725 - 33
Potentialization of the lactoperoxidase system for preservation of raw milk in the tropics; Aparicio MA et al.; The antimicrobial ability of the lactoperoxidase system was increased by the addition of larger amounts of the thiocyanate and hydrogen peroxide at levels above those suggested by other authors . Results of laboratory and field trials revealed that the potentialized system was able to preserve poor-quality raw milk for longer periods of time, at "tropical" temperatures, than when used as recommended previously . It was possible to preserve some milks at 20 degrees C for more than one day, without diminishing their overall quality . At 36 degrees C, the milks did not show acidity development for about 10 hours . Tests conducted under real collection and transportation conditions validated these findings . It was therefore proved that the system can be used practically and that its bactericidal/bacteriostatic effect on the spoilage flora of milk can be increased in order to overcome the particularly adverse conditions of milk handling in the tropics.

Acta Pathol Microbiol Immunol Scand {B}, 1986 Dec, 94(6), 393 - 8
The antibacterial effect of selected phenothiazines and thioxanthenes on slow-growing mycobacteria; Kristiansen JE et al.; The aim of the present investigation was to illustrate the antibacterial effect of various phenothiazine and thioxanthene derivatives on mycobacteria in vitro . It was demonstrated that clopenthixol is about twice as potent as chlorpromazine (CPZ) and levomepromazine-maleate is about half as potent as CPZ, measured by the inhibitory effect on the growth of the mycobacterial strains . Measured in the same way the stereoisomeric compounds of flupenthixol are shown to be more potent than the stereo-isomeric compounds of clopenthixol and chlorprothixen . The two last-named compounds are equal in potency . The stereo-isomeric analogs of the thioxanthene derivatives are equal in antibacterial potency against the slow-growing mycobacteria . The mycobacterial strains investigated show no difference in sensitivity between the cis (Z)--and and trans (E)--compounds of the thioxanthenes . It seems particularly promising that also the more resistant mycobacteria other than Mycobacterium tuberculosis, e.g . M . avium and M . intracellulare, are sensitive in the concentration range investigated . Considered as a whole, these results might be a stimulus to investigate the antimicrobial effect of the thioxanthenes in vivo.

J Pharm Sci, 1986 Dec, 75(12), 1180 - 4
Synthesis and antimicrobial activities of N4-(2-acetoxyethoxymethyl)thiosemicarbazones and N3-(2-acetoxyethoxymethyl)thioureas; Foye WO et al.; A series of thiosemicarbazones and thioureas having an open-chain analogue of the ribosyl group, the 2-acetoxyethoxymethyl moiety, has been synthesized . Significant growth inhibitory activity versus gram-positive and gram-negative organisms, a yeast, and a mold has been found with the 2-acetoxyethoxymethyl derivatives of N-alkyl-, aryl-, and heteroaryl-thiosemicarbazones and thioureas . The molecules may function as inhibitors of ribonucleotide reductase or in utilization of the carbamyl group in pyrimidine biosynthesis.

Antibiot Med Biotekhnol, 1986 Dec, 31(12), 905 - 9
{Comparative study of the surface-active properties of gramicidin S and its derivatives by polarography}; Korolev PN et al.; Gramicidin S and its derivatives by the free amino groups of the ornithine moieties were studied with respect to their effect on interface tension of mercury and the polarographic background for comparative estimation of the surface active properties of these compounds . The same way as the compounds preserving their main properties, the neutral and acid derivatives lowered the polarographic maximum . No correlation between the level of the antimicrobial and membrane activity and the surface active properties of the tested compounds was observed . It is likely that the direct cause of the induced biological effect is not connected with the surface active properties responsible for possible interaction of the tested substances with the cell (protoplast).

Biochim Biophys Acta, 1986 Nov 6, 862(1), 211 - 9
Relationship between antimicrobial activity and amphiphilic property of basic model peptides; Lee S et al.; Several cationic model peptides of the prepiece moieties of mitochondrial protein precursors were found to be active against Gram-positive bacteria, but inactive against Gram-negative bacteria . The CD spectra of the model peptides in the presence of phospholipid liposomes demonstrated that antimicrobial activity was generally in parallel with the content of the alpha-helical amphiphilicity . The results indicate that appropriate positioning of cationic and hydrophobic groups in the stable alpha-helical structure of the peptides is important to exhibit antimicrobial activity . These peptides also have an ability to leak carboxyfluorescein from acidic and neutral phospholipid vesicles, suggesting that the peptides interact with the bacterial membrane to perturb it.

Zhonghua Min Guo Wei Sheng Wu Ji Mian Yi Xue Za Zhi, 1986 Nov, 19(4), 289 - 94
{Fatal septicemia due to Chromobacterium violaceum}; Wu SH et al.; A 2-year old boy was suffered from an infection caused by Chromobacterium violaceum . This is the first case of C . violaceum infection reported in Taiwan . The boy was treated with chloramphenicol and gentamicin but died after one month of illness due to the incooperation of patient's family . The causative agent was isolated from patient's blood and scar . Complete bacteriologic characteristics and antimicrobial susceptibility pattern of this isolate are reported.

Res Vet Sci, 1986 Nov, 41(3), 386 - 90
Chemotherapy and pharmacokinetics of some antimicrobial agents in healthy dwarf goats and those infected with Ehrlichia phagocytophila (tick-borne fever); Anika SM et al.; The therapeutic efficacy and pharmacokinetics of oxytetracycline (10 mg kg-1), ampicillin (20 mg kg-1) and a combination (TSS) of trimethoprim (20 mg kg-1), sulphadimidine (50 mg kg-1) and sulphamethylphenazole (50 mg kg-1) were investigated in normal dwarf goats and in those infected with Ehrlichia phagocytophila . Goats given oxytetracycline or TSS intravenously showed improvement, whereas ampicillin was ineffective . The infected goats had significantly prolonged elimination half-life values for sulphadimidine and oxytetracycline . The disposition kinetics of ampicillin and sulphamethylphenazole showed no marked differences between the healthy and infected animals . The tick-borne fever model used in the present study can be of value in testing the therapeutic efficacy and pharmacokinetics of chemotherapeutic agents in rickettsial infections.

Antimicrob Agents Chemother, 1986 Nov, 30(5), 739 - 42
In vitro susceptibility of Capnocytophaga species to 29 antimicrobial agents; Rummens JL et al.; A hemoglobin-supplemented medium composed of Columbia agar base supplemented with 1% hemoglobin and 1% Polyvitex was used to investigate the in vitro activity of 29 antimicrobial agents against Capnocytophaga species . Clindamycin was the most active agent, with all strains being inhibited by 0.06 microgram/ml or less . Amoxicillin-clavulanic acid and imipenem were the most active among the beta-lactam antibiotics (MIC for 90% of strains tested {MIC90}, 0.50 microgram/ml); other very active drugs were BMY 28142, cefpirome, cefotaxime, ceftazidime, and ceftriaxone (MIC90, 0.06 to 0.50 micrograms/ml), although at least one strain showed resistance to each of these antibiotics (MIC, greater than or equal to 16 micrograms/ml) . Ciprofloxacin was the most active among the quinolones, with all strains being inhibited by 0.50 microgram/ml . The MICs of the other four drugs ranged from 0.12 to 4 micrograms/ml . Ampicillin, penicillin G, ticarcillin, aztreonam, and temocillin were moderately active (MIC90, 1 to 8 micrograms/ml; MIC range, less than or equal to 0.03 to greater than 128 micrograms/ml) . All strains were uniformly resistant to the aminoglycosides, polymyxin B, vancomycin, trimethoprim, and amphotericin B . Three strains produced beta-lactamase . No significant difference was found between the susceptibility of strains isolated from various sources or patients.

Zh Mikrobiol Epidemiol Immunobiol, 1986 Nov, (11), 99 - 102
{Analysis of the possible mechanisms of the action of socioeconomic factors on the epidemic process whose biological base is an open parasitic system}; Zaritskii AM; The mechanism of action of socioeconomic factors on the epidemic process have been analyzed on the basis of the study of the influence, exerted on the biological properties of infective agents by environmental factors resulting from human activities, and the theory of the self-regulation of the parasitic system . Such mechanisms can be subdivided into the mechanisms affecting the epidemiological triad (the source of infection, the mechanism of transfer, and the susceptibility of the population) and the mechanisms facilitating the formation of infective agents with selective advantages (decreased virulence, resistance to antimicrobial preparations, etc.) under the influence of environmental factors resulting from human activities . The former mechanisms suppress and tend to localize the epidemic process, while the latter ones activate this process under the conditions becoming more complicated for the spread of the infective agent.

J Antibiot (Tokyo), 1986 Nov, 39(11), 1551 - 6
Synthesis and antimicrobial activity of a new penem, sodium (5R,6S)-2-(2-fluoroethylthio)-6-{(1R)-1-hydroxyethyl}penem-3- carboxylate; Kawamoto I et al.; The synthesis and in vitro antimicrobial activity of a new penem antibiotic, sodium (5R,6S)-2-(2-fluoroethylthio)-6-{(1R)-1-hydroxyethyl}penem-3-ca rbo xylate (1), are reported . The MIC values of 1 are compared with those of some related 2-haloalkylthio penems prepared in this work, and also Sch 29482 and thienamycin.

Am J Dis Child, 1986 Nov, 140(11), 1186 - 90
Clinical and nasopharyngeal isolates of unusual multiply resistant pneumococci; Klugman KP et al.; Routine surveillance of pneumococcal isolates for resistance to antibiotics has revealed the emergence of an unusual pattern of multiple antimicrobial resistance in South Africa . Thirty-nine pneumococcal isolates, including 21 from clinical specimens, showed resistance to tetracycline, erythromycin, clindamycin, trimethoprim, and a combination product of trimethoprim and sulfamethoxazole sodium (co-trimoxazole), yet susceptibility to penicillin G . Multiple resistance has to date been almost invariably associated with resistance to beta-lactam antibiotics . A survey of nasopharyngeal carriage revealed carriage of an additional 21 isolates of multiply resistant pneumococci, representing 7.9% of children investigated in Johannesburg, but these organisms were not found in children in Soweto or four rural villages . We present the minimum inhibitory concentrations of 15 antimicrobial agents against 15 of these 21 strains . These findings are discussed in relation to exposure of these populations to antibiotics and to the treatment of local and systemic pneumococcal disease . Of all 60 isolates of multiply resistant pneumococci isolated to date, those fully characterized serologically belong to serotypes 6B, 14, or 19F.

Pharmazie, 1986 Nov, 41(11), 761 - 9
Synthesis of alkyloxybenzamide derivatives as potential antimicrobial agents; Habib NS et al.; Three series of alkyloxybenzamido derivatives have been prepared . The first comprises N1-{4-(4-alkyloxybenzamido)benzoyl}-N2-substituted alkylidene hydrazine, the second involves 1-{4-(4-alkyloxybenzamido)benzoyl}-4-alkyl, aryl, or aralkyl-3-thiosemicarbazides, and the third includes 1-substituted-5-{4-(4-alkyloxybenzamido)phenyl}-1,3,4-triazole-2-t hione . Representative samples of the prepared compounds were tested for their in-vitro antimicrobial activity.

Jpn J Antibiot, 1986 Nov, 39(11), 3094 - 109
{A nationwide study of the antimicrobial susceptibility of clinical isolates of Escherichia coli in Japan}; Igari J et al.; We studied the antimicrobial susceptibility of E . coli isolated in 1983 and 1984 and also the yearly changes of the susceptibility of E . coli from 1980 to 1984 isolated in 103 hospitals in Japan . Antibiotics used for MIC determination were ampicillin (ABPC) as a penicillin, cefazolin (CEZ) as a cephalosporin, cefmetazole (CMZ) as a cephamycin and gentamicin (GM) as an aminoglycoside . Numbers of isolates tested were 2,321 strains in 1983 and 1,965 strains in 1984 . CMZ was the most effective agent among the 4 antibiotics tested, followed by GM and CEZ in this order . A large number of the isolates were inhibited by 1.56 micrograms/ml on CMZ and GM and by 6.25 micrograms/ml of CEZ . About two-thirds of the isolates were inhibited at a concentration of 12.5 micrograms/ml or less of ABPC . The susceptibility of E . coli against the 4 antibiotics changed little year by year and the tendency of the appearance of resistant strains did not increase in the last 5 years.

Infection, 1986 Nov-Dec, 14(6), 261 - 7
Empiric antimicrobial therapy in febrile granulocytopenic patients . Randomized prospective comparison of amikacin plus piperacillin with or without parenteral trimethoprim/sulphamethoxazole; Menichetti F et al.; In a prospective randomized trial parenteral trimethoprim/sulphamethoxazole was added to amikacin plus piperacillin in order to compare triple-drug antibiotic combination with a standard regimen as empiric therapy of fever in patients with granulocytopenia . One hundred and sixty-one episodes were evaluated; 74 episodes with amikacin plus piperacillin and 87 episodes with amikacin plus piperacillin plus trimethoprim/sulphamethoxazole . The overall response to therapy (63% vs . 84%) as well as the response of microbiologically documented infections (60% vs . 82%) was significantly better in patients treated with the triple-drug combination (p less than 0.05) . However, no statistically significant differences in response to antibiotics at different infection sites or with regard to any single pathogen was found between the two groups . Trimethoprim/sulphamethoxazole seemed to be responsible for additional toxicity (nausea and vomiting) when added to amikacin plus piperacillin, but these side-effects were clearly related to the rate of infusion of trimethoprim/sulphamethoxazole . The findings of this study support the use of a three-drug versus a two-drug combination as empiric antibiotic regimen in febrile granulocytopenic patients.

Antimicrob Agents Chemother, 1986 Nov, 30(5), 659 - 63
Modulation of bacteriolysis by cooperative effects of penicillin-binding proteins 1a and 3 in Escherichia coli; Tuomanen E et al.; Escherichia coli characteristically lyses upon treatment with most beta-lactam antimicrobial agents . In contrast, an investigational aminothiazole cephem, CGP 31523A, produced a new combination of antibacterial effects: it was highly bactericidal without causing cell wall degradation or lysis . Killing was associated with the formation of vacuolated filaments . Because the compound bound to penicillin-binding proteins (PBPs) 1a and 3, we investigated the role of PBP 3 in modulation of lysis caused by inhibition of PBP 1a . A temperature-sensitive mutant with a nonfunctional PBP 3 lysed when treated with CGP 31523A . The combination of a PBP 1 inhibitor (cefsulodin) and a PBP 3 inhibitor (aztreonam) also caused filamentation and death without lysis of wild-type cells over a narrow concentration range . We conclude that cooperative effects between PBPs in E . coli can lead to a dissociation of bacterial killing and lysis.

J Clin Periodontol, 1986 Nov, 13(10), 965 - 74
Modes of application of anti-plaque chemicals; Newman HN; Because interdental and subgingival sites are relatively inaccessible to mouthrinsing, they necessitate alternative methods of application of anti-plaque chemicals . These include routine oral hygiene aids, surfactants to enhance uptake and retention of antimicrobials, gels and periodontal dressings . The principal modes of application that have received attention recently, apart from the systemic route, are syringe and pulsated jet irrigation and slow release compounds . Slow release devices currently receiving attention may be classified as membrane diffusion, solution of drug in polymer and solid drug dispersed in polymer matrix . The most widespread dental instance of a slow release device appears to be the use of varnishes and resins to carry fluoride . Recent attempts at devising improved methods of antimicrobial application include the testing of materials for their biodegradability or for their potential to adhere to mucosal surfaces . It is concluded that the potential exists for antimicrobials applied directly to the site of intended action to contribute significantly to dental health, particularly when employed as components of practical oral hygiene regimes.

J Clin Periodontol, 1986 Nov, 13(10), 957 - 64
Chlorhexidine compared with other locally delivered antimicrobials . A short review; Addy M; Based on the association of bacterial plaque with the initiation of chronic gingivitis and progression of chronic periodontitis, chemical antiplaque agents have been employed both in prevention of periodontal disease and its treatment . In supragingival plaque control regimens, chlorhexidine has not been superceded as a chemical anti-plaque agent, although other compounds have been shown to be useful . The local side-effects of chlorhexidine and other cationic antiseptics, however, limit their long-term use for prevention . Extrinsic tooth staining in particular remains the greatest problem . Short-term anti-plaque uses for chlorhexidine include as an adjunct to mechanical cleaning in the initial oral hygiene phase of treatment, in situations where mechanical oral hygiene is difficult, including postsurgery, intermaxillary fixation, fixed orthodontic therapy, physically and mentally handicapped individuals, systemic diseases with oral manifestations such as leukaemia . More recent interest in chlorhexidine has resulted from the delivery of compounds subgingivally in the treatment of chronic periodontitis . Such methods have extended the use of chlorhexidine into areas inaccessible to the action of antimicrobial drugs delivered locally by conventional means, such as tooth brushing or mouth rinsing . Available evidence suggests that chlorhexidine may not be as effective as some antimicrobial drugs whose activity is more specific for those organisms considered particularly pathogenic to the periodontal tissues.

Am J Trop Med Hyg, 1986 Nov, 35(6), 1129 - 33
Giardia lamblia: a culture method for determining parasite viability; Hill DR et al.; A simple, quantitative method has been developed to assess the viability of Giardia lamblia trophozoites after exposure to a potentially lethal agent . This method utilizes the ability of trophozoites which remain viable to replicate and multiply . In this study, the percent dead trophozoites after incubation in 20% fresh human serum was determined first by morphologic criteria and then by the ability of parasites to multiply in fresh medium over 48 hr . Using the number of parasites after 48 hr of growth, the original number of dead trophozoites in the serum-exposed samples was determined by extrapolation from a standard growth curve . Ten sera which killed from 7% to 89% of trophozoites by morphologic criteria, killed 8% to 92% using the culture method; these two assays for viability correlated highly (r = 0.96) . Use of the culture assay allows the assessment of the lethal effects of serum and can be applied both to the study of other host defense mechanisms on Giardia trophozoites and to antimicrobial susceptibility testing.

Drug Intell Clin Pharm, 1986 Nov, 20(11), 833 - 6
Hematological effects associated with beta-lactam use; Babiak LM et al.; Beta-lactam antibiotics have continued to be the mainstay of antiinfective treatment . Newer agents, such as the third-generation cephalosporins or ureidopenicillins, have the advantage of a broader antimicrobial spectrum and improved pharmacokinetics . The beta-lactams are often promoted as alternatives to more toxic antibiotic regimens . However, several of the beta-lactams have been shown to produce hematological effects, some of which can be life threatening . The primary hematological effects appear to be inhibition of normal platelet function and the coagulation cascade, which is reflected by changes in bleeding times and increases in prothrombin time and activated partial thromboplastin time, respectively . Although not all patients will develop bleeding problems associated with these agents, close monitoring of patients with risk factors for bleeding and dosage adjustments may help to avert these drug-induced hematological problems.

Am J Surg, 1986 Nov, 152(5), 552 - 9
Single dose systemic antibiotic prophylaxis of surgical wound infections; DiPiro JT et al.; The proper duration of antimicrobial use for the prevention of postoperative surgical infection has been a subject of controversy . Currently, more than 40 published clinical trials are available in which the efficacy of single dose surgical prophylaxis with parenteral antimicrobials has been studied . These studies have compared single doses versus multiple doses of the same agent, single doses of antimicrobial versus placebo, single doses of various antimicrobials, and a single dose of one agent versus multiple doses of another agent . In all trials in which single dose regimens were compared with multidose regimens, the single dose regimens resulted in a similar frequency of postoperative wound infections . Single antimicrobial doses, usually cephalosporins given immediately before operation, are effective in preventing wound infections in gastric, biliary, and transurethral operations, hysterectomies and cesarean sections . For colorectal operations, the value of single parenteral doses of various agents has been established; however, it is not clear if there is an added benefit when oral antimicrobials are also used . For open heart operations or those in which prosthetic materials are implanted, the value of single dose regimens has not been established.

Urol Clin North Am, 1986 Nov, 13(4), 627 - 35
Urosepsis; Bahnson RR; Many years ago Osler suggested that "it is of use from time to time to take stock, so to speak, of our knowledge of a particular disease to see where we stand in regard to it, to inquire to what conclusions these accumulated facts seem to point, and to ascertain in what direction we may look for fruitful investigations in the future." With regard to gram-negative bacteremia, there is extant a notable and striking increase in both the incidence of these infections and the involvement of organisms that previously caused disease only uncommonly . Factors related to this escalation include an increase in the number of elderly and debilitated hospitalized patients, the large number of individuals with malignant disease who are immunosuppressed by their disease and the drugs used to treat them, the ubiquity of various types of respirators, drainage tubes, and catheters that may be colonized by gram-negative bacteria, and the progressively increasing resistance of these organisms to a growing number of antimicrobial agents . The emergence of resistance is at least partly due to the inappropriate use of antibiotics, often in combination, for prophylaxis or empiric therapy . It is unfortunate that even the necessary use of antibiotics will increase the frequency of disease caused by these gram-negative organisms . The inescapable conclusion is that gram-negative infections and bacteremia will only increase in prevalence in the future . Investigation of the pathophysiology of shock due to gram-negative sepsis has revealed that most of the physiologic alterations are mediated by products of the host's own immune system.(ABSTRACT TRUNCATED AT 250 WORDS)

Urol Clin North Am, 1986 Nov, 13(4), 577 - 90
Therapeutic principles of antimicrobial therapy and new antimicrobial agents; Hanno P; It is important that newly developed antibiotics be used so as to increase our ability to eradicate infection, rather than to complicate the treatment of infection by spawning the creation of organisms resistant to multiple antibiotics . One must peruse the literature with a very critical eye, as most new agents are touted as tremendous advances on past antibiotics . With rising medical costs becoming of ever-greater significance, proper choice of antimicrobial agent assumes more importance as well . The proper bacterial coverage in a given clinical setting, duration of treatment, and drug pharmacokinetics and the concept of the "total cost" of administering an antibiotic (taking into account fixed and variable hospital costs) all must be considered . Although it is virtually impossible to become experienced in using all of the currently available antibiotics, it is not necessary, either . Based on the literature and discussion with infectious disease colleagues, one can choose to use one or two antimicrobials in each broad class and gain the benefits of that class for his or her patients.

Antimicrob Agents Chemother, 1986 Nov, 30(5), 743 - 8
Inhibition of Legionella pneumophila multiplication within human macrophages by antimicrobial agents; Vilde JL et al.; The activity of serial concentrations of different antimicrobial agents on the multiplication of Legionella pneumophila within human monocyte-derived macrophages was studied . The results led to the definition of a minimal extracellular concentration inhibiting intracellular multiplication (MIEC) . According to the MIECs, the antimicrobial agents tested were classified in three groups: very active (MIEC less than or equal to 0.06 microgram/ml), such as erythromycin, rifampin, and pefloxacin; active (1 microgram/ml greater than or equal to MIEC greater than or equal to 0.1 microgram/ml), such as sulfamethoxazole-trimethoprim or doxycycline; and ineffective, such as cefoxitin, which was not active within macrophages at as high as 64 micrograms/ml despite a low MIC (0.2 microgram/ml) on bacterial charcoal-yeast extract agar . The activity of netilmicin was difficult to assess because of its effect on extracellular legionellae . Combinations of erythromycin with rifampin and pefloxacin with erythromycin, rifampin, doxycycline, or netilmicin showed an additive effect and no antagonism . These results obtained in a cellular model are in agreement with the efficacy of antimicrobial agents in experimental infections and in Legionnaires disease . They sustain clinical interest in the new quinolones, such as pefloxacin, and in combinations of antimicrobial agents for the treatment of Legionnaires disease.

Antimicrob Agents Chemother, 1986 Nov, 30(5), 806 - 7
Antimicrobial activity of U-70138F (paldimycin), roxithromycin (RU 965), and ofloxacin (ORF 18489) against Chlamydia trachomatis in cell culture; Stamm WE et al.; The MICs of three new antimicrobial agents of different classes, U-70138F, roxithromycin (RU 965), and ofloxacin (ORF 18489), versus Chlamydia trachomatis in McCoy cell cultures were 0.25, 0.8, and 1.0 microgram/ml, respectively . For each test drug, the MIC and MBC were identical or were within 1 dilution of one another . These drugs possessed sufficient activity in cell culture to suggest possible clinical effectiveness.

J Burn Care Rehabil, 1986 Nov-Dec, 7(6), 479 - 83
Norfloxacin and silver-norfloxacin as topical antimicrobial agents: results of in vitro susceptibility testing against bacteria and Candida sp isolated from burn patients; Holder IA et al.; Because of its broad spectrum of antibacterial action, Norfloxacin, a new quinoline carboxylic acid compound, was formulated in a topical cream base and tested for activity against a variety of bacteria and yeasts isolated from burn patients . An in vitro agar well diffusion topical susceptibility test was used . The silver salt of Norfloxacin also was tested . For comparative purposes, commonly used topical antibacterial and antifungal preparations were examined as well . No bacterial isolate tested was resistant to the action of Norfloxacin or that of silver-Norfloxacin . Furthermore, all Candida organisms assayed were susceptible to silver-Norfloxacin . All other topical agents tested had some strains of bacteria or yeast, or both, that were resistant to their action . Therefore, Norfloxacin and, particularly, silver-Norfloxacin, warrant further development as topical anti-infective agents for use in treating burn patients.

Anaesth Intensive Care, 1986 Nov, 14(4), 418 - 20
Antimicrobial activity of bupivacaine and pethidine; Grimmond TR et al.; The antimicrobial activity of bupivacaine and pethidine in concentrations commonly used in epidural practice was studied by an agar dilution method against ten common micro-organisms . Both drugs showed increasing microbe inhibition with increasing drug concentrations . Bupivacaine at common epidural concentrations inhibited eight of the ten organisms and pethidine inhibited six . These findings confirm previous reports of microbe inhibition by bupivacaine, and in addition demonstrate a similar but slightly lesser activity by pethidine . Although antimicrobial activity of epidural drugs can be regarded as a desirable property, clinical implications of such findings remain unclear.

J Gen Intern Med, 1986 Nov-Dec, 1(6), 351 - 63
Cost-effective choice of antimicrobial therapy for serious infections; Weinstein MC et al.; The authors evaluated the financial and health implications of treatment choices for three serious classes of infection: hospital-acquired pneumonia, intra-abdominal infection, and sepsis of unknown origin . Data were obtained from a systematic review of clinical literature and published data bases, by written questionnaire from a panel of infectious disease authorities, and from actual costs at a tertiary-care hospital . For pneumonia and sepsis, the third-generation cephalosporin evaluated (ceftizoxime) was found to be less expensive than other regimens, when costs of dose preparation and administration, monitoring, and toxicity were added to drug acquisition costs . The lowest-cost regimen for intra-abdominal infection was metronidazole plus gentamicin . Modest differences in efficacy would easily outweigh differences in toxicity, however, and could justify the use of more expensive regimens (e.g., mezlocillin plus gentamicin for hospital-acquired pneumonia, and cefoxitin plus gentamicin for intra-abdominal infection) . If all regimens are assumed to be equally efficacious, then the third-generation cephalosporin was both lowest in cost and, owing to its low toxicity, greatest in net health benefit.

Br J Dermatol, 1986 Nov, 115(5), 551 - 6
The in vitro antimicrobial effect of azelaic acid; Leeming JP et al.; Various strains of cutaneous micro-organisms were tested in vitro for their survival rates in 0.5 mol/l (8.4% w/v) azelaic acid solution . All bacterial strains exhibited large reductions in viability (at least 40-fold) over a 24 h test period, but little response was noted with Pityrosporum ovale . The bactericidal effect of azelaic acid was reduced considerably in the presence of nutrients . Minimum inhibitory concentrations (MICs) and minimum bactericidal (or fungicidal) concentrations (MBCs) were also determined . MICs varied from 0.03 mol/l to 0.25 mol/l; MBCs were all either 0.25 mol/l or greater.

J Hosp Infect, 1986 Nov, 8(3), 257 - 62
Single dose intra-operative antimicrobial prophylaxis during prostatectomy: gentamicin compared with cefotetan; Leach RD; Two hundred consecutive patients undergoing prostatectomy were given a single dose of gentamicin or cefotetan intra-operatively . Both antibiotics afforded good protection against postoperative bacteriuria and septicaemic symptoms were fewer in those patients given cefotetan, although this difference was not statistically significant.

Wien Klin Wochenschr, 1986 Oct 24, 98(20), 683 - 9
{Immunoglobulin A in the sebaceous glands . Light and electron microscopy immunomorphologic detection}; Gebhart W et al.; This paper presents evidence for the presence of immunoglobulin A in human sebaceous glands . Light- and electron-microscopic immune cytochemistry techniques revealed secretory IgA in normal sebocytes and within pilosebaceous ducts . The secretory process corresponds to the well-established production of IgA at the site of other internal body surfaces . Basal and suprabasal sebocytes contain IgA in linear extracellular, as well as aggregated intracellular patterns . However, maximal diffuse concentrations are present at the opening of the pilosebaceous duct . This distribution pattern indicates an antimicrobial protective character of IgA, corresponding to similar functions on mucous membrane surfaces . Thus, another important humoral factor contributing to the complex system of skin-associated lymphoid tissue is postulated.

Chem Biol Interact, 1986 Oct 15, 60(1), 67 - 84
Cyclic voltammetry of phenazines and quinoxalines including mono- and di-N-oxides . Relation to structure and antimicrobial activity; Crawford PW et al.; Cyclic voltammetry data were obtained for eight phenazines and phenazine-N-oxides, and eleven quinoxalines and quinoxaline-N-oxides: 1,6-phenazine-diol-5,10-dioxide (iodinin), iodinin copper complex, 6-methoxy-1-phenazinol-5,10-dioxide 1,6-dimethoxyphenazine-5-oxide, 1,6-phenazinediol, 1,6-dimethoxyphenazine, quinoxaline-1,4-dioxide, 2-methylquinoxaline-1,4-dioxide, 2,3-diphenylquinoxaline-1,4-dioxide, 2-carboxyquinoxaline-1,4-dioxide, 5-hydroxyquinoxaline-1,4-dioxide, 5-hydroxy-8-methoxyquinoxaline-1,4-dioxide, 2-methylquinoxaline, 2,3-diphenylquinoxaline, 5-hydroxyquinoxaline, 5-hydroxy-8-methoxyquinoxaline and 2-(2-quinoxalinylmethylene)hydrazine carboxylic acid methyl ester-1,4-dioxide (Carbadox) . The di-N-oxides exhibit the most positive E1/2 values within each class . Reversible first wave reductions were observed for iodinin, iodinin copper complex, 1,6-dimethoxyphenazine-5-oxide, 1,6-dimethoxyphenazine, quinoxaline-1,4-dioxide, 2-methylquinoxaline-1,4-oxide and 2,3-diphenylquinoxaline-1,4-dioxide . The results are correlated with structure . Some relationships exist between reduction potential and reported antimicrobial activity . A possible mechanism of drug action is addressed.

J Immunol, 1986 Oct 15, 137(8), 2662 - 9
Interferon-gamma-activated human monocytes inhibit the intracellular multiplication of Legionella pneumophila; Bhardwaj N et al.; We have examined the interaction between interferon-gamma (IFN-gamma)-activated human monocytes and Legionella pneumophila, the agent of Legionnaires' disease . Human monocytes activated with human recombinant IFN-gamma inhibit the intracellular multiplication of L . pneumophila . The degree of inhibition is proportional to the concentration of IFN-gamma, and maximal inhibition consistently occurs with greater than or equal to 2 micrograms/ml . Monoclonal anti-IFN-gamma antibody completely neutralizes the capacity of IFN-gamma to activate monocytes . Monocytes infected 24 hr after explantation maximally inhibit L . pneumophila multiplication if treated with IFN-gamma before infection or up to 2 hr after infection; treatment 6 hr or more after infection results in submaximal inhibition . Monocytes infected 48 hr after explantation inhibit L . pneumophila multiplication maximally if treated with IFN-gamma up to 12 hr before infection, but submaximally if treated at the time of infection . Once activated, monocytes inhibit L . pneumophila multiplication in the absence of IFN-gamma in the culture . Strikingly, monocytes maximally inhibit L . pneumophila multiplication after treatment with IFN-gamma for as briefly as 1 hr before infection . In the absence of anti-L . pneumophila antibody, neither IFN-gamma-activated monocytes nor nonactivated monocytes kill L . pneumophila . In the presence of specific antibody and complement, IFN-gamma-activated monocytes kill a proportion (0.5 log) of an inoculum but not more than nonactivated monocytes . L . pneumophila forms a specialized phagosome in IFN-gamma-activated monocytes that does not differ ultrastructurally from the L . pneumophila phagosome in nonactivated monocytes . These results demonstrate that IFN-gamma can activate human monocytes to exert a potent antimicrobial effect against a highly virulent intracellular bacterial pathogen . These findings extend previous observations on interactions between activated mononuclear phagocytes and L . pneumophila, and additionally support the hypothesis that cell-mediated immunity plays a major role in host defense against L . pneumophila.

Hosp Physician, 1986 Nov, 22(11), 19 - 21
Cost-effective utilization of microbiology data; Cunha BA et al.; A significant number of bacterial cultures are ordered by health care professionals each day, yet the actual utilization of culture results, either for determining specific diagnoses or for targeting antimicrobial therapy, is much lower than would be anticipated . A multifactorial study was conducted to determine the rate of "appropriate" usage of culture results in a community teaching hospital . The effect of several variables on culture utilization was analyzed, including: initiator of the request for culture (physician or nurse); hospital service requesting the culture; and culture site . Utilization of results differed considerably within all three variables, yet the general conclusion could be drawn that cost-effectiveness would be significantly improved if hospital personnel gave careful consideration to the need for microbiologic cultures before they request them.

Med Inform (Lond), 1986 Oct-Dec, 11(4), 307 - 16
Computerized analysis of antimicrobial drugs interactions in biological systems using an IBM-PC microcomputer; Ozanne G; We have developed a computer program to analyse the individual and combined effects of two treatments applied concurrently to a biological system . Analysis is done in regard to: level of significance selected for the statistical test (two-sided Student's t test); number of data available; expected combined effect resulting from addition (computed by the program); experimental hypothesis tested (synergism or antagonism) . The main program gives access to eight options: input of new data; input of data from file; addition or modification to data in memory; display on monitor the results from analysis or the contents of a data file; analysis with another level of significance; printout; kinetics of interaction; end of program . The program is designed to work with an IBM-PC, Epson MX/FX 80/100 printer and Roland DXY 800 plotter . Sample runs are given.

Antimicrob Agents Chemother, 1986 Oct, 30(4), 606 - 7
Ciprofloxacin therapy for Mediterranean spotted fever; Raoult D et al.; We report the treatment of five patients with Mediterranean spotted fever with the antimicrobial agent ciprofloxacin . The treatment was administered intravenously for 2 days and then perorally for 8 days . All five patients were cured . These preliminary data seem to correlate with the in vitro activity of ciprofloxacin against Rickettsia conorii.

Antimicrob Agents Chemother, 1986 Oct, 30(4), 565 - 9
Effect of saturable serum protein binding on the pharmacokinetics of unbound cefonicid in humans; Dudley MN et al.; Previous studies have demonstrated high, concentration-dependent serum protein binding of cefonicid . To determine the in vivo pharmacokinetic significance of these observations, the pharmacokinetics of both total and unbound (non-protein-bound) cefonicid was studied in six volunteers after a single intravenous dose of 30 mg/kg . Saturable serum protein binding was observed in vivo; the mean +/- standard deviation free fraction of cefonicid was 17.6 +/- 6.1% immediately after administration and declined to a constant value of approximately 2% as total serum concentrations fell below 100 micrograms/ml . This nonlinear binding was associated with a pronounced decline in unbound serum cefonicid concentrations during the first 3 h after administration, with low or undetectable unbound drug concentrations by 12 h . Renal clearance of total cefonicid averaged 21.1 ml/min per kg and did not vary with time; in contrast, the mean +/- standard deviation unbound cefonicid renal clearance increased from 5.7 +/- 2.1 to 10.8 +/- 1.6 ml/min per kg with time (P less than 0.02) . This study may partially explain the poor results obtained with single daily dosing of cefonicid in endocarditis . Dosage regimens of certain antimicrobial agents with high, saturable serum protein binding and extensive renal tubular secretion may be most appropriately designed based on unbound drug pharmacokinetics.

J Appl Bacteriol, 1986 Oct, 61(4), 299 - 314
The identification of Pseudomonas cepacia and its occurrence in clinical material; Holmes B; During the 19 year period ending December 1984, 4840 strains of Gram-negative non-fermentative bacteria were submitted to the National Collection of Type Cultures for identification . Of these, 195 strains (4.0% of the total) were identified as Pseudomonas cepacia which demonstrates both that the species is regularly encountered in clinical material in the UK and that several laboratories have experienced difficulty in identifying the organism . The sources from which the 195 strains were isolated are reported and also the characteristics by which the species may be recognized . The clinical significance of Ps . cepacia is reviewed, and the resistance of this species to disinfectants and antimicrobial agents commonly used to treat pseudomonas infections is discussed to underline the necessity for the precise identification of Ps . cepacia.

Am J Kidney Dis, 1986 Oct, 8(4), 271 - 3
Suppurative bacterial pyelonephritis as a cause of acute renal failure; Thompson C et al.; Acute oliguric renal failure associated with bacterial pyelonephritis is a rarely recognized clinical entity . We report a woman with an ectopic pregnancy who developed acute renal failure requiring dialytic support . The renal biopsy revealed focal microabscess formation and leukocyte interstitial infiltration compatible with suppurative pyelonephritis . Although her renal function improved gradually with antimicrobial treatment, the process was incomplete and renal dysfunction persisted at a 10-week follow-up, suggesting permanent renal damage.

Am J Clin Pathol, 1986 Oct, 86(4), 546 - 9
Disseminated zygomycosis masquerading as cerebral lupus erythematosus; Wong KL et al.; Zygomycosis often occurs in patients with an underlying disease, e.g., diabetes mellitus, leukemia, and lymphoma, or an immunocompromised state . This report discusses a case of a 21-year-old woman with systemic lupus erythematosus complicated by uremia, acidosis, steroid therapy, prolonged antimicrobial therapy, and disseminated zygomycosis.

J Med Chem, 1986 Oct, 29(10), 2020 - 4
Studies on prodrugs . 5 . Synthesis and antimicrobial activity of N-(oxoalkyl)norfloxacin derivatives; Kondo H et al.; Several N-(oxoalkyl)norfloxacin derivatives (3a-g) were synthesized and evaluated for antibacterial activity in vitro and in vivo . Most of the compounds exhibited in vitro activity comparable to that of norfloxacin for Gram-positive bacteria, whereas their activity was lower than for Gram-negative bacteria . N-(2-Oxopropyl)norfloxacin (3b) liberated norfloxacin in the blood after oral administration in mice, and the serum level of norfloxacin was about 3-fold higher than that of norfloxacin itself . Thus, 3b showed high antibacterial activity in vivo.

Clin Pediatr (Phila), 1986 Oct, 25(10), 510 - 5
Erythromycin prophylaxis for recurrent otitis media; Lampe RM et al.; Patients with recurrent otitis media without persistent middle ear effusion were studied for antibiotic prophylaxis efficacy . In the first phase, erythromycin ethylsuccinate was used as prophylaxis for otitis media in 45 patients in a dose of 10 mg/kg twice daily . Acute otitis media occurred in eight of 45 (18%) while receiving erythromycin, and in 22 of 41 (54%) following prophylaxis termination . The attack rate (episodes of otitis media per 2-month period) was 0.86 before prophylaxis, 0.20 during prophylaxis, and 0.79 following prophylaxis . In a second phase of the study, erythromycin was compared with sulfisoxazole for otitis media prophylaxis in a group of 42 children . Sulfisoxazole (500 mg per dose) was administered twice daily . Acute otitis media occurred in five of 28 (18%) children while receiving erythromycin and in nine of 21 (43%) children while receiving no prophylaxis . The attack rate (episodes of otitis media per 2-month period) was 0.81 before erythromycin prophylaxis, 0.18 while receiving erythromycin, and 0.50 after erythromycin prophylaxis . Acute otitis media occurred in eight of 14 (51%) children while receiving sulfisoxazole, and in two of five (40%) children while receiving no prophylaxis . The attack rate (episodes of otitis media per 2-month period) was 0.78 before sulfisoxazole, 0.72 while receiving sulfisoxazole, and 0.56 after sulfisoxazole prophylaxis . Erythromycin antimicrobial prophylaxis for children with recurrent otitis media was superior to no prophylaxis and to sulfisoxazole prophylaxis in this study of patients with recurrent otitis media without persistent middle ear effusion.

Xenobiotica, 1986 Oct-Nov, 16(10-11), 1073 - 8
Metabolic aspects of antioxidants and preservatives; Daniel JW; The use of chemical preservatives serves to ensure the nutritional adequacy, palatability and safety of processed foods and beverages . The toxicity of some of the more ubiquitous antimicrobial agents (sorbic acid, p-hydroxybenzoates, sulphur dioxide) and antioxidants (propyl gallate, butylated hydroxyanisole (BHA) and butylated hydroxytoluene (BHT} is reviewed together with the role of metabolic data in assessing the 'safety-in-use' of these and other food-additives.

Drug Intell Clin Pharm, 1986 Oct, 20(10), 803 - 5
Antimicrobial surveillance in a VAMC teaching hospital--resulting cost avoidance; Powers DA; The economic impact of an antimicrobial surveillance service is presented . The antimicrobial surveillance service operates as a component of antimicrobial utilization review and serves as a means of identifying and reporting patterns of antimicrobial usage for the hospital . A record of all antimicrobial agent orders is maintained by the pharmacy service . Concurrent antimicrobial utilization review is conducted on specific agents using previously approved criteria . All cases of antimicrobial use failing to meet established criteria receive immediate intervention . From September, 1983 to June, 1985, a total of 229 cases of antimicrobial use received clinical pharmacy intervention . The cost avoidance appreciated from the selection of a more cost-effective regimen was $65,381.60 . Additionally, extensive educational efforts directed to cefazolin q8h vs . cefazolin q6h administration resulted in a substantial reduction in cefazolin expenditures . Indiscriminate/inappropriate use of antimicrobial agents delivers a tremendous economic burden to the health care system . Utilizing antimicrobial surveillance as a component of antimicrobial utilization review serves as a means for identifying and reporting patterns of antimicrobial usage for the medical center and has a positive economic impact as illustrated.

Infect Immun, 1986 Oct, 54(1), 250 - 4
Bactericidal-activities of human polymorphonuclear leukocyte proteins against Escherichia coli O111:B4 coated with C5 or C8; Tedesco F et al.; The postnuclear supernatant of disrupted polymorphonuclear leukocytes exhibited bactericidal activity on Escherichia coli O111:B4 coated with immunoglobulin M antibodies and C5 or C8 but not on C3- or C7-coated bacteria . To characterize this antimicrobial activity further, granules obtained from the postnuclear supernatant were extracted with sodium acetate (pH 4) and the soluble extract was subsequently fractionated through carboxymethyl cellulose and Sephacryl S-200 . Over 90% of the activity present in the starting material was recovered in the soluble granule extract . Kinetic and dose-response analyses of the bacterial activity of the polymorphonuclear leukocyte extract on BAC1-5 and BAC1-8 revealed different susceptibilities to killing of these two bacterial intermediates; they also differed for their susceptibilities to killing at 37 degrees C and at room temperature . The suggestion raised by these data, that BAC1-5 and BAC1-8 could be killed by different bactericidal factors, was confirmed by the findings that separate fractions of the soluble granule extract obtained by carboxymethyl cellulose and Sephacryl S-200 chromatography exhibited specific activity on either BAC1-5 or BAC1-8, whereas other fractions were active on both intermediates.

J Infect Dis, 1986 Oct, 154(4), 631 - 8
Escherichia coli O157:H7 diarrhea in a nursing home: clinical, epidemiological, and pathological findings; Ryan CA et al.; In September 1984, an outbreak of Escherichia coli O157:H7 infection occurred in a nursing home . It was the first recognized outbreak of this organism in the United States since 1982, when two outbreaks led to its recognition as a pathogen . Thirty-four of 101 residents developed a diarrheal illness; 14 were hospitalized with a severe illness characterized by crampy abdominal pain, marked abdominal distention, and grossly bloody diarrhea, and four died . The spectrum of illness associated with the infection was broad and included the following: asymptomatic infection, nonbloody diarrhea, hemorrhagic colitis, hemolytic uremic syndrome, and death . Clinical, radiographic, and postmortem pathological findings suggested involvement of the cecum and right colon . No evidence of response to antimicrobial agents could be documented, and antidiarrheal agents may have aggravated the disease . This investigation implicated hamburger as the vehicle transmission . Seventeen of 19 residents with hemorrhagic colitis, but only 28 of 67 healthy residents, had eaten hamburger on 13 September (P less than .001, Fisher's two-tailed exact test; relative risk {RR} = 7.7) . Infection with E . coli O157:H7 can cause a wide range of manifestations . In the elderly these can be particularly severe and may resemble ischemic colitis.

Jpn J Antibiot, 1986 Oct, 39(10), 2695 - 700
{Prophylactic and therapeutic use of cefotetan, a cephem antibiotic, for infections in the field of obstetrics and gynecology}; Chimura T et al.; This paper deals with results obtained from the cefotetan (CTT, Yamatetan) study group of department of obstetrics and gynecology in Yamagata prefecture . Efficacy of CTT, a new cephamycin antibiotic, was studied in 50 cases (39 cases of prophylactic use for postoperative infections and 11 cases of several different infections) . CTT was administered to each of the patients at a daily dose of 2 grams . No other drugs such as antimicrobial agents, steroids and antiinflammatory drugs which might affect the efficacy of CTT were permitted during the study except for the drug therapy or surgical procedures required for treating underlying diseases . Fever index, one of the examination items to assess the prophylactic effect for postoperative infections as well as daily changes in maximum body temperature, was examined in the prophylactic group . Daily changes in febrile pattern were examined in the infection group . The fever index were 3.4 +/- 4.0 degree hours in cases subjected to cesarean sections in the prophylactic group, 3.7 +/- 3.0 degree hours in cases subjected to gynecological operations in the prophylactic group and 4.5 +/- 5.5 degree hours in the infection group . The clinical efficacy rate in the 11 cases of the infection group was 100%; excellent in 3 cases and good in 8 cases . Bacteriological examination was conducted in 3 of the 11 cases and bacteria were eliminated in all 3 cases . The overall clinical efficacy rate was also 100%; excellent in 5 cases and good in 6 cases . No abnormal laboratory findings nor side effects were observed in any of the cases.

Oral Surg Oral Med Oral Pathol, 1986 Oct, 62(4), 441 - 8
Clinical and experimental observations on resinifying therapy; Wu MK et al.; The principles, indications, and techniques of resinifying therapy and the composition of a resinifying agent are described in this article . The permeability and bacteriostasis of the agent and the volume change of the agent after treatment were observed, and 14C-labeled phenoaldehyde showed that the agent not only filled the main canals and accessory canals but also infiltrated into dentinal tubules with a depth one fourth to one third the total length of the tubules . The antimicrobial activity of the agent after polymerization for 2 to 6 months was determined . Even 9 months after treatment, no change in volume of the agent was found in vivo, and sealing of canals was maintained . Seventy-eight teeth in 69 patients with pulpoperiapical diseases were subjected to resinifying therapy and followed up for 6 to 12 months; the success rate was 82.05% . The histologic study indicated that, of the specimens experimentally treated for 6 to 12 months, 85.7% showed mild or no inflammation while 53.6% showed complete healing or an obvious healing tendency . Furthermore, the mechanisms and advantages of this therapy are discussed.

Mol Pharmacol, 1986 Oct, 30(4), 364 - 9
Antimalarial activity of selected aromatic chelators . IV . Cation uptake by Plasmodium falciparum in the presence of oxines and siderochromes; Scheibel LW et al.; The growth of Plasmodium falciparum, a human malaria parasite, is sensitive to inhibition by chelators of several types . The alkylthiocarbamates and 8-hydroxyquinoline at pharmacologic doses selectively inhibit glycolysis within 6 hr in parasitized erythrocytes . The mechanism attributed to these agents is through the extracellular formation of lipid-soluble 2:1 metal complexes which enter susceptible cells and liberate a lethal 1:1 complex . This study further supports this mechanism since the uptake of 59Fe:oxine complexes within 6 hr occurs at doses corresponding to, or less than, those producing the lethal effects and metabolic changes . Fifty per cent of the uptake occurs in less than 6 hr . The presence of 8-hydroxyquinoline facilitates entry of the radiolabeled cations and uninfected erythrocytes take up less cation, especially in the absence of chelator . The siderochromes, rhodotorulic acid and mycobactin P, when mixed with 59Fe, result in an insignificant uptake, i.e., none of the former and only 12% of the latter penetrate the parasitized cells in 6 hr . Less than 25% of 59Fe:iodochlorhydroxyquin enters infected cells and 8% enters normal erythrocytes, suggesting that very little antimicrobial activity of the iodinated oxines is due to chelation unlike an agent such as KAN-322 . In fact, 30% of the oxine complex and possibly more KAN-322 appears to partition in the intracellular parasite itself.

J Ethnopharmacol, 1986 Sep, 17(3), 269 - 75
Active principles of Tetradenia riparia . I . Antimicrobial activity of 8(14),15-sandaracopimaradiene-7 alpha,18-diol; van Puyvelde L et al.; Tetradenia riparia is one of the most popular medicinal plants in Rwanda . Previously, several new substances have been isolated from the leaves of this plant, including a new diterpene diol, i.e . 8(14),15-sandaracopimaradiene-7 alpha,18-diol . This new diterpene diol exhibits significant antimicrobial activity against several bacteria and fungi . The minimum inhibitory concentration (MIC) of the substance for microorganisms which were inhibited ranged from 6.25 to 100 micrograms/ml.

Am J Otol, 1986 Sep, 7(5), 338 - 46
Reversible and permanent bone conduction threshold shift in cases of chronic suppurative otitis media; Papastavros T et al.; Bone conduction thresholds were measured in sixty-six cases of chronic suppurative otitis media before and after successful oral antimicrobial chemotherapeutic treatment . Comparison of pre- and post-treatment cumulative clinical audiograms of the diseased and the control ears of the same patients disclosed the presence of sensorineural hearing loss with a reversible and a permanent component in the diseased ears . The reversible threshold shift was observed over the higher frequencies, while the permanent threshold shift was equally imposed upon the whole range of the five tested frequencies.

J Antibiot (Tokyo), 1986 Sep, 39(9), 1219 - 24
Adecypenol, a unique adenosine deaminase inhibitor containing homopurine and cyclopentene rings . Taxonomy, production and enzyme inhibition; Omura S et al.; Adecypenol, which exhibits potent inhibitory activity against calf intestinal adenosine deaminase (EC 3.5.4.4), was isolated from the cultured broth of Streptomyces sp . OM-3223 . Adecypenol was classified as a semi-tight binding inhibitor . The Ki value against calf intestinal adenosine deaminase was 4.7 X 10(-9) M . No acute toxicity of adecypenol was observed at 100 mg/kg in mice . Adecypenol exhibited no antimicrobial activity against various bacteria and fungi at the concentration of 1.0 mg/ml.

Farmaco {Sci}, 1986 Sep, 41(9), 729 - 36
Synthesis of some 1-acetylindoline-5-sulphonylamino acid derivatives and studies of their antimicrobial activities; Zaher MR et al.; The synthesis of a series of 1-acetylindoline-5-sulphonylamino acids and some of the corresponding methyl esters and hydrazides (II-XXIII) is described . Coupling of 1-acetylindoline-5-sulphonylamino acids with amino acid methyl ester hydrochlorides in THF-Et3N medium, using the dicyclohexylcarbodiimide method gave the desired 1-acetylindoline-5-sulphonyldipeptide methyl esters (XXIV-XXVIII) . Most of the synthetic 1-acetylindoline-5-sulphonylamino acid and dipeptide derivatives (II-XXVII) were found to possess various antimicrobial activities against a number of microorganisms.

Farmaco {Sci}, 1986 Sep, 41(9), 666 - 75
{Some derivatives of the 2-{4-pyrazolinyl}-1,3,4-thiadiazole system}; Auzzi G et al.; The synthesis of some 2-{5-amino-1-methyl-3-oxo-4-pyrazolynyl}-1,3,4-thiadiazole derivatives is accomplished by reacting 5-amino-1-methyl-3-oxopryrazolynyl-4-dithiocarbohydrazide with carboxylic acid derivatives . The structure of the compounds obtained is verified by means of 1H and 13C-N.M.R . spectra . Antimicrobial and antifungal activity of some of the described compounds was tested in a preliminary screening.

Clin Pharmacokinet, 1986 Sep-Oct, 11(5), 402 - 10
Effects of ischaemic heart disease, Crohn's disease and antimicrobial therapy on the pharmacokinetics of sulphinpyrazone; Strong HA et al.; The renewed interest in sulphinpyrazone in recent years has arisen from its potential to inhibit platelet aggregation . In vivo much of the activity is probably due to the thioether or sulphide metabolite which has a greater potency and a longer half-life than the parent compound . The sulphide metabolite is formed exclusively by the gut microflora in man . The pharmacokinetics of sulphinpyrazone (200 mg orally) have been studied, with particular attention to the formation of the sulphide metabolite, in groups of patients who might be expected to show abnormal formation of this active metabolite due to altered delivery of the drug to the lower gut or altered gut flora . Five patients studied 1 month after a myocardial infarction did not differ markedly from young, normal volunteers with respect to either sulphinpyrazone or its metabolite . Crohn's disease in the quiescent phase did not significantly alter the pharmacokinetics or metabolism of the drug, but 1 patient who had undergone a hemicolectomy formed negligible concentrations of the active metabolite . Antimicrobial therapy produced highly variable results with almost complete suppression of sulphide formation in some subjects but no apparent effect in others.

Antibiot Med Biotekhnol, 1986 Sep, 31(9), 648 - 55
{Use of mathematical theory in experiments evaluating the protective properties of antimicrobial preparations}; D'iakov SI et al.; Mathematical design of multifactorial experiments in investigation of protective properties of antimicrobial drugs provided acceleration of preclinical study of new antimicrobial drugs, increasing its level and decreasing its size and cost . The advantage of the experiment mathematical design in investigation and estimation of protective properties of antimicrobial drugs was shown on a model of doxycycline chemotherapy of experimental anthracic infection caused by the vaccinal strain of the causative agent in albino mice . Second order quasi-D-optimal plans for 3-, 4- and 5-factorial experiments are presented and variation ranges of the main factors affecting chemotherapeutic activity of antimicrobial drugs are recommended: daily doses of the antibiotic, the inoculum size, the time of chemotherapy initiation after inoculation and the period of the preventive treatment . The main advantages of the experiment mathematical design in preclinical chemotherapy, along with economic utilization of experimental animals, are the following: possible estimation of the effect of every of the active factors on drug protective properties, objective evaluation of protective activity of drugs under various regimens of their use and feasibility of developing optimal schemes for drug use.

Age Ageing, 1986 Sep, 15(5), 257 - 66
Real-time measurement of serum C-reactive protein in the management of infection in the elderly; Cox ML et al.; The serum concentration of C-reactive protein (CRP), a nonspecific acute phase reactant which responds sensitively to bacterial infection, was measured by homogeneous enzyme immunoassay in all patients admitted to a general hospital geriatric unit . It was then monitored frequently in those in whom infection was suspected . Results were reported rapidly to the clinical team and particularly in the context of a patient population with complex multisystem pathology, often without pyrexia, leucocytosis or other classical signs of infection, they made a significant contribution to patient management . Very high CRP levels were most commonly due to infection (75% of those over 50 mg/l and 94% of those over 100 mg/l) and the pattern of the CRP response during antimicrobial therapy provided a sensitive, objective index of its efficacy . Failure of CRP levels to fall promptly stimulated additional diagnostic investigations, revealing resistant infection, localized pus or serious noninfective pathology, particularly malignancy, and led to appropriate management . Furthermore the CRP results on admission were of considerable prognostic significance, being significantly higher (median 70 mg/l) in those patients who did not survive than in those who did (18 mg/l).

Ann Ophthalmol, 1986 Sep, 18(9), 262, 267 - 70
Opportunistic infections of the retina and posterior segment; Letson AD; Opportunistic infections of the retina are becoming a more frequent diagnostic and therapeutic challenge as immunosuppressed patients become more common . Viral, fungal, protozoan, and bacterial agents may be encountered . Diagnostic and therapeutic considerations, illustrated by case histories, are presented in this article . Viral infections are characterized by progressive exudation and hemorrhagic necrosis in a segmental distribution corresponding to the retinal vasculature . Protozoan, fungal, and bacterial infections may demonstrate more focal lesions with greater vitreous involvement . Diagnosis is established by clinical examination of body fluids . Antimicrobial drugs alone or combined with vitrectomy are effective therapy for fungal, bacterial, and protozoan infections . Antiviral drugs have yielded more disappointing results in the management of viral retinitis.

Am J Hosp Pharm, 1986 Sep, 43(9), 2194 - 7
Cost savings achieved through cephalosporin use review and restriction; Dzierba SH et al.; Attempts to control costs associated with antimicrobial therapy and surgical prophylaxis with injectable cephalosporins in a 335-bed, acute-care, county teaching hospital are described . An ABC analysis of our pharmacy inventory revealed that 11.8% of the annual pharmaceutical budget was represented by cefamandole and that this agent was used primarily for surgical prophylaxis . Initial attempts to replace cefamandole with cefuroxime met with unexpected resistance from the department of surgery and were unsuccessful . A cost analysis revealed that annual savings in supply and personnel costs of $115,819 could be realized if cefazolin were substituted for cefamandole . Substitution of cefazolin resulted in an additional cost savings of $40,000 above our original proposal involving cefuroxime . Persistent efforts of the department of pharmacy aided the effective implementation of this alteration in cephalosporin prescribing practices.

Diagn Microbiol Infect Dis, 1986 Sep, 5(3), 215 - 20
Amikacin, ethambutol, and rifampin for treatment of disseminated Mycobacterium avium-intracellulare infections in patients with acquired immune deficiency syndrome; Baron EJ et al.; Synergistic combinations of achievable serum levels of amikacin, rifampin, and ethambutol were tested for their ability to inhibit growth of Mycobacterium avium-intracellulare strains isolated from seven patients with acquired immune deficiency syndrome . Even when the isolates were very resistant to the individual antimicrobial agents in vitro, growth was completely inhibited by all combinations of the three agents tested . Four of the patients treated with a combined regimen of amikacin, rifampin, and ethambutol showed clinical improvement . Synergistic antimicrobial susceptibility tests seem to more accurately represent the efficacy of combined regimens used to treat these extremely resistant mycobacteria than do conventional susceptibility determinations with individual antimicrobial agents.

Arch Ophthalmol, 1986 Sep, 104(9), 1313 - 7
Acanthamoeba sclerokeratitis . Determining diagnostic criteria; Mannis MJ et al.; Acanthamoeba infection of the cornea is an entity now recognized with increasing frequency . We saw two cases of Acanthamoeba sclerokeratitis in contact lens wearers in whom scleritis (anterior and posterior) played a central role in the clinical course of the disease . Scleritis is probably a more common component of Acanthamoeba infection than has generally been acknowledged . Posterior scleritis has not, to our knowledge, been reported previously in this disorder . The clinical diagnosis of Acanthamoeba infection has often been missed due to lack of a definition of the historical and clinical criteria by which this disease is characterized . We reviewed the 26 previously reported cases and suggest a set of criteria that can be used to establish an early diagnosis . Historical criteria include minor corneal trauma, exposure to soil or standing water, or contact lens wear . Clinical characteristics include severe pain, infiltrative (often ring-shaped) stromal keratitis, variable anterior uveitis, epithelial erosion, scleritis, standard bacterial culture negativity, chronicity, and lack of response to antimicrobial agents.

Pediatr Infect Dis, 1986 Sep-Oct, 5(5), 520 - 4
Antibiotic-resistant pneumococcal disease in children at Baragwanath Hospital, Johannesburg; Oppenheim B et al.; Seventeen of 60 cases of pneumococcal bacteremia in children at Baragwanath Hospital in 1983 were caused by strains not fully susceptible to penicillin G . Eight strains had minimal inhibitory concentrations of greater than 1 microgram/ml and five were resistant to four or more antimicrobial agents . Only three isolates were resistant to chloramphenicol . Antibiotic-resistant strains occurred in younger children with a mean age of 13.1 months compared with a mean age of 31.6 months in children with susceptible strains (P less than 0.01) . Underlying conditions, including nutritional status, did not correlate with antibiotic resistance of isolates from blood . Some of the resistant strains were apparently community-acquired . Of 3379 nasopharyngeal swabs taken from hospitalized children 829 yielded pneumococci and 408 of these carrier strains were either relatively or fully resistant to penicillin while 241 were resistant to four or more antibiotics . Multiply resistant strains from patients and carriers belonged to serovars 6A, 6B and 19A.

Rev Infect Dis, 1986 Sep-Oct, 8(5), 792 - 802
Blood cultures: issues and controversies; Washington JA 2nd et al.; Blood-culture procedures must be designed to overcome the intermittency and low order of magnitude of most bacteremias and fungemias and to inhibit any antimicrobial properties or components of the blood . Among the several variables affecting yields, the volume of blood cultured appears to be most important . It is recommended that at least 10 ml, and preferably 20-30 ml, of blood be obtained for each of two to three separate cultures . More than three separate blood cultures per septic episode is rarely necessary . Other issues involve the systems used for blood culture and the procedures used for their examination.

Rev Infect Dis, 1986 Sep-Oct, 8(5), 756 - 9
Antimicrobial agents and the medical journal: trends in publishing, 1936-1983; Berger SA; Thirty-seven thousand one hundred twenty-six Index Medicus citations dealing with antimicrobial agents were selected for the period 1936 through 1983 . Seventy-five percent of the citations have appeared since 1964, and the percentage of papers published in the English language has increased steadily since 1965 . The mean number of relevant papers cited per page and unit weight of the bound Index has declined in recent years, suggesting that current publishing trends increasingly favor literature in other fields.

Antimicrob Agents Chemother, 1986 Sep, 30(3), 375 - 81
Synthesis and antimicrobial activity of a series of caespitin derivatives; Van der Schyf CJ et al.; Chemical modification of the naturally occurring phlorophenone antimicrobial agent caespitin is described . These modifications include variations in the phenone side chain, substitution with prenyl, allyl, and benzyl in the 4-position of the phlorophenone nucleus, and ring cyclizations via etherification to give furan and chroman compounds . Several of these derivatives show enhanced in vitro potency over caespitin . Studies on the development of microbial resistance against these compounds show that no or very little resistance developed after several passes of these compounds in representative microbial strains.

Vet Microbiol, 1986 Sep, 12(3), 269 - 76
Evaluation of a rapid inoculum standardization system for antimicrobial susceptibility testing of bacterial isolates from the bovine mammary gland; Watts JL et al.; A commercially available rapid inoculum standardization system (RISS) was compared to the broth inoculum standardization method (BIS) for antimicrobial susceptibility testing of bacterial isolates from the bovine mammary gland . Overall agreement between RISS and the BIS method was 95.9% . RISS bypasses the 2-8 h incubation period required by BIS, thus providing antimicrobial susceptibility test data in a more timely manner . RISS was determined to be an acceptable alternative method to the BIS method for preparation of standardized inoculum for antimicrobial susceptibility testing of bovine mammary gland isolates.

Int Dent J, 1986 Sep, 36(3), 168 - 76
Juvenile periodontitis; Genco RJ et al.; Juvenile periodontitis occurs in children and young adults and can be classified into: periodontitis which occurs in otherwise healthy individuals, and periodontitis which occurs in juveniles with systemic disease . The periodontitis which occurs in otherwise healthy individuals consists of two major forms: juvenile periodontitis, also called periodontosis or localized juvenile periodontitis (LJP), and generalized juvenile periodontitis which includes early onset adult periodontitis, recurrent necrotizing ulcerative periodontitis and the true generalized form of juvenile periodontitis . Periodontitis in systemically diseased individuals can be divided into three subgroups: juvenile periodontitis associated with primary neutrophil disorders, juvenile periodontal disease in which neutrophils are secondarily abnormal, and juvenile periodontitis associated with other diseases . Juvenile periodontitis is perhaps the best understood form of periodontal disease . A major infecting organism, Actinobacillus actinomycetemcomitans, is strongly associated with the disease, and may be an exogenous pathogen since it is not found in healthy individuals or in healthy sites in LJP patients . It is virulent with marked leukaggressive properties and it induces a marked antibody response in infected patients . Eradication of Actinobacillus actinomycetemcomitans requires attention to the fact that it invades the tissue and hence systemic antimicrobials or surgical excision of the tissues is necessary for eradication . Marked suppression of the organism from subgingival sites is associated with healing . Host responses in LJP have also been well described and most immune functions studied appear to be normal . The notable exception is neutrophil chemotaxis which is depressed . Associated with depressed neutrophil chemotaxis is a reduction of neutrophil receptors for several chemotactic factors including C5a, the fifth component of complement.(ABSTRACT TRUNCATED AT 250 WORDS)

Clin Chest Med, 1986 Sep, 7(3), 393 - 412
Respiratory pharmacology . Antibiotics . I . Beta-lactam antibiotics, the tetracyclines, chloramphenicol, erythromycin, clindamycin, metronidazole, and the quinolones; Segreti J et al.; Pneumonia, acute bronchitis, and sinusitis are common infections encountered by the pulmonary specialist . Such conditions are usually treated with antibiotics, and their use requires an understanding of their pharmacokinetic properties as well as their antimicrobial spectrum and adverse side effects.

Infection, 1986 Sep-Oct, 14(5), 226 - 32
Prevention of infection in acute leukemia: a prospective randomized study on the efficacy of two different drug regimens for antimicrobial prophylaxis; Kurrle E et al.; In a prospective study patients with acute leukemia undergoing remission induction therapy were randomized to receive either a regimen of non-absorbable antimicrobial drugs (colistin and neomycin) or of absorbable and non-absorbable drugs (trimethoprim-sulfamethoxazole {TMP-SMZ} and colistin) for antibacterial prophylaxis . For antifungal prophylaxis patients in both groups were given oral amphotericin B . The proportion of patients without acquired infections and the median of study time to the first acquired infection did not differ significantly between the two treatment groups (p greater than 0.05) . Septicemias occurred in nine out of 49 recipients of colistin and neomycin and in one out of 56 patients receiving TMP-SMZ and colistin (p = 0.03) . Localized infections and fever episodes without proven infections were equally distributed between the two groups . The incidence of febrile days and of days on parenteral antibiotic therapy was significantly lower in the group given TMP-SMZ and colistin (p less than 0.05) . The duration of severe granulocytopenia and thrombocytopenia did not differ significantly between the two groups (p greater than 0.05).

Jpn J Antibiot, 1986 Sep, 39(9), 2497 - 518
{Pharmacokinetic and clinical studies of cefotiam in the perinatal period}; Hayasaki M et al.; Patients, who had undergone cesarean sections, and those who had experienced premature rupture of membranes, received cefotiam (CTM) and the clinical efficacy and the safety for mothers and fetuses were investigated . At the same time, pharmacokinetic analysis was done to study the maternal fetal transfer . Following results were observed . In cases of premature rupture of membranes, the maternal-fetal transfer ratio after intravenous administrations of CTM was 50.3% at a dosage of 1 g . Maternal and fetal serum concentrations of CTM were maintained higher levels than the MIC80 (0.78 micrograms/ml) against major pathogens excluding anaerobic of gynecologic-obstetric infections and were maintained up to 5.87 hours and 6.15 hours in mothers and fetuses, respectively . The CTM was administered once every 12 hours at a dosage of 1 g to 38 cases up to the 3rd or 4th day of puerperium after the rupture of membranes . Also, the CTM was administered up to times of delivery to another 20 cases, in one of which the fetus developed pneumonia . The maternal-fetal prophylactic effect was recognized in 98.3% (57/58) of cases . Forty-three cesarean section cases received CTM at a dosage level of 1 g by one-hour intravenous drip infusion in the following manner: after surgery to the 4th day, twice a day; from the 5th to the 7th day, once a day . Postoperative prophylactic effect against infection was achieved in all the cases . In 1 case, a slight transient elevation in the maternal GOT was observed . Neonatal jaundice with total bilirubin levels higher than 15.0 mg/dl was observed in 19 neonates (32.8%) in the group in which premature rupture of the membranes had occurred . However, the cause/effect relationship between CTM and the total bilirubin levels is unclear . The maternal-fetal transition of CTM was excellent, and the safety toward the fetus and neonate was high . When an antimicrobial activity and pharmacokinetics are considered, CTM will be a useful drug in the treatment of perinatal infections.

J Periodontol, 1986 Sep, 57(9), 555 - 61
The effects of a dentifrice containing zinc citrate and 2,4,4' trichloro-2'-hydroxydiphenyl ether; Saxton CA; The effects of a dentifrice which contained 1% zinc citrate and 0.5% of a nonionic antimicrobial agent, 2,4,4' trichloro-2'-hydroxydiphenyl ether on plaque and gingival health have been investigated . In a 4-day nonbrushing study in which dentifrices were used as slurries, this dentifrice inhibited plaque accumulation significantly more than dentifrices which contained either zinc citrate or Triclosan separately . In a 28-day double-blind cross-over study, a significant reduction in plaque accumulation and improvement in gingival health was demonstrated for the test dentifrice compared to the placebo . The effect was demonstrated with a group of well motivated volunteers who had a good standard of oral health . Analysis of the data suggested that the benefit might be extended to a less motivated population.

Semin Respir Infect, 1986 Sep, 1(3), 151 - 9
Pulmonary infections due to Legionella in immunocompromised patients; Gump DW et al.; At present, 11 different species of Legionella have been implicated in human disease . It has become apparent that disease caused by Legionella is acquired from a variety of environmental sources and that water is the factor that links many of them . Patients who are immunosuppressed, such as individuals receiving cancer chemotherapy or therapy designed to prevent organ rejection, are particularly susceptible to such environmental sources . It appears that intact cell-mediated immunity is more important in host defense than are adequate numbers of granulocytes or immunoglobulin concentrations . Diagnostic steps should be undertaken in all patients developing nosocomial pneumonia who present with a picture suspicious for this disorder . In the meantime, appropriate antimicrobial therapy with erythromycin and rifampin should be begun . If clusters of cases are detected in a hospital, immediate steps should be taken to attempt to isolate the organism from any aqueous environmental sources, and if found appropriate, steps taken . Awareness of the threat of legionnaires' disease must be maintained among clinicians and hospital epidemiologists because it is unlikely that the problem of nosocomial legionnaires' disease will disappear.

Hinyokika Kiyo, 1986 Sep, 32(9), 1387 - 408
{A clinical evaluation of MK-0787/MK-0791 for long-term administration in urological infections}; Suzuki K et al.; MK-0787 (Imipenem)/MK-0791 (Cilastatin sodium), a new compound of Thienamycin, was administered in treatment of 35 patients (36 cases) with chronic complicated UTI or for prevention of serious infections with much complicated factors . The patients were principally treated at a daily dose of 1 g for over 10 days . The efficacy rate of 26 patients who were evaluable in the early phase (4-7 days) was 88.5%, while it became up to 92.3% in the final phase judgment . As for clinical usefulness, the result was obtained to be as high as that of the clinical efficacy . In bacteriological study, 35 strains were clinically isolated including 7 strains of P . aeruginosa from UTI . All the strains disappeared with an eradication rate of 100% after treatment . Strains appearing after Imipenem/Cilastatin sodium treatment mainly consisted of fungi . Usefulness judgements tended to be greater in the final phase than in the early phase . As for side effects, vomiting was recorded in one case, in which the administration was discontinued . In laboratory findings there were 3 cases with elevated GPT, 2 cases with elevated GOT, one case with elevated gamma-GTP, one with thrombocytopenia, and one with eosinophilia each, but these abnormal values were slight and transient . In summary our clinical study showed that Imipenem/Cilastatin sodium was a very effective antibiotic in treatment on moderate or serious UTI or preventive use for infections in compromised hosts . Considering the features of this agent, it might be more effective and useful for clinical use in treatment on polymicrobial infections including stubborn organisms than any other antimicrobial compounds . Furthermore, it was safe and well tolerable in a long term treatment.

Antimicrob Agents Chemother, 1986 Sep, 30(3), 390 - 4
Aryl-fluoroquinolone derivatives A-56619 (difloxacin) and A-56620 inhibit mitogen-induced human mononuclear cell proliferation; Gollapudi SV et al.; Aryl-fluoroquinolone derivatives A-56619 (difloxacin) and A-56620 were found to inhibit human peripheral blood mononuclear cell (MNC) proliferation (measured by {3H}thymidine uptake) that was induced by concanavalin A or monoclonal antibody OKT3 . These antimicrobial agents exert their maximum suppressive effect when added within the first 24 h after the onset of culture with concanavalin A . No increase in the concentration of mitogen or the duration of incubation of MNC cultures reversed this inhibitory effect, but the removal of the drug from cultures reversed the suppression of DNA synthesis . A-56619 appeared not to interfere with the triggering of MNC activation by mitogen because it did not inhibit mitogen-induced increase in protein synthesis (measured by {3H}leucine incorporation), interleukin-2 receptor expression (measured by the binding of fluorescein-conjugated monoclonal antibody against interleukin-2 receptor), and cell volume . These findings are considered in terms of possible interference of aryl-fluoroquinolones with mammalian topoisomerase and DNA polymerases.

Pediatr Infect Dis, 1986 Sep-Oct, 5(5), 525 - 7
C-reactive protein in acute otitis media; Principi N et al.; This study was designed to explore whether C-reactive protein (CRP) in serum is helpful in assessing the etiologic diagnosis of acute otitis media (AOM) in children . CRP was measured serially by a radial immunodiffusion method in sera from 67 children with AOM and in 67 matched controls, affected by noninfectious neurologic disorders . In the study group 43 (64%) children had a confirmed bacterial AOM and 24 (36%) showed no bacterial growth from middle ear fluid . The upper limit of CRP in controls was 15 mg/liter . Concentrations of CRP in patients with bacterial AOM ranged from less than 6 to 150 mg/liter; in 71% of the cases the value was greater than 15 mg/liter . In the patients with sterile middle ear fluid CRP ranged from less than 6 to 110 mg/liter; in 67% of the cases the level was greater than 15 mg/liter . CRP greater than 15 mg/liter showed sensitivity of 72%, specificity of 33%, predictive value of a positive test of 66% and predictive value of a negative test of 40%, in detecting bacterial AOM . Measurement of CRP should not be used in the decision regarding antimicrobial therapy for AOM in children.

J Clin Microbiol, 1986 Sep, 24(3), 343 - 8
Pig skin as test substrate for evaluating topical antimicrobial activity; Bush LW et al.; The feasibility of using pathogen-contaminated pig skin as a model substrate for evaluating skin disinfectants was demonstrated . A test methodology is described that is safe, convenient to use, and adaptable to a variety of hand-washing conditions . The treatment protocol, pathogen contamination conditions, and application technique variables can all be carefully controlled to simulate clinical use conditions . The number of organisms transferred by contact was compared with the total organism count on the pig skin . The quantity of organisms transferred ranged from 10 to 60% of the total organisms, depending on the nature of the contamination conditions . The cumulative results of multiple imprint and stripping measurements were consistent with the concentration of inoculated organisms . Tests with alcohol solutions validated the methodology and clearly showed the dependence of topical antimicrobial activity on both the concentration and structure of the alcohol . Activity increased with increasing alcohol concentration and in the following order: ethanol, isopropanol, and n-propanol . All of the alcohols became less active as the severity of the test conditions was increased, i.e., higher inoculum levels for a longer incubation time before treatment . The contact imprint and stripping methods used to evaluate bacterial growth on the skin clearly showed that the alcohol treatments reduced but did not eliminate the inoculated pathogens . It was found that long lifetimes (several hours) for pathogens on the skin are possible under some environmental conditions . This observation strongly suggests that frequent hand washing is a necessary infection control practice even when opportunities for repeated pathogen contamination have not occurred.

Clin Chest Med, 1986 Sep, 7(3), 413 - 23
Respiratory pharmacology . Antibiotics . II . Aminoglycosides, polymyxins, vancomycin, trimethoprim-sulfamethoxazole, and pentamidine; Kuriyama S et al.; This article provides the pulmonary specialist with a summary description of these commonly used antimicrobial agents, including mode of action, antimicrobial spectrum, pharmacology, toxicity, indications for use, and recommended dosages.

J Med Chem, 1986 Sep, 29(9), 1709 - 14
Synthesis of anthraquinonyl glucosaminosides and studies on the influence of aglycone hydroxyl substitution on superoxide generation, DNA binding, and antimicrobial properties; Abramson HN et al.; A series of anthraquinonyl glucosaminosides (10a-e) were synthesized by Koenigs-Knorr glycosidation of the corresponding aglycones (11a-e) with bromo sugar 12 followed by saponification . These glycosides were intended to serve as models to study the role played by the hydroxyl substituents on the aglycone portion of the antitumor anthracycline antibiotics . Superoxide generation as measured in rat heart sarcosomes was found to increase with the addition of successive hydroxyl groups to the anthraquinone nucleus . The 1,8-dihydroxy pattern was determined to generate significantly less superoxide than the 1,4-dihydroxy pattern . Hydroxyl substitution was also observed to stabilize the complex formed between the anthraquinones and DNA and was required for antibacterial activity against a number of Gram-positive organisms.

J Hosp Infect, 1986 Sep, 8(2), 168 - 77
Antibiotic costs and prescribing patterns in a recently commissioned Liverpool teaching hospital . Part II: Antimicrobial chemoprophylaxis; Griffiths LR et al.; All antibiotics prescribed for prophylaxis in a major teaching hospital were prospectively surveyed during 31 consecutive days . Of 2350 patients admitted during that period, 238 (10.1%) received antibiotics for prophylaxis . A total of 1238 operations were performed during the period of study, of which 201 (16.2%) were covered with antibiotics, at a cost of 3472 pounds . The use of prophylaxis increased according to the risk of peri-operative wound contamination, from 15.8% in Class I to 52.4% in Class III operations . The average cost of chemoprophylaxis also increased correspondingly . A further 40 regimens were issued for non-surgical prophylaxis at a cost of 258 pounds . Twenty antibiotics were prescribed either alone or in 37 different combinations for surgical prophylaxis, the most frequent being cephradine (22%), metronidazole (17%), penicillin (12%), and tobramycin (11%) . The mean duration of antibiotic administration for all surgical procedures was 6.1 days.

N Engl J Med, 1986 Aug 28, 315(9), 552 - 8
A randomized trial comparing ceftazidime alone with combination antibiotic therapy in cancer patients with fever and neutropenia; Pizzo PA et al.; To assess the efficacy of single-agent therapy relative to standard combination antibiotic therapy for the initial management of fever and neutropenia in cancer patients, we conducted a randomized trial comparing ceftazidime alone with a combination of cephalothin, gentamicin, and carbenicillin . Of 550 evaluable episodes of fever and neutropenia, 282 were treated with ceftazidime alone and 268 with the combination . All episodes were evaluated for responses at 72 hours after the start of treatment and at resolution of the neutropenia . Of the patients with unexplained fever who were given ceftazidime alone, 99 percent were alive at 72 hours and 98 percent were alive when the neutropenia resolved, as compared with 100 percent and 98 percent, respectively, of those given combination therapy . Of the patients with documented infection who were given ceftazidime alone, 98 percent were alive at 72 hours and 89 percent when the neutropenia resolved, as compared with 98 percent and 91 percent, respectively, of those given combination therapy . The majority of episodes of documented infection in both treatment groups necessitated additional antimicrobial treatment or other modifications of the initial regimen, as compared with only 22 percent of the episodes of unexplained fever . We conclude that initial single-agent therapy with certain beta-lactam antibiotics is a safe alternative to standard combination antibiotic therapy, although patients with documented infection or protracted neutropenia are likely to require additional or modified treatment.

Pharmazie, 1986 Aug, 41(8), 563 - 5
Novel benzimidazoles with potential antimicrobial and antineoplastic activities; Rida SM et al.; The synthesis of some substituted 4-{1-(1-(1H-benzimidazol-2-yl) alkylamino}-1,5-dihydro-2H-pyrrol-2-ones and 3-{1-(1H-benzimidazol-2-yl)alkyl}-2-substituted-4(3H)-quinazolinon es is described . Five compounds displayed in vitro antibacterial and antifungal activities . Three of these compounds were tested against P-388 lymphocytic leukemia in mice and were inactive.

J Reprod Med, 1986 Aug, 31(8), 709 - 12
Single-dose antibiotic prophylaxis in high-risk patients undergoing cesarean section . A comparative trial; Saltzman DH et al.; A prospective, double-blind study was performed to evaluate the comparative efficacy of single- and multiple-dose antimicrobial prophylaxis for preventing infection in high-risk patients undergoing cesarean section . One hundred fifty-eight patients were randomly assigned to receive either a single perioperative dose of mezlocillin, three doses of mezlocillin or three doses of cefoxitin . The incidence of endometritis was 5.9%, 4.0% and 4.0%, respectively . The incidence of febrile morbidity was 5.9%, 2.0% and 6.1%, respectively . These differences are not statistically significant . The single perioperative dose of mezlocillin was as effective as the three-dose regimen of either mezlocillin or cefoxitin.

J Antibiot (Tokyo), 1986 Aug, 39(8), 1108 - 22
Synthesis and antimicrobial evaluation of acyl derivatives of 16-membered macrolide antibiotics related to tylosin; Kirst HA et al.; A large number and wide variety of acyl derivatives of the tylosin-related macrolides 23-demycinosyltylosin (DMT), 23-demycinosyloxytylosin (DMOT) and 5-O-mycaminosyltylonolide (OMT) were synthesized and evaluated . This encompassed conversion of the hydroxyl groups at 2',4' and 23 of the appropriate macrolides to the corresponding esters, in which a variety of different substitution patterns were examined . A wide range of acyl substituents was investigated, particularly for 23-O-acyl derivatives of OMT, since these were substantially more active in vitro than OMT itself . However, the acyl derivatives which were prepared demonstrated no substantial improvement in oral efficacy or bioavailability over the parent macrolides.

Farmaco {Sci}, 1986 Aug, 41(8), 637 - 43
{3,3'-bi-1,3-thiazolidine}-4,4'-dione system . III . Evaluation of the antimicrobial and antitumor properties of 2,2'-disubstituted derivatives and their 1,1'-disulfones; Basile M et al.; A series of dl and meso 2,2'-disubstituted-{3,3'-bis-1,3-thiazolidine}-4,4'-diones and their 1,1'-disulfone derivatives have been tested for their antimicrobial activity against gram-positive, gram-negative and Candida strains and for antitumor activity against leukemic P.388 tumor system in mice . None of the tested bi-thiazolidinones showed any significant antitumor properties; only few 1,1'-disulfones exhibited some antibacterial activity.

Farmaco {Sci}, 1986 Aug, 41(8), 622 - 9
Synthesis and antimicrobial properties of new aroyl-acrylic esters of polyethylene glycols; Dal Pozzo A et al.; Eight new aroyl-acrylic esters of polyethylene glycols were prepared using different synthetic ways . They are supposed to possess a higher activity as antimicotic agents for topical use, by favouring skin absorption . Except in few cases, the antimicrobial activity of the oligomeric derivatives resulted generally decreased in vitro, in comparison to simple alkyl esters previously prepared . However, only pharmacological screenings for antimicotic activity in vivo will give a definite response on whether the new derivatives are advantageous for topical use.

Arch Intern Med, 1986 Aug, 146(8), 1563 - 5
Spontaneous vs secondary bacterial peritonitis . Differentiation by response of ascitic fluid neutrophil count to antimicrobial therapy; Runyon BA et al.; A retrospective chart review revealed 24 patients who had at least one subsequent ascitic fluid neutrophil count within 14 days of the ascitic fluid analysis that was diagnostic of spontaneous bacterial peritonitis . The neutrophil count decreased (after antibiotic therapy was started) at an exponential rate, with a half-life of 34 +/- 35 hours . In none of four episodes of secondary bacterial peritonitis was there an exponential decline in neutrophil count after antimicrobial therapy was initiated . In fact, the first follow-up neutrophil count was greater than the baseline value in all four episodes . The response pattern of the ascitic fluid neutrophil count to antimicrobial therapy is helpful in differentiating spontaneous from secondary bacterial peritonitis.

Emerg Med Clin North Am, 1986 Aug, 4(3), 595 - 604
Emergency department management of mammalian bites; Edlich RF et al.; Mammalian bites have reached epidemic proportions with more than one half million people being bitten by an animal or another person . Although the bite wound may initially appear to be innocuous, it may lead to severe complication that can be prevented by a timely and comprehensive treatment program that is outlined in this report . Our approach to these challenging injuries includes a complete evaluation of the injury, planned surgical intervention, antimicrobial therapy, immunoprophylaxis, and appropriate postoperative care.

Br J Hosp Med, 1986 Aug, 36(2), 119 - 23
New antimicrobials; Stone JW et al.; Two groups of compounds, the beta-lactams and the quinolones, account for the main developments in antimicrobials in the last 5 years . Efforts to overcome emerging problems of resistance and to broaden further the spectrum of similar existing agents have been the main impetus to the pharmaceutical industry, though some compounds have also been developed with a narrow spectrum intended for specific pathogens . This article reviews antibiotics that have recently become available in the UK and also discusses compounds that are undergoing clinical trials at present.

Antimicrob Agents Chemother, 1986 Aug, 30(2), 270 - 3
Therapy of experimental cerebral nocardiosis with imipenem, amikacin, trimethoprim-sulfamethoxazole, and minocycline; Gombert ME et al.; A mouse model of cerebral nocardiosis was used to determine relative antibiotic efficacy by reducing bacterial colony counts per gram of brain tissue . The antimicrobial agents employed were demonstrated in vitro to be inhibitory to most strains of Nocardia asteroides at very low concentrations . The agents used in this study were imipenem-cilastatin, amikacin, trimethoprim-sulfamethoxazole, and minocycline . Antibiotics were administered every 4 h for 72 h before animal sacrifice . Bacterial colony counts were assayed at various time points before the completion of therapy . Imipenem-cilastatin and amikacin were the most effective agents tested . Trimethoprim-sulfamethoxazole was less effective than imipenem and amikacin but more effective than minocycline . Minocycline did not eradicate intracerebral organisms and was similar to saline (control) in its effects.

Antimicrob Agents Chemother, 1986 Aug, 30(2), 248 - 53
Isolation and characterization of norfloxacin-resistant mutants of Escherichia coli K-12; Hirai K et al.; We isolated spontaneous mutants from Escherichia coli K-12 with low-level resistance to norfloxacin . These mutants were classified into the following three types on the basis of their properties: (i) NorA appeared to result for mutation in the gyrA locus for the A subunit of DNA gyrase; (ii) NorB showed low-level resistance to quinolones and other antimicrobial agents (e.g., cefoxitin, chloramphenicol, and tetracycline), and the norB gene was considered to map at about 34 min on the E . coli K-12 chromosome; (iii) NorC was less susceptible to norfloxacin and ciprofloxacin but was hypersusceptible to hydrophobic quinolones such as nalidixic acid and rosoxacin, hydrophobic antibiotics, dyes, and detergents . Susceptibility to bacteriophages and the hydrophobicity of the NorC cell surface also differed from that of the parent strain . The norC gene was located near the lac locus at 8 min on the E . coli K-12 chromosome . Both NorB and NorC mutants had a lower rate of norfloxacin uptake, and it was found that the NorB mutant was altered in OmpF porin and that the NorC mutant was altered in both OmpF porin and apparently in the lipopolysaccharide structure of the outer membrane.

Emerg Med Clin North Am, 1986 Aug, 4(3), 561 - 80
Antimicrobial treatment of minor soft tissue lacerations: a critical review; Edlich RF et al.; This article is a collective review of all the prospective clinical studies that assessed the therapeutic value of antibiotics in minor soft tissue lacerations . This review critically evaluates each study that tests the hypothesis that antibiotic treatment reduces the incidence of infection . Even though the design of each of the studies was scientifically inadequate, important factors were identified that influenced the incidence of infection . On the basis of this collective review as well as other studies, indications for antibiotic therapy of minor soft tissue lacerations have been identified . Future clinical studies must be designed to test more precisely the validity of these recommendations.

J Antimicrob Chemother, 1986 Aug, 18(2), 281 - 5
A simple computer program for calculating areas under concentration-time curves; Storey BE et al.; A simple program has been developed for calculating areas under concentration-time curves with a home computer . Although it was primarily produced in BBC BASIC for the BBC microcomputer, an adaptation has been made to allow its use with a limited subset of BASIC commands on other computers . After the time and concentration data have been entered, the computer produces a smooth curve running through all data points and employs a spline-fitting interpolation technique to produce equally spaced points, as required by Simpson's rule which is used as the numerical integration procedure . The areas of the vertical strips so formed are then calculated and added together, the integration times being selected by the investigator himself . Comparison with a traditional method showed a good correlation, as did comparison with a commercial NONLIN program . The simple program allows a large number of observations to be analysed quickly, and has proved very useful in calculating AUC values in individual patients in studies with various new antimicrobial agents.

Clin Haematol, 1986 Aug, 15(3), 873 - 904
Infection and transfusion therapy in acute leukaemia; Ho WG et al.; Granulocytopenia is the single most important risk factor for infection in patients with acute leukaemia . There are limitations to the effective prophylaxis of infection in granulocytopenic patients, but practical measures include the management of the patient in a private hospital room, the requirement of all medical personnel and visitors to wash their hands carefully and to wear masks, restricting the patient to a low-bacteria diet devoid of fresh fruit, vegetables and salads, and the administration of oral antimicrobial agents for gastrointestinal decontamination . When fever develops, empirical therapy with a combination of an aminoglycoside plus an antipseudomonal beta-lactam should be started promptly . A double beta-lactam combination of cefoperazone or ceftazidime plus piperacillin can be substituted if nephrotoxicity is a concern . The addition of empirical intravenous amphotericin may be useful in patients who remain febrile and granulocytopenic on broad-spectrum antibiotics, especially if surveillance cultures indicate fungal colonization . Amphotericin is also the most reliable agent for the treatment of established fungal infections . Acyclovir is not recommended for prophylaxis in acute leukaemia patients but should be reserved for the treatment of well-documented and clinically significant herpes simplex viral infections . During periods of remission, most patients with AML remain free of infection except when they become granulocytopenic again during intensification or consolidation chemotherapy . On the other hand, children with ALL in remission may experience frequent infections unrelated to granulocytopenia as a consequence of their maintenance chemotherapy . Pneumocystis carinii, varicella zoster, and other viruses are common pathogens . Trimethoprim-sulphamethoxazole is effective prophylaxis against Pneumocystis carinii pneumonia in patients with ALL, while intravenous acyclovir is the drug of choice for treatment of varicella zoster infection . Transfusion therapy in the acute leukaemia patient is guided by the patient's peripheral blood counts and degree of sensitization to blood products . Generally, packed red blood cells are given in order to maintain the haematocrit at greater than 30%, while random-donor platelets are administered to keep the platelet count at greater than 20 X 10(9)/l . If refractoriness to platelet transfusions develops, HLA-matched platelets from family members or selected unrelated donors can be used . Similarly, washed or filtered red blood cells may be given to patients with previous and recurrent non-haemolytic febrile reactions to red blood cell transfusions.(ABSTRACT TRUNCATED AT 400 WORDS)

Oral Surg Oral Med Oral Pathol, 1986 Aug, 62(2), 142 - 4
An evaluation of the efficacy and irritability of Sporicidin as a hand dip; Holderman RD et al.; Sporicidin, diluted 1:16, used as a disinfectant hand dip, was found to produce substantial percent reductions in the mean number of colony-forming units in comparisons between microbial recoveries of the control and Sporicidin-dipped hands . Sporicidin at this concentration appears to demonstrate efficacy as an antimicrobial agent, but dermal irritation, sensitivity and yellowing of the skin, and its objectionable odor may preclude its routine clinical use.

J Hyg (Lond), 1986 Aug, 97(1), 61 - 9
The effect of oxygen-dependent antimicrobial systems on strains of Legionella pneumophila of different virulence; Jepras RI et al.; Four strains of Legionella pneumophila of different virulence as identified by ability to produce pneumonia and death in guinea-pigs infected by a fine-particle aerosol were examined for factors which may intracellularly influence virulence . Possible bactericidal mechanisms possessed by alveolar phagocytes were examined . A relationship could be established between resistance to H2O2, catalase activity and virulence amongst the strains . Virulent strains resisted the bactericidal activity generated by the xanthine oxidase system; avirulent strains did not . Incorporation of various specific inhibitors of the xanthine oxidase system indicated that the main bactericidal activities were associated with the production of H2O2 and hydroxyl radicals (.OH) . All strains of L . pneumophila were susceptible to the bactericidal activity generated by the myeloperoxidase-H2O2-halide system, confirming earlier observations that polymorphonuclear neutrophil leucocytes (PMNLS) are able to kill both virulent and avirulent strains of L . pneumophila.

JAMA, 1986 Jul 25, 256(4), 484 - 90
An outbreak of a newly recognized chronic diarrhea syndrome associated with raw milk consumption; Osterholm MT et al.; A previously undescribed chronic diarrhea syndrome affected 122 residents of Brainerd, Minn, between December 1983 and July 1984 . The illness lasted at least one year for 75% of case-patients and was characterized by acute onset, marked urgency, a lack of systemic symptoms, and a failure of response to antimicrobial agents . Clinical and laboratory data indicate that the diarrhea was caused by a secretory mechanism . Consumption of raw milk from a single dairy was associated with illness (odds ratio, 28.3; 95% confidence interval, 9.0 to 89.0) . A median incubation period of 15 days was determined for seven case-patients . Possible secondary transmission was noted in one family . Extensive laboratory examination did not identify an etiologic agent . Outbreaks or sporadic cases of a similar illness have occurred in at least seven states; the outbreaks were less extensively investigated and findings were not published, but raw milk consumption was common in the affected persons . This illness appears to represent a previously unrecognized but important clinical entity and public health problem . The etiology and effective therapy for this illness must be determined by further studies of sporadic cases and outbreaks.

J Biol Chem, 1986 Jul 25, 261(21), 9694 - 702
Oxidation of chloride and thiocyanate by isolated leukocytes; Thomas EL et al.; Peroxidase-catalyzed oxidation of chloride (Cl-) and thiocyanate (SCN-) was studied using neutrophils from human blood and eosinophils and macrophages from rat peritoneal exudates . The aims were to determine whether Cl- or SCN- is preferentially oxidized and whether leukocytes oxidize SCN- to the antimicrobial oxidizing agent hypothiocyanite (OSCN-) . Stimulated neutrophils produced H2O2 and secreted myeloperoxidase . Under conditions similar to those in plasma (0.14 M Cl-, 0.02-0.12 mM SCN-), myeloperoxidase catalyzed the oxidation of Cl- to hypochlorous acid (HOCl), which reacted with ammonia and amines to yield chloramines . HOCl and chloramines reacted with SCN- to yield products without oxidizing activity, so that high SCN- blocked accumulation of chloramines in the extracellular medium . Under conditions similar to those in saliva and the surface of the oral mucosa (20 mM Cl-, 0.1-3 mM SCN-), myeloperoxidase catalyzed the oxidation of SCN- to OSCN-, which accumulated in the medium to concentrations of up to 40-70 microM . Sulfonamide compounds increased the yield of stable oxidants to 0.2-0.3 mM by reacting with OSCN- to yield derivatives analogous to chloramines . Stimulated eosinophils produced H2O2 and secreted eosinophil peroxidase, which catalyzed the oxidation of SCN- to OSCN- regardless of Cl- concentration . Stimulated macrophages produced H2O2 but had low peroxidase activity . OSCN- was produced when SCN- was 0.1 mM or higher and myeloperoxidase, eosinophil peroxidase, or lactoperoxidase was added . The results indicate that SCN- rather than Cl- may be the physiologic substrate (electron donor) for eosinophil peroxidase and that OSCN- may contribute to leukocyte antimicrobial activity under conditions that favor oxidation of SCN- rather than Cl-.

J Chromatogr, 1986 Jul 18, 362(2), 263 - 73
Determination of Ro 14-1761, a new third-generation cephalosporin, in the plasma and milk of cattle by column switching high-performance liquid chromatography; Jordan JC et al.; A sensitive and specific high-performance liquid chromatographic procedure was developed for the determination of the third-generation cephalosporin Ro 14-1761 in cow plasma and milk . The molecular structure of the new antimicrobial was very close to that of ceftriaxone, but the high-performance liquid chromatographic methods available for the latter could not be used as Ro 14-1761 adsorbed and/or degraded during the chromatographic process . Furthermore, the high-performance liquid chromatographic technique derived for ceftriaxone was not sensitive enough for our purposes . In the new assay, the plasma (milk) protein was precipitated with acetonitrile after dilution of the sample with water . For low concentrations (less than or equal to 10 micrograms/ml), the supernatant obtained after centrifugation was concentrated by extracting acetonitrile with methylene chloride . Quantification was performed by column switching high-performance liquid chromatography with UV detection (274 nm) using ion-pair reversed-phase chromatography . Ethylenediaminotetraacetic sodium salt had to be added to the mobile phase (1.2 mM) to prevent adsorption and/or degradation of the cephalosporin on the analytical column . The selectivity of the chromatographic separation was enhanced by heating the column to ca . 50 degrees C . The drug recovery was better than 85% . The limit for quantitative determination in both milk and plasma was 0.1 microgram of Ro 14-1761 per millilitre with an accuracy of 1% (coefficient of variation 10%) . The overall accuracy and precision were 1-10% in the 0.1-100 micrograms/ml concentration range.

J Immunol, 1986 Jul 15, 137(2), 689 - 92
Oxygen-independent inhibition of intracellular Chlamydia psittaci growth by human monocytes and interferon-gamma-activated macrophages; Rothermel CD et al.; We have demonstrated previously that Chlamydia psittaci grows well in human monocyte-derived macrophages, but to a limited extent in lymphokine-or interferon-gamma (IFN-gamma)-activated macrophages . In this investigation, freshly explanted human monocytes inhibited chlamydial inclusion formation by 85% as compared to macrophages, and the level of inhibition was similar to that exhibited by lymphokine-activated macrophages (79%) . To determine whether the oxygen-dependent antimicrobial mechanisms of the mononuclear phagocyte were involved in the inhibition, cells were infected with C . psittaci in the presence of agents that either inhibit the respiratory burst (glucose deprivation) or diminish the effect of H2O2 (catalase) . These treatments had no effect on the capacity of monocytes and lymphokine-activated macrophages to restrict chlamydial growth . In addition, monocytes and activated macrophages from an individual with chronic granulomatous disease suppressed chlamydial growth as effectively as normal cells . Oxidatively deficient HeLa and endothelial cells, once stimulated by lymphokine, also displayed normal levels of antichlamydial activity . The induction of this apparently oxygen-independent antichlamydial effect by lymphokine was completely neutralized by a monoclonal anti-IFN-gamma antibody, and could be achieved by treatment with recombinant (r)IFN-gamma alone . These results indicate that the primary antimicrobial mechanism of the human monocyte against C . psittaci is oxygen-independent, and that this response can be effectively stimulated in the macrophage by lymphokine (IFN-gamma).

Farmaco {Sci}, 1986 Jul, 41(7), 566 - 76
Pyrrolnitrin analogues . XII . Synthesis and biological activity of some pyrazole carboxylic acids; Palazzino G et al.; Some 1,5-diaryl-, 1-aryl-5-(2-nitrobenzyl)-3-methylpyraloze-4-carboxylic acids and some of their 4-morpholino- and 4-N-methylpiperazino amides are prepared and tested as antibacterial agents . None of the tested compounds shows any noteworthy antimicrobial activity . The results are discussed and compared with the previously published results for other similarly structured compounds.

Farmaco {Sci}, 1986 Jul, 41(7), 558 - 65
{Synthesis and microbiologic activity of a new class of imidazole derivatives}; Stradi R et al.; The synthesis of a new class of imidazole derivatives with the structure of 1-{2-(2,4-dichlorophenyl)-2-tert.amino}ethylimidazoles is described . Preliminary data on their antimicrobial activity are reported.

Farmaco {Sci}, 1986 Jul, 41(7), 499 - 507
2,2'-Bipyridyl-6-carboxamidoximes with potential antitumor and antimicrobial properties; Cristalli G et al.; A series of derivatives of 2,2'-bipyridyl-6-carboxamidoxime which combine structural features of antitumor compounds and of the antifungal antibiotic caerulomycin have been synthesized and evaluated for antitumor, antibacterial and antifungal activities . Many of the studied compounds displayed significant antifungal activity.

Am J Vet Res, 1986 Jul, 47(7), 1442 - 5
Biochemical characteristics of various strains of Mycobacterium paratuberculosis; Chiodini RJ; Biochemical activities of 20 wild-type strains and of 2 laboratory strains of Mycobacterium paratuberculosis were evaluated . Biochemical activities evaluated were growth at 30 C, 37 C, and 42 C; production of urease, niacin, pyrazinamidase, arylsulfatase, and catalase; hydrolyzation of Tween 80; reduction of nitrate and tellurite; and growth in 5% NaCl . Antimicrobial susceptibility to thiophene-2-carboxylic acid hydrazide (10 micrograms/ml), neotetrazolium chloride (1:40,000), streptomycin (2 micrograms/ml), rifampin (0.25 micrograms/ml), and isoniazid (10 micrograms/ml) also was determined . Generally, M paratuberculosis was biochemically inactive, with only a few strains producing pyrazinamidase and maintaining catalase activity after heating . All strains grew optimally at 37 C, grew slightly at 30 C, and did not grow at 42 C . Wild-type strains did not grow in the presence of neotetrazolium chloride, streptomycin, and rifampin, and grew in the presence of thiophene-2-carboxylic acid hydrazide and isoniazid . Although biochemical evaluation can be used as an aid in the identification of M paratuberculosis, growth rate, and mycobactin dependency remain major criteria for positive identification.

Laryngoscope, 1986 Jul, 96(7), 763 - 7
Bacterial infections of the orbital and periorbital soft-tissues in children; Spires JR et al.; Periorbital soft-tissue bacterial infections are relatively common during childhood and with appropriate antimicrobial therapy usually resolve quickly . Orbital soft-tissue infections, in contrast, are rare and frequently cause serious morbidity . Two hundred forty-one children with periorbital or orbital soft-tissue infections have been hospitalized since 1962 and constitute the data base for this study . Two hundred twenty-six children, half under 1 year of age, had periorbital soft-tissue infections . Response to antimicrobials was prompt and only two children (1%) developed complications . True orbital infections occurred in the remaining 15 children, three of whom were under 6 years of age . Eleven children had orbital cellulitis, 3 had subperiosteal abscesses, and 1 had cavernous sinus thrombosis . Antecedent sinusitis was present in 12 cases and, in seven, effective treatment required surgical drainage in addition to intensive antimicrobial therapy . Three children (20%) developed significant complications.

Diagn Microbiol Infect Dis, 1986 Jul, 5(2), 163 - 9
Antimicrobial susceptibility of clinical isolates of Brucella; Mortensen JE et al.; A number of antimicrobial agents have been used in the treatment of human brucellosis with varying effectiveness . The purpose of this study was to test the in vitro susceptibility of isolates of four Brucella species to a variety of antimicrobial agents, and to study in vitro synergy of combinations of agents . Minimal inhibitory concentrations (MICs) were determined using conventional broth microdilution methods and commercially available systems . Conventional checkerboard synergy microdilutions were prepared for gentamicin or streptomycin plus tetracycline, and rifampicin plus tetracycline . Synergy or antagonism was determined by the fractional inhibitory concentration index . Penicillin G and ampicillin showed in vitro activity against Brucella (MIC90 4 micrograms/ml), whereas the antipseudomonal penicillins were less active (carbenicillin MIC90 12 micrograms/ml, piperacillin MIC90 32 micrograms/ml) . Among the third generation cephalosporins tested, cefotaxime (MIC90 2 micrograms/ml) demonstrated greatest activity . As a class, aminoglycosides were equivalent (MIC90 1-4 micrograms/ml) . All strains were sensitive to tetracycline (MIC90 0.25 microgram/ml), trimethoprim-sulfamethoxazole (MIC90 1/19 micrograms/ml), and rifampin (MIC90 1 microgram/ml) . Erythromycin (MIC90 greater than 8 micrograms/ml) and vancomycin (MIC90 greater than 16 micrograms/ml) demonstrated no activity . In vitro synergy (fractional inhibitory concentration index less than 0.5) was demonstrated with tetracycline plus rafampin in six of eight isolates tested.

Pediatr Med Chir, 1986 Jul-Aug, 8(4), 471 - 4
{Neonatal bacterial infections}; Granati B et al.; Bacterial infections during the first months of life remain a significant cause of neonatal mortality and morbidity . This article reviews the recent knowledges of responsible bacteria and pathogenetic mechanisms as well as advancements in life support therapy, in antimicrobial agents and in immunotherapy.

Pediatr Med Chir, 1986 Jul-Aug, 8(4), 501 - 7
{Multicenter study on bronchopneumonia treated in a hospital environment in Friuli-Venezia Giulia: 2) Antibiotic therapy}; Longo G et al.; An analysis of a year's admissions for Pneumonia in all the Paediatric Department of the Region Friuli Venezia Giulia is presented . The study was conducted as activity of the Regional Section of the Italian Paediatric Society . The survey of the 14 Paediatric Centres produced a total of 536 cases of Pneumonia in the period January-December 1982 and was focused on antimicrobial therapy adopted pre and after hospitalization . General and specific therapeutic choices are discussed . Drawing the attention on the differences among centres.

Sex Transm Dis, 1986 Jul-Sep, 13(3 Suppl), 179 - 84
Problems in the treatment of bacterial sexually transmitted diseases; Handsfield HH; Despite the development of many antimicrobial drugs that are active against sexually transmitted bacterial pathogens, various problems limit the success of treatment of bacterial sexually transmitted diseases (STD) . These problems include the evolution and spread of antibiotic-resistant pathogens, inconsistent therapeutic efficacy of some regimens despite in-vitro activity against the infecting organism, toxicity, inconvenience of administration, lack of compliance by patients, and cost . Diseases affected by one or more of these therapeutic problems include gonorrhea, chlamydial infections, pelvic inflammatory disease, bacterial vaginosis, syphilis, and chancroid . Ceftriaxone, a new cephalosporin, addresses some of these problems as they relate to gonorrhea, chancroid, and, possibly, syphilis.

Rev Infect Dis, 1986 Jul-Aug, 8 Suppl 3, S315 - 8
Limitations of animal models in predicting beta-lactam efficacy for endocarditis and meningitis; Gerberding JL et al.; Animal models are important in predicting the efficacy in humans of antimicrobial agents for various disease conditions, including endocarditis and meningitis . Screening models are useful in assessing antibiotic effectiveness and toxicity; their advantages include simplicity, a reproducible course of infection, a well-defined therapeutic end point, and low cost . However, the inoculum size, the virulence of the organism, and the production of beta-lactamases can have important effects on outcome and must be considered in the interpretation of data obtained from such models . Discriminative models are those designed to mimic human disease as closely as possible with respect to infectious inoculum, host response, and course of disease . Each drug's pharmacokinetics must be carefully documented before being extrapolated to humans . Rigid criteria must be established to minimize misinterpretation of results from animal studies before conclusions from in vivo animal models are applied to human disease.

Drug Intell Clin Pharm, 1986 Jul-Aug, 20(7-8), 583 - 6
Antimicrobial update; Prince RA; New and soon-to-be introduced antimicrobials are reviewed and compared with agents already in use to determine possible therapeutic and/or cost advantages . Drugs discussed are amdinocillin, ticarcillin/clavulanic acid, ceftriaxone, ceftazidime, imipenem/cilastatin, aztreonam, and quinolones.

Crit Care Med, 1986 Jul, 14(7), 623 - 8
Tobramycin therapy for lethal sepsis in the dog; Hinshaw LB et al.; Antimicrobial effectiveness and effect on survival of single-dose vs . multiple-dose aminoglycoside antibiotic therapy (with and without steroid) for lethal sepsis were evaluated . Adult dogs of either sex were anesthetized, divided into five groups, and infused iv for one hour with Escherichia coli . Group A was given no drug . Group B was given a 45-mg/kg, 10-min iv injection of tobramycin (TOB) at 65 min . Group C was given a 3-mg/kg, 10-min TOB injection at 65 min, followed by an 8.25-mg/kg iv infusion for 285 min, and three 11.25-mg/kg intramuscular injections at 6, 12, and 18 h (total 45 mg/kg) . Group D was given the same TOB regimen as B, plus a 30-mg/kg iv injection and 30-mg/kg iv infusion of methylprednisolone sodium succinate (MPSS) from 15 to 360 min . Group E was given the same TOB regimen as C, plus the same MPSS regimen as D . Treated dogs also received 11.25 mg/kg of TOB daily for 4 days . The percent surviving more than 7 days was 0, 0, 17%, 83%, and 83%, for groups A through E, respectively . By 4 h, TOB-treated groups had significantly (p less than .05) lower E . coli blood levels than group A . Also E . coli levels in group B were significantly (p less than .05) lower than those in groups C, D, or E . High trough serum TOB concentrations were associated with death and very low levels with recovery . Serum urea nitrogen and creatinine concentrations increased in all groups, but returned to normal by 7 days in survivors.(ABSTRACT TRUNCATED AT 250 WORDS)

Med Clin North Am, 1986 Jul, 70(4), 933 - 44
Considerations in the therapy of septic shock; Karakusis PH; In summary, gram-negative sepsis is unique among infectious illnesses in that it is a disorder that recruits endogenous physiologic processes to mediate tissue injury . This host damage frequently occurs in the absence of microbial invasion of affected organs . The resultant hypotension, coagulation defects, and organ dysfunction may be associated with serious morbidity or may contribute to mortality . Ultimately, however, mortality in patients with septic shock depends on the nature of the infectious process and the severity of the underlying illnesses . Unfortunately, attempts to aggressively treat septic patients with a formidable array of antimicrobial and pharmaceutical agents have not remarkably reduced mortality . Nor does it seem likely that future elucidation of the inflammatory mechanisms of sepsis will lead to the generation of therapeutic agents that will significantly improve survival . On the other hand, prophylactic or therapeutic modalities that deter colonization or invasion by pathogenetic organisms or that alter the ability of pathogens to evoke adverse host responses may be more likely to impact on the incidence and morbidity of gram-negative bacillary infections . Until modifications in the initial interactions of gram-negative pathogens with human hosts can be realized, the mortality of gram-negative sepsis is likely to remain high.

South Med J, 1986 Jul, 79(7), 863 - 70
Clinical experience with amphotericin B in acute myelogenous leukemia; Stein RS et al.; The empirical use of amphotericin B in febrile leukemic patients not responding to antimicrobial agents has previously led to a significant decrease in fatal fungal infections and a significant increase in complete remissions . In this series of 66 patients receiving induction therapy for acute myelogenous leukemia (AML), 49 (74%) received amphotericin B . The median interval between institution of antibiotics and amphotericin B was ten days . Fifteen patients had clinical evidence of fungal infection, but only two (3%) died of fungal infection during induction therapy for AML . We discontinued amphotericin B upon granulocyte recovery (greater than 500/cu mm) unless a pulmonary infiltrate was present . Even though only five of 15 patients with probable fungal infection received more than 1,000 mg of amphotericin B, no patient had recurrent fungal disease while in remission . The incidence of clinically suspected fungal pneumonia during consolidation therapy and reinduction therapy also suggested that our therapy was adequate . An increased incidence of late fungal pneumonia in patients receiving reinduction was associated with prolonged neutropenia (greater than 50 days) . This study supports the empirical use of amphotericin B during induction therapy for AML, and suggests that doses can be smaller than those generally recommended for fungal infection.

J Antibiot (Tokyo), 1986 Jul, 39(7), 934 - 7
Semi-synthesis of A23187 (calcimycin) analogs . IV . Cation carrier properties in mitochondria of analogs with modified benzoxazole rings . Antimicrobial activity; Prudhomme M et al.; The transporting abilities in the mitochondrial membrane for Ca++ and Mg++ of ten semi-synthetic analogs A23187 (calcimycin) and X14885A are compared . Analogs classified as efficient divalent cation carrier retained the calcimycin antimicrobial activity against three Gram-positive strains tested.

J Pediatr Surg, 1986 Jul, 21(7), 592 - 5
Discharge planning for children with perforated appendicitis; Birken GA et al.; Optimal management of children with perforated appendicitis remains a controversial clinical problem . Until very recently, the criteria for hospital discharge on our surgical service included the absence of fever and leukocytosis for a period of 48 hours following completion of antimicrobial therapy, uncomplicated wound healing, a normal rectal examination, and unimpaired gastrointestinal function . With the introduction of cost-containment programs, the necessity for the period of inpatient observation following cessation of antibiotics was questioned . The records of 87 consecutive children with perforated appendicitis were analyzed prospectively in order to determine if our discharge policies were medically sound and cost-effective . Seventy-five patients (86%) recovered uneventfully while 12 children required prolonged hospitalization for management of various postoperative complications . The 12 patients who developed complications were all identifiable early in the postoperative period because of persistent fever, leukocytosis, and elevated band counts . Of the 75 children who recovered uneventfully, all met standard discharge criteria on the final day of antibiotic therapy with the exception of completing the mandatory 48-hour period of inpatient observation . These children were maintained in the hospital a total of 142 additional days following discontinuation of antibiotics . The average cost per patient day for children with perforated appendicitis during the study period was $506.32, which represented unnecessary hospital charges of $71,897.44 . It was concluded that inpatient observation following cessation of antibiotic therapy in children who experience an uneventful recovery from perforated appendicitis is neither necessary nor cost-effective.(ABSTRACT TRUNCATED AT 250 WORDS)

J Clin Microbiol, 1986 Jul, 24(1), 1 - 6
Selection of a reference lot of Mueller-Hinton agar; Pollock HM et al.; A collaborative study was undertaken to evaluate the performance of currently marketed Mueller-Hinton agars from seven manufacturers by replicate disk diffusion tests with standard quality control strains . Identification of the manufacturers was concealed, and the resulting data were evaluated for the selection of a physical reagent standard against which the performance of future production lots would be tested and made to conform . A medium was selected which was sufficiently close to existing National Committee for Clinical Laboratory Standards quality control limits that current interpretive criteria would require minimum modification . Two of the seven lots were eliminated from further consideration because the final pHs were outside acceptable limits . The remaining four lots had 96% of mean zone diameters less than or equal to 2 mm from those of the chosen lot and 65% of the means were less than or equal to 1 mm from those of the chosen lot for all 28 antimicrobial agent-organism combinations . Manufacturers then attempted to produce new lots of Mueller-Hinton agar which performed within the prescribed limits of the chosen lot . One lot performed in close conformity with the selected standard, but the overall performance of the media was essentially the same as that of the randomly chosen lots in the initial study . It was concluded that one of the original seven lots demonstrated properties which made it a tentative candidate for a physical reagent standard and that the use of a physical reagent standard in evaluating production lots might aid in stabilizing the performance of Mueller-Hinton agar.

Sex Transm Dis, 1986 Jul-Sep, 13(3), 134 - 7
The spermicide nonoxynol-9 does not inhibit Chlamydia trachomatis in vitro; Kappus EW et al.; The antimicrobial effects of the active ingredient, nonoxynol-9, and the base component of a commercially available spermicide were tested in vitro against Chlamydia trachomatis . The infectivity of cell-free elementary bodies was not affected by nonoxynol-9 or the base after incubation for 30, 60, or 180 min in direct contact with serial twofold dilutions of each agent . The spermicide's effect on the in-vitro growth of C . trachomatis was evaluated after exposure of C . trachomatis-infected McCoy cells to serial dilutions of each agent for 2 hr and for 72 hr . A significant cytopathic effect of nonoxynol-9 on the host cell membrane was observed at concentrations of spermicide between 100% and 0.0014% . However, neither agent was effective in inhibiting the intracellular growth of C . trachomatis at concentrations (0.0014-0.0004%) of nonoxynol-9 that produced no evident cytopathic effect on McCoy cells . Thus, nonoxynol-9 was found to be ineffective in inhibiting infectivity or subsequent growth of C . trachomatis.

Am J Med, 1986 Jun 30, 80(6B), 88 - 97
In vitro evaluations of amikacin: an assessment of the currently used methods of disk diffusion and dilution susceptibility, antimicrobial synergy, and the measurement of amikacin concentrations; Jones RN; The amikacin antimicrobial susceptibility tests were reviewed and found to be acceptable for clinical laboratory use . The early change from the 10-micrograms to the 30-micrograms diagnostic disk concentrations has resulted in reasonable accuracy, according to data from surveys of the College of American Pathologists, and acceptable discrimination between susceptible and resistant microorganisms . Similarly, standardized dilution susceptibility methods have proven acceptable, but great care must be exercised to select an agar medium in which performance was evaluated by the criteria of the National Committee for Clinical Laboratory Standards . Breakpoint concentrations selected as susceptible for amikacin (equal to or less than 16 micrograms/ml) were based on infected patient pharmacokinetics and previously correlated with patient bacteriologic outcome . Amikacin serum levels have been accurately measured by numerous procedures, including gas-liquid chromatography, radioimmunoassay, radioenzymatic assay, bioassay, and latex agglutination tests . Recent surveys of the College of American Pathologists support the earlier suspicions of lower accuracy and specificity with the bioassay method . Care must be taken to rapidly and appropriately process specimens from patients receiving concurrent high doses of antipseudomonal penicillins because of documented inactivation of some aminoglycosides by these penicillins . Amikacin is less affected by these beta-lactams . Evaluations of the antibacterial activity of amikacin in combination with other antimicrobial agents, principally the beta-lactams, continue to show high rates of enhanced killing or synergy . Although the methods for assessment of synergy have not been standardized, remarkably favorable and similar results between laboratories have been reported.

Am J Med, 1986 Jun 30, 80(6B), 179 - 81
Challenging conventional aminoglycoside dosing regimens . The value of experimental models; Kapusnik JE et al.; Although newer antimicrobials look promising for the treatment of serious gram-negative infections, aminoglycosides still remain part of the mainstay of their therapy . Traditional intermittent therapy is based upon the premise that high serum aminoglycoside concentrations are toxic . However, the rate of bacterial killing for aminoglycosides is also a concentration-dependent phenomenon . Two animal models of Pseudomonas pneumonia were utilized to examine the efficacy of non-traditional aminoglycoside dosing regimens, i.e., single, high daily doses versus the conventional, intermittent low doses of aminoglycosides . Other recent data suggest that toxicity might also be less with the large, single daily dose regimen . The current dosing strategy used for aminoglycosides may not be maximizing their therapeutic potential, nor minimizing their toxicities.

J Chromatogr, 1986 Jun 27, 361, 279 - 84
Determination of sodium caprylate in plasma volume expanders by gas chromatography; Lee YC et al.; A quantitative gas chromatographic method for the determination of the sodium (caprylate) octanoate, antimicrobial in the plasma volume expanders hydroxyethyl starch and human serum albumin, has been developed . The sodium caprylate and the internal standard were converted to pentafluorobenzyl derivatives . The reaction mixture was extracted with methylene chloride and chromatographed on a 1.8-m OV-17 column at 170 degrees C with flame ionization detection . The method is linear over the concentration range studied (40-700 micrograms/ml) . The method is precise (coefficient of variation less than 2%).

J Am Vet Med Assoc, 1986 Jun 15, 188(12), 1444 - 6
Chlorpyrifos intoxication in a bull; Scarratt WK et al.; A mature Brangus bull received the recommended dose of chlorpyrifos and became dull and inappetent 3 days later . Clinical findings included weakness, dehydration, rumen stasis, and rumen distention with fluid and gas . Blood cholinesterase activity was 25% of normal . The bull's condition improved after treatment with pralidoxime, antimicrobials, electrolyte solutions, vitamins, and adsorbents . Five weeks later, the bull had gained weight, the blood cholinesterase activity was 70% of normal, and the results of a semen evaluation indicated he was a satisfactory potential breeder.

FEBS Lett, 1986 Jun 9, 201(2), 233 - 6
Seminalplasmin and caltrin are the same protein; Sitaram N et al.; The sequence of seminalplasmin, a basic antimicrobial and transcription-inhibitory protein from bovine seminal plasma, has been determined using an automated sequenator . This sequence is slightly different from that reported earlier by Theil and Scheit {(1983) EMBO J . 2, 1159-1163} and identical with that of caltrin, a Ca2+-transport-inhibitory protein of bovine seminal plasma . Caltrin and seminalplasmin are, therefore, the same protein.

J Antibiot (Tokyo), 1986 Jun, 39(6), 762 - 72
A new antitumor complex, WF-1360, WF-1360A, B, C, D, E and F; Kiyoto S et al.; A complex of the new antitumor antibiotics (WF-1360, WF-1360A, B, C, D, E and F) was produced by Rhizopus sp . No . F-1360 . Structural studies of these compounds suggested that they were novel 16-membered-ring lactones having an oxazole ring in their structures . WF-1360 was found to be identical with rhizoxin (1) and WF-1360B, C, E and F were determined to be homologues of 1 with structures 2, 3, 4 and 5, respectively . These compounds were cytotoxic when tested on P388 leukemia cells in vitro . WF-1360 was highly active against leukemia L1210 and melanoma B16 . They also exhibited potent antifungal activities, but weak antimicrobial activities against some Gram-positive or negative bacteria.

Appl Environ Microbiol, 1986 Jun, 51(6), 1285 - 92
Coincident plasmids and antimicrobial resistance in marine bacteria isolated from polluted and unpolluted Atlantic Ocean samples; Baya AM et al.; Sewage effluent and outfall confluence samples were collected at the Barceloneta Regional Treatment Plant in Barceloneta, Puerto Rico; outfall confluence samples at Ocean City, Md., were also collected . Samples from uncontaminated open ocean areas served as clean-water controls . Bacteria were enriched in marine broth 2216 amended with 1 microgram of one of a set of chemicals selected for study per ml: nitrobenzene, dibutyl phthalate, m-cresol, o-cresol, 4-nitroaniline, bis(tributyltin) oxide, and quinone . MICs of the chemicals were determined individually for all isolates . Bacterial isolates were evaluated for resistance to nine different antibiotics and for the presence of plasmid DNA . Treated sewage was found to contain large numbers of bacteria simultaneously possessing antibiotic resistance, chemical resistance, and multiple bands of plasmid DNA . Bacteria resistant to penicillin, erythromycin, nalidixic acid, ampicillin, m-cresol, quinone, and bis(tributyltin) oxide were detected in nearly all samples, but only sewage outfall confluence samples yielded bacterial isolates that were resistant to streptomycin . Bacteria resistant to a combination of antibiotics, including kanamycin, chloramphenicol, gentamicin, and tetracycline, were isolated only from sewage effluent samples . It is concluded that bacterial isolates derived from toxic chemical wastes more frequently contain plasmid DNA and demonstrate antimicrobial resistance than do bacterial isolates from domestic sewage-impacted waters or from uncontaminated open ocean sites.

J Dairy Sci, 1986 Jun, 69(6), 1733 - 42
Mammary leukocyte response to drug therapy; Nickerson SC et al.; The possibility exists that antibiotics and anti-inflammatory agents will be used indiscriminately in attempts to reduce leukocyte or somatic cell counts in mammary secretions to conform with Interstate Milk Shippers quality standards for raw milk to be implemented July 1, 1986 . Recent in vivo studies evaluating the effect of intramammary drug injection on milk leukocytes confirmed previous in vitro investigations demonstrating that certain drugs have a significant effect on leukocyte antimicrobial activity . Antibiotics commonly included in commercial infusion products used in this country such as penicillin G, semisynthetic penicillins, the mycins, cephalosporins, and sulfonamides did not affect leukocyte function . However, some drugs were detrimental, notably chloramphenicol, tiamulin, tetracycline, gentamicin, rifampicin, amikacin, and nitrofurantoin . In vitro investigations on the use of anti-inflammatory agents demonstrated that methylprednisolone had a stabilizing effect on leukocytes by maintaining viability and reducing degranulation, whereas flumethasone was detrimental to cell viability . The nonsteroid agent, ibuprofen, decreased viability and increased degranulation but also increased phagocytosis and bacterial killing . Intramammary infusion of anti-inflammatory agents was generally ineffective in lowering somatic cell counts of endotoxin-infused quarters, but certain drugs may be advantageous in limiting milk production losses during udder inflammation.

Neurosurgery, 1986 Jun, 18(6), 685 - 8
Prevention of primary wound infection in neurosurgical patients: a 10-year study; Savitz MH et al.; Two neurosurgeons in private practice at three community hospitals followed a regimen of antimicrobial prophylaxis for 10 years . No primary wound infection occurred in a series of 2000 consecutive major operations . The study gives rise to certain recommendations for the prevention of postoperative sepsis in neurosurgical patients.

Clin Otolaryngol, 1986 Jun, 11(3), 171 - 4
Tonsil flora in the very young tonsillectomy patient; Toner JG et al.; The tonsil flora of 20 children below the age of 4 years undergoing tonsillectomy, and a control group of 18 children were studied using tonsil swabs and core specimens . The study group had a significantly higher culture rate of anaerobic organisms, whereas there was no significant difference between the groups in respect of aerobic pathogens . Since most anaerobic organisms are relatively resistant to the antibiotics usually prescribed for recurring tonsillitis, the use of more appropriate antimicrobial therapy may be helpful in the prevention of early tonsillectomy.

Chemioterapia, 1986 Jun, 5(3), 191 - 5
Epidemiology of resistance to netilmicin and other aminoglycosides; Toscano MA et al.; The authors carried out a study to evaluate the epidemiology and resistance of netilmicin, gentamicin, tobramycin and amikacin during the 1984-1985 period . Clinical specimens of different origin, drawn both from hospitalized and outpatients were used in the study . The strains were tested for their sensitivity to aminoglycosides . In particular the degree of resistance in both fermentative and non-fermentative gram-negative strains was determined . As previously pointed out in other works, netilmicin showed good antimicrobial activity in respect to other aminoglycosides.

Pediatr Res, 1986 Jun, 20(6), 496 - 504
Postnatal maturation of pulmonary antimicrobial defense mechanisms in conventional and germ-free lambs; Weiss RA et al.; The phagocytic and bactericidal capacities of ovine bronchoalveolar lavage (BAL) cells were investigated as a function of postnatal age . In addition, age-related changes in the elaboration by alveolar macrophages of chemotaxins for neutrophils, concentrations of BAL fluid and serum immunoglobulins, and serum opsonic capacity were determined . BAL cells exhibited major changes in morphology, composition, and in vitro proliferation during the 1st postnatal wk . Studies in germ-free lambs indicated that the antigenic burden of the ambient environment markedly influenced the concentration of BAL neutrophils but had no effect on the influx, phagocytic, and proliferative activities of alveolar macrophages . Phagocytic and bactericidal functions of BAL cells improved rapidly during the 1st postnatal wk, then declined, and did not reattain adult levels until day 180 . The capacity of alveolar macrophages to elaborate chemotaxins for neutrophils was deficient at day 8, but not at subsequent ages . The concentration of BAL IgG1 increased until day 8, fell at day 21, and then continued to increase gradually . IgA was not detected in BAL until day 21 and increased rapidly thereafter . Serum opsonic capacity at days 1 and 4 was comparable to that of adult serum, but sera from days 8 to 42 showed a marked reduction in opsonic capacity . Pulmonary antimicrobial defenses in neonatal sheep were thus found to be deficient to some degree throughout the first 3 months of life . It was not until day 180 that the parameters investigated in this study approximated those of adult sheep.

Laryngoscope, 1986 Jun, 96(6), 630 - 4
Post-tympanostomy otorrhea; Gates GA et al.; Otorrhea is the most common complication of surgical drainage of the tympanum for the treatment of chronic secretory otitis media . Otorrhea present at the first postoperative visit may be due to the operative procedure, the underlying disease process, or both . After analyzing data from 525 operations on 1045 ears of 396 children with chronic secretory otitis media, and finding an over-all incidence of immediate postoperative otorrhea of 3.4%, we conclude that preparations of the ear canal with povidone iodine and the postoperative prophylactic use of an antimicrobial-corticosteroid topical preparation provides optimal control of postoperative wound infection . Sporadic increases in the incidence of postoperative otorrhea may be due to extrinsic factors such as outbreaks of upper respiratory infection.

Cent Afr J Med, 1986 Jun, 32(6), 147 - 8
Attitude of medical practitioners to antibiotic prescribing in Zimbabwe; Morton DJ; PIP: A survey was conducted to ascertain the attitudes of medical practitioners to the usage of antibiotics in Zimbabwe; their actual usage of antibiotics was not investigated . This study was prompted by previous reports which found that antibiotic usage in Zimbabwe was considerably higher than in both the UK and the US . The findings indicate that a majority (91%) of medical practitioners are aware of the dangers of antibiotic abuse and consider patient variables in the choice of drug, the dose, and duration of therapy . 49% of the respondents use combinations of antimicrobial agents but reserve them for severe and refractory infections . The major problem area appears to be patient pressure on medical practitioners to prescribe antibiotics unnecessarily . (72% of respondents) . Other potential areas of concern are the tendency of some practitioners to use a broad-spectrum antibiotic as a 1st choice which may be considered unnecessarily harsh therapy for ailments that may well respond to a less deleterious agent, and the tendency of some the respondents to use an antibiotic for shorter period of time than that recommended, a choice that appears to be empirically based . If these problems are controlled, the hazards associated with antibiotic usage will be minimized .

Pathol Biol (Paris), 1986 Jun, 34(5 Pt 2), 631 - 3
{Antibacterial activity in vitro of 10 quinolones against 20 strains of Legionella pneumophila}; Deforges L et al.; Minimal inhibitory concentrations (MICs) of 10 quinolones were determined by dilution method on BCYE, for 20 strains of Legionella pneumophila . Since the BCYE Agar medium reduces the antibacterial activity of some antimicrobials, a correction factor was calculated . It was found to be 1 to 16 according to the antibiotic tested . The following mode adjusted MIC show the good in vitro antibacterial activity of quinolones on L . pneumophila: ofloxacin, pefloxacin, ciprofloxacin, norfloxacin, A 56620 cMIC: 0.06 microgram/ml), A 56619, enoxacin (cMIC: 0.12 microgram/ml), rosoxacin (cMIC: 0.25 microgram/ml) . Pipemidic acid (cMIC: 2 micrograms/ml) and nalidixic acid (cMIC: 1 microgram/ml) were the least active.

Chirurg, 1986 Jun, 57(6), 406 - 10
{Antimicrobial chemoprevention in colorectal interventions: a single parenteral dose at the start of surgery is adequate}; Hancke E et al.; The effectivity in reducing septic complications after colorectal operations of oral 1 g Neomycin plus 0.25 g Metronidazol t.i.d . on the last preoperative day vs . intravenous single dose 5 g Mezlocillin plus 0.5 g Metronidazole was tested by sequential medical plan . There was no statistically significant difference between both chemoprophylaxis groups (p = 0.10) . It is concluded that the intravenous chemoprophylaxis should be preferred because of the lowest dosage and therefore the fewest side-effects.

J Periodontol, 1986 Jun, 57(6), 370 - 7
Chlorhexidine . An adjunct to periodontal therapy; Greenstein G et al.; Chlorhexidine is an effective antimicrobial agent . Its application can enhance periodontal therapy . The pharmacology of chlorhexidine and suggestions for its use are outlined . In addition, its potential for inducing cancer and bacterial resistance are discussed.

Surg Clin North Am, 1986 Jun, 66(3), 459 - 65
Diagnosis and treatment of infection in cardiac transplant patients; Gentry LO et al.; Despite major advances in the management of rejection and the development of newer and more potent antimicrobials, infection still constitutes a major problem in transplant patients and other immunosuppressed hosts . Infectious complications in transplant patients clearly occur in two phases . The first phase includes the first 30 to 60 days after transplantation . During this period, nosocomial bacterial infections are most commonly encountered . Pulmonary, renal, and wound infections have all been encountered, and prophylactic antibiotics appear to decrease their frequency . Opportunistic infections usually do not occur during this period unless the patient undergoes treatment for acute rejection . The second phase of infectious complications usually follows the first month after transplantation . In this period, the level of immunosuppression is high, and opportunistic infections are common . Opportunistic pulmonary infections caused by P . carinii, L . pneumophila, cytomegalovirus, Aspergillus, and Nocardia spp . all are potentially life-threatening complications to the transplant patient . Aggressive diagnostic tests such as bronchoscopy, percutaneous needle biopsy, or open lung biopsy are frequently needed to make a diagnosis . Empiric broad-spectrum antimicrobial therapy is indicated in the ill patient; however, more specific therapy should be instituted once the diagnosis is confirmed.

J Clin Microbiol, 1986 Jun, 23(6), 1052 - 5
Detection of Pseudomonas mesophilica as a source of nosocomial infections in a bone marrow transplant unit; Gilchrist MJ et al.; Pseudomonas mesophilica was isolated from fungal blood cultures of two bone marrow transplant recipients who consecutively occupied the same room . The isolation of P . mesophilica was temporally associated with febrile illness in these two granulocytopenic patients at 1 and 3 weeks posttransplant . A third patient, housed separately on the same bone marrow transplant unit, had nasopharyngeal colonization by this organism . Epidemiologic risk factors in common included staff, medications, and oral and perineal irrigations with tap water . Surveillance cultures detected P . mesophilica in none of 24 pharmaceutical preparations and in 10 of 40 tap water samples (100 to 600 CFU/ml) from implicated and control rooms on the same floor . Antimicrobial susceptibility testing of 14 patients and environmental isolates by agar dilution revealed similar profiles; some environmental isolates exhibited higher MICs . Because of restrictive nutritional and temperature requirements, P . mesophilica is undetected by many clinical laboratory protocols and may represent a previously undetected source of febrile illness in neutropenic patients.

Semin Respir Infect, 1986 Jun, 1(2), 118 - 29
The role of extracellular bactericidal factors in pulmonary host defense; Coonrod JD; Extracellular killing provides an attractive hypothesis to explain the rapid alveolar killing of inhaled bacterial pathogens in the absence of conventional opsonins for phagocytosis . Some evidence of extracellular killing of inhaled pneumococci has been obtained using histologic studies and bronchoalveolar lavage . Although studies of the antimicrobial activity of lung lavage fluid in vitro have given variable results, a variety of antimicrobial factors have been detected in lung lavage fluids . Studies of lysozyme, peptides, iron binding proteins, free fatty acids and other factors that are found free in lung lavage fluid indicate that some of these factors could be a part of extracellular pulmonary host defenses . However, their precise role is not known . A survey of mechanisms of extracellular killing shows that granulocytes, monocytes, macrophages, and T lymphocytes all have the capacity to kill extracellularly in vitro in some circumstances . It remains to be determined which of these diverse mechanisms operate within the lung and how they function in relationship to other host defenses.

J Antimicrob Chemother, 1986 Jun, 17(6), 811 - 4
Influence of ofloxacin, norfloxacin, nalidixic acid, pyromidic acid and pipemidic acid on human gamma-interferon production and blastogenesis; De Simone C et al.; Several new quinolone derivatives were investigated for their influence on human lymphocyte blastogenesis and gamma-interferon production following concanavalin A stimulation . All the antimicrobials induced inhibition of lymphocyte DNA synthesis . The gamma-interferon measurements showed that nalidixic acid and norfloxacin have a negative influence on lymphokine production and release.

Int J Oral Maxillofac Surg, 1986 Jun, 15(3), 339 - 41
Stomal sepsis and fatal haemorrhage following tracheostomy; Moar JJ et al.; A case of stomal sepsis and fatal haemorrhage following an emergency tracheostomy in a 28-year-old woman is presented . It is proposed that major haemorrhage can occur in the absence of a large vessel lesion as a result of local sepsis and inflammation . Infection in this setting can be predicted to be polymicrobial in origin and attention is therefore drawn to the need for early prophylactic antimicrobial therapy as well as the need for meticulous care of the stomal site.

J Clin Pathol, 1986 Jun, 39(6), 654 - 60
Biochemical and cultural characteristics of "JK" coryneforms; Bayston R et al.; Antibiotic resistant coryneforms (group JK) have increasingly been reported as causes of serious sepsis in the immunosuppressed and in patients with implants . Their cultural and biochemical characteristics were examined in an attempt to provide a simple scheme for their recognition in the clinical laboratory . Their susceptibilities to a range of antimicrobials were determined, and an enriched selective medium was developed for their isolation from normally non-sterile sites . The JK coryneforms fell into a fairly homogeneous group, producing colonial morphology and biochemical profiles identical with reference strains, which allowed their recognition and differentiation from other coryneforms . All strains were resistant to penicillin and susceptible to vancomycin, but there was considerable variation with respect to other antimicrobials . There is scope for further rationalisation of biochemical tests for the recognition of these organisms.

Antimicrob Agents Chemother, 1986 Jun, 29(6), 1073 - 8
Effect of 4-quinolones and novobiocin on calf thymus DNA polymerase alpha primase complex, topoisomerases I and II, and growth of mammalian lymphoblasts; Hussy P et al.; The influence of ciprofloxacin, nalidixic acid, norfloxacin, novobiocin, and ofloxacin on elements of eucaryotic DNA replication was investigated in vitro . Each of the 4-quinolones, when present in amounts of more than 100 micrograms/ml, reversibly inhibited the DNA synthesis performed by the 95 DNA polymerase alpha primase complex from calf thymus . Novobiocin at 500 micrograms/ml or at higher concentrations irreversibly inactivated DNA polymerase alpha primase complex . The accuracy of in vitro DNA synthesis in the absence of repair mechanisms was determined from amber-revertant assays with phi X174am16(+) DNA as template . The antimicrobial agents did not significantly increase the frequencies of base pairing mismatches during the course of replication, indicating that the basal mutation rate is not affected by novobiocin and the 4-quinolones . The Ki values of 50% inhibition of DNA topoisomerases from calf thymus by ciprofloxacin, norfloxacin, novobiocin, nalidixic acid, and ofloxacin were 300, 400, 1,000 or more, 1,000 or more, and 1,500 or more micrograms/ml, respectively, in the case of topoisomerase I, and the Ki values were 150, 300, 500, 1,000, and 1,300 micrograms/ml, respectively, in the case of topoisomerase II . The procaryotic topoisomerase II is approximately 100-fold more sensitive to inhibition by ciprofloxacin, norfloxacin, and ofloxacin than is its eucaryotic counterpart . Growth curves of lymphoblasts were recorded in the presence of ofloxacin and ciprofloxacin . Neither 1 nor 10 micrograms of ciprofloxacin or of ofloxacin per ml affected cell proliferation . Ofloxacin and ciprofloxacin at 100 micrograms/ml inhibited cell growth; 1,000 micrograms/ml led to cell death . No correlation exists between the antimicrobial and cytotoxic activities of the 4-quinolones.

Am J Med, 1986 May 30, 80(5C), 96 - 100
Antibiotic synergism and response in gram-negative bacteremia in granulocytopenic cancer patients; De Jongh CA et al.; To determine whether antimicrobial synergism affects the outcome of gram-negative bacteremia among profoundly (less than 100/microliter) neutropenic cancer patients, the clinical courses of 75 such patients who received empiric therapy with combination, broad-spectrum antibiotics were analyzed . Twenty-nine of 34 (85 percent) patients whose granulocyte count increased to more than 100/microliter during therapy improved, whereas only 12 of 41 (29 percent) patients with no increase in granulocyte count showed improvement (p = 0.0002) . The critical group for further analysis was, therefore, those patients with persistent, profound granulocytopenia . Among these 41 patients, synergism was associated with a substantially better response rate: eight of 18 (44 percent) improved compared with none of 13 in whom synergism was not detected (p = 0.005); presence or absence of synergism could not be assessed for the pathogens isolated from the remaining 10 patients because the organisms were exquisitely susceptible to one of the two antibiotics used . Further evaluation of these persistently neutropenic patients indicated that synergism appeared critical even when the pathogen was susceptible to both antibiotics . Thus, seven of 11 (64 percent) showed response when the two drugs were synergistic in activity, compared with none of six when synergism was not present (p = 0.01) . These data again demonstrate the importance of granulocyte recovery to patient response and further indicate that synergistic combinations of antibiotics are indicated for cancer patients with gram-negative bacteremia and persistent, profound granulocytopenia.

Am J Med, 1986 May 30, 80(5C), 59 - 63
Laboratory support for choosing and monitoring antimicrobial therapy in severely ill patients; Zinner SH et al.; The microbiology laboratory plays an important role both in choosing initial antimicrobial therapy and in monitoring such therapy during the course of treatment . In septicemic patients who have few, if any, clinical findings suggesting a specific etiologic diagnosis, it is useful to know the antibiotic susceptibility patterns for the given hospital or community . This type of empiric approach to therapy might require a larger variety of antibiotics than that usually considered for treatment of infected neutropenic patients . In the absence of neutropenia, there is perhaps more latitude in the initial choice, and single-drug therapy often can be considered . While patients are receiving antibiotics that should be appropriate for an identified pathogen, several laboratory procedures can be used to monitor this treatment . Antibiotic synergism studies may be useful in neutropenic patients, as well as assays of serum bactericidal activity . The serum bactericidal activity may be useful also in monitoring therapy for bacterial endocarditis or for osteomyelitis, especially when oral or home therapy is considered . Similarly, drug levels may be measured by a variety of techniques to ensure appropriate serum concentrations and to minimize drug toxicity . In addition, the preclinical evaluation of antibiotics alone and in combination can be used in guiding the design of clinical studies of these drugs in certain patient groups, such as neutropenic patients.

Am J Med, 1986 May 30, 80(5C), 85 - 95
Monotherapy for empiric treatment of fever in granulocytopenic cancer patients; Wade JC et al.; Infection remains a major complication of severe granulocytopenia . The administration of empiric antibiotic therapy at the first sign of infection or fever has significantly reduced the sequelae of infection in such compromised patients . Yet, the appropriate composition of the empiric antibiotic regimen continues to be debated . Antibiotic combinations have been the standard approach; multiple studies have confirmed the importance of antibiotic combinations in patients who are profoundly granulocytopenic and have gram-negative rod bacteremia . The presence of a synergistic antibacterial effect and high serum bactericidal activity of the antimicrobial regimen improves the response rate in such severe infectious episodes . However, the occurrence of such infections at certain centers is declining, and the introduction of new, highly active, broad-spectrum beta-lactam antibiotics has raised the question of using a single agent, or monotherapy, as empiric treatment of febrile granulocytopenic cancer patients . Approximately 20 studies have been completed, and although these trials have demonstrated support for this approach, caution must be exercised because of the inconsistent study designs, wide range of response definitions, small patient numbers, and limited frequency of treated documented infections . Therefore, at present, a broad-spectrum antibiotic combination still remains the treatment of choice for empiric therapy of febrile granulocytopenic cancer patients . Carefully designed, prospective, randomized, double-blind trials investigating new approaches, such as monotherapy, must continue.

Schweiz Med Wochenschr, 1986 May 17, 116(20), 670 - 3
{Accepted principles for the prevention and therapy of travelers' diarrhea}; Steffen R; Diarrhea is the most frequent health problem in travellers to developing countries . The syndrome is usually caused by an infection acquired by ingesting fecally contaminated food or beverages . Various bacteria, viruses and protozoa may cause traveller's diarrhea, the leading pathogen being enterotoxigenic E . coli . Antimicrobial drug prophylaxis is not recommended in view of the potential side effects . A more sensible approach is self-therapy with anti-motility agents in mild and uncomplicated cases, while for more severe illness an antimicrobial drug may be used . However, in view of the usually mild, self-limited disorder, therapy should be considered optional . Oral rehydration should be instituted when necessary.

Arch Intern Med, 1986 May, 146(5), 902 - 4
Therapy of Mycobacterium marinum infections . Use of tetracyclines vs rifampin; Donta ST et al.; We describe four patients with Mycobacterium marinum infections who did not respond to two- to six-week courses of therapy with tetracycline, minocycline, and doxycycline . All four patients had prompt responses to therapy with either rifampin alone (two patients) or rifampin in combination with ethambutol . Results of antimicrobial sensitivity tests may be helpful in guiding therapy . Rifampin may be the drug of choice for treatment of these infections.

Ann Emerg Med, 1986 May, 15(5), 544 - 7
Promptness of antibiotic therapy in acute bacterial meningitis; Bryan CS et al.; We reviewed 135 cases of acute community-acquired bacterial meningitis at a municipal teaching hospital during a six-year period, with special emphasis on promptness of initial antimicrobial therapy . Overall mortality was 5% for the 121 childhood cases, compared to 43% for the 14 adult cases (P less than .001) . The mean duration between arrival in the emergency department and the administration of appropriate antibiotics was 2.1 hours for the pediatric cases, compared to 4.9 hours for the adult cases (P less than .02) . Factors that may contribute to delays in institution of appropriate antimicrobial therapy for adult patients with meningitis include the relative infrequency of this condition, the presence of concomitant disease processes, and the frequent practice of obtaining a computed tomography scan prior to performing lumbar puncture . Prompt institution of antimicrobial therapy for acute meningitis, especially for adult pneumococcal meningitis, remains a major challenge for emergency physicians.

Pharmazie, 1986 May, 41(5), 324 - 6
Syntheses and in vitro antimicrobial activities of thiazolo-{3,2-a}benzimidazol-3(2H)-ones; Rida SM et al.; Taking advantage of the nucleophilic reactivity of the 2-methylene carbon atom in thiazolo{3,2-a}-benzimidazol-3(2H)-one, a number of 2-isatinylidene and 2-arylazo derivatives have been prepared . The novel compounds were subjected to antimicrobial testing.

Rev Infect Dis, 1986 May-Jun, 8(3), 488 - 93
Role of the infectious disease specialist in containing costs of antibiotics in the hospital; Moleski RJ et al.; Antimicrobial agents account for a significant proportion of drug expenditures and are used inappropriately approximately half the time in hospital practice . This has led to substantial increases in medical costs for hospitalized patients . Methods have been proposed to reduce inappropriate use of antibiotics, particularly in hospitalized patients . Two of these methods, education and control, were employed effectively by infectious disease specialists at a university teaching hospital to reduce inappropriate use of second-generation cephalosporins . These efforts resulted in significant savings of approximately $130,00 per year . The infectious disease specialist may also make major contributions to cost containment of antibiotics in other equally important areas, including other classes of antibiotics, inappropriate daily frequency, excessive duration of administration, and prevention of adverse drug reactions . The infectious disease specialist is better trained in appropriate antimicrobial use and clinically more knowledgeable in treating infections than other medical specialists and is the best-equipped member of the medical staff to educate the medical community on antibiotic use and to control antibiotic costs.

Pediatr Infect Dis, 1986 May-Jun, 5(3), 328 - 32
Incidence and clinical characteristics of "culture-negative" infective endocarditis in a pediatric population; Walterspiel JN et al.; Sixty episodes of infective endocarditis were analyzed in 56 pediatric patients over a 10-year period from 1974 to 1984 . Culture-negative infective endocarditis was noted on five occasions or 8.3% of all episodes . In addition to the physical findings, a combination of laboratory parameters including anemia, erythrocyte sedimentation rate, elevated rheumatoid factor, C1q activation and microhematuria supported the diagnosis . The clinical characteristics of these patients are described in detail . Pretreatment with an antimicrobial agent was only one factor associated with the failure to isolate an organism . Empiric treatment with penicillin and gentamicin and in one case nafcillin/ampicillin and gentamicin was satisfactory.

Biomaterials, 1986 May, 7(3), 193 - 6
Biosoluble surgical material from 2,3-dialdehyde cellulose; Syamala Devi K et al.; Dialdehyde cellulose (DAC) was prepared by periodate oxidation of various cellulosic materials in the form of sutures and bandages . The suitability of using DAC for making bioabsorbable sutures and antimicrobial wound dressing bandages was studied . The investigations indicated that DAC combines the requisite mechanical strength with an inherent antimicrobial nature . It was found that the oxidation of cellulose to yield DAC also rendered it bioabsorbable . The DAC was coated with different concentrations of urea formaldehyde in order to improve the mechanical properties for making sutures.

Ann Otol Rhinol Laryngol, 1986 May-Jun, 95(3 Pt 1), 222 - 4
Acute mastoiditis: a review of 69 cases; Rosen A et al.; Sixty-nine cases of acute mastoiditis were managed at the Kaplan Hospital in Israel during a 10-year period . About two thirds (68%) recovered with conservative therapy consisting of wide myringotomy and intravenous antimicrobial therapy, usually ampicillin and cloxacillin . One third (22 patients) were managed surgically by complete mastoidectomy . Indications for surgery were subperiosteal abscess, based on clinical findings in 20 patients; one had septic fever that did not respond to antimicrobial therapy, and one had signs of meningeal irritation . Mastoid radiographs played no role in the decision to operate . Four cases of unsuspected epidural abscess were found, two behind intact tegmental bone . Acute mastoiditis develops mostly in ears that have not been immune to previous infections; thus the mucosal barrier is broken easily and osteitis occurs . Although with the advent of antimicrobial therapy the presentation and course of the disease are milder, the disease is still serious and potentially lethal.

J Clin Microbiol, 1986 May, 23(5), 959 - 61
Effect of storage temperature and pH on the stability of antimicrobial agents in MIC trays; Hwang JM et al.; Twelve antimicrobial agents, ampicillin, aztreonam, cefamandole, cefazolin, cefonicid, ceforanide, ceftazidime, ceftizoxime, ceftriaxone, cefuroxime, ciprofloxacin, and norfloxacin, were prepared at pH 6.80 and 7.31 in microdilution trays for storage at 4, -10, -25, and -70 degrees C and for weekly susceptibility testing . All 12 drugs had stable biological activity when stored at -70 degrees C for 1 year . All but ampicillin and aztreonam were stable at -25 degrees C . Storage at -10 degrees C was least satisfactory . Desiccation occurred at 4 degrees C, but short-term storage at this temperature is possible since the antimicrobial agents are stable for up to several months.

J Antimicrob Chemother, 1986 May, 17 Suppl C, 195 - 201
Empirical antimicrobial therapy with Timentin plus amikacin in febrile granulocytopenic cancer patients; Meunier F et al.; Timentin (ticarcillin plus clavulanic acid) plus amikacin was administered as an empirical regimen to 52 febrile granulocytopenic patients with cancer and appeared as effective as the other commonly recommended combinations of antimicrobial agents . A favourable response was observed in 61% of episodes with bacteraemia and in 83% of the episodes without bacteraemia . However, the efficacy in Gram-positive bacteraemia was suboptimal and the emergence of superinfections caused by Gram-positive cocci may represent a clinical challenge.

J Antimicrob Chemother, 1986 May, 17 Suppl C, 149 - 59
Timentin in the antimicrobial treatment of nosocomial and polymicrobial infections; Carlet J et al.; The combination of ticarcillin and clavulanic acid (Timentin) was used in a nonrandomized open study in 28 patients with severe nosocomial infections . The infections were polymicrobial in 19 cases . Ten patients were bacteraemic and all were severely ill, receiving mechanical ventilation and with at least one organ system failure . Seventeen patients were treated with Timentin alone, 11 with a combination of Timentin and aminoglycosides . Timentin was used empirically, before identification of the bacteria in 14 patients (group I) and after identification of all the micro-organisms in 14 patients (group II) . In group I, the empirical choice of Timentin was wrong in four cases, because at least one micro-organism was resistant to this drug . In the remaining 24 evaluable patients 12 patients were definitively cured . A relapse of the infection occurred in two cases . Five patients were initially improved but a secondary failure occurred due to a residual abscess in one case and to the underlying disease in four cases . Five initial failures due to the underlying disease in three cases were noted . The antimicrobial spectrum of Timentin is valuable in the management of nosocomial and polymicrobial infection, especially intra-abdominal infections and this study confirms a good clinical efficacy . However, combination with aminoglycosides seems mandatory, at least until the identification of all the micro-organisms involved in the infection.

Rev Infect Dis, 1986 May-Jun, 8 Suppl 2, S207 - 16
Antimicrobial therapy for infectious diarrhea; Levine MM; Acute diarrheal disease may be due to viral, bacterial, or protozoal enteropathogens . In our current state of knowledge and medical practice, specific antiviral agents are not used in the treatment of known or presumed viral diarrhea . In contrast, for a number of the bacterial and protozoal diarrheal infections, therapy with certain antimicrobial agents can significantly ameliorate the severity and duration of illness and curtail the excretion of the pathogen . A recurring theme encountered in reviewing information on the therapy for diarrheal infections is that demonstration of the susceptibility in vitro of a bacterial pathogen to a particular antibiotic by no means assures clinical success . Many antibiotics that show potent activity in vitro have little or no efficacy in vivo . Controlled clinical trials are necessary to assess the clinical and bacteriologic efficacy of an antibiotic in diarrheal infections.

Rev Infect Dis, 1986 May-Jun, 8 Suppl 2, S160 - 6
Antimicrobial prophylaxis of travelers' diarrhea: a selected summary; Sack RB; This paper summarizes the published controlled studies of the prophylaxis of travelers' diarrhea in which the following drugs have been used: neomycin, nonabsorbable sulfonamides, Streptotriad, doxycycline, erythromycin, and mecillinam . These studies have shown that antimicrobial prophylaxis can be highly effective in preventing episodes of travelers' diarrhea . The protection, however, lasts only as long as the drugs are being taken; there is no evidence that subclinical infections occur while the drug is being taken . None of the data suggest that antimicrobial prophylaxis increases the probability of infection with drug-resistant enteric pathogens . In these studies few subjects have experienced adverse drug reactions; however, the number of subjects has been too small to allow determination of accurate incidence data . Antimicrobial prophylaxis for travelers' diarrhea can be effectively and safely used on an individualized basis for persons traveling to areas of high risk.

J Appl Bacteriol, 1986 May, 60(5), 401 - 11
Identification and distribution of Pseudomonas stutzeri in clinical material; Holmes B; During the 19 year period ending December 1984, 114 (2.4%) of 4840 strains of Gram-negative non-fermentative bacteria submitted, mainly by laboratories in the UK, to the National Collection of Type Cultures for computer-assisted identification were strains of Pseudomonas stutzeri . These figures suggest that Ps . stutzeri is a relatively uncommon species in clinical material in the UK but that when it does occur laboratories have difficulty in identifying it . The sources from which the strains were isolated and also characteristics of the species by which it may be recognized are reported . The clinical significance of Ps . stutzeri is discussed and also the susceptibility of this species to antimicrobial agents.

J Pediatr, 1986 May, 108(5 Pt 2), 854 - 60
Cephalosporin therapeutics in cystic fibrosis; Blumer JL et al.; Cephalosporins modified at the C-3 and C-7 positions of the cephem-nucleus have high antimicrobial activity and are safe . With evolution through first, second, and third generations, they have gained increasing gram-negative activity, but often at the expense of potency against gram-positive organisms . All third-generation cephalosporins have some intrinsic anti-Pseudomonas activity, indicating their potential benefit in the treatment of acute pulmonary exacerbations in patients with cystic fibrosis . Rational therapy in this clinical setting requires recognition of the pharmacodynamic and pharmacokinetic idiosyncrasies intrinsic to this patient population . When these priorities are recognized, only two of the available agents, cefsulodin and ceftazidime, appear to be of any therapeutic value . Both agents have been evaluated extensively in the treatment of acute pulmonary exacerbation in cystic fibrosis, and both have been found to be safe and effective.

J Dent Res, 1986 May, 65(5), 695 - 7
Effect of antimicrobial agents on root surface caries, alveolar bone loss, and microflora in rice rats; Toth A et al.; Two antimicrobial agents, 9-aminoacridine (0.2%) and minocycline (0.2%), were evaluated for their efficacy in inhibiting root surface caries, bone loss, and microflora in rice rats . A solution of 5000 ppm fluoride was used as a positive control for the inhibition of root surface caries, and double-distilled water was used as a negative control group . Each rat was treated by having its molar teeth swabbed 2 X per day with the prescribed agent in its group for nine weeks . Root caries reduction in the minocycline and fluoride groups was not significantly different, but the reduction was significantly greater than in the 9-aminoacridine group, with the caries score in all three groups being significantly less than that in the water control . Bone loss reduction for the minocycline group was significantly greater than that for any other group.

Arch Intern Med, 1986 May, 146(5), 953 - 7
Life-threatening complications of infective endocarditis and their management; Weinstein L; Life-threatening complications of acute infective endocarditis are still a problem despite the availability of effective antimicrobial agents . These complications, divided into two main categories, cardiac and extracardiac, and a review of the literature are presented.

Am J Med, 1986 May, 80(5), 884 - 90
Norfloxacin versus vancomycin/polymyxin for prevention of infections in granulocytopenic patients; Winston DJ et al.; Selective antimicrobial decontamination with norfloxacin was compared with vancomycin/polymyxin for prophylaxis of bacterial infections in granulocytopenic patients . In the group of patients receiving norfloxacin, there were a lower number of acquired gram-negative bacillary organisms per patient (0.88 versus 1.86, p = 0.002), fewer patients with documented infection (16 of 36 versus 20 of 30, p = 0.12), and fewer cases of gram-negative septicemia (0 of 36 versus five of 30, p = 0.02) . Norfloxacin was better tolerated (30 of 36 versus 16 of 30 patients highly compliant, p = 0.02), and associated with fewer gastrointestinal side effects (eight of 36 versus 14 of 36 patients, p = 0.07) . These results suggest that norfloxacin is a more tolerable and efficacious oral antimicrobial agent than vancomycin/polymyxin for the prevention of serious gram-negative bacillary infections in granulocytopenic patients.

Immunology, 1986 May, 58(1), 125 - 30
Depression of human polymorphonuclear leucocyte function by anti-malarial drugs; Ferrante A et al.; The effect of the anti-malarial drugs quinine, chloroquine, pyrimethamine, mefloquine and quinacrine on human polymorphonuclear leucocyte (PMN) function was examined in vitro . In general, all drugs had their greatest effect on PMN iodination reaction and locomotion, intermediate effects on PMN hexose-monophosphate shunt activity, and least effect on PMN adherence . The most potent of these were pyrimethamine and mefloquine . The PMN iodination reaction and locomotion were inhibited between 0.5-1 microgram/ml (congruent to 2-4 X 10(-6) M) pyrimethamine and 1-4 micrograms/ml (congruent to 0.25-1 X 10(-5) M) mefloquine . The study demonstrates that anti-malarial drugs depress PMN functions associated with antimicrobial activity of the cell.

Infect Immun, 1986 May, 52(2), 529 - 33
Recombination near the antibiotic resistance locus penB results in antigenic variation of gonococcal outer membrane protein I; Danielsson D et al.; In gonococci, the nonspecific antimicrobial resistance locus penB is known to be closely linked to loci designated nmp that alter the Mr and antigenicity of the outer membrane porin protein I (P.I) . We report that after selection for the linked donor penB locus, occasional recombinants expressed P.I with some epitopes from each parent . These hybrid P.I antigens were stable on subculture and were transformed at a locus closely linked to penB . The hybrid P.I antigens were detected with monoclonal antibodies in both coagglutination and Western blot assays . The alterations of P.I antigenicity may have resulted from recombination between structural genes for P.I that are closely linked to penB.

Biochim Biophys Acta, 1986 Apr 22, 870(3), 385 - 91
Is thiocyanate peroxidation at equilibrium in vivo?
Pruitt KM, Tenovuo J, Mansson-Rahemtulla B, Harrington P, Baldone DC.
The peroxidase-catalyzed oxidation of SCN- by H2O2 is an important in vivo reaction because it limits the accumulation of toxic H2O2 and provides significant concentrations of the antimicrobial agents, HOSCN and OSCN- . Data presented in this report suggest that the reaction: (Formula: see text) is in a state of dynamic equilibrium in vivo . Since OSCN- can form the weak acid HOSCN (pKa = 5.3), the equilibrium constant expression (Kox) for thiocyanate peroxidation is dependent on the concentration of hydrogen ions as well as the concentrations of H2O2, SCN-, HOSCN, OSCN- and water, and on the HOSCN ionization constant, Ka: (Formula: see text) . The concentration of water is assumed to be constant and unaffected by the other components and is omitted from the Kox equation . The value of Kox was estimated from in vitro data to be 3.7 X 10(3) M-1 (S.D . = 0.8 X 10(3) M-1, n = 8) . Using this value for Kox and observations of salivary concentrations of SCN- and HOSCN + OSCN- from several previous reports, the equilibrium concentrations of H2O2 in whole saliva were calculated to range from 8 to 13 microM . This range is consistent with reported estimates of 10 microM as the hydrogen peroxide tolerance limit for human cells.

S Afr Med J, 1986 Apr 12, 69(8), 495 - 7
Ceftriaxone therapy in adults with severe lower respiratory tract infections; Potgieter PD et al.; Ceftriaxone, a third-generation cephalosporin with a wide spectrum of antimicrobial activity and a long half-life of 8 hours permitting administration every 24 hours, was evaluated in 33 patients with severe lower respiratory tract infections . Twenty-nine patients showed a favourable clinical response and 2 failed to respond to therapy . In 2 patients the clinical response was impossible to assess . In 19 of the 23 patients in whom it was possible to assess bacteriological response, there was a favourable outcome . Serum ceftriaxone levels were well maintained above the minimal inhibitory concentrations of sensitive organisms for the entire dosage interval whether the drug was given by intramuscular or intravenous injection . There were no side-effects that could be attributed to ceftriaxone, which was highly effective in the immediate treatment of both community and nosocomial acquired severe lower respiratory tract infections.

JAMA, 1986 Apr 4, 255(13), 1750 - 6
Treatment of sexually transmitted chlamydial infections; Sanders LL Jr et al.; Publication Types:

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