Am Fam Physician, 1986 Apr, 33(4), 147 - 53 Preventing wound infections; Mancusi-Ungaro HR Jr et al.; Quantitative bacterial studies have demonstrated that successful wound closure and healing can be expected if fewer than 10(5) bacteria per gram of tissue are present . The aim of wound management techniques is to reduce bacterial counts . Among the techniques are pulsatile jet lavage, with or without mechanical debridement; the application of biologic dressings; meticulous hemostasis and evacuation of hematomas, and antimicrobial therapy. Zh Mikrobiol Epidemiol Immunobiol, 1986 Apr, (4), 24 - 30 {Sensitivity of the intestinal microflora of patients to antimicrobial preparations studied in order to conduct rational antibiotic treatment}; Korshunov VM et al.; The oral administration of amikacin, ampiox, nystatin to CBA mice and the external treatment of the animals with 1% chlorhexidine solution makes it possible to create the germ-free state in the animals which must be then kept in a sterile box . If such animals receive the decantate of the patient's feces, introduced in a single administration, the microflora, which is subsequently formed in the intestine of the recipient animals, is identical to the donor's microflora . This permits the rapid and accurate determination of the sensitivity of the patient's intestinal microflora to different antimicrobial preparations and their combinations . The antibacterial preparations, effectively suppressing the patient's intestinal anaerobic opportunistic microflora in the intestine of the recipient mice, produce, if subsequently prescribed for treatment, a pronounced corrective effect on such microflora in the patient's intestine. J Antimicrob Chemother, 1986 Apr, 17(4), 489 - 98 Interaction of antimicrobial agents with human peripheral blood leucocytes: uptake and intracellular localization of certain sulphonamides and trimethoprims; Climax J et al.; The uptake of sulphamethoxazole, sulphadiazine, sulphamerazine, sulphanilamide, trimethoprim and brodimoprim by human peripheral blood leucocytes, has been investigated . High performance liquid chromatography (HPLC) was used to assay drug concentrations before and after incubation with leucocyte suspensions . Using radiolabelled material the intracellular localization of two of these compounds was also determined . The results indicated that all the investigated drugs were taken up by leucocytes . Differential studies demonstrated that mononuclear cells accumulated higher drug concentrations (0.13-0.55 microgram/10(7) cells), than resting neutrophils (0.02-0.26 microgram/10(7) cells) with the exception of sulphanilamide, which was taken up to a greater extent by neutrophils (0.75 microgram/10(7) cells) . During neutrophil phagocytosis intracellular levels of all the drugs except brodimoprim increased from 3 to 130-fold as compared to resting neutrophils . The uptake of 14C-sulphanilamide and 14C-trimethoprim, in neutrophils and mononuclear blood cells, as assessed by measurement of the cell-associated radioactivity, correlated well with that determined by the HPLC procedure . In the intracellular localization studies 14C-sulphanilamide and 14C-trimethoprim exhibited similar distribution profiles . In neutrophils, 35-40% of radiolabelled drug was located in both the microsome and cytosol fractions whereas in peripheral blood mononuclear cells 40-60% was found in the cytosol and 10-20% in the microsome fraction . The results of this study suggest that, following activation, leucocytes may actively transport these drugs and release them locally at sites of infection . The ability of neutrophils to further concentrate the drugs during phagocytosis may result in reduced survival time of some ingested bacteria . These concepts may be important in designing treatment stratagems for intracellular pathogens. J Anim Sci, 1986 Apr, 62(4), 997 - 1004 The effects of a dietary antimicrobial on the biological half-life of chenodeoxycholic acid and plasma bile acid concentration patterns in the young pig; Tracy JD et al.; Carbodox (CX), an antimicrobial agent, was fed at 0 or 58 ppm in a 19.5% crude protein corn-soybean metal diet to young pigs (12 to 15 kg) . Radiolabeled chenodeoxycholic acid (CDC) was infused into the hepatic portal vein; after each of the subsequent six meals, blood samples were collected from the anterior vena cava (VC) and the hepatic portal (HP) veins . For the first 5 min after CDC infusion, the level of radioactivity in the CX pigs was significantly lower in the HP plasma and the slopes of the two curves of the plasma activity for the first hours were significantly different . The plasma bile acid concentrations (as measured by radioactivity) were significantly higher in the CX-treated animals following all meals . The biological half-life of CDC was 6.4 d in the controls and 5.7 d in the CX pigs . The increased rate of excretion was significant . These data indicate that bile acid metabolism in the young pig was significantly affected by feeding a subtherapeutic level of the antimicrobial CX. J Antibiot (Tokyo), 1986 Apr, 39(4), 525 - 34 The penems, a new class of beta-lactam antibiotics . 7 . Synthesis and antimicrobial activity of 2-heterocyclylmercaptoalkyl derivatives; Lang M et al.; 2-Heterocyclylmercaptoalkyl penems were synthesized and their in vitro potency was established . The compounds exhibit moderate to strong antibacterial activity against various Gram-positive and Gram-negative bacteria . Their antimicrobial activity is related to the nature of the heterocycle, the length of the hydrocarbon spacer between the 2-position of the penem nucleus and the mercapto group, and the substitution pattern of the C-6 position of the penem skeleton. Farmaco {Sci}, 1986 Apr, 41(4), 292 - 307 {Substances with antibacterial and antifungal activity . I . Synthesis and microbiologic activity of imidazolylmethylanilines}; Scalzo M et al.; The synthesis and antifungal activities of many derivatives of 1-(2-imidazolylmethyl)aniline and of 1-(4-imidazolylmethyl)aniline are reported . Antimicrobial data in comparison with miconazole show that many compounds containing chlorine atoms and nitro group exhibit an interesting antimycotic activity . The results obtained are discussed on the basis of structure-activity relationships. Antimicrob Agents Chemother, 1986 Apr, 29(4), 602 - 7 Influence of six antifungal agents on the chemiluminescence response of mouse spleen cells; Abruzzo GK et al.; The luminol-enhanced chemiluminescence (CL) assay is a measure of the early events of phagocytosis, leukocyte activation, and immune cell interactions . Reduction in the CL response of immune cells may be indicative of an inhibition of the immune response . This study was undertaken to examine the effects of antifungal agents tested at concentrations above and below therapeutically achievable levels on the CL response of mouse spleen cells . The effects of six antifungal agents--amphotericin B, ketoconazole, miconazole, 5-fluorocytosine, Bay-n-7133, and ICI 153,066--were studied . Changes in the CL response were assessed in terms of peak intensity and area under the intensity-time curve compared with appropriate diluent controls for each drug . Only amphotericin B and ketoconazole caused statistically significant lowering of the peak intensity at levels that are therapeutically attainable (mean peak plasma levels of 2 to 4 and 3.5 to 16 micrograms/ml, respectively) . Although amphotericin B and ketoconazole caused reduction in the CL response, removal of the unbound drug in the preparation by centrifugation, washing, and suspension of cells in fresh drug-free medium resulted in a return of CL activity equivalent to the activity observed in cells not exposed to these agents . These results suggest that amphotericin B and ketoconazole at therapeutic concentrations may cause a reduction in immune cell antimicrobial activity; the clinical significance of these observations remains to be determined. J Clin Microbiol, 1986 Apr, 23(4), 786 - 8 Mycobacterium fortuitum peritonitis associated with continuous ambulatory peritoneal dialysis; Woods GL et al.; Mycobacterium fortuitum has been isolated from skin and soft tissue lesions with increasing frequency . Rarely, however, has it been a documented cause of peritonitis in patients receiving continuous ambulatory peritoneal dialysis . We report here the second such case and discuss both the possibility of M . fortuitum or similar organisms as one cause of "sterile" peritonitis in this patient population and the in vitro antimicrobial susceptibility testing of such isolates. Zentralbl Bakteriol Mikrobiol Hyg {A}, 1986 Apr, 261(2), 187 - 97 {Automated technics in microbiological diagnosis compared with conventional methods}; Schmitt Y; Two different tools for automation in medical microbiological diagnosis were tested . The results of biochemical identification of bacteria and antimicrobial susceptibility testing were compared with conventional methods--biochemical identification with Minitek and API 20 E and susceptibility testing wih the nutrient agar diffusion test . Sceptor from Becton Dickinson is usable because of a good accordance with conventional methods and the good quality of the associated computer program (different types of statistical evaluation) . The 'fully automated' MS 2 from Abbott has more limitations and is more expensive in material, but is able to give a diagnosis in few hours, if a pure culture is available . Differences to conventional methods are greater. Sex Transm Dis, 1986 Apr-Jun, 13(2), 76 - 80 Partial efficacy of clindamycin against Chlamydia trachomatis in men with nongonococcal urethritis; Bowie WR et al.; Tetracyclines are the drugs of choice for treatment of Chlamydia trachomatis infection, but alternative antimicrobial agents are needed . Clindamycin has moderate in-vitro activity against C . trachomatis . In this study clindamycin (600 mg orally three times daily for seven days) was given to 76 men with nongonococcal urethritis . Initial microbiologic and clinical responses were significantly better in men from whom C . trachomatis was initially isolated, compared with men from whom Ureaplasma urealyticum was initially isolated, but by 42 +/- 7 days after initiation of treatment, persistence or recurrence of urethritis had occurred in 39% of men with either organism initially isolated . C . trachomatis was ultimately reisolated at follow-up evaluation from seven of 23 men who initially had had positive cultures for C . trachomatis . There was no apparent relationship between the in-vitro susceptibility of C . trachomatis and the ultimate response . These results indicate that clindamycin cannot be relied upon to eradicate C . trachomatis from men with urethritis. Clin Biochem, 1986 Apr, 19(2), 90 - 100 Tissue penetration of antibiotics; Bergeron MG; To be effective, antibiotics must be active against the offending pathogen(s) and must reach sufficient concentrations at the site of infection where microorganisms have induced severe inflammation . Such inflammation may, depending on the infected tissue, increase or decrease antibiotic penetration . Once it has reached the infected site an antibiotic may be inactivated locally . In this work, we have reviewed: 1 . Factors modulating the penetration of antibiotics in tissues of normal and infected humans and animals; 2 . The relationship between concentrations and efficacy of antimicrobials in experimental and human infections; 3 . The mechanisms by which high tissue levels of antibiotics may be toxic; 4 . New antibiotic targetting delivery systems which may increase tissue concentrations of antibiotics . To better understand the interaction between antimicrobial agents, pathogens in specific infected sites and the host, more experimentation dealing simultaneously with tissue penetration and antibiotic efficacy in acute and chronic infection is required . Innovative approaches to the therapy of human infections are needed. Drug Intell Clin Pharm, 1986 Apr, 20(4), 261 - 6 Norfloxacin: a quinoline antibiotic; Marble DA et al.; Norfloxacin is a quinoline (quinolinecarboxylic acid) that should prove successful in treating infections that currently require hospitalization and intravenous antibiotics . Although a nalidixic acid derivative, it possesses greater antibacterial activity against gram-positive and gram-negative bacteria . Compared with other antimicrobial agents, norfloxacin is more potent than the aminoglycosides, first-, second-, and third-generation cephalosporins, tetracycline, trimethoprim-sulfamethoxazole, carbenicillin, piperacillin, nalidixic acid, oxolinic acid, cinoxacin, and enoxacin . In the clinical studies to date, the side effects of norfloxacin have been minimal, but include nausea, vomiting, anorexia, dizziness, headache, drowsiness, depression, and a bitter taste in the mouth . In studies with more than 4000 patients, the incidence of side effects ranged from 3.9 to 4.7 percent, with most appearing by the second day of therapy. Am J Obstet Gynecol, 1986 Apr, 154(4), 960 - 3 Cefotetan versus cefoxitin as prophylaxis in hysterectomy; Orr JW Jr et al.; Seventy hospitalized women were entered into an open, randomized, parallel study of antimicrobial prophylaxis for abdominal and vaginal hysterectomy with the use of either cefotetan, a new long-acting cephalosporin, or cefoxitin . Ninety-four percent of cefotetan recipients and 83% of cefoxitin recipients did not develop clinical signs or symptoms of infection . The satisfactory bacteriologic response rates were significantly different: 91% satisfactory (43 of 47 patients) for cefotetan and 74% satisfactory (17 of 23 patients) for cefoxitin . The two treatment groups demonstrated no significant differences in postoperative temperature changes, duration of hospitalization, or grading of surgical wounds . Neither drug was associated with significant side effects. Surg Gynecol Obstet, 1986 Apr, 162(4), 313 - 6 Assessment of antimicrobial penetrance into the pancreatic juice in humans; Wallace JR et al.; The penetrance of mezlocillin, metronidazole and trimethoprim-sulfamethoxazole into the pancreatic juice of humans was measured in ten patients convalescing from acute pancreatitis at the time of endoscopic retrograde cholangiopancreatography . Therapeutic levels were obtained in the serum for all three antimicrobial agents; simultaneously aspirated nonbile stained pancreatic juice contained therapeutic levels of metronidazole and trimethoprim-sulfamethoxazole . Mezlocillin was not present in a therapeutic level in any patient with nonbile stained pancreatic fluid. J Antimicrob Chemother, 1986 Apr, 17 Suppl B, 41 - 8 Efficacy of pefloxacin in comparison with erythromycin in the treatment of experimental guinea pig legionellosis; Dournon E et al.; Pefloxacin was compared to erythromycin in the treatment of guinea pigs severely infected with Legionella pneumophila . In this experimental model, two single intraperitoneal injections of either pefloxacin (10 mg/kg at 48 h and 5 mg/kg at 55 h) or erythromycin (40 mg/kg at 48 and 55 h) were administered 48 h post-infection (2 X 10(7) virulent L . pneumophila intraperitoneally) . Counts of bacteria in blood monocytes and lungs of animals killed at different times after the completion of treatment, demonstrated a quick and highly significant reduction of the pretreatment bacterial load in pefloxacin-treated guinea pigs . Conversely, in erythromycin-treated animals the number of bacteria was only slightly reduced 17 h after the completion of the treatment and then multiplication up to pre-treatment levels occurred . The overall mortality was significantly lower in pefloxacin-treated animals with this therapeutic protocol . The remarkable results of pefloxacin in this model, were obtained with serum and lung levels of this drug lower than those achieved in man with the currently accepted regimens . Thus, pefloxacin appears to be a new promising antimicrobial agent for Legionnaire's disease. J Antimicrob Chemother, 1986 Apr, 17(4), 453 - 7 In-vitro activity of cefpirome (HR-810), WIN-49375, BMY-28142 and other antibiotics against nosocomially important isolates from cancer patients; Rolston KV et al.; The activity of three new antimicrobial agents {cefpirome (HR 810), BMY 28142, WIN 49375}, and imipenem was compared to that of four currently available agents, ceftazidime, aztreonam, timentin and piperacillin, against 253 bacterial isolates from cancer patients . The activity of all four agents not yet in clinical use at our institution was significantly greater than that of the four antibiotics already in use. Scand J Dent Res, 1986 Apr, 94(2), 89 - 94 Scanning electron-microscopic study of pellicle and plaque formation on tetracycline-impregnated dentin; Bjorvatn K; Previous experiments have shown that tetracyclines may react with hydroxyapatite, e.g . in enamel and dentin, without losing their antimicrobial capacity . The present paper examines the pattern of pellicle and plaque formation on doxycycline-treated dentin by the use of scanning electron microscopy (SEM) . From newly extracted human teeth were prepared standardized dentin slabs, half of which were soaked in aqueous solutions of doxycycline HCl, 10 mg/ml (pH 2.5) for 10 min . Seven volunteers carried doxycycline-impregnated specimens ligated to the buccal surface of a maxillary molar for 2 h, 8 h, 24 h and 120 h, respectively . Untreated control specimens were ligated to the contralateral teeth . After removal from the oral cavity, the dentin slabs were briefly rinsed in water, allowed to air dry and processed for SEM . SEM assessment of the specimens showed that doxycycline-impregnation resulted in a superficial etching of the dentin, a reduced rate of pellicle formation as well as an impairment of pellicle adhesion, and a retarded bacterial plaque formation on the dentin surfaces. Biotechnol Appl Biochem, 1986 Apr-Jun, 8(2-3), 103 - 47 Natural antimicrobial systems and their potential in food preservation of the future; Banks JG et al.; The extensive literature on natural antimicrobial systems in animals, plants, and microorganisms is surveyed and particular systems are discussed, viz., the peroxidase systems in saliva and milk, singlet oxygen in the phagosome, cecropins and attacins in insects, complement, lysozyme and, to a limited extent, phytoalexins . The review draws attention to the cardinal role of targets on the cell envelopes of alien cells, especially bacteria, and emphasizes a possible approach to preservation based on the selection of specific agents for particular targets . The available evidence suggests that the perturbation of the homeostasis of all the organisms in the mixed flora of a food is unlikely to be achieved by one antimicrobial substance in isolation . Future studies need to consider therefore a tandem approach with two or more agents chosen because of their complementary action . Alternatively, natural system(s) and an established preservative method, either chemical or physical, warrant investigation . The extensive literature on the mechanisms whereby specialist pathogens overcome the defenses of plants and animals emphasizes the inherent dangers of selection leading to the persistent contamination of food processing areas with organisms tolerant of a particular antimicrobial system. Contact Dermatitis, 1986 Apr, 14(4), 201 - 4 Allergic contact dermatitis due to a biocide containing 5-chloro-2-methyl-4-isothiazolin-3-one; Pilger C et al.; 3 cases of contact allergy due to the biocides 5-chloro-2-methyl-4-isothiazolin-3-one and 2-methyl-4-isothiazolin-3-one are reported . 2 workers exposed to a soluble oil containing these 2 biocides experienced allergic contact dermatitis from them . The 3rd case was that of the chemist who separated the 2 materials for the execution of this investigation . These compounds are chemically related to the biologically active components of Ectimar, Skane M-8 and Proxel CRL . Further instances of contact allergy due to these and related compounds are likely because of the apparently increasing use of such substances as antimicrobial agents in various commercial products. J Antimicrob Chemother, 1986 Apr, 17(4), 459 - 61 In-vitro activity of ciprofloxacin, ceftriaxone and five other antimicrobial agents against 95 strains of Brucella melitensis; Bosch J et al.; We studied the in-vitro activity of seven antibiotics against 95 strains of Brucella melitensis isolated in blood cultures of 95 patients with brucellosis . The minimum inhibitory concentration (MIC) was measured by the agar dilution method . All strains of B . melitensis were inhibited by doxycycline at 0.25 mg/l, tetracycline at 0.5 mg/l, ciprofloxacin at 0.5 mg/l, streptomycin at 1 mg/l, ceftriaxone at 1 mg/l, rifampicin at 4 mg/l and by co-trimoxazole at 0.5/9.5 mg/l . We did not find strains resistant to any of the antibiotics studied . All antibiotics, including ciprofloxacin and ceftriaxone, showed a good in-vitro activity against B . melitensis. Proc Natl Sci Counc Repub China B, 1986 Apr, 10(2), 98 - 104 A new antitumor antibiotic, chounghwamycin A . I . Taxonomy, isolation and characterization; Liu YT et al.; Chounghwamycin A, a new antitumor antibiotic produced by a strain of Streptomyces sp . No . PL-D-5, was isolated and characterized . It appeared to belong to the actinomycin group of antibiotics from physico-chemical studies and has an empirical formula of C63H88N11O21 . The antibiotic is extractable into an organic solvent from the fermentation broth, possessing potent antileukemic activity against P388 mouse leukemia in mice and antimicrobial activity against Gram-positive bacteria with MIC values about 0.1-0.4 microgram/ml, but showed no activity on Gram-negative bacteria, yeast and fungi tested. Drug Intell Clin Pharm, 1986 Mar, 20(3), 214 - 8 The use of subtherapeutic antibiotics in animal feed and its implications on human health; Gersema LM et al.; Antibiotics were approved for use as animal feed additives in 1950 after it was discovered that their use increased growth rate, improved feed utilization, and reduced mortality and morbidity from clinical and subclinical infections in animals . Subtherapeutic use of antibiotics in animal feed grew extensively and concern has arisen that this "indiscriminate" use of antibiotics could lead to increased numbers of antimicrobial-resistant bacteria and ultimately compromise treatment of human bacterial infections . Three recently published studies seem to indicate that animal-to-man transmission of antimicrobial-resistant bacteria is possible . Increased debate on the continuing allowance of antibiotic feed additives has ensued . The National Resources Defense Council has recently petitioned the FDA to disallow penicillin and tetracycline use in animal feed, and legislation has been introduced in the U.S . House of Representatives that would limit the subtherapeutic use of antibiotics in animal feed . Experts have predicted that meat prices would increase and meat quality would decrease if antibiotics are disallowed as a feed additive . It is the opinion of the authors that there is no conclusive evidence at this time to support the premise that subtherapeutic use of antibiotics in animal feed poses a greater threat to human health than if antibiotic feed additives were banned. Am J Hosp Pharm, 1986 Mar, 43(3), 664 - 70 Computer-assisted antimicrobial-use monitoring; Inaraja MT et al.; The development and use of a hospital-pharmacy-based, computer-assisted antimicrobial monitoring program are described . In the pharmacy department of a teaching hospital in Spain, a manual system for collecting data on use of antimicrobial agents was replaced with a computer-assisted program that compiles data on culture and sensitivity results, the number of patients receiving antimicrobial or bacteriostatic agents (including combination therapy), and the specific agents used by hospital ward, clinical department, and physician . The antimicrobial report is reviewed daily by a pharmacist, and identified problems are discussed with the prescribing physician; about two hours per day is spent in this activity . Data for 1984 compiled by the computer program regarding the use of antimicrobial agents by group and by hospital ward and the relationship between cost and use of antimicrobial agents were evaluated . Based on the computer-generated data, guidelines for antibiotic use in surgical prophylaxis were proposed, and the pharmacy and therapeutics committee approved a new antibiotic policy that led to a reduction in the use of cephalosporins and to subsequent cost savings . Antimicrobial use at this hospital is similar to that reported at other institutions . In 1984 penicillins were the most commonly used agents, followed by aminoglycosides and cephalosporins . Antimicrobial agents accounted for 24.4% of all drug costs . This computer-assisted system of antimicrobial monitoring was used effectively to assess both individual patient therapy and overall antimicrobial use in a teaching hospital. J Antibiot (Tokyo), 1986 Mar, 39(3), 335 - 44 Crisamicin A, a new antibiotic from Micromonospora . I . Taxonomy of the producing strain, fermentation, isolation, physico-chemical characterization and antimicrobial properties; Nelson RA et al.; A microorganism, designated as RV-79-9-101 and now identified as Micromonospora purpureochromogenes subsp . halotolerans, isolated from a mud sample in the Philippines, has been shown to produce a complex of antibiotics called crisamicins . Thin-layer chromatography and bioautography, employing solvent extracts of whole fermentation broths, revealed a minimum of five antimicrobial components . The major biologically-active component of the antibiotic complex, crisamicin A, was obtained in pure form after preparative silica gel column chromatography followed by crystallization . Based on physico-chemical data crisamicin A has been identified as a novel member of the isochromanequinone group of antibiotics . It exhibits excellent in vitro activity against Gram-positive bacteria but little or no activity towards Gram-negative bacteria or fungi. Br J Hosp Med, 1986 Mar, 35(3), 171, 174 - 7 Neonatal infection; Bommen M; Neonatal septicaemia and meningitis remain major causes of mortality and of neurodevelopmental sequelae, especially in premature and low birthweight babies: early diagnosis with appropriate antimicrobial and supportive treatment is essential to minimize the risk of complications . Congenital viral and protozoal infections also require diagnosis in the neonatal period so that long-term surveillance and management for complications can be planned. Farmaco {Sci}, 1986 Mar, 41(3), 196 - 204 New long-acting 3-azinomethyl-rifamycins; Bruzzese T et al.; A number of basic 3-azinomethyl-rifamycins have been prepared . Their synthesis and antibacterial activity in vitro are reported, as well as the preliminary pharmacokinetic data . While the antimicrobial activity is comparable with that of rifampicin, serum levels in mice are much longer lasting . One of the compounds was selected for further studies. Am J Hosp Pharm, 1986 Mar, 43(3), 641 - 6 Controversies in antimicrobial therapy: pitfalls in monitoring aminoglycoside therapy; Fant WK; Efficacy, safety, and cost factors related to aminoglycoside therapy, which is the treatment of choice for mixed infections of the skin, respiratory tract, and abdominal cavity, are reviewed . The cost of therapy must include all measurable costs of drug preparation, administration, monitoring, and potential toxicity or treatment failure . These costs are often difficult to quantify, as are potential differences in efficacy . Aminoglycosides are usually given by injection and are excreted unchanged by the kidneys . They are concentrated in the renal cortex, leading some investigators to assess the correlation of this uptake with renal toxicity . An increase in serum aminoglycoside concentrations serves as a retrospective, nonspecific marker of the renal toxicity that occurs in up to 35% of patients receiving these drugs . Pharmacokinetic monitoring of aminoglycoside therapy is used to assure therapeutic drug concentrations . Blood samples for aminoglycoside assays must be drawn, stored, separated, and assayed correctly, and the timing and labeling of the sample is of utmost importance . Nomograms and pharmacokinetic models, which can be used with computers and hand-held calculators, are useful for predicting initial doses and modifying subsequent doses . Aminoglycoside therapy is important in selected patients, but the comparative efficacy and safety of these drugs remains insufficiently assessed . Pharmacokinetic monitoring is helpful in assuring safe and effective dosing of aminoglycosides. Am J Hosp Pharm, 1986 Mar, 43(3), 630 - 40 Controversies in antimicrobial therapy: critical analysis of clinical trials; Polk RE et al.; Problems with design and statistical evaluation of clinical efficacy trials of antimicrobial agents are reviewed . Of the three major criteria used for evaluating antimicrobial agents (efficacy, toxicity, cost), the most important is efficacy . Clinical efficacy can be evaluated in uncontrolled or controlled clinical trials . Uncontrolled trials are often conducted to satisfy Food and Drug Administration requirements during premarketing testing; the response rate is typically high because only patients with susceptible infections may be treated and large doses are given . Controlled antibiotic trials should be randomized, blinded, parallel comparisons of an investigational agent versus the best available agent at an accepted dose . However, interpretation of these studies is frequently clouded by poor study design, small sample sizes, and heterogeneous patient populations . Controlled trials are usually centered around a null hypothesis (i.e., that no difference will be found between the agents being compared) . All conclusions (to reject or not reject the null hypothesis) should be carefully evaluated by clinicians seeking to apply the available data to patient care . Researchers can incorrectly conclude that two therapies have equal efficacy because of insufficient statistical power (i.e., small sample size) or poor study design . Likewise, researchers may incorrectly conclude that there is a statistical difference between two therapies because of poor design or improper sample selection . For the clinician, clinical relevance takes precedence over statistical significance . Before the results of a study are allowed to affect drug use in an institution, strong similarities between subjects and methods in the study and patients and care in the institution should be demonstrated. Am J Hosp Pharm, 1986 Mar, 43(3), 625 - 9 Controversies in antimicrobial therapy: formulary decisions on third-generation cephalosporins; Barriere SL; Factors affecting the admission of antimicrobial agents to hospital formularies are discussed, using third-generation cephalosporins as examples . Inappropriate antimicrobial therapy is costly in terms of wasted drugs, ineffective therapy, and drug toxicity . In 1984, 10 of the top 15 drug products (in sales to hospitals) were antimicrobial agents; these accounted for $1 billion in sales . Since third-generation cephalosporins are very similar in terms of spectra, clinical efficacy, and safety, they are useful in illustrating the process a hospital might use in deciding which individual agent to admit to a formulary . Five factors should be considered in formulary evaluations of antimicrobial agents: in vitro activity, pharmacokinetic disposition, adverse effects, clinical efficacy, and total economic impact . As applied to third-generation cephalosporins, this decision analysis leads to the conclusion that these agents should be considered therapeutic alternates . The decision would then rest solely on the institution-specific factors of microbial susceptibility patterns, patient case-mix, and acquisition costs . Antimicrobial agents account for the largest financial expenditure among hospital drug products; a set of these agents should be selected carefully to meet the needs of the individual institution. J Antimicrob Chemother, 1986 Mar, 17 Suppl A, 41 - 54 Is there a role for monotherapy with beta-lactam antibiotics in the initial empirical management of febrile neutropenic cancer patients? Hathorn JW, Pizzo PA. In empirical antimicrobial chemotherapy for febrile neutropenic cancer patients, drug combinations are commonly used, and aminoglycosides are usually included for their excellent activity on Gram-negative organisms and for potential synergism . However, new beta-lactams have at least as good a spectrum and in many ways better pharmacology . More Gram-positive infections are now being reported and the sensitivity of the causative organisms varies . This provides reasons for examining alternatives to aminoglycosides, and the use of monotherapy . Clinical results suggest that the emergence of resistance may be a problem with ureidopenicillins used alone, and that double beta-lactams may be as good as but not better than standard regimens . New cephalosporins have been used alone in 14 trials (not all of them well designed) with results as good as those of standard regimens in many, although superinfection with resistant organisms has been a problem in some . It is possible that early supplementation, with aminoglycosides, of empirical monotherapy with such agents as ceftazidime may solve some of the problems posed by resistant organisms. Vet Clin North Am Small Anim Pract, 1986 Mar, 16(2), 325 - 31 Bacterial culture of uroliths . Techniques and interpretation of results; Ruby AL et al.; This article discusses techniques of bacterial culture of uroliths, interpretation of results of culture, and antimicrobial therapy of bacteria associated with uroliths. J Antimicrob Chemother, 1986 Mar, 17(3), 353 - 60 Lack of synergy between phagocytes and antimicrobials against Nocardia asteroides; Filice GA et al.; Previous observations suggested that synergy between antimicrobials and phagocytes may occur during Nocardia asteroides infection . We incubated N . asteroides with seven antimicrobials, and then exposed the nocardiae to phagocytes . Neutrophils and monocytes killed about half the nocardiae whether or not the nocardiae had been preincubated with antimicrobials . We also determined whether exposure to neutrophils led to increased susceptibility of nocardiae to antimicrobials, and it did not . We found no evidence for synergy between antimicrobials and phagocytes in host defence against this bacterium. Ann Emerg Med, 1986 Mar, 15(3), 317 - 23 Cerebrospinal fluid cultures and analysis; Dougherty JM et al.; Prompt and accurate diagnosis of acute central nervous system infections is of vital importance to the emergency physician . With the advent of modern antimicrobial therapy, the nearly uniformly fatal outcome of untreated bacterial meningitis can be reduced substantially . Proper test selection is crucial in arriving at a correct and timely diagnosis . A variety of tests are currently available for evaluation of the patient with an acute central nervous system infection . We review the current state of the art in central nervous system testing . Cost considerations and an algorithm for efficient selection of appropriate tests are presented. Acta Otolaryngol, 1986 Mar-Apr, 101(3-4), 348 - 52 Effect of erythromycin on adenoid bacteria; Palva T et al.; Seventy-eight patients with secretory otitis media were given erythromycin ethylsuccinate 50 mg/kg/day, divided into 2 doses, for 7-8 days before undergoing adenoidectomy and tympanostomy . Nasopharyngeal swabs for bacterial culture were obtained before medication and at surgery and the adenoid homogenate was also studied for bacteria . Pneumococci and Branhamella strains became significantly reduced, while Hemophilus influenzae showed no change . Pneumococcus and Branhamella strains partially returned one month after surgery and in part were found in patients who had not had these strains before antimicrobial therapy . Erythromycin ethylsuccinate can sterilize neither the adenoids nor the middle ear space if the causative agent is Hemophilus influenzae. Biol Chem Hoppe Seyler, 1986 Mar, 367(3), 229 - 33 The major basic proteins of bull seminal vesicle secretion; Scheit KH; We have employed HPLC on reversed phase columns to analyse the major basic proteins from bull seminal vesicle secretion . The identification of proteins was achieved by comparison with authentic protein samples from bull seminal plasma as well as immunological characterisation using antisera directed against the latter proteins . The major basic proteins from bull seminal plasma: bull seminal proteinase inhibitor II (BUSI II), the seminal ribonuclease BS1, the protein P6 as well as the antimicrobial protein were also identified as the main constituents of the fraction of basic proteins derived from seminal vesicle secretion . FPLC using Mono S HR columns was also found to resolve the mixture of basic proteins and proved to be especially useful with respect to the isolation of the antimicrobial protein from basic proteins of seminal vesicle secretion . The identity of the antimicrobial protein from bull seminal plasma with the respective protein from seminal vesicle secretion was confirmed by amino-acid analysis and comparison of tryptic peptide patterns by HPLC . The antimicrobial protein was isolated from seminal vesicle secretion with a yield of 3 mg/ml of secretion. Infection, 1986 Mar-Apr, 14(2), 79 - 81 Comparison of the binding of gram-negative bacterial endotoxin by polymyxin B sulphate, colistin sulphate and colistin sulphomethate sodium; Rogers MJ et al.; Polymyxins are cyclic polypeptide antibiotics . In addition to their bactericidal activity they bind lipid A and neutralize the biological effects of bacterial endotoxin . We have studied the three available polymyxin preparations: polymyxin B sulphate (PB), colistin sulphate (CS) and colistin sulphomethate sodium (CMS), and compared their endotoxin binding capacity at equivalent therapeutic dosage . Each polymyxin was bound to a column of Sepharose 4B and challenged with 5 micrograms of endotoxin from Escherichia coli O127:B8 . Recovery of endotoxin in the eluate was measured by a quantitative Limulus lysate microassay . PB and CS bound 94% of the challenge dose, CMS 89% and the control column (Sepharose alone) 24% . These results suggest that parenteral CMS (the least toxic polymyxin) retains useful anti-endotoxin capacity, and that in neutropenic patients, oral polymyxin may exert both anti-endotoxin and antimicrobial effects. J Clin Invest, 1986 Mar, 77(3), 925 - 33 Exudation primes human and guinea pig neutrophils for subsequent responsiveness to the chemotactic peptide N-formylmethionylleucylphenylalanine and increases complement component C3bi receptor expression; Zimmerli W et al.; After circulating in the vascular system a short time, polymorphonuclear leukocytes (PMN) migrate to extravascular sites in response to chemotactic stimuli . Prestimulation of PMN in vitro by secretagogues has been shown to increase their number of N-formylmethionylleucylphenylalanine (fmet-leu-phe) and complement component C3bi (CR3) receptors . We investigated whether the same phenomenon occurred in vivo, comparing characteristics of human skin chamber and guinea pig peritoneal exudate and blood PMN . Exudate PMN of both species contained approximately 28% less of the specific granule marker vitamin B12-binding protein (P less than 0.01) but a similar amount of the azurophil granule marker beta-glucuronidase . The total number of fmet-leu-phe receptors was 5.9 times higher in guinea pig exudate than in blood PMN (P less than 0.01) and 2.9 times higher in human exudate than in blood PMN (P less than 0.02) . All exudate PMN and most blood PMN preparations showed a high affinity receptor (Kd approximately 2.3 X 10(-8) M) and a low affinity receptor (approximately 1.5 X 10(-7) M) . The upregulation of fmet-leu-phe receptors in exudate PMN correlated with an improved responsiveness to fmet-leu-phe induced membrane depolarization, oxidative metabolism, and chemotaxis . In addition, the concentration of fmet-leu-phe that produced a half-maximal response of chemotaxis, superoxide production, and membrane potential depolarization was 10-fold lower in exudate PMN than in blood PMN . Human exudate PMN had a twofold increased C3bi receptor expression compared with blood PMN . Thus, a preferential loss of specific granules is associated with increased number of high and low affinity fmet-leu-phe receptors and increased C3bi receptor expression not only in vitro, but also in vivo . The data indicate that exudation primes PMN for their subsequent responsiveness to fmet-leu-phe, a modification that may be crucial for efficient antimicrobial host defense. Otolaryngol Head Neck Surg, 1986 Mar, 94(3), 350 - 4 Medical treatment of chronic otitis media with effusion (secretory otitis media); Gates GA et al.; To determine whether antimicrobial therapy is of value in the treatment of chronic otitis media with effusion (secretory otitis media), we treated 1,429 4- to 8-year-old children--2224 affected ears--with a fixed regimen of an antibiotic mixture (Pediazole) for 10 days and a decongestant (Novafed) for 30 days . We observed the children monthly to determine the rate of clearance . Validity of diagnosis was greater than 90% with an algorithm of pneumatic otoscopy and tympanometry . Medication compliance was not measured . At 1 month, 45% of the children (48% of the ears) had cleared and at 2 months, 60% of the children (63% of the ears) had cleared . Factors such as sex and prior treatment in the preceding 3 months were no different in the cured vs . the uncured groups . Age significantly influenced the cure rate (P less than 0.0001); the older the child, the higher the clearance rate . Tympanograms type 5, 8, and 12-14 were significantly more prevalent in the uncleared group (P = 0.0001) . The clear rate for unilateral cases was 76% and for bilateral cases, 47% (P less than 0.0001) . Children with chronic otitis media with effusion are most likely to be cured by medical therapy/time if they are older, have unilateral disease, or a peaked tympanogram . Surgery should be withheld in these children for 2 or more months to permit the highest rate of spontaneous resolution. Am J Hosp Pharm, 1986 Feb, 43(2), 372 - 5 Patient-teaching program for home intravenous antimicrobial therapy; Schad RF et al.; The development of a home i.v . antimicrobial therapy program and associated procedures for patient teaching are described . The pharmacy department at a 940-bed, acute-care, general medical-surgical teaching hospital participated with four other departments in the development of standardized teaching methods for a home i.v . antimicrobial therapy program . The pharmacy and nursing departments each developed sections of a home antimicrobial therapy manual . Over a 16-month period, i.v . antimicrobial therapy was prescribed for 37 patients who were discharged from the hospital . Most patients or their care-givers were able to prepare and administer the medications . After the patient was discharged, the pharmacy department offered services such as supplying medications, coordinating pharmacokinetic dosing, providing drug information, and acting as a patient contact . Hospitals that provide home i.v . antimicrobial therapy should coordinate the resources of the various departments involved to develop standardized patient-teaching methods. Arch Surg, 1986 Feb, 121(2), 153 - 6 Single-antibiotic use for penetrating abdominal trauma; Nelson RM et al.; A prospective randomized study compared the use of moxalactam disodium vs clindamycin phosphate and tobramycin sulfate for treatment of 190 patients with penetrating abdominal trauma . Twenty-seven patients were disqualified because of early death or failure to follow the protocol . The patients in each group were comparable regarding the cause and severity of injury . No significant difference was seen in the incidence of intra-abdominal infection between the moxalactam-treated group (13%) and the clindamycin- and tobramycin-treated group (9%) . The intra-abdominal infection rate in patients with colon injuries (21%) was significantly increased when compared with the patients without colon injuries (6%), but the antibiotic regimen did not significantly change the infection rate . No evidence of bleeding problems from moxalactam were noted . Changes in prothrombin and partial thromboplastin times appeared to be related to shock rather than the use of moxalactam . The most severe coagulopathies occurred prior to moxalactam therapy and were seen only in those patients who had shock requiring 10 or more units of blood . Moxalactam is as effective as combination (clindamycin and tobramycin) antimicrobial therapy in patients with penetrating abdominal trauma. Toxicol Appl Pharmacol, 1986 Feb, 82(2), 307 - 15 On the capacity of nitroheterocyclic compounds to elicit an unusual axial asymmetry in cultured rat embryos; Greenaway JC et al.; A series of nitroheterocyclic compounds with antimicrobial and radiosensitizing properties was tested for embryotoxicity in cultured Sprague-Dawley rat embryos, and their effects were compared with various other five-membered heterocycles . Nifuroxime, furazolidone, nitrofurazone, niridazole, 2-nitroimidazole, and ronidazole each elicited a striking malformation characterized by asymmetrical, right-sided hypoplasia when coincubated with embryos for 26 hr . Minimum concentrations required to elicit this unusual defect ranged from 0.01 mM with nifuroxime and furazolidone to 0.5 mM with ronidazole and were roughly correlated with single electron redox potentials; i.e., agents with relatively high redox potentials were generally more effective than those with low potentials . Nitrofurantoin failed to elicit this unusual malformation but exhibited an extremely steep dose-response curve for embryolethality . Metronidazole and 4-nitroimidazole, nitroheterocyclic agents with relatively low redox potentials, did not produce the asymmetric abnormality nor were they highly embryotoxic, even at concentrations up to 2 mM . 2-Amino-5-nitrothiazole and 4'-methylniridazole also failed to evoke the asymmetric malformation but produced significant embryotoxicity as manifested by decreased growth parameters and elicitation of other kinds of malformations . Heterocyclic compounds not bearing a nitro group (furosemide, 2-aminothiazole, and 2-aminoimidazole) failed to elicit axial asymmetry at concentrations up to 1.0 mM but produced other signs of embryotoxicity at the highest concentrations tested . The results suggest that the presence of a reducible nitro group is critical for generation of the unusual malformation and that the single-electron redox potential of the nitro group plays a dominant but not exclusive role in the capacity of these chemicals to evoke axial asymmetry in cultured rat embryos. J Trauma, 1986 Feb, 26(2), 140 - 2 Metabolic rate alterations in early excision and grafting versus conservative treatment; Rutan TC et al.; This study was done to determine whether early massive excision and grafting would decrease the hypermetabolic response that characterizes burn injury . Thirteen consecutively admitted adult males with burns over more than 45% of the total body surface area (TBSA) were randomly assigned to one of two treatment groups . One group was treated by excising the burn within 72 hours of injury and grafting with autograft overlaid with cadaveric allograft or cadaveric allograft alone depending on available donor sites and size of recipient areas . The second group was treated conservatively with daily hydrotherapy and twice daily applications of topical antimicrobial agents until granulating beds could receive autografts . Resting energy expenditure (REE) was calculated from measurement of vO2 and vCO2 at the patient's bedside . The responses of the two groups were comparable: the REE was approximately 20-30% above the predicted basal metabolic rate (BMR) . Excisional therapy did not markedly decrease the hypermetabolic response to burn injury. J Antibiot (Tokyo), 1986 Feb, 39(2), 175 - 83 Production of novel antibiotic, dopsisamine, by a new subspecies of Nocardiopsis mutabilis with multiple antibiotic resistance; Takahashi A et al.; An actinomycete isolate designated as TS-1980 with multiple resistance to aminoglycoside antibiotics was found to produce novel antibiotics . The strain showed taxonomic features identical to the type strain of Nocardiopsis mutabilis except for the temperature range for growth and the utilization of mannitol and raffinose . Based on the capability of growing at lower temperature range, the strain was named N . mutabilis subsp . cryophilis subsp . nov . Physico-chemical and biological characterization of a purified antibiotic revealed its novel polyamine-type nature with a broad antimicrobial activity . The antibiotic was named dopsisamine. Am J Vet Res, 1986 Feb, 47(2), 283 - 5 Blood flow to the distal part of the teat (mammary papilla) of lactating dairy cows; Jankus EF et al.; Relative blood flow to tissues of the distal part of the teat (mammary papilla) in 5 lactating dairy cows was determined, using 15-microns nonradioactive carbonized microspheres . Highest relative blood flow occurred in the epithelial region (zone A) of the teat canal (papillary duct) which comprised both teat canal epithelium and papillated portion of the stratum papillare . Blood flow to these tissues was more than 4 times greater than blood flow to equivalent tissues of the mucosal rosette . The high rate of metabolic activity indicated by this relatively high blood flow may be required to support secretion of antimicrobial substances and continual synthesis of epithelial cells to replace those lost during milking. Neurol Clin, 1986 Feb, 4(1), 69 - 90 Pyogenic bacterial infections of the CNS; Overturf GD; The etiology of pyogenic infections of the brain and meninges varies principally by age, predisposing causes or conditions, and anatomic site of the infection . An appreciation of these factors, plus the prudent use of noninvasive anatomic diagnostic techniques (such as CT) and examination of the CSF, will provide a basis for the empiric use of appropriate antibiotics . The beta-lactam antibiotics remain the preferred drugs whenever possible because of their broad spectrum on antimicrobial activity, efficacy in CNS infections, low cost, and low toxicity. Neurol Clin, 1986 Feb, 4(1), 3 - 12 Cerebrospinal fluid formula in patients with central nervous system infection; Leonard JM; Knowledge of the CSF formula is clinically useful and at times critical in the analysis of a number of diagnostic problems presented by patients with CNS infections . The decision to withhold antimicrobial therapy in the patient with an acute meningitis syndrome, when viral etiology is suspected, is justified in the presence of a polymorphonuclear cellular reaction provided the CSF glucose is greater than 45 mg per dl and the protein less than 130 mg per dl . Patients who fail to improve clinically should be retapped in 8 to 12 hours . A persisting PMN reaction or the combination of a PMN pleocytosis and hypoglycorrachia virtually rules out viral infection and, in the face of negative routine cultures, requires a diligent search for focal parameningeal suppuration and consideration of CNS tuberculosis and fungal infection . Careful re-evaluation of the patient emphasizing factors such as duration of illness and potential sites of parameningeal suppuration will be useful in guiding further diagnostic studies . Head CT scanning including views of the sphenoid sinuses may be especially helpful in this regard. Jpn J Antibiot, 1986 Feb, 39(2), 317 - 25 {Studies on antimicrobial concentration of clindamycin phosphate in serum, pelvic dead space exudate, and pelvic organs/tissues}; Obata T et al.; In women undergoing radical and total abdominal hysterectomy, clindamycin phosphate (CLDM-P) in a dose of 1,200 mg was administered by intravenous drip infusion over 1 hour and the drug concentrations in serum and pelvic dead space exudate, as well as pelvic organs/tissues, were determined over time . The following results were obtained: The serum concentration of clindamycin (CLDM) after intravenous infusion showed the peak value of 24.54 +/- 7.02 micrograms/ml at the end of infusion and then gradually decreased to 3.87 +/- 0.70 micrograms/ml in 6 hours . Concentration in pelvic dead space exudate, which was 2.82 +/- 3.90 micrograms/ml at the end of intravenous infusion, gradually increased to the peak value of 13.49 +/- 6.62 micrograms/ml in 1 hour . Two hours after infusion, the level of 12.43 +/- 5.56 micrograms/ml outstripped serum concentration . Continuously in excess of serum concentration, the exudate concentration gradually decreased to 6.65 +/- 2.27 micrograms/ml at 6 hours after infusion . Cubital venous serum concentration (16.36 +/- 3.68 micrograms/ml) was almost equal to uterine arterial serum concentration (16.36 +/- 4.05 micrograms/ml) of CLDM at uterine removal . In the pelvic organ/tissue concentrations, 15.71 +/- 3.86 micrograms/g in endometrium was highest, followed by 15.19 +/- 3.80 micrograms/g in oviduct, 14.80 +/- 3.52 micrograms/g in myometrium, 14.74 +/- 4.02 micrograms/g in ovary, 14.09 +/- 2.90 micrograms/g in portio vaginalis . The concentration was lowest (11.49 +/- 1.44 micrograms/g) in cervix uteri . Clinically, combined treatment with CLDM-P and ceftizoxime was excellently effective for endometritis induced by P . asaccharolyticus.(ABSTRACT TRUNCATED AT 250 WORDS) Farmaco {Sci}, 1986 Feb, 41(2), 168 - 74 {N-substituted p-fluorobenzencarboxyamides . Evaluation of the in vitro antimicrobial activity}; Vigorita MG et al.; As part of our investigations on fluorine containing compounds of potential pharmacological interest, a series of N-substituted p-fluorobenzencarboxyamides, analogs of previously studied p-fluorobenzensolfonamides, was prepared . The in vitro antibacterial and antimycotic properties were also assayed . The replacement of the sulfonamide group with an isosteric carboxyamide one, was found to confer to trifluoromethylsubstituted compounds good activity against some strains of yeasts (Candida) and hyphomycetes (Tricophyton, Aspergillus, Microsporum, Epidermophyton) . These compounds however are not very active against the gram-positive and gram-negative bacteria on which the corresponding sulfonanilides showed significant activity. Infect Control, 1986 Feb, 7(2), 59 - 63 Physiologic and microbiologic changes in skin related to frequent handwashing; Larson E et al.; Handwashing practices may be adversely influenced by the detrimental effects of handwashing on skin . A protocol was developed to assess the physiologic and microbiologic effects of frequent handwashing . Fifty-two female volunteers washed their hands 24 times per day for 5 days . Five agents were tested: water alone, non-medicated bar soap, a chlorhexidine-containing antiseptic, and two agents containing povidone-iodine (one currently available on the market and one being tested for possible marketing) . Some damage to the outer membrane of skin, the stratum corneum, occurred in all groups . There were significant changes in the amount of evaporation water loss (p = .001) and in self assessments of skin condition (p = .005) from pre-to-post test for the entire group . Skin damage was also assessed by visualizing desquamating stratum corneum cells, which are shed in large aggregates when detergents injure skin . Significantly less such shedding occurred in subjects using water alone, bar soap, and the chlorhexidine formulation (p = .02) . Greater antimicrobial activity of an agent was not correlated with increased skin trauma . We have quantitated, using objective physiologic parameter, the skin damage that occurs during even a short period of frequent handwashing . We recommend that further studies using the methods described be conducted to quantitate skin damage over longer periods of time, more closely resembling handwashing practices of health care personnel. Neurol Clin, 1986 Feb, 4(1), 249 - 64 Experimental models of CNS infections . Contributions to concepts of disease and treatment; Tauber MG et al.; Lessons learned from studies of experimental meningitis and brain abscess in animal models of infection represent major, highly significant contributions to our understanding of the pathogenesis and antimicrobial chemotherapy of these infections . For example, studies of experimental meningitis in rabbits demonstrated that the subarachnoid space is deficient in local host defenses, a finding that explains why only bactericidal antibiotic regimens are effective in treating this disease; studies of the efficacy of corticosteroids as adjunctive therapy for meningitis yielded data indicating that both beneficial and detrimental effects on the host are imparted by these compounds . These and a number of other key investigations of experimental meningitis and brain abscess, the results of these investigations, and the clinical significance of these results are presented in this article. Antimicrob Agents Chemother, 1986 Feb, 29(2), 263 - 70 Prospective randomized comparison of three antibiotic regimens for empirical therapy of suspected bacteremic infection in febrile granulocytopenic patients; Klastersky J et al.; The standard regimen used by members of the European Organization for Research on Treatment of Cancer Antimicrobial Therapy Cooperative Group for empiric therapy of febrile neutropenic cancer patients has been treatment with ticarcillin plus amikacin . A three-arm prospective randomized controlled trial was performed to determine whether the extended-spectrum antipseudomonal penicillin azlocillin or the extended-spectrum cephalosporin cefotaxime had more or less efficacy than the beta-lactam in the ticarcillin-plus-amikacin regimen . A total of 742 patients from 22 institutions were evaluated . Single gram-negative rod bacteremias accounted for 83 episodes, and it was among these patients that the prognosis was least satisfactory, leading to a more intensive evaluation of this patient group . In these patients the azlocillin-plus-amikacin regimen resulted in a 66% response rate, compared with a 37% response rate for patients who received cefotaxime plus amikacin (P = 0.080) and a 47% response rate for patients who received ticarcillin plus amikacin (P = 0.207) . The patients with gram-negative rod bacteremias and persistently profound granulocytopenia had substantially poorer response rates (37%) than the patients with rising granulocyte counts (73%; P = 0.004) . A logistic regression analysis indicated that the following factors also affected infection resolution: beta-lactam utilization in the regimen (azlocillin was better than ticarcillin or cefotaxime), resolution of profound granulocytopenia (less than 100 cells per microliter) during therapy, and susceptibility to the beta-lactam antibiotic. J Clin Microbiol, 1986 Feb, 23(2), 350 - 3 Addi-Chek filtration, BACTEC, and 10-ml culture methods for recovery of microorganisms from dialysis effluent during episodes of peritonitis; Males BM et al.; The Addi-Chek (filtration; Millipore Corp., Bedford, Mass.) and BACTEC (radiometric detection of growth in culture media; Johnston Laboratories, Inc., Towson, Md.) systems were compared with the 10-ml culture (centrifugation) method for the recovery of microorganisms from peritoneal dialysate collected from patients with clinical evidence of peritonitis and containing greater than or equal to 200 leukocytes per mm3 . Both alternate methods were comparable, and results were not significantly different from those of the conventional 10-ml culture method . All systems were adversely affected in their capacity to recover organisms when dialysates had been collected during periods of antimicrobial therapy. J Antimicrob Chemother, 1986 Feb, 17(2), 185 - 93 An in-vitro study of oral therapeutic doses of co-trimoxazole and erythromycin stearate on abnormal polymorphonuclear leucocyte migration; Ras GJ et al.; The effects of administration for four days of co-trimoxazole (2 X 500 mg tablets daily) and erythromycin stearate (3 X 500 mg tablets daily) on persistently abnormal polymorphonuclear leucocyte (PMNL) migration in six individuals with a history of chronic or recurrent bacterial infections were studied . The effects of co-incubation of PMNL in vitro with both antimicrobial agents at concentrations of 12(-5) and 10(-4) M were also investigated . Two different leucoattractants were used, autologous serum activated with bacterial endotoxin (EAS) and the synthetic chemotactic tripeptide FMLP . In three homosexual males with the acquired immunodeficiency syndrome (AIDS) abnormal PMNL motility was associated with the presence of serum inhibitor(s) of cell migration . In a fourth female subject, with recurrent episodes of acute periodontitis, and intrinsic cellular defect of PMNL migration associated with markedly impaired FMLP-induced degranulation and binding to PMNL was observed . In the remaining two subjects with chronic osteomyelitis, the precise abnormality of PMNL movement was not defined but appeared to be of the cellular intrinsic type . Co-incubation of PMNL with erythromycin, but not cotrimoxazole, at both concentrations tested (10(-5) and 10(-4) M) significantly improved cell migration to EAS, Likewise administration of erythromycin, but not cotrimoxazole, significantly improved PMNL migration to EAS . Improvement or correction of abnormal PMNL motility during antimicrobial chemotherapy with erythromycin may be a useful property of this antimicrobial agent. Oral Surg Oral Med Oral Pathol, 1986 Feb, 61(2), 197 - 200 In vitro antimicrobial activity of six pulp-capping agents; Lado EA et al.; The antimicrobial activity of six commonly used pulp-capping agents was compared to reagent Ca(OH)2 by means of an in vitro microbiologic assay . Microbial samples were collected from deep carious lesions in each of twelve teeth and plated onto T-soy blood agar . Uniform disks of each pulp-capping agent were pressed slightly below the surface of each agar dish, and zones of bacterial inhibition were measured at 24 hours to the nearest 0.1 mm . All agents, including IRM, demonstrated significantly more antimicrobial activity than reagent Ca(OH)2 with the exception of Pulpdent . This tends to indicate that the antibacterial properties associated with these capping compounds are not entirely due to the high pH associated with Ca(OH)2. Pediatr Res, 1986 Feb, 20(2), 192 - 6 Response of human and rat small intestinal mucosa to oral administration of Saccharomyces boulardii; Buts JP et al.; To evaluate the response of the small intestinal mucosa to Saccharomyces boulardii (S.b.), a yeast widely used in some countries as an adjuvant drug with oral antimicrobial therapy, seven healthy adult volunteers were treated with high doses of lyophilized S.b . (250 mg four times per day) for 2 wk . A peroral jejunal suction biopsy was performed on days 0 and 15 of the study . Compared to the initial biopsy, histological examination of the posttrial biopsy revealed no morphological alteration nor change in villus height or crypt depth . After treatment, the specific activity (per U protein) of sucrase, lactase, and maltase was, respectively, increased by 82% (p less than 0.05) 77% (p less than 0.05), and 75% (p less than 0.05) over the basal activity of the enzymes measured on day 0, whereas mucosal protein content remained unchanged . Similar findings were found in the jejunum of adult rats treated for 5 days with either viable or killed S.b . cells . The changes in total enzyme activity (per jejunal segment) paralleled the changes in specific enzyme activity . In vitro assays on freshly prepared suspensions of S.b . (6.0 X 10(8) viable cells/ml) evidenced a high activity for sucrase (mean +/- SE: 8 364 +/- 1280 U X g X protein-1) but no maltase, neutral lactase, acid beta-galactosidase, or aminopeptidase activity . To determine whether treatment with S.b . could influence the incorporation rate of neutral lactase into the brush border membrane, 14-day-old sucklings treated either with saline or with S.b . were given intraperitoneally a dose of 20 microCi D-{1(14)C} glucosamine 3 hours before sacrifice.(ABSTRACT TRUNCATED AT 250 WORDS) Yale J Biol Med, 1986 Jan-Feb, 59(1), 17 - 23 Bilateral otitis media and hearing loss in an adult; Colodny SM et al.; Bilateral otitis media, an uncommon entity in adults, may represent the initial manifestation of a life-threatening systemic disease . Prompt recognition and treatment of the underlying disease is needed to preserve auditory function and prevent involvement of other organ systems . We present the case of a thirty-four-year-old male with bilateral serous otitis media and progressive hearing loss, which was refractory to antimicrobial therapy and middle ear drainage . A mastoid biopsy revealed necrotizing granulomatous inflammation . The differential diagnosis and probable cause of this unusual finding are discussed. Padiatr Padol, 1986, 21(1), 31 - 6 {Pharmacokinetic-therapeutic studies of ceftriaxone in premature and mature newborn infants}; Guggenbichler JP et al.; Ceftriaxone a third generation Cephalosporine exhibits a high degree of antimicrobial activity against the most common pathogens causing life threatening infections in premature and newborn infants . Ceftriaxone was used therapeutically in 16 premature and newborn infants with proven or suspected bacterial infections . Pharmakokinetic investigations were performed during this therapeutic trial . 0.1 ml of blood was taken at 2, 6 and 10 hours after intravenous administration of 50 mg/kg BW Ceftriaxone administered as a single daily bolus injection . Again on day two and four 2 hours after readministration of the same dose, serum concentrations were determined by a biologic test method . With these five samples only, we were able to calculate all clinically relevant pharmakokinetic parameters . There was a high degree of agreement between the experimentally determined and the calculated parameters . Premature infants showed a lower Cmax (115 micrograms/ml) which corresponded to the higher volume of distribution of 44% in this age group . Newborn infants in contrast showed a Cmax of 129 micrograms/ml corresponding to a volume of distribution of 39% . The halflife of elimination was 10.4 and 9.6 hours resp . for premature and mature newborn infants . Cumulation of the drug was seen during the first two days of treatment . A steady state however ensued on day three in both age groups after which no further increase in maximum serum concentrations was seen . Our data suggest, that 50 mg/kg BW once daily given intravenously by bolus-injection or short infusion over 30 minutes constitutes sufficient therapy for serious bacterial infections in premature and newborn infants with susceptible organisms.(ABSTRACT TRUNCATED AT 250 WORDS) Clin Plast Surg, 1986 Jan, 13(1), 29 - 38 Respiratory care of the burn patient; Madden MR et al.; The vast majority of respiratory disorders in thermally injured patients arise from associated inhalation injuries . The major forms of these injuries are carbon monoxide poisoning, injury to the upper airway, and pulmonary parenchymal damage . One hundred per cent oxygen, initiated at the scene of the accident, is the single most effective treatment of carbon monoxide toxicity, which must be assessed by carboxyhemoglobin determinations . Respiratory tract damage is identified by fiberoptic bronchoscopy and xenon ventilation-perfusion scintigrams . The compromised airway is protected by tracheal intubation, and respiratory failure is treated with assisted ventilation and supplemental oxygen . Pulmonary infection requires specific antibiotics based on isolated organisms and their sensitivities to antimicrobials . The upper respiratory tract of patients requiring long-term intubation should be assessed by fiberoptic bronchoscopy and other modalities to prevent fatal late airway occlusion. Chemotherapy, 1986, 32(1), 18 - 24 Influence of various antimicrobial agents on the chemiluminescence of phagocytosing human granulocytes; Duncker D et al.; In a standardized experimental model 51 antimicrobial agents were coincubated with polymorphonuclear granulocytes (PNG) of healthy human donors and then screened for a modulation of chemiluminescence (CL) reaction during zymosan phagocytosis . Initial studies with low, therapeutic and high, nontherapeutic concentrations showed CL suppression by amoxicillin, tetracycline, doxycycline, trimethoprim, sulfamethoxazol, clindamycin, fusidic acid, rifampicin, isoniazid and amphotericin B, yet stimulation of CL reaction by ceftriaxone, enoxacin, and norfloxacin . Dose-effect relationships for most of these substances showed a sigmoid-like graph with little influence upon most of the therapeutic range, but markedly increasing suppression (or stimulation) from a certain 'threshold' concentration . For certain substances this curve might indicate a narrowed therapeutic range of antimicrobial chemotherapy due to impairment of phagocytic functions. Br J Surg, 1986 Jan, 73(1), 70 - 1 Restorative rectal resection: an audit of 220 cases; Tagart RE; Two hundred and twenty consecutive, unselected cases of restorative rectal resection are reported . The operative mortality was 8.3 per cent; 3.5 per cent in patients less than 70 years old and 13 per cent over that age . Leakage at the colorectal suture line was an intractable problem, uninfluenced by anastomotic technique, but the introduction of antimicrobial prophylaxis as a routine was followed by a statistically significant reduction in the leak rate . Postoperative rectal function was satisfactory but temporary stenosis at the suture line was not uncommon . In only one case was it permanent, requiring regular dilatation . Recurrence of malignant disease occurred in 50 per cent of cases followed for at least 2 years; 35 per cent general disease, 15 per cent localized to the pelvis . These figures do not differ significantly from those following total rectal excision, which is now necessary in only 1 in 10 cases where the growth lies within 10 cm of the anus. Am J Vet Res, 1986 Jan, 47(1), 96 - 101 Controlled wound repair in guinea pigs, using antimicrobials that alter fibroplasia; Kenyon AJ et al.; The repair processes of incised wounds depend, in part, on fibroplasia induced by soluble mediators from monocytic macrophages . Two topical antimicrobials were evaluated, each of which effectively controlled wound sepsis and yet each had widely different effects on fibroplasia and wound strength . Paired-incision dermal wounds on the flanks of guinea pigs were treated with a substance containing reactive chlorine (Alcide) or with a compound that is a mixture of two surfactants . One side of each guinea pig was treated with one of the antimicrobials (treated wounds); the opposite side was treated with isotonic saline solution (control wounds) . At 7, 10, and 16 days after surgery, tensiometric measurements of C31G (a surfactant)-treated wounds were 99%, 139%, and 195% of control wound values, respectively . Alcide-treated wounds were 76%, 58%, and 88% of control wounds, respectively . Wounds treated with chlorhexidine had reduced strength at 7 days (73%) and at 10 days (78%), but by 14 days, they were similar to control wounds (94%) . The main difference between the wounds was the amount of collagen formation . Alcide-treated wounds incorporated less than 50% of the amount of 14C-proline than did the wounds treated with C31G . However, Alcide-treated wounds epithelialized as rapidly as did control wounds, and had minimal scar formation . Microscopic evaluations indicated greatly reduced inflammatory infiltrates in Alcide-treated wounds, indicating that reduced wound strength may be associated with lack of fibroblast-stimulating activity by monocytes. Pediatr Infect Dis, 1986 Jan-Feb, 5(1 Suppl), S155 - 61 Unresolved problems and future considerations in diarrheal research; Guerrant RL; PIP: This paper addresses the growing magnitude of morbidity and mortality from diarrheal disease; the definition, causes, and impact of chronic diarrhea; and unanswered questions about microbial etiologies, determinants of host susceptibility and impact, and the relevance of sociocultural setting to control strategies . Over 7% (12,600 children/day) of children in Africa, Asia, and Latin America die from diarrhea in their first 5 years of life, and poverty and rapid population growth are contributing to a worsening of this situation . Although advances have been made in our understanding of the etiology and management of acute diarrhea, little is known about the problem of chronic diarrhea the illness associated with the greatest risk of malnutrition . Moreover, 30-50% of cases of diarrhea remain with undiagnosed etiologies . Further study is needed to determine the role of cellular and humoral immunity in the specific enteric infections in order to enhance this immunity in new vaccine development . Genetic and age determinants of host susceptibility are important problems requiring further study . The social setting in which enteric infections take place may contribute to the transmission of or susceptibility to enteric infections . Future approaches to the control of diarrheal diseases must integrate advances in the following areas: epidemiologic, physiologic, biochemical, pharmacologic, immunologic, and antimicrobial control . The modern tools of molecular biology and improved understanding of scientific and social issues are expected to usher in an exciting new era in research on diarrheal diseases . Arch Ophthalmol, 1986 Jan, 104(1), 84 - 6 Outpatient treatment of microbial corneal ulcers; Groden LR et al.; Outpatient and inpatient management of culture-proved microbial corneal ulcers was evaluated . Twenty-six consecutive patients were reviewed . Twenty had been managed as outpatients, six as inpatients . All ulcers were treated with intensive topical antimicrobial therapy, and all steadily healed, as evidenced by epithelialization and resolution of infiltrate . None progressed to extreme stromal thinning, descemetocele, or perforation . Inpatients and outpatients did not differ in terms of healing time, although this can vary considerably for the same causative organism . Complete epithelialization took two to 56 days . Pseudomonas ulcers healed in seven to 42 days (mean, 22 days), which is similar to previously published reports of inpatient therapy . This study suggests that with careful patient selection and follow-up, infectious corneal ulcers can be successfully managed on an outpatient basis. Arch Ophthalmol, 1986 Jan, 104(1), 130 - 1 Susceptibility of Acanthamoeba to cryotherapeutic method; Meisler DM et al.; Acanthamoeba keratitis is becoming an increasingly well-known clinical entity . The Acanthamoeba species in their encysted state are resistant to antimicrobial agents, resulting in corneal infections that are refractory to medical therapy . Corneal cryotherapy has been used to treat Acanthamoeba keratitis with varying and equivocal success . We subjected trophozoites and cysts of two species of Acanthamoeba recovered from corneal infections to trials of in vitro freeze-thaw-refreeze cryotherapeutic methods . The trophozoites of both species were killed in all trials . However, the cysts of both species survived all trials . Cryotherapy may not be an effective means to eliminate Acanthamoeba cysts from the cornea. Chest, 1986 Jan, 89(1), 85 - 7 Incidence of fever and bacteremia following transbronchial needle aspiration; Witte MC et al.; Fiberoptic bronchoscopy and transbronchial needle aspiration were performed on 50 occasions in 47 afebrile patients . The aspirations were followed by endobronchial or transbronchial biopsies in 22 patients, as well as bronchial brushings and washings where appropriate . Blood for cultures was drawn at 5 and 30 minutes following needle aspiration, as well as at the time of any temperature above 38 degrees C during the 24 hours following the procedure . In five (10 percent) of the 50 cases, there was temperature greater than 38 degrees C (100.4 degrees F) in the 24 hours following the bronchoscopy; in no patient were cultures of blood positive, whether done early after the procedure or at the time of fever . We conclude that transbronchial needle aspiration, a new procedure gaining widespread popularity in diagnostic thoracic medicine, is not associated with clinically detectable bacteremia . This procedure should not require antimicrobial prophylaxis in patients susceptible to endocarditis. Zentralbl Mikrobiol, 1986, 141(7), 561 - 5 Antimicrobial activities of some flavonoid compounds; el-Gammal AA et al.; 6 flavonoid compounds, namely kaempferol, quercetin, myricetin, rutin, naringin, and formononetin were separated from different plant materials . They were identified using column and paper chromatography techniques, and physicochemical methods were applied to determine their structure . Isolated flavonoids were tested for their antimicrobial property against different bacterial and fungal strains as test organisms. Int J Immunopharmacol, 1986, 8(7), 805 - 9 The interference of antibiotics with antigen-specific antibody responses in man; Villa ML et al.; The effect of a series of antimicrobial drugs on human antigen-specific primary antibody response in vitro was investigated . Of the five agents tested, only streptomycin and gentamicin induced an appreciable reduction in the antibody response; penicillin G, rifampin and amikacin had a poor or irregular effect . The precise mechanisms of action of these substances on mammalian cells remain to be elucidated since an assessment of their capacity to interfere with the immune system is of particular importance in those patients with induced or acquired immunodeficiencies . In this respect, we provide an inexpensive and sensitive method for the preliminary screening of potentially immunosuppressive drugs. J Hyg Epidemiol Microbiol Immunol, 1986, 30(3), 283 - 6 Prevention and treatment of nosocomial infections, with special reference to antibiotic policy; Vymola F et al.; Hospital infections are of a major and growing health concern worldwide . They are the cause of appreciable economic loss, but what raises the particular alarm, both ethically and as a public health problem, is their continuous trend towards increasing lethality . The incidence of nosocomial infections can be prevented by creating a system of barriers that would interrupt their spread and transmission . Apart from strict adherence to general hygiene rules and the rational employment of examination methods it is essential in this respect that a prime attention is paid to the sensible use of antimicrobials, i.e . the persuance of a sound antibiotic policy . Its integral components are the systematic laboratory control, continuous epidemiological surveillance of bacterial drug resistance patterns, study of variations in the biological properties of multiple resistant bacterial strains, and the development of, and adherence to, effective and indicated treatment schedules . The particular problems related to bacterial enzyme activities and the genetic information (plasmids) coding for resistance to antimicrobials, as well as the virulence and pathogenicity of agents responsible for the onset of hospital infection are also discussed in this context . It is pointed out that for an effective hospital infection control it is essential to avoid the onesided pressure of badly applied antibiotic therapy. J Int Med Res, 1986, 14(5), 236 - 41 Efficacy and clinical tolerance of a new combination of trimethoprim with sulphonamide . A post-marketing and a literature survey; Celotti F et al.; To obtain a direct clinical evaluation of a new sulpha-trimethoprim combination product (Kelfiprim) from general practitioners or specialist practitioners, an extensive post-marketing survey has been organized in Brazil involving 1,177 doctors and 5,885 patients . These experienced different infections susceptible to oral antimicrobial chemotherapy with a sulpha-trimethoprim combination . The results indicated that the product was very effective (91.2% cure rate) and well tolerated (4% incidence of side-effects) . Side-effects were usually mild and transient . No life-threatening adverse reactions were observed . The results obtained support those already published in clinical trials involving 1,119 patients. Pol J Pharmacol Pharm, 1986 Jan-Feb, 38(1), 99 - 106 Synthesis of new quinoline derivatives as antimicrobial agents; Zayed AH et al.; 2-Hydroxyquinoline-4-hydrazide was condensed with some aromatic aldehydes and acetophenones to give the hydrazones 1a-h . It was also reacted with HCOOH, PhCOCl and p-CH3O-PhCOCl to afford 2a-c . Cyclization of 2b was completed by using PPA, POCl3 and/or P2S5, which gave compounds 3, 4, and 6 respectively . Reaction of 4 with some amines gave the corresponding derivatives 5a-f . The thiosemicarbazide 7 was cyclized under acid and basic condition to give the thiadiazolyl-8 and triazolyl-10 derivatives. J Antibiot (Tokyo), 1986 Jan, 39(1), 32 - 7 Actinopyrones A, B and C, new physiologically active substances . I . Producing organism, fermentation, isolation and biological properties; Yano K et al.; A strain of Streptomyces was found to produce new physiologically active substances . The active compounds were purified and separated into three substances named actinopyrones A, B and C . Actinopyrones exhibited coronary vasodilating activities in anesthetized dogs and weakly antimicrobial activities against some Gram-positive bacteria and dermatophytes. Can J Vet Res, 1986 Jan, 50(1), 7 - 14 The relationship among current management systems, production, disease and drug usage on Ontario dairy farms; Meek AH et al.; The study involved 110 randomly selected dairy farms located in the Ontario, Canada counties of Bruce, Grey, Huron, Oxford, Perth, Waterloo and Wellington . Herds were classified as "intensive" and "extensive" . On extensive farms, data were collected at the herd level only, while on intensive farms, data were recorded at both the individual animal and herd level . Data collection continued for approximately two and one-half years . At each visit, technicians collected production data from the most recent production recording scheme report and from the "daily log" maintained by each producer . As well as the ongoing data collection procedures, a number of supplementary data collections were made . The average 305 day milk production increased gradually during the three calendar years from 6224.6 kg in 1981 to 6443.7 kg in 1983 . The average calving interval was stable at 13.2 months for all three years . The majority of cows removed from the herds were culled for beef (0.243 per animal year) . The next highest removal rate was for domestic sale, followed by death, export sale and destroyed . The highest disease rate, for those conditions whose rates were based on calving, was for retained placenta (0.09 per calving), while clinical mastitis was highest for those conditions whose rates were based on animal years (0.37 per animal year) . The overall crude antimicrobial dosage rate, that is, including any antimicrobial used for either prophylactic or therapeutic purposes, was 3.85 doses per animal year . The rate for therapeutic purposes only was 3.6 doses per animal year . Penicillin/streptomycin was used most often with a rate of 1.45 doses per animal year. Can J Vet Res, 1986 Jan, 50(1), 15 - 22 A path model of factors influencing morbidity and mortality in Ontario feedlot calves; Martin SW et al.; The principles of path analysis and causal modelling are discussed . Path analysis was applied to three data sets to assess the relationship between group characteristics (number per group and "mixing" subgroups of cattle, feeding-management of the group and processing factors (vaccination and prophylactic antimicrobials) and subsequent morbidity and mortality in feedlot cattle . The major findings agree with previously reported results but the timing and pathways of the effects are elaborated . In general, morbidity in week 1 was correlated with morbidity in week 2, which was correlated with morbidity in weeks 3-5 . The same was generally true for mortality . In general, morbidity was not strongly correlated with mortality . Lots (unmixed groups) did not arrive in better condition, but experienced fewer subsequent health problems than mixed groups . (Silage-fed lots appeared to do poorly, however this was apparently due to the positive association between lots and vaccination, the latter being detrimental to mortality rates.) The more cattle per group, the greater the health problems in weeks 3-5 postarrival . Prophylactic antimicrobials in the water supply on arrival lead to increased health problems in the three to five week postarrival period . Antibiotic containing starter rations had a beneficial effect on health status in this period . This effect appeared to be partly due to delaying making silage the major ration component in silage-fed cattle receiving antimicrobial containing starter rations . Vaccination against respiratory disease in either of the first two weeks postarrival had detrimental direct and indirect effects on subsequent health status . Vaccination during weeks 3-5 postarrival was not significantly related to health status in that period. Microbios, 1986, 46(187), 87 - 93 Inhibitory activity of the genus Chrysosporium in relation to the composition of the culture media used; Calvo MA et al.; The effect of nutrients on the formation and accumulation of secondary metabolites in species of the genus Chrysosporium was examined . The study was performed according to the method of Campbell (1960), and among the results obtained was the fact that the only significant increase in antimicrobial capacity was observed when the strains were grown on a 2% malt extract agar and when micro-organisms were assayed using Aspergillus niger. Drugs, 1986, 31 Suppl 3, 83 - 6 Branhamella catarrhalis respiratory infections in The Netherlands; Maesen FP et al.; In the southern Netherlands, Branhamella catarrhalis can be cultured from sputum in more than 20% of patients with purulent lower respiratory tract infections and approximately 40% of strains produce beta-lactamase . With increasing resistance to co-trimoxazole (10%) and erythromycin (6%) this produces many treatment problems, particularly in general practice . Recent results in the treatment of B . catarrhalis respiratory infections with newer antimicrobial agents and new combinations of beta-lactamase inhibitors are presented . Cefotaxime and ceftazidime are predictably effective but, considering their cost and the fact that they require parenteral administration, they need to be reserved for strict indications. Acta Paediatr Hung, 1986, 27(1), 31 - 41 Alloimmune neonatal neutropenia: clinical observations and therapeutic consequences; Hinkel GK et al.; Alloimmune neonatal neutropenia is a rare condition, it must be distinguished from hereditary forms of neutropenia and acquired neutropenia accompanying sepsis . In a family with four affected newborns, the degree of the disease became more and more severe from the first child to the third child . The third child died of sepsis . After birth of the third child, specific antibodies (anti-NA 1) reacting with the neutrophils originating from the father and the first two children were detected in the mother's serum . No neutrophils were detectable in the fourth child immediately after birth . In this child falling concentrations of diaplacentally transferred antibodies could be demonstrated over 8 weeks after birth . Neutrophil counts returned to normal as the antibodies disappeared . In this newborn, infection could be prevented by the use of a germ-free environment and antimicrobial prophylaxis . The antibody titres could only be lowered by repeated exchange transfusions with Na 1-free blood . White blood cell transfusion only resulted in a short transient effect on neutropenia. Ter Arkh, 1986, 58(3), 99 - 101 {Various problems of dynamics of the defense mechanisms of the body, the mechanism of development of infection and formation of metastases during infection}; Shakina IuG et al.; Based on the study of the bactericidal activity of the purulent fluid and cytograms of 55 patients with suppurative processes and 19 patients with sepsis the authors explain the character of the antimicrobial "struggle" of the macroorganism in the infected wound and formation of septicopyemic metastases during sepsis . A test for diagnosing sepsis is suggested. Fundam Appl Toxicol, 1986 Jan, 6(1), 1 - 6 A wound healing study of chlorhexidine digluconate in guinea pigs; Saatman RA et al.; Formulations with and without chlorhexidine digluconate, a broad-spectrum antimicrobial, were tested for their effects on the healing of incisions and abrasions surgically induced in male guinea pigs . Formulations containing chlorhexidine were a skin cleanser formulation (4% w/v), a tinted tincture (0.5% w/v), and both 0.5 and 4% w/v aqueous solutions . Control materials were saline, and both the skin cleanser and the tincture formulations without chlorhexidine . Presurgical preparation was limited to closely clipping the hair and wiping each wound area with saline to remove loose hair, dander, and dirt . Each incision and abrasion was irrigated with its assigned material at surgery and daily thereafter until necropsy . Guinea pigs were killed on Days 3, 6, 9, 14, and 21, and wound sites were removed and fixed for histologic evaluation of healing . Daily progress of the wound healing appeared comparable for all treatment groups and there was no gross evidence of treatment effects at necropsy . For the animals with incisions, there were no remarkable histological differences among the treatment groups at Day 3 . At Days 6 and 9, the two formulations containing 4% chlorhexidine produced a slight delay in healing when compared with the other treatment groups . These differences decreased with time, and by Day 21, there were no remarkable histological differences among animals of the various treatment groups . For the animals with abrasions, all treatment groups with and without chlorhexidine had slightly delayed healing compared to the saline control animals on Day 3 and 6.(ABSTRACT TRUNCATED AT 250 WORDS) Scand J Infect Dis, 1986, 18(2), 153 - 60 Selective antimicrobial modulation of the intestinal microbial flora for infection prevention in patients with hematologic malignancies . Evaluation of clinical efficacy and the value of surveillance cultures; Guiot HF et al.; To confirm the results obtained in an earlier study, the incidence of infection was evaluated in 54 patients (62 periods of admission), nursed in conventional rooms and given a regimen of antimicrobial agents intended to modulate the intestinal flora selectively as a method to prevent infection during severe granulocytopenia . In 62 patients receiving selective antimicrobial modulation (SAM), 18% acquired major infections which was similar to 19% in patients on SAM in an earlier double-blind placebo controlled study and lower than 47% in the controls . Evaluation of a large number of surveillance cultures showed that the presence of specific potentially pathogenic aerobic bacteria was associated with the occurrence of major infection . If the bacterial species in question were not found in the cultures the chance of becoming infected was less than 5%, whereas the chance ranged between 42 and 62% depending on the species involved when these microorganisms were isolated. J Clin Microbiol, 1986 Jan, 23(1), 143 - 8 Evaluation of the MicroScan antimicrobial susceptibility system with the autoSCAN-4 automated reader; Baker CN et al.; The American MicroScan (American MicroScan, Mahwah, N.J.) identification and antimicrobial susceptibility system consists in part of an automated reading system (autoSCAN-4) with data management capabilities . We evaluated the system with 404 gram-negative and 170 gram-positive facultative anaerobic and aerobic bacteria . We compared MicroScan results read automatically and visually with each other and with the results obtained by the reference method (read visually) . The overall agreement within +/- 1 log2 dilution was 94.3% when the MicroScan system (read automatically) was compared with the reference method (read visually), 96.4% when MicroScan panels (read visually) were compared with reference panels, and 97.4% when the autoSCAN-4 automated reading was compared with the visual reading of the MicroScan panels . Total discrepancies (susceptibility interpretation category changes) for the MicroScan system compared with the reference method were 7%, with 6.2% considered a minor discrepancy . The autoSCAN-4 and the complete MicroScan system yielded accurate results compared with the reference method. Scand J Infect Dis Suppl, 1986, 49, 85 - 8 Effects of antimicrobial agents upon the functional part of the intestinal flora; Midtvedt T; For functional studies of the complex intestinal ecosystem, two recently introduced terms have been shown to be of value . A Microflora-Associated Characteristic--MAC--is defined as the recording of any anatomical structure, physiological or biochemical function in a macroorganism which has been influenced by the microflora . When functionally active microbes are absent, as in germfree animals, the recording of a MAC can be defined as a Germfree Animal Characteristic--GAC . In our ongoing, long-term ecological studies we have investigated the influence of a long list of antimicrobial agents upon various biochemical MACs in man and rats . Parameters such as conversion of cholesterol to coprostanol, 7-dehydroxylation of bile acids, transformation of bilirubin, degradation of mucin, production of short chain fatty acids and inactivation of tryptic activity have been the MACs most often studied . Each antibiotic may create its own MAC/GAC profile, partly reflecting its antibacterial spectrum and concentration in the intestinal tract and partly the characteristics of the microbial species actually involved in the reaction . MACs influenced mainly by species dominated by a K-selection are generally more disturbed than MACs influenced by species dominated by a r-selection. Scand J Infect Dis Suppl, 1986, 49, 64 - 72 Antimicrobial induced alterations of the human oropharyngeal and intestinal microflora; Nord CE et al.; Although the role of the normal oropharyngeal and intestinal microflora is not fully understood, there are evidences that alterations in the flora may have serious consequences . The most common and significant cause of disturbances in the normal microflora is the administration of antimicrobial agents . The microflora can be influenced by antimicrobial agents because of incomplete absorption of any orally administered antimicrobial agent, secretion of an antimicrobial agent by the salivary glands or in the bile, or secretion from the intestinal mucosa . In most cases the influence is not beneficial to the patient because suppression of the indigenous microorganisms often permits potential pathogens to overgrow and cause septic conditions, stomatitis, diarrhoea, or colitis . Antimicrobial agents that influence the normal microflora also promote the emergence of antimicrobial-resistant strains . During the recent years, the impact of different antimicrobial agents on the human microflora has been investigated by our research group . Thus the effects on the oropharyngeal and intestinal microflora by peroral administration of penicillin, bacampicillin, erythromycin, clindamycin, doxycycline, nitroimidazole, norfloxacin and ciprofloxacin have been studied . The impact on the microflora by parenteral administration of ampicillin + sulbactam, azlocillin, aztreonam, piperacillin, cefoperazone, cefoxitin, ceftriaxone, moxalactam, imipenem, nitroimidazole and clindamycin has also been investigated . Pronounced changes were observed in the microflora in patients receiving clindamycin, erythromycin, cefoperazone, ceftriaxone and moxalactam, whereas moderate changes were seen in those patients receiving doxycycline, cefoxitin, aztreonam, ampicillin + sulbactam, azlocillin and piperacillin . Penicillin, bacampicillin, imipenem, nitroimidazole, ciprofloxacin and norfloxacin produced only minor changes.(ABSTRACT TRUNCATED AT 250 WORDS) Scand J Infect Dis Suppl, 1986, 49, 46 - 55 R-factors in gram-positive and gram-negative aerobic bacteria selected by antimicrobial therapy; Buu-Hoi A et al.; Populations of resistant bacteria emerge by the operation of selective pressure on resistant bacteria . The acquisition of resistance by sensitive bacteria is dependent upon the genetic determinant of the resistance, and its ability to move between different bacterial cells and within cells between different replicons . In contrast to chromosomal mediated resistance, plasmids and transposable elements coding for resistance to antibiotics have been the major factors in the spread of resistance and the prevalence of resistant bacteria in humans, farm animals and poultry . Different types of R-factors can be described . Resistance to ampicillin, tetracycline, chloramphenicol, gentamicin, trimethoprim, erythromycin may exemplify epidemiological aspects of resistance genes in Gram-negative and Gram-positive bacteria . The ecological destiny of resistant bacterial populations suggests the role of other factors than antibiotic resistance: characters of a particular host, host-plasmid relationship and properties which may lead to survival and adaptation in a given niche. Infection, 1986, 14 Suppl 4, S307 - 8 Clinical experience with ofloxacin (DL 8280) in the therapy of various infections: preliminary report; Cristiano P et al.; Thirteen hospitalized patients with various infections, five with typhoid fever, two with gastroenteritis, four with respiratory tract infection and two with biliary tract infection, were treated with ofloxacin at a daily dosage ranging between 600 and 900 mg orally . 12 patients completely recovered from the infection, and the pathogens were eradicated . Treatment failed in one patient suffering from respiratory tract infection . No side effects were recorded . In these cases ofloxacin can be considered as a safe and effective antimicrobial agent. J Immunoassay, 1986, 7(4), 241 - 55 A rapid enzyme immunoassay for measurement of HBK in blood; Ueda T et al.; An enzyme immunoassay has been developed for the measurement of HBK (4-amino-2-hydroxybutylyldibekacin) a new semisynthetic aminoglycoside antibiotic . Antisera were raised in rabbits by immunization with HBK conjugated to bovine serum albumin (BSA) . 3'-Eno-HBK conjugated to alkaline phosphatase (ALP) was used as an enzyme labeled antigen . The antibody-bound drug was separated from free using goat anti-rabbit IgG serum . The assay can be completed within one hr by co-incubating the first and the second antibody . The present immunoassay allows detection of 10 ng HBK per ml of serum, and is applicable for monitoring HBK level in blood . HBK concentrations in human sera were determined by the immunoassay during and after infusion and the levels were compared with those determined by high performance liquid chromatography (HPLC) and antimicrobial assay. Scand J Infect Dis, 1986, 18(5), 461 - 3 Evaluation of an Antimicrobial Removal Device (ARD) for detection of septicemia; Lundholm M; An Antimicrobial Removal Device (ARD) shown to inactivate 13 commonly used antimicrobial agents was used for processing blood samples before culture and compared with a conventional biphasic blood culture medium . 448 blood samples were processed using the ARD bottle with 472 parallel conventional cultures . The rates of clinically significant positive blood cultures were 6.9% and 8.9% respectively (not statistically significant) . This study does not show any increased detection rate in ARD-processed cultures compared with conventional cultures in patients receiving antimicrobial agents. Microbiol Immunol, 1986, 30(5), 413 - 23 Ecological studies of Legionella species . I . Viable counts of Legionella pneumophila in cooling tower water; Ikedo M et al.; The occurrence and viable counts of Legionella pneumophila in acid-treated water samples of 62 cooling towers on the main island of Japan were determined by inoculating them onto plates of Wadowsky-Yee-Okuda (WYO) agar medium . WYO plate cultures of 39 (63%) of the samples yielded L . pneumophila with viable counts ranging from 10 to 10(4) colony-forming units per 100 ml . Of the L . pneumophila isolates, 157 were serologically identified as serogroup 1, and the remaining 21 were agglutinated by serogroup 3 (2 strains) and serogroup 6 (19 strains) antisera . In each culture-positive water sample, the pH and the number of other bacteria were found not be statistically significantly correlated with the viable counts of L . pneumophila . However, a higher rate of recovery of L . pneumophila was obtained with the water samples with a smaller number of other bacteria . Practical use of commercially available antialgal or antimicrobial agents was found not to be significantly effective for controlling the occurrence and growth of L . pneumophila in cooling tower water. Med Cutan Ibero Lat Am, 1986, 14(1), 49 - 54 {Botryomycosis}; Prado de Oliveira ZN et al.; Four cases of botryomycosis are presented . All patients had fistulous and ulcerated lesions of the lower limbs . Diagnosis was based on the clinical and laboratory findings (presence of grains on direct microscopy examination and positive bacterial cultures) . All patients had osteomyelitis . Three were treated with antibiotics or sulfonamides (orientated by the antimicrobial susceptibility test) and were cured. Trans Ophthalmol Soc U K, 1986, 105 ( Pt 1), 43 - 60 Acute bacterial infection of the eye: bacterial keratitis and endophthalmitis; Wilson LA; Bacterial keratitis and endophthalmitis are serious disorders which can result in partial or total loss of vision . The epidemiology, common aetiopathogens, clinical features, diagnostic techniques and management are reviewed with an emphasis on laboratory diagnosis and antimicrobial therapy. Chemotherapy, 1986, 32(1), 44 - 58 Kill kinetics of bacteria under fluctuating concentrations of various antibiotics . II . Description of experiments; Konig P et al.; Differences in kill kinetics and regrowth patterns of bacteria under the influence of various antibiotics are frequently not represented by their MIC values . The area under the concentration curve represents antimicrobial activity more accurately than the peak concentration . Readministration of antibiotics should occur prior to bacterial regrowth for optimal efficacy . When administering antibiotics in combinations nonsimultaneous dosing is superior to simultaneous administration. Drugs, 1986, 31 Suppl 3, 28 - 33 Epidemiological and bacteriological findings on Branhamella catarrhalis respiratory infections in The Netherlands; Davies BI et al.; The frequency of isolation of Branhamella catarrhalis from sputum in a laboratory in the southern part of the Netherlands is reviewed; at present 23% of positive cultures contain these organisms . Seasonal variations include a considerable reduction in frequency of isolation in the summer months . The possible role of heavy industry and air pollution is briefly discussed . Evidence for the direct pathogenicity of B . catarrhalis is presented, and although this may be considered as only circumstantial it is still convincing, particularly in acute otitis media and in acute purulent exacerbations of chronic respiratory disease . The possibility of indirect pathogenicity through beta-lactamase production is discussed as is the evidence obtained by the use of several new antimicrobial agents which were subsequently shown to have been inappropriate. Drugs, 1986, 31 Suppl 3, 17 - 22 Sensitivity of Branhamella catarrhalis to oral antibiotics; Kallings I; B . catarrhalis is a potential pathogen in the upper and lower respiratory tract which has been implicated as a clinically important cause of chronic bronchitis and otitis media in children . Since the late 1970s the proportion of B . catarrhalis strains elaborating beta-lactamase seems to have significantly increased; some centres are now reporting prevalence rates as high as 76% . Such a dramatic increase in the number of beta-lactamase positive strains is of clinical importance when assessing the indirect pathogenic potential of B . catarrhalis and when selecting suitable antimicrobial therapy . Early studies showed that B . catarrhalis was sensitive to penicillin V with a MIC90 of 1.2 mg/L while, more recently, MIC90 values of 2.0 mg/L have been noted . Ampicillin and, perhaps surprisingly, cefaclor are also inactivated by some beta-lactamase-producing strains of B . catarrhalis . A majority of strains of B . catarrhalis is susceptible to erythromycin (MIC90 0.15 to 0.5 mg/L) and tetracyclines (especially doxycycline, MIC90 0.25 to to 0.5 mg/L) . Co-trimoxazole also seems to be effective against most isolates of B . catarrhalis whereas trimethoprim alone is relatively ineffective. Drugs, 1986, 31 Suppl 3, 125 - 31 Acute otitis media in Sweden . Role of Branhamella catarrhalis and the rationale for choice of antimicrobial therapy; Lundgren K et al.; The occurrence of Branhamella catarrhalis in the nasopharynx and middle ear exudate was investigated in 3 studies . Bacteria were isolated from the nasopharynx in 63% of 180 healthy children and B . catarrhalis, the most common bacterium present, was isolated in 36% . In 75 children with primary acute otitis media, bacteria were isolated from the nasopharynx in 98% and from the middle ear exudate in 80% . B . catarrhalis was found in the nasopharynx in 43% and in the middle ear exudate in pure culture in 9% . In those children in whom B . catarrhalis was isolated from the middle ear exudate it was also present in the nasopharynx . In 420 children, 338 with primary acute otitis media and 82 who relapsed or did not respond to previous antibiotic therapy, B . catarrhalis was isolated from the nasopharynx in approximately 50% . About half of the B . catarrhalis strains were beta-lactamase-producing and the majority of these strains were isolated in children under 3 years of age . Of children with primary acute otitis media who had beta-lactamase-producing B . catarrhalis about 50% had not previously received antibiotic treatment . B . catarrhalis is commonly found in the nasopharynx of healthy children as well as in children with acute otitis media . Many of the strains are beta-lactamase-producing though many of the children have not been previously treated with antibiotics . In middle ear exudate, B . catarrhalis is found in about 10% of cases.(ABSTRACT TRUNCATED AT 250 WORDS) Drugs, 1986, 31 Suppl 3, 11 - 6 The incidence and antibiotic susceptibility of Branhamella catarrhalis in respiratory infections; Calder MA et al.; The incidence of Branhamella catarrhalis in respiratory infections at City Hospital, Edinburgh from January 1981 to April 1984 is described . Beginning in January 1982 there was an increased incidence associated with a high proportion of beta-lactamase-producing strains . The number of these strains increased: from January 1981 to April 1983, 61% of strains produced beta-lactamase, and 83% produced beta-lactamase from January to April 1984 . 53% of patients were infected in hospital . Environmental studies showed that 7% of staff and 8% of patients were carriers; there was also circumstantial evidence of ward and patient-to-patient infection . The antimicrobial susceptibility of 54 clinical strains was tested: all strains were resistant to trimethoprim but were susceptible to clavulanic acid plus amoxycillin, chloramphenicol, erythromycin, co-trimoxazole, cefotaxime and cefuroxime . beta-Lactamase-negative strains were uniformly susceptible to penicillin and ampicillin. J Antibiot (Tokyo), 1986 Jan, 39(1), 111 - 20 The synthesis and biological evaluation of 7 beta-{2-(5-amino-{1,2,4} oxadiazol-3-yl)-2-Z-methoximinoacetamido}-cephalosporin derivatives; Wheeler WJ et al.; A series of 7 beta-{2-(5-aminooxadiazol-3-yl)-2-Z-methoximinoacetamido} -3-cephem-4-carboxylic acids (7a-g) were synthesized and evaluated microbiologically Although somewhat less active than cefotaxime 7a-g showed good antimicrobial activity against a wide variety of Gram-positive and Gram-negative bacteria . The beta-lactamase stability of 7a and 7f was also discussed. Pediatr Infect Dis, 1986 Jan-Feb, 5(1 Suppl), S21 - 8 Pediatric diarrheal diseases: a global perspective; Kumate J et al.; PIP: This overview of pediatric diarrheal disease presents information on mortality, diarrhea and socioeconomic development, enteropathogen microbes, clinical features, nutritional sequelae, and preventive interventions . Differences in mortality rates between developed and developing countries may be more than 500 times for infant mortality due to gastroenteritis and 300 times for preschool children . Socioeconomic development influences the number of diarrheal episodes/child/year as well as clinical aspects related to etiology, severity, and nutritional sequelae . Diarrheal episodes are more severe in developing countries, their duration is longer, and dehydration is more likely to be a life-threatening complication . Of the major public health problems in developing countries, mortality in children under 5 years of age due to diarrhea is one of the most amenable to control measures . Oral rehydration, coupled with early restoration of foods and continuity of breast fe