Microbiol Sci, 1985 Jul, 2(7), 212 - 7 Bactericidal cationic peptides involved in bacterial antagonism and host defence; Sahl HG; There are numerous reports in the literature on small, strongly cationic peptides displaying marked antimicrobial activity . These peptides are produced by bacteria as well as higher organisms, and are thought to be involved in bacterial antagonism or host defence mechanisms. Pediatrie, 1985 Jul-Aug, 40(5), 363 - 73 {Guidelines for antibiotic therapy in an infectious risk unit}; Demont F et al.; This surveillance made possible an immediate check up for an appropriate use of guidelines, allowing an optimal usage of antimicrobial agents . It's interest at term is to document audits (yearly for example) to discuss the effectiveness of our guidelines and, if necessary, to make new therapeutic choices, proven to be effective after investigation for clinical and microbiological data . Our surveillance system can be easily investigated by the physicians . It consists in checking on a weekly sheet all the new antimicrobial therapy courses, with name of patient, age, cause of antimicrobial therapy and hospitalization, bacteria, antibiotics used, for infection, before superinfection, previous superinfection, prophylaxis . A shift in usage of antibiotics can be observed, with consequences in antimicrobial therapy and hospital hygiene. J Antimicrob Chemother, 1985 Jul, 16(1), 49 - 59 Analysis of a new method for assessing activity of combinations of antimicrobials: area under the bactericidal activity curve; Barriere SL et al.; We have applied a new method of assessment of bactericidal activity in vivo . Calculation of area under the bactericidal activity curve (AUBC) provides a value which involves both the in-vitro bactericidal activity of the drug and its pharmacokinetics . With this method, the activity of combinations of antimicrobials can be assessed in vivo by comparing the AUBC obtained from the combination vs the sum of AUBC from each drug alone . This method may allow a more rational selection of dosage regimens and drug combinations for the treatment of infections. Rev Infect Dis, 1985 Jul-Aug, 7(4), 547 - 59 Responsibility of the infectious disease community for optimal use of antibiotics: views of the membership of the Infectious Diseases Society of America; Kunin CM et al.; A questionnaire was sent to 1,500 members and fellows of the Infectious Diseases Society of American to elicit their views on the use of antimicrobial agents . The rate of return was 58.7% . A high proportion of respondents (86.8%) stated that they had a strong professional interest in antimicrobial therapy and were active in infection control and antibiotic use in their institutions--488 hospitals including community, university, children's, and governmental facilities . The membership was concerned with problems of antibiotic use in hospitals, laboratory methods of reporting susceptibility, promotional practices of industry, and development of microbial resistance . Members were troubled by how best to deal with excessive use of antibiotics in hospitals . Respondents strongly supported efforts to improve the control of antimicrobial use in hospitals and to examine issues of drug use and resistance in developing countries; they provided suggestions for development of a code of ethical conduct with industry. J Appl Bacteriol, 1985 Jul, 59(1), 61 - 3 A note on an in vitro test system to compare the bactericidal properties of wound dressings; Holland KT et al.; An in vitro method of comparing the antimicrobial properties of dressings used on human skin is described and has been tested with two samples of tulle gras . The method has advantages over agar diffusion methods by providing flexibility of test conditions and kinetic data for analysis. J Trauma, 1985 Jul, 25(7), 639 - 43 Prophylactic antibiotics and no antibiotics compared in penetrating chest trauma; Mandal AK et al.; Conflicting data exist concerning the value of antimicrobial prophylaxis in chest trauma . In a prospective and randomized study, we assessed the value of antibiotic prophylaxis in 80 consecutive relatively young, predominantly male patients admitted for gunshot or knife injuries of the chest . Forty patients received intravenous doxycycline and 40 received no antibiotic . Between the two groups we found no difference in the incidence of postoperative infections: we conclude that routine antibiotic prophylaxis is not recommended in penetrating chest trauma in patients such as ours. Pediatr Neurol, 1985 Jul-Aug, 1(4), 201 - 9 Current therapy of acute bacterial meningitis in children: Part II; Bell WE et al.; Despite many advances in the past decade in the development of new antimicrobials, acute bacterial meningitis continues to have significant morbidity and mortality in infants and children . Regardless of the effectiveness of the antibiotic preparations, future improvements in outcome is most likely to occur because of more rapid diagnosis and initiation of therapy . The standard penicillins, chloramphenicol, and the aminoglycosides continue to hold an important place in treatment . The recent introduction of new extended spectrum penicillins, including piperacillin and mezlocillin, in addition to the development of the third generation cephalosporins, have expanded alternatives for treating bacterial meningitis . The most appropriate and effective antibiotic or combination of antibiotics must first be selected; thereafter, its use must be monitore to identify its beneficial effects as well as possible adverse effects. Antibiot Med Biotekhnol, 1985 Jul, 30(7), 498 - 503 {Kinetics of the antimicrobial effect in a dynamic system: the microcalorimetric recording method and choice of parameters for characterizing kinetic curves}; Chernykh VM et al.; The kinetics of the in-vitro antimicrobial effect of sisomicin on E . coli, A 20363 was studied microcalorimetrically in a dynamic model simulating the pharmacokinetic profiles (intramuscular administration in a dose of 1 mg/kg) of the antibiotic obeying the one-compartmental model with first-order absorption . The microcalorimetric method was more accurate than the count of the colony forming units (CFU) . Unlike the CFU method, it permits continuous recording of the process and unlike the turbidimetric method, it is more sensitive and selective . For quantitative characteristic of the curves of the antimicrobial effect kinetics it is suggested to use a new parameter, the effect duration (Td) which is determined by the difference in the moment of the antibiotic administration into the dynamic model (Tin) and the moment (Tout) when the rate of heat production or the number of the CFU or the optical density during the microbial secondary growth was the same as that at Tin . It was shown that the values of Td estimated in experiments with recording of the antimicrobial effect by different methods are similar . Evaluation of Td may be useful in predicting the optimal dosing intervals. J Infect, 1985 Jul, 11(1), 51 - 5 Legionella lung abscess after renal transplantation; Bauling PC et al.; Although Legionella infections have been widely reported, the clinical importance of Legionella lung abscess has not been sufficiently emphasised . A renal transplant recipient with a pulmonary abscess due to Legionella pneumophila is presented and 21 other cases from the literature are reviewed . Seven abscesses arose in renal transplant patients . Even though an abscess may develop during treatment, superimposed infection with other micro-organisms appears to be uncommon, and an abscess may be expected to resolve with prolonged appropriate antimicrobial therapy alone . Recognition of lung abscess as a complication of legionella infection will therefore prevent unnecessary operations. J Am Vet Med Assoc, 1985 Jul 1, 187(1), 41 - 5 Immune mechanisms of the bovine udder: an overview; Nickerson SC; Understanding basic defenses of the udder is instrumental in developing measures to prevent mastitis . The teat canal is the first defense against pathogens, providing a physical barrier and antimicrobial substances . When bacteria breach the teat canal, milk leukocytes provide a second defense by ingesting pathogens . Intramammary devices have been used experimentally to increase leukocyte numbers and to enhance destruction of bacteria . Milk antibodies opsonize and lyse bacteria, neutralize toxins, and prevent adhesion to tissue . Vaccinating cows against mastitis generally has been unsuccessful; however, immunization is useful in controlling specific bacterial strains . Antibody-producing plasma cells preferentially accumulate in internal teat end tissues . Because bacteria contact these tissues to reach milk-producing areas of the udder, an immunostimulant to enhance locally the protective nature of plasma cells may decrease the occurrence of infection. Oral Surg Oral Med Oral Pathol, 1985 Jul, 60(1), 125 - 9 The granulocytopenic patient: another consideration for antimicrobial prophylaxis; Otis LL et al.; Infection in the granulocytopenic patient is often life-threatening, and the frequency and severity of infection are increased regardless of the cause of leukocyte suppression . Trimethoprim-sulfamethoxazole plus nystatin is known to be effective in preventing colonization and infection by the primary pathogens responsible for the morbidity and mortality associated with granulocytopenia . When treating granulocytopenic patients, clinicians should use proper barrier techniques to minimize nosocomial colonization . When foci of oral infection are present or bacteremia is predictable, appropriate antibiotics should be prescribed. Arch Surg, 1985 Jul, 120(7), 829 - 32 Intraoperative serum and tissue activity of cefazolin and cefoxitin; DiPiro JT et al.; We determined the intraoperative serum and wound-muscle concentrations of cefazolin and cefoxitin in 40 patients who were undergoing cholecystectomies . The study employed an open-label design in which all of the patients randomly received cefazolin sodium (20 mg/kg) or cefoxitin sodium (30 mg/kg) intravenously while the patient was in the ward ("on call") or with the induction of anesthesia . Multiple blood and wound-muscle samples were collected intraoperatively and assayed for their cephalosporin concentrations . Considerable differences in intraoperative serum and tissue concentrations between antibiotics were apparent; there were usually higher levels of cefazolin . In all of the patients who received cefazolin sodium, the antimicrobial was detectable in wound tissue at wound closure, while it was detectable in 86% and 38% of patients who received cefoxitin sodium with anesthesia and on call, respectively . Because cefoxitin has a much shorter elimination half-life than cefazolin it seems prudent to administer the agent as close to the start of the operation as possible, and readminister the agent every two to three hours until the wound is closed . For cefazolin, on-call administration appears to be acceptable, with readministration not required for at least four hours. Infect Immun, 1985 Jul, 49(1), 212 - 8 Antimicrobial activities of dialysate-elicited and resident human peritoneal macrophages; Peterson PK et al.; Recent studies of the antimicrobial capacity of peritoneal macrophages (PM phi) isolated from patients undergoing chronic peritoneal dialysis have raised the question of whether these cells might be analogous to stimulated or activated murine PM phi . To explore this possibility, we compared PM phi from these patients (dialysate-elicited PM phi) with PM phi obtained from women undergoing laparoscopy (resident PM phi) in several in vitro assays of phagocyte function . Although bacterial phagocytosis by cells from both groups of donors was similar, significant differences were found in their chemiluminescence responses to opsonized zymosan . Although the mean peak luminol-enhanced chemiluminescence response of dialysate-elicited PM phi was 4.7 X 10(5) cpm, that of resident PM phi was only 1.3 X 10(5) cpm (P less than 0.05) . In a lucigenin-enhanced chemiluminescence assay, dialysate-elicited PM phi again generated significantly greater chemiluminescence than did resident PM phi, suggesting that dialysate-elicited PM phi have a relatively increased capacity for O2- production . Using a fluorochrome microassay to assess the intracellular candidicidal activities of these cells, we found that dialysate-elicited PM phi killed 17% of cell-associated blastospores compared with only 1.5% killing by resident PM phi (P less than 0.05) . These investigations led us to conclude that results of studies of the functional activity of dialysate-elicited PM phi cannot necessarily be extrapolated to resident PM phi and that dialysate-elicited PM phi do in some respects behave as stimulated or activated cells. Antimicrob Agents Chemother, 1985 Jul, 28(1), 165 - 6 Penetration of sulbactam-ampicillin and clavulanic acid-amoxicillin into the pelvic peritoneum; Houang ET et al.; Sixteen patients were given single intravenous injections of ampicillin (0.5 g) with sulbactam (0.5 g), and 15 patients were given amoxicillin (1 g) with clavulanic acid (0.2 g) before elective laparoscopy . At 2 h after dosing, the concentrations of the four compounds in serum and in the peritoneal fluid from the Pouch of Douglas and the ratio of each combination reached levels shown to be effective for antimicrobial activity in vitro. Pediatrics, 1985 Jul, 76(1), 79 - 83 Adenoviral diseases in children: a study of 105 hospital cases; Ruuskanen O et al.; The clinical findings for 105 children hospitalized with adenoviral infection were studied prospectively . In 82 children, the diagnosis was based on the detection of adenovirus antigen in the nasopharyngeal specimens and in 17 children in the feces . In the remaining six patients, findings from nasopharyngeal specimens were negative but a significant increase in CF (complement fixation) titers was detected . The clinical picture of adenoviral infection was characterized by high-grade (mean 39.4 degrees C) and prolonged fever (mean duration 5.4 days) . Tonsillitis, otitis, and gastroenteritis were the most common illnesses . In 17% of the patients, no identifiable focus of infection could be demonstrated; nine children with no identifiable focus of infection had febrile convulsions . The WBC count and ESR varied from normal values to values seen in bacterial infections; thus it was difficult to distinguish adenoviral disease from a bacterial disease . Forty-five children were referred to the hospital due to infection unresponsive to antimicrobial therapy . The rapid detection of adenovirus antigen in nasopharyngeal specimens or feces proved to have a great clinical value in the diagnosis of adenoviral infections. Am J Med, 1985 Jun 28, 78(6B), 38 - 44 Emerging perspectives in management and prevention of infections of the respiratory tract in infants and children; Klein JO; New products, new procedures, new information, and new legislation will have a significant impact on management and prevention of respiratory infections in children . Current areas of investigation include the changing epidemiology (increased number of children in day care), concern about morbidity of common infections (hearing impairment and effect on development of speech and language due to otitis media), and new modes of microbiologic diagnosis (antigen detection) . New antimicrobial agents have wider spectrums of activity, increased concentrations in body fluids, and lesser toxicity than available drugs . New uses of old drugs are identified (value of erythromycin for Legionella pneumophila, Chlamydia trachomatis, and Mycoplasma pneumoniae) . Increased usage of chemoprophylaxis for prevention of recurrences of acute otitis media follows publication of impressive results of recent studies . New conjugate polysaccharide vaccines are immunogenic in young infants . Finally, and of major importance to children, physicians, and manufacturers, is vaccine liability legislation, now in congressional committee. S Afr Med J, 1985 Jun 22, 67(25), 1007 - 9 A comparison of the effects of tobramycin and netilmycin on the functions of human polymorphonuclear leucocytes and lymphocytes in vitro and in vivo; Anderson R et al.; The effects of the antimicrobial agents tobramycin and netilmycin on the functions of human polymorphonuclear leucocytes (PMNLs) and on the mitogen-induced transformation of lymphocytes have been investigated both in vitro and in vivo before and 1 hour after a single intramuscular injection of the antibiotics . Neither antibiotic affected the migratory, phagocytic or antimicrobial capacities of PMNLs or the proliferative responses of lymphocytes to mitogens, at therapeutic concentrations or at 10-100-fold greater than therapeutic concentrations . Likewise, no alterations in these leucocyte functions accompanied the intramuscular injection of either antibiotic . neither tobramycin nor netilmycin therefore interferes with host immunodefence mechanisms. Schweiz Med Wochenschr, 1985 Jun 15, 115(24), 831 - 6 {Alloimmune neonatal neutropenia: clinical observations and therapeutic results}; Hinkel GK et al.; Alloimmune neonatal neutropenia is a rare disease . A family with four affected newborns is described in which the course of the disease aggravated from the first to the third child . The third child died from generalized infection . In the mother's serum specific antibodies against neutrophils (anti-NA 1) were detected which reacted with cell suspensions from the father and the other children . In the fourth child no neutrophils were present even immediately after birth . In this child the diaplacental transferred antibodies were detectable in falling concentrations over 8 weeks . The number of neutrophils normalized when the antibodies disappeared . Infection in the newborn was prevented by care in an environment poor in bacteria and by antimicrobial prophylaxis . Repeated exchange transfusions with NA 1-free blood only lowered the antibody titer . Transfusions of white blood cell concentrates had only shortlived effects on the neutropenia. J Pediatr Gastroenterol Nutr, 1985 Jun, 4(3), 381 - 7 Value of breath hydrogen analysis in management of diarrheal illness in childhood: comparison with duodenal biopsy; Davidson GP et al.; Breath hydrogen tests were carried out on 157 children either because they had chronic diarrhea or because they were on disaccharide-free diets . Lactose malabsorption was common in patients with postgastroenteritis syndrome (43%), and sucrose malabsorption was readily detected in patients with congenital sucrase-isomaltase deficiency . Secondary sucrose malabsorption and small bowel bacterial overgrowth were also detected . In predicting clinical response to dietary change, the breath hydrogen test, as we perform it, was clearly the most specific and sensitive and had a predictive accuracy of 96% . Duodenal biopsy results obtained from 48 of the children gave a 23% incidence of misleading disaccharidase results (16.7% falsely normal, 6.3% falsely abnormal), but biopsy remains vital in the diagnosis of congenital sucrase-isomaltase deficiency . False negative breath hydrogen results were obtained on occasions (4%) but in most instances were related to recent antimicrobial therapy or failure of the breath test mechanics (e.g., vomiting, length of sampling). Appl Environ Microbiol, 1985 Jun, 49(6), 1407 - 11 Inhibition by antimicrobial food additives of ochratoxin A production by Aspergillus sulphureus and Penicillium viridicatum; Tong CH et al.; The effects of antimicrobial food additives on growth and ochratoxin A production by Aspergillus sulphureus NRRL 4077 and Penicillium viridicatum NRRL 3711 were investigated . At pH 4.5, growth and toxin production by both A . sulphureus and P . viridicatum were completely inhibited by 0.02% potassium sorbate, 0.067% methyl paraben, 0.0667% methyl paraben, and 0.2% sodium propionate . At pH 5.5, 0.134% potassium sorbate and 0.067% methyl paraben completely inhibited growth and ochratoxin A production by both fungi . Sodium bisulfite at 0.1%, the maximum level tested, was found to inhibit growth of A . sulphureus and P . viridicatum by 45 and 89%, respectively . Toxin production was inhibited by 97 and 99%, respectively . Sodium propionate (0.64%) at pH 5.5 inhibited growth of A . sulphureus and P . viridicatum by 76 and 90%, respectively . Toxin production was inhibited by greater than 99% for each fungus . Antimicrobial agents were ranked as to effectiveness by comparing the level required for complete inhibition of ochratoxin A production to the highest antimicrobial agent level normally used in food . At pH 4.5, the most effective inhibitor of growth and toxin production was potassium sorbate, followed by sodium propionate, methyl paraben, and sodium bisulfite, respectively, for both fungi . However, at pH 5.5, the most effective antimicrobial agents for inhibiting ochratoxin production were methyl paraben and potassium sorbate, followed by sodium propionate . Sodium bisulfite was not highly inhibitory to these toxigenic fungi at the higher pH value tested. Am J Hosp Pharm, 1985 Jun, 42(6), 1343 - 7 Controlling cephalosporin and aminoglycoside costs through pharmacy and therapeutics committee restrictions; Hayman JN et al.; The cost-reducing effect of antibiotic restrictions imposed by a pharmacy and therapeutics (P & T) committee was evaluated . The pharmacy department developed guidelines restricting the use of second-generation cephalosporins and aminoglycosides in cooperation with the infectious disease division . The P & T committee approved the restrictions, and the pharmacy department disseminated information on the program to the hospital's physicians . Specific indications were developed for the use of amikacin, tobramycin, cefoxitin, and cefamandole . In order to prescribe a restricted antibiotic, physicians are required to write an approved indication on the physician's order form . Residents cannot prescribe restricted antibiotics for unapproved indications unless they acquire the signature of an attending physician . Pharmacy personnel closely monitor the restricted antibiotic use and enforce the established guidelines . The major impact of the restrictions was the reversal of a previous trend toward the use of more expensive second-generation cephalosporins and tobramycin to the use of first-generation cephalosporins and gentamicin . Injectable antibiotic expenses decreased by $193,172 in the first 12 months of the program . Antibiotic restrictions imposed by the P & T committee were effective in reducing the cost of antimicrobial therapy. J Med Chem, 1985 Jun, 28(6), 733 - 40 Synthesis and antimicrobial evaluation of bicyclomycin analogues; Williams RM et al.; The synthesis and antimicrobial evaluation of novel bicyclomycin analogues are described . The series of analogues were prepared from the basic 8,10-diaza-2-oxabicyclo{4.2.2}decane-7,9-dione, 7,9-diaza-2-oxabicyclo{3.2.2}nonane-6,8-dione 8,10-diaza-5-methylene-2-oxabicyclo{4.2.2}decane-7,9-dione and 7,9-diaza-4-methylene-2-oxabicyclo{3.2.2}nonane-6,8-dione nuclei . For compounds where R1 = p-methoxybenzyl, deprotection of the lipophilic amides with ceric ammonium nitrate affords the corresponding lipophobic free amides . The basic bicyclic nucleus of bicyclomycin (8h, R1 = R2 = R3 = R4 = H) has been synthesized for the first time as well as increasingly more complex congeners bearing the C-6 OH, 5-methylene; C-1'-C-3' trihydroxyisobutyl group . In general, it has been found that the bicyclic nucleus of bicyclomycin is devoid of antimicrobial activity, the entire structure of bicyclomycin being generally obligate for activity . In one instance, the racemic analogue 10c (R1 = CH2Ph, R2 = OH, R3 = H) showed interesting antimicrobial activity against several Gram-positive organisms; the minimum inhibitory concentrations were of the same order of magnitude as bicyclomycin displays toward Gram-negative organisms . Totally synthetic (+/-)-bicyclomycin was half as active as the natural antibiotic . The design, synthesis, and antimicrobial activity (and/or lack thereof) of bicyclomycin and the analogues are discussed in the context of a proposed chemical mechanism of action. J Appl Toxicol, 1985 Jun, 5(3), 178 - 81 The effect of Alcide, a new antimicrobial drug, on rat blood glutathione and erythrocyte osmotic fragility, in vitro; Abdel-Rahman MS et al.; Alcide is an antimicrobial drug which has been demonstrated to kill a variety of common pathogenic bacteria as well as fungi, in vitro . This agent is supplied in liquid and gel forms and consists of two parts, one of which contains sodium chlorite, while the other contains lactic acid as the active ingredients . Mixing of the two parts prior to use produces chlorine dioxide (ClO2), a strong oxidizing agent . A dose-dependent decrease in glutathione content and erythrocyte osmotic fragility occurred after incubation of whole blood with Alcide . Glutathione concentration and erythrocyte osmotic fragility approached the control values after 240 min of incubation with Alcide containing 1 mM NaClO2 . The addition of exogenous glutathione (50 mg 100 ml-1) or glutathione reductase and NADPH to rat blood in the presence of Alcide returned erythrocyte osmotic fragility to control values . Treatment of rat blood with Alcide did not change glutathione reductase or glutathione peroxidase activities after 1 h of incubation. Biochem Pharmacol, 1985 Jun 1, 34(11), 1963 - 70 Metabolic and morphologic effects of the antimicrobial agent nitrofurantoin on human erythrocytes in vitro; Dershwitz M et al.; We have reported previously that the antimicrobial nitrofurantoin stimulates superoxide production and methemoglobin formation from HbO2 as an isolated hemeprotein and in hemolysates {M . Dershwitz and R . F . Novak, J . biol . Chem . 257, 75 (1982); M . Dershwitz and R . F . Novak, J . Pharmac . exp . Ther . 222, 430 (1982)} . The production of hydrogen peroxide and methemoglobin by nitrofurantoin has been determined in normal erythrocytes in vitro . Hydrogen peroxide production increased 5-fold during a 20-hr incubation in the presence of 840 microM nitrofurantoin, while methemoglobin content increased to over 20% of the total hemoglobin concentration of the cells . Consequent metabolic and morphologic alterations also occurred . Concomitant with nitrofurantoin-stimulated hydrogen peroxide production were time- and concentration-dependent decreases in cellular levels of GSH and ATP, as well as alterations in red cell morphology . Significant differences in GSH and ATP levels between control and nitrofurantoin-treated erythrocytes occurred after 12 hr and proceeded maximally from 18 to 21 hr . After a 21-hr incubation, 840 microM nitrofurantoin caused the cellular GSH and ATP levels to fall 65 and 75%, respectively, while controls exhibited only 29 and 43% decreases in ATP and GSH levels, respectively . Studies on the concentration dependence of such decreases demonstrated that the EC50 values for depletion of GSH and ATP were similar in blood obtained from an individual donor . The EC50 values varied from approximately 10 microM to 100 microM among the various donors whose blood was studied . Incubation of normal red cells with nitrofurantoin also resulted in an increased conversion of red cells to echinocytes as observed by scanning electron microscopy . These metabolic effects, coupled with increased oxidative stress via hydrogen peroxide generation, lend support to the mechanism for nitrofurantoin-induced hemolysis in erythrocytes compromised by certain enzyme deficiencies which result in low basal levels of GSH or diminished rates of GSH synthesis. Arch Otolaryngol, 1985 Jun, 111(6), 406 - 8 Tuberculous petrous apicitis; Kearns DB et al.; Tuberculous osteomyelitis of the temporal bone is a rare and dangerous entity that should be included in the differential diagnoses of infectious processes of the base of skull . A 21-year-old man presented with petrous apicitis, extradural and retromandibular abscesses, and paresis of the facial nerve . Immediate middle fossa craniotomy and drainage of the extradural abscess, in combination with a mastoidectomy, incision and drainage of the facial abscess, and antimicrobial therapy for gram-positive cocci, failed to check the destructive nature of the infection . The patient subsequently developed labyrinthitis, sensorineural hearing loss, and meningitis . Intraoperative biopsy specimens confirmed the presence of tuberculoid granulomas, and the infectious process responded to triple-drug therapy . Tuberculosis of the temporal bone should not always be considered an indolent infection . The management of tuberculous infection of the temporal bone is outlined. Am Rev Respir Dis, 1985 Jun, 131(6), 869 - 74 Mycoplasma pneumoniae induces cytotoxic activity in guinea pig bronchoalveolar cells; Kist M et al.; Precultured guinea pig alveolar macrophages (AM) and freshly harvested alveolar cells (FHAC) activated by interaction with Mycoplasma pneumoniae were cytotoxic for xenogeneic 75selenomethionine-labeled tumor target cells . Phagocytosis of whole opsonized or nonopsonized M . pneumoniae cells was more effective in eliciting cytotoxicity than uptake of sonicated microorganisms . The addition of living mycoplasma cells to the assay system enhanced the cytotoxic effect considerably . Target cells were significantly more susceptible to the cytotoxic action of phagocytes if they were coated with mycoplasma antigen or cocultured together with M . pneumoniae . The activation of the phagocytes could be inhibited by 2-deoxy-D-glucose but not by antimicrobial substances suppressing mycoplasma protein synthesis . It was accompanied by 51Cr release without detectable signs of cell damage . The supernatants of activated cells were cytotoxic for approximately 24 h . Inhibition, release, and cytotoxic activity indicate the necessity of an intact metabolism of the effector cells and suggest a secretion of cytotoxic substances. Pathol Biol (Paris), 1985 Jun, 33(5 Pt 2), 493 - 6 {Structure-activity relationship of semi-synthetic derivatives of the PIA component of pristinamycin}; Paris JM et al.; Pristinamycin is a naturally occurring streptogramin made up of 2 groups of synergistic components (PI and PII) . Because these components are not water soluble, use of pristinamycin has up till now been confined to the oral route . Water soluble semisynthetic derivatives of the PIA component, appropriate for parenteral use, have lately been developed . PIA is a peptidic macrolactone . As opening of the lactone results in total loss of biologic activity, semisynthesis must spare this function and preserve the macrocycle . Reactions at 5 gamma and 5 delta yielded 4 families of derivatives . Antimicrobial activity has been studied for more than 80 compounds . Several derivatives are promising as they are water soluble and have in vitro and in vivo (mice) activities similar to those of the original PIA component. J Antimicrob Chemother, 1985 Jun, 15(6), 685 - 93 Antimicrobial effects of cefotaxime as studied by the potentiometric measurement of lipoic acid reduction in Escherichia coli cultures; Junter GA et al.; Continuous potential-time measurements of lipoic acid reduction by cultures of Escherichia coli were carried out in the presence of increasing amounts of cefotaxime . Original information on the kinetics of action and antibacterial activity of the drug was deduced from the resulting potential-time curves and confirmed by classical measurements of bacterial growth and substrate consumption . In particular, surprisingly stimulative effects of cefotaxime on the reductive activity of organisms were elicited by the potentiometric technique, and are discussed at the cellular level. Int J Pept Protein Res, 1985 Jun, 25(6), 640 - 7 Synthesis of analogs of K-582A, an antibiotic heptapeptide; Mihara H et al.; K-582 A, an antibiotic heptapeptide, has a sequence of H-L-Arg-L-Arg(OH)-D-Orn-L-Thr-D-Orn-L-Lys-D-Tyr-OH (Arg(OH), threo-gamma-hydroxyarginine) . In order to investigate the relationship between structure and antimicrobial activity, four shortened analogs, des-L-Arg1, L-Arg(OH)2-K582 A (pentapeptide), des-L-Arg(OH)2-K-582 A (hexapeptide) and their N-acetyl derivatives, were synthesized by the conventional method . None of them, however, showed any antimicrobial activity . Three more analogs, {L-Lys2}K-582 A, {L-Orn2}K-582 A and {L-Arg2}K-582 A, were synthesized . Among them, only {L-Arg2}K-582 A showed substantial activity against Candida krusei and Saccharomyces rouxii, indicating that the presence of a guanidyl side chain at position 2 is an essential factor for the induction of activity. J Clin Hosp Pharm, 1985 Jun, 10(2), 185 - 92 A comparison of the antimicrobial activities of noxythiolin and formaldehyde solutions; Gorman SP et al.; The availability of a rapid and highly specific polarographic method of analysis for formaldehyde enabled investigation of the rate of formaldehyde release from noxythiolin solutions and actual concentrations of formaldehyde in solutions during clinical use and storage . The antimicrobial activity of noxythiolin solutions, equivalent pure formaldehyde solutions and N-methylthiourea individually or in combination was examined against standard bacteriological strains and clinical isolates . Several interesting observations were made . Clinical isolates were found to be relatively susceptible to noxythiolin in contrast to laboratory strains . The growth phase of the organism radically affects activity, early exponential phase cells being susceptible to 1.0% noxythiolin . Levels of formaldehyde detected in fresh noxythiolin solutions are extremely low and would not appear to be solely responsible for the antimicrobial activity observed. J Am Acad Dermatol, 1985 Jun, 12(6), 1026 - 31 Pseudomonic acid, a new antibiotic for topical therapy; Wuite J et al.; Pseudomonic acid, a new wide-spectrum antimicrobial agent, was evaluated as a 2% formulation in a cream . Animal studies showed that this formulation was just capable of penetrating the skin . When administered parenterally to animals, pseudomonic acid was converted to inactive metabolites that were quickly eliminated from the body . When pseudomonic acid was applied as a cream to human skin, no sensitization was observed . In an open clinical study, sixty-eight patients with skin infections (mostly superficial conditions such as impetigo, infected eczema, folliculitis, or balanitis) applied pseudomonic acid cream three times a day for 5 days . In fifty patients the infections completely cleared within 2 days of the end of therapy, and considerable clinical improvement was noted in sixteen more . One patient stopped the treatment prematurely due to local burning pain, and one patient could not be evaluated clinically. J Clin Microbiol, 1985 Jun, 21(6), 941 - 6 Evaluation of the BACTEC radiometric method for detection of 1% resistant populations of Mycobacterium tuberculosis; Tarrand JJ et al.; BACTEC and conventional methods of antimicrobial susceptibility testing were compared with the use of artificial mixtures of 1% resistant and 99% susceptible Mycobacterium tuberculosis strains . Inocula for the assays were prepared on the basis of radiometric readings . A total of 40 resistant strains were tested: 18 were resistant to isoniazid, 16 to rifampin, 5 to streptomycin, and 1 to ethambutol . The BACTEC method detected 27 of 39 strains at the greater than 0.5% resistance level, whereas the conventional plate method detected only 8 of 40 . In addition, the results of the BACTEC assay were closer to the expected 1% resistance level (0.7%) than were the data obtained with the proportional plate method (0.3%; P = 0.001) . This difference was most striking with the isoniazid-resistant strains . The precision of the assay methods was quite different (coefficients of variation, 26% for BACTEC and 54% for plates; P = 0.0002) . Streptomycin-resistant strains had the highest variability in both assay methods . A 1-day delay in calculating the BACTEC data after the control vial reading was equal to or greater than 30 resulted in a 25% reduction in the calculated level of resistance (0.7 to 0.53) . By adhering exactly to the recommended procedures for the BACTEC test method and by using log-phase inocula, this method shows better precision and accuracy at the 1% resistance level than does the proportional plate method. Farmaco {Sci}, 1985 Jun, 40(6), 404 - 16 Chemotherapeutic agents with an imidazole moiety . I . Synthesis and antifungal activities of 1-aryl-4-p-nitrophenylimidazoles; Porretta GC et al.; The synthesis and antifungal activities of 1-aryl-4-p-nitrophenylimidazoles and their 2-mercaptoderivatives is reported . Antimicrobial data in comparison with antifungal antibiotic pyrrolnitrin attributed the best activity to 1-p-methoxyphenyl-4-p-nitrophenylimidazole . The tested compounds were prepared by reacting p-nitrophenacylanilines with potassium thiocyanate in acidic medium to afford 1-aryl-2-mercapto-4-p-nitrophenylimidazoles, which were then transformed into the title compound by treatment with nitric acid. Pediatr Res, 1985 Jun, 19(6), 561 - 5 Sequential changes in the antimicrobial protein concentrations in human milk during lactation and its relevance to banked human milk; Lewis-Jones DI et al.; The concentrations of eight antimicrobial proteins, 11S IgA, IgG, IgM, alpha 1-antitrypsin, lactoferrin, lysozyme, C3, and C4 were measured in sequential samples of colostrum, transitional and mature milk from 47 women in Merseyside, England by single radial immunodiffusion . Concentrations were highest in colostrum and then declined until relatively stable concentrations were reached in mature milk . A wide variation in protein concentrations was noted in the milk from different individuals at any given postpartum time interval and this was particularly so during the first 4 days postpartum . The decline in individual antimicrobial protein concentrations seen in samples of transitional milk appeared to take a variable period of time to stabilize to mature milk concentrations of each protein . These variations may reflect different rates of transport or secretion of these proteins from the alveolar epithelial cells into the alveolar lumen . Because of the wide variations in antimicrobial proteins observed in milk samples from the individuals in this study at similar postpartum time intervals, it is suggested that banked milk should be monitored not only for bacterial contamination, but also for levels of antimicrobial proteins, if it is considered that a major advantage of unprocessed human milk is the immune protection which it confers. Scand J Dent Res, 1985 Jun, 93(3), 192 - 7 Tetracycline-impregnated enamel and dentin: duration of antimicrobial capacity; Bjorvatn K et al.; The present study was done in order to examine the durability of the tetracycline-induced antimicrobial capacity, and also to assess the reproducibility of the bacterial growth-inhibitory assay used . Standardized enamel and dentin specimens were impregnated in aqueous solutions of tetracycline HCl, oxytetracycline HCl or doxycycline HCl, rinsed in water, and stored dry for 200 days . Another series of specimens was impregnated in solutions of doxycycline HCl and then rinsed in tap water for varying periods up to 35 days . In addition, drug-impregnated specimens were used for reproducibility tests without storage or prolonged rinsing . Impregnated specimens were tested for antimicrobial capacity on agar plates seeded with S . sanguis . After 24 h aerobic incubation in 10% CO2 atmosphere, the plates were inspected and the diameter of the bacterial growth inhibition zones measured . The drug-impregnated enamel and dentin specimens consistently demonstrated growth-inhibitory capacity . The results of the reproducibility tests showed moderate intrasample and day-to-day variation . Two hundred days of dry storage or 35 days soaking in water reduced, but did not eliminate, the bacterial growth-inhibitory capacity of the impregnated dental specimens . The results show that a short-term exposure of dental hard tissues to tetracyclines may result in a long-lasting antibacterial capacity. Int Dent J, 1985 Jun, 35(2), 124 - 32 The development and clinical use of acrylic strips containing anti-microbial agents in the management of chronic periodontitis; Addy M et al.; Several methods have been used to deliver antimicrobial drugs into periodontal pockets . This study was concerned with the development of acrylic in strip form for such an application . Initially the release of chlorhexidine acetate from cold cured acrylic strips into water, was measured spectrophotometrically over a 15 day period . The release of chlorhexidine was highest on day 1, was reduced considerably by day 2 and then fell progressively to day 15 . With the exception of the release on day 1 there was little difference in daily release from drug admixtures between 40 to 80 per cent . Comparison of the release of chlorhexidine, metronidazole and tetracycline demonstrated a similar release pattern for metronidazole and chlorhexidine but the daily release of tetracycline was considerably less . A bioassay indicated that all drugs were released in active form . In a clinical study chlorhexidine, tetracycline and metronidazole rods were placed in periodontal pockets for 2-3 days and the effects monitored by dark field microscopy . All drugs produced a proportional increase in cocci and marked reductions in other organisms, notably the curved and motile rods and spirochaetes . The effects of metronidazole and tetracycline were greater than those of chlorhexidine . A second clinical study compared the effects of metronidazole and tetracycline strips placed for 2 weeks . Clinically, both treatment methods had immediate effects upon pocketing, bleeding on probing and crevicular flow, which for metronidazole were maintained to the 3-month follow-up period . For tetracycline, the bleeding and crevicular flow were significantly reduced and maintained to the 3-month period but the initial pocket reduction returned to baseline levels by 3 months.(ABSTRACT TRUNCATED AT 250 WORDS) Infect Control, 1985 Jun, 6(6), 226 - 30 Hospital usage of parenteral antimicrobial agents: a gradated utilization review and cost containment program; Pelletier LL Jr; Forty percent to 60% of antimicrobial agents administered in hospitals without effective antimicrobial review and control programs are not needed . Excessive use of antimicrobial agents in the hospital promotes colonization of patients with resistant organisms, needlessly exposes them to the risk of an adverse drug reaction, and increases the cost of care . A gradated antimicrobial utilization review program is presented that determines hospital usage, develops guidelines for appropriate cost-effective drug administration, provides several options for implementation, and monitors outcome so that measures can be modified for specific situations . The techniques used are basic epidemiologic measures currently used to assess hospital infections. J Neurosurg Nurs, 1985 Jun, 17(3), 210 - 4 Drug stop: newer beta-lactam antimicrobials; McCloskey WW et al.; The newer beta-lactam antimicrobials offer an expanded spectrum of activity and a similar safety profile compared to their older counterparts . The penicillins appear to be useful in the combination treatment of systemic Pseudomonal infections, and cefuroxime and the third generation cephalosporins may be valuable in the management of meningitis caused by susceptible organisms . However, to avoid the emergence of resistance and to help contain the cost of antimicrobial therapy, these newer agents should be reserved for those clinical situations where older beta-lactams would not be indicated. J Antibiot (Tokyo), 1985 Jun, 38(6), 699 - 705 Studies on a novel cytocidal antibiotic, trienomycin A . Taxonomy, fermentation, isolation, and physico-chemical and biological characteristics; Umezawa I et al.; A new antibiotic, trienomycin A, has been isolated from the culture broth of Streptomyces sp . No . 83-16 . The physico-chemical characteristics of the antibiotic suggested that it belongs to the group of ansamycin antibiotics with a triene moiety in the molecule . The molecular formula of trienomycin A is C36H50N2O7 (MW 622) . The antibiotic possesses potent cytocidal activity against HeLa S3 and PLC hepatoma cells at concentrations of 0.1 and 0.01 micrograms/ml (IC50 value) respectively . However, trienomycin A showed no antimicrobial activity against the bacteria, fungi and yeasts examined with the exception of weak activity versus Piricularia oryzae at a concentration of 1,000 micrograms/ml. JAMA, 1985 May 10, 253(18), 2700 - 4 Travelers' diarrhea . NIH Consensus Development Conference; Antimicrobially active alkaloids from Tabernaemontana chippii; From Tabernaemontana chippii root bark, forty-five alkaloids were isolated; thirty-four were fully characterized by means of their spectral data and/or co-tlc; eight alkaloids were new, four of them being 3-hydroxy derivatives of known dimeric voacamine type alkaloids . Most of the twenty-six known alkaloids belonged to the corynanthean, ibogan, or bisindole classes . The structures of eleven other alkaloids--all minor--were only partially elucidated, most of them being new alkaloids . All the dimeric alkaloids were shown to possess strong antimicrobial activity against gram-positive bacteria and moderate to weak activity against gram-negative bacteria. J Infect, 1985 May, 10(3), 240 - 8 Antibiotic advice based on an intra-operative Gram-stain during cholecystectomy; Sturm AW; Intra-operative microscopy of the bile was performed during cholecystectomy in 335 patients . Based on the results, individual antibiotic advice was given . Bacteria were seen in the Gram-stained smear from 96 patients of whom 86 had a positive culture . In five patients a negative Gram-stain correlated with a positive culture (sensitivity 94.5%, specificity 95%, positive predictive value 89.5% and negative predictive value 97.5%) . In only four patients (1.2%) did the antibiotic advice turn out to be wrong . Eight patients (2.4%) had signs of postoperative infection: one after wrong antibiotic advice, one who did not have prophylaxis because of false negative microscopy, four who did not have prophylaxis for clinical reasons but who had positive Gram-stains, and two despite apparently appropriate antimicrobial prophylaxis . An intra-operative Gram-stain as a guide to individual antibiotic advice given by a medical microbiologist during cholecystectomy is recommended. Rev Infect Dis, 1985 May-Jun, 7(3), 357 - 67 The use of antimicrobial agents for noninfectious diseases; Berger SA; Antimicrobial agents are used in the treatment of a variety of noninfectious diseases . Therapeutic action may be directed against the host immune system as well as against the microbe . Some actions conventionally classified as toxic may be therapeutically or diagnostically desirable under unusual clinical circumstances . Antibiotics are used for both their antimicrobial and antiinflammatory properties to treat several dermatologic and immune-mediated diseases . Tetracycline fluorescence indicates necrotic or malignant tissue and the depth of dermal burns . Tetracycline's affinity for new bone tissue formation has applications in both research and diagnostic assessments . Radiolabeled tetracycline can act as an imaging agent for the gall bladder and kidney . The sulfonamides and sulfones, chloramphenicol, metronidazole, and some aminoglycosides also have been demonstrated to have unusual therapeutic and diagnostic efficacy, albeit by mechanisms not always understood . Although not all reported unconventional applications of antimicrobial agents remain in use, sharpening awareness of their multifaceted actions should encourage broader understanding of all agents traditionally confined to specific uses. Rev Infect Dis, 1985 May-Jun, 7 Suppl 2, S318 - 26 Therapy for nonvenereal treponematoses: review of the efficacy of penicillin and consideration of alternatives; Brown ST; Penicillin therapy has been a crucial element in public health programs for control of nonvenereal treponematoses . The recommendations made by the World Health Organization on penicillin therapy and the literature substantiating the effectiveness of penicillin therapy are reviewed . In mass public health programs, the recommended penicillin regimen can confidently be used . Although penicillin is the drug of choice for all treponemal infections, some individuals will be allergic to this drug . For these persons tetracyclines are the most thoroughly evaluated alternative antimicrobial agent and seem highly effective . However, further comparative evaluations of various tetracycline regimens are needed if tetracyclines are required by more than the occasional individual . The long-acting tetracyclines may be particularly appropriate in minimizing problems of compliance. Mycopathologia, 1985 May, 90(2), 107 - 11 Studies of the effects of spherulin from Coccidioides immitis on human polymorphonuclear leukocytes; Galgiani JN; The effects of spherule lysate (spherulin) on human polymorphonuclear leukocyte (PMN) function was examined . PMN adherence to glass and capping was increased by spherulin, findings which may account for spherulin's interference with complement-mediated migration through cellulose ester filters . In contrast, PMN attachment to yeast, killing of bacteria, and effects on spherules were virtually unaffected by spherulin, suggesting that it does not directly inhibit PMN antimicrobial function. J Antimicrob Chemother, 1985 May, 15(5), 533 - 8 An in-vitro investigation of synergy and antagonism between antimicrobials against Chlamydia trachomatis; How SJ et al.; Chequerboard titrations of antimicrobials were carried out against Chlamydia trachomatis in vitro to assess possible synergy or antagonism . None of the antimicrobial pairs produced any detectable antagonism . Penicillin and ciprofloxacin showed independent activity . Tetracycline and penicillin, tetracycline and erythromycin, tetracycline and chloramphenicol, erythromycin and penicillin, and erythromycin and chloramphenicol showed additive inhibitory activity and limited synergy . Trimethoprim and sulphamethoxazole was the only combination to produce clear synergistic activity against Chlam . trachomatis in vitro. Farmaco {Sci}, 1985 May, 40(5), 315 - 24 {Antibacterial and antifungal agents . IV . Synthesis and antifungal activity of econazole analogs with pyrrole structure}; Corelli F et al.; The synthesis of analogues of antifungal econazole with a pyrrole moiety starting from 1-(4-chlorophenyl)-2-(1H-pyrrol-1-yl)ethanone and from 1-(4-chlorophenyl)-2-(1H-pyrrol-1-yl)ethanol is described . Results of antimicrobial screening of the new derivatives in comparison with econazole are also reported. Clin Nephrol, 1985 May, 23(5), 218 - 21 Pharmacokinetics of fosfomycin in hemodialyzed patients; Bouchet JL et al.; The pharmacokinetics of fosfomycin, an original antimicrobial agent, were investigated in 11 voluntary hemodialyzed patients . Fosfomycin, 2 g, was administered intravenously, 15 minutes before hemodialysis began in group 1 (6 patients), and just after hemodialysis in group 2 (6 patients) . Blood samples were collected during 8 hours (group 1) and during 44 hours (group 2) . Antibiotic concentrations were determined microbiologically . In group 1, half-life was 4.2 +/- 0.27 hours, total clearance 65.1 +/- 7.1 ml/mn and clearance by hemodialyzer 103 +/- 10 ml/mn . In group 2 plasma levels were 60 mg/l at the 44th hour and half-life was 48.8 +/- 17.5 hours . These results suggest that fosfomycin is actively eliminated by the hemodialyzer in group 1, and largely retained between two dialysis sessions in group 2 . As for therapy, intravenous administration of 2 g after dialysis and further administration after each succeeding session are proposed. Pediatr Infect Dis, 1985 May-Jun, 4(3), 330 - 5 Pneumonia: antimicrobial therapy for infants and children; Teele D; Pneumonia in infancy and childhood presents the practitioner with the frustrating problem of a disease that is self-limited in the majority but poses a real threat to the minority . Existing diagnostic methods are inadequate and are likely to remain so in the foreseeable future . In the absence of specific etiologic information, physicians must make decisions about use of antimicrobial therapy based only on probabilities that are themselves derived from less than perfect studies . It is the thesis of this review that, when confronted with a baby with pneumonia, the physician should perform a limited number of diagnostic tests and prescribe antimicrobial therapy . Choice of antimicrobial therapy is usually most heavily influenced by the age of the patient and only to a lesser extent by clinical presentation or results of laboratory tests. Pediatr Infect Dis, 1985 May-Jun, 4(3), 315 - 20 Neonatal infections; Bradley JS; The spectrum of neonatal infections continues to evolve with changes in the types and antibiotic susceptibilities of bacterial pathogens and the prominent appearance of new clinical syndromes of infection in the newborn intensive care unit . Fortunately with the development of new antibiotics and thorough reevaluation of older antibiotics in the neonate, effective antimicrobial therapy is still available . With the knowledge of national and local trends of infecting organisms, it is possible to select an accurate empiric antibiotic regimen for neonatal sepsis. J Cardiovasc Surg (Torino), 1985 May-Jun, 26(3), 307 - 9 Mycobacterium fortuitum infections of the mediastinum; Sethi GK et al.; The clinical course of a patient with M . fortuitum infection of the mediastinum following open heart surgery is presented . Cure was achieved by aggressive and thorough surgical debridement of the mediastinum (including the edges of the sternum and other involved tissues) and by the administration of antimicrobial agents which are not usually thought to be effective in the treatment of mycobacterial infections. J Cardiovasc Surg (Torino), 1985 May-Jun, 26(3), 270 - 4 A randomized, prospective study of perioperative antimicrobial prophylaxis for vascular access surgery; Bennion RS et al.; A blinded, randomized, prospective study of 38 chronic renal failure patients was done to evaluate perioperative antibiotics in the prevention of postoperative infection of vascular access prostheses . Expanded polytetrafluoroethylene (PTFE) hemodialysis grafts were placed either in radiocephalic (19) or femorosaphenous (19) position . Cefamandole or placebo was given intravenously 30 minutes prior to operation and six to 12 hours postoperatively . The overall infection rate for the group was 26.3 percent with two of 19 antibiotic-treated and eight of 19 placebo-treated patients developing an infection (p less than 0.04) . Grafts placed in the thigh have a greater risk of intraoperative contamination and infection . Postoperative infection associated with implantation of hemodialysis prostheses was significantly reduced by perioperative antimicrobials. Am Surg, 1985 May, 51(5), 262 - 4 Actinomycosis . Surgical aspects; Harris LF et al.; Actinomycosis is an anaerobic infection caused by actinomycetes, which are part of the normal flora in the oral cavity and intestine . Antecedent disease or surgery predisposes to infection, and involved tissue becomes indurated and forms multiple draining fistulae discharging characteristic sulfur granules . Three principal clinical syndromes are described: cervicofacial, thoracic, and abdominal . Recently pelvic actinomycosis has become more prevalent and associated with women who use the intrauterine device . The diagnosis of actinomycosis usually is made at surgery . Biopsied material histologically demonstrates sulfur granules and filamentous gram-positive rods . The differential diagnosis includes cancer and other chronic infections . Treatment consists of appropriate antimicrobial therapy and often surgery including incision and drainage or excision of abscesses, drainage of empyemas, and removal of persistent sinuses. Br J Clin Pharmacol, 1985 May, 19(5), 657 - 68 Comparative pharmacodynamics and clinical pharmacokinetics of phenoxymethylpenicillin and pheneticillin; Overbosch D et al.; In this study the antimicrobial effects of phenoxymethylpenicillin (PM) and pheneticillin (PE) in vitro and in an experimental animal infection model were compared as well as the pharmacokinetic properties of both drugs in patients . For the inhibitory effect of PM on short-term (3 h) growth of S . aureus in vitro, this drug was 2.13 times more potent than PE . The protein binding of both drugs was similar (78-80%) . The potency ratio of PM to PE against S . aureus in an experimental mouse-thigh infection was only 1.25 to 1 . This is explained by the difference in the AUC after subcutaneous administration of PM (0.47 mg 1(-1) h) and PE (0.92 mg 1(-1) h) . The plasma clearance after intravenous administration of PM was 476.4 ml/min and that of PE was 295.1 ml/min; the plasma clearance of both drugs was strongly correlated with the creatinine clearance . The volume of distribution in the steady state of PM was 35.41 and that of PE 22.51 . In 10 patients, the absorption after oral administration of PM as the acid was 48% and that of the potassium salt of PE was 86% of the dose . From the present results it can be concluded that a difference in effectiveness of different formulations of PM and PE would depend entirely on differences in absorption. Rev Infect Dis, 1985 May-Jun, 7(3), 404 - 18 Effects of bacterial endotoxins on neutrophil function; Wilson ME; The neutrophil is a key element in host resistance to bacterial infection . Bacterial products capable of subverting the antimicrobial properties of neutrophils can have a potentially deleterious effect on the host . Current knowledge of the effects of endotoxins derived from the outer cell envelope of gram-negative bacteria on neutrophil function is summarized . Available evidence indicates that endotoxins bind to neutrophils, both in vitro and in vivo . The lipid A region of the endotoxin macromolecule appears to be important in promoting the association of endotoxin with the neutrophil cell membrane . Endotoxin-neutrophil interactions can result in altered neutrophil adhesive and locomotory properties . Moreover, endotoxins have been demonstrated to induce selective degranulation of specific (secondary) granule constituents and to alter the oxidative and microbicidal properties of the neutrophil . Further studies are needed to define on a molecular level the nature of the endotoxin receptor, the precise structural components of endotoxin responsible for altering neutrophil behavior, and the transductional event(s) leading to neutrophil activation as a result of endotoxin exposure. Rev Infect Dis, 1985 May-Jun, 7(3), 398 - 403 Neutrophil killing of bacteria by oxygen-independent mechanisms: a historical summary; Spitznagel JK et al.; The historical development of the concept of neutrophil killing of bacteria by oxygen-independent mechanisms is traced . The role of oxygen-independent microbicidal mechanisms in relationship to neutrophil management of microbes is critically evaluated . In the ultrastructural sense, oxygen-independent killing of bacteria requires the deposition of a bactericidal component (granule proteins) or the establishment of a hostile, non-physiologic environment in the phagolysosome . Accordingly, this review is concerned with the identification and cellular location of cationic proteins that participate in nonoxidative killing of gram-negative bacteria by human polymorphonucleur neutrophil granulocytes . Studies reviewed support the hypothesis that oxygen-independent mechanisms function in vivo and are important in host defense against infection . The chemistry of antimicrobial proteins, the biologically active site of each protein, and the mechanism by which the proteins trigger bacterial death all need to be determined at the molecular level. Rev Infect Dis, 1985 May-Jun, 7(3), 287 - 313 Pharmacokinetics and safety of antimicrobial agents during pregnancy; Chow AW et al.; The use of antimicrobial agents during pregnancy poses unique concerns because of both potential toxicity and special pharmacokinetic considerations that have important therapeutic implications for both mother and fetus . Various physiologic adaptations occur with advancing gestation, including marked increases in maternal intravascular volume, glomerular filtration, and hepatic and metabolic activities; thinning and maturation of the fetomaternal membrane; and increases in transplacental diffusion capacity . The net result is that maternal antimicrobial concentrations tend to be 10%-50% lower in late pregnancy and the immediate postpartum period than in the nonpregnant state . Placental transfer of antimicrobial agents and their excretion in amniotic fluid or breast milk are similarly affected by hemodynamic changes, membrane transport characteristics, and maturation or metabolic activity of the specific organs involved . Review of the literature suggests that, although the need for caution in the use of antimicrobial agents during pregnancy has been well emphasized, firm data on the pharmacokinetics, efficacy, and optimal use of these drugs in this situation are extremely sparse and urgently needed . However, recommendations regarding the use of specific antibacterial, antifungal, antiviral, and antiparasitic agents against selected infections during pregnancy can be made. J Trauma, 1985 May, 25(5), 385 - 92 Effect of oral antibiotics and bacterial overgrowth on the translocation of the GI tract microflora in burned rats; Deitch EA et al.; Infections in burned patients have generally been considered to arise from exogenous organisms . Consequently, the therapy of burned patients has emphasized the use of infection control policies and topical antimicrobial agents to reduce bacterial colonization . Even though enteric bacteria are frequently found in the burn wound little attention has been paid to the patient's own GI tract microflora as a potential source of organisms colonizing the burn wound . The current experiments were carried out to determine if the bacteria present in the GI tract of healthy animals would penetrate (translocate) through the GI mucosa and spread to visceral organs after a moderate or major thermal injury . The results of these experiments indicated that bacteria can translocate across the wall of the GI tract and survive in the mesenteric lymph nodes in healthy rats . Furthermore, when the GI tract microflora is altered, either due to bacterial overgrowth or under the influence of oral antibiotic therapy, not only will bacteria translocate to the mesenteric lymph nodes but bacteria will also spread to other visceral organs . The results of these experiments support the hypothesis that the GI tract can serve as a reservoir for nosocomial infections in the burned patient, since bacteria can translocate across the mucosal barrier of the GI tract after thermal injury and survive in visceral organs before colonization of the burn wound occurs. Diagn Microbiol Infect Dis, 1985 May, 3(3), 201 - 12 Effectiveness of antibiotic removal by the antibiotic-binding blood culture systems; Smith SM et al.; The effectiveness of antibiotic removal by the BACTEC aerobic resin-containing blood culture medium (16B) and the Antimicrobial Removal Device (ARD) was compared for 12 antibiotics: ampicillin, cephalothin, cefoperazone, cefotaxime, moxalactam, nafcillin, gentamicin, tobramycin, azlocillin, mezlocillin, piperacillin, and ticarcillin . The ability to recover eight commonly encountered species of bacteria from antibiotic-containing serum by these two systems showed that recovery of antibiotic-exposed bacteria was dependent not only upon the amount and rate of the antibiotic removal but also upon the kinetics of bacterial killing by the antibiotic(s) . The 16B medium had difficulty recovering organisms exposed to ticarcillin and moxalactam, whereas the ARD had difficulties with moxalactam and sometimes with cefotaxime and cefoperazone . Although neither system was able to recover all species of microorganisms tested, these in vitro results suggest that to use optimally these new culture systems, knowledge of the suspected pathogen(s), the amount and kind of antibiotic(s) administered, and the rate of bacterial killing by the antibiotic(s) is required. Am J Surg, 1985 May, 149(5), 615 - 9 Mechanical preparation of the large bowel for elective surgery . Comparison of whole-gut lavage with the conventional enema and purgative technique; Panton ON et al.; In this prospective, randomized study, 121 elective colorectal surgery patients had whole-gut lavage (n = 67) or enemas and purgatives (n = 54) . Patient characteristics were well matched . Intravenous metronidazole and tobramycin were administered preoperatively initially in 53 patients, with the remaining 68 patients receiving the drugs perioperatively . Bowel preparation was satisfactory (minimal or no contents remaining) in 92.8 percent of patients with whole-gut lavage and 92.6 percent with enemas and purgatives (p = 0.72) . Nasogastric tube insertion was poorly tolerated by 39 percent of the patients receiving whole-gut lavage, and enema tube insertion by 23 percent with enemas and purgatives . Fluid infusion tolerance was similar with both techniques . Abdominal wound sepsis occurred in 22 patients (18.8 percent), being unrelated to mechanical preparation or antimicrobial prophylaxis (p = 0.19) . Colostomy closure was associated with a 42.8 percent sepsis rate . Excluding this group, wound sepsis with the remaining procedures was 13 percent (statistically significant, p = 0.03) . Other complications included intraabdominal abscesses (3.3 percent), anastomotic leaks (2.5 percent), eviscerations (1.6 percent), and an operative mortality of 1.6 percent . We have concluded that whole-gut lavage and enemas and purgatives are equally efficacious mechanically with similar associated wound sepsis rates. Postgrad Med, 1985 May 1, 77(6), 137 - 46 Choosing antimicrobials . Factors to consider, available agents; Pankey GA et al.; Many factors are involved in choice of an antimicrobial agent . Cost has become a matter of increasing concern . Of course, overall expense for the hospitalized patient includes costs of tests for monitoring for toxicity as well as administration costs, which are affected by the dosing frequency . A reasoned choice necessitates knowledge of the place of newer agents in the therapeutic armamentarium and of some new applications of well-established drugs. Am J Orthod, 1985 May, 87(5), 421 - 31 Orthodontic therapy in patients with juvenile periodontitis: clinical and microbiologic effects; Folio J et al.; The correction of malocclusions in juvenile periodontitis (JP) patients completing periodontal therapy is a problem of increasing clinical concern to orthodontists, since many teeth with severe alveolar bone loss in these patients can now be successfully treated without extraction . In this report, fixed edgewise orthodontic therapy was carried out after the completion of periodontal therapy on four JP patients . The orthodontic therapy included extensive intrusion of teeth severely affected by JP . Phase-contrast microscopic analysis of subgingival plaque from orthodontically treated teeth was used to monitor longitudinally the effects of fixed orthodontic bands on the subgingival flora and also to monitor the efficacy of topical and systemic antimicrobial therapy aimed at suppression of suspected periodontopathic bacteria . Orthodontic movement was completed on most periodontally compromised teeth without significant evidence of additional deterioration in periodontal status . However, within the first 6 months of orthodontic band placement, all patients had significant increases in the number of spirochetes and motile rods in their subgingival flora . Three of the patients also developed high levels of crevicular polymorphonuclear leukocytes around orthodontically treated teeth, indicating significant subgingival inflammation . Intensive antimicrobial measures, including topical inorganic salt applications and systemic tetracycline, were helpful in limiting clinical inflammation and subgingival colonization by periodontopathogens during orthodontic therapy . The results demonstrate that successful orthodontic repositioning can be carried out in treated JP patients . In addition, bacteriologic monitoring and chemotherapeutic suppression of periodontal pathogens may be valuable in the prevention of further destructive periodontal disease activity in periodontitis patients undergoing orthodontic therapy. J Am Coll Cardiol, 1985 May, 5(5 Suppl A), 82A - 90A Pharmacokinetic interactions between digoxin and other drugs; Marcus FI; Drug interactions with digoxin are important because of this agent's narrow therapeutic index . Among the drugs that can decrease digoxin bioavailability are cholestyramine, antacid gels, kaolin-pectate, certain antimicrobial drugs and cancer chemotherapeutic agents . In selected patients, antibiotics may enhance digoxin bioavailability by eliminating intestinal flora that metabolize digoxin . Antiarrhythmic drugs, such as quinidine and amiodarone, can markedly increase steady state serum digoxin levels . Certain calcium channel blocking drugs, particularly verapamil, have a similar effect . Potassium-sparing diuretic drugs, such as spironolactone, can alter digoxin pharmacokinetics . Indomethacin may decrease renal excretion of digoxin in preterm infants . Finally, rifampin, an antibiotic used in the treatment of tuberculosis, may lower steady state serum digoxin levels in patients with severe renal disease . Physicians must maintain constant vigilance whenever medications are added to or withdrawn from a therapeutic regimen that includes digoxin. Kosm Biol Aviakosm Med, 1985 May-Jun, 19(3), 68 - 71 {Effect of dibazol on indices of nonspecific resistance in human subjects in a hermetically sealed enclosure}; Novikov VS et al.; Prophylactic administration of dibazol (5 mg/day) prevents a decrease of nonspecific resistance and ensures stable variations of adaptive processes in men working in enclosures for a long time . The positive effect of the drug occurs 10-15 days after the administration and involves a combined action on phagocytosis, blood homeostasis, and skin antimicrobial resistance . The integrated parameters of nonspecific protection of the test subjects who took dibazol are close or even better than the pretest level . For instance, the efficiency of intracellular digestion increases and the microbial content of blood decreases . Coincidentally, the health condition improves and physical work capacity increases . Dibazol also exerts a beneficial effect on the adaptive process and morbidity rate of the subjects . The data obtained suggest that dibazol affects favorably the nonspecific resistance of the human body . In view of this, it can be recommended as a stimulating and training agent. J Biol Chem, 1985 Apr 25, 260(8), 4579 - 84 Primary structures of six antimicrobial peptides of rabbit peritoneal neutrophils; Selsted ME et al.; Six microbicidal peptides, NP-1, NP-2, NP-3a, NP-3b, NP-4, and NP-5, from rabbit peritoneal neutrophils were characterized . As a family, the peptides were 32-34 residues in length, were cystine- and arginine-rich, and each contained three intramolecular disulfide bonds . Within their sequences, the six peptides shared 11-residue positions, which included the six half-cystines contained in each peptide . NP-1 and NP-2 differed by a single residue and were identical in their respective sequences to MCP-1 and MCP-2, the peptide analogs from rabbit alveolar macrophages . NP-4 and NP-5 were homologous in 27 of their residues, but NP-3a and NP-3b shared little more than the 11-residue backbone common to all members of this peptide family. Z Hautkr, 1985 Apr 15, 60(8), 628, 633 - 4, 637-8 passim {The "unspecific" immune state in skin diseases with special reference to microphage functions}; Djawari D et al.; Polymorphonuclear leucocytes (PMNL) or microphages resp . are essentially involved, on account of their ubiquity within the entire organism as well as their phagocytic and intracellular killing properties, in the complex organization of the antimicrobial and antitumoral protective capacity of man . Positive chemotaxis triggers the migration of PMNL to the specific danger area and thus initiates an immune reaction . An either inborn or acquired defect or functional weakness of PMNL may entail a state of persisting viral, fungal and/or bacterial infections . Impairment of various PMNL functions may result from different metabolic disorders, internal malignancies, and/or immunosuppressive therapy . Disturbances of various PMNL functions can be especially analysed in vitro . After delineation of different techniques available to check the immunological defense system of the human organism, we report on our results of PMNL function analysis in patients suffering from chronically recurrent pyoderma (n = 22), oral precancer and cancer (n = 13), chronic mucocutaneous candidosis (n = 10), recurrent aphthous ulcers (n = 33), as well as Behcet's disease (n = 20). Biochem J, 1985 Apr 15, 227(2), 609 - 19 Isolation, characterization and possible mode of action of antiseminalplasmin, a new protein that inhibits the antimicrobial activity of seminalplasmin; Rao VN et al.; The isolation from bovine seminal plasma and purification of a new protein called 'antiseminalplasmin', which reverses the inhibition of the growth of, and RNA synthesis in, Escherichia coli by seminalplasmin (another protein of bovine seminal plasma), is described . Antiseminalplasmin, a weakly acidic protein, has a minimum Mr of about 39 000 and appears to consist of three acidic peptide chains that move close to each other on electrophoresis on cellulose acetate strips or on sodium dodecyl sulphate/18%-(w/v)-polyacrylamide gels . Antiseminalplasmin has a tendency to oligomerize at slightly alkaline pH values; it does not bind to seminalplasmin or to DNA, and does not reverse the inhibition by seminalplasmin of transcription in vitro by purified E . coli RNA polymerase . It appears that antiseminalplasmin may act by binding to the cell surface and preventing the entry of seminalplasmin into the cells . By itself, antiseminalplasmin has no effect on the growth of E . coli. Hosp Formul, 1985 May, 20(5), 629 - 31, 634 Policy issues concerning antimicrobials: problems with the regulatory process governing their introduction; Simon HJ; Clinicians, representatives from industry, and independent observers have voiced complaints about the cumbersome and lengthy process employed by governmental regulatory agencies before approving new antimicrobials for marketing . The currently used drug approval process is probably not entirely appropriate for antimicrobials . In fact, the situation for antimicrobials is qualitatively so different from that of other drugs that antimicrobials should almost certainly undergo review specifically designed in accordance with such differences . Modifications in the pre- and postmarketing approval process for antimicrobials are proposed. Drug Intell Clin Pharm, 1985 Apr, 19(4), 288 - 90 Evaluation of antibiotics for home care programs; Reed MD; A number of antimicrobial agents have been used successfully to treat patients with chronic infectious diseases in the home health care environment . This diversity in types of antibiotics used reflects more than ten years' development of active home medical care programs . With continuing experience, it is clear that the number and types of antibiotics available on formulary for routine use in home programs can be condensed . Since a patient should in most cases be treated in the home environment with the same antibiotic that has demonstrated efficacy and safety upon initial therapy during hospitalization, the selection of available antibiotics will affect the hospital's formulary selection process . This process must critically evaluate the documented efficacy and safety of each agent, since the drug's primary use will be in a relatively uncontrolled environment, devoid of continuous professional assessment . The beta-lactam antibiotics appear to be preferred agents for outpatient use, particularly as monotherapy . These agents offer desirable in vitro activity and potency, ease of administration, overall efficacy, and safety . However, despite a preference for beta-lactam antibiotics, additional and alternative agents must be routinely available in program formularies. Immun Infekt, 1985 Apr, 13(2), 65 - 75 {Antibiotic therapy in patients with immunologic deficiency}; Wirsing von Konig CH et al.; Basic aspects in the treatment of immunocompromised patients are discussed with respect to medical and paediatric oncology, surgical intensive care and clinical pathology . Defining the type of immunological deficiency seems of primary importance, since it can be caused by haematological diseases, their treatment, by repeated surgery or by a polytrauma . The degree of immune deficiency should be quantitated by laboratory procedures, whenever possible . The treatment of these patients may include substitution therapy, decontamination and antimicrobial chemotherapy . Since the immune deficiency can only rarely be specifically substituted, hygiene plans should be made up for every patient, including the selective decontamination . An intensive microbiological surveillance can give early information about the prevalence of certain microorganisms, thereby facilitating a subsequent treatment . The antimicrobial chemotherapy of an overt infection in medical and pediatric oncology can follow fixed schedules, taking into account the various causative agents that can be expected . This procedure has proven to be efficient in the treatment of infections occurring during the therapy of acute lymphoblastoid leukemia in childhood . In surgical intensive care units, however, treatment of infections should be based on microbiological findings in conjunction with the local profile of bacterial resistance . Furthermore, it is important to be aware that "non-pathogenic" microorganisms can be the cause of life-threatening infections in immunocompromised patients . Our experience shows that interdisciplinary cooperation and a mutual exchange of information is important for an efficient treatment of infections in patients with immunological deficiencies. J Clin Pathol, 1985 Apr, 38(4), 459 - 63 Serum C-reactive protein concentration in the management of infection in patients treated by continuous ambulatory peritoneal dialysis; Hind CR et al.; In a prospective study over 21 months, serum C-reactive protein (CRP) concentration was measured serially in 39 consecutive patients undergoing continuous ambulatory peritoneal dialysis . All patients with peritonitis mounted a CRP response, and the height of the response correlated well with the severity and extent of the peritoneal damage . Patients who recovered uneventfully after antimicrobial treatment showed a prompt fall in CRP from its peak value towards normal . In contrast, each patient in whom the serum CRP value remained raised after antimicrobial treatment had a complicated course . During routine outpatient follow up the serum CRP value remained within the normal range in the absence of intercurrent complications . These results, together with the commercial availability of rapid and precise assays for CRP, indicate that serial CRP measurements may be useful in monitoring the efficacy of antimicrobial treatment during episodes of peritonitis and in the recognition of intercurrent complications in patients undergoing continuous ambulatory peritoneal dialysis. Can Med Assoc J, 1985 Apr 1, 132(7), 785 - 9 Quality of use of parenteral metronidazole therapy in a teaching hospital; Jewesson PJ et al.; The recent release, relatively high cost and potential adverse effects of parenterally administered metronidazole prompted a quality-of-use audit at a 1000-bed teaching hospital . Ninety-two courses of treatment in 81 inpatients during a 6-week period were studied . Appropriateness of therapy was assessed on the basis of published indications . Parenterally administered metronidazole was prescribed primarily in anaerobic and anaerobic-aerobic infections . It was used as frequently for prophylaxis as for therapy . Surgical services accounted for 95% of the treatment courses . Inappropriate use was noted in 27 (29%) of the courses: agents other than parenterally administered metronidazole were indicated in 12 (13%), while the dose, dosing interval or duration of treatment was suboptimal in 15 (16%) . Substantial savings would be achieved if oral or rectal metronidazole therapy were substituted for intravenous therapy for perioperative prophylaxis in elective colorectal surgery . Written justification for use and automatic stop orders are recommended to improve the cost effectiveness of both prophylactic and therapeutic use of selected antimicrobial agents. Drug Intell Clin Pharm, 1985 Apr, 19(4), 278 - 81 Cost-containment of antimicrobial therapy; Barriere SL; In 1983, health care services for Medicare and Medicaid patients become tied to a diagnosis-related group (DRG) classification and reimbursed based on predetermined rates, regardless of the amounts expended . U.S . hospitals that formerly encouraged resource consumption to generate revenue now urge judicious use of drugs, laboratory tests, and radiology in an effort to contain costs while maintaining quality patient care . Antimicrobials account for the largest proportion of all drugs used in hospitals, but their inappropriate use, unfortunately, is widespread, resulting in poor therapy, emergence of resistance, increased adverse effects, and wasted health care dollars . Newer beta-lactam agents offer enhanced in vitro potency and spectra of activity, improved pharmacokinetic characteristics, and a relative lack of adverse effects . However, these drugs are expensive, and excessive use defeats cost-containment programs necessary under DRG reimbursement . To ensure their appropriate use, a variety of methods and some control system is probably necessary in most hospitals . In certain situations early discharge of hospital patients and home antimicrobial therapy may be the most desirable method to conserve hospital resources and provide quality health care. Vet Clin North Am Equine Pract, 1985 Apr, 1(1), 51 - 75 Aspects of pharmacology in the neonatal foal; Vaala WE; Other therapeutic agents used in foals for specific diseases are discussed elsewhere . The marked effect of species, age, and degree of maturity on drug metabolism in the neonate reinforces the danger of interspecies extrapolation of pharmacology, the need for information specific for the foal, and the necessity for monitoring drug levels in the individual . Suggested antimicrobial doses are listed in Tables 3, 4, and 6 . Recommended doses of anticonvulsants and sedatives are listed in Table 8 and in the article "Intensive Care of the Neonatal Foal." The following are recommendations for drug therapy in the neonate: Avoid unnecessary administration of drug to the dam at parturition because of possible placental transfer of the drug with subsequent effects on the neonate . If possible, avoid unnecessary drug therapy in foals under 30 days of age . Select a drug that undergoes minimal biotransformation (hepatic metabolism) and is not highly protein bound . Owing to probable immunodeficiency in the neonate, broad-spectrum, bactericidal drugs are preferred for treatment of life-threatening infections . Every attempt should be made to identify the etiologic agent so that drug therapy can be based on cultures and sensitivity test results to maximize the benefit-risk ratio . Parenteral (intramuscular or intravenous) drug administration is preferable to oral . Avoid drugs that are known oxidants, which may produce hemolysis or methemoglobinemia . In general, the same or a slightly higher initial dose should be employed in the neonate, but it should be given less frequently than in the adult if it has a high potential to cause toxicity . When possible, individual monitoring of serum levels of potentially toxic drugs should be employed in premature and newborn foals unless specific drug pharmacokinetics are known for that age group. Am J Vet Res, 1985 Apr, 46(4), 989 - 91 Use of epidemiologic markers to identify the source of Escherichia coli infections in poultry; Barbour EK et al.; During an epidemiologic study of poultry colisepticemia on 2 Saudi Arabian poultry broiler farms, Escherichia coli was isolated from 101 (40.4%) of the 250 specimens examined . The antigenic structure and the drug resistance pattern of 65.4% of the E coli isolates from different sources were used as epidemiologic markers to trace the source of the infection . The predominant E coli serotypes involved in infections of 2 poultry broiler progeny farms were 033:H4 (51.8%) and 078:H- (19.6%) that had the following respective drug resistance patterns: furazolidone-streptomycin-sulfathiazole and streptomycin-sulfathiazole-tetracycline . Escherichia coli strains with typical epidemiologic markers were isolated from various sources on a broiler breeding farm, but not from well waters of the infected progeny farm . Three other E coli serotypes (045:H10{14.3%}, 0119:H27{1.8%}, and 0145:H25{1.8%}) were involved in poultry infection, but to a lesser extent . These 3 serotypes were multiply resistant against 5 to 6 of the antimicrobials evaluated. J Antimicrob Chemother, 1985 Apr, 15(4), 399 - 404 A comparison of the in-vitro activity of antimicrobials against Chlamydia trachomatis examined by Giemsa and a fluorescent antibody stain; How SJ et al.; Minimum concentrations for the inhibition of normal chlamydial inclusions (MICN) and abnormal inclusions (MICA) were obtained for a range of antimicrobials titrated against Chlamydia trachomatis in McCoy cell cultures . Each antibiotic titrated produced an MICN which was the same whether examined by Giemsa or fluorescent antibody staining methods (rifampicin 0.007 mg/l, tetracycline, erythromycin and penicillin 0.062 mg/l, chloramphenicol and spiramycin 0.25 mg/l, ciprofloxacin 1.0 mg/l, and cycloserine 250 mg/l) . With the exception of penicillin the MICA (Giemsa) was between two- and four-fold higher than the MICN, and the MICA (fluorescent antibody) a further two-fold higher . Penicillin was alone in the wide concentration range over which abnormal inclusions were detected (0.0062 mg/l to 5 g/l). J Clin Periodontol, 1985 Apr, 12(4), 327 - 41 The effect of Keyes' method of oral hygiene on the subgingival microflora compared to the effect of scaling and/or surgery; Greenwell H et al.; The present study was conducted on 18 individuals to determine if Keyes' method of oral hygiene would present an alternative to traditional periodontal therapy in terms of establishing a subgingival microflora compatible with periodontal health . Oral hygiene, gingival conditions and subgingival microbial proportions assessed by dark field microscopy were measured at baseline, then once every 2 weeks for the remainder of this 8-week study . In addition, probing depths and bleeding on probing were evaluated . Group I (9 patients) was treated non-surgically, while Group II (9 patients) had received surgical therapy within the last 4 years . Both groups received routine scaling and root planing (Sc/RP) on one arch at time 0, and both were instructed to use Keyes' method of oral hygiene on one side of the mouth while the other side served as a control . This yielded a split-plot experimental design which permitted examination of the effects of Keyes' method of oral hygiene, Sc/RP and surgery . The results revealed no statistically significant differences between Keyes' method of oral hygiene and conventional oral hygiene in patients treated with a single session of Sc/RP . When scaling was not employed, Keyes' method was more effective than conventional oral hygiene . Surgical status was found to be the most significant factor in reducing clinical indicator values and establishing control of the subgingival microflora . In summary, oral hygiene alone had only minimal effects on subgingival microbial proportions . The primary antimicrobial effect observed, as evidenced by shifts in subgingival morphotype proportions, was produced by the Sc/RP procedure . This effect was enhanced by improved access (surgical status). J Hyg (Lond), 1985 Apr, 94(2), 181 - 91 Escherichia coli 0142.H6; a drug-resistant enteropathogenic clone? Gross RJ, Rowe B, Threlfall EJ. For many years strains of Escherichia coli belonging to particular serotypes (EPEC) were a common cause of outbreaks of infantile enteritis in Europe and North America . E . coli 0142.H6 was first isolated from infants with diarrhoea in Indonesia in 1960 and a further outbreak occurred in Mexico in 1965 . Between 1967 and 1972 outbreaks of infantile enteritis caused by E . coli 0142 were reported in hospitals in Scotland, England, Northern Ireland and Eire . Sporadic cases occurred in Canada in 1972 and a further outbreak occurred in Arizona, U.S.A . in 1975 . Strains from all these incidents were examined by biochemical and serological methods . Their resistance to antimicrobial drugs was determined and their resistance plasmids characterized; their plasmid profiles were visualized by agarose gel electrophoresis . The cumulative evidence suggests that strains isolated in the British Isles all belonged to a single clone and were related to those isolated in Indonesia, the U.S.A . and Canada . However, the strains from Mexico appeared to be unrelated . This study demonstrates that single clones of enteropathogenic E . coli may spread throughout the world, causing outbreaks of diarrhoeal disease and acquiring resistance to antimicrobial drugs. Pediatrics, 1985 Apr, 75(4), 684 - 6 Evolution of short-course antimicrobial treatment of tuberculosis in children, 1951-1984; Kendig EL Jr; Although the first unrecognized indication that short-course antimicrobial treatment of tuberculosis might be effective came in reports of tuberculous meningitis and miliary tuberculosis in children so treated by Lorber (1951 to 1956), the 1977 American Lung Association-American Thoracic Society recommendation for antimicrobial therapy of tuberculosis in adults still specified an 18-month course . The first prospective study on the short-course antimicrobial treatment of children in the United States was published in December 1983 . The long delay before recognition of the practicability of short-course antimicrobial treatment of tuberculosis has probably been occasioned by ignorance of drug actions and the mechanisms involved. Antimicrob Agents Chemother, 1985 Apr, 27(4), 646 - 7 In vitro susceptibilities and beta-lactamase production of 53 clinical isolates of Branhamella catarrhalis; Alvarez S et al.; We tested 53 clinical isolates of Branhamella catarrhalis recovered from patients with respiratory symptoms to determine the susceptibility of the isolates to 25 antimicrobial agents, including the newer beta-lactam antibiotics . Of the 53 strains, 46 (86.7%) were beta-lactamase producers . All the strains were susceptible to the majority of the new penicillins and cephalosporins . The combinations of amoxacillin-clavulanic acid and ticarcillin-clavulanic acid were also very active against the beta-lactamase-producing strains. Antimicrob Agents Chemother, 1985 Apr, 27(4), 499 - 502 In vitro susceptibilities of isolates from patients with Branhamella catarrhalis pneumonia compared with those of colonizing strains; Sweeney KG et al.; Branhamella catarrhalis has recently been recognized as an opportunistic respiratory pathogen . We tested 10 isolates recovered from patients with documented B . catarrhalis pneumonia and 15 colonizing isolates for their susceptibility to 19 antimicrobial agents and for their ability to produce beta-lactamase . Eight of ten disease isolates and 12 of 15 colonizing isolates produced a detectable beta-lactamase . The isolates that were negative for beta-lactamase were susceptible to all agents tested, including penicillin G . Although all strains were found to be susceptible to the majority of the newer agents by broth dilution testing, the most active new semisynthetic penicillin was azlocillin (MIC that inhibited 90% of strains, 0.5 micrograms/ml), and moxalactam had the greatest potency among the cephalosporins (MIC that inhibited 90% of strains, 0.06 micrograms/ml) . Members of the first- and second-generation cephalosporins had only moderate activity . All disease isolates were susceptible to the aminoglycosides and to trimethoprim-sulfamethoxazole and resistant to vancomycin . The antibiotic susceptibilities of the disease isolates were not different from those of the colonizing strains . The results of standardized disk diffusion testing did not correlate well with those of dilution testing for penicillin or ampicillin . However, disk diffusion testing did predict susceptibility adequately for the remainder of the antibiotics tested. Am J Med, 1985 Apr, 78(4), 609 - 16 Open lung biopsy in patients with acute leukemia; McCabe RE et al.; The results of open lung biopsy in 15 patients with acute leukemia, pulmonary infiltrates, neutropenia, and fever were reviewed . The patients averaged 26 hospital days of neutropenia and 20 hospital days of fever before open lung biopsy, and all patients received broad-spectrum antibacterial agents (mean 17 days) before open lung biopsy . Nine (67 percent) received amphotericin B prior to open lung biopsy (mean 22 days) . Open lung biopsy yielded a specific clinically helpful diagnosis in six patients, but only two of these patients survived the hospitalization during which open lung biopsy was performed . Open lung biopsy detected fungus in four patients and leukemic infiltrates in two patients . Management was appropriately modified in these patients . In nine patients, a specific diagnosis of the pulmonary infiltrate was not obtained by open lung biopsy . Antimicrobial regimens were not changed substantially for these patients . In six patients, the results of open lung biopsy may have been misleading . Two patients had pulmonary fungal diseases at autopsy, undetected by open lung biopsy eight days and five weeks prior to death . Another patient had invasive aspergillosis and one had cytomegalovirus pneumonitis not detected by open lung biopsy . Two patients had false-positive preliminary histologic reports of pulmonary infection . On the basis of this experience, in this specific population of patients, open lung biopsy was often of little help in directing medical therapy or influencing clinical outcome. J Antibiot (Tokyo), 1985 Apr, 38(4), 449 - 54 Novel potentiators of beta-lactam antibiotics . Isolation of SQ28,504 and SQ28,546 from Chromobacterium violaceum; Cooper R et al.; Two novel compounds, SQ28,504 and SQ28,546 are produced by Chromobacterium violaceum . These compounds enhance the antibacterial activity of beta-lactam antibiotics against Gram-negative organisms . Both SQ28,504 and SQ28,546 induce morphological changes in the presence of beta-lactam antibiotics . Only SQ28,546 has weak antimicrobial activity against several Gram-negative organisms. J Clin Microbiol, 1985 Apr, 21(4), 501 - 4 Catheter-associated fungemia caused by Fusarium chlamydosporum in a patient with lymphocytic lymphoma; Kiehn TE et al.; A case of catheter-associated fungemia caused by Fusarium chlamydosporum is described in a patient with lymphocytic lymphoma . The fungus, which has been isolated from soil but not reported to cause human infection, characteristically produces microconidiophores that are polyphialides bearing microconidia that are spindle-shaped but never globose . Results of in vitro antimicrobial susceptibility tests depended on the test conditions used. Antimicrob Agents Chemother, 1985 Apr, 27(4), 531 - 4 Quantitation of ciprofloxacin in body fluids by high-pressure liquid chromatography; Weber A et al.; We describe a reverse-phase high-pressure liquid chromatography method for the quantitation of a new quinoline carboxylic acid antimicrobial agent, ciprofloxacin (Bay o 9867) . This assay utilizes the intrinsic fluorescence of ciprofloxacin for primary detection but employs UV absorption as a secondary detection system . Mobile phases contained methanol and phosphate buffer and used a common C18 mu Bondapak column . A single precipitation step of a 50-microliter specimen was the only sample preparation necessary . The assay is linear from 2,000 to 10 ng/ml and sensitive to 5 ng/ml . The mean recovery of ciprofloxacin from serum was 105.7% . The coefficient of variation was less than or equal to 3.1% for same-day precision and less than or equal to 6.3% for assay-to-assay precision . Because the assay requires only small specimen volumes and minimal sample preparation and because of its defined characteristics, this assay would be ideal for clinical trials and pharmacokinetics studies of ciprofloxacin. Drugs, 1985 Apr, 29(4), 330 - 41 Ciclopirox olamine 1% cream . A preliminary review of its antimicrobial activity and therapeutic use; Jue SG et al.; Ciclopirox olamine is a substituted pyridone antimycotic, unrelated to the imidazole derivatives, with activity against a broad spectrum of dermatophytes, yeasts, actinomycetes, molds, other fungi, and a variety of Gram-positive and Gram-negative bacteria . The efficacy of ciclopirox olamine cream has been demonstrated in open and placebo-controlled studies in patients with superficial dermatophyte or yeast infections, and in double-blind comparative trials in patients with dermatomycoses, topical ciclopirox olamine was comparable to or better than clotrimazole in efficacy and caused a similar number of side effects . Ciclopirox olamine penetrates through fingernails and in preliminary studies has been successfully used in onychomycoses . However, further studies are needed to establish the role of ciclopirox in the treatment of onychomycoses and dermatomycoses relative to that of the more recently introduced antigungal agents. Methods Find Exp Clin Pharmacol, 1985 Apr, 7(4), 195 - 201 In vitro potential measurement, anaesthetic and antimicrobial effects as indicators of beta-blocker toxicity of the cornea; Himber J et al.; Three tests were utilized to determine and compare the toxicity of timolol, propranolol and two new aliphatic and alicyclic oxime ethers with beta-blocking activity (falintolol and compound POS 7) . Effects on the electrical potential difference across the in vitro bovine corneal epithelium . Local anaesthesia on in vivo rabbit cornea . Antimicrobial activity on bacterial and fungal suspensions . In addition, partition coefficients were determined as physicochemical properties of the drugs . Falintolol, as well as timolol produced a minor change in electrophysiology at clinical concentration . They had neither local anaesthetic, nor antimicrobial effects . Conversely, propranolol and compound POS 7 showed acute corneal toxicity in the present models . It was concluded that changes in the potential difference across a perfused cornea in vitro, local anaesthesia and bacterial inhibition, might be a demonstration of the cytotoxicity of certain topical agents in terms of acute eye tissue reaction . They might represent a valuable model for the acute corneal toxicity evaluation of topical beta-blockers. Pediatr Med Chir, 1985 Mar-Apr, 7(2), 195 - 201 {20 years (1960-1980) of bacterial meningitis in childhood . I . Epidemiological and clinical data}; Della Giustina E et al.; One hundred forty six children having suffered bacterial meningitis at any age have been collected and retrospectively studied over a period of a twenty year survey (1960 to 1980) . In our series we can confirm the prominent epidemiologic and clinical features emerging from the literature . It is notewborty to outline the great percentage of cases lacking any bacterial identification due to previous antimicrobial treatment for parameningeal foci . This raises some major problems about early diagnosis, validity and signification of lumbar punctures, and usefulness of starting treatment with large spectrum antibiotics. Quad Sclavo Diagn, 1985 Mar, 21(1), 1 - 9 {Validity of the ABAC II system: applicability in the hospital laboratory and verification of breakpoint concentrations in the determination of antibiotic sensitivity}; Sala A et al.; Two different sensitivity testing methods were evaluated on 183 bacterial strains of Gram-negative clinical isolates in relation to 13 antimicrobial drugs . Comparison between both methods: conventional technique of disk diffusion (Kirby-Bauer) and the automated ABAC breakpoints system, has shown a good agreement of the results (91.1%) according to several investigators . The authors analyze the role of ABAC system and its achievement in routine work of a medium bacteriological hospital laboratory. Age Ageing, 1985 Mar, 14(2), 85 - 90 The problem of bacteriuria with indwelling urethral catheterization; Sabanathan K et al.; Bacteriuria following long-term catheterization is more likely to occur in elderly females over the age of 50 years, in patients with some abnormality of the bladder and when traumatic catheterization has taken place . Breaks in the closed system of drainage are the most important factors leading to bladder infections which, once there, are difficult to eradicate . Antiseptics are important at the time of catheterization but have little place afterwards except to reduce cross-infection and growth in the catheter bag . Systemic antimicrobials are only of use over a short period of catheterization and should be reserved in long-term catheterized patients for those with systemic manifestations of infection. J S Afr Vet Assoc, 1985 Mar, 56(1), 43 - 6 The treatment of canine demodecosis with amitraz; Davis DA; The treatment of a series of 27 clinical cases of canine demodecosis is reported . Three of 4 applications of a wash containing 0,025% amitraz, together with antimicrobial and antipruritic therapy where necessary, were sufficient to effect clinical cure in 25 out of 26 cases mildly to severely affected . In one case, very severely affected, 9 weekly applications, together with antimicrobial and antipruritic therapy, effected clinical and parasitological cure. Med Clin North Am, 1985 Mar, 69(2), 399 - 413 Viral meningitis; Ratzan KR; Viral meningitis is part of the aseptic meningitis syndrome but must be distinguished from bacterial meningitis on the basis of a careful examination of the CSF and sound clinical judgment . Enteroviruses probably account for the bulk of cases of aseptic meningitis that occur in the United States and which are reported to the Centers for Disease Control each year . The seasonal pattern in the incidence of aseptic meningitis is largely due to the seasonal variation of enteroviral infections . Early on, the CSF in patients with viral meningitis frequently contains a predominance of polymorphonuclear leukocytes and may even have a low glucose level . The presence of neutrophils in the initial CSF sample is especially common in patients with enteroviral infections . A CSF glucose level lower than 50 per cent of a simultaneously drawn blood glucose determination is not uncommon in patients with viral meningitis due to mumps, LCM, and herpes simplex . In a patient with a predominance of polymorphonuclear leukocytes in the initial CSF specimen and in whom a viral infection is suspected, antibiotics may be withheld if a spinal tap is repeated within 12 hours . A shift from polymorphonuclear leukocytes to mononuclear cells makes viral meningitis the likely diagnosis . Both herpes simplex and varicella-zoster may infect the meninges by means of spread from cervical and dorsal root ganglia in a retrograde fashion much the way they spread in an antegrade fashion to the skin . HSV-2 is more likely to cause the clinical syndrome of viral meningitis, while HSV-1 is more likely to cause a meningoencephalitis with serious brain dysfunction . The identification of a specific viral agent in body fluids, especially the CSF, in a patient with aseptic meningitis is of more than academic interest, since it can shorten duration of hospital stay and eliminate unnecessary antimicrobial therapy . The diagnosis of enteroviral infections depends upon the isolation of a virus from CSF, stool, or throat plus a fourfold antibody response in the serum to the viral isolate . The 60-odd serotypes of enterovirus, each with different antigenic determinants, preclude serologic testing alone as a useful diagnostic test to identify the patient infected with coxsackievirus or echovirus . For infections, due to herpes simplex, varicella-zoster, LCM, and arboviruses, a serologic test alone can be useful.(ABSTRACT TRUNCATED AT 400 WORDS) Med Clin North Am, 1985 Mar, 69(2), 231 - 41 Acute bacterial meningitis in children and adults . A perspective; Bolan G et al.; Bacterial meningitis is an acute and serious illness associated with significant morbidity and mortality . Although methods to make the diagnosis are relatively simple and effective antimicrobial agents are available, bacterial meningitis accounts for more than 2000 reported deaths per year in the United States . The majority of cases and deaths occur in otherwise healthy individuals. J Trauma, 1985 Mar, 25(3), 250 - 2 Hydrocarbon contact injuries; Hansbrough JF et al.; Cutaneous injury caused by exposure to gasoline and other hydrocarbons is a clinical entity with potentially life-threatening effects . We report four cases of such injury . One patient developed full-thickness skin loss following gasoline immersion, and another developed severe systemic complications following contact with a carburetor cleaning solvent . Initial therapy should consist of removal of solvent-containing clothing and extensive lavage or soaking with water, followed by wound care that is generally similar to that used in the treatment of partial-thickness burns . In most cases this includes debridement, topical antimicrobial agents, and dressing changes . Severe pulmonary, cardiovascular, neurologic, renal, and hepatic complications may accompany hydrocarbon absorption, particularly in cases involving gasolines containing lead additives . Therefore immediate surgical debridement should be considered if there is suspicion of continued absorption of toxic compounds from the wound. J Clin Microbiol, 1985 Mar, 21(3), 454 - 6 Inability to adequately control antimicrobial agents on AutoMicrobic System Gram-Positive and Gram-Negative Susceptibility Cards; Kellogg JA; The Vitek Gram-Positive Susceptibility Card (GPS) and Gram-Negative General Susceptibility Plus Card (GSC Plus) were tested on the AutoMicrobic System (AMS) 50 times each with the recommended control organisms . Only 1 drug (chloramphenicol) of 11 on the GPS and 1 (gentamicin) of 10 on the GSC Plus could be adequately controlled, leaving unsubstantiated the results obtained with patient isolates on the remaining 19 antimicrobial agents. J Clin Microbiol, 1985 Mar, 21(3), 293 - 7 Collaborative evaluation of the UniScept qualitative antimicrobial susceptibility test; D'Amato RF et al.; The UniScept system (Analytab Products, Plainview, N.Y.) is a commercially prepared microdilution antimicrobial susceptibility test for the determination of qualitative susceptibility results for gram-negative and gram-positive bacteria . The system showed excellent correlation with the reference agar diffusion approach for organisms from clinical specimens and with stock and reference cultures . Intra- and interlaboratory reproducibility was high. Surgery, 1985 Mar, 97(3), 331 - 6 The effect of metronidazole on wound healing in rats; Borden EB et al.; Metronidazole is gaining increasing acceptance as a perioperative antimicrobial agent . We studied the effect of metronidazole on wound healing in Sprague-Dawley rats, which received seven daily intraperitoneal injections of either metronidazole, 20 mg/kg/day, (simulating a therapeutic course) or equivalent volumes of physiologic saline solution . On the second day of treatment 25 treated rats and 20 control rats had full-thickness circular skin defects created on the back and standardized midline celiotomy incisions . The fascial incisions were closed with staples, and the abdominal skin was closed with silk sutures . On the seventh postoperative day all rats were put to death . The breaking strength of 1 cm wide segments of skin and fascial celiotomy wounds was measured, and the contraction of the open back wounds was computed . There was no significant difference in wound contraction or skin wound breaking strength, but fascial wound breaking strength was lower in treated rats than in control rats (283 versus 548 gm mean; 2 p less than 0.001) . To determine whether metronidazole permanently altered or only temporarily delayed fascial wound healing, 39 additional rats treated with metronidazole and 40 control rats underwent celiotomies as described above on the second day of a 7-day course of treatment . Fascial wound breaking strength was measured 2, 3, and 5 weeks after operation . The wound breaking strength in rats treated with metronidazole remained significantly lower than that of control rats at 2 and 3 weeks (860 versus 1005 gm at 2 weeks and 1071 versus 1369 gm a