Chemioterapia, 1984 Oct, 3(5), 295 - 8 Single-dose ceftriaxone versus multi-dose cefotaxime as short-term antimicrobial prophylaxis in urologic surgery . Preliminary results of a multicenter prospective randomized study; Periti P et al.; This controlled multicenter study on 407 evaluable patients demonstrates the equal efficacy of two short-term antimi crobial prophylactic regimens in urological surgery involving a single dose of a long-acting cephalosporin, ceftriaxone, in comparison with a multiple dose of cefotaxime . Fifty-three of the 196 patients (27%) on the cefotaxime regimen and 47 of the 211 patients (22.3%) who received ceftriaxone showed postoperative infectious complications . There were no differences in these results. J Mol Biol, 1984 Sep 25, 178(3), 783 - 5 Characterization of two crystal forms of neutrophil cationic protein NP2, a naturally occurring broad-spectrum antimicrobial agent from leukocytes; Westbrook EM et al.; A hexagonal crystal form (P6(3)22, a = b = 34.0 A, c = 113.5 A) and a monoclinic form (P2(1), a = 37.1 A, b = 32.2 A, c = 32.4 A, beta = 110 degrees) of neutrophil cationic protein NP2, isolated from rabbit leukocytes, have been characterized . The monoclinic form, containing two promoters (Mr = 3844) per asymmetric unit, diffracts to at least 1.8 A and is suitable for high-resolution structural studies. Yale J Biol Med, 1984 Sep-Oct, 57(5), 787 - 95 Fever, jaundice, and histiocytic erythrophagocytosis: fulminant infection or malignancy? Heiman DF, Haas M, Griffiths JK, Bia FJ. Some of the problems which we see on the infectious disease consultation service can be quite frustrating . This is one such case . A middle-aged man presented to our medical service with fever and dyspnea . His fulminant downhill course was characterized by anemia, jaundice, hypercalcemia, pulmonary abnormalities, and a lack of responsiveness to conventional antimicrobial therapy . At autopsy, malignant-appearing histiocytes were present in several organs including spleen, lymph nodes, and lung . Histopathological examination of tissues obtained at autopsy confirmed the presence of phagocytized erythrocytes within such histiocytes . This case aptly illustrates the hazy dividing line which sometimes exists between infectious and/or malignant processes which are, at present, still of undetermined etiology. Antimicrob Agents Chemother, 1984 Sep, 26(3), 424 - 5 Antimicrobial susceptibility of Branhamella catarrhalis isolates from bronchopulmonary infections; Ahmad F et al.; Fifty-four clinical isolates of Branhamella catarrhalis from patients with bronchopulmonary infections were studied . The MICs for 50 and 90% of the isolates and the geometric mean MICs were determined for 11 antimicrobial agents . All the strains were resistant to trimethoprim but were susceptible to clavulanate-potentiated amoxicillin (Augmentin; Beecham Research Laboratories, London), chloramphenicol, co-trimoxazole, erythromycin, cefotaxime, and cefuroxime . Beta-lactamase-negative strains were uniformly susceptible to penicillin and ampicillin. South Med J, 1984 Sep, 77(9), 1211 - 2 Endocarditis due to Veillonella alcalescens; Greaves WL et al.; A 60-year-old man with a history of a benign heart murmur for 25 years had evaluation of six months of unexplained fever and heart disease . The fever responded to nonspecific antimicrobial therapy, but progressive aortic insufficiency necessitated aortic valve replacement . Although numerous preoperative blood cultures were negative, Veillonella alcalescens was isolated in pure culture from the excised valve . The patient remained well after two weeks of intravenous therapy with cephalothin and three months of oral therapy with penicillin. Biol Reprod, 1984 Sep, 31(2), 303 - 11 Antibacterial activity of mare uterine fluid; Strzemienski PJ et al.; Luminal fluid from the mare uterus was used to investigate its relation to antibacterial defenses . Uterine flushings were collected at Day 3 of estrus, Day 8 postovulation and Day 15 postovulation . Uterine proteins were concentrated by ultrafiltration, dialyzed and examined for chemotactic activity to neutrophils and for antibacterial properties . Serum taken at the time of flushing was dialyzed and studied in a similar manner . Neutrophil migration in response to serum from Day 3 estrus and Day 8 postovulation was increased (P less than 0.05) above controls . Uterine protein from Day 8 postovulation and from Day 3 of estrus also stimulated neutrophil migration (P less than 0.05) above values of controls . Antibacterial activity was measured by incubation of S . zooepidemicus with concentrated uterine flushing or serum . Serum from all three estrous cycle intervals diluted 1:10 or used at a protein concentration equal to the protein concentration of uterine fluid did not inhibit growth . After 4 h of incubation, bacterial growth in estrous serum was significantly greater (P less than 0.01) than serum taken at Day 8 and Day 15 postovulation . Uterine flushings from Day 8 postovulation significantly decreased bacterial colony-forming units (P less than 0.01) . Heating flushings at 56 degrees C for 30 min did not abolish the antimicrobial activity, while heating flushings for 30 min at 80 degrees C removed this activity . The antibacterial activity does not appear to be due to agglutinating antibody. J Med Chem, 1984 Sep, 27(9), 1212 - 5 Benzisoxazolones: antimicrobial and antileukemic activity; Wierenga W et al.; An unusual acid-mediated rearrangement of o-nitrostyrene oxide afforded 1-(hydroxymethyl)-2,1-benzisoxazol-3(1H)-one which exhibited broad-spectrum antimicrobial and cytotoxic activity . A number of analogues were prepared by employing a modified zinc-reduction procedure on o-nitrobenzoate . Several of these analogues exhibited interesting antipseudomonal activity in agar and broth but were ineffective in vivo. J Clin Pathol, 1984 Sep, 37(9), 1066 - 70 Capnocytophaga ochracea infection: two cases and a review of the published work; Hawkey PM et al.; Bacteria of the genus Capnocytophaga are recently recognised pathogens which may cause oral disease and subsequent septicaemia in the immunocompromised host . We present two cases of infection caused by Capnocytophaga ochracea; a soft tissue infection in an immunologically normal patient and an episode of septicaemia in a child with leukaemia . The microbiology, pathogenicity, and antimicrobial susceptibility of the genus capnocytophaga are reviewed. J Clin Invest, 1984 Sep, 74(3), 771 - 82 Interaction between the legionnaires' disease bacterium (Legionella pneumophila) and human alveolar macrophages . Influence of antibody, lymphokines, and hydrocortisone; Nash TW et al.; We have studied the interaction between virulent Legionella pneumophila and human alveolar macrophages, the resident phagocytes at the site of infection in Legionnaires' disease . L . pneumophila multiplied 2.5-5 logs within 3 d, as measured by colony forming units, when incubated with freshly explanted alveolar macrophages in monolayer culture . At the peak of bacterial multiplication, the alveolar macrophage monolayers were destroyed . L . pneumophila multiplied more rapidly in 4-d-old than in freshly explanted alveolar macrophages . Inside alveolar macrophages, L . pneumophila were located within membrane-bound vacuoles whose cytoplasmic sides were studded with ribosomes . Alveolar macrophages that were incubated with concanavalin A (Con A) stimulated human mononuclear cell supernatants (cytokines), inhibited L . pneumophila multiplication, and the degree of inhibition was proportional to the concentration of Con A supernatant added . Anti-L . pneumophila antibody in conjunction with complement promoted phagocytosis of L . pneumophila by alveolar macrophages . By electron microscopy, most (75%) of the phagocytized L . pneumophila were intracellular . However, freshly explanted alveolar macrophages were able to kill only 0-10% of an innoculum of L . pneumophila even in the presence of antibody and complement . At the same time, alveolar macrophages also killed opsonized Escherichia coli poorly . Increasing the ratio of macrophages to bacteria, adhering the macrophages to microcarrier beads, or preincubating the macrophages for 24 or 48 h with Con A supernatants failed to augment alveolar macrophage killing of opsonized E . coli . Corticosteroids appear to increase patient susceptibility to Legionnaires' disease . However, pretreatment of alveolar macrophages and monocytes with hydrocortisone had no influence on intracellular multiplication of L . pneumophila or on the inhibition of that multiplication by activated alveolar macrophages or monocytes . Hydrocortisone did impair cytokine-induced aggregation of alveolar macrophages . These findings demonstrate that L . pneumophila multiplies in human alveolar macrophages and that they do so within a ribosome-lined phagosome; that freshly explanted alveolar macrophages kill few L . pneumophila even in the presence of antibody and complement; that activated alveolar macrophages inhibit L . pneumophila multiplication; and that steroids do not exert a direct suppressive effect on the anti-L . pneumophila activity of activated or nonactivated alveolar macrophages . Our findings indicate that alveolar macrophages may play a central role in both the pathogenesis of Legionnaires' disease and in host defense against it . This paper shows that human resident macrophage can be activated to a higher state of antimicrobial capacity and that the human alveolar macrophage can serve as an effector call in call-mediated immunity. Pharmacotherapy, 1984 Sep-Oct, 4(5), 248 - 71 Surgical antimicrobial prophylaxis: principles and guidelines; Burnakis TG; Antimicrobial prophylaxis for surgical procedures is an area that is recognized as being subject to individual clinical variations . This review gives practitioners some basic principles of rational prophylaxis as defined by the medical literature . In addition, this literature is evaluated and condensed to provide clinicians with guidelines for particular procedures: obstetric, gynecologic, gastric, biliary, colonic, urologic, cardiac, thoracic, vascular, orthopedic and head and neck . Each section concludes with recommendations for the clinically most accepted prophylactic regimens . Antibiotics discussed include not only the older agents, but where good information exists, the newer cephalosporins . The suggested regimens consider efficacy, safety and cost as determinants in rational prescribing . Although research into even shorter, and perhaps more cost-effective, regimens continues, this compilation lists state-of-the-art recommendations. Obstet Gynecol Surv, 1984 Sep, 39(9), 537 - 54 The use of prophylactic antibiotics in obstetrics and gynecology . A review; Cartwright PS et al.; PIP: This review first makes some general comments about prophylactic antibiotics: animal models for antimicrobial prophylaxis, bacterial flora of the female genital tract, timing and duration of prophylactic antibiotic administration, and drug of choice for prophylaxis . Subsequent sections cover the following: prophylaxis for bacterial endocarditis; prophylaxis for vaginal hysterectomy; prophylaxis for elective abortions; prophylaxis for infertility and reconstructive surgery; prophylaxis for cesarean section (risk factor for postoperative infection, antibiotic of choice, timing of administration, duration of administration, and alternatives ot systemic prophylactic antibiotics); prophylactic antibiotics and cervical cerclage; and prophylaxis for preterm rupture of membranes . The recommendations are preceded by a description of the various categories suggested by the Centers for Disease Control, which recognizes that some recommendations are more firmly based on objective data than others: category 1 -- strongly recommended for adoption; category 2, moderately recommended for adoption; and category 3, weakly recommended for adoption . The recommendations include the following: all patients with a prosthetic cardiac valve should receive antibiotic prophylaxis for endometrial biopsy, insertion of IUD, urethral catheterization, dilation and curettage, hysterectomy, normal vaginal delivery, cesarean section, and sigmoidoscopy (category 1); premenopausal patients undergoing vaginal hysterectomy , with or without vaginal repair, should receive prophylactic antibiotics (category 1); and postmenopausal patients, with or without estrogen replacement therapy, may receive prophylaxis (category 2); regarding abdominal hysterectomy, patients with valvular heart disease, low socioeconomic status, cervical conization preceding hysterectomy from 2-21 days, or underlying conditions making a prolonged or difficult operation likely may benefit from prophylaxis (category 2); for elective abortion, patients with valvular heart disease, or a history of acute salpingitis may benefit from prophylaxis (category 2); patients undergoing surgical management of infertility secondary to endometriosis, pelvic adhesions, or distorted tubal architecture may benefit from prophylaxis; and regarding cesarean section, indigent or medically compromised patients with rupture of membranes over 8 hours and labor only 12 hours should receive prophylaxis (category 1) . Hautarzt, 1984 Sep, 35(9), 447 - 54 {Therapy of atopic eczema}; Braun-Falco O et al.; When a decision is being made on the therapy of atopic eczema, the complex pathogenetic interactions involved in this disease have to be taken into consideration . The acute inflammatory changes respond to short-term glucocorticoid steroid treatment (topical); long-term steroid therapy should be avoided . In chronic lichen-type lesions, non-steroid topical applications can be helpful . Frequent acute infections of the skin require the application of antimicrobials . Intense pruritus is treated by antihistamines (possibly also H2-antagonists) . Due to the well-known psychosomatic influence in this disease, careful counseling of the patient (and if a child, of the family) is necessary . Pathogenetically relevant allergic reactions of the immediate type can be treated successfully in some cases by hyposensitization . Prophylactic measures include allergen avoidance (climate therapy, no pets, well-established food allergens etc.) . Possible new perspectives may be seen in the development of agents acting at the disturbed T-cell regulation, as well as by the introduction of mast-cell-blocking substances . The basis of every therapeutic approach in atopic eczema is, however, intensive skin care, using emollients and oil baths, especially during the remission phase. Rev Infect Dis, 1984 Sep-Oct, 6(5), 689 - 703 Focal hepatic candidiasis: a distinct clinical variant of candidiasis in immunocompromised patients; Tashjian LS et al.; Focal hepatic candidiasis is a distinct clinical variant of candidiasis in immunocompromised hosts . Although affected patients may exhibit previous evidence of extra-hepatic candidal infection, manifestations of disease at the time hepatic involvement is documented are localized to the liver . Five cases of focal hepatic candidiasis in immunocompromised patients were diagnosed antemortem in the past 15 months at our institution . Clinical, laboratory, and radiologic findings from those five patients, as well as from 20 additional cases reported in the medical literature, are reviewed . Patients with focal hepatic candidiasis had fever unresponsive to antimicrobial therapy, prominent gastrointestinal symptoms and signs, elevated levels of alkaline phosphatase, and hepatic, with or without accompanying splenic, defects noted on abdominal computed tomography . Liver biopsy usually revealed yeast and/or hyphal forms, but cultures were frequently negative . Response to therapy occurred in only 13 (59%) of 22 assessable patients . The apparent increasing incidence of focal hepatic candidiasis may be due to the recent use of more intensely cytotoxic chemotherapies for cancer. J Clin Microbiol, 1984 Sep, 20(3), 351 - 6 Evaluation of new blood culture processing systems; Moody JA et al.; The Antimicrobial Removal Device (ARD; Marion Scientific) was evaluated in vitro with simulated blood culture samples in fresh blood and clinically with samples from potentially septic patients to test its ability to remove antimicrobial agents and recover bacteria from blood culture specimens containing these drugs . In simulated specimens, the ARD was evaluated for adverse affects on microorganisms as well as compared with lysis-centrifugation (Isolator; Du Pont Co.), biphasic brain heart infusion bottles, and tryptic soy broth bottles for antimicrobial inactivation and organism recovery . There was no adverse effect of the ARD on organisms during a 4-h test period . The ARD was the only system to actually inactivate antimicrobial agents and removed greater than 99.2% of all antimicrobial agents tested from spiked and clinical specimens . Overall, with simulated blood culture specimens, the ARD recovered 90% of bacteria spiked into fresh blood containing antimicrobial agents, Isolator recovered 73%, biphasic brain heart infusion bottles recovered 31%, and tryptic soy broth bottles recovered 24% . In the clinical study, 43 of 86 clinically significant isolates were recovered only by ARD-assisted processing, 6 were recovered only by conventional processing, and 37 were recovered by both methods (the advantage of ARD processing over conventional processing in the clinical study was significant at P less than 0.001) . Both clinical and simulated specimens demonstrated the ARD-associated blood culture processing to be the most efficient method for the isolation of microorganisms from specimens containing antimicrobial agents. Drugs, 1984 Sep, 28(3), 263 - 80 Treatment of male fertility disturbances . Current concepts; Schill WB et al.; Medical therapy of male infertility aims to improve or normalise the fertility status of a subfertile patient . However, this can be a frustrating task due to limited knowledge about the pathophysiology of male reproductive functions, and the fact that pharmacological therapy is mainly empirical and less often specific . Nevertheless, the spectrum of treatment approaches has increased within the last decade and comprises hormonal and non-hormonal compounds . Hormonal therapy is performed with antioestrogens (clomiphene, tamoxifen), gonadotrophin-releasing hormone (GnRH), prolactin inhibitors (bromocriptine), gonadotrophins (hMG, hCG), androgens (testosterone, mesterolone), and testosterone aromatase inhibitors (testolactone) . Tissue hormone-releasing proteases (kallikrein) can also be applied, liberating kinins as mediator substances with different effects at the cellular level . Non-hormonal therapy includes improvement of testicular microcirculation by oxpentifylline, antimicrobial and anti-inflammatory agents, drugs to improve or allow emission and ejaculation, and psychotropic and antispasmodic drugs to diminish functional disturbances induced by emotional stress . Treatment schedules are either specifically or empirically based . If treatment is based on a pathophysiological concept which implies strong patient selection, success of treatment is excellent . In contrast, despite an increased number of compounds, empirically based therapies remain unpredictable and the results are moderate and often not reproducible . However, when different drugs are compared with a placebo group in selected, well-controlled patients with idiopathic normogonadotrophic oligozoospermia, pregnancy rates will be in the range of 30 to 40% within an observation period of 1 year, as compared with the spontaneous conception rate of between 10 and 20%. Br J Pharmacol, 1984 Sep, 83(1), 15 - 21 In vivo and in vitro studies of bacterial endotoxin-membrane interactions and the effects of membrane-active agents; Garnett ME et al.; The characteristics of 51Cr-labelled E . coli endotoxin binding to human erythrocyte membranes in vitro have been investigated . A saturable component of binding was apparent at low endotoxin concentrations (less than 50 micrograms ml-1) relevant to its in vivo actions, while at higher concentrations binding was non-saturable and increased in linear fashion . Experiments examining the ability of unlabelled endotoxin to antagonize the binding of labelled toxin provided further evidence for these specific and non-specific modes of endotoxin-membrane interaction . Membrane-active agents previously shown to reduce endotoxin toxicity in vivo decreased endotoxin binding to erythrocyte membranes in vitro, with propranolol and pranolium being the most effective in this regard . Tissue distribution studies following administration of radiolabelled endotoxin to guinea-pigs showed a positive correlation between the accumulation of 51Cr-endotoxin in lung and elevations in plasma acid phosphatase activity, a measure of in vivo endotoxin toxicity . The in vivo accumulation of 51Cr-endotoxin in guinea-pig lung was reduced by prior treatment with (+)-propranolol or pranolium, paralleling the results of the in vitro binding studies . Our results suggest that membrane-active agents such as (+)-propranolol may be useful adjuncts to antimicrobial drugs in the therapy of gram-negative endotoxaemia. J Infect Dis, 1984 Sep, 150(3), 372 - 9 Trimethoprim-sulfamethoxazole in the prevention of infection in neutropenic patients . EORTC International Antimicrobial Therapy Project Group; Infection of a ventricular aneurysm and cardiac mural thrombus . Survival after surgical resection; Infections of cardiac mural thrombi are rare, and because antemortem diagnosis is difficult and antibiotic therapy alone ineffective, the associated mortality has been significant . A patient with gram-negative bacillary infection of a mural thrombus is described . Gallium 67 citrate isotope scanning and two-dimensional echocardiography were helpful adjuncts in establishing the diagnosis . Surgical resection of the infected myocardial tissue and prolonged antimicrobial therapy were necessary for cure. Farmakol Toksikol, 1984 Sep-Oct, 47(5), 44 - 7 {Spasmolytic and anti-inflammatory activity of 8-hydroxyquinolines}; Zaks AS et al.; It has been shown that quinozole (aqueous solution), enteroseptol and nitroxoline (suspension with Tween-80) in a concentration of 0.2 X 10(-6)-1.10(-5) decrease the tone of the rat and guinea-pig ileum and diminish their peristalsis . When administered in the same concentrations quinozole removes or prevents the spasmogenic effects of barium chloride (1 X 10(-5)-4.10(-5), of histamine (2 X 10(-5) and -6) but not of acetylcholine (1 X 10(-6)) . When administered orally in a dose 50 mg/kg to rats enteroseptol and nitroxoline inhibit the serotonin-, agar- and carrageenin-induced edemas of the rat paws without changing the response to subplantar injection of histamine . The data obtained should be taken into consideration during the use of 8-hydroxyquinolines as antimicrobial substances. Vet Microbiol, 1984 Sep, 9(5), 467 - 75 Antimicrobial drug resistance in porcine enterotoxigenic Escherichia coli of 0-group 149 and non-enterotoxigenic Escherichia coli; Franklin A; Enterotoxigenic Escherichia coli (ETEC) strains (104) and 96 non-ETEC, all isolated from herds with piglet diarrhea in 1981 and 1982, were investigated with regard to antimicrobial drug resistance and colicinogeny . Eighty strains (77%) of the ETEC were drug resistant as compared to 66 strains (69%) of the non-ETEC . There were no significant differences between ETEC and non-ETEC in the frequencies of the drug resistance determinants investigated, except for tetracycline, to which 51 (49%) of the former and 30 (31%) of the latter strains were resistant (0.05 greater than P greater than 0.01) . Of all strains 116 (58%) were resistant to streptomycin, 93 (47%) to sulphadimidin, 81 (41%) to tetracycline, 20 (10%) to trimethoprim, 14 (7%) to ampicillin, 11 (6%) to neomycin, 6 (3%) to chloramphenicol and none to nitrofurantoin . The frequencies of the different drug resistance determinants correlated well with the total amount of active substance of each drug used in farm animals in Sweden in 1981 . Of the ETEC, 97 (93%) were colicinogenic whereas only 13 (14%) of the non-ETEC were colicinogenic. Infect Control, 1984 Sep, 5(9), 448 - 52 Detection of bacteremia and fungemia: microscopic examination of peripheral blood smears; Graham BS; Microscopic examination of stained granulocyte smears can lead to the early identification of bacterial and fungal infections . The technique is simple, inexpensive, and safe . Although the test can be time consuming, it is clinically useful if performed when a high grade bacteremia or fungemia is likely to be present (Table 3) . The results are examiner dependent, but in the proper clinical setting should be reliable . Moreover, the slide can be saved as a part of the medical record, examined by others, and restained if necessary . A positive smear allows the physician to strengthen the empirical antimicrobial regimen against a particular organism which will hopefully improve the outcome of the septic process. Am Rev Respir Dis, 1984 Sep, 130(3), 467 - 71 Abnormal phagolysosome fusion in pulmonary alveolar macrophages of rats exposed chronically to cigarette smoke; Harris JO et al.; Cigarette smoking is strongly associated with functional and morphologic changes in pulmonary alveolar macrophages (PAM) . Phagocytic activity is a primary function of PAM, and although the ingestion of particles appears to be normal in the PAM of cigarette smokers, published data suggest that antimicrobial activity of these cells might be diminished . Because phagolysosome fusion (PLF) is an important aspect of the phagocytic process subsequent to the ingestion phase, PLF was evaluated in PAM lavaged from the lungs of male Fisher 344 rats that had been exposed for 8 wk to whole cigarette smoke, to the gas phase of cigarette smoke, or to air as a sham control . Using the acridine orange assay with viable yeast as the phagocytic challenge, we found no difference in the numbers of PAM from each group that had phagocytic activity after a 2-h challenge . However, PLF expressed as the number of orange-fluorescing phagosomes per total number of yeast-containing phagosomes was 35 +/- 1% (X +/- SE) for the group exposed to whole smoke, 53 +/- 2% for the gas phase group, and 65 +/- 1% for the control group . These differences are highly significant, with p less than 0.001 for the whole smoke versus control and p less than 0.01 for the gas phase versus control . Tight phagosomal membranes suggest normal PLF, whereas loose membranes suggest that PLF is inhibited . When the structure of yeast-containing phagosomes was examined and PLF was calculated with the number of phagosomes with tight membranes substituted for the number of orange-fluorescing phagosomes, PLF in smoke-exposed PAM was found to be significantly (p less than 0.01) different from that in sham-exposed control PAM.(ABSTRACT TRUNCATED AT 250 WORDS) J Antimicrob Chemother, 1984 Sep, 14 Suppl B, 331 - 5 Safety of cefotaxime and other new beta-lactam antibiotics; Parker RH et al.; beta-Lactam antimicrobial agents have until recently enjoyed a reputation of reliability and safety . Now serious problems have emerged associated with use of some of the newer drugs of this class . Latamoxef (moxalactam) and cefoperazone, both of which have a methyltetrazolethiol side chain, have been reported to cause coagulation abnormalities, clinical bleeding, and disulfiram-like reactions . In addition, an unusually high incidence of diarrhoea has been associated with administration of cefoperazone . Cefotaxime does not have the {methylthiotetrazole} side chain and has not caused bleeding, coagulopathy, or disulfiram-like reactions . Diarrhoea, usually mild, has been observed in only 1% of patients given cefotaxime in clinical trials . The remarkable safety record of cefotaxime is an important consideration for clinicians in the selection of an antimicrobial agent for seriously ill patients. J Antimicrob Chemother, 1984 Sep, 14 Suppl B, 217 - 21 Single-dose cefotaxime versus 3 to 5 dose cefoxitin for prophylaxis of vaginal or abdominal hysterectomy; Roy S et al.; We evaluated a single 1-g dose regimen of cefotaxime versus the standard three to five 2-g cefoxitin regimen for prophylaxis in vaginal or abdominal hysterectomy to determine whether acceptable rates of morbidity could be achieved . The antibiotics were administered as follows: cefotaxime, 1 g im or iv on call to the operating room; cefoxitin, 2 g im or iv on call to the operating room, followed by 2 g intravenously at 6 hourly intervals for up to 24 h . The patients received a povidone-iodine vaginal preparation immediately before surgery; vaginal packs, when used, contained no antimicrobial agents . Surgical procedures were comparable for each antibiotic and surgery group . The results showed that among cefotaxime treated subjects who underwent hysterectomy only 1 of 37 (2.7%) vaginal cases and 5 of 60 (8.3%) abdominal cases developed operative site infections requiring parenteral antibiotics . For cefoxitin, 3 of 41 (7.3%) vaginal cases and 6 of 41 (14.6%) abdominal cases, similarly, required antibiotics . The incidence of postoperative infections was not different between regimens, irrespective of the type of hysterectomy, but considerable cost-savings by reduced drug and administration expenses were realized with the single-dose cefotaxime regimen. Pharm Weekbl Sci, 1984 Aug 24, 6(4), 157 - 60 The essential oil of Ducrosia anethifolia (DC.) Boiss . Chemical composition and antimicrobial activity; Janssen AM et al.; The essential oil from herb of Ducrosia anethifolia (DC.) Boiss., growing wild in Iran, was investigated by LSC, GLC and GC-MS . The oil consisted mainly of aliphatic compounds . alpha-Pinene, myrcene and limonene were main components of the hydrocarbons present in the oil, while n-decanal, n-dodecanal, n-decanol, trans-2-dodecenal, and cis-chrysanthenyl acetate were the major oxygen-containing constituents . The oil and the main oxygen-containing aliphatic components showed a remarkable antimicrobial activity against gram-positive bacteria, a yeast, and some dermatophytes. Am J Ophthalmol, 1984 Aug 15, 98(2), 203 - 7 Recurrences of acute posterior multifocal placoid pigment epitheliopathy; Lyness AL et al.; Acute posterior multifocal placoid pigment epitheliopathy recurred in seven patients (all men, ranging in age from 25 to 43 years) . In all seven cases swelling of the pigment epithelium resolved rapidly but left a permanent pigmentary disturbance . Loss of choriocapillaris occurred in six cases . Three patients had severe unilateral visual loss . Three patients had used antimicrobial drugs (two of them repeatedly), suggesting that in some cases this condition may be a manifestation of a hypersensitivity reaction to the antimicrobial agent. Schweiz Med Wochenschr, 1984 Aug 7, 114(31-32), 1079 - 86 {Standardized disk tests for the determination of bacterial resistance }; von Graevenitz A et al.; This paper describes the standardized Kirby-Bauer disc method for the determination of antibacterial susceptibility, also including choice of antimicrobials, interpretation of results, problems with particular bacteria, and quality control . Only a meticulous adherence to the details of the method will guarantee reliable results. J Urol, 1984 Aug, 132(2), 362 - 4 Renal handling and lymph concentration of tetroxoprim and metioprim: an experimental study in dogs; Iversen P et al.; The renal handling and renal lymph concentrations of tetroxoprim and metioprim, 2 trimethoprim analogs, were investigated during constant intravenous infusion in 8 dogs . The mean ratios of tetroxoprim and metioprim clearance to creatinine clearance were 0.40 and 0.16 respectively . After compensation for protein binding, both antimicrobials were found to undergo a renal tubular net reabsorption of 55 to 60 per cent of the filtered amount . Renal lymph was obtained by direct cannulation of capsular lymphatics, and the mean lymph-to-arterial plasma concentration ratios were 0.93 and 0.74 for tetroxoprim and metioprim, respectively . Renal tissue concentrations of the 2 microbials were many times higher than the simultaneous concentrations in plasma, suggesting that lymph concentrations do not represent the entire interstitial compartment or that significant amounts of antimicrobial are located intracellularly . Tetroxoprim and metioprim concentrated well in the kidney, but their potential use in the treatment of pyelonephritis awaits verification in clinical trials. Obstet Gynecol, 1984 Aug, 64(2), 170 - 2 Gardnerella vaginalis bacteremia: a review of thirty cases; Reimer LG et al.; The authors documented thirty cases of bacteremia, all in gynecologic and obstetric patients, over a four-year period at a university hospital . Sixteen of the patients had polymicrobial infections . Most of the patients recovered completely whether or not antimicrobial therapy directed against Gardnerella vaginalis was given . G vaginalis bacteremia may occur more often than has been reported. J Dent Res, 1984 Aug, 63(8), 1051 - 5 Fissure removal and needle scraping for evaluation of the bacteria in occlusal fissures of human teeth; Meiers JC et al.; The bacterial counts obtained with a needle-scrape method for collecting plaque samples from human occlusal fissures with incipient caries were compared with the microflora remaining in the fissures as determined with a fissure removal method . Scraping of six fissures with a sterile needle recovered only 18.2% of the total recovered fissure flora . The needle-scrape method failed to detect specific cariogenic bacteria which were present in four of the fissures . Treatment of nine fissures with an antibacterial solution demonstrated that the needle method failed to detect viable bacteria in eight of the fissures which were subsequently shown to contain bacteria by fissure removal . The commonly used needle-scraping method does not appear adequate for studies on the effect of antimicrobial agents on fissure plaque. Am J Infect Control, 1984 Aug, 12(4), 221 - 7 A national task analysis of infection control practitioners, 1982 . Part Three: The relationship between hospital size and tasks performed; Pugliese G et al.; One aspect of the Certification Board of Infection Control's (CBIC) task analysis survey was to determine those tasks done most frequently and considered most important by ICPs . A randomized stratified sample of ICPs was taken from U.S . hospitals of various bed-size categories . There were 473 responses (78.8%) from a targeted sample of 600 ICPs . Statistical analyses were done to find if a relationship existed between hospital size and the tasks performed . The frequency of performance and importance of the majority of infection control tasks studied were found to vary in relation to hospital size . Some tasks were found to be both important and frequently performed by the majority of ICPs in all hospital bed-size categories . These included performing and reporting epidemiologic surveillance, educating personnel, developing infection control policies and procedures, and consulting with hospital personnel . Other tasks were found to be relatively less important and infrequently performed by the majority of ICPs in all hospital bed-size categories . These included performing bedside patient care procedures, recommending specific antimicrobial therapy, and using statistical methods . The greatest differences in the performance of tasks were found in the subsample of the ICPs from hospitals with less than or equal to 100 beds. Contraception, 1984 Aug, 30(2), 135 - 41 The effect of chemical intravaginal contraceptives and Betadine on Ureaplasma urealyticum; Amortegui AJ et al.; PIP: An in vitro study was conducted in an effort to find a barrier contraceptive agent capable of controlling infections and sexual transmission of Ureaplasma urealyticum from the female genital tract, especially to help reduce nongonococcal urethritis in males caused by this organism . The in vitro antimicrobial activity of 6 intravaginal contraceptives and Betadine against the 8 serotypes of the organism was investigated . All 8 serotypes of Ureaplasma urealyticum exhibited a uniform response to each of the different products tested . Metabolic inhibition of Ureaplasma was examined at 24, 48, and 72 hours . At 24 hours, metabolic inhibition was observed with 6 of the 8 agents tested . 2 of the agents, Betadine solution and Betadine vaginal gel, produced inhibition up to 1:64 . 4 agents -- Emko foam, Delfen foam, Kormex ii, and Conceptrol -- exhibited inhibition at either 1:16 or 1:32 . The 2 other agents, NeoSampoon and Encare Oval, failed to produce inhibition of the lowest dilution tested . There was no change in the observed endpoint of 1:64 for the Betadine preparations at 48 and 72 hours . 4 of the agents demostrated a decrease in the endpoint upon prolonged incubation to 72 hours, with growth of the organism in the lowest dilutions of Emko and Delfen foams . Results of subcultures of all dilutions of the agent-broth mixtures at 5 minutes showed that Betadine in its 2 forms tested, Koromex II and Conceptrol, produced apparent killing of Ureaplasma at dilutions of 1:32, 1:4, and 1:4 respectively . Subcultures after 24 hours of contact between the agent and Ureaplasma indicated a killing effect up to dilutions of 1:64 for the Betadine preparations and 1:4 for Meko foam . All other endpoints remained unchanged at 24 hours . The measurements of the pH of the emulsions and the pH of 1:1 mixture of U9B medium with the agent emulsion ranged from 4.0 (Concetrol) to 7.9 (NeoSampoon) for the agent emulsons and from 4.2 Conceptrol) to 7.3 (Neo Sampoon) for the the U9B-emulsion mixtures . Betadine solution and gel were found to have a pH of 2.5 in saline dilution and 3.5 in solution with U9B broth . On the basis of these "in vitro" experiments, the intravaginal contraceptives may have a role in the prevention of sexually transmissble infection or colonization by Ureoplasma . Br J Vener Dis, 1984 Aug, 60(4), 214 - 8 Clinical course and treatment of venereal spirochaetosis in New Zealand white rabbits; DiGiacomo RF et al.; Ten sporadic cases of venereal spirochaetosis, caused by Treponema paraluis-cuniculi, were seen in New Zealand white rabbits in two years . An equal number of males and females were affected . Females tended to have milder clinical signs than males . Lesions were usually found on the prepuce in males and the vulva in females, although the anus and skin of the perineum were also affected . Facial lesions were rare . Lesions healed in seven to 28 days in rabbits treated with penicillin . Eight rabbits had antibodies reactive in the Venereal Disease Research Laboratory (VDRL), rapid plasma reagin (RPR), and fluorescent treponemal antibody absorbed (FTA-ABS) tests when the disease was first diagnosed . In several rabbits followed longitudinally, RPR test results became negative two to four months after antimicrobial treatment, VDRL antibody titres diminished but usually persisted at low levels, while FTA-ABS antibodies declined slowly and were still evident 12 months after treatment. J Antimicrob Chemother, 1984 Aug, 14 Suppl A, 43 - 55 Baculovirus replication: effects of inhibitors of macromolecular synthesis; Kelly DC; A number of inhibitors of DNA, RNA, protein and polyamine synthesis have been used to elucidate the mode of replication of baculoviruses . An overview of the viruses, the antimicrobial inhibitors used, and the effects of the drugs are presented . Although certain inhibitors of protein synthesis and DNA synthesis are useful in determining the program of expression of the viral genome into immediate early, delayed early, late and very late phases of synthesis, few drugs have proved useful as antimicrobial agents . Bromovinyldeoxyuridine (BVDU) is a potent inhibitor of baculovirus replication inhibiting viral DNA synthesis by blocking the virus induced DNA polymerase . Preliminary experiments suggest that BVDU suppresses baculovirus disease in insect larvae. J Pharm Sci, 1984 Aug, 73(8), 1166 - 8 Synthesis and biological evaluation of new 2,3-dihydrothiazole derivatives for antimicrobial, antihypertensive, and anticonvulsant activities; Omar AM et al.; A novel series of 2-arylimino-2,3-dihydrothiazole derivatives, substituted in the 3-position with a beta-phenethyl moiety and the 4-position with substituted aryl functions, was synthesized as potential antimicrobial, antihypertensive and anticonvulsive agents . While no antimicrobial or significant antihypertensive activity was observed for the products, XII, XIII, and XXI displayed potent anticonvulsant activity. Chirurg, 1984 Aug, 55(8), 515 - 8 {Experimental and clinical studies of the efficacy of an antimicrobial incision drape}; Manncke K et al.; The antibacterial activity of an antimicrobial incise drape containing povidone-iodine was compared to a normal drape by experimental and clinical investigations . In vitro, no difference in the survival rate of six bacterial species depending on the kind of the drape, could be demonstrated . Clinical studies by contact cultures, postoperatively taken from the skin after removal of the drape, yielded no significant difference in the recolonisation of the skin during the operations . The importance of the preoperative, antimicrobial preparations of the skin is discussed. Can J Physiol Pharmacol, 1984 Aug, 62(8), 1044 - 8 The use of antimicrobial drugs in agriculture; Black WD; Antibacterial drugs have been used widely in animal production for treatment and prevention of disease and for growth promotion . Concern has been expressed about possible harm to humans, through the use of drugs, in the following ways: increased microbial drug resistance; drug residues in food; allergic reactions and sensitization to antimicrobials; and drug toxicity . Research has shown that microbial resistance in people can develop from drugs used in animals . Farmers, butchers, etc., have been shown to have an increased incidence of drug-resistant organisms . Resistance to antibiotics can develop in two ways; genetic mutation and natural selection, and through R-factor plasmid transfer . Allergic reactions have been reported following the ingestion of penicillin-containing milk; however, residues in other foods have not caused allergic reactions . Sensitization of humans to antimicrobials through the consumption of drug residues in foods has never been documented . Evidence suggests that the residue levels in food are too low to cause sensitization . Drug toxicity, other than allergic reactions, appears not to result from residues of antimicrobial drugs in food . While it has been studied many times, monitoring programs have failed to find any evidence of a problem . This appears to reflect the low toxicity of these agents and the small amounts obtained in the food, however, it could also reflect failure of the monitoring systems. Antimicrob Agents Chemother, 1984 Aug, 26(2), 228 - 30 Moxalactam penetration into normal heart valve, cardiac vegetations, and myocardium in relation to protein binding and physiological distribution spaces; Fitzpatrick BC et al.; Rabbits with catheters implanted in the left ventricle were given a single dose of moxalactam and sacrificed at various times thereafter for measurement of the concentration of this antimicrobial agent in serum, heart muscle, and various heart valves . Penetration into both extravascular sites was rapid; steady state was achieved within 5 min after the dose . Moxalactam showed essentially complete penetration into valve lesions, whereas concentrations in heart muscle were only 20% of those in serum . The physiological distribution of moxalactam in heart muscle was beyond the inulin space, but substantially lower than total body water . This myocardial distribution ratio was not predicted by the serum-free fraction or blood trapped in tissues alone, but was in good agreement with that of extracellular fluid plus blood trapped in tissues . The moxalactam distribution profile was most compatible with that of drugs which are excluded from cells but readily distributed throughout extracellular fluids . This explains its nearly complete penetration into heart valves as well as its incomplete penetration into heart muscle, since the two sites differ in their relative proportions of cells and extracellular fluid spaces. J Antibiot (Tokyo), 1984 Aug, 37(8), 829 - 35 Phosalacine, a new herbicidal antibiotic containing phosphinothricin . Fermentation, isolation, biological activity and mechanism of action; Omura S et al.; Phosalacine, a new herbicidal antibiotic containing phosphinothricin was isolated from the culture filtrate of a soil isolate Kitasatosporia phosalacinea KA-338 . It was a water soluble, amphoteric compound obtained as an amorphous powder (C14H28N3O6P, MW 365) . The antibiotic exhibited antimicrobial activity against Gram-positive and Gram-negative bacteria and some fungi on a minimal medium and the activity was reversed by L-glutamine . It also showed herbicidal activity against alfalfa . It is suggested that phosalacine was decomposed to provide phosphinothricin after its incorporation into microbial or plant cells, and exhibited the antimicrobial and herbicidal activities by inhibiting glutamine synthetase with phosphinothricin although phosalacine itself hardly inhibited the enzyme. Burns Incl Therm Inj, 1984 Aug, 10(6), 415 - 9 Clinical experience with Biobrane biosynthetic dressing in the treatment of partial thickness burns; Hansbrough JF et al.; Biobrane, a synthetic, bicomposite wound dressing, has been used to treat 17 patients with partial thickness burn wounds covering 0.5-12.5 per cent of the total body surface area (mean 4.4 per cent) . In 16 patients we found complete healing of the wound after removal of the dressing, 6-15 days after the injury . In one patient, the wounds were determined on the third day post-injury to be deeper than initially suspected, and she was taken to the operating room for surgical debridement and grafting . Biobrane is an effective wound covering for clean, superficial partial thickness burns of limited extent; the simultaneous use of topical antimicrobial agents for such wounds is not necessary. Int J Radiat Oncol Biol Phys, 1984 Aug, 10(8), 1293 - 300 Pharmacology and toxicology of sensitizers: mechanism studies; Rauth AM; Nitroimidazoles are being studied extensively as hypoxic cell radiosensitizers . Besides their ability to selectively sensitize hypoxic cells to radiation, which depends on the parent compound, nitroimidazoles have a variety of other effects in vitro, in vivo and clinically which appear to require reductive metabolism . These other effects include direct cytotoxicity to hypoxic cells, mutagenicity and antimicrobial effects . As a first step to suggesting possible mechanisms for these other biological effects, a summary has been made of the known oxidative and reductive products of the two most widely studied radiosensitizers, metronidazole and misonidazole . Focussing on reductive products, it is clear that a great variety exists which are or may be reactive with biological molecules . Knowledge about the reduction chemistry of nitroimidazoles is new and far from complete . As a second step to suggesting possible mechanisms for these biological effects, it is important to view the problem in terms of the in vivo situation where distribution and sites of metabolism of the drug and its reduction products will be important factors . Variables such as levels of tissue oxygenation and nitroreductase activity will be important to assess . Combining basic information about the reduction chemistry of nitroimidazoles with knowledge about the pharmacology of drugs and their reduced products should allow a better assessment of mechanism of action as well as a better implementation of these drugs clinically. Eur J Respir Dis, 1984 Aug, 65(6), 402 - 10 Various colony-formers of Mycobacterium avium-intracellulare; Kuze F et al.; Four disease-associated strains of Mycobacterium avium-intracellular isolated in our laboratory from human sputum gave rise to transparent, opaque, intermediate, and rough colony forms on cornmeal glycerol medium . Each colony-former was purified, and both the virulence to conventional ddY strain of mice and in vitro susceptibilities to various antimicrobial drugs were compared among different colony-formers . The opaque colony-formers were more susceptible to cephalothin, rifampicin, gentamicin, tobramycin, and kanamycin than the other colony-formers . Simultaneous evaluation of virulence to the mice revealed both opaque and intermediate colony-formers to be less virulent than transparent and rough colony-formers. Surg Clin North Am, 1984 Aug, 64(4), 653 - 8 The compromised bed technique . An improved method for skin grafting problem wounds; Tobin GR; An improved method for skin grafting wounds that are compromised by bacterial contamination or other risk factors for graft loss is described . This method involves the use of partially expanded, perforated skin grafts that allow delivery of topical antimicrobial chemotherapy and provide wound bed drainage. Am Surg, 1984 Aug, 50(8), 412 - 7 Ampicillin versus cefamandole in biliary tract surgery . A prospective, randomized clinical and bacteriological study; Levi JU et al.; A prospective, randomized study was conducted on 219 surgical patients with biliary tract disease . There were 100 patients undergoing elective biliary surgery, and 119 others with suspected biliary sepsis who were assigned to Prophylactic or Therapeutic clinical categories, then randomized into ampicillin or cefamandole treatment groups . Organisms resistant to the antibiotics given were found less often among patients in the cefamandole groups than among those in the ampicillin groups . No postoperative wound or intra-abdominal sepsis (IAS) occurred in the Prophylactic category . In the Therapeutic category there were two cases (3.2%) of wound and IAS in the ampicillin group and one case (1.8%) of wound infection in the cefamandole group . Overall, cefamandole showed superior coverage in vitro against the biliary flora, but both drugs were equally effective in maintaining a low incidence of postoperative sepsis as well as a minimal number of febrile or total hospital days . The authors suggest that the choice of antimicrobials may not be as critical as effective surgical management in the prevention of septic complications following biliary tract surgery. Food Chem Toxicol, 1984 Aug, 22(8), 655 - 60 The sensitizing potential of metalworking fluid biocides (phenolic and thiazole compounds) in the guinea-pig maximization test in relation to patch-test reactivity in eczema patients; Andersen KE et al.; The sensitizing potential of seven industrial antimicrobial agents was evaluated using the guinea-pig maximization test . Preventol O extra (o-phenylphenol) did not produce a sensitization reaction . Preventol ON extra (sodium salt of o-phenylphenol), Preventol GD (dichlorophene) and Proxel XL and HL containing 1,2-benzisothiazolin-3-one were weak sensitizers, while Preventol CMK and Preventol L, both containing chlorocresol, were classified as extreme potential sensitizers . Both the weak and the extreme experimental sensitizers are occasional human sensitizers . The interpretation of the test results is discussed. Ann Trop Med Parasitol, 1984 Aug, 78(4), 345 - 54 Evaluation of a range of antimicrobial agents against the parasitic protozoa, Plasmodium falciparum, Babesia rodhaini and Theileria parva in vitro; McColm AA et al.; Eighteen antimicrobials commonly used in tissue culture were screened in three different protozoan test systems in order to establish their suitability for routine inclusion in protozoal cultivation systems . The human malaria parasite, Plasmodium falciparum, was inhibited by more than half the antibiotics tested at concentrations recommended for normal tissue culture use . Eight compounds were well tolerated and thus could be used prophylactically to prevent microbial contamination . These antimicrobials were the bactericidal aminoglycoside antibiotics, streptomycin, gentamicin and kanamycin, the bacteriostatic protein synthesis inhibitors, chloramphenicol and chlortetracycline and the antifungals, 5-fluorocytosine, nystatin and amphotericin B . Babesia rodhaini and Theileria parva were less sensitive than P . falciparum and tolerated all 18 compounds at concentrations well above 100 micrograms ml-1 . Extension of the study to examine direct antiprotozoal action of these and other antimicrobials not normally used in culture confirmed that P . falciparum was significantly more sensitive than the other parasites . Tylosin, rifamycin, gramicidin D and valinomycin were all strongly antimalarial with IC50 values of 0.245, 1.20, 1.3 X 10(-3) and 1.9 X 10(-3) micrograms ml-1 respectively . This compares with a value of 1.35 X 10(-2) micrograms ml-1 for the standard antimalarial, chloroquine . Only valinomycin and, more particularly, gramicidin D were significantly active against B . rodhaini and T . parva . Gramicidin D was more effective, but more toxic, than the standard antiprotozoal agents tested at curing in vivo malarial and babesial infections in mice. J Am Geriatr Soc, 1984 Jul, 32(7), 513 - 9 Twelve-month surveillance of infections in institutionalized elderly men; Nicolle LE et al.; Surveillance of infectious episodes in institutionalized elderly men permanently resident on two wards of a veterans' hospital was undertaken for a 12-month period . One-hundred eleven episodes were identified in 50 residents (74 per cent) . The most frequent infections included lower respiratory tract infections (incidence 59/100 patient-years), febrile episodes with no source (43.4), skin and soft tissue infections (36.5), and gastroenteritis (33) . Only pneumonia was associated with significant mortality . A specific etiologic agent was seldom identified other than for skin and soft tissue infections . Antimicrobial therapy was prescribed for 87 per cent of all infections . Ward staff absenteeism was associated with peak occurrences of infections in residents . Resident characteristics that correlated with infection were incontinence of bladder and of bowel . Mental status or degree of mobility did not correlate . While infections occur frequently in this population, mortality is common only with pneumonia . Infections occur more frequently in residents who have greater functional impairment. Infect Immun, 1984 Jul, 45(1), 150 - 4 Purification and antibacterial activity of antimicrobial peptides of rabbit granulocytes; Selsted ME et al.; Six antimicrobial peptides, corresponding to the family of "lysosomal cationic proteins" described previously by Zeya and Spitznagel (H . I . Zeya and J . K . Spitznagel, J . Bacteriol . 91:750-754, 1966; H . I . Zeya and J . K . Spitznagel, J . Bacteriol . 91:755-762, 1966), were purified from rabbit peritoneal granulocytes by preparative acrylamide gel electrophoresis and reversed-phase high-pressure liquid chromatography . Each of the peptides was of low molecular weight (ca . 4,000) as determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis . The two most cationic peptides, NP-1 and NP-2, were active against a broad spectrum of gram-positive and gram-negative bacteria . The remaining four peptides, NP-3A, NP-3B, NP-4, and NP-5, had more selective antibacterial activity . None of the peptides was active against Bordetella bronchiseptica, a common pathogen of domestic rabbits . Antibacterial activity was best expressed at near neutral pH under conditions of low ionic strength. Gut, 1984 Jul, 25(7), 732 - 6 Impact of preoperative weight loss and body composition changes on postoperative outcome in surgery for inflammatory bowel disease; Higgens CS et al.; One hundred and twenty seven patients undergoing elective surgery for inflammatory bowel disease were divided into three groups according to their preoperative ideal body weight (less than 80%, 80-90%, and greater than 90%) . The groups were well matched in respect of age, sex, corticosteroid therapy, pre-existing sepsis, peroperative antimicrobial chemotherapy, and resection site . None received peroperative nutritional support . The postoperative outcome was similar in each of the three nutritional groups including the incidence of postoperative sepsis, duration of hospital stay, and mortality . Serial peroperative changes in weight, fat, and muscle bulk were assessed by anthropometric measurements in 21 of these patients . The deficits in weight, fat, and muscle bulk were similar at 10 and 21 days postoperatively in the three groups . At 84 days those malnourished preoperatively had recovered their nutritional status faster than the well nourished patients . We conclude that in these patients undergoing elective resection for inflammatory bowel disease preoperative weight loss did not adversely affect the postoperative outcome. J Clin Periodontol, 1984 Jul, 11(6), 379 - 86 Comparison of the immediate effects on the sub-gingival microflora of acrylic strips containing 40% chlorhexidine, metronidazole or tetracycline; Addy M et al.; In the management of chronic periodontitis, there has been a renewed interest in the local delivery of antimicrobial drugs into periodontal pockets . This study assessed the effects of the acrylic strip delivery system containing chlorhexidine, metronidazole or tetracycline on subgingival microflora assessed by dark field microscopy . Strips containing 40% chlorhexidine, metronidazole or tetracycline were placed for 2 to 3 days into pockets greater than 6 mm which bled on probing . Plaque samples were obtained before and after treatment and counts of morphological and motile groups of organisms were made by dark field microscopy . Prior to treatment, the dark field microscopic counts were similar to those previously reported for diseased sites with motile bacteria, in particular spirochaetes, present in high numbers . Following treatment, all 3 antimicrobial drugs produced a significant increase in the proportion of cocci and significant decreases in all other types of organisms . Motile organisms, in particular, were markedly reduced and spirochaetes could not be recovered from some sites treated with metronidazole and tetracycline . Metronidazole was significantly more effective than tetracycline or chlorhexidine on spirochaetes . The results indicate that acrylic strips may be useful in the management of chronic periodontitis as an adjunct to routine mechanical methods. Pediatr Infect Dis, 1984 Jul-Aug, 3(4), 392 - 6 Surgical management of otitis media; Bluestone CD; In summary there are four surgical procedures commonly used for treatment of otitis media . Myringotomy and aspiration of the middle ear effusion is indicated for acute otitis media: (1) when a child has persistent or recurrent symptoms while on appropriate antimicrobial therapy; (2) if there is severe otalgia initially requiring immediate relief; (3) when a suppurative complication is present, such as facial paralysis; or (4) whenever a diagnostic tympanocentesis (for microbiology) is indicated, such as for the critically ill child, the neonate or a child who is immunologically compromised . In addition the potential benefit from more liberal use of the procedure initially might decrease the persistence and recurrence . Myringotomy without tympanostomy tube insertion is a reasonable treatment option for infants and children with chronic otitis media with effusion that is unresponsive to antimicrobial therapy if the procedure can be performed without the administration of a general anesthetic; however, if not, then a tympanostomy tube should be inserted since the recurrence rate is high . In addition to chronic otitis media with effusion, myringotomy with tympanostomy tube insertion is indicated for: (1) recurrent acute otitis media, especially if unresponsive to prophylactic antimicrobial therapy; (2) eustachian tube dysfunction, in which one or more of the following is present--otalgia, significant and symptomatic hearing loss, vertigo or tinnitus; (3) severe retraction pocket of the tympanic membrane; (4) suppurative complication to maintain adequate drainage; and (5) at the time of repair of a tympanic membrane defect, i.e . tympanoplasty, when the eustachian tube function is poor.(ABSTRACT TRUNCATED AT 250 WORDS) Acta Diabetol Lat, 1984 Jul-Sep, 21(3), 275 - 80 Diabetes as pro-infective risk factor in total hip replacement; Vannini P et al.; It is widely accepted that diabetic patients, above all poorly controlled ones, are more susceptible to infection . To verify whether diabetes might be considered a pro-infective risk factor in total hip replacement, 1,042 patients, who from 1969 to 1979 underwent an operation for arthropros thesis of the hip, were studied . The patients were subdivided into two groups according to whether they were diabetic or not . The diabetic patients, though well controlled by diet or by diet plus oral hypoglycemic agents, received insulin for at least two days before surgery . In the early post-operative phase they showed transient worsening of glycemic control rapidly corrected by increased insulin dosage . The patients of both groups were operated in low air exchange operating theaters, by the same staff and using standardized surgical techniques, and all received antibiotic coverage as preventive treatment against infections for a week after surgery . Infection and suppuration occurred in 11% of diabetic patients and only in 2% of non-diabetic patients (p less than 0.001); in these cases the prostheses were removed after unsuccessful antimicrobial treatment . Our study indicates that diabetes mellitus must be considered a proinfective risk factor in patients who undergo an operation for total hip replacement and suggests that a conservative approach is required in diabetic patients. Yale J Biol Med, 1984 Jul-Aug, 57(4), 549 - 53 Susceptibility of the Lyme disease spirochete to seven antimicrobial agents; Johnson SE et al.; The antimicrobial susceptibility of five Lyme disease spirochete strains (two human and three tick isolates) was determined . A macrodilution broth technique was used to determine on three separate test occasions the minimal inhibitory concentrations (MICs) of seven antibiotics . The Lyme disease spirochete was most susceptible to erythromycin with a MIC of less than or equal to 0.06 micrograms/ml . The spirochete was also found to be susceptible to minocycline, ampicillin, doxycycline, and tetracycline-HCL with respective mean MICs of less than or equal to 0.13, less than or equal to 0.25, less than or equal to 0.63, and less than or equal to 0.79 micrograms/ml . The spirochete was moderately susceptible to penicillin G with a mean MIC of 0.93 micrograms/ml . All strains were resistant to rifampin at the highest concentration tested (16.0 micrograms/ml). J Pharm Sci, 1984 Jul, 73(7), 1012 - 3 Antimicrobial activity of triethylammonium chloride-N-substituted N'-cyano-O-(triphenylstannyl)-isourea complexes; Kupchik EJ et al.; The triethylammonium chloride complexes of N-substituted N'-cyano-O-(triphenylstannyl)isoureas were generally found to be better antifungal and antibacterial agents than the uncomplexed compounds. J Antibiot (Tokyo), 1984 Jul, 37(7), 738 - 49 Chemical modification of spiramycins . II . Synthesis and antimicrobial activity of 4'-deoxy derivatives of neospiramycin I and their 12-(Z)-isomers; Sano H et al.; 4'-Deoxy derivatives of neospiramycin I and their 12-(Z)-isomers were synthesized by reductive dechlorination via 4'-epi-chloro derivatives . The 12-(Z)-derivatives were more active against bacteria in vitro than the corresponding 12-(E)-derivatives in spite of their low affinities to ribosomes. Jpn J Antibiot, 1984 Jul, 37(7), 1272 - 8 {An evaluation of antimicrobial removal device to isolate bacteria from bacteremic patients with hematological disorders}; Nakazawa H et al.; Antibiotics contained in blood specimens often inhibit bacterial growth in culture media . Recently, the antimicrobial removal device (ARD) containing resins to absorb antibiotics has been made available . To evaluate the effectiveness of the ARD, we investigated how much the antibiotics were removed by the ARD . The ARD method was compared to the conventional culturing method in isolating organisms from blood specimens of patients with hematological disorders receiving antimicrobial agents . The antibiotics, including cefotiam, cefsulodin, cefmenoxime, cefazolin and sulbenicillin, were proved to be almost completely removed by the ARD . Bacteria were detected only by use of the ARD in the blood cultures from 2 of 21 blood specimens (11 patients) entered in the study, while all of the blood cultures were negative by the conventional method . These isolated bacteria were S . aureus and P . aeruginosa, of which septicemias were cured by intensive antibiotic therapy for these bacteria . It is suggested that pretreatment with the ARD makes detection of bacteria easier in blood from the patients receiving antibiotics . Literatures were reviewed concerning improvement and shortened time for isolation of organisms by using the ARD. Antimicrob Agents Chemother, 1984 Jul, 26(1), 26 - 30 New micromethod to study the effect of antimicrobial agents on Toxoplasma gondii: comparison of sulfadoxine and sulfadiazine individually and in combination with pyrimethamine and study of clindamycin, metronidazole, and cyclosporin A; Mack DG et al.; An in vitro method by which reagents, cells, and Toxoplasma gondii trophozoites are conserved (micromethod) was developed to quantitate the effect of antimicrobial agents on T . gondii . Sulfadoxine alone had no effect on T . gondii in vitro when evaluated with a macromethod, the new micromethod, or visual inspection of Giemsa-stained preparations . Sulfadoxine combined with pyrimethamine inhibited T . gondii more than did pyrimethamine alone, but the combination of sulfadoxine plus pyrimethamine was slightly less active than was the combination of sulfadiazine plus pyrimethamine . Neither clindamycin nor metronidazole, alone or in combination with sulfadiazine or pyrimethamine and sulfadiazine, had any effect on intracellular T . gondii . Brief exposure (10 min before and during challenge) to clindamycin had no effect on extracellular T . gondii when clindamycin was studied alone or with sulfadiazine or pyrimethamine plus sulfadiazine . Cyclosporin A inhibited T . gondii replication at concentrations of ca . greater than or equal to 2 micrograms/ml. Vestn Khir Im I I Grek, 1984 Jul, 132(7), 57 - 9 {Urea as an antimicrobial and dehydration agent for the local treatment of suppurative surgical infection}; Tiukina AA et al.; The 30% solution of urea is found to be an effective quick-acting means against gram-positive and gram-negative pyogenic microflora . Microorganisms discharged from purulent foci of patients were sensitive to the drug in 100% of cases . The local application of the 30% urea solution as irrigation used in 156 patients with pyo-surgical infection has shown the drug to be well endured by the patients . It has no side effects . The purulent process can be cupped off 1,5-1,7 times quicker. Orthop Clin North Am, 1984 Jul, 15(3), 547 - 64 Antimicrobial therapy in musculoskeletal surgery; Thompson RL et al.; The treatment of musculoskeletal infections often involves a combined surgical and antibiotic approach . The antimicrobial therapy of these infections does not differ in basic principles from that of other infections . Because many different microorganisms can cause musculoskeletal infection, appropriate antimicrobial therapy depends on proper culturing, isolation, identification, and antibiotic susceptibility testing of the etiologic infectious agent . The need for long-term treatment makes the proper selection of antibiotic and monitoring of therapy imperative . The least toxic, least expensive, and most effective antibiotic should be selected. J Pharm Sci, 1984 Jul, 73(7), 982 - 5 Synthesis and antimicrobial activity of novel quinazolone derivatives; Habib NS et al.; Three novel series of 4-oxoquinazoline derivatives were prepared and evaluated as potential antimicrobial agents . Evaluation of the antimicrobial activity of a variety of 4-substituted-1-thiosemicarbazides, 3,4-disubstituted thiazolines, and 3-substituted-5-thiazolidones reveals that the majority possess significant in vitro activity against Gram-positive organisms . Some derivatives also exhibited antifungal activity. J Pharm Sci, 1984 Jul, 73(7), 903 - 5 Preformulation method for parenteral preservative efficacy evaluation; Akers MJ et al.; A method is described for rapidly and reliably evaluating parenteral preservative efficacy . Solutions containing antimicrobial preservatives were challenged with microorganisms, sampled from 0.5 to 6 h following introduction of the challenge, cultured, and counted for surviving microbial cells . Data were analyzed by computer according to two models: linear and quadratic . Decimal reduction times (D values) were calculated for each microbial challenge in each preservative solution . A D value of less than or equal to 2 h for bacteria predicts that the preservative system will pass the British Pharmacopoeia (BP) preservative efficacy test, a more rigorous test than the USP test . Fourteen preservative systems were tested in both neutral isotonic saline solutions and neutral regular insulin solutions . D values and correlation coefficients for both models were calculated . The ranking of preservative effectiveness in neutral saline solutions closely correlated with the results found using neutral regular insulin solutions . The most effective preservative systems were found to be 0.3% m-cresol and various combinations of m-cresol and phenol . The advantages and limitations of this method are discussed. Antimicrob Agents Chemother, 1984 Jul, 26(1), 35 - 8 Duodeno-pancreatic secretions enhance bactericidal activity of antimicrobial drugs; Mett H et al.; We have studied the action of various antimicrobial agents in microbiological media and in human duodeno-pancreatic secretions . In the latter medium, clioquinol exhibited a rapid bactericidal effect on both growing and stationary bacteria at concentrations near its MIC . However, it was merely bacteriostatic in microbiological media, even at high concentrations . Phanquinone, chlorquinaldol, and, to a lesser extent, also chloramphenicol and trimethoprim likewise displayed enhanced bactericidal activity in duodeno-pancreatic secretions, but various other antibacterial agents did not . These findings suggest that duodeno-pancreatic secretions contain a factor augmenting the antibacterial activity of a number of drugs. Dent Clin North Am, 1984 Jul, 28(3), 423 - 32 Principles of anti-infective therapy; Montgomery EH et al.; Antimicrobial drugs, along with competent surgical procedures, provide an effective means for restoration of oral health . In dentistry, antibiotics are indicated for either treatment of acute infections or for prophylactic coverage of patients at risk for developing bacterial endocarditis or other infections as the result of bacteremia caused by dental procedures . Whenever possible, a bactericidal agent is preferred because of greater effectiveness and less reliance on host defense mechanisms . For maximal effectiveness of antibiotic therapy of orodental infections, several factors must be evaluated in choosing an antibiotic: (1) antibacterial spectrum and specificity of the agent; (2) degree of bacterial resistance reported for the antibiotic; (3) concentrations achieved at various sites; (4) age, type, and extent of infection; and (5) various host factors. Pediatr Infect Dis, 1984 Jul-Aug, 3(4), 389 - 91 Otitis media and the development of speech and language; Klein JO; Otitis media is one of the most common infectious diseases of childhood, and many children have many episodes in infancy . Fluid persists in the middle ear for weeks to months after every episode of acute otitis media in spite of apparently appropriate antimicrobial therapy . Persistent or fluctuating hearing loss accompanies middle ear fluid . Children from a high socioeconomic group with recurrent and persistent otitis media in infancy scored lower on tests of speech and language administered at 3 years of age than did their disease-free peers. Schweiz Med Wochenschr, 1984 Jun 30, 114(26), 956 - 60 {Recommendations for the systemic perioperative prevention of infections in gynecology and obstetrics}; Kunz J et al.; Antibiotic prophylaxis for gynecologic and obstetric surgery is reviewed . Numerous clinical studies conducted under controlled conditions have established and confirmed the beneficial effects of short term (preferentially single-dose) perioperative antibiotic prophylaxis for various procedures . Cephalosporins, particularly of the first generation, have been used extensively despite the fact that their antimicrobial spectrum does not include all pathogens recovered from postsurgical infections in gynecology . Perioperative antibiotic prophylaxis is effective in reducing the incidence of infection-related morbidity and mortality of vaginal hysterectomy, especially in premenopausal women . This protective effect is less pronounced for abdominal hysterectomy . The incidence of postoperative infections at a particular hospital should be used as guideline as to whether antibiotic prophylaxis will be beneficial or not for these patients . The same applies to C-sections, for which antibiotic prophylaxis should be administered to high risk patients only, such as secondary C-section or patients with severe underlying diseases . The optimal timing appears to be after cord clamping, which prevents transfer of the antibiotic to the newborn. FEBS Lett, 1984 Jun 25, 172(1), 21 - 4 Effect of seminal plasmin on rRNA synthesis in Saccharomyces cerevisiae; Venkov P et al.; Seminal plasmin, the highly basic, antimicrobial protein, isolated from bull semen, was found to inhibit the transcription of ribosomal RNA in yeast . Protein synthesis and processing of rRNA remained unaffected . Seminal plasmin appears to be useful for studies of the biosynthesis of yeast rRNA in pulse-chase experiments. Am J Obstet Gynecol, 1984 Jun 15, 149(4), 363 - 6 Patient costs in the prevention and treatment of post-cesarean section infection; Iams JD et al.; The total cost to the patient is an important consideration in the selection of antimicrobials for prevention and treatment of post-cesarean section endomyometritis . We compared the cost to the patient of commonly used therapeutic and prophylactic agents in a theoretical model population of 450 women who were delivered by cesarean section . Cost of the drug alone on a per gram, per dose, or per day of therapy basis is not an accurate way of estimating the cost eventually paid by the patient . The therapeutic efficacy, frequency of administration, and need for ancillary services for each treatment regimen affect significantly the patient's costs. Fundam Appl Toxicol, 1984 Jun, 4(3 Pt 1), 479 - 84 Pharmacodynamics of alcide, a new antimicrobial compound, in rat and rabbit; Scatina J et al.; Alcide is a germicidal preparation which has been shown to kill a wide range of common pathogenic bacteria as well as fungi, in vitro . This preparation is composed of Part A and Part B which contains sodium chlorite (NaClO2) and lactic acid as the active ingredients, respectively . The two parts are combined in equal volumes immediately prior to application resulting in the formation of chlorine dioxide (ClO2) . Alcide gel was applied to the shaven backs of 18 female Sprague-Dawley rats in a 2.0-g/kg dose by combining 1 g of each part immediately prior to administration . This dose was applied for a period of 10 days to reach a steady state . On the 11th day, 36Cl-labeled Alcide gel, which contained Na36ClO2 in Part A, was administered to the animals in a 0.6-g dose (2.0 g/kg) containing 0.1 microCi . The half-life for 36Cl absorption was 22.1 hr while the elimination half-life was 64.0 hr . 36Cl was excreted by the kidneys with chloride (Cl-) and chlorite as the metabolites . Ninety-six hours after Alcide administration, radioactivity was highest in whole blood and lowest in fat . In a 90-day subchronic dermal toxicity study in rabbits, exposure to Alcide gel resulted in decreased glutathione concentrations in blood of the group receiving 2.0 g/kg Alcide as well as in the placebo gel group which received the same dose of gel. Diagn Microbiol Infect Dis, 1984 Jun, 2(3), 229 - 31 Thrombocytosis: an acute-phase reactant, not an adverse reaction to the new beta-lactam antibiotics; Parry MF et al.; Thrombocytosis has been described as an adverse drug reaction in up to 30% of patients treated with new beta-lactam antibiotics . We evaluated 350 patients with acute noninfectious conditions and infectious diseases treated with a variety of new and old agents . Results indicate that thrombocytosis is an acute-phase reactant and not an adverse reaction to any antimicrobial agent. Am J Vet Res, 1984 Jun, 45(6), 1079 - 80 Antimicrobial susceptibility of Prototheca zopfii isolated from bovine intramammary infections; McDonald JS et al.; In vitro antimicrobial susceptibility tests were carried out on 48 strains of Prototheca zopfii, an achlorophyllous algae causing refractory mastitis in dairy cows; 27 antimicrobials were evaluated . All strains were susceptible to both myxin and nystatin . In addition, 22 strains were susceptible to amphotericin B, 21 to polymyxin B, and 18 to gentamicin . Only 1 strain was susceptible to kanamycin . All strains were resistant to ampicillin, bacitracin, carbenicillin, cephalothin, chloramphenicol, clotrimazole, cloxacillin, erythromycin, flucytosine, ketoconazole, lincomycin, miconazole, neomycin, nitrofurazone, novobiocin, oleandomycin, penicillin, rifampin, streptomycin, tetracycline, and vancomycin. Biol Reprod, 1984 Jun, 30(5), 1237 - 41 Immunological identification of seminalplasmin in tissue extracts of sex glands of bull; Shivaji S et al.; Using immunoglobulin G (IgG) antibodies raised against highly purified, homogeneous seminalplasmin, an antimicrobial protein of bovine seminal plasma, it has been shown that bovine ampullae, gland vesicularis and corpus prostate, but not testes and epididymis, contain seminalplasmin . The content as estimated by radioimmunoassay employing 125I-seminalplasmin was: ampullae, 267 +/- 13; gland vesicularis, 275 +/- 14; and corpus prostate, 445 +/- 22 micrograms per g wet weight of the tissue . Seminalplasmin, as characterized by high-performance liquid chromatography and in vivo inhibition of RNA synthesis in E . coli, was isolated from gland vesicularis . The seminalplasmin content of bovine seminal plasma was shown to be 1% . A chymotryptic peptide of seminalplasmin comprising residues 1-13 from the amino terminus was found to compete with 125I-seminalplasmin for binding to anti-seminalplasmin IgG. Am Rev Respir Dis, 1984 Jun, 129(6), 933 - 7 Uptake of antibiotics by human alveolar macrophages; Hand WL et al.; To provide additional criteria for therapy of pulmonary infections caused by facultative intracellular bacteria, we studied the uptake of 12 antibiotics by alveolar macrophages (AM) obtained from healthy, young volunteers by bronchoalveolar lavage . These human AM were incubated with radiolabeled antibiotics for periods as long as 2 h . Entry of antimicrobials into the cells was determined by means of a velocity-gradient centrifugation technique . Antibiotic uptake was expressed as the ratio of the cellular to the extracellular drug concentration (C/E) . Penicillin G, cefamandole, and gentamicin were taken up poorly by human AM (C/E = 0.5 to 0.8) . Isoniazid achieved a cellular concentration similar to the extracellular level of the drug (C/E = 0.9) . Chloramphenicol, rifampin, tetracycline, and lincomycin, drugs that are lipid-soluble, were concentrated several-fold by AM (C/E = 2 to 5) . The remaining antibiotics tested, clindamycin, erythromycin, erythromycin propionate, and ethambutol, were markedly concentrated by AM (C/E = 9 to 23) . Accumulation of clindamycin (C/E = 23) was a rapid, active, energy-requiring process, which appeared to be dependent upon mitochondrial oxidative metabolism . The ability of the tested antimicrobial agents to enter human AM correlates well with the efficacy of these drugs in treatment of certain intracellular pulmonary infections. Am J Clin Pathol, 1984 Jun, 81(6), 783 - 6 Evaluation of the BACTEC 16B medium in a cancer center; Tegtmeier BR et al.; The routine use of the new resin-containing BACTEC 16B (Johnston Laboratories, Inc., Cockeysville, MD) culture medium was evaluated in a population consisting primarily of cancer patients . Of 1,163 paired blood culture sets collected, 652 (56%) were collected in the presence of antimicrobial therapy . Eighty-three aerobic and facultatively anaerobic isolates were recovered from 79 positive blood culture sets . No significant difference could be demonstrated between the 16B and the 6B medium in the group of blood cultures collected from patients not receiving antibiotic therapy at the time of blood collection . In contrast, a significantly greater proportion of isolates (P less than 0.005) was recovered from the 16B medium (96%) than the 6B medium (68%) in the group of blood cultures collected in the presence of antimicrobial therapy . In this group, 43% of the isolates were either detected earlier or recovered solely from the 16B medium. Pediatrics, 1984 Jun, 73(6), 811 - 5 Legionellosis in children with leukemia in relapse; Kovatch AL et al.; Two children with legionellosis complicating a relapse of acute lymphoblastic leukemia are reported . A 5-year-old boy with pneumonia had Legionella pneumophila cultured from a tracheal aspirate following a rapid deterioration in his respiratory status and intubation . This child had severe and irreversible granulocytopenia and died in spite of therapy with erythromycin and rifampin added five days later . Combination antimicrobial therapy is suggested for immunosuppressed children with legionellosis if resolution of neutropenia is not readily anticipated . Culture of Legionella sp from respiratory tract secretions or sputum, as reported for the first time in the pediatric literature, should be attempted in all children in whom this infection is suspected . A 13-year-old boy with pneumonia recovered in spite of therapy with antimicrobial agents not proven to be effective against the legionellae . Clinical improvement coincided with increase in absolute granulocyte count . A retrospective diagnosis was made when seroconversion to Legionella micdadei (less than 1:16 to 1:1,024) was determined during a survey of unselected sera from 255 hospitalized children . This is the first documented case of Pittsburgh pneumonia described in a child. J Clin Microbiol, 1984 Jun, 19(6), 723 - 9 Disk diffusion antimicrobial susceptibility testing of members of the family Legionellaceae including erythromycin-resistant variants of Legionella micdadei; Dowling JN et al.; Disk diffusion antimicrobial susceptibility testing of members of the family Legionellaceae was accomplished on buffered charcoal yeast extract agar by allowing the bacteria to grow for 6 h before placement of the disks, followed by an additional 42-h incubation period before the inhibitory zones were measured . This system was standardized by comparing the zone sizes with the MICs for 20 antimicrobial agents of nine bacterial strains in five Legionella species and of 19 laboratory-derived, erythromycin-resistant variants of Legionella micdadei . A high, linear correlation between zone size and MIC was found for erythromycin, trimethoprim, penicillin, ampicillin, carbenicillin, cephalothin, cefamandole, cefoxitin, moxalactam, chloramphenicol, vancomycin, and clindamycin . Disk susceptibility testing could be employed to screen Legionella isolates for resistance to any of these antimicrobial agents, of which only erythromycin is known to be efficacious in the treatment of legionellosis . With selected antibiotics, disk susceptibility patterns also appeared to accurately identify to the species level the legionellae . The range of the MICs of the legionellae for rifampin and the aminoglycosides was too small to determine whether the correlation of zone size with MIC was linear . However, laboratory-derived, high-level rifampin-resistant variants of L . micdadei demonstrated no inhibition zone around the rifampin disk, indicating that disk susceptibility testing would likely identify a rifampin-resistant clinical isolate . Of the antimicrobial agents tested, the only agents for which disk susceptibility testing was definitely not possible on buffered charcoal yeast extract agar were oxacillin, the tetracyclines, and the sulfonamides. Eur J Clin Microbiol, 1984 Jun, 3(3), 253 - 7 DF-2: a fastidious fermentative gram-negative rod; Rubin SJ; Current information is reviewed from 26 cases of human infection by DF-2, a fastidious gram-negative rod . These infections are typically associated with dog contact or dog bites . Underlying diseases or prior splenectomy are predisposing factors for severe infection with a potentially fatal outcome . The methods for isolating and identifying the microorganism are given . Long, thin, slowly growing, oxidase-positive, catalase-positive gram-negative rods that do not grow on MacConkey agar should suggest DF-2 . Although testing of antimicrobial susceptibility is problematic, DF-2 has been found to be resistant to aminoglycosides . The drug of choice is penicillin. Chemioterapia, 1984 Jun, 3(3), 156 - 8 In vivo study of xibornol on phagocyte functions; Zanon P et al.; Polymorphonuclear leukocytes (PML) represent the first step of defense against bacteria and fungi . Since many antimicrobial drugs have been reported to inhibit phagocyte function, we tested the interference of xibornol, a new antimicrobial agent, on phagocyte functions, in order to evaluate its possible use in chronic respiratory diseases . In the patients treated with xibornol (500 mg every 8 h for 7 days) we did not find any modification in phagocytosis frequency (PMF), phagocytosis index (PHI), nitroblue tetrazolium (NBT), reduction frequency (NRF), microbicidal activity and neutrophil mobility of PML, before, during and after the end of therapy. Antibiotiki, 1984 Jun, 29(6), 430 - 4 {Effectiveness of the rapid intravenous administration of rifampicin and isoniazid and of the intramuscular administration of streptomycin in disseminated destructive pulmonary tuberculosis in dogs}; Bondarev IM et al.; Soluble rifampicin and isoniazid injected rapidly by the intravenous route and streptomycin injected intramuscularly to dogs with disseminated destructive tuberculosis of the lungs provided sterilization of the organs with respect to M . tuberculosis for the period of their use for 2 months . This was confirmed microbiologically . The treatment resulted in resolution of the dissemination foci in the organs and stimulation of immunomorphological and connective tissue reactions in the lungs until the foci cicatrized . The shifts in liver function (bilirubin, ALT and AST) and coagulograms during the treatment were temporary and came to normal by the end of the treatment . The organotropic effect of soluble rifampicin in combination with isoniazid injected rapidly by the intravenous route and streptomycin injected intramuscularly was not observed during the treatment of the dogs with disseminated destructive tuberculosis of the lungs . Rapid intravenous injection of rifampicin in combination with other antimicrobial drugs will provide a significant decrease in the periods of chemotherapy of patients with disseminated destructive tuberculosis of the lungs. J Antimicrob Chemother, 1984 Jun, 13 Suppl C, 43 - 7 Rifampicin in collections of pus--a kinetic study in human abscesses; Suter F et al.; Most of the successful non-surgical management of abdominal abscesses is based upon the presence of therapeutic amounts of effective antibiotics within the collection . However few data are currently available concerning antimicrobial levels in human purulent lesions . To study the relationship between serum and pus concentrations of rifampicin, 11 patients with deep-seated abscesses were given 900 mg intravenously of rifampicin daily; after 3, 8 and 20 h from injection, an ultrasound-guided percutaneous aspiration of the collection was performed . Samples were obtained on the first day of therapy in six cases, while in other six the aspiration took place on the third day . Rifampicin levels of therapeutic value were present after 8 h from the first injection . From this time antibiotic amounts in pus, ranging from 1.6 to 5.8 mg/l, were consistent with a long persistence of rifampicin in abscesses, without any evidence of accumulation. Pathol Biol (Paris), 1984 Jun, 32(5 Pt 2), 581 - 4 {Multicenter study of the antimicrobial activity of antiseptics on the hands . Protocols and results}; Savage C et al.; Quantitative evaluation of in vivo activity of antiseptics in surgical-type handwashing is achieved by comparing bacterial counts on one hand after disinfection and on the other untreated hand . Handwashing, bacterial recovery and bacterial counts must be performed according to strictly standardized methods . A large number of participants is required. J Clin Microbiol, 1984 Jun, 19(6), 783 - 8 Suitability of the ASM-2 standard test of the National Committee for Clinical Laboratory Standards for evaluation of antimicrobial disk potency; Tardio JL et al.; Standard disks of 25 antimicrobial agents were prepared and tested at three levels of potency (67, 100, and 150% of labeled quantity) . The method used was a modification of the approved standard M2-A2 of the National Committee for Clinical Laboratory Standards . Forty-seven susceptibility tests were performed at each potency level by using one to three test organisms . Labeled-potency (100%) disks were within accuracy limits for 85% of the tests and were within daily control limits for 94% of the tests . All susceptibility test data for labeled disks, however, were considered acceptable . The majority (63%) of mean zone diameter data for labeled-content disks were in the upper-one-third percentile of accuracy control limits . A significant proportion (91%) of low-potency disks and considerably fewer (34%) of the high-potency disks were found acceptable when daily control limits were applied . Of most concern are those antimicrobial agents whose low-potency disks approach the lower region of control limits . Zone diameter data from standard disks in the range of potency levels tested suggest that control ranges are excessive for some antimicrobial agent-test organism combinations. Otolaryngol Head Neck Surg, 1984 Jun, 92(3), 261 - 5 Craniocervical necrotizing fasciitis; Spankus EM et al.; Craniocervical necrotizing fasciitis (CCNF) is a severe, progressive bacterial infection of the cervical fascia . The most significant manifestations of this disease are extensive fascial necrosis with widespread undermining of the surrounding tissues and extreme systemic toxicity . We are adding three cases to the 29 previously reported cases of CCNF . We will discuss the regional anatomy, focusing on the relationship of the cervical fascial planes to vital structures . Available data suggest that CCNF is a synergistic infection produced in most instances by a combination of facultative anaerobic and obligate anaerobic organisms . Although antimicrobial therapy should provide broad-spectrum activity against mixed flora, treatment also includes aggressive excision and debridement of involved fascia, subcutaneous tissue, and necrotic skin. Chemioterapia, 1984 Jun, 3(3), 200 - 2 Lung damage due to antimicrobial drugs: a minireview; Bassetti D et al.; Untoward reactions induced by antimicrobial chemotherapeutic agents have had an increasing frequence in recent years . Lung and respiratory tract reactions are generally underestimated in comparison with those affecting other anatomical areas . The pathogenic mechanisms are reviewed under four headings, 1) toxic effects, 2) allergic reactions, 3) damage due to the antibacterial activity itself, and 4) lesions due to different causes . The various chemotherapeutic agents involved are thus mentioned in connection with these mechanisms. Vestn Khir Im I I Grek, 1984 Jun, 132(6), 129 - 34 {Prevention of suppuration of surgical wounds in abdominal surgery}; Korepanov VI et al.; The modes of local treatment of the operation wound, the contents of hollow organs of the gastro-intestinal tract are described . The principles of systemic application of antimicrobial medicine (antibiotics) are considered from the viewpoint of the present-day clinicians and practical doctors. Surg Gynecol Obstet, 1984 Jun, 158(6), 601 - 7 The excretion of antibiotics by the biliary tract; Nagar H et al.; Although the clinical significance of a high antibiotic level of the biliary tract has not been proved, few antibiotics are both well excreted and active against the common pathogens of bile . The biliary excretion of these agents is a complex phenomenon which may be altered by a number of host factors . The results of studies on the levels of antimicrobial agents vary with respect to the timing of antibiotic measurement, type of bile sampled, presence or absence of biliary tract obstruction and assessment of data. Crit Care Med, 1984 Jun, 12(6), 483 - 5 Pharmacokinetic assessment of immunosuppressive activity of antibiotics in human plasma by a modification of the mixed lymphocyte reaction; De Simone C et al.; Antibiotics may impair the development and expression of specific or nonspecific immune responses . Prophylactic administration of antibacterial antibiotics is widely used in ICUs . We studied the immunosuppressive activities of cefotaxime, chloramphenicol, gentamicin, metronidazole, and rifamycin as a function of time after the administration of these drugs to ICU patients, finding that the last 4 drugs had an immunosuppressive activity detectable up to 8 h by a mixed lymphocyte reaction . When these antimicrobial agents were added to normal pooled plasma in concentrations similar to those obtained in vivo, a similar degree of inhibition was observed. Boll Ist Sieroter Milan, 1984 May 31, 63(2), 104 - 10 Evaluation of automatic antimicrobial susceptibility testing with the MS-2 system; Mascellino MT et al.; We present the results of sensitivity of 191 Gram-negative bacteria towards the following antibiotics: aminoglycosides (amikacin, gentamicin, tobramycin, netilmicin), cephalosporines (moxalactam, cefotaxime, ceftazidime) and piperacilline obtained by agar diffusion method (Kirby-Bauer) versus automatic system MS 2 Abbott . Essential accord expressed in percentage is for amikacin 96%, for gentamicin 93%, for moxalactam 91%, for tobramycin 95%, for cefotaxime 92%, for piperacilline 89%, for netilmicin 90%, for ceftazidime 92 . Full accord gives more discrepant results especially for cephalosporins . For aminoglycosides no significative differences were observed between the two methods . For cephalosporins the incidence of discordance was a little more high . A better sensitivity was obtained by Kirby-Bauer method versus automatic system, which can be considered a therapeutical tool as it furnishes rapidly (4 hours) MIC values, useful to establish antibiotic doses. Am J Med, 1984 May 15, 76(5A), 99 - 106 Impact of antimicrobial agents on the gastrointestinal microflora and the risk of infections; Nord CE et al.; The most common and significant cause of disturbances in the normal gastrointestinal microflora is the administration of antimicrobial agents . The microflora can be influenced by antimicrobial agents because of incomplete absorption of any orally administered antimicrobial agent, secretion of an antimicrobial agent by the salivary glands and in the bile, or secretion from the intestinal mucosa . In most cases the influence is not beneficial to the patient because suppression of the indigenous microorganisms often permits potential pathogens to overgrow and cause septic conditions, diarrhea, or colitis . Antimicrobial agents that influence the normal microflora also promote the emergence of antimicrobial-resistant strains . The authors' experience on the impact of different beta-lactams, erythromycin, clindamycin, tetracycline, and nitroimidazoles on the gastrointestinal microflora and the risk of infections when these agents are used is reviewed. Am J Med, 1984 May 15, 76(5A), 224 - 30 Principles in the treatment of bacterial meningitis; Tauber MG et al.; The pathophysiologic aspects of bacterial meningitis impose some specific requirements on successful antimicrobial therapy of this disease . Because infections of the subarachnoid space rapidly produce destruction of the brain tissue, treatment must be instituted as early as possible . In the subarachnoid space, efficient host defense mechanisms are absent, particularly at the start of the infection, and therefore antibiotics have to produce a bactericidal effect to eliminate the microorganisms . As animal studies indicate, only drug concentrations 20- to 100-fold higher than the minimal bactericidal concentration are effective in vivo . Because penetration of antibiotics to the site of infection is limited by the blood-brain barrier, the high cerebrospinal fluid concentrations necessary to kill the bacteria may be difficult to achieve and therapy may be limited by toxicity . Even with optimal antibiotic therapy, the morbidity and mortality remain high, and new therapeutic interventions are necessary and should be aimed at modifying selective components of the inflammatory process. Am J Med, 1984 May 15, 76(5A), 208 - 14 Extrinsic factors that put patients at risk of acquiring central nervous system infections; Robinson EN Jr et al.; Although many host defenses, including physical barriers, phagocytic cells, and humoral elements, normally protect the central nervous system from microbial pathogens, a variety of extrinsic factors may compromise these defenses and put patients at risk of acquiring central nervous system infection . These risk factors include: (1) communication of the cerebrospinal fluid space with integumentary surfaces; (2) communication of the cerebrospinal fluid space with other body spaces through shunts; (3) suppurative foci contiguous to the central nervous system; (4) hematogenous spread of infectious agents; (5) new acquisition of infectious agents with a propensity for causing central nervous system infection; and (6) administration of certain antimicrobial or immunosuppressive drugs . Recognition that these factors are present and therefore that the patient is at risk allows monitoring for and prompt response to signs and symptoms of central nervous system infection. Am J Med, 1984 May 15, 76(5A), 2 - 10 Host defense abnormalities predisposing the patient to infection; Peterson PK; Considerable progress has recently been made in defining the cellular and molecular mechanisms involved in host resistance to infection . Virtually every decision related to antibiotic therapy is influenced by an assessment of the integrity of these resistance mechanisms . Defects in each major aspect of host defense, that is, humoral immunity, polymorphonuclear leukocyte defense, and cell-mediated immunity, increase the risk of infection caused by specific groups of microorganisms . Knowledge of these defects will guide the initial (empiric) selection of antibiotics, the dosage and duration of antibiotic therapy, and decisions regarding antibiotic prophylaxis . In the severely immunocompromised patient, antimicrobial therapy frequently involves both the administration of antibiotics and the use of treatment modalities that are likely to augment host defenses. Monatsschr Kinderheilkd, 1984 May, 132(5), 303 - 5 {Pharmacotherapy of acute infant enteritis}; Heimann G; The management of acute diarrhea in infants with drugs is justified only where these drugs have specific interactions with the pathophysiologic mechanisms involved . Most of the infectious diarrheas are self-limited, many patients recover spontaneously . Antimicrobial drugs are only indicated if mucosal destruction takes place and symptoms of dysentery respectively inflammation are observed . Some authors propose to treat newborn and young infants in case of doubt . If antimicrobial drugs are given uncritically a selection of not obligatory microorganisms can occur, or the number of asymptomatic carriers increases . There is no confirmation that drugs like adsorbents (kaolin, pectin, charcoal) or lyophilized microorganisms have a therapeutic effect . In contrast morphine derivatives like loperamide act not only by slowing the intestinal motility but also by inhibiting the secretion mechanisms of the enterocyts . Nevertheless these drugs can not be recommended for infants since ileus symptoms have been observed. Pediatr Infect Dis, 1984 May-Jun, 3(3 Suppl), S5 - 8 Bacteremia in ambulatory children; Klein JO; Bacteremia is a relatively common event in young, apparently mildly ill febrile children . The bacteremia is associated with certain risk factors including age, elevated temperature and high white blood cell count or increased erythrocyte sedimentation rate . The disease and bacteremia clears without antimicrobial agents in some children, but many untreated children have persistent disease . Culture of blood is valuable in children with risk features and may be enhanced in the future as methods for detection of antigen become more widely available . Available data from randomized trials of therapy do not provide clear guidelines for treatment and opinions about optimal management of children at risk for bacteremia vary . My judgement is that presumptive therapy is warranted for the child who is 6 to 24 months of age, who has high fever and has high white blood cell count . Therapy should be effective for the pneumococcus and for H . influenzae . Currently, I recommend amoxicillin or, for children allergic to penicillin, trimethoprim-sulfamethoxazole or cefaclor . After 48 to 72 hours the physician can judge the clinical course and will have data from cultures to base decisions about management of the illness. Drugs, 1984 May, 27(5), 459 - 68 Epidemiology and therapy of Chlamydia trachomatis infections; Bowie WR; Chlamydia trachomatis infections are exceedingly prevalent, and can be associated with significant sequelae . The major infections are urethritis, cervicitis, salpingitis, and ocular infection . Chlamydial genital infections present as syndromes, where C . trachomatis is one of the causes of the syndrome . Because specific laboratory diagnosis of a chlamydial infection is often not available, and even if available does not exclude the concurrent presence of other pathogens, therapy should usually be directed at all the major causes of the syndrome . Thus, although C . trachomatis is readily eradicated by tetracyclines, macrolides, sulphonamides, and rifampicin, for most situations tetracyclines are the drugs of choice . Penicillins have some activity when used in multiple-dose therapy, but are not reliable for eradication of chlamydiae . Aminoglycosides, nitroimidazoles, and the newer cephalosporins have minimal or no useful activity . Seven days of tetracycline hydrochloride 500mg 4 times daily or doxycycline 100mg twice daily are the optimum regimens for uncomplicated urethritis, cervicitis (except in pregnancy), and gonorrhoea . These regimens should be extended to 10 days for epididymitis and salpingitis . Additional antimicrobials should be added to the salpingitis regimen . For chlamydial infection during pregnancy, erythromycin 500mg 4 times daily for 1 week or 250mg 4 times daily for 2 weeks should be utilised . Neonatal infection requires 2 to 3 weeks of systemic treatment with erythromycin . Inclusion conjunctivitis responds well to antimicrobials, but improved sanitation has a greater effect than antimicrobial therapy in the management of trachoma. Am J Surg, 1984 May, 147(5), 633 - 7 Antimicrobial prophylaxis in elective colon surgery . Experience of 1,035 operations in a community hospital; Peck JJ et al.; An 11 year study of 1,035 elective colon resections reaffirmed the value of oral antibiotic prophylaxis . Five antibiotic regimens were used in 88 percent of the patients . The most effective and most frequently used regimen was the combination of parenteral cephalosporin with oral erythromycin and an aminoglycoside . The overall infection rate with this regimen was 11 percent and the wound sepsis rate was 2.5 percent . The use of parenteral cephalosporins alone was not effective . Furthermore, resistant bacteria were cultured from the wound infections of parenteral cephalosporin patients . A nondirective annual review of these data and each surgeon's infection rate resulted in a change in the antibiotic ordering practices and decreased infection rates . It is no longer acceptable surgical practice to omit antibiotic prophylaxis in colon operations. J Clin Periodontol, 1984 May, 11(5), 321 - 30 Effect of combined systemic antimicrobial therapy and mechanical plaque control in patients with recurrent periodontal disease; Lundstrom A et al.; The aim of the present study was to analyze the effect of systemic antimicrobial therapy and mechanical plaque control in patients with recurrent periodontal disease . 9 patients volunteered for the combined therapy . At a baseline examination they were randomly distributed into 2 groups, one given tetracycline therapy for 2 weeks and the other metronidazole therapy for 1 week . A mechanical plaque control program comprising oral hygiene training, professional cleaning of all teeth and subgingival debridement at diseased sites was carried out at the baseline examination and at all recall visits, i.e . once every month during the first 6 months and then after 9, 12, and 18 months . The results demonstrated clinically and microbiologically that a combination of an initial antimicrobial and a continuous systematic mechanical plaque control program may be a valuable therapeutic approach in a strictly selected group of refractory patients . Recurrent periodontal lesions which still displayed severe inflammation despite renewed conventional therapy showed a marked reduction in probing depths, bleeding and suppuration from the pockets, and further, a reduced presence of spirochetes and motile rods during the trial . The results indicate that the level and longevity of success is also related to whether or not self-performed oral hygiene measures are sufficiently carried out . No superior effect of the combined program could be observed in cooperating patients receiving tetracycline as compared with those given metronidazole. Hautarzt, 1984 May, 35(5), 225 - 9 {Cephalosporin allergy and cephalosporin-penicillin cross allergies with special reference to venereologic therapy of severe anaphylactic reactions}; Korting HC; The newer cephalosporins are gaining more and more importance in antimicrobial chemotherapy . This also applies to venereology . Yet before widespread use, their potential for anaphylactic reactions must be defined, as they are not uncommon with penicillin . In fact, the first cephalosporins shared this drawback with penicillin . According to the experimental and clinical data available, the newer cephalosporins, however, should not give rise to severe allergic reactions of the immediate type . This at least holds true for individuals without a history of allergy to beta-lactam-antibiotics but, in fact, not even they should be endangered . This, however, still needs further confirmation. Pediatr Infect Dis, 1984 May-Jun, 3(3), 204 - 7 Duration of middle ear effusion after acute otitis media; Schwartz RH et al.; In approximately 50% of young children persistent otitis media with effusion (POME) is found by otoscopic examination or by tympanometry 10 to 14 days after the physician institutes antimicrobial treatment for acute otitis media . Over a 180-day period the course of persistent otitis media with effusion was studied in predominantly middle class, otherwise healthy white children under 3 years of age . One month after POME was first diagnosed, 22 (29%) of the children still had POME . By the second month 11 (14%) of these children still had POME . Only 5 (6%) of the study population had POME which persisted for more than 90 days . The mean duration of POME was 40 days; (median 14 days) . These data suggest that in most cases POME is a self-limiting condition when found in young, otherwise healthy, middle class white children. Cardiol Clin, 1984 May, 2(2), 201 - 10 Acute infective endocarditis; Smilack JD et al.; Acute infective endocarditis is an important cardiovascular emergency that can be detected with improved diagnostic techniques . In the last few decades we have witnessed a changing spectrum of microorganisms causing infective endocarditis . Successful treatment of infective endocarditis is enhanced by the combined and cooperative efforts of the internist and the surgeon . In this article, we have discussed the clinical evaluation, laboratory techniques, and noninvasive studies by which proper diagnosis can be made and appropriate antimicrobial therapy instituted . We have also reviewed the indications for surgical intervention . With careful clinical evaluation and proper