Antimicrobials

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 application of the diagnostic and therapeutic modalities, acute infective endocarditis can often be cured.

Radiobiologiia, 1984 May-Jun, 24(3), 389 - 90
{Increase in the agglutination activity of rat blood serum following total body irradiation with supralethal doses}; Ivanov AA et al.; Irradiation of immunized (during the decrease in the immune response, i.e . on the 14th day following the immunization with sheep erythrocytes) and nonimmunized rats leads to a considerable increase in the level of immune and normal antimicrobial antibodies 3 and 24 h following irradiation . Irradiation on the 7th day of the immune response does not cause the increase in the level of antibodies.

Infect Immun, 1984 May, 44(2), 534 - 6
Toxic effect of the peroxidase-hydrogen peroxide-halide antimicrobial system on Mycobacterium leprae; Klebanoff SJ et al.; Mycobacterium leprae are killed by myeloperoxidase (or eosinophil peroxidase), H2O2, and a halide, thus suggesting a mechanism for their destruction by peroxidase-containing phagocytes.

J Antimicrob Chemother, 1984 May, 13 Suppl B, 43 - 8
The assessment of antimicrobial activity in an in-vitro model of the treatment of bacterial cystitis; Greenwood D; In order to investigate the comparative activity of agents of the nalidixic acid series, cultures of nalidixic acid sensitive strains of E . coli were exposed to the drugs in an in-vitro model that simulates the hydrokinetic aspects of the treatment of bacterial cystitis . Intrinsic activity, as judged by the response to a single dose of drug and resistance as judged by response to a repeat dose, were investigated . All seven compounds tested in this way were able to inhibit bacterial growth for considerable periods of time even when the peak concentration achieved was as low as 10 mg/l . However, resistance emerged readily, particularly to nalidixic acid, pipemidic acid and piromidic acid . Norfloxacin was the most active of the seven compounds tested and was the only one to which resistance did not emerge at the concentrations tested . However, when two nalidixic acid resistant strains were tested in the bladder model, norfloxacin resistance was observed to emerge with one strain, but not with the other.

J Antimicrob Chemother, 1984 May, 13 Suppl B, 33 - 8
Frequency of appearance of resistant variants to norfloxacin and nalidixic acid; Duckworth GJ et al.; The clinical use of nalidixic acid has been hampered by the rapid appearance of resistant variants . This study compares the frequency of appearance of resistant variants to nalidixic acid and norfloxacin, a new quinolone-carboxylic acid with superior antimicrobial activity . We found a lower frequency of appearance of resistant variants with norfloxacin, although there was some cross-resistance between the two drugs . A gradation in this frequency was also noted between the species of Gram-negative rods tested, so that larger numbers of resistant variants appeared with the non-fermenters.

J Biol Chem, 1984 Apr 10, 259(7), 4305 - 12
Enzymatic basis of macrophage activation . Kinetic analysis of superoxide production in lysates of resident and activated mouse peritoneal macrophages and granulocytes; Tsunawaki S et al.; To compare the kinetics of the O-2-generating enzyme in nonactivated and activated macrophages and granulocytes from the mouse peritoneal cavity, we sought conditions in which the activity of this enzyme in cell lysates was comparable to that in intact cells . Pretreatment of macrophages with 10 mM diethyldithiocarbamate inhibited endogenous superoxide dismutase by 70% and enhanced O-2 secretion up to 15-fold, so that it was comparable to H2O2 secretion . O-2 secretion was terminated by detergent lysis and reconstituted by addition of NAD(P)H to the lysates . Optimal detection of O-2 production in lysates depended on prior stimulation of the respiratory burst, lysis with 0.05% deoxycholate rather than any of 4 other detergents or sonication, acetylation of the cytochrome c used as an indicator, and addition of NADPH rather than NADH . Kinetic analysis using NADPH-reconstituted deoxycholate lysates, together with spectra of oxidized and reduced cells, failed to reveal either marked differences in the Vmax of the O-2-generating enzyme or correlations between O-2 secretion and cytochrome b559 content among 5 macrophage populations whose H2O2 secretion ranged from 0 to 365 nmol/90 min/mg of protein . In contrast, the Km of the oxidase for NADPH varied markedly and inversely with the capacity of the intact cells to secrete O-2 or H2O2: J774G8 histiocytoma cells, 1.43 mM; resident macrophages, 0.41 mM; proteose peptone-elicited macrophages, 0.20 mM; casein-activated macrophages, 0.05 mM; NaIO4-activated macrophages, 0.05 mM; and granulocytes, 0.04 mM . These results suggest that macrophage activation, a process that enhances oxygen-dependent antitumor and antimicrobial functions, may equip the cell to secrete increased amounts of reactive oxygen intermediates largely by increasing the affinity of the oxidase for NADPH.

N Engl J Med, 1984 Apr 5, 310(14), 883 - 9
Impaired production of lymphokines and immune (gamma) interferon in the acquired immunodeficiency syndrome; Murray HW et al.; To examine the cellular immune defect that predisposes patients with the acquired immunodeficiency syndrome (AIDS) to opportunistic infections, we tested T lymphocytes from 16 patients for the capacity to secrete macrophage-activating products (lymphokines) including gamma interferon . Mononuclear cells from 10 of 11 patients did not generate an effective lymphokine in response to mitogen, and 11 of 16 produced subnormal levels of gamma interferon (less than 300 U per milliliter) . In addition, upon stimulation with specific microbial antigen, cells from none of 14 patients generated active lymphokines, and cells from 13 to 14 completely failed to secrete gamma interferon . However, the antimicrobial function of monocytes from the patients was intact, and once stimulated with normal lymphokines or gamma interferon alone, macrophages derived from patients' monocytes responded with enhanced and effective intracellular antimicrobial activity . These results suggest that impaired lymphokine production may predispose patients with AIDS to opportunistic infections, and they provide a rationale for using gamma interferon as immunotherapy.

J Gen Microbiol, 1984 Apr, 130 ( Pt 4), 901 - 6
Antibiotic susceptibility of Legionella pneumophia Philadelphia-1 in cultured guinea-pig peritoneal macrophages; Yoshida S et al.; The effect of antimicrobial agents on the intracellular multiplication of Legionella pneumophila in cultured guinea-pig peritoneal macrophages was measured . Beta-lactam antibiotics at concentrations 5 to 400 times the MIC in vitro did not inhibit the intracellular growth of the organism . Gentamicin inhibited the growth considerably but failed to eliminate the organism from the phagocytic mixture . Chloramphenicol or tetracycline at 10 micrograms ml-1 (40 or 5 times the MIC in vitro respectively) did not eliminate the organism . At a higher concentration (30 micrograms ml-1), however, these drugs eliminated the bacterium from the mixture . Only erythromycin and rifampin were effective in killing the organism at very low concentration (1 microgram ml-1) . Intracellular multiplication of L . pneumophila was observed clearly by light microscopy using Wright-Giemsa staining.

Am J Med, 1984 Apr, 76(4), 711 - 7
Endocarditis prophylaxis for patients with mitral valve prolapse . A quantitative analysis; Bor DH et al.; Antimicrobial prophylaxis of bacterial endocarditis is widely recommended for patients with mitral valve prolapse who undergo procedures that may cause bacteremia . The benefits and risks of this practice have been analyzed on the basis of published data and response to a questionnaire survey of leading authorities on bacterial endocarditis . Among 10 million patients with mitral valve prolapse undergoing a dental procedure, an estimated 47 nonfatal cases and two fatal cases of bacterial endocarditis would occur if no prophylaxis were given, five cases of bacterial endocarditis and 175 deaths due to drug reactions would occur if all patients were given prophylaxis with a penicillin, and 12 nonfatal cases and one fatal case of bacterial endocarditis would be expected if a policy of prophylaxis with erythromycin were adopted . Even using assumptions most favorable to the penicillin regimen, this analysis predicts that no prophylaxis and penicillin prophylaxis would result in a similar number of deaths . No prophylaxis or prophylaxis with erythromycin appears preferable to prophylaxis with a penicillin.

Pediatrics, 1984 Apr, 73(4), 526 - 9
Chronic sinus disease with associated reactive airway disease in children; Rachelefsky GS et al.; Sinus disease has been described as one of several aggravating factors for chronic adult-onset asthma . Forty-eight children whose reactive airway disease (asthma) was significantly improved with treatment of their sinusitis have been observed . All of the subjects were seen in the office with chronic (more than 3 months) respiratory symptoms; all had daytime and nighttime cough and/or wheeze . The 48 children (32 male and 16 female) had a mean age of 8.2 +/- 1.2 (SD) years (range 4 to 13 years) . Fourteen (35%) were nonatopic as determined by family history, personal history, and skin test reactivity to inhalant and pollen antigens . Eighteen of the patients were receiving or had recently received oral corticosteroids . All had been taking bronchodilators daily for at least 3 months without adequate control of the asthma . Sinus radiographs (Waters view) revealed the following abnormalities of the maxillary sinuses: greater than 6 mm of mucosal thickening (ten children {21%}), one opacified (12 children {25%}), bilateral opacification (18 children {38%}) and air fluid level(s) (eight children {17%}) . All children were treated with antimicrobial agents for 2 to 5 weeks . Thirty-nine responded both clinically and radiologically . Antral lavage was performed in nine children . Of the 48 subjects, 38 (79%) were able to discontinue taking the bronchodilators with resolution of their sinusitis . It is concluded that sinus disease in children may be an aggravating factor for chronic reactive airway disease and that proper, aggressive treatment of the former will notably improve the latter.

Laryngoscope, 1984 Apr, 94(4), 483 - 7
Otorhinological brain abscess therapy--past and present; Brand B et al.; In the past several years a concensus approach has been reached in diagnosis and therapy of brain abscess . The ease and accuracy of evaluation of intracranial lesions afforded by third generation computerized tomography scanners has lead to reliable, quick, non-surgical diagnoses and monitoring which is relatively non-invasive . The use of multiple agent, increased spectrum, antimicrobials has resulted in acceptable reduced morbidity and mortality . This has decreased the need for therapeutic surgical intervention . The non-surgical approach was preceded by several other modes of management which were acceptable in their time . During the past 21 years, 17 patients have been under the care of one or more of the above authors . A review of these cases is presented with instructive and informative histories . A knowledge of past therapeutic modalities and their attendant complications compared with present medical therapy assures an acceptance of the latter as the method of choice . A search of the general literature shows wide acceptance in other fields; however, no reference could be found in the recent otolaryngological literature to support a non-surgical approach.

Am J Infect Control, 1984 Apr, 12(2), 83 - 7
Duration of handwashing in intensive care units: a descriptive study; Quraishi ZA et al.; The duration of handwashing was studied in two community hospitals (teaching and nonteaching) . The duration in seconds of 180 handwashes by health care personnel and 52 handwashes by non-health care personnel were recorded . The mean duration for health care personnel was 8.62 +/- 0.29 SEM; the degree of patient contact did not influence the duration of handwashing . The duration of handwashing was two times longer in health care personnel vs . non-health care personnel (8.62 +/- 0.29 vs . 4.14 +/- 0.42; t = 7.7; p less than 0.001) . Comparisons revealed no statistically significant difference in duration between personnel at teaching and nonteaching hospitals or among those in different occupations . The data indicate that the duration of handwashing among health care personnel is below the standard recommended by authorities in hospital infection control . This may be an important factor in the transmission and persistence of nosocomial infection in critical care units . The antimicrobial efficacy of handwashing agents should be reevaluated considering the actual duration of handwashing by health care personnel within the hospital environment or efforts should be made to increase the duration of handwashing.

Scott Med J, 1984 Apr, 29(2), 96 - 100
Acute infectious disease presenting as acute renal failure; Mactier RA et al.; A diverse range of infectious diseases has presented with acute renal failure (ARF) in the West of Scotland in the past five years . Full recovery is possible provided the specific diagnosis is made early and treatment with temporary renal support is combined with effective antimicrobial therapy.

J Appl Bacteriol, 1984 Apr, 56(2), 221 - 5
The antimicrobial properties of two commonly used antiseptic mouthwashes--Corsodyl and Oraldene; Ashley KC; The antimicrobial activities of the mouthwashes Corsodyl and Oraldene against common buccal organisms were essentially similar . The concentration of the active substance in the two mouthwashes was well in excess of the minimum inhibitory concentrations determined . Also a rapid lethal effect on the bacteria was found which, when combined with the previous property, may well account for the usefulness of these products in infectious conditions.

Obstet Gynecol, 1984 Apr, 63(4), 467 - 72
Cefoperazone and cefoxitin prophylaxis for abdominal hysterectomy; Hemsell DL et al.; One hundred one women undergoing elective abdominal hysterectomy were given perioperative cefoperazone or cefoxitin in a prospective randomized blinded study . Both regimens were well tolerated and no significant toxic or allergic manifestations were observed . Interrelationships between antimicrobial concentration in serum and pelvic tissues, intraoperative cardinal ligament cultures, febrile morbidity, and major postoperative infection were determined . At uterine removal, mean cefoperazone concentrations in serum (56.1 micrograms/mL) and pelvic tissues (18.6 micrograms/g) were significantly higher than mean concentrations of cefoxitin, ie, 16.1 micrograms/mL and 8.1 micrograms/g, respectively (P less than .001) . The incidence of major postoperative infection was 6% or less with both regimens . Perioperative prophylaxis significantly reduced the incidence of this infection . When it did develop, however, it continued to cause significant morbidity, prolonging hospital stay a mean of more than four days (P less than .001) and increasing the hospital bill a mean of almost $1500 (P less than .001).

Diagn Microbiol Infect Dis, 1984 Apr, 2(2), 151 - 5
Disseminated sporotrichosis with Sporothrix schenckii fungemia; Morgan MA et al.; The laboratory diagnosis and therapeutic management of disseminated sporotrichosis can present many problems to the clinical laboratory and the clinician . Culturing of clinical specimens is necessary because the direct microscopic examination of specimens for Sporothrix schenckii often is not useful . Although this organism has been recovered from many specimen sites, recovery from blood has been rare . This report summarizes data concerning recovery of S . schenckii from clinical specimens and the use of serologic and fungal antimicrobial susceptibility data . It appears to be the first antemortem recovery of S . schenckii from blood reported since 1909.

Am J Med, 1984 Mar 30, 76(3A), 101 - 10
Limitations of current antimicrobial therapy in the immunosuppressed host: looking at both sides of the coin; Pizzo PA et al.; During the last twenty years there have been considerable advances in the antimicrobial management of the immunosuppressed host . These include the development of antibiotics with broad-spectrum and high bactericidal activity along with the appreciation of the importance of promptly initiating empiric antibiotic therapy when the granulocytopenic patient becomes febrile and continuing them (in some cases with empiric antifungal therapy) until the resolution of granulocytopenia . Nonetheless, infection still remains a major cause of death in compromised hosts and a number of limitations of therapy persist . Included are a limited repertoire of drugs active against fungi (particularly Aspergillus) as well as certain viruses (for example, cytomegalovirus) and the inability to eradicate certain sites of infection (for example, Pseudomonas pneumonia) even with effective agents . Current investigations are focused on developing new antimicrobial agents as well as methods to improve the altered host defenses of immunosuppressed patients, both as adjuvants to therapy and, eventually, as a means to prevent infectious complications.

Presse Med, 1984 Mar 29, 13(13), 838 - 40
{Role of azlocillin in the treatment of immunocompromised patients . Results of the EORTC (European Organization for Research on the Treatment of Cancer) study)}; Jacquillat C et al.; A multicentre clinical trial was organized by the International Antimicrobial Therapy Project Groups of the European Organisation for Research on the Treatment of Cancer (E.O.R.T.C.) to compare the effectiveness of three combinations of antibiotics (azlocillin + amikacin; cefotaxime + amikacin and ticarcillin + amikacin) in patients with malignant leukopenic and febrile diseases (polymorphonuclears less than 1000/mm3; temperature greater than 38.5 degrees C) . Some 800 patients from 20 centres entered the study . Preliminary results in 421 assessable patients showed a 62% positive response rate . The response rate in patients with bacteraemia was twice as high in the azlocillin group than in the other groups, the difference being significant at p less than 0.02 . This difference does not seem to be due to a distribution bias, since the responsible micro-organisms, the severity of granulopenia, the incidence of bacterial-resistant strains, etc., were similar in all three groups . Similarly, the death rate was 12% in the azlocillin-amikacin group as against 15% and 17% respectively in the other groups . It would appear from this trial that the azlocillin-aminoglycoside treatment is superior to the other antibiotic combinations tested in this category of patients.

Mod Vet Pract, 1984 Mar, 65(3), 197 - 201
Standardizing antimicrobial disk sensitivity testing; Faler K; Before antimicrobial sensitivity testing, any pathogens must be isolated by streaking the clinical specimen on a plate of nutritive medium . Selecting a drug based on tests of a mixed culture from which a pathogen has not been isolated encourages unnecessary treatment . A plate of Mueller-Hinton agar is swabbed with an inoculum from a standardized broth culture . Drug-impregnated paper disks are applied to the plate at least 3 cm apart and at least 2 cm from the plate's edge . The zone of inhibition varies with each drug and is measured, after overnight incubation at 35-37 C, with the aid of over-the-shoulder lighting and a dark background.

Immunobiology, 1984 Mar, 166(2), 177 - 89
Formation of EAC142 and EAC1423 with macrophage culture supernatant containing the secreted complement components C1 to C3; Brade V et al.; Culture supernatants of thioglycollate-elicited guinea pig peritoneal macrophages contained hemolytic C1, C4, C2 and C3, whereas hemolytic C5, C6, C7, C8 or C9 were not detected . Activity of C1, C2 and C3 increased up to a 48 h culture period, whereas C4 activity already declined in 2 day old cultures . After secretion, the hemolytic activity of C1 was least stable in culture supernatant . Sensitized sheep erythrocytes (EA) when incubated with culture supernatant initiated activation and functional cooperation of secreted C1 to C3 as indicated by formation of EAC142 and EA1423 intermediates . Decay and regeneration with purified C2 was shown for EAC142 and deposition of C3 fragments on EAC1423 was demonstrated with anti-C3 . On an average, supernatants of 2 day old macrophage cultures were most suitable for formation of EAC142 and EAC1423 . The rate of EAC142 and EAC1423 formation, and also of C2 and C3 inactivation, during incubation of EA with culture supernatant was slow; addition of purified C1 to culture supernatant, however, greatly enhanced the same reactions of EA with supernatant which indicated that C1 was the rate limiting factor . Local secretion of hemolytic C1, C4, C2 and C3 by macrophages may have an important role in antimicrobial defense mechanisms due to the well-known functional cooperation between macrophages and activated C3.

Antimicrob Agents Chemother, 1984 Mar, 25(3), 385 - 6
Antibiotic resistance of Erysipelothrix rhusiopathiae isolated from pigs with chronic swine erysipelas; Takahashi T et al.; The susceptibility of 258 isolates of Erysipelothrix rhusiopathiae from slaughtered pigs affected with chronic erysipelas in Japan to antimicrobial agents was determined . A total of 111 (43.0%) strains showed resistance to erythromycin, oleandomycin, oxytetracycline, or dihydrostreptomycin . Plasmids were not detected . This is the first report of resistance of E . rhusiopathiae to these antibiotics.

Rev Infect Dis, 1984 Mar-Apr, 6 Suppl 1, S270 - 5
The impact of different antimicrobial agents on the normal gastrointestinal microflora of humans; Nord CE et al.; In the present study the impact on the gastrointestinal microflora of peroral administration of penicillin, bacampicillin, clindamycin, erythromycin, doxycycline, and tinidazole was investigated . The effects on the colonic flora of parenteral administration of ampicillin plus sulbactam, cefoxitin, clindamycin, and tinidazole also were studied . Pronounced changes were observed in the oropharyngeal and colonic microflora in patients receiving clindamycin, erythromycin, and tinidazole (intravenous), whereas moderate changes were seen in those patients receiving doxycycline, cefoxitin, and ampicillin plus sulbactam . Penicillin, bacampicillin, and tinidazole (peroral) produced only minor changes . In most patients with an altered microflora, colonization with new bacterial strains was found.

J Anal Toxicol, 1984 Mar-Apr, 8(2), 75 - 7
Vancomycin: a rapid HPLC assay for a potent antibiotic; Hoagland RJ et al.; Vancomycin 'Vancocin HCl' is a potent antimicrobial used most frequently in the treatment of gram positive septicemias . Ototoxicity has occurred at serum levels of 80 micrograms/mL . A rapid, sensitive assay for vancomycin that utilizes high-pressure liquid chromatography with ultraviolet detection, and requires only 100 microL of serum, is presented . The method shows excellent linearity and precision throughout the therapeutic and toxic range.

J Pharm Sci, 1984 Mar, 73(3), 407 - 8
Synthesis and antibacterial activity of some 5-nitro-3-phenyliminoindol-2(3H)-ones and their N-Mannich bases; Daisley RW et al.; The antimicrobial and antifungal activities of a series of 5-nitro-3-phenyliminoindol-2(3H)-ones and their 1-piperidinomethyl analogues (N-Mannich bases) were investigated . Growth inhibition of Gram-positive bacteria was observed with little or no activity against Gram-negative bacteria . Antifungal activity was absent . The syntheses were accomplished from 5-nitroindol-2,3-dione by condensation with the appropriate aniline followed by formation of the N-Mannich base.

J Clin Microbiol, 1984 Mar, 19(3), 318 - 20
Evaluation of the Precept microdilution MIC system for single-drug testing in individual trays; Lairscey RG et al.; This study presents an evaluation of a commercial system for the MIC testing of single drugs dehydrated in disposable plastic trays (Precept, Austin Biological Laboratories, Inc., Austin, Tex.) . The commercial system was compared with a reference agar dilution method, and 203 clinical bacterial isolates were tested by each method . For a total of 767 determinations, there was 94.2% agreement between the two methods, and of the discrepancies encountered, 0.8% were very major, 2.1% were major, and 2.9% were minor . The results suggest that the Precept system may provide a practical and reliable method for MIC determinations of individual antimicrobial agents.

Laryngoscope, 1984 Mar, 94(3), 330 - 5
Infectious diseases of the sphenoid sinus; Holt GR et al.; Thirty-one patients with sphenoid sinusitis were treated from 1978-1982 . Twenty patients had infections contiguous with other paranasal sinus disease . Five of these patients had fungal sinusitis . Eleven patients were seen with isolated sphenoid sinusitis; 3 were secondary to trauma and 8 were due to nontraumatic causes . Possible etiologies include upper respiratory infections, developmental abnormalities, and water forced into the nasal cavity during swimming . The immunocompromised patient is more likely to present with minimal symptoms with a fungal infection, and aggressive diagnostic and therapeutic measures should be undertaken . Because the symptoms of headache, nasal stuffiness, proptosis, ptosis and decreased visual acuity may be interpreted as an intracranial, neurological, or vascular problem, a misdiagnosis may be made . A high index of suspicion for sphenoiditis should be maintained . Therapy involves a combination of medical (antimicrobial agent) and surgical (sinus drainage and marsupialization) management.

Clin Lab Med, 1984 Mar, 4(1), 99 - 121
Controversies in antimicrobial susceptibility testing; Witebsky FG; This article examines a number of areas of disagreement surrounding antimicrobial susceptibility testing and discusses some of the useful susceptibility testing techniques for which no standardized procedures have been established.

Age Ageing, 1984 Mar, 13(2), 89 - 94
Acute phase protein response to infection in elderly patients; Kenny RA et al.; The presence of infection is often difficult to diagnose in elderly patients . In view of this, laboratory markers of infection are of great clinical importance . The pattern of change in acute phase proteins has not hitherto been studied in elderly patients . In a prospective series of 114 acute elderly admissions to a Geriatric Unit there was a significant change with infection in all proteins studied, but C-reactive protein was the most sensitive marker of the presence and severity of infection and the response to antimicrobial therapy . The best pair of acute phase proteins in the prediction of infection were alpha 1-acid glycoprotein and C-reactive protein whilst albumin and alpha 1-acid glycoprotein together contributed significantly to the prediction of outcome.

Hautarzt, 1984 Mar, 35(3), 132 - 7
{Pyoderma vegetans of facial orifices in T-cell immunodeficiency}; Hornstein OP et al.; This is a report of a 24-year follow-up of a man now 33 years of age, who suffers almost continuously from severe inflammatory lesions of the lips, nose and eyelids, with increased susceptibility to respiratory infections since early childhood . The condition, previously described as "pyo-rhino-blepharo-stomatitis vegetans (McCarthy)", was treated with systemic corticosteroids and antimicrobial agents for years, but failed to improve until the immune status of the patient was checked after withdrawal of the steroids . T lymphocytes were found to be abnormal as to count in peripheral blood and various functional qualities determined in vivo and in vitro . For treatment, levamisole and thymopoietin pentapeptide (TP-5) were given . Subsequently each drug induced rapid and complete clearing of all lesions, but was followed by the recurrence of facial periorificial lesions after drug withdrawal . Change of the regimen by administering either inosiplex orally or commercial calf thymus extract parenterally, remained ineffective . During therapy with levamisole as well as TP-5, the number of T lymphocytes in peripheral blood normalized, yet impaired functions failed to improve . There was an elevated ratio of T-suppressor/T-inducer cells in blood using OKT antibodies . In vitro testing of different functions of polymorphonuclear leucocytes revealed normal results except for a slight decrease of chemotactic activity during levamisole . In view of the long clinical course, the mass of clinical and immunological data collected over decades, and the therapeutic results as a whole, the disease can be characterized as a peculiar type of pluriorificial pyoderma vegetans, caused by a distinct immunodeficiency of T lymphocytes.

Pharmazie, 1984 Mar, 39(3), 176 - 80
{Anthracycline antibiotics from genetically modified streptomycetes . The isolation, spectroscopic structural elucidation and biologic effects of beta-rhodomycin I}; Ihn W et al.; By mutagenic treatment and selection procedures the mutant ZIMET 43678 was obtained from a population of the interspecific recombinant Streptomyces violaceus subsp . iremyceticus ZIMET 43615, which showed a changed spectrum of secondary metabolites . The main component isolated from the fermentation broth was a pure anthracycline evidenced by TLC . By means of acid hydrolysis, identification of the degradation products and also by spectroscopic UV/VIS-, IR-, MS-, 1H/13C-NMR- and CD-investigations with intact anthracycline the structure 7-(alpha-L- rhodosaminyl )-beta- rhodomycinon with the absolute configuration 7S, 9R , 10R was found . The anthracycline called beta- rhodomycin -1 (1) exhibits antimicrobial and cytostatic activity in vitro and is also effective on tumour cells in tumour bearing animals.

J Clin Pathol, 1984 Mar, 37(3), 348 - 51
Is the antimicrobial removal device a cost-effective addition to conventional blood cultures?
Munro R, Collignon PJ, Sorrell TC, Tomlinson P.
Two hundred and thirty-four blood cultures from 140 patients receiving antibiotics were processed using the antimicrobial removal device (ARD) in parallel with conventional blood cultures . One hundred and seventy cultures were obtained from patients suspected to have bacteraemia and 64 from patients known to have a positive conventional blood culture within the preceding three days . A total of 38 (16.2%) ARD-processed cultures were positive, compared with 21 (8.9%) conventional cultures (p less than 0.0001, Fisher's exact test) . No instances of positive conventional cultures and negative ARD-processed cultures were identified . Thirty-three of 38 ARD-processed cultures became positive within 24 h, compared with 14 parallel conventional cultures (p less than 0.0001 Fisher's exact test) . Although the yield and rapidity of isolation of bacteria from blood were improved by ARD processing, in only one of 140 patients did this information alter treatment . As the use of an ARD is associated with a sixfold increase in the cost of blood cultures, we conclude that, in our hands, general use of the device in patients receiving antibiotics is not cost-effective . Considerable care should be taken in selecting patients for ARD-processing of blood cultures.

Allergol Immunopathol (Madr), 1984 Mar-Apr, 12(2), 123 - 8
{Monocyte chemotaxis: critical evaluation of 2 methods of quantification}; Jimenez Lopez A et al.; The mononuclear phagocytic system (Mo) possesses a series of well defined functions regarding both its circulatory components--monocytes--and histiocytic macrophages . These functions--antimicrobial defense, elimination of cellular particles or detritus, immunological interaction with lymphocytes cells, antitumoral defense and control of granulopoiesis--require chemotaxis and phagocytosis or preceding steps . Although knowledge of these functional aspects is continually becoming better--always assured by advances obtained in the study of the function and pathology of polymorphonuclear cells--, an authentic pathology of monocyte chemotaxis as an independent clinical entity doesn't exist . This is attributed to of these cells . The techniques currently in use differ not only in their methodology but also in their bases and thus the results obtained by various authors are not generally comparable . All this led us to do a comparative study, in control subjects, between two techniques which explore the chemotactic capacity of monocytes from peripheral blood . The chemotactic capacity of monocytes from peripheral blood in control subjects, measured by two distinct quantification methods, were studied: Radioanalytic Method (monocytes tagged with 99 mTc) and a morphological method (counting the number of monocytes per field in immersion) . The results obtained from both techniques were very similar, the existence of significant differences in cell behavior with exposure to the different chemotactic substances used could not be demonstrated . These results are commented on.

Methods Find Exp Clin Pharmacol, 1984 Mar, 6(3), 139 - 42
Antimicrobial susceptibility testing of pathogenic Escherichia coli using non-standard conditions; Ring DL et al.; Results of non-standardized disc agar diffusion and broth microdilution antimicrobial susceptibility tests on blood culture isolates of Escherichia coli were compared with those of standardized tests . Test incubation at 40 degrees C, versus 35 degrees C, did not significantly affect results for either method . However, anaerobic incubation significantly altered results for several antimicrobials in both testing methods . The implications of these alterations will be discussed in the text.

Southeast Asian J Trop Med Public Health, 1984 Mar, 15(1), 37 - 43
Antimicrobial resistance and conjugative R plasmids in Escherichia coli strains isolated from animals in Peninsular Malaysia; Koh CL et al.; Fifteen independent E . coli strains of avian, bovine and porcine origin in Peninsular Malaysia were tested for antibiotic resistance and conjugative R plasmids . Eight (53%) isolates were found to be antibiotic resistant . Among them, 37.5% were mono-resistant and 62.5% were resistant to three or more antibiotics, i.e., multi-resistant . All of them were resistant to Tc and sensitive to Gm and Nx . Three of the eight antibiotic resistant strains were able to transfer all or part of their resistance to an E . coli K12 recipient by conjugation . The transfer frequencies of Km, Sm and Tc resistance of the three donors varied between 4.5 X 10(-8) to 6.8 X 10(-7) . Analysis of the plasmid profiles of all the three donors and their respective transconjugants after agarose gel electrophoresis provided conclusive evidence that the transferable resistance traits were plasmid-mediated.

Rev Infect Dis, 1984 Mar-Apr, 6 Suppl 1, S80 - 4
Jejunoileal bypass: change in the flora of the small intestine and its clinical impact; Corrodi P; Among the complications of jejunoileal bypass for morbid obesity are proctitis, bypass enteritis, liver disease, dermatitis, and arthritis, all of which are thought to be connected with the intestinal microflora . Quantitative cultures from the small bowel of patients before the establishment of the bypass and from patients with reoperations indicate colonization of both the functioning small bowel (bacterial counts, 10(5.0)-10(7.6)/ml) and of the bypassed loop (bacterial counts, 10(6.4)-10(9.7)/ml) . Experiments in animals have shown that the presence of a bypassed loop, as compared with that of a resected bowel, is necessary for increased weight loss and for the development of liver disease . Clinical evidence for the impact of the intestinal microflora is based on the beneficial effect of antimicrobial agents, especially metronidazole, and on the demonstration of immunologic phenomena involving antigens of bacterial origin . Complications of jejunoileal bypass may serve to elucidate the pathogenesis of other diseases.

Am J Med, 1984 Mar, 76(3), 414 - 20
Symposium on infectious complications of neoplastic disease (Part I) . Introduction and epidemiology; Louria DB; An approach to infections in cancer patients is outlined that divides such infections into those due to underlying disease, those related to underlying disease plus therapy, and those related to therapy alone . The incidence of such infections in each of the categories is discussed, together with a general outline of patterns and trends in regard to involved microorganisms . Several specific areas discussed include: problems of superinfection with newer antimicrobial agents; the current inadequacy of diagnostic techniques; the potential for early treatment with monoclonal antibodies; the potential for augmenting one or more host defenses prior to sundering other defenses during antitumor chemotherapy; the potential value of a variety of nutrients that either may be depleted or might be of benefit in enhancing host defense mechanisms.

J Immunol, 1984 Mar, 132(3), 1494 - 500
Macrophage activation to kill Leishmania tropica: kinetics of macrophage response to lymphokines that induce antimicrobial activities against amastigotes; Oster CN et al.; Lymphokine (LK) treatment of resident peritoneal macrophages from C3H/HeN mice induced two antimicrobial activities against Leishmania tropica: increased resistance of activated macrophages to infection with amastigotes and intracellular destruction of those parasites that entered activated cells . The onset and duration of these two antimicrobial activities were quite different . Resistance to infection was observed as early as 4 hr after the addition of LK, became maximal at 8 hr, and persisted in a subpopulation of treated cells for as long as 72 hr . In contrast, intracellular killing occurred with as little as 4 hr of LK treatment after infection, and maximal killing was observed in cultures exposed to LK 24 hr . Intracellular killing capacity of lymphokine-treated cells was progressively lost in macrophages treated longer than 12 hr before exposure to parasites . This decay in ability to destroy intracellular L . tropica was also seen in macrophages cultured longer than 12 hr before LK treatment, and may reflect loss of macrophage responsiveness to LK with increasing time in vitro . Thus, treatment of macrophages with lymphokines induced both a stable change in cell-parasite interactions, resistance to infection, and a short-lived capacity to destroy intracellular amastigotes.

Jpn J Antibiot, 1984 Mar, 37(3), 309 - 17
{Concentrations of cefotiam and cefmenoxime in the human bone marrow blood and osseous tissue}; Kumano O et al.; Prophylactic antimicrobial therapy for the prevention of infection during total joint arthroplasty or spinal surgery was investigated using cefotiam (CTM) and cefmenoxime (CMX), which are cephems having broad antimicrobial spectrum . Seven patients received 2 g of CTM, and 12 patients 2 g of CMX, by intravenous drip infusion over 15 minutes . Blood, bone marrow and osseous tissue samples were obtained at the end of the infusion, and 30, 60, 90 and 120 minutes after the beginning of the infusion . The concentrations of CTM and CMX were detected by the agar-well method . CTM and CMX were smoothly distributed from blood to bone marrow and osseous tissue, and kept on the effective concentrations for prophylaxis against postoperative infections . The primary wound healing was obtained in all cases, and no side effects were also recognized.

Zentralbl Bakteriol Mikrobiol Hyg {A}, 1984 Mar, 256(3), 328 - 34
Antimicrobial activity of Obioactin; Osaki H et al.; A newly developed enzyme-hydrolyzed toxoplasma-hyperimmune bovine serum preparation, Obioactin , was examined for its anti-microbial and related actions against heterologous protozoa, bacteria, and viruses both in-vivo and in-vitro . An appreciable efficacy of Obioactin in a combination with nifurtimox, Lampit was observed in experimental Trypanosoma cruzi infections in mice . But prophylactic applications of the agent alone or joint with Lampit were in vain in mice . In-vitro digestion of certain bacteria in mouse peritoneal macrophages was accelerated in the presence of the agent being three to ten times stronger than that in untreated macrophages . Inhibitory effect of Obioactin on in-vitro infectivity of viruses was suggested.

Rev Infect Dis, 1984 Mar-Apr, 6 Suppl 1, S283 - 92
Prospective, randomized, comparative trials in the therapy for intraabdominal and female genital tract infections; Harding GK et al.; The results of four prospective, randomized comparative trials, in which the authors' two university teaching hospitals participated, that compared selected antimicrobial regimens with the combination of clindamycin and an aminoglycoside in the therapy for intraabdominal and female genital tract infections are reviewed . In the first trial, the rates of cure for patients with intraabdominal infections were 33 (79%) of 42 treated with clindamycin and gentamicin, 43 (81%) of 53 treated with chloramphenicol and gentamicin, and 35 (90%) of 39 treated with ticarcillin and gentamicin . The rates of cure for females with genital tract infections were 16 (94%) of 17, 11 (100%) of 11, and 12 (92%) of 13 treated with the three respective combinations . The rates of cure in the second study were 22 (88%) of 25 treated with metronidazole and gentamicin and 23 (88%) of 26 treated with clindamycin and gentamicin . In the third study, the rates of cure were 23 (82%) of 28 treated with cefoxitin and tobramycin as compared with 24 (89%) of 27 treated with clindamycin and tobramycin . In the fourth study, 21 (87%) of 24 patients treated with ceftizoxime alone are cured as compared with 13 (87%) of 15 treated with clindamycin and tobramycin . These prospective, randomized trials suggest that chloramphenicol and gentamicin, ticarcillin and gentamicin, metronidazole and gentamicin, cefoxitin and tobramycin, or ceftizoxime alone are as effective as clindamycin and gentamicin or tobramycin in therapy for mixed aerobic/anaerobic infections.

J Med Chem, 1984 Mar, 27(3), 306 - 10
Structure-activity relationships among DNA gyrase inhibitors . Synthesis and biological evaluation of 1,2-dihydro-4, 4-dimethyl-1-oxo-2-naphthalenecarboxylic acids as 1-carba bioisosteres of oxolinic acid; Hogberg T et al.; A series of oxolinic acid analogues was synthesized in an attempt to evaluate the role, if any, played by the N-1 atom in putative modes of action of antimicrobial DNA gyrase inhibitors . Carba analogues were prepared because these have no possibility of an internal resonance contribution of the nitrogen atom and yet could otherwise satisfy electronic requirements of putative modes of action . Successful routes were developed involving Friedel-Craft's cycloaddition of suitable aromatic compounds with 4,4-dimethylbutyrolactone, followed by ethoxycarbonylation, oxidation with dichlorodicyanobenzoquinone, and careful saponification . The gem-dimethyl group of these analogues prevents aromatization at the cost of nonplanarity . Only the unsubstituted parent compound, 1,2-dihydro-4,4-dimethyl-1-oxo-2-naphthalenecarboxylic acid, possessed any appreciable antimicrobial activity in vitro . This may be due to a different mode of action, however, since gave no measurable inhibition of DNA gyrase in vitro . Thus, the N-1 atom plays a significant role in enzymic and bacteriological inhibition that cannot be compensated for by the presence of C-6 oxygen atoms.

Resuscitation, 1984 Mar, 11(3-4), 243 - 8
Diagnosis and treatment of bacterial meningitis; Thys JP; In the clinical approach of bacterial meningitis, the following points are stressed . Rapid identification of the germ, pending the results of the cultures . Various laboratory procedures are reviewed such as the Gram stain, the counterimmunoelectrophoresis, lactate determination and limulus assay of the CSF . Because of the local impaired host defences as well as the poor penetration and partial bioinactivation of most of the antibiotics in the CSF, large doses of the drugs are necessary to ensure sufficient levels and bactericidal titers . Specific antimicrobial therapy of meningitis is reviewed, with an emphasis on the third generation cephalosporins which appears to be the key to the treatment of Gram negative infections.

Gastroenterology, 1984 Mar, 86(3), 402 - 12
Specific and nonspecific humoral defense factors in the epithelium of normal and inflamed gastric mucosa . Immunohistochemical localization of immunoglobulins, secretory component, lysozyme, and lactoferrin; Valnes K et al.; Epithelial distributions of immunoglobulin A, secretory component, lysozyme, and lactoferrin were studied by paired immunofluorescence staining in ethanol-fixed biopsy specimens from gastric antral and body mucosa . Fluorescence scores were assigned semiquantitatively for the epithelium in three mucosal zones (foveolar, isthmus, and glandular) . In each case, degree of inflammation was graded blindly after conventional histologic staining of serial sections . The results showed that the overall epithelial expression of local defense factors was significantly enhanced in association with gastritis, both with regard to nonspecific antimicrobial substances (lysozyme and lactoferrin) and the external transfer of immunoglobulin A (mediated by secretory component) as a potential carrier of protective antibodies . The antral isthmus and glandular zones were most active in both respects . Despite the expression of relatively large amounts of epithelial immunoglobulin A and secretory component in metaplastic glands, these elements lacked the nonspecific defense factors (except for lysozyme in Paneth cells)--even when they occurred in the antral mucosa--and may, therefore, represent particularly vulnerable areas.

Biochim Biophys Acta, 1984 Feb 24, 781(1-2), 187 - 91
Seminal plasmin, an antimicrobial protein from bull semen, inhibits gene expression in E . coli; Scheit KH et al.; RNA synthesis in Escherichia coli was immediately inhibited after addition of seminal plasmin, an antimicrobial protein from bull semen . RNA synthesis progressively decreased within 12 min and then ceased completely . In contrast, protein synthesis was not affected within the first 12 min, but thereafter became progressively inhibited . Inhibition of RNA synthesis by seminal plasmin in E . coli interfered with induction of beta-galactosidase by isopropyl-beta-D-thiogalactoside (IPTG) . This implied inhibition of beta-galactosidase mRNA synthesis by seminal plasmin in vivo . The sensitivities of total in vivo RNA synthesis and beta-galactosidase mRNA synthesis against seminal plasmin were found to be similar . Seminal plasmin had no effect on the uptake of the inducer IPTG by E . coli cells.

J Chromatogr, 1984 Feb 10, 305(2), 325 - 34
Electron-capture gas chromatographic assays of 5-nitroimidazole class of antimicrobials in blood; Bhatia SC et al.; Sensitive and selective electron-capture gas chromatographic methods for the determination of N-1-substituted 5-nitroimidazole class of antiprotozoals from blood are described . Metronidazole, secnidazole and ornidazole having a hydroxyl function in the N-1 substitution, were converted to their respective trimethylsilyl derivatives before chromatography on an OV-11 column . Tinidazole and satranidazole, devoid of the hydroxy group but containing a sulphur atom in the molecule, were chromatographed as such on the same stationary phase . Blood levels as low as 50 ng/ml for all the 5-nitroimidazoles have been measured with good precision . The methods can be readily utilized for pharmacokinetic studies.

Vestn Khir Im I I Grek, 1984 Feb, 132(2), 32 - 5
{Electron microscopic study of the liver after experimentally resecting it and covering its surface with BAPP and BAPK}; Penchev R et al.; An analysis of data of electron microscopic investigations of liver preparations within the terms of from 7 to 425 days after resection of the liver in which the liver wound was covered by the antimicrobial polycaproamid gauze made in Bulgaria has shown that the polymer material does not cause alterations in the liver structure and cell organelles of hepatocytes not preventing regeneration of the liver.

Pharmazie, 1984 Feb, 39(2), 101 - 3
Synthesis of some 1.3.4-thiadiazoles of possible antimicrobial activity; el-Dine SA et al.; Different new esters of 5-aryl-1,3,4-thiadiazol-2-ylcarbazic acid and dithiocarbazic acid were prepared . In addition, the synthesis of 2-(N,N'-dialkylcarboxy)hydrazino-5-aryl-1,3,4-thiadiazoles is described . IR and NMR data of the new compounds are discussed . Some of these compounds showed a reasonable activity against Gram positive bacteria and fungi.

Lab Anim Sci, 1984 Feb, 34(1), 91 - 3
Pneumatocele in a pig-tailed macaque (Macaca nemestrina); Gillett CS et al.; Radiographic examination of a pig-tailed macaque (Macaca nemestrina) with pneumonia revealed a large pneumatocele . The pneumatocele, a thin-walled, partially fluid filled radiolucent area, occupied approximately one-third of the left thorax . Rapid resolution of the pneumatocele accompanied antimicrobial treatment of the pneumonia and coincided with clinical improvement . Severe pulmonary acariasis was found at postmortem 15 months later.

J Antibiot (Tokyo), 1984 Feb, 37(2), 85 - 95
Actaplanin, new glycopeptide antibiotics produced by Actinoplanes missouriensis . The isolation and preliminary chemical characterization of actaplanin; Debono M et al.; Actaplanin (A4696), a new complex of broad spectrum Gram-positive antibiotics is produced by Actinoplanes missouriensis . High performance liquid chromatography was used to show that this complex is composed of several actaplanins . Hydrolytic experiments with acetaplanins A, B1, B2, B3, C1 and G showed that these actaplanins were composed of the same peptide core, an amino sugar and varying amounts of glucose, mannose and rhamnose . The neutral sugar content was determined for each actaplanin . A bioautographic study of aglycone formation during hydrolysis of the actaplanin complex showed that within a short time a simple mixture of two antimicrobially active hydrolysis products was obtained . These substances retained the antimicrobial spectrum and a high percentage of the antibiotic activity of the parent actaplanin complex . Methanolysis of the acetaplanin complex as well as the individual actaplanins resulted in the selective loss of the neutral sugar moieties and the isolation of actaplanin psi (pseudo)-aglycone--the core peptide which still retained an amino sugar group . The 1H NMR spectrum of this substance indicated a similarity to many features of ristocetin psi-aglycone . Hydrolytic studies showed that the amino sugar present in actaplanin was identical with L-ristosamine . It is concluded that the aglycone of actaplanin is a complex peptide composed of aromatic amino acids, and that the actaplanins each possess this aglycone and L-ristosamine but are differentiated by their neutral sugar composition.

J Antibiot (Tokyo), 1984 Feb, 37(2), 130 - 5
Deepoxidation of 16-membered epoxyenone macrolide antibiotics . III . In vitro and in vivo evaluation of deepoxidation products of carbomycin A, deltamycin A1, 4"-phenylacetyldeltamycin, angolamycin and rosamicin; Sakamoto M et al.; Deepoxidation products P1, P2 and P3 of carbomycin A, deltamycin A1 and 4"-phenylacetyldeltamycin showed high in vitro antibacterial and antimycoplasmal activities which were comparable to those of the respective parent compounds . By contrast, the in vitro antimicrobial potencies of angolamycin P1 and rosamicin P1 were about ten-fold lower than those of the parent macrolides . In mice, the increase in the plasma levels of the epoxyenone macrolides due to deepoxidation was highly significant with the P1, P2 and P3 derivatives of carbomycin A and 4"-phenylacetyldeltamycin, whereas angolamycin P1 gave a moderately-improved plasma level compared with angolamycin.

J Urol, 1984 Feb, 131(2), 363 - 9
Longitudinal studies of prostatic fluid immunoglobulin in men with bacterial prostatitis; Fowler JE Jr et al.; To better characterize the apparent secretory immune response of the prostate to bacterial infection of the genitourinary tract, we assayed serial expressed prostatic secretion (EPS) specimens for total and antibacterial immunoglobulin . Three men with bacterial prostatitis, including 2 otherwise healthy men with chronic infections and 1 man with IgG multiple myeloma and an acute infection, were studied . In the former 2 cases the infections were associated with greater increases in total EPS IgA than total EPS IgG or IgM . The patient with multiple myeloma had markedly elevated serum IgG levels and subnormal serum IgA and IgM levels and the acute infection was accompanied by increases in total EPS IgG and IgM but consistently low total EPS IgA . Antibacterial EPS IgA, which was measurable in each case, was always quantitatively greater than antibacterial EPS IgG . Antibacterial IgM was never detectable . Alterations in the concentrations of antibacterial EPS IgG and IgA were generally not associated with comparable alterations of total EPS IgG and IgA, respectively, and the concentrations of antibacterial EPS IgG and IgA did not correlate well with the clinical or bacteriologic response to antimicrobial therapy . The concentration of antibacterial IgA expressed as a function of total IgA was as much as 1550 times greater in the EPS than in the serum . However, the relative concentrations of antibacterial IgG and IgM were similar in the EPS and serum . These data suggest local synthesis of antibacterial IgA in the prostate that persists following eradication of the infection and that is regulated independent of both the systemic immune response and the concentration of total prostatic fluid immunoglobulin.

J Urol, 1984 Feb, 131(2), 327 - 9
Ureteral obstruction during pregnancy; Laverson PL et al.; We report on a woman with recurrent renal failure due to bilateral ureteral obstruction during the mid trimester of pregnancy . The first pregnancy was terminated due to obstructive renal failure . In the second pregnancy renal function again deteriorated due to bilateral ureteral obstruction . After successful placement of a right ureteral catheter and a left percutaneous nephrostomy, renal function normalized and the gestation was continued through 37 weeks . Recurrent ureteral obstruction during pregnancy was attributed to changes following bilateral ureteral reimplantation . Patients with a history of urologic surgery warrant surveillance for renal failure secondary to mechanical obstruction . Those with a history of proved obstruction during pregnancy might benefit from the prophylactic placement of ureteral catheters and chronic antimicrobial therapy during subsequent gestations.

J Clin Microbiol . 1984 Feb;19(2):300.
Evaluation of the Dynatech MR 580 microplate reader for routine antimicrobial susceptibility testing; Mazens MF et al.; In microdilution antimicrobial susceptibility tests in our laboratory, only two concentrations of each antimicrobial agent are used . Plate reading with the Dynatech MR 580 Microplate Reader was compared with visual inspection . An Apple II computer printed results as S, I, or R . Reproducibility between visual and MR 580 readings was 99.4%.

Scand J Dent Res, 1984 Feb, 92(1), 38 - 42
Effect of antimicrobial mouthrinses on salivary microflora in healthy subjects; Dahlen G; The antibacterial effects of chlorhexidine and an oxygen releasing agent on the salivary microflora were evaluated in healthy subjects in two separate experiments: 1) mouthrinsing on a single occasion and 2) mouthrinsing two or four times a day for 1 wk . Both experiments were performed in a cross-over study, and each subject was randomly tested for both rinsing agents and a saline control . The total bacterial number and some selected bacterial genera were followed in saliva samples taken prior to (zero-samples) and on three occasions after the rinsing or rinsing period . The reduction of the total bacterial number by mouthrinsing two or four times a day for 1 wk with chlorhexidine was statistically significant and lasted for over 4 h . After rinsing with chlorhexidine on one single occasion the reduction of the microflora was statistically significant and of the same magnitude as after rinsing two or four times daily for 1 wk . Although statistically significant reduction was obtained, the significant biologic effect of antimicrobial agents may be questioned . The number of Strep . mutans was dramatically reduced with chlorhexidine in some subjects and this reduction lasted for over 1 wk . The oxygen releasing agent did not reduce salivary flora significantly when rinsing took place two or four times daily for 1 wk.

Infect Control, 1984 Feb, 5(2), 95 - 7
Pharmacokinetics of antimicrobial agents; Norris SM et al.; The use of formulas or nomograms is not a substitute for or in conflict with measurement of drug levels . We are always obligated to use the best available strategy in choosing a loading and maintenance dose . We must likewise measure and use serum levels for drugs with a narrow therapeutic margin, drugs administered for a long duration of time, and when there is uncertainty about a drug's kinetics . (The classic example is a patient on an aminoglycoside for more than three days, elderly or in renal failure).

Antimicrob Agents Chemother, 1984 Feb, 25(2), 205 - 11
Detection and quantitation of chloramphenicol by competitive enzyme-linked immunoassay; Campbell GS et al.; A competitive enzyme-linked immunoassay for the detection and quantitation of chloramphenicol has been developed . The binding of specific rabbit antibody to solid-phase-bound chloramphenicol was competitively inhibited by free chloramphenicol in the sample to be assayed . Antibody not displaced was indicated by using a commercially available, enzyme-linked, anti-rabbit immunoglobulin preparation and reacted with added substrate . Enzyme activity, measured spectrophotometrically, was inversely proportional to the concentration of chloramphenicol in the sample . Quantitation of the antibiotic was linear to 100 ng/ml, with a lower limit of detection of 1 ng/ml (P less than 0.05) . Specificity was demonstrated by the lack of inhibition by any of 31 selected antimicrobial agents or chemicals tested in the assay . Chloramphenicol sodium succinate and thiamphenicol, an experimental antibiotic similar in structure to chloramphenicol, were the only drugs found to produce cross-reactions . In addition to excellent sensitivity and specificity, the assay was shown to have good precision and economy and could be completed in approximately 24h.

Antimicrob Agents Chemother, 1984 Feb, 25(2), 165 - 7
In vitro susceptibility of Nocardia asteroides to 25 antimicrobial agents; Dewsnup DH et al.; Fifty-two clinical isolates of Nocardia asteroides were tested by agar dilution for their susceptibility to 25 antimicrobial agents . In general, susceptibility could not be predicted based on the antibiotic class tested . However, the beta-lactams, including third-generation cephalosporins, were generally ineffective (MIC for 90% of the organisms {MIC90}, between 64 and greater than 256 micrograms/ml), whereas minocycline and doxycycline were generally effective (MIC90, 4 and 8 micrograms/ml, respectively) . Cycloserine was not effective below 60 micrograms/ml . The MIC50 and MIC90 of sulfamethoxazole was 16 and 32 micrograms/ml, respectively, and that of trimethoprim varied widely (16 and greater than 256 micrograms/ml, respectively) . Based on MIC90 data, only doxycycline, minocycline, sulfamethoxazole, and imipenem could be applied empirically.

Am J Obstet Gynecol, 1984 Feb 1, 148(3), 235 - 40
Therapy for acute pelvic inflammatory disease: a critique of recent treatment trials; Brunham RC; Recent approaches to determine optimal antimicrobial treatment for acute pelvic inflammatory disease are reviewed . From this review, it is suggested that in future studies a randomized study design, with controls for known factors which influence prognosis, and a uniform objective scoring system for monitoring clinical response be used and long-term evaluation of tubal function be performed . Such studies are urgently needed if optimal therapy for pelvic inflammatory disease is to be defined.

Clin Nephrol, 1984 Feb, 21(2), 89 - 90, 91-2
Impaired oxidative metabolism by leukocytes from renal transplant recipients: a potential mechanism for the increased susceptibility to infection; Shah SV et al.; Stimulated neutrophils exhibit a burst of oxidative metabolism which results in the formation of superoxide anion and other oxygen species that participate in bacterial killing . Chemiluminescence which is also produced is a sensitive measure of oxidative metabolism and correlates well with antimicrobial activity . Because infection is an important cause of morbidity and mortality in renal transplant recipients we examined chemiluminescence and superoxide production by leukocytes from transplant patients in response to a soluble (phorbol myristate acetate) and to a particulate stimulus (opsonized zymosan) . Using phorbol myristate acetate as a stimulus, leukocytes from patients had a reduced chemiluminescence response {controls 515 +/- 105, n = 18; patients 225 +/- 40, peak cpm X 10(3)/10(6) PMN, n = 13, (P less than 0.05)} and reduced superoxide anion production {controls 43.3 +/- 3.4, n = 18, patients 29.3 +/- 3.9 nmoles/15 min/10(6) PMN, n = 13 (P less than 0.025)} . Significantly reduced chemiluminescence response (P less than 0.025) and superoxide production (P less than 0.05) were also observed using opsonized zymosan as a stimulus . The impaired oxidative burst by leukocytes may contribute to impaired microbial killing and may explain the increased morbidity and mortality from infection in renal transplant patients.

J Clin Invest, 1984 Feb, 73(2), 366 - 73
Myeloperoxidase modulates the phagocytic activity of polymorphonuclear neutrophil leukocytes . Studies with cells from a myeloperoxidase-deficient patient; Stendahl O et al.; Patients lacking the primary granulae enzyme, myeloperoxidase (MPO), do not usually show any increased susceptibility to infection or altered inflammatory response, in contrast to several other biochemical defects in polymorphonuclear neutrophils . We have now evaluated the role of MPO on phagocyte function in a patient with complete MPO deficiency suffering from generalized pustular psoriasis . We found that the MPO-deficient neutrophils showed enhanced phagocytosis (greater than 200% of normal) of IgG- and C3b-opsonized yeast particles and prolonged N-formylmethionyl-leucyl-phenylaline-mediated stimulation of superoxide production . When purified human MPO was added to normal neutrophils during cell adhesion, their Fc- and C3b-mediated phagocytosis was reduced without affecting cell viability . 1 microgram/ml of MPO reduced the Fc and C3b phagocytosis to 47 and 65%, respectively, whereas 10 micrograms/ml reduced the activity to 20 and 54% . Both attachment and ingestion were reduced to a similar extent, indicating that MPO affected the receptor function per se . When MPO was added to the hyperactive MPO-deficient cells, phagocytosis was reduced more rapidly . Catalase, azide, and methionine eliminated the inhibitory effect, and catalase and methionine, in fact, enhanced the phagocytic activity of adherent neutrophils . These data indicate that, apart from being a potent antimicrobial system, the oxidizing activity of the MPO-H2O2-halide system may modulate the inflammatory response by impairing certain receptor-mediated recognition mechanisms of phagocytic cells, which otherwise could elicit inflammatory reactions and tissue injury.

J Am Vet Med Assoc, 1984 Jan 15, 184(2), 161 - 3
Isolation of mastitis pathogens from quarters of cows recently treated with antimicrobial agents; Stem ES 3rd et al.; Milk samples for aerobic culturing were collected from 72 quarters of cows with clinical mastitis that had been nonresponsive to antimicrobial intramammary treatment . All samples were collected within 24 hours of the most recent treatment . Mastitis pathogens were isolated from 56 samples (78%).

Exp Cell Biol, 1984, 52(4), 260 - 8
A transparent chamber for the dorsal skin fold of athymic mice; Falkvoll KH et al.; A transparent chamber designed for insertion in the dorsal skin fold of athymic mice is described . The chamber is based on ingrowth of a layer of granulation tissue from the surrounding subcutis of the animals . The thickness of the tissue layer in the chamber is accurately given by an exchangeable chamber component and the construction allows repetitive access to the tissue inside the chamber . A freely movable skin flap is prepared surgically on the back of the animals, and the chamber is inserted in this flap in a second operation about 2 weeks later . In the absence of air bubbles, infectious foci and excessive adipose tissue in the chamber, ingrowth of granulation tissue is completed 2-4 weeks after the insertion . When infections of the skin enclosing the chamber and atrophy of the skin flap are prevented, the functioning time of the transparent chamber is determined by the life span of the animals . In the present study the athymic mice remained healthy for 4-5 months after insertion of the chamber although they were kept under conventional conditions, but were given antimicrobial covering . Since athymic mice accept some human xenografts, both normal tissues and neoplasms, vital microscopical studies of such xenografts implanted into the chamber can be performed . Preliminary results of such studies on a human malignant melanoma are presented.

Chemotherapy, 1984, 30(3), 182 - 7
In vitro antibiotic susceptibility of Legionellaceae: search for alternative antimicrobial drugs; Traub WH et al.; Reference strains of Legionella pneumophila (serotypes 1-4, and 6), Legionella micdadei , and Legionella bozemanii proved susceptible (agar dilution test, buffered charcoal yeast extract agar) to erythromycin, rifampin, augmentin (amoxycillin plus clavulanic acid), cefotaxime, cefoxitin, enoxacin , fusidic acid, and norfloxacin; cefamandole was less active . The strains varied in susceptibility to fosfomycin.

Gerontology, 1984, 30(3), 167 - 77
Characteristics of the phagocytically induced respiratory burst in leukocytes from young adult and aged beagle dogs; Johnson DD et al.; Phagocytically stimulated canine leukocyte suspensions obtained from 12 young adult and 43 aged individuals were examined for several physiological manifestations of the phagocytically induced respiratory burst . There was considerable variation in levels of oxygen consumption, glucose oxidation via the hexose monophosphate shunt (HMPS), and chemiluminescence response by both resting and phagocytically stimulated leukocytes from different individual animals in each age-group . Leukocyte suspensions from specific individuals in each age-group exhibited a weakly responsive respiratory burst . Chronological age could not be used as a predictor of either the specific (oxygen consumption and HMPS activity) or nonspecific (chemiluminescence response) manifestations of the respiratory burst . The kinetics of the chemiluminescence response were similar for all age-groups . Collectively, the results suggest that there is not an age-related alteration in the phagocytically induced respiratory burst of canine neutrophils and that cells from young adult and aged dogs have a comparable capacity to generate levels of highly reactive antimicrobial oxidizing agents . The increased relative susceptibility of aging dogs to microbial agents is apparently not related to an absent, abbreviated, or reduced leukocyte respiratory burst.

Pediatr Infect Dis, 1984 Jan-Feb, 3(1), 40 - 5
Antimicrobial therapy of febrile children with malignancies and possible sepsis; Frazier JP et al.; A prospective study of 100 pediatric patients (2 months to 17 years of age) who had malignancies and fever was conducted . Gentamicin or netilmicin and a beta-lactam antibiotic were administered as initial empiric treatment . Before therapy profound granulocytopenia (fewer than 500 polymorphonuclear leukocytes/microliter) was present in 66% of children and persisted to the end of therapy in 42% of children . Of the 40 children with microbiologically documented infections, 38 (95%) responded to therapy . The aminoglycoside dosing regimen of 2 mg/kg/dose intravenously over 60 minutes every 6 hours produced antibiotic concentrations in serum of 5.8 +/- 0.3 microgram/ml at the end of the infusion in the netilmicin group and 1.5 +/- 0.1 microgram/ml 6 hours after the infusion and of 6.2 +/- 0.2 and 0.9 +/- 0.1 microgram/ml for the two time periods in the gentamicin group . The serum half-lives, volumes of distribution and the total body clearance rates were comparable for netilmicin and gentamicin . No accumulation of netilmicin or gentamicin was noted . Seven patients had renal compromise, five before institution of antibiotic therapy and two while on therapy . Four episodes of ototoxicity were not related to antibiotic therapy . Superinfection occurred in five children . The combination of either gentamicin or netilmicin with a beta-lactam antibiotic produced excellent results for episodes of fever in neutropenic children with cancer . In children with severe underlying disease and/or granulocytopenia, antibiotic combinations have achieved an optimal efficacy . Future emphasis should be placed on prevention, immunoregulation and nonbacterial pathogens.

J Antimicrob Chemother, 1984 Jan, 13 Suppl A, 47 - 9
The clinical versatility of aminoglycosides; Jackson GG; The value of netilmicin, like that of other antibiotics, is influenced by its antimicrobial specificity, dosage and ease of administration, activity in pus and the underlying condition of the host . Different classes of antibiotics and different members among a group of antibiotics have relative strengths and weaknesses among these clinical factors that affect the results of antibacterial therapy and must be determined by careful clinical investigation.

Scand J Infect Dis, 1984, 16(1), 103 - 9
Patterns of antimicrobial therapy for pediatric patients; Kjellman B et al.; The pattern of antimicrobial prescribing for outpatients and inpatients in a Swedish pediatric department was evaluated in 1975 and 1982 . The changes in the pattern during these 7 yr were small and, with regard to outpatients, very similar to those in the whole of Sweden . In these children phenoxymethylpenicillin (penicillin V) was the predominant antimicrobial (approximately 70%), followed by erythromycin and medium wide-spectrum penicillins (ampicillin/amoxycillin) . Prescriptions for erythromycin in outpatients increased from 8 to 16% . The corresponding figures for Sweden as a whole were from 13 to 20% . This increase might partly be explained by the higher frequency of pertussis in Sweden in the last few years, but it is probably also a manifestation of an insufficiently motivated widening of the range of indications for erythromycin . A comparison between the prescribing patterns in Sweden and North America showed an obvious difference . In the USA the medium wide-spectrum penicillins are more used than penicillin V . This difference is discussed and found to be probably due to a real difference in antimicrobial policy . Penicillin V and G also dominated the inpatient prescriptions (51% in 1975 and 42% in 1982), which also differed from some North American hospitals.

J Antimicrob Chemother, 1984 Jan, 13(1), 55 - 64
Branhamella catarrhalis: antibiotic sensitivities and beta-lactamases; Stobberingh EE et al.; Twenty-eight strains of Branhamella catarrhalis, isolated from patients with acute exacerbations of chronic bronchitis, were tested both for beta-lactamase production and for sensitivity to a wide range of antimicrobial agents . A microtitre broth dilution technique was used for the latter and the MIC50, MIC90, and geometric mean MIC values were all calculated . Eleven strains were found to produce beta-lactamases . Isoelectric focusing in polyacrylamide gels showed four different band patterns, of which the most common was identical with that of the Ravasio type enzyme . Substrate profiles of the four types of branhamella beta-lactamases differed from each other although one was again similar to the Ravasio enzyme profile . Most of these beta-lactamases were readily inhibited by clavulanic acid (with I50 values of 0.01-0.08 mg/l) but were less readily inhibited by oxacillin . Attempts to isolate extrachromosomal DNA were unsuccessful . These results suggest that at least five possible different beta-lactamases can be demonstrated in Bran . catarrhalis strains, and that they are chromosomally determined.

Scand J Infect Dis Suppl, 1984, 43, 24 - 33
Antimicrobial agents and host defence; Forsgren A; Reports from different laboratories on effects of different antibiotics on host defence are often hard to compare because of differences in experimental design . The purpose of this presentation was to describe the effect of many different antibiotics with the same standardized techniques . E . coli and S . aureus pre-exposed to different beta-lactam antibiotics or gentamicin in subinhibitory concentrations were more susceptible to phagocytosis and killing by granulocytes than non-treated bacteria . A markedly depressed chemotaxis was detected when human leucocytes were incubated with fusidic acid and rifampicin in clinically obtainable concentration and well absorbed tetracyclines at high concentrations . The incorporation of 14C-leucine into a trichloracetic-acid insoluble form by human neutrophils was markedly depressed by the same antibiotics . Many other antibiotics did not inhibit granulocyte or lymphocyte functions . At therapeutic concentrations fusidic acid and rifampicin had a pronounced inhibition effect on the incorporation of 3H-thymidine by human T-lymphocytes stimulated by PHA and B-lymphocytes by S . aureus, Cowan I . At concentrations above the therapeutic level, inhibition was detected for doxycycline, erythromycin, clindamycin and nitrofurantoin . Due to high albumin binding for some of the tested antibiotics and other factors involved, experiments were performed to test whether depression also takes place in vivo . The cellular immunity in mice was registered by monitoring the survival of transplanted heart grafts . Rifampicin at human therapeutic dose had a strong inhibiting effect (p less than 0.001) on the rejection of heart grafts . The effect of doxycycline (2.5 mg/kg/day) and fusidic acid (25 mg/kg/day) was slight but significant (p less than 0.02).

Arzneimittelforschung, 1984, 34(11), 1552 - 4
{The antibacterial activity in vitro of ofloxacin in comparison with other orally administered antimicrobial substances on ampicillin-resistant clinical isolates}; Seibert G et al.; The antibacterial activity of Ofloxacin (DL 8280, Hoe 280 Tarivid) against Ampicillin-resistant clinical isolates was compared to, Penicillin V, Tetracyclin-HCl, Cefalexin, Cefaclor, Co-trimoxazole and nalidixic acid . Ofloxacin proved to be the most active compound against all species tested.

Schweiz Med Wochenschr Suppl, 1984, 17, 29 - 34
{Antimicrobial treatment of diarrhea of infectious origin}; Butzler JP; Since dehydration is the most frequent complication of acute diarrhoea, fluid and electrolyte repletion are the most important components of treatment . In mild diarrhoea and cases where the etiologic agent is unknown there is no need for antimicrobial chemotherapy . Indeed the benefit of an antibiotic has never been proven in these cases . Moreover side effects can occur: change in gut flora causing chronic diarrhoea, selection of drug-resistant strains, pseudomembranous colitis, toxicity of the drug . Antibiotics are often useless because a large number of diarrhoeal illnesses are caused by viruses or are of nonmicrobial origin (Rotaviruses may be responsible for up to 60% of winterdiarrhoea in children) . When the diagnosis is in doubt between a primary bowel infection and a septicaemic illness antibiotic therapy is of course fully justified.

Scand J Gastroenterol Suppl, 1984, 100, 10 - 5
Different antimicrobial agents in treatment and prophylaxis of experimentally induced intraabdominal sepsis; Lahnborg G et al.; A reproducible experimental model of intraabdominal infection in rats has been worked out in order to simulate intraabdominal sepsis seen in humans and to test different antimicrobial agents in treatment and prophylaxis of intraabdominal infections . This experimental model was used to evaluate the efficacy of benzylpenicillin, benzylpenicillin plus sulbactam, cefoxitin, thienamycin, clindamycin, tinidazole, netilmicin, clindamycin plus netilmicin, and tinidazole plus netilmicin in the treatment of intraabdominal sepsis . Sixty-five per cent of the untreated animals died within two days . Within four days, 43% of the animals receiving clindamycin alone, 22% receiving tinidazole alone and 46% receiving netilmicin alone died . Animals treated with piperacillin, clindamycin plus netilmicin or tinidazole plus netilmicin showed a significantly decreased mortality and increased cure rates during the experimental period . Sixty-five per cent of the untreated animals and the animals given sulbactam alone died within 48 h . Over 90% of the animals given benzylpenicillin died within five days . Animals treated with benzylpenicillin plus sulbactam, cefoxitin or thienamycin had a significantly decreased mortality . Within four days 22% of the animals receiving tinidazole alone, 43% receiving clindamycin alone and 46% receiving netilmicin alone died . Animals treated with tinidazole plus netilmicin or clindamycin plus netilmicin had a significantly decreased mortality and increased cure rates during the experimental period . Only 5% of these animals died . In the prophylaxis experiment the following agents were tested: cefoxitin, doxycycline, tinidazole plus netilmicin, clindamycin plus netilmicin, and trimethoprim-sulfa plus tinidazole . One dosage of the antimicrobial(s) reduced the mortality rate significantly.(ABSTRACT TRUNCATED AT 250 WORDS)

Arch Oral Biol, 1984, 29(6), 445 - 51
The protective effect of peroxidase and thiocyanate against hydrogen peroxide toxicity assessed by the uptake of {3H}-thymidine by human gingival fibroblasts cultured in vitro; Tenovuo J et al.; The hypothiocyanite ion (OSCN-) is the principal oxidation product of the salivary peroxidase-thiocyanate (SCN-)-hydrogen peroxide antimicrobial system . Supplementation of human saliva in vitro and in vivo with low amounts (less than 1.0 mM) of hydrogen peroxide increase the concentration of salivary OSCN- (in vivo up to 0.3 mM) . Elevated concentrations of OSCN- are strongly antimicrobial and may therefore be protective against dental caries . However, as OSCN- is a highly-reactive oxidizing agent, its possible toxic effect on human cells was studied using gingival fibroblasts as target cells . Concentrations of OSCN- (up to 300 microM) had no effect on {3H}-thymidine incorporation into the cells . However, fibroblasts were sensitive to peroxide so that 100 microM of H2O2 caused over 80 per cent reduction in {3H}-thymidine incorporation . The toxicity of H2O2 could be entirely prevented by adding lactoperoxidase and SCN- to the cell culture before the addition of peroxide . Thus, conversion of toxic H2O2 to non-toxic OSCN- in fibroblast culture by lactoperoxidase and SCN- suggests a dual role for the salivary peroxidase system: protection of human cells from H2O2 toxicity and antimicrobial action against oral pathogens . Furthermore, the elevated concentrations of OSCN- which produce inhibition of bacterial metabolism did not damage human cells.

Scand J Gastroenterol Suppl, 1984, 90, 71 - 5
Management of surgical infections; Kosmidis J; Results of treatment of 151 surgical infections with a variety of antimicrobial regimes were retrospectively compared . Diagnoses included diffuse peritonitis (43), severe soft tissue infections (11), septicaemia accompanying abdominal infections (29), intra-abdominal abscesses (36), local peritonitis (27) and other localized infections (5) . A total of 211 anaerobic and 130 aerobic strains were isolated . A cure rate of 92% was achieved with metronidazole or ornidazole used alone and 89% with these nitroimidazoles plus an aminoglycoside . Results were equally satisfactory regardless of whether a surgical procedure, such as drainage was performed . Clindamycin and the aminoglycosides had satisfactory results in combination, but not when used alone . Good controlled trials are now justified to define the need for an aminoglycoside and/or surgery in addition to a nitroimidazole.

Scand J Gastroenterol Suppl, 1984, 90, 15 - 9
Efficacy of metronidazole and fosfomycin alone and in combination in the treatment of experimentally induced intra-abdominal infections; Nord CE et al.; A reproducible experimental model of intra-abdominal infection in rats has been worked out in order to simulate intra-abdominal sepsis seen in humans and to test different antimicrobials in the treatment of intra-abdominal infections . This experimental model was used to evaluate the efficacy of metronidazole and fosfomycin alone and in combination in the treatment of intra-abdominal sepsis . Seventy per cent of the untreated animals died within two days . Within seven days, 33% of the animals receiving metronidazole alone, and 40% receiving fosfomycin alone died . Animals treated with metronidazole plus fosfomycin showed a significantly decreased mortality and increased cure rates during the experimental period.

J Dent Res, 1984 Jan, 63(1), 32 - 6
An incisor plaque model in rats; Schemehorn BR et al.; An in vivo model for studying plaque accumulation in rats has been described . This model investigates plaque formation on the mandibular incisors in animals which have been found to be rapid plaque-formers during a pre-test period . The accessibility of these tooth surfaces permits the removal of plaque prior to initiation of tests, the use of test groups balanced on the basis of plaque-forming potential, and interim assessments of plaque formation throughout the test period . In addition, baseline plaque scores of near zero can be attained, thereby permitting investigations of the impact of experimental measures on plaque formation . Moreover, the model permits intermittent plaque assessments throughout the test period . This model was found to have adequate sensitivity to distinguish effects between antimicrobial agents known to differ in their clinical activity and to detect differences between varying concentrations of the same agent.

Ciba Found Symp, 1984, 102, 100 - 18
Phytoalexins and disease resistance mechanisms from a perspective of evolution and adaptation; Kuc J; Plants respond to cellular injury and infection by accumulating low molecular weight antimicrobial stress metabolites called phytoalexins . The accumulation of phytoalexins, together with lignification, suberization, callose formation and the production of agglutinins and inhibitors of extracellular microbial hydrolases, appears to be part of a multi-component response mechanism associated with disease resistance and wound repair . Compared to the antibody-antigen response in animals, the phytoalexin response in plants has low specificity for induction and activity of the phytoalexins . Plants also contain preformed antimicrobial chemical and physical barriers to infection in their external tissues . The successful pathogen has evolved to cope with preformed inhibitors and barriers and either avoids eliciting the response mechanism, or suppresses the mechanism, or detoxifies its antimicrobial components . Annual plants can be systemically immunized against diseases caused by viruses, bacteria and fungi by limited infection with any one of the respective organisms . As with animals, disease resistance in plants depends on the rate and magnitude of response rather than on the ability to respond . The genetic information for disease resistance is found in all organisms, and disease resistance is the rule in nature . The interactions of plants with microorganisms in their environment are nature's example of diplomacy--compromise, adjustment to change and avoidance of deadly conflict.

J Clin Apheresis, 1984, 2(1), 98 - 104
Putative methods for prevention and treatment of neonatal septicemia; Christensen RD; The high mortality rate observed in newborn infants who contract bacterial sepsis within the first day of life has prompted investigators to seek new methods for the prevention and treatment of this disorder . Among the putative measures recommended for prevention are: administration of antimicrobials to all infants at the time of delivery, identification and treatment of pregnant women colonized with those bacteria known to be major neonatal pathogens and immunization of women to major neonatal pathogens . Three other measures, targeted at diminishing the mortality and morbidity in those in whom preventive measures fail, include: granulocyte transfusion, exchange transfusion and administration of antibody.

Magn Reson Imaging, 1984, 2(1), 53 - 6
Nuclear magnetic resonance (NMR) imaging in the diagnosis of spinal osteomyelitis; Smith FW et al.; Nuclear Magnetic Resonance Imaging (NMR) was performed on two patients whose clinical radiograph and bone scanning suggested spinal osteomyelitis before and after successful antimicrobial therapy . The images obtained suggest that NMR may be more useful in the diagnosis of this condition than other conventional imaging techniques . Hitherto NMR has not been considered particularly useful for the diagnosis of bone disease . This may be true for cortical bone, from which no signal is obtained using the NMR technique, but for medullary bone it appears to be a potentially useful, non-invasive and safe method of diagnosis.

Scand J Infect Dis, 1984, 16(4), 369 - 72
The effect of a therapeutic doxycycline concentration on polymorphonuclear leukocyte migration in vitro; Back O et al.; Tetracyclines, and especially doxycycline, have been reported to inhibit polymorphonuclear leukocyte (PMN) migration . The effect of a therapeutic doxycycline concentration (4.33 micrograms/ml) on PMN migration in vitro was tested with the leading-front technique . No significant effect could be demonstrated on PMN chemokinesis and chemotaxis . It is thus concluded that the effect of therapeutic doxycycline concentrations on PMN migration is negligible . This conclusion has a bearing upon the choice of antimicrobial therapy.

J Med Primatol, 1984, 13(2), 105 - 16
Utilization of chlorhexidine gluconate to evaluate a nonhuman primate skin-degerming model; Deuel DM et al.; We have developed a nonhuman skin-degerming model to predict the in vivo effectiveness of topical antimicrobial formulations . The model incorporates a balanced, randomized, complete block design and uses the hands of anesthetized cynomolgus monkeys as treatment sites to measure product effectiveness . Two different 4% chlorhexidine gluconate formulations were evaluated in the primate model and then retested in a human skin-degerming model of identical design . Statistical analysis of the data revealed no significant differences between the two models with regard to the response exhibited by each to the test formulations.

Immunol Lett, 1984, 8(4), 215 - 7
Enhancement of base hexose-monophosphate shunt activity of human polymorphonuclear leucocytes by human beta-interferon; Ferrante A et al.; The effect of human fibroblast interferon (HuIFN-beta) on the HMP shunt activity of human polymorphonuclear leucocytes (PMNLs) was examined . HuIFN-beta caused an increase in the base level of the HMP shunt activity . No significant increase was observed in the same PMNLs stimulated with opsonized zymosan . The augmentation of this property, generally associated with antimicrobial and cytotoxic properties of the PMNLs, may be of potential importance in host defences against microbial and malignant diseases.

Eur J Clin Pharmacol, 1984, 27(2), 237 - 41
Drug utilization in paediatrics: non-medical factors affecting decision making by prescribers; Stanulovic M et al.; The study was done to show that in certain areas of paediatric pharmacotherapy unexpected discrepancies may arise between accepted therapeutic principles and the actual behaviour of a prescribing doctor . The first example was of a great reduction in penicillin use in a university teaching hospital after certain therapeutic accidents: in one year, there were 2 fatal cases of rhabdomyolysis due to use of procaine benzyl-penicillin . Other antimicrobial drugs inferior to penicillin, such as lincomycin and sulphonamides, replaced penicillins . The second example showed the inverse relationship between the use of antitussives and other drugs in symptomatic treatment of respiratory diseases in outpatients and inpatients; the pressure of unduly optimistic expectations of therapy imposes a high prescribing rate of these drugs in the outpatient population, in contrast to hospitalized patients, whose doctors, being spared such pressure, prescribe antitussives far less often . The third example demonstrates the possibility of inadequate education in the use of antimicrobial drugs . Although doctors from regional hospitals receive their training at an university hospital, they tend to prescribe chloramphenicol ten times more per bed-day than their colleagues in an university hospital . In terms of the cost/effectiveness ratio, a high prescribing rate of cephalosporins is not economically favourable in a university teaching hospital . It is also shown that studies of drug utilization in children are feasible if age--appropriate adaptation of the statistical value expressed as the defined daily dose is performed . The adaptation was evaluated by comparing pharmacy-based drug consumption data expressed in "paediatric defined daily doses", with actual days of treatment with particular drugs, i.e . data from patient records for 244 beds in the University Teaching Hospital.

Scand J Infect Dis, 1984, 16(3), 323 - 4
Persistence of pneumococcal antigens in sputum after treatment of pneumonia; Telenti A et al.; Persistence of pneumococcal capsular antigens (PCA) in sputum was studied by counterimmunoelectrophoresis (CIE) in 36 cases of pneumococcal pneumonia . Antigens were still detected 24 and 48 h after start of antimicrobial treatment, in 92% and 76% respectively of the patients with lobar or multilobar infiltrates . Persistence of PCA was associated with radiologic extension of lung infiltrate . CIE appears to be a valuable diagnostic tool for pneumococcal pneumonia, when treatment has been instituted before admission to the hospital.

Gerontology, 1984, 30(5), 275 - 8
Aging and infectious diseases: state of the art; Yoshikawa TT; Infectious diseases are major causes for morbidity and mortality in the elderly population . A variety of factors contribute to the elderly person's increased susceptibility to infection . Diagnosis of infections in the old individual is often difficult, and antimicrobial strategies may have to be altered in this patient population . Newer and innovative strategies in management are needed in the field of aging and infections.

Folia Microbiol (Praha), 1984, 29(4), 348 - 52
A comparative study of raw garlic extract and tetracycline on caecal microflora and serum proteins of albino rats; Shashikanth KN et al.; Studies conducted on the comparative action of raw garlic extract and tetracycline hydrochloride on equal concentrations showed the raw garlic extract to be a more potent antimicrobial agent than tetracycline . The reversion to normalcy of caecal microflora and serum proteins after the withdrawal of test materials indicated an inverse relation between intestinal microflora and serum globulins.

Epilepsia, 1984, 25 Suppl 2, S118 - 31
Interactions between anticonvulsants and other commonly prescribed drugs; Kutt H; Many drug interactions can be demonstrated, but only a few are so clinically significant that they necessitate adjusting drug dosages . The same drug combination may produce changes of variable extent or direction in different individuals . The reasons for this variability include genetic control of the rate and inducibility of drug metabolism, and environmental factors such as contact with chemicals . Among antimicrobial agents, chloramphenicol may cause accumulation of phenytoin (PHT) and phenobarbital (PB), and isoniazid may cause PHT, carbamazepine (CBZ), and primidone (PRM) to accumulate . Erythromycin may cause accumulation of CBZ . Among anti-ulcer agents, antacids may reduce PHT concentration while cimetidine may cause accumulation of PHT, CBZ, and diazepam (DZP) . Salicylates displace strongly binding drugs such as PHT, DZP, or valproate (VPA) from the binding sites in plasma proteins, which may lead to some decline of the total plasma level with an increase in the unbound drug percentage . Conversely, anticonvulsants may influence the dosage requirements of oral anticoagulants by inducing their metabolism . Failures of oral contraceptives have been attributed to anticonvulsants in some patients . Probably the most predictable interaction that necessitates dosage adjustment is accumulation of PB caused by VPA . Intentional inhibition of PRM metabolism by nicotinamide serves as an example of attempts to utilize an interaction for improved therapeutic effect.

Am J Pediatr Hematol Oncol, 1984 Winter, 6(4), 449 - 54
Dr . James A . Wolff . II . First successful chemotherapy of acute leukemia; Pochedly C; Until the late 1940s, no therapy was available for leukemia other than blood transfusion and a few antimicrobial agents . The disease ran its course uninfluenced by this treatment; most children died in a matter of a few months . The success of nitrogen mustard in the treatment of lymphomas and chronic leukemias encouraged efforts to try various drugs in the treatment of acute leukemia . In 1948, Farber and colleagues at the Boston Children's Hospital reported that aminopterin produced complete remissions in about one-third of children with acute leukemia . The dramatic success of this trial proved to be a monumental step forward for the field of cancer chemotherapy . Dr . Wolff was a pediatric resident and hematology fellow at the Boston Children's Hospital during the time that this important study was done . His first-hand experience gives valuable historical insight into how this giant step in cancer therapy research was accomplished.

Med Cutan Ibero Lat Am, 1984, 12(6), 461 - 7
{Non-gonococcal urethritis caused by Chlamydia trachomatis: factors affecting its incidence}; Garcia De Lomas J et al.; A retrospective study to investigate the relationship between the isolation of Chlamydia trachomatis and other factors occurring in 146 patients suffering of non-gonococcal urethritis, has been released 39 being positive for C . trachomatis . The relationship between the isolation of C . trachomatis and previous antibiotic treatment, age, sexual different contacts in the last month and year has been studied . The main feature affecting the isolation is the absence of antimicrobial therapy a previously to the specimen collection and being performed after four days post-contact.

Physiol Chem Phys Med NMR, 1984, 16(3), 175 - 95
Free radicals and disease in man; Proctor PH et al.; Free radicals and related activated electronic species are produced in biological systems in antimicrobial defense, through the action of the mixed function monooxygenases, by various oxidative enzymes such as xanthine oxidase, and by autooxidations mediated by such agents as heavy metals or quinones . While the evidence is circumstantial, excessive unconfined or inappropriate production of radical species in inflammation, the metabolism of exogenous chemicals, or through autooxidation probably plays a significant role in human disease.

Surv Synth Pathol Res, 1984, 3(3), 201 - 18
The distribution and function of peroxidases in the respiratory tract; Christensen TG; Heme-containing peroxidases have been demonstrated both biochemically and cytochemically in a variety of cells that either reside in the respiratory tract or circulate through it via the vasculature . The peroxidases in neutrophils and eosinophils have long been known to function in lung defense through their participation in an antimicrobial system involving hydrogen peroxide and chloride ions . Recent studies indicate that this system is also toxic to tumor cells and, as such, it may have a protective or mitigative effect on tumor formation in the lung . Eosinophil peroxidase may be involved in immediate hypersensitivity reactions in the lung because of its secretory effect on mast cells . Platelets contain peroxidases, but how they function is unknown . Whether peroxidase occurs in lymphocytes is controversial, but until more compelling evidence is presented they should be considered peroxidase-negative . A number of cells indigenous to the respiratory tract contain peroxidase activity, but there is considerable variability among species as to its presence and amount . When careful consideration is given to fixation and incubation conditions, peroxidase can be demonstrated cytochemically in the nuclear envelope and endoplasmic reticulum of some endothelial cells and type II cells of certain rodents, but its physiological role is speculative . The alveolar macrophages of most species possess little or no peroxidase activity apart from catalase which can function as a peroxidase under certain conditions . Mast cells in the respiratory tract contain peroxidase, but it is more easily demonstrated biochemically than cytochemically . The function of mast cell peroxidase is unknown, but two hypotheses worthy of investigation are its possible role in modulation of atopic allergic reactions and involvement in an antitumor defense mechanism similar to that of myeloperoxidase . Peroxidase is most abundant in the secretory cells of the tracheobronchial epithelium and glands where, in a number of species, it is synthesized and secreted as a component of mucus . Its possible contribution to lung defense is discussed in view of its morphologic similarity to the antibacterial peroxidase of milk and saliva . Because of the ease with which peroxidases can be demonstrated cytochemically, it is not surprising that morphologic information regarding their distribution in the respiratory tract has greatly exceeded insights into their functional significance . It is hoped that advancements in cell dissociation and culture, along with biochemical isolation and purification techniques, will lead to definitive conclusions concerning their physiologic roles in lung metabolism and defense.

Int J Clin Pharmacol Res, 1984, 4(3), 201 - 7
Clinical multicentre trial with josamycin propionate in paediatric patients; Privitera G et al.; Josamycin propionate, a tasteless josamycin derivative suitable for the preparation of paediatric oral suspension, was employed in a large, multicentre clinical study aimed at evaluating the effectiveness and safety of the drug . Two hundred paediatric practitioners participated in the study, and 1908 children (mean age 5.27 years) were treated . Respiratory and pararespiratory infections were the most common diagnosis . The mean daily dose of josamycin was 53.5 mg/kg and the drug was administered for an average of 7.31 days . Josamycin proved to be a highly effective antimicrobial agent for the treatment of infections occurring in paediatric practice, with a success rate of 97.1% . The drug also showed a high degree of acceptance by the young patients and was very well tolerated: only 98 children (5.14%) developed side-effects during the treatment . However, the side-effects observed were reliably attributable to josamycin in only 10 out of 300 subjects who were not receiving other drugs; among these the frequency rate was 3.33%.

J Int Med Res, 1984, 12(4), 266 - 70
Celestone phosphate injection high dose: treatment of septic shock and impending transplant rejection; Carreno CA; Celestone Phosphate Injection was administered as an intravenous bolus to twenty patients, eighteen with septic shock and two with impending acute renal transplant rejection . Within 4 hours following the diagnosis of septic shock, adjunctive corticosteroid therapy in a dosage ranging from 2.88-3.11 mg/kg was given every 4 hours . The two patients with impending acute renal transplant rejection were dosed every 24 hours . Intravenous fluids, ventilatory assistance, antimicrobial agents, vasoactive agents, diuretics, digitalis and antipyretics were among the concomitant therapies . Among measurements monitored during the study, vital signs, arterial blood gases, central venous pressure, complete blood count, blood chemistry, electrocardiograms and chest radiographs indicated improvement in each patient's condition by the end of therapy . Rapid clinical improvement occurred within 4-8 hours for patients with septic shock and within 48 hours for patients with kidney transplants . Two to three doses of medication were required . Complete reversal of shock was achieved in eighteen (100%) patients with septic shock; both (100%) renal transplant patients experienced reversal of impending rejection . Tolerance was good and no adverse experiences were reported.

Contemp Top Immunobiol, 1984, 14, 283 - 343
Nonoxidative antimicrobial reactions of leukocytes; Spitznagel JK; Increasingly abundant evidence supports the hypothesis that PMNs and perhaps alveolar macrophages have antimicrobial mechanisms independent of the presences of molecular oxygen for effective action against an array of bacteria and against some fungi . Eosinophils have mechanisms toxic for schistosomula and Trichinella larvae . In all instances the antimicrobial substances isolated have been cationic proteins and, in PMNs, associated with the azurophil cytoplasmic granules of the PMNs . Several of these substances have thus far demonstrated no enzymic function . Two of these substances are serine proteases but in one, chymotrypsin-like protein, the antimicrobial action depends on the cationic properties of the protein and is independent of the proteolytic action of the substance . In most instances, these proteins are cationic due to relatively large proportions of arginine . In two instances, a large proportion of lysine is present . All have high proportions (about 50%) of hydrophobic amino acid . Such proteins occur in the PMNs of man, rabbit, guinea pig, rat, cow, and chicken . The present view is that they are most active against gram-negative bacteria . At least two of them-37-kd and 57-kd proteins (Shafer and Spitznagel, 1983)-act on S . typhimurium in a manner analogous to that of polymyxin B through binding to lipid A . Currently available results shows that anaerobic PMNs have substantial antimicrobial capacity . Whether this capacity is due to the O2-independent mechanisms discussed in this chapter remains to be established with greater certainty.

J Toxicol Environ Health, 1984, 13(2-3), 471 - 8
Similarities of host defense mechanisms against pulmonary infectious diseases in animals and man; Green GM; Evidence linking exposure to air pollutants with increased susceptibility to infectious diseases in humans comes from epidemiological, clinical, and experimental laboratory studies . The data suggest that the most common, and perhaps the most sensitive, index of the pulmonary effect of air pollutant exposure is on post upper respiratory infection, prolonged cough, phlegm, and purulent sputum . Experimental models of these relationships for extrapolation to humans should be able to measure such minor changes in symptomatology and physiology rather than require major lethal events . The bacterial aerosol model for quantifying nonspecific defense mechanisms of the bronchopulmonary tree utilizing nonpathogenic organisms fulfills this criterion . The function of the six major components of pulmonary antimicrobial defense mechanisms--including aerodynamic filtration, secretory respiratory tract fluid, fluid transport at the alveolar and bronchial levels, the phagocytic function of alveolar macrophages, the augmenting mechanisms of blood-derived inflammatory cells, and the secretory and cellular-specific immune mechanisms and their mediator products--can all be quantified by this experimental animal model system . The defensive functions are remarkably similar across animal species, and available human data suggest that findings obtained using the model may be extrapolated to humans.

Rev Infect Dis, 1984 Jan-Feb, 6(1), 96 - 106
Oral candidiasis: pathogenesis and host defense; Epstein JB et al.; Oral candidiasis is a common problem, frequently presenting as a chronic recurring infection . Oral infection is a potential reservoir of organisms for severe, spreading, local disease and systemic disease in the compromised host . Nonspecific local oral factors in host defense include the epithelial barrier, flow or saliva, microbial interactions, antimicrobial constituents of saliva, lysozyme, lactoferrin, the lactoperoxidase system, levels of iron, and salivary glycoproteins . Immunoglobins are present in saliva, but their role is poorly understood . The activity of antibody against Candida on oral mucosal surfaces may not be mediated by complement and phagocyte activity . Specific antibodies against Candida may function by aggregating the organisms and preventing mucosal adherence of the fungi.

Appl Environ Microbiol, 1984 Jan, 47(1), 88 - 93
Adsorption of Escherichia coli onto insolubilized lauryl pyridinium iodide and its bacteriostatic action; Nakagawa Y et al.; Insoluble lauryl pyridinium iodide {C12(50)} was synthesized as an antimicrobial agent . Escherichia coli cells were not killed by C12(50) but only adsorbed onto it . Though cells on C12(50) could not grow in nutrient agar, they possessed the ability to develop once they were liberated from C12(50) . The adsorption of cells onto C12(50) was inhibited by iodide anions released from C12(50) itself . The ability of C12(50) to adsorb was decreased by the adsorbed cells, but C12(50) could be reactivated by washing with alkaline solutions . It was, therefore, suggested that this adsorption was mainly due to the electrostatic interaction between cells and C12(50) . The adsorption of cells onto C12(50) was confirmed by scanning electron microscopy.

Surg Gynecol Obstet, 1984 Jan, 158(1), 1 - 8
A comparative study of cefamandole versus gentamicin plus clindamycin in the treatment of documented or suspected bacterial peritonitis; Busuttil RW et al.; Our data support the premise that antimicrobial therapy for peritonitis must be individualized . In the patient with minimal and moderate contamination who is not suppressed and who will undergo prompt and correct surgical therapy, then a single antimicrobial agent, such as cefamandole or perhaps even a first generation cephalosporin, such as cefazolin, will be adequate therapy even in instances of polymicrobial peritonitis when anticipated resistant organisms are present . In this situation, a single drug will be just as effective and safer when compared with the combination of an aminoglycoside and a specific antianaerobic agent . On the other hand, in the patient with immunosuppression, who is late to come to treatment or who has hospital acquired sepsis with probably a large contamination of resistant organisms, either a third generation cephalosporin with extended coverage or triple drug therapy, including a broad spectrum penicillin, an aminoglycoside and an anaerobic effective agent, should be the treatment of choice . Also, for infections with a culture proved overwhelming anaerobic flora, an antimicrobial specific for these pathogens should be used . The dictum, however, that all instances of peritonitis mandate double or triple drug therapy is a clinical impression based upon experimental models which do not correctly simulate the clinical situation.

Laryngoscope, 1984 Jan, 94(1), 46 - 51
Antimicrobial prophylaxis for contaminated head and neck surgery; Johnson JT et al.; The use of antibiotic prophylaxis in head and neck surgery is controversial . Most surgeons agree that when surgery requires entry into the aerodigestive tract through the skin the wound is by definition contaminated and antibiotic prophylaxis is indicated as it is in other contaminated wounds . There is no general agreement as to which antibiotic or combination of antibiotics to use or what the schedule of dosage administration should be . In order to obtain a meaningful data to help in decision making, a double blind, randomized study was performed to investigate whether cefazolin alone or a combination of gentamicin and clindamycin was more effective in prophylaxis . All patients entered into the study underwent major oncologic head and neck surgery requiring entry into the upper aerodigestive tract through the skin . Patients were stratified at entry according to the stage of disease, surgical procedure, and the existence of a prior tracheotomy or prior radiation therapy . Subsequently, patients were randomly assigned to 1 of 4 treatment groups . Group I: Cefazolin 1 day, placebo day 2 to 5 . Group II: Cefazolin days 1 to 5, Group III: Gentamicin and clindamycin 1 day, placebo days 2 to 5 . Group IV: Gentamicin and clindamycin days 1 to 5 . Drugs were given intravenously beginning 3 hours preoperatively and continued postoperatively every 8 hours, according to the assigned schedule . All wounds were observed daily following surgery and were graded on a predetermined scale by 3 unbiased observers . Significantly wound infections occurred in 15% of all patients . Group I, 33%; Group II, 20%; Group III, 7%; Group IV, 4% . In Group III and Group IV there was a statistically significant (P less than .05) reduction in the rate of postoperative wound infection . Multifactorial analysis demonstrated that patients whose surgery included repair with a regional pectoral flap had a statistically significant increased chance of developing postoperative wound infection (P less than .05) . Patients undergoing laryngectomy, with or without neck dissection, were at less risk of postoperative infection tham patients undergoing oropharyngeal resection (P less than .05) . The preoperative existence of tracheotomy or prior radiation therapy had no demonstrable effect on the incidence of wound infection postoperatively in this study.

Acta Otolaryngol Suppl, 1984, 407, 14 - 22
Interaction of microbial agents with the immune system during infectious disease; Froland SS; Research during the last years has revealed a considerable complexity of the immune system . It is clear that immunological reactions depend on extensive and only partly clarified interactions between a number of different cell types (e.g . B lymphocytes, plasma cells, T cell subpopulations, cytotoxic K and NK cells, monocytic cells, neutrophilic and eosinophilic granulocytes) and their molecular products (e.g . immunoglobulins, lymphokines and interleukins) . These components further interact with the complement system, as well as with immunologically nonspecific components like acute phase proteins (e.g . C-reactive protein) and with other pathophysiological phenomena occurring during infections, e.g . the fever response . The application of these observations from basic and experimental immunology to the investigation of antimicrobial immune reactions is still only in its beginning, but has already resulted in new concepts of clinical value for the understanding of infectious diseases . The present paper briefly describes certain aspects of the immune response to infections with various microbial agents, with particular emphasis on reactions of clinical importance . In addition to B and T cell reactions, possible antimicrobial functions of K cells and NK cells are discussed, and the possible importance in infectious disease of various T cell subpopulations, particularly T suppressor cells, is discussed . Lastly, various escape mechanisms are mentioned whereby certain microbial agents may evade elimination by the immune response of the host.

Oral Surg Oral Med Oral Pathol, 1984 Jan, 57(1), 114 - 7
The asplenic patient: a consideration for antimicrobial prophylaxis; Terezhalmy GT et al.; Removal of the spleen predisposes the patient to the development of overwhelming sepsis without a primary site of infection . Transient, usually asymptomatic, bacteremias occur in a wide variety of dental manipulations, particularly those involving the mucous membranes . Occasionally these bacteremias can give rise to serious complications in susceptible patients . A prophylactic preoperative and postoperative antimicrobial regimen is presented for asplenic patients undergoing bacteremia-causing dental treatment.

J Int Med Res, 1984, 12(2), 128 - 31
The anti-inflammatory action of flurbiprofen suppositories in paediatric urology in comparison with co-trimoxazole; Bono AV et al.; Fifty male children, aged between 3 and 10 years, were treated for a 12-day period with either trimethoprim (80-160 mg) plus sulphamethoxazole (400-800 mg) daily (co-trimoxazole) or 50-125 mg/day flurbiprofen rectally . The patients had been treated surgically for criptorchidism . Flurbiprofen showed good effectivity in controlling post-operative inflammation in urology . It is concluded that antimicrobial agents such as cotrimoxazole, because of their potential risks of damage at the cell's level, should be used only in presence of a bacterial infection.

Bull Clin Neurosci, 1984, 49, 99 - 104
Nocardia brain stem abscess: diagnosis and response to medical therapy; Bertoldi RV et al.; A patient with a rapidly progressive brain stem syndrome is reported . CT scan showed a ring enhancing lesion in the pons and CSF examination showed elevated protein and pleocytosis . A pulmonary abscess containing Nocardia was found and antimicrobial therapy produced progressive reduction in size of the pontine lesion and clinical improvement without surgical drainage . This is the first documented diagnosis and survival of a medically treated patient with a brain stem abscess of presumed Nocardia etiology.

Clin Ther, 1984, 6(4), 488 - 99
Effect of frequency of administration on therapeutic efficacy of cefotaxime; Parker RH; Clinical trials with cefotaxime have demonstrated that this antibiotic is effective and safe in a wide range of dosage schedules . Because of uncertainty about the most appropriate dosage regimen, physicians may be inclined to prescribe cefotaxime in higher doses and greater frequencies of administration than are required or economical (eg, dosing every six hours for an infection caused by a highly susceptible microorganism) . To demonstrate that cefotaxime offers the physician great flexibility in dosing to achieve successful treatment with optimal cost-effectiveness, efficacy data from comparative and noncomparative studies in the United States were analyzed . Cases reviewed were those in which both the initial and final dosage regimens corresponded to one of several predetermined dosing schedules . These schedules included doses of 0.5 to 2.0 gm administered from two to six times a day . Patients were categorized according to severity of infection, and clinical and bacteriological responses were summarized according to frequency of administration . The analysis yielded 2,096 clinically evaluable cases and 1,755 bacteriologically evaluable cases . Uniformly good clinical and bacteriological success rates were achieved in all dosage regimens, indicating that in many circumstances the most appropriate regimen is every eight hours or, for highly susceptible pathogens, every 12 hours . Giving cefotaxime every six hours or more often is justified only when high concentrations of antibiotic are needed at the site of infection . Prescribing cefotaxime in the most appropriate dosage regimen will have a significant impact on the cost-effectiveness of antimicrobial therapy.

Dev Biol Stand, 1984, 57, 117 - 23
Cellular immunity (T-cell subset using monoclonal antibody) in tuberculosis, melioidosis, pasteurellosis, penicilliosis; and role of levamisole and isoprinosine; Tanphaichitra D et al.; In vitro and in vivo evaluation of cellular immunity (T-cell subset--using monoclonal antibody--immunofluorescent staining technique; E-rosette formation to 2.4-Dinitrochlorobenzene reaction) were made in tuberculosis, melioidosis, pasteurellosis and penicilliosis . The data demonstrate depressed cellular immunity especially a significant decrease in numbers of T-helper cells and T-helper/T-suppressor subset ratio fell to less than 1.0 . Of greater importance, in tuberculous patients and patients with melioidosis treated with levamisole, 150 mg/day, twice a week, along with a specific antitubercular or antimicrobial agent for appropriate duration, improved faster both clinically, microbiologically and in cellular immunity.

Folia Haematol Int Mag Klin Morphol Blutforsch, 1984, 111(6), 725 - 34
Investigations on the effect of antimicrobial drugs on platelet aggregation in vitro and ex vivo; Cronberg S et al.; The influence of ten betalactam antibiotics and ten other antibiotics on platelet aggregation induced by ADP or adrenaline was investigated in vitro . In concentrations of 900 mg/l most antimicrobial drugs exerted a moderate inhibition that was not seen in concentrations of 90 mg/l that better corresponded to therapeutic levels . The influence on the platelets of a single large intravenous dose was also tested using eight antimicrobial drugs, viz . benzylpenicillin, ampicillin, carbenicillin, piperacillin, cloxacillin, cefuroxime, cefotaxime and erythromycin . Each drug was given to five healthy volunteers but none caused any significant inhibition of platelet aggregation . The second wave of aggregation persisted after administration of the drugs and it was even seen after the administration of such a high dose as 10 g of carbenicillin.

Z Gesamte Inn Med, 1983 Dec 15, 38(24), 653 - 9
{Damage caused by antibiotics and chemotherapeutic agents}; Tauchnitz C et al.; Side effects of antibiotics are based on direct toxic effects, depending on dose and excretion function, on allergico-immunological reactions and on interactions with other pharmaca . Furthermore the falsification of laboratory parameters and the disturbance of the microecology are significant . World-wide clinical observations lasting for decades are the basis of the knowledge about frequent and infrequent side effects . As to the most frequently used remedies from the groups of the antibiotics, antimicrobial chemotherapeutics and systemic antimycotics, these side effects were described in detail.

J Antibiot (Tokyo), 1983 Dec, 36(12), 1644 - 50
Histidinomycin, a new antifungal antibiotic; Ishimaru K et al.; A new antifungal antibiotic named histidinomycin was isolated from the broth filtrate of a streptomycete, tentatively designated as isolate H 878-MY 1 . Histidinomycin was purified as the monohydrochloride and the molecular formula was proposed to be C22H30N8O11.HCl . The antibiotic gave histidine by acid hydrolysis . Histidinomycin showed rather narrow antimicrobial spectrum for only few genera of phytophathogenic fungi.

J Antibiot (Tokyo), 1983 Dec, 36(12), 1595 - 600
Novel antitumor agents CI-920, PD 113,270 and PD 113,271 . I . Taxonomy, fermentation and biological properties; Tunac JB et al.; CI-920 (PD 110,161) and two analogues (PD 113,270 and PD 113,271) are novel antitumor compounds produced by a new actinomycete characterized as Streptomyces pulveraceus subsp . fostreus ATCC 31906 . The antitumor compounds are predominantly produced during the stationary (idiophase) growth phase of the organism . CI-920 is active versus the murine P388 lymphocytic and L1210 lymphoid leukemia with T/C values of 246 and 207, respectively . This compound has no significant antimicrobial activity.

J Ethnopharmacol, 1983 Dec, 9(2-3), 167 - 223
The African Strychnos species and their alkaloids: a review; Ohiri FC et al.; A review of the phytochemistry of African Strychnos species and the biological activities of some species as well as of some individual alkaloids isolated from them is presented . Although pharmacological studies of 48 species showed that muscle-relaxant and/or convulsant properties were generally present, antimicrobial, cytotoxic and hypotensive properties among others have also been demonstrated by some of the species and/or alkaloids.

Pharmazie, 1983 Dec, 38(12), 858 - 9
Effect of some selected salts and non-ionic surfactants on the antimicrobial activity of nalidixic acid; Gadalla MA et al.; The effect of different concentrations of some selected salts, namely, sodium chloride, potassium chloride, ammonium chloride, monosodium dihydrogen phosphate, calcium chloride, dibasic sodium phosphate, sodium sulphate, aluminium chloride and sodium citrate on the antimicrobial activity of nalidixic acid was investigated . It was found that all the salts tested, except aluminium chloride and sodium citrate, exert no antimicrobial activity . The effect of 10% non-ionic surface active agents, namely, Myrj 51, 52, 59, Brij 35, 58, 98, Tween 20, 40, 60, and 80 on the antimicrobial activity of nalidixic acid was studied . The results indicated that the activity of nalidixic acid was decreased in the presence of these surfactants . Furthermore, the effect of different concentrations of sodium chloride on the antimicrobial activity of nalidixic acid-surfactants systems was reported.

Pharmazie, 1983 Dec, 38(12), 838 - 41
Uracil, 2,4-dichlorophenol and diphenylether derivatives with antimicrobial activity; Badawi A et al.; For possible antimicrobial activity, 5-chlorosulphonyl-chloride uracil, 6-chlorosulphonyl-2,4-dichlorophenol and 4,4'-dichlorosulphonyldiphenylether were condensed with amines, hydrazine hydrate, amino acids and amino acid esters.

Pharmazie, 1983 Dec, 38(12), 833 - 5
Synthesis and antimicrobial testing of certain oxadiazoline and triazole derivatives; Hassan E et al.; The synthesis of some novel oxadiazolines and triazoles is described . Cyclization of nicotinic acid hydrazones using acetic anhydride afforded 2-substituted 3-acetyl-5-(3-pyridyl)-1,3,4-oxadiazolines . Likewise, when potassium dithiocarbazate--prepared from nicotinic acid hydrazide--was reacted with hydrazine hydrate, cyclization and production of 4-amino-3-(3-pyridyl)-5-mercapto{4H}-1,2,4-triazole was achieved . Ten new azomethine derivatives were prepared through the condensation between the latter amine and different aromatic aldehydes . The novel compounds were subjected to preliminary antimicrobial testing and the data obtained are summarized.

J Clin Hosp Pharm, 1983 Dec, 8(4), 339 - 44
Analysis and microbiological stability of an isosorbide 50% mixture; Brown AF et al.; Isosorbide mixture containing 50% w/v isosorbide and 5% w/v sorbitol is used in the treatment of hydrocephalus . The G.L.C . analysis of the mixture is described and its antimicrobial properties investigated . Results for the determination of lead in the mixture are given and the significance of the levels discussed with relevance to the treatment of infants.

J Antibiot (Tokyo), 1983 Dec, 36(12), 1713 - 21
Chemical modification of tylosin: synthesis of amino derivatives at C-20 position of tylosin and demycarosyltylosin; Matsubara H et al.; Reductive aminations of the aldehyde group at C-20 position of tylosin and demycarosyltylosin (desmycosin) were carried out using primary and secondary amines in the presence of sodium cyanoborohydride . Some of these derivatives brought about higher antimicrobial and ribosome-binding activities, and the structure-activity relationship is discussed.

J Antibiot (Tokyo), 1983 Dec, 36(12), 1709 - 12
Ribosome-binding activities and antimicrobial activities of tylosin and its related compounds; Omura S et al.; Structure-activity relationships of tylosin and related compounds were evaluated in terms of their antimicrobial and ribosome-binding activities . Demycarosyl derivatives, demycarosyltylosin and 20-deoxydemycarosylrelomycin, were slightly weaker than tylosin and 20-deoxyrelomycin, respectively, both in antimicrobial activity and in affinity to ribosomes . The corresponding demycarosyl-demycinosyl derivatives had weaker antimicrobial activities despite their relatively high affinities to ribosomes . A 23-deoxy-demycarosyl-demycinosyl derivative, 20-oxo-5-O-mycaminosylprotylonolide, had a higher affinity to ribosomes than that of tylosin and was equivalent to tylosin in antimicrobial activity against Gram-positive bacteria . These results suggest that the mycinose moiety increases the ability of the molecule to enter bacterial cells . Among the derivatives tested, a 23-iodo derivative, 20-deoxy-23-iodo-5-O-mycarosyltylonolide, had the highest affinity for ribosomes as well as the highest antimicrobial activity.

Antimicrob Agents Chemother, 1983 Dec, 24(6), 905 - 8
In vitro susceptibilities of five Leptospira strains to 16 antimicrobial agents; Oie S et al.; The in vitro activities of 16 antibiotics against five serovar strains of the genus Leptospira were determined . Five of the antibiotics (ampicillin, cefmetazole, moxalactam, ceftizoxime, and cefotaxime) exhibited a lower minimal inhibitory concentration than did penicillin G . In tests for minimal bactericidal concentration, ceftizoxime and cefotaxime were found to be more effective than penicillin G, streptomycin, tetracycline, ampicillin, and cefmetazole.

Arch Dermatol, 1983 Dec, 119(12), 994 - 7
Primary granulomatous dermatitis caused by Rhodochrous . Evidence for a pathogenic role in humans; Chanda JJ et al.; Bacteria belonging to the Rhodochrous complex are of uncertain taxonomic status . Currently excluded from the genus Mycobacterium, these organisms are more closely allied to Nocardia . Organisms of the Rhodochrous complex have only rarely been implicated as human pathogens . An 81-year-old man had a plaquelike cutaneous granuloma from which Rhodochrous was both cultured and demonstrated in tissue section . A pathogenic role for Rhodochrous causing a primary cutaneous infection is suggested . Specific antimicrobial treatment with doxycycline hydrochloride was successful and there has been no recurrence of the infection after three years.

J Pediatr Surg, 1983 Dec, 18(6), 816 - 21
Open lung biopsy in the immunocompromised pediatric patient; Imoke E et al.; Rapidly progressive pulmonary distress occurs as a secondary complication in immunocompromised pediatric patients . These patients usually develop a pattern of diffuse alveolar and/or interstitial infiltrates on chest x-ray and pursue a rapidly downhill course despite intensive respiratory support with the use of multiple and varied antimicrobial regimens . These patients are subjected to diagnostic open lung biopsies to establish a diagnosis . The diagnostic value of open lung biopsy and its current impact on therapy is not clearly established . This retrospective study attempts to determine the impact of open lung biopsy on diagnosis and therapeutic outcome . Between November, 1974, and October, 1982, 40 diagnostic open lung biopsies were performed on immunocompromised patients with clinically progressive respiratory disease . Adequate follow-up for complete evaluation was possible in 34 of these patients . Most of these patients had hematologic malignancies and all were on chemotherapeutic drugs at time of open lung biopsy . Open lung biopsy was considered helpful, ie, resulted in a change in antimicrobial therapy or substantiated preoperative therapy, in 17 of our 34 patients (50%) . A "treatable" condition, amenable to antimicrobial therapy, was diagnosed in 16 of our patients (47%) . Pneumocystis carinii pneumonitis (PCP) was the most common diagnosis in 11 (69%) of our "treatable" patients . The remaining five "treatable" patients had sarcoidosis (1), histiocytosis X (1), bacterial pneumonitis (1) and fungal pneumonitis (2) . No diagnosis was achieved by open lung biopsy in ten (30%) of our patients . There were two complications attributable to open lung biopsy (6%), including one death . All PCP patients treated with trimethoprim sulfamethoxazole (T/S) survived.(ABSTRACT TRUNCATED AT 250 WORDS)

Med Hypotheses, 1983 Dec, 12(4), 341 - 57
Altered arachidonic acid synthesis and lipid peroxidation in diabetes mellitus: possible roles in leukocyte dysfunction and other cellular defects; Metz SA; Hyperglycemic diabetics are prone to unusual or especially severe infections; at the cellular level, diabetic polymorphonuclear leukocytes (PMNs) show defects in several antimicrobial functions . However, the basis for these defects is unknown, and they may not be fully ascribable to hyperglycemia, hypoinsulinemia or acidosis alone . Recently, it has been shown that several important PMN functions may be mediated (at least in part) by metabolites of arachidonic acid synthesized via the lipoxygenase pathway, especially arachidonate hydroperoxides and leukotriene (LT) B4 . We speculate that synthesis of these mediators may be deficient in severely hyperglycemic diabetics (fasting plasma glucose greater than 250-300 mg/dl) due to deficiencies of substrate (arachidonic acid) synthesis and release . Such defects might be expected since, in animal studies, severe insulin lack and glucagon excess inhibit the desaturation of precursor fatty acids to arachidonic acid . On the other hand, whereas low levels of lipid peroxides or their derivatives may be required in certain cells for normal function, excessive levels of such compounds also are detrimental to cellular function and could play a role as well in the complications of milder or partially treated diabetics who manifest high basal insulin levels . For example, cells which may be particularly sensitive to an excess of peroxides include islet beta cells, PMNs and possibly vascular endothelial cells (all of which appear to be deficient in glutathione peroxidase) . These observations suggest a role for accumulation of lipid peroxides in the impaired insulin secretion, defective PMN function and possibly endothelial death and increased vascular (retinal, endothelial, and renal) permeability of some milder diabetics . The available data are compatible with the speculation that in partially treated or lesser degrees of hyperglycemia, increased arachidonate synthesis and excessive lipid peroxidation may be present . Although it remains to be established that all of the results from experimentally-induced diabetics can be extrapolated to humans, these findings suggest that the cell damage attendant upon peroxide generation might be susceptible to prophylactic treatment with anti-oxidants such as alpha-tocopherol or ascorbic acid . In the more severe or later stages of hyperglycemia, a deficiency of lipoxygenase-derived products may supervene; dietary modifications designed to increase essential fatty acid availability might present a unique ancillary therapeutic approach at this stage of diabetes.

J Antimicrob Chemother, 1983 Dec, 12 Suppl D, 97 - 108
Pharmacokinetic and bacteriological correlations between antimicrobial therapy of experimental meningitis in rabbits and meningitis in humans: a review; McCracken GH Jr; Animal models of bacterial meningitis have been developed to study antimicrobial pharmacokinetics and efficacy for eliminating bacteria from cerebrospinal fluid (CSF) and to study pathophysiology . The correlation between observations in the rabbit model and in paediatric patients with meningitis was evaluated . When dosages of the beta-lactam or aminoglycosidic antibiotics which will produce serum concentrations approximating those in the human were given to rabbits, the degree of penetration of antibiotics into CSF and the bactericidal activity in CSF were comparable in rabbits and humans . Differing rates of elimination of Gram-negative enteric bacteria from rabbit CSF correlated directly with the bactericidal titres . However, in children with meningitis, this correlation was not found . Instead, it appeared that there was a critical level of bactericidal activity of 1:8 at which optimal killing of bacteria occurred . Increasing the bactericidal activity beyond that point did not accelerate elimination of bacteria from CSF . It is concluded that the rabbit model of bacterial meningitis is useful for predicting pharmacokinetics and activity of new antibiotics in CSF, but not for predicting differing degrees of effectiveness among antibiotics.

Aust Vet J, 1983 Dec, 60(12), 353 - 61
Plasma concentration and disposition of antimicrobial agents in the dog; English PB; Although there is sufficient information on the pharmacology and therapeutic application of the antimicrobial drugs to permit their effective use, they are still often misused in canine practice . This paper collates the data on drug dose rate/plasma concentration relationships observed in dogs after the administration of specific members of the major antimicrobial drug groups and on the possible impact of drug disposition (distribution and elimination) on therapeutic effect . Some information gleaned from studies in other animal species is added.

J Hosp Infect, 1983 Dec, 4(4), 391 - 8
Improvements in medicated tulle dressings; Thomas S et al.; The antibacterial activity of four new medicated tulle dressings was determined by a modified zone inhibition method . Six different test organisms were used and from the results of the investigation, it was concluded that although the dressings differed in their duration of action and the rate at which the medicaments were released from their individual formulations, they all possessed significant antimicrobial activity.

J Hosp Infect, 1983 Dec, 4(4), 383 - 90
Metronidazole prophylaxis in colorectal surgery: the need for additional aminoglycoside?
Hansell DT, Thomson GJ, Simpson CJ, Morran C, Smith DC, McNaught W, Gillespie G.
A randomized double-blind trial was conducted in two phases to compare the efficacy of prophylactic oral and intravenous administration of kanamycin and metronidazole in preventing wound infection and other complications in patients undergoing colorectal surgery, and also to assess the need for inclusion of an aminoglycoside in the prophylactic regimen . Adequate prophylaxis did not depend on the route of antimicrobial administration, but wound infection rates were increased following exclusion of kanamycin.

J Infect Dis, 1983 Dec, 148(6), 1090 - 5
Susceptibility testing of Entamoeba histolytica; Cedeno JR et al.; The growth of Entamoeba histolytica in microtiter plates in vitro in a variety of environments with reduced oxygen tensions is reported . With 3% O2, 3% CO2, and 94% N2, the parasite growth in microtiter plates was identical to that in screw-capped culture tubes, as measured by {3H}thymidine incorporation and by quantitative parasite counts . There were no significant differences between the drug concentrations necessary to inhibit parasite growth by 50% based on {3H}thymidine incorporation vs those defined by quantitative parasite counts for the 15 antimicrobial agents tested (including seven drugs used for the treatment of amebiasis) . This technique provides a reproducible method to quantitate the activity of potential antiamebic agents in vitro . The isotopic method should be of particular value in defining the metabolism of the parasite and effects of antimicrobial agents on it, whereas the morphologic method may be more valuable for workers with limited resources available to them.

Boll Ist Sieroter Milan, 1983 Nov 30, 62(5), 402 - 5
Susceptibility of Mycobacterium fortuitum to antibacterial agents as evaluated by disk diffusion and agar dilution methods; Orefici G et al.; The susceptibility of 34 strains of M . fortuitum to several antimicrobial agents was comparatively tested by the disk diffusion and the agar dilution methods . The results obtained by these two methods essentially showed that the microorganism was fully sensitive to amikacin and kanamycin and only partially sensitive to sisomicin and rifampicin . Streptomycin, erythromycin and cephotaxime were inactive . The disk diffusion method seems advisable as a rapid screening procedure for antibiotic susceptibility testing M . fortuitum.

JAMA, 1983 Nov 18, 250(19), 2641 - 5
Failure of beta-lactam antibiotics to eradicate Chlamydia trachomatis in the endometrium despite apparent clinical cure of acute salpingitis; Sweet RL et al.; Chlamydia trachomatis was isolated from 17 (24%) of 71 patients with acute salpingitis (AS) hospitalized for parenteral treatment . For patients with AS, antimicrobial therapy was started immediately on admission and before the availability of culture results . Notable clinical response was seen in 16 of 17 chlamydial-positive cases . Despite apparent clinical cure, posttreatment cultures from the endometrial cavity yielded C trachomatis from 12 of 13 patients treated solely with second- or third-generation cephalosporins as single-agent therapy . The finding of persistent chlamydial infection of the endometrium suggests that some patients treated for AS, despite apparent clinical response, maintain chlamydial infection of the endometrium that might cause relapse or chronic fallopian tube infection with tubal obstruction and infertility, or perhaps reflect a similar tubal persistence of Chlamydia . Treatment of AS should routinely include coverage for C trachomatis, as clinical response and findings may not reflect its presence or persistence.

Radioisotopes, 1983 Nov, 32(11), 539 - 45
{Radiolysis of acrinol in radio-sterilization of acrinol pharmaceuticals}; Kimura S et al.; Acrinol in dry solid state after gamma irradiation with 80 kGy (8 Mrad) undergoes 8% decomposition, with G(-M)=30, and in wet solid state (10% moisture content) undergoes 15% decomposition, with G(-M)=56, as shown by absorbed spectrometric measurement . From these results, it is estimated that the irradiation dose of 25 kGy (2.5 Mrad) prefered by many countries as sterilization dose will achieve the radiolysis rate of 2.8% or 4.7% for dry solid state or wet solid state acrinol, respectively . The stickiness power of plaster tape made of raw rubber and polyterpene resin don't decrease with irradiation dose of less than 40 kGy (4 Mrad) . Then, the radio-sterilization on the dose of 25 kGy (2.5 Mrad) may be applied to solid pharmaceuticals such as commercial rubber adhesive plaster with acrinol pad . Besides, acrinol in 0.1% aqueous solution after irradiation of 10 kGy (1 Mrad) at room temperature undergoes 20% decomposition, with G(-M)=0.5 . The radiolysis rate in this state is estimated 45% with the dose of 25 kGy (2.5 Mrad) . Then, the radio-sterilization with this dose must not be applied to liquid pharmaceuticals such as 0.1% acrinol aqueous solution . While, it was reported by Hosobuchi and Sato that the antimicrobial effect of irradiated acrinol to Staphlococcus aureus increased with irradiation dose . Then, it is expectable that some materials with antimicrobial activity are prodused by gamma irradiation.

Pharmazie, 1983 Nov, 38(11), 747 - 8
The antimicrobial activity of garlic and onion extracts; Elnima EI et al.; Aqueous extracts of garlic (Allium sativum) and onion (Allium cepa) were tested for activity against Gram-positive organisms, Gram-negative organisms and fungi . A significant growth inhibition was shown by most of the organisms, tested at random . A quantitative assessment of the activity was carried out by determining the minimum bacteriostatic and bactericidal concentrations of the extracts against Gram-positive and Gram-negative organisms . Garlic extract showed greater activity as compared to the extract of onion . The activity of the garlic extract on the mouth flora of volunteers was then investigated . A mouth wash containing 10% garlic in quarter Ringer solution produced a drastic reduction in the number of oral bacteria.

J Antibiot (Tokyo), 1983 Nov, 36(11), 1490 - 4
Chemical modification of ravidomycin and evaluation of biological activities of its derivatives; Rakhit S et al.; Several derivatives of the antitumor antibiotic ravidomycin were synthesized and their antitumor and antimicrobial activities and mode of action were evaluated . Deacylation produced a compound with higher biological activity than the parent . Structure-activity relationship of the derivatives is discussed.

J Pharm Sci, 1983 Nov, 72(11), 1363 - 5
Effect of nutrient depletion on the sensitivity of Pseudomonas cepacia to antimicrobial agents; Cozens RM et al.; Pseudomonas cepacia depleted of various nutrients showed marked variation in sensitivity to cetrimide, chlorhexidine, and benzalkonium chloride . In all cases cells depleted of magnesium were the most resistant . It is proposed that these observations may be due to alterations of the envelope of P . cepacia in response to changes in the growth environment . This may have profound implications for investigations of the resistance of this organism both in vivo and in vitro.

J Med Chem, 1983 Nov, 26(11), 1648 - 50
Synthesis and antibacterial activities of new (alpha-hydrazinobenzyl)cephalosporins; Balsamo A et al.; Some (alpha-hydrazinobenzyl)cephalosporins, I (R = Me, CH2OAc, Cl) and II (R = Me, CH2OAc), structurally related (formula; see text) to cephalexin, cephaloglycin, and cefaclor have been prepared and evaluated in vitro for their antimicrobial activity . The synthesis involves the condensation of the chloride hydrochloride III (R = H or Me) with the 7-aminocephem derivatives IV . The hydrazino compound I (R = Cl), an analogue of cefaclor, resulted in being the most active compound of the series.

Isr J Med Sci, 1983 Nov, 19(11), 1004 - 5
Antibacterial prophylaxis in chronic granulomatous disease . A case report; Mendelsohn HB et al.; The value of long-term prophylactic treatment of chronic granulomatous disease (CGD) in childhood cannot be established with certainty, as controlled studies are not available . We describe a boy, presently 15 years old, who suffered from CGD since early infancy . By the clinical, laboratory and genetic features, this case appeared to be a new variant of CGD, combining elements of the "childhood" type with others that characterize the "adult" type of the syndrome . For years, the patient had been almost continuously ill and needed frequent and prolonged hospitalizations because of severe bacterial infections . At age 13 years, long-term prophylactic treatment with trimethoprim-sulfamethoxazole (TMP-SMX) was instituted . With this regimen, the patient was maintained practically infection-free, relapsing only in those instances when he neglected to comply with the prophylactic regimen for 1 to 2 weeks . Thus, the patient served as his own control in demonstrating the efficacy of antimicrobial prophylaxis in CGD . The rationale for employing TMP-SMX for the prophylactic regimen is discussed.

Antimicrob Agents Chemother, 1983 Nov, 24(5), 667 - 73
Metabolism and metronidazole uptake in Trichomonas vaginalis isolates with different metronidazole susceptibilities; Muller M et al.; Three Trichomonas vaginalis isolates with low in vivo susceptibilities to metronidazole (95% curative dose, greater than 3 X 100 mg kg-1 in subcutaneous infections in mice) were compared with strain ATCC 30001 and with four isolates exhibiting high in vivo susceptibilities (95% curative dose, less than 3 X 15 mg kg-1) . Activity of pyruvate:ferredoxin oxidoreductase, anaerobic fermentation, and anaerobic intracellular accumulation of {14C}metronidazole label showed no significant isolate-dependent differences which could be correlated with drug susceptibility . The results suggest that processes providing electrons for metronidazole activation are not defective in the resistant strains . Aerobiosis, known to inhibit the antimicrobial action of metronidazole, inhibited accumulation of label more strongly in resistant isolates than in susceptible ones . No differences were detected, however, between resistant and susceptible isolates in respiration, aerobic fermentation, and the specific activity of NADH and NADPH oxidases, the main terminal oxidases of T . vaginalis . These findings suggest that the production of electrons is not diminished under aerobic conditions . The inhibitory effect of aerobic conditions on metronidazole activation, possibly due to competition for the electrons, is markedly enhanced in the resistant isolates compared to the susceptible ones . The mechanism of this effect, however, remains unknown.

JOGN Nurs, 1983 Nov-Dec, 12(6), 391 - 4
Care of the infant with sclerema neonatorum; Ferguson CK; High-risk infants are particularly prone to sepsis which can be accompanied by sclerema neonatorum . This condition is manifested by skin hardening . Causation of hardening of a sick infant's skin must be identified for appropriate treatment to be implemented . Nursing care of the infant with sclerema is very complex . Throughout the course of the disease, the infant frequently requires antimicrobial therapy, ventilatory support, exchange transfusions, precise intake and output measurements, and temperature control . Psychosocial support for the family and infant is also an important part of the nurse's role . In spite of standard therapy, the mortality rate for infants with sclerema remains high . New advances, such as exchange transfusions, give some hope for the survival of these very ill infants.

Am J Med Technol, 1983 Nov, 49(11), 761 - 7
Strategies for antimicrobial susceptibility testing of fastidious aerobic bacteria; Hindler J; There are several "non-standardized" test methodologies for performing antimicrobial susceptibility tests on clinical isolates of fastidious aerobic organisms . Critical to the interpretation of a susceptibility test (or any clinical laboratory test) is correlation of the results with the clinical status of the patient . If previous extensive studies have not been performed for a given antimicrobial-organism combination using a specific method, the results must be interpreted with discretion . Even when documented correlative data are available, strict quality control measures must be followed to ensure optimal performance of the test system . Ideally, these include testing of quality control organisms of known susceptibilities similar to the test isolate . Such quality control strains of fastidious organisms are not readily available; however, they may be obtained through local health departments . In our laboratory, in order to inform clinicians of the limitations of the results generated from antimicrobial susceptibility testing of fastidious aerobic bacteria using non-standardized (not NCCLS) procedures, we have adopted a mechanism for reporting results of disc tests as "presumptive" (Figure 1) . When reporting dilution test results that are derived using methods other than those described by the NCCLS dilution protocol, we indicate the modifications employed in the particular test (Figure 2) . Our goals are to attempt to identify unusual resistance that may occur and to generate results that are as accurate, precise, and meaningful as possible, yet we must be aware of the limitations of the procedures with which we are working (Table V) . It is only with these understandings that we can be of service to our clinicians and patients.

Med Hypotheses, 1983 Nov, 12(3), 227 - 37
Allium sativum (garlic)--a natural antibiotic; Adetumbi MA et al.; Allium sativum (garlic) has been recognized not only as a spice but also as a substance which exerts a control on microorganisms . Recent publications indicate that garlic extract has broad-spectrum antimicrobial activity against many genera of bacteria and fungi . The active component (allicin) has been isolated and characterized . Because many of the microorganisms susceptible to garlic extract are medically significant, garlic holds a promising position as a broad-spectrum therapeutic agent . Furthermore, garlic plants may also play an important role in the ecological control of pathogenic microorganisms in nature.

Am J Obstet Gynecol, 1983 Nov 1, 147(5), 520 - 8
Prevention of major infection after elective abdominal hysterectomy: individual determination required; Hemsell DL et al.; A retrospective chart analysis of women undergoing elective abdominal hysterectomy in Parkland Memorial Hospital indicated significant postoperative antibiotic administration . For that reason, we conducted a prospective, double-blind, placebo-controlled study to determine the incidence of infection and febrile morbidity in this patient population and to evaluate the efficacy of perioperative cefoxitin in modifying the incidence of these conditions . Three 2 gm intramuscular doses of cefoxitin over 12 hours significantly reduced the incidence of major infection to 12% from 32% observed in the placebo group . The mean hospital stay for women given cefoxitin (5.6 days) was also significantly reduced when compared to that for women given placebo (6.4 days) . The incidence of febrile morbidity not requiring therapy was significant and was not altered by perioperative cefoxitin . Febrile morbidity was observed in 42% of women given cefoxitin and in 34% of women given placebo . Administration of perioperative antimicrobial agents is necessary for women undergoing elective abdominal hysterectomy in our hospital, but we believe that individual determination is required.

Am J Kidney Dis, 1983 Nov, 3(3), 209 - 12
Stability of single and combination antimicrobial agents in various peritoneal dialysates in the presence of insulin and heparin; Sewell DL et al.; The antimicrobial activity of ampicillin, azlocillin, cefotaxime, cephapirin, clindamycin, mezlocillin, nafcillin, piperacillin, tobramycin, and vancomycin was tested in peritoneal dialysate at room temperature for 24 hours and 48 hours . All of the antimicrobial agents were active at 24 hours . The bioactivity of cefotaxime, nafcillin, and vancomycin declined 15% to 20% after 48 hours (P less than 0.001) . The addition of heparin or insulin did not affect the activity of any of the study drugs . The combination of cephapirin and tobramycin remained bioactive for 24 hours at room temperature and 35 degrees C . The preparation of drug-dialysate solution every one to two days is feasible for the treatment of peritonitis in patients on continuous ambulatory or continuous cycled peritoneal dialysis.

J Antimicrob Chemother, 1983 Nov, 12(5), 469 - 74
Susceptibility to mecillinam and other antibiotics and serogroups of enterotoxigenic Escherichia coli from children in Addis Ababa; Stintzing G et al.; The in-vitro susceptibility of 64 strains of enterotoxigenic Escherichia coli (ETEC) was determined for eight antimicrobial agents . The strains were of 27 different O-serogroups of which 078 was the most common . All strains were susceptible to mecillinam, cefoxitin, gentamicin, and trimethoprim-sulphamethoxazole . Two strains were resistant to ampicillin, 15 to doxycycline, 5 to cephalothin, and 13 to chloramphenicol . No difference was found in the antibiotic susceptibility of ETEC strains producing only heat-labile enterotoxin compared with those producing both heat-labile and heat-stable enterotoxin.

Rev Infect Dis, 1983 Nov-Dec, 5(6), 1033 - 48
Antimicrobial resistance in hospital organisms and its relation to antibiotic use; McGowan JE Jr; Organisms causing nosocomial infection are frequently resistant to antimicrobial agents . Studies of the reasons for this have been hindered by difficulties in defining terms, by selection biases, by artifacts produced by study methods, and by failure to control for confounding variables . Major factors leading to increased prevalence of resistant organisms in hospitals are changes in organisms causing nosocomial infection (due in part to changes in characteristics of hospital populations and in procedures and instruments used in patient care), increasing prevalence of resistance in bacteria causing community-acquired infection, and use of antimicrobial agents . A causal relationship between antibiotic usage and resistance of hospital organisms is supported by consistent association and concurrent variation in several populations, presence of a dose-response pattern, and existence of a reasonable biologic model to explain the relationship . Major influences on emergence of resistant hospital bacteria include antimicrobial effects in treated individuals, mechanisms for transfer of resistance between bacteria, and routes of transmission within the hospital for bacteria or their resistance factors . Barrier isolation techniques can help control resistant hospital bacteria . However, virtually all reports agree that careful, discriminating use of antimicrobial agents remains the keystone for minimizing this problem . This need must be communicated more effectively to prescribers.

J Immunol, 1983 Nov, 131(5), 2542 - 4
Gamma-interferon is the factor in lymphokine that activates human macrophages to inhibit intracellular Chlamydia psittaci replication; Rothermel CD et al.; We have demonstrated previously that mitogen-induced lymphokines activate human monocyte-derived macrophages to inhibit the intracellular replication of Chlamydia psittaci . To identify the factor(s) in crude lymphokines responsible for this antimicrobial effect, we tested human Con A-induced lymphokines for interferon activity . We also attempted to neutralize the lymphokines with a monoclonal antibody directed against human gamma-interferon and examined the ability of partially purified human gamma-interferon to induce macrophage antichlamydial activity . The lymphokine-induced antichlamydial effect was measured by the inhibition of chlamydial inclusion formation in Giemsa-stained macrophage cultures . Our lymphokines were found to be rich in gamma-interferon; treatment of cells for 48 hr before infection with lymphokines containing 300 U/ml of interferon resulted in an 89% inhibition of chlamydial growth . This lymphokine effect was completely abolished by monoclonal antibody against human gamma-interferon, but not by antisera against human alpha- or beta-interferons . In addition, partially purified human gamma-interferon alone induced macrophages to restrict chlamydial growth by 95% . We conclude that it is the gamma-interferon present in human Con A-induced lymphokines that activates monocyte-derived macrophages to inhibit chlamydial replication.

Am J Clin Pathol, 1983 Nov, 80(5), 706 - 10
Evaluation of the BACTEC resin blood-culture medium; Strand CL et al.; A study to determine the value of the BACTEC resin-containing medium, 16B, used in conjunction with radiometric detection of bacteremia using three media was conducted . During a six-month period, 2,104 blood-culture sets consisting of the four media (6B, 7C, 8B, and 16B) were collected . There were 158 significant positive cultures (excluding contaminants) that yielded 168 pathogenic isolates . The data were divided into two patient groups: patients receiving antibiotics and patients not receiving antibiotics . In contrast to previous studies, there was no significant difference in the detection rate of significant positive cultures by the different media in either group of patients . However, in patients receiving antimicrobial therapy, 41 of 55 significant positive cultures (74.5%) were detected by 16B medium, while 34 of 55 (61.8%) were detected by 6B medium . Although this difference is not statistically significant, this trend suggests that 16B medium may be useful in these patients . However, the isolation rate of significant positive cultures is the same for the resin medium and the hypertonic aerobic medium for both groups of patients . Thus, it is possible that the hypertonic medium is as efficacious as resin-containing media in blood culturing.

Am J Vet Res, 1983 Nov, 44(11), 2155 - 9
Effect of antimicrobial agents and corticosteroids on bovine polymorphonuclear leukocyte chemotaxis; Jayappa HG et al.; The effect of certain antimicrobial agents and corticosteroids on bovine polymorphonuclear leukocyte chemotaxis was investigated . Peripheral blood was fractioned by density-gradient centrifugation, using Ficoll-Hypaque . The chemotactic assay was performed in modified Boyden chambers, using Micropore filters, and the chemotactic response was measured by the leading-front technique . Tetracyclines, streptomycin, and penicillin had no effect on chemotaxis at concentrations normally achieved in blood during systemic treatment . However, higher concentrations that were achievable with local therapy, such as intramammary injection or topical application, inhibited the chemotactic response . This inhibition was eliminated by serum . Dexamethasone stimulated polymorphonuclear leukocyte chemotaxis with the effect being manifested after the cells were incubated with the drug for 3 hours . Hydrocortisone caused slight inhibition of chemotaxis, whereas prednisone and prednisolone had no effect.

S Afr Med J, 1983 Oct 29, 64(19), 733 - 6
Efficacy of ampicillin and cefoxitin in the treatment of acute pelvic inflammatory disease . A comparative study; de Beer JA et al.; Sixty patients with acute uncomplicated pelvic infection were treated with cefoxitin or ampicillin alone, the purpose being to show that a relatively cheap antimicrobial agent (ampicillin) could be used . The groups (30 patients in each) were clinically comparable (P greater than 0,01--Hotelling T-square test) . In the first group 2 g ampicillin was administered intravenously on admission followed by 1 g intravenously 4-hourly, and in the second group 2 g cefoxitin was administered intravenously on admission followed by 1 g intravenously every 8 hours . A good response was obtained in both groups . On the basis of cost ampicillin would seem to be the treatment of choice in uncomplicated acute pelvic infection.

N Z Med J, 1983 Oct 26, 96(742), 785 - 7
Antimicrobial prescribing errors in children; Grimwood K et al.; During a 120 day period, the charts of patients who had received antimicrobial agents were examined . This group numbered 255 and comprised 52% of children admitted with infections . Patients treated by family doctors and/or hospital staff predominantly had respiratory infections and the ampicillin/amoxycillin group of drugs was most commonly prescribed . Of the 203 antimicrobial agents prescribed by hospital staff, 64% were considered to be prescribed appropriately . The major errors related to dosage, the most potentially serious relating to the prescribing of aminoglycosides and chloramphenicol . Of the 203 antimicrobial agents prescribed for 171 children in the community, 11% were considered to be appropriately prescribed or without error . The major error was the prescribing of these drugs for syndromes of known viral aetiology . Errors were also frequent in relation to dosage, duration and choice of antimicrobial agents.

Am J Obstet Gynecol, 1983 Oct 15, 147(4), 379 - 85
Moxalactam versus cefazolin prophylaxis for vaginal hysterectomy; Hemsell D et al.; Moxalactam is a newer beta-lactam antibiotic with increased activity and an extended antimicrobial spectrum . Three 1 gm doses were given to women scheduled for elective vaginal hysterectomy . This perioperative regimen was prospectively compared to identical doses of cefazolin, a first-generation cephalosporin of proved efficacy . The overall incidence of major postoperative infection in 193 women was less than 5% and there were no significant interregimen differences . The incidence of major infection was directly related to the type of procedure performed.

Mayo Clin Proc, 1983 Oct, 58(10), 684 - 6
Invasive disease caused by Trichosporon beigelii; Libertin CR et al.; An immunocompromised patient had cellulitis that was unresponsive to conventional antimicrobial therapy . Skin biopsy specimens and fungal blood cultures revealed the offending organism as Trichosporon beigelii . Recognition of this opportunistic pathogen in immunocompromised patients is important.

Hinyokika Kiyo, 1983 Oct, 29(10), 1219 - 30
{Concentration of antimicrobial agents in male genital organs}; Kataoka N; The relationship between the concentrations of various antimicrobial agents in the genital organs of male rats, serum, liver and kidney after oral administration, intramuscular infusion and i.v . infusion were systematically compared and studied . The concentration of Ampicillin in human prostatic tissues after intramuscular infusion was also measured . The drug concentration in the prostatic tissues after oral administration of nalidixic acid (20 mg/kg) was highest 21.5 micrograms/g (2-hour value) which was about 4 times the serum level, followed by chloramphenicol, Cefalexin, Ampicillin, piromidic acid and erythromycin . The concentration of Ampicillin and Cefaloridine in the prostatic tissues after intramuscular infusion was high, but the concentration of Cefazolin, was low after both intramuscular infusion and i.v . infusion . The drug concentration in the prostatic tissues after i.v . infusion of Cefaloridine, Erythromycin, and Ampicillin was high . The concentration of Erythromycin was high only after i.v . infusion . The concentration of both Chloramphenicol and Gentamicin in the blood, and in the prostatic tissues were low . Of the drugs tested, the concentration of Ampicillin in human prostatic tissues was the highest being about 8 micrograms/g at 60 minutes after intramuscular infusion, which was about 40% of its concentration in the blood . The concentrations of antimicrobial agents in the epididymis and testis of the rats were low . Even the relatively high values were only about 10% of the concentration in the blood . The concentration of nalidixic acid in the prostatic tissues was 4 times as high as that of Piromidic acid . In summary, the antimicrobial agents showing high concentrations in the prostatic tissues were nalidixic acid by oral administration, Ampicillin and Cefaloridine by intramuscular infusion, and i.v . infusion, which showed relatively high concentrations in the blood . Irrespective of the route of administration, the concentrations of Chloramphenicol and Gentamicin in the male genitals were low . The drug concentration in the testis was very low irrespective of the chemotherapeutic and administration form . This seems to signify the presence of the so-called blood-testis barrier to protect the important function of spermatogenesis.

J Pharm Sci, 1983 Oct, 72(10), 1226 - 8
Arylidenepyruvic acid thiosemicarbazone and thiazoline derivatives as potential antimicrobial agents; Omar ME et al.; Two novel series of arylidenepyruvic acid thiosemicarbazone and thiazoline derivatives were synthesized and evaluated as potential antimicrobial agents . These substances did not exhibit any significant antibacterial effects when tested against a variety of microorganisms.

J Antimicrob Chemother, 1983 Oct, 12 Suppl C, 1 - 11
Interactions of antibiotics and phagocytes; Hand WL et al.; Optimal therapy of infections due to organisms capable of surviving within phagocytes would include use of antimicrobials that penetrate phagocytic cells and inactivate intracellular organisms . To establish those characteristics of drug and cell that mediate the antibiotic-phagocyte interaction, we have studied the uptake of radiolabelled antibiotics by rabbit alveolar macrophages (AM), human AM from smokers and non-smokers, and human polymorphonuclear leukocytes (PMN) . Relative entries of drug groups into the three types of phagocytic cells were similar . Penicillin G and cephalosporin antibiotics were taken up poorly by phagocytes . Lipid-soluble antibiotics, such as rifampicin and chloramphenicol, were concentrated several-fold (2-5) by phagocytes . Ethambutol, erythromycin and clindamycin were concentrated many-fold (5-50) by phagocytic cells . Human AM of smokers accumulated certain antibiotics more avidly than AM of non-smokers . Clindamycin entry into phagocytes was shown to be an active, energy-requiring process, mediated by the nucleoside transport system . Ingestion of microbial particles by PMN stimulated transport of both clindamycin and nucleoside (adenosine) into the cell.

Ann Intern Med, 1983 Oct, 99(4), 475 - 7
Bacteremia caused by a previously unidentified species of rapidly growing Mycobacterium successfully treated with vancomycin; Jadeja L et al.; Bacteremia caused by rapidly growing mycobacteria are usually due to Mycobacterium fortuitum or M . chelonei . Other rapidly growing mycobacteria generally are considered to be nonpathogenic . We report the case of a patient with bacteremia due to an unidentified, rapidly growing, scotochromogenic mycobacteria that was detected by a radiometric blood culture system . Results of in-vitro susceptibility testing indicated that the organism was susceptible to vancomycin and other antimicrobial agents, and the patient was successfully treated with vancomycin . We believe that this is the first report of successful use of vancomycin therapy for a mycobacterial infection.

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