Antimicrobials

Clin Orthop, 1983 Oct, (179), 253 - 65
Bone and serum concentrations of five cephalosporin drugs . Relevance to prophylaxis and treatment in orthopedic surgery; Williams DN et al.; Bone and serum concentrations of five cephalosporins were assayed in 92 patients undergoing elective hip or knee prosthetic joint arthroplasty . One hundred twenty-five bone samples were assayed . Although there was no direct relation between serum and bone antibiotic concentrations, a trend toward increased bone antibiotic concentration for drugs with higher serum levels and longer half-lifes (cefazolin and ceforanide) was noted . Bone antibiotic concentrations were maximal within 60 minutes of drug administration . Although bone antibiotic concentrations following 2-g doses were greater than those following 1-g doses, the differences were not statistically significant . A trend toward higher bone antibiotic concentrations at hip surgery was noted, and this difference achieved statistical significance (p less than 0.05) for cefazolin . As a result of analysis of bone antibiotic concentrations, antimicrobial sensitivities, and cost, administration of 2 g of cefazolin immediately prior to operation, followed by 1 g every eight hours for 24 hours, is recommended in elective prosthetic joint surgery.

Br J Urol, 1983 Oct, 55(5), 519 - 21
Review of results of four regimens for treatment of chronic non-bacterial prostatitis; Thin RN et al.; Review of the treatment of chronic non-bacterial prostatitis, defined by the presence of more than 500 leucocytes per mm3 in the expressed prostatic secretion (EPS), showed symptomatic response after 3 months of minocycline, trimethoprim, co-trimoxazole or diazepam . Reduction in the EPS cell count was most marked with minocycline, trimethoprim was less effective and poor results were obtained with co-trimoxazole and diazepam . In the absence of established treatment for chronic non-bacterial prostatitis it is suggested that antimicrobial therapy is worth consideration.

Acta Anaesthesiol Scand, 1983 Oct, 27(5), 403 - 9
A comparative evaluation of disposable humidifiers; Mebius C; The performance of four hygroscopic condenser humidifiers (HCH) and two conventional heat and moisture exchangers (HME), all commercially available, have been evaluated in laboratory tests . A clinical study was also made in order to confirm the test results . It was found that the new generation of heat and moisture exchangers, which have hygroscopic properties, are superior to conventional HME units . When dry inspired gases are used, the HCH units, but not the HME units, deliver a moisture level that is comparable to what is produced in the upper trachea during normal breathing the nose . Our clinical experience as well as the extensive body of literature on humidification requirements support the conclusion that in most cases they can be recommended to be used for extended time periods even with dry gases . The humidification efficiency decreases with increasing tidal volume for all units . However, the best units can be used up to tidal volumes of 1000-1500 ml . The dead space of these units varies from 90 ml to 100 ml and the resistances are only about 50 Pa at 0.5 l/s . The weight is in the range 18-40 g . One of the best HCH devices also has distinct antimicrobial properties . The others are found at least not to promote organism growth . This feature added to others such as safety and simplicity in use make an HCH device an attractive alternative to conventional humidification techniques.

J Dent Res, 1983 Oct, 62(10), 1062 - 6
A mouthrinse which optimizes in vivo generation of hypothiocyanite; Mansson-Rahemtulla B et al.; We report here the properties of a mouthrinse which enhances one of the natural defense factors in human saliva, the salivary peroxidase system . Concentrations of the antimicrobial agent, the hypothiocyanite (OSCN-) ion, can be increased in vivo to bacteriostatic levels by use of a mouthrinse which is 4 mM (0.014%) in hydrogen peroxide and 1 mM (0.0097%) in potassium thiocyanate at pH 5.5 . The volume of the rinse, the H2O2 concentrations, and the pH were shown to be determinants of the concentration of OSCN- generated by the rinse.

Sex Transm Dis, 1983 Oct-Dec, 10(4 Suppl), 366 - 70
Antimicrobial susceptibility and susceptibility testing of Mycoplasma hominis: a review; Bygdeman SM et al.; The determination of the minimal growth-inhibiting concentration (MIC), the minimal metabolism-inhibiting concentration (MMC), and the minimal mycoplasmacidal concentration (MCC) of various antimicrobial compounds for Mycoplasma hominis is influenced by the pH of the test media, the inoculum size, and the incubation time, although each of these factors generally do not affect the minimal concentration more than fourfold . M . hominis is resistant to beta-lactam antibiotics, vancomycin, sulfonamides, trimethoprim, and polymyxin B . There are great differences in the susceptibility of M . hominis to various macrolide antibiotics . Thus the organism is resistant to erythromycin and oleandomycin, moderately resistant to tylosin and spiramycin, susceptible to josamycin as well as to another macrolide drug, labelled M-4365G . M . hominis is also highly susceptible to the macrolide-like compound rosaramicin and to the tetracyclines (although resistant strains occur) . It is susceptible to lincomycin and clindamycin, and moderately susceptible to chloramphenicol and rifampicin . The aminoglycosides have limited activity against M . hominis.

Am J Clin Pathol, 1983 Oct, 80(4 Suppl), 622 - 5
Contemporary quality control practices for antimicrobial susceptibility tests: a report from the microbiology portion of the College of American Pathologists (CAP) surveys program; Jones RN et al.; The evaluation of quality control (QC) practices from the College of American Pathologists (CAP) Microbiology Surveys demonstrates a trend away from daily controls similar to that first noted in 1980 . Previous recommendations for more relevant cost-containment oriented weekly QC procedures are discussed, and the 1982 CAP Surveys statistics confirm earlier comparability between the daily and weekly QC participant groups . Each QC practice subgroup (daily or weekly) had nearly identical mean disk inhibitory zone diameters, and the performance accuracy on two 1982 challenge strains were very similar . Generally, disk zone diameter from those laboratories using weekly QC were smaller, but the frequency of minor and major (false-resistant) errors was only slightly increased . The authors recommend the conversion to weekly QC of disk or dilution antimicrobial susceptibility tests after an acceptable daily QC performance has been established (See criteria in discussion).

Arch Intern Med, 1983 Oct, 143(10), 1868 - 73
Single daily dose treatment of severe refractory infections with ceftriaxone . Cost savings and possible parenteral outpatient treatment; Baumgartner JD et al.; Ceftriaxone sodium, a new cephalosporin with a very broad spectrum of action and a very long serum half-life, was administered to 127 patients in the treatment of 133 severe infections at our institution in Lausanne, Switzerland . Eighty infections had previously been treated unsuccessfully with other antimicrobials to which the pathogens were most often resistant . Sixty-five episodes were treated with two daily injections until there was an improvement in the patient's clinical condition, while 67 infections were treated from the start by a single daily injection . The results in the two groups were similar . One hundred fifteen infections (86%) were cured or improved, ten (8%) did not respond to therapy or recurred, and eight (6%) were not evaluable . The treatment was well tolerated, even by the 18 patients who received the drug for more than four weeks . The administration of a single daily dose instead of four doses as with standard antibiotic regimens produced a saving of Sfr 84,000 (+42,000) in the 127 patients . The single daily dose also made it possible to treat 25 of the 127 severely ill patients as outpatients, with a saving of Sfr 388,500 (+195,000) with respect to the hospital costs that would have been incurred for the same time period.

Obstet Gynecol, 1983 Oct, 62(4), 489 - 97
Cefotaxime sodium therapy for endomyometritis following cesarean section: dose-finding and comparative studies; Hemsell DL et al.; One hundred eighteen women who developed endomyometritis after cesarean section in Parkland Memorial Hospital were treated with parenteral cefotaxime sodium . The requirement for additional antimicrobial therapy was significantly higher at an initial daily dose of 3 g/day (16.4%) than when the dose was 6 g/day (4.8%) (P less than .05) . The latter clinical efficacy and the observed in vitro susceptibility of 88% of isolates indicate that cefotaxime is well suited for single-agent parenteral therapy for this polymicrobial pelvic infection . Subsequently, 120 women with the same diagnosis were randomly treated with cefotaxime or clindamycin and gentamicin . Patient populations, surgical variables, in vitro microbiologic data, and side effects were similar for both groups . Clinical success observed was also similar: it was 97.5% for women given cefotaxime and 95% for women given clindamycin and gentamicin.

Biochem Biophys Res Commun, 1983 Sep 30, 115(3), 1009 - 14
Production of a monoclonal antibody-bleomycin conjugate utilizing dextran T-40 and the antigen-targeting cytotoxicity of the conjugate; Manabe Y et al.; Bleomycin (BLM), a potent anticancer glycopeptide antibiotic, was linked covalently to murine monoclonal anti-HLA IgG1 antibody (H-1) with the use of dextran T-40 . As determined spectrophotometrically, the conjugate was composed of 57.5 moles BLM per mole antibody . Of the substituted BLM, 18.4% (10.6 moles BLM per mole antibody) exhibited antimicrobial activity . The BLM-(H-1) conjugate showed stronger cytotoxicity than BLM alone against HLA-bearing cells in cultivation after a 30-min exposure to the drugs . In the same experiment, the conjugate was less toxic than BLM against cells lacking HLA.

Biochim Biophys Acta, 1983 Sep 13, 759(3), 229 - 35
The effect of trypsin and chymotrypsin on the in vitro antimicrobial and iron-binding properties of lactoferrin in human milk and bovine colostrum . Unusual resistance of human apolactoferrin to proteolytic digestion; Brines RD et al.; The susceptibility of lactoferrin in bovine colostrum and human milk to digestion by trypsin and chymotrypsin has been investigated . Neither enzyme had much effect on the lactoferrin-mediated antimicrobial activity of human milk, and the iron binding capacity of lactoferrin in the milk was only slightly reduced . Likewise both enzymes had only a slight effect on the iron-binding capacity of purified lactoferrin . Although iron-free (apo)lactoferrin was slightly more susceptible to digestion, especially by chymotrypsin, than the iron-saturated form, the difference was much less than has been found in earlier studies with other proteins of the transferrin class . In contrast, trypsin destroyed the antimicrobial activity of bovine colostrum, and, in line with earlier studies, appreciably reduced the iron-binding capacity of both colostrum and purified bovine apolactoferrin . Bovine iron-saturated lactoferrin was more resistant to digestion . The unusual resistance of human apolactoferrin to proteolysis may reflect an evolutionary development designed to permit its survival in the gut of the infant.

Yale J Biol Med, 1983 Sep-Dec, 56(5-6), 551 - 6
Role of mycoplasmas in chronic prostatitis; Peeters MF et al.; In 17 out of 102 patients with clinically diagnosed chronic prostatitis the disease could be attributed to known urogenital tract pathogens . Of the remaining 85 patients, Ureaplasma urealyticum was isolated from 38, Chlamydia trachomatis from five, and both organisms together from two . The results of antimicrobial treatment of the patients suggest an etiological relationship between Ureaplasma urealyticum and certain cases of chronic prostatitis . In these cases urethritis seems to be an accompanying symptom (urethro-prostatitis) . No relation could be demonstrated between a favorable outcome of therapy and particular serotypes of ureaplasma . Our study could not establish any pathogenic role for Mycoplasma hominis.

Methods Find Exp Clin Pharmacol, 1983 Sep, 5(7), 457 - 60
A critical comment on the use of the plate diffusion test for QSAR considerations; Rehn D et al.; The plate diffusion test is widely used for the screening of possible antimicrobials . Antibiograms play an important role for the selection of suitable antibiotics in the routine treatment of infections . We are able to show with a series of O-acylated 4-hydroxybenzoic acids that the percentage of the dose which did not diffuse into the agar plate depends on physico-chemical parameters of the compounds . The amount of the residue is linearly related both to the lipophilic behaviour expressed by the partition coefficients (log Pf) and the spatial extension expressed as Van der Waals Volumes (Vw) . The plate diffusion test should be used with caution for studies of QSAR and also relative comparisons of activities.

Jpn J Antibiot, 1983 Sep, 36(9), 2391 - 4
{Clinical evaluation of latamoxef in perinatal infections}; Ishikawa M et al.; Latamoxef (LMOX) is a new oxacephem antibiotic with a broad spectrum of antimicrobial activity . In vivo transfer and therapeutic efficiency of this drug have studied in perinatal field . The following results have been obtained . Transfer of this drug to umbilical blood was higher than its MIC against majority of Gram-negative pathogens . In the treatment of 5 cases of perinatal infection, the preparation showed excellent efficiency in 2 cases and good efficiency in 3 cases . No side effect was evidenced in any of our patients . In conclusion this drug has satisfactory fetal transfer as well as sufficient safety and excellent efficiency in treatment of perinatal infection cases.

Arch Inst Cardiol Mex, 1983 Sep-Oct, 53(5), 435 - 40
{Actinobacillus actinomycetem comitans endocarditis . Report of a case and review of the literature}; Soto Ramirez L et al.; A case of infectious endocarditis caused by Actinobacillus actinomycetem comitans in a young male is presented . The clinical features and the microbiologic data are reviewed as well as the diagnostic and therapeutic procedures including the echocardiographic findings . A review of the literature is presented with 23 cases of endocarditis caused by this bacterium . An analysis of the cases with special emphasis in clinical presentation, predisposing factors, complications and antimicrobial therapy is made . A . actinomycetem comitans could be a cause of blood culture negative endocarditis due to the slow growth of the bacterium and the subacute course of the disease.

Acta Anaesthesiol Belg, 1983 Sep, 34(3), 163 - 71
Prophylactic antibiotics in surgery; Naessens A et al.; Prospective double blind studies have demonstrated that brief courses of antibiotics active against major contaminating bacterial pathogens are effective in certain surgical interventions if these agents are given prior to surgery . Administration of antibiotics for long periods after surgery has no beneficial effect on the postoperative infection rate . In addition it may increase the risk of adverse effects and results in widespread emergence of resistant organisms . Until now brief courses of antimicrobial agents have not resulted in an increasing number of resistant bacteria, however surveillance must be continued (Acta anaesth . belg., 1983, 34, 163-171).

Pharmazie, 1983 Sep, 38(9), 587 - 9
{Synthesis and antibacterial activity of perchlorylchloramphenicol}; Ziebell G et al.; Starting from p-perchloryl acetophenone we have synthesized the perchloryl analogue of chloramphenicol . The new compound is the first chloramphenicol analogue possessing a higher antimicrobial activity as chloramphenicol itself . It showed an about twofold activity against 18 different microbes in the hole plate diffusion test, compared with the parent compound.

J Ethnopharmacol, 1983 Sep, 8(3), 287 - 302
Screening of antimicrobial activity of some plants belonging to the Apocynaceae and Loganiaceae; Verpoorte R et al.; A review is given of the literature on the antimicrobial activity of various indole alkaloids . The data are briefly discussed . A screening was performed of a series of plants belonging to the indole alkaloid rich plant families Apocynaceae and Loganiaceae, 25 materials representing 14 Apocynaceae species and 54 materials representing 41 Strychnos species were investigated . No activity against the yeast or the fungus, used as test organisms was found . A number of extracts showed activity against the gram-positive test organisms, 4 species showed activity against gram-negative bacteria.

Farmaco {Sci}, 1983 Sep, 38(9), 630 - 9
Pyrrolnitrin analogues . VIII - Synthesis and antibacterial activity of new 1,4- and 1,5-diarylpyrroles; Filacchioni G et al.; From ethyl 1-aryl-2-methyl-4-(4-nitrophenyl)pyrrole-3-carboxylates new 1-aryl-2-methyl-4-(4-nitrophenyl)pyrrolderivatives wer prepared . These compounds and some previously reported 1,4- and 1,5-diarylpyrroles were subjected to in vitro antimicrobial screenings . Namely some 1-aryl-2-methyl-4-(4-nitrophenyl)pyrrole-3-carboxylic acids and its 5-chloroderivatives are the most potent . The results obtained are discussed on the basis of structure-activity relationships.

J Clin Microbiol, 1983 Sep, 18(3), 449 - 51
Evaluation of the BACTEC antimicrobial removal system for detection of bacteremia; McGuire NM et al.; The BACTEC 16B resin medium was developed to detect bacteremia in patients receiving antimicrobial therapy . Over a 9-month period, we compared the efficacy of the BACTEC 16B bottle to the conventional aerobic BACTEC 6B bottle . Of a total of 1,524 sets of blood cultures, 79 yielded presumed pathogens . Of these 79 sets, 42 (53.2%) were positive in both the 16B and 6B bottles, 23 (29.1%) were positive only in the 16B bottle, and 14 (17.7%) were positive only in the 6B bottle . For patients receiving antimicrobial drugs, 33 of 34 (97.1%) sets were positive for pathogens in the 16B bottle, but only 15 of 34 (44.1%) were positive in the 6B bottle . In 19 (55.9%) of the 34 sets, only the 16B bottle yielded growth . The resin bottle was more useful for patients with gram-positive bacteremia than for those with gram-negative bacteremia . The BACTEC 16B resin medium increases the recovery of organisms from bacteremic patients receiving antimicrobial agents and should be used in addition to the standard BACTEC aerobic bottle for such patients.

Contact Dermatitis, 1983 Sep, 9(5), 397 - 401
Bronopol allergic contact dermatitis; Peters MS et al.; Bronopol (2-bromo-2-nitropropane-1, 3-diol) is an antimicrobial compound widely used as a preservative, primarily in cosmetic formulations . Analysis of patch tests performed on our patients revealed an incidence of 12.5% relevant positive results to 0.5% and/or 0.25% bronopol . This result reflects a history of prolonged use of bronopol-containing lubricants in our referral population of patients with different types of severe, extensive dermatitis . Contact sensitization to bronopol in this population is probably facilitated by abnormal cutaneous barrier function . Our findings emphasize the need for further clinical study of the potential for bronopol to produce contact sensitivity, and suggest caution with regard to its use in patients with dermatitis.

Ann Otol Rhinol Laryngol, 1983 Sep-Oct, 92(5 Pt 1), 525 - 7
Osteomyelitis of the clavicle; Krespi YP et al.; Osteomyelitis of the clavicle is rare; however, it may occur following head and neck surgery . Risk factors include radiation, long-standing tracheitis, disruption of the periosteum or the cortical bone with interruption of the blood supply to the clavicle . Proper management includes early diagnosis, surgical debridement of soft tissue and bone, appropriate antimicrobial therapy, and coverage of the defect with a myocutaneous flap to protect the great vessels of the upper mediastinum.

Am J Kidney Dis, 1983 Sep, 3(2), 106 - 10
Antimicrobial therapy in patients with impaired renal function; Aronoff GR; In order to formulate a thoughtful and rational approach to drug dosing in renal failure, the nephrologist must consider several features that influence drug disposition in uremia . Drug bioavailability is generally adversely influenced in patients with renal disease . Drug distribution is frequently altered to an unpredictable degree . Drug protein binding is affected not only by changes in the amount of circulating binding protein but also by the accumulation of endogenous toxins . Renal failure frequently affects drug biotransformation . Drug-dosing tables and nomograms are important; however, they are not a substitute for an encompassing clinical approach and sound clinical judgment.

Surg Gynecol Obstet, 1983 Sep, 157(3), 265 - 8
A comparative study of surgical skin preparation methods; Geelhoed GW et al.; Analysis of a randomized study of preoperative skin preparation techniques in thoracic and general surgical patients revealed that the use of a one minute alcohol cleansing and application of an antimicrobial film provides equivalent bactericidal activity to a five minute iodophor scrub and paint . Initial bacterial kill is greater with a one minute alcohol cleansing than a five minute iodophor scrub . There were fewer patients with high bacterial counts at the time of closure in the groups treated with the antimicrobial film than in the traditional iodophor scrub group . Saving in preoperative operating room time can be achieved using a one minute alcohol cleansing plus application of an antimicrobial film with equal antibacterial efficacy to that of conventional methods.

Surg Gynecol Obstet, 1983 Sep, 157(3), 197 - 200
The importance of early diagnosis and surgical treatment of necrotizing fasciitis; Miller JD; Necrotizing fasciitis is a severe infection with a mixed bacterial population involving a single tissue plane . It is best diagnosed by the history of minor trauma, extreme toxicity, anesthesia of the skin and roentgenologic evidence of soft tissue gas . Initial treatment consists of antibiotics, intravenously administered fluids, blood transfusions, calcium and general patient support . Surgical procedures include extensive debridement as soon as possible and as needed for continued necrosis, secondary closure and skin grafting . The mortality of this disease has not been altered by antimicrobials . Only early recognition and surgical treatment will improve the prognosis.

Arch Neurol, 1983 Sep, 40(9), 596 - 7
Acute toxoplasmic encephalitis in a normal adult; Bach MC et al.; Acute encephalitis associated with an impressive skin rash developed in an otherwise healthy man . Brain biopsy findings were not diagnostic, but serologic data confirmed the diagnosis of acute toxoplasmosis . The patient improved after antimicrobial therapy with pyrimethamine and sulfadiazine, but he was left with neurologic deficits.

Rev Infect Dis, 1983 Sep-Oct, 5(5), 843 - 53
A reevaluation of the roles of the O2-dependent and O2-independent microbicidal systems of phagocytes; Elsbach P et al.; In recent years the bactericidal and cytotoxic actions of phagocytes and particularly neutrophils have been attributed mainly to O2-dependent systems that depend on the accumulation of chemically reactive derivatives toxic to the bacteria . This view has been reexamined in the light of new observations on the properties and potency of O2-independent bactericidal proteins that have been purified from neutrophils . These proteins include several enzymes as well as a granule-associated protein that acts specifically against certain gram-negative bacteria . Exposure of susceptible bacteria to this latter protein produces three effects: loss of ability to multiply, a discrete increase in permeability of the outer membrane of the envelope, and activation in the bacterial envelope of degradative enzymes that act on phospholipids and peptidoglycan . It is concluded that effective antimicrobial activity rests on the coexistence of O2-independent bactericidal proteins that are highly specific for certain microbial species and O2-requiring systems that nonspecifically attack all cells.

J Clin Periodontol, 1983 Sep, 10(5), 487 - 514
Microbiological and clinical effects of topical subgingival antimicrobial treatment on human periodontal disease; Rosling BG et al.; This study was undertaken to evaluate the microbiological and clinical effects of a subgingivally applied mixture of H2O2-NaCl and NaHCO3 followed by subgingival irrigation with 1% Betadine in the treatment of periodontal disease . 20 adults with moderate to severe periodontal disease were included in a split mouth design study . All patients were given oral hygiene instruction and were subjected to supragingival scaling in all 4 quadrants, and subgingival scaling and root planing of half the dentition . 10 patients were instructed to use the chemical antimicrobial mixture twice a day instead of dentifrice, and also received professional application of the mixture once every 14 days for 3 months in connection with reinstruction in oral hygiene procedures . The remaining 10 patients received oral hygiene instructions combined with professional tooth cleaning without use of chemicals once every 14 days during a 3-month period . The effect of treatment was evaluated by monitoring the subgingival microflora, clinical periodontal parameters, and by computer assisted subtraction analysis of serial standardized radiographs to determine changes in mass of the supporting alveolar bone . The present study revealed that subgingival debridement combined with mechanical plaque control resulted in decreased numbers of subgingival microorganisms including spirochetes and motile rods, and arrested the progressive breakdown of the periodontal tissues . Topical antimicrobial agents used in combination with subgingival scaling further reduced the subgingival microflora and substantially improved early periodontal healing including gain of probing attachment level and gain in radiographic alveolar bone mass during the 12 months of observation . No clinical improvement but a tendency to further periodontal breakdown was found in the unscaled quadrants, even in those which were subjected to a personal application of the topical antimicrobial mixture . This study indicates that professional and personal subgingival application of a mixture of H2O2-NaCl and NaHCo3 will significantly enhance the microbiological and clinical effects of periodontal scaling and root planing . These agents, and the topical mode of antimicrobial therapy seem promising in the management of human periodontal diseases.

J Antibiot (Tokyo), 1983 Sep, 36(9), 1228 - 35
Inhibition of nucleic acid biosynthesis in procaryotic and eucaryotic cells by cyanocycline A; Hayashi T et al.; Cyanocycline A was cytotoxic against Meth A cells in vitro, and also showed marked activity against the same cell line grown as an experimental ascites tumor . This antibiotic inhibited nucleic acid synthesis in Escherichia coli and Meth A cells . The antimicrobial activity of the antibiotic was reversed by addition of exogenous herring sperm DNA . Cytofluorometric analysis of cyanocycline A-treated Meth A cells showed an unusual pattern of the relative content of DNA and RNA per cell . These results suggested that cyanocycline A binds to DNA, and that it inhibits nucleic acid synthesis.

Rev Infect Dis, 1983 Sep-Oct, 5 Suppl 4, S806 - 22
Microbial interactions with neutrophils; Spitznagel JK; Bacterial pathogenesis is heavily dependent on the capacities of microbial cells to avoid activating or to resist antimicrobial mediators of neutrophil polymorphonuclear granulocytes, the first line of phagocytic defense against infection . These capacities can but be understood in terms of the cell biology of neutrophils . The relevant microbial mechanism largely reside in the biochemical structures of their cell surfaces and their secretions . These factors are reviewed, and the importance of biochemical genetic analysis in seeking new solutions to old and new problems is stressed.

J Antibiot (Tokyo), 1983 Sep, 36(9), 1097 - 100
Aculeximycin, a new antibiotic from Streptosporangium albidum . II . Isolation, physicochemical and biological properties; Ikemoto T et al.; A new larvicidal antibiotic, aculeximycin, was found in the culture broth of an actinomycete identified as Streptosporangium albidum . Aculeximycin was isolated from the culture filtrate by adsorption on a Diaion HP-20 column and successive elution with acidic aqueous acetone . It was extracted from the concentrated active fraction with 1-butanol and subjected to column chromatography on a Sephadex LH-20 column . Aculeximycin exhibited strong larvicidal activity against mosquito larvae as well as antimicrobial activities against Gram-positive and Gram-negative bacteria, yeasts and molds.

Schweiz Med Wochenschr, 1983 Aug 20, 113(33), 1112 - 7
{The role of complement and specific antibodies in the development and defense mechanism of sepsis and septic shock}; Nydegger U; Sepsis, abscess formation or development of purulent exudates in closed cavities expresses insufficient host defense against pyogenic infections . An attempt is made to analyse the reasons for diminished host resistance and/or increased virulence of the invading microbes . While the role of cellular defense mechanisms is not considered, a number of humoral components, such as lysozymes glycolipids, lactoperoxidase, fibronectin, esterases and haptoglobin, participate in efficient defense . Special emphasis is placed on serum complement, both with regard to its unspecific but nevertheless efficient alternative pathway, and with respect to its phylogenetically much more recent classical pathway . Recognition of bacteria by either mechanism of complement activation leads to C3b deposition on the microbial surface for efficient opsonization, while the juxtaposition of at least two molecules of antibodies contained in the immunoglobulin fraction of plasma safely leads to complement activation via the classical pathway . Therefore, specific recognition of bacteria by immunoglobulin-antibodies remains the core of anamnestic antimicrobial defense, the more so since some antibodies may also confer on the bacterial surface the capacity to activate the alternative pathway . The recent description of monoclonal antibody directed at bacteria relevant in sepsis opens perspectives in the near future when such components will eventually be used for therapeutic purposes, along with antibodies also directed towards the pathogenetic bacterial products endo- and exotoxin.

Am J Clin Pathol, 1983 Aug, 80(2), 182 - 9
Cefuroxime, cefamandole, cefoxitin, and cephalothin in vitro susceptibility tests: reassessment of the "class representative" concept, confirmation of disk interpretive criteria, and proposed quality control guidelines; Barry AL et al.; The relationship of cefuroxime in vitro susceptibility tests to similar cephalosporins (cefamandole, cefoxitin, and cephalothin) was evaluated using 396 recent clinical isolates . The previously published interpretive criteria of greater than or equal to 18 mm (less than or equal to 8.0 micrograms/mL) = susceptible and less than or equal to 14 mm (greater than or equal to 32 micrograms/mL) = resistant for each drug were considered appropriate . The results of all study methods demonstrated cefuroxime to be slightly less active than cefamandole against most species, yet both drugs possessed nearly identical antimicrobial spectra . Cephalothin and cefoxitin were confirmed to have spectra significantly different from cefamandole and from each other, thus requiring separate testing . The application of the "class representative" concept to cefuroxime and cefamandole seems justified . Use of a 30-micrograms cefuroxime disk yielded the best predictive results and minimized the number of false-susceptible (very major) interpretive errors . Quality control guidelines are presented in a tentative form for cefuroxime, and modifications in the cephalothin and cefamandole zone limits are suggested.

Obstet Gynecol, 1983 Aug, 62(2), 151 - 4
Perioperative antimicrobials for cesarean delivery: before or after cord clamping?
Cunningham FG, Leveno KJ, DePalma RT, Roark M, Rosenfeld CR.
To determine neonatal risk of exposure to intrapartum antimicrobials given to reduce maternal infection following cesarean delivery, 642 mother-infant pairs were evaluated . In 464, the mother was given an initial dose of antimicrobial(s) before cord clamping, whereas in the remaining 178 administration of these drugs was not begun until after delivery . Despite the facts that all infants were at equivalent risk for infection and that none were proved to have bacteremia, 28% of those exposed to intrapartum maternal antimicrobials were evaluated for sepsis whereas only 15% of those not exposed were evaluated (P less than .001) . Excess hospital charges for infants in whom sepsis workup was initiated was $127 greater than that for infants not suspected of having sepsis (P less than .025) . Of 305 women given three-dose perioperative antimicrobial therapy, 255 were given the initial dose before cord clamping and 24% experienced a subsequent uterine infection . This was not significant when compared with a uterine infection rate of 22% in 50 women in whom three-dose therapy was not initiated until after cord clamping . As maternal benefits that accrue from such intrapartum therapy are equivalent regardless of the timing of three-dose treatment, and as fetal exposure to these drugs has significant clinical and economic impacts, it is concluded that antimicrobials given to these women at high risk should be withheld until after cord clamping.

J Antibiot (Tokyo), 1983 Aug, 36(8), 1034 - 9
Synthesis and in vitro activity of a new carbapenem, RS-533; Miyadera T et al.; The synthesis and in vitro antimicrobial activity of a new synthetic carbapenem, (5R,6S)-6-{(R)-1-hydroxyethyl}-2-{(S)-1-acetimidoylpyrrolidin -3-ylthio}-1-carbapen-2-em-3-carboxylic acid (RS-533), are described . The MIC values of related penems and carbapenems are also given for comparison with those of the new carbapenem.

J Antibiot (Tokyo), 1983 Aug, 36(8), 1020 - 33
Cephalosporin antibiotics . Synthesis and antimicrobial activity of 7 beta-{2-(5-amino-1,2,4-thiadiazol-3-yl)-2-oxyiminoacetamido}cephalosporin derivatives; Csendes I et al.; Cephalosporins with a 7 beta-{2-(5-amino-1,2,4-thiadiazol-3-yl) -2-oxyiminoacetamido} side chain were synthesized and their in vitro inhibitory potency was established . The compounds exhibit a strong antibacterial activity against various Gram-positive and Gram-negative bacteria . The antimicrobial activity is related to the oxime-substituent R1 and the C-3 substituent R2 . Selected amino-1,2,4-thiadiazolyl-cephems 1 show a prolonged half-life in mice.

Z Kardiol, 1983 Aug, 72(8), 476 - 80
{Prosthesis endocarditis with embolization of a Smeloff-Cutter aortic valve prosthesis . Diagnosis, surgical management, clinical and hemodynamic course to 3 years' postoperative follow-up}; Horstkotte D et al.; In a 47-year-old man a late postoperative chronic infective prosthetic valve endocarditis became evident 8 years after implantation of a Smeloff-Cutter aortic valve prosthesis . Signs and symptoms of valve endocarditis increased rapidly, so that within 12 months a total valve embolization was found intraoperatively . Three years after emergency reoperation and implantation of a Bjork-Shiley prosthesis, good clinical and hemodynamic results were established . Thus, even in prosthesis valve endocarditis with severe consecutive hemodynamic impairment, immediate surgical treatment seems to be mandatory and can be performed successfully with good long-term results if the diagnosis is made in time and if effective antimicrobial therapy is begun.

J Antimicrob Chemother, 1983 Aug, 12(2), 133 - 9
Susceptibility of penicillin-resistant pneumococci to eighteen antimicrobials: implications for treatment of meningitis; Tweardy DJ et al.; The minimal inhibitory concentrations (MICs) of 18 antibiotics including 16 beta-lactam antibiotics were determined by agar dilution on 70 strains of pneumococci (25 penicillin sensitive, 18 intermediate resistant and 27 resistant) . The antimicrobials tested were penicillin G, ampicillin, carbenicillin, ticarcillin, piperacillin, mezlocillin, cephalothin, cefoxitin, cefamandole, latamoxef (moxalactam), cefotaxime, cefoperazone, ceftazidime, ceftriaxone, N-formimidoyl thienamycin, SCH 29482, chloramphenicol and vancomycin . Of these agents, only cefotaxime demonstrated greater activity than penicillin against intermediate penicillin-resistant strains while cefoperazone, ceftriaxone, N-formimidoyl thienamycin and vancomycin as well as cefotaxime demonstrated activity superior to penicillin against penicillin-resistant strains . Comparison of the MIC90s of these agents with the achievable cerebrospinal fluid levels suggests that meningitis caused by penicillin-resistant pneumococci should respond to treatment with cefotaxime, cefoperazone, ceftriaxone and vancomycin.

Hoppe Seylers Z Physiol Chem, 1983 Aug, 364(8), 1003 - 9
Purification and spectral characterization of seminalplasmin, an antimicrobial protein from bull semen; Theil R et al.; A new method for the purification of seminalplasmin, an antimicrobial protein from bull semen, was developed . The last step of the procedure involved preparative high performance liquid chromatography on a reversed phase column . Highly purified seminalplasmin was characterized by CD, absorption, fluorescence spectroscopy, double immunodiffusion and biological activity . Analytical ultracentrifugation revealed a molecular mass of 6300 Da . Amino-acid analysis of the protein preparation indicated the absence of sulfur-containing amino acids cysteine and methionine.

Am J Hematol, 1983 Aug, 15(1), 57 - 63
Acute leukemia and infections: perspectives from a general hospital; Balducci L et al.; The incidence and etiology of infections in 210 acute leukemics at the University of Mississippi Medical Center between 1962 and 1978 were reviewed . Infections episodes occurred 269 times in 148 patients . In 193 infections, potential pathogens were cultured . Infection was a contributing cause of death in 89 patients . E . Coli, S . aureus, K . pneumoniae, and P . aeruginosa accounted for 58% of the isolates . No unusual patterns of antimicrobial resistance were observed . The outcome of the infections was related to the absence or resolution of neutropenia . Among 48 patients febrile on first admission, four cases of gram-negative pneumonia, two cases of fungal pneumonia, and two cases of pseudomonas cellulitis were diagnosed . We conclude that the etiology of infections was similar to that of cancer centers; multidrug-resistant gram-negative organisms were not prevalent; absence or resolution of neutropenia indicates a good prognosis for outcome of infection; and untreated acute leukemics may acquire opportunistic infections.

J Clin Endocrinol Metab, 1983 Aug, 57(2), 402 - 9
Chemiluminescence and superoxide anion production by leukocytes from diabetic patients; 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 is also produced and is a sensitive measure of oxidative metabolism and correlates well with antimicrobial activity . Since infection is an important cause of morbidity and mortality in diabetic patients we examined chemiluminescence and superoxide production by leukocytes from diabetics in the resting state and in response to a soluble (phorbol myristate acetate) and to a particulate stimulus (opsonized zymosan) . No significant difference in the resting chemiluminescence was observed . However, the resting superoxide anion production by patients' leukocytes was significantly higher in autologous serum; when patients' leukocytes were placed in normal serum, a significant reduction in the resting superoxide anion production was observed . Using phorbol myristate acetate as a stimulus, leukocytes from diabetic patients had a markedly reduced chemiluminescence response {controls 388 +/- 48, n = 22, patient 220 +/- 37, peak cpm X 10(3)/10(6)P leukocytes, n = 22, (P less than 0.01)} and reduced superoxide anion response {controls 30.1 +/- 3.8, n = 16, patients 13.3 +/- 2.6 nmol/15 min/10(6)P leukocytes, n = 16 (P less than 0.001)} . Significantly reduced chemiluminescence response (P less than 0.05) and superoxide production (P less than 0.05) by leukocytes from diabetic patients were also observed using opsonized zymosan as a stimulus . No significant effects on chemiluminescence or superoxide response to phorbol myristate acetate were observed with cross-incubation studies in which patients' leukocytes were placed in normal serum or control leukocytes in patient serum . In vitro addition of insulin (25 microU; 100 microU/ml) had no significant effect on patient cell response; similarly increasing the glucose concentration from 100 mg/dl to 200 mg/dl and 400 mg/dl had no significant effect on control cell response . Glucagon in a lower concentration (200 pg/ml) had no significant effect; only at a higher concentration (400 pg/ml), it caused an inhibition of the phorbol stimulated chemiluminescence and superoxide response of control leukocytes . These results show an impaired oxidative burst by leukocytes from diabetic patients which may contribute to impaired bacterial killing and may explain, in part, the morbidity and mortality in diabetic patients suffering from infection.

Am J Med, 1983 Jul 28, 75(1B), 31 - 6
Resin-process methods for improved isolation of organisms from blood and other body fluids; Hansen SL et al.; Two resin-based processes and conventional culturing methods were compared in isolating organisms from blood specimens of patients given antimicrobial agents . Of 20 patients whose specimens were found to contain clinically relevant organisms, one or both of the resin-process methods isolated organisms in eight after conventional culturing was unsuccessful . Conventional cultures were successful in five cases in which the resin-process methods did not work, and both resin-process and conventional culturing were successful in seven cases . In eight cases in which other body fluids were cultured, only a resin-process method was successful in four, although they are intended for use only with blood specimens . Data indicate that resin-process methods should be used along with conventional culturing methods when patients have already been given an antimicrobial . A review of the literature shows that the devices improve the recovery of organisms but does not establish that detection time is decreased.

Arch Biochem Biophys, 1983 Jul 15, 224(2), 494 - 505
Detoxification of the phytoalexin pisatin by a fungal cytochrome P-450; Matthews DE et al.; The fungus Nectria haematococca, a pathogen of garden pea (Pisum sativum), can demethylate pisatin, an antimicrobial compound synthesized by infected pea tissue . The phenolic product is less toxic than pisatin to many microorganisms . Cell extracts catalyzing pisatin demethylation were obtained from N . haematococca, and the properties of the reaction were examined . The enzyme activity was greatest in the high-speed pellet fraction, in which rates up to 20 nmol/min/mg protein were observed . The Km for pisatin was relatively low, less than 5 microM . The reaction was dependent on NADPH, which could not be replaced by any other cofactor tested . However, in the presence of NADPH, NADH increased the rate of demethylation . Oxygen uptake by the enzyme was stimulated by addition of pisatin, the increment of oxygen utilization being approximately equimolar with pisatin added . Formaldehyde was a product of the reaction . The effects of various inhibitors were tested to determine whether this reaction is mediated by cytochrome P-450 . The respiratory inhibitors KCN (1 mM) and antimycin A strongly inhibited the demethylation of pisatin by intact cells of the fungus, but not by the NADPH-supplemented enzyme . The cytochrome P-450 inhibitors SKF 525-A and 1-(2-isopropylphenyl)imidazole inhibited demethylation both in whole cells and in the enzyme preparation, though the latter compound was effective only at high concentrations . Most other cytochrome P-450 inhibitors tested had little effect . However the reaction was quite sensitive to CO, and this inhibition was readily reversed by light at wavelengths near 450 nm . It is concluded that pisatin demethylase is a cytochrome P-450 monooxygenase.

Am J Vet Res, 1983 Jul, 44(7), 1378 - 81
Effect of C31G, an antimicrobial surfactant, on healing of incised guinea pig wounds; Michaels EB et al.; An anti-infective surfactant composition (C31G) promoted healing of infected and noninfected wounds in guinea pigs . In this animal model, histologic features of wounds treated topically with C31G revealed an increased rate of wound closure associated with decreased inflammatory response and increased C31G fibroblast infiltration and epithelialization . The effect of C31G on fibrin formation, the initial event of wound healing, was compared with effects of anionic and cationic surfactants that delay healing . The surfactants had different effects on clotting time, platelet activation, and cross-linkage of the stabilized clot . Seemingly, C31G increased the protein cross-linking of fibrin in clots containing fibronectin.

Am Rev Respir Dis, 1983 Jul, 128(1), 173 - 5
Melioidosis: recrudescence with a strain resistant to multiple antimicrobials; Shaefer CF et al.; We describe a recent case of melioidosis presenting classically in a young Vietnam veteran . The case demonstrates extensive antibiotic resistance in this isolate and failure of ceftriaxone, despite its in vitro efficacy . Other multiple antimicrobial regimens also failed . Melioidosis remains a concern in patients who have previously lived in endemic areas . A high level of diagnostic suspicion is required, especially in patients with a febrile illness or tuberculosis-like presentations . Early detection of Pseudomonas pseudomallei and rational treatment of adequate duration are critical in successful management.

J Exp Med, 1983 Jul 1, 158(1), 234 - 9
Lymphokine enhances oxygen-independent activity against intracellular pathogens; Murray HW et al.; To determine if mechanisms other than the generation of toxic oxygen intermediates are active against intracellular pathogens, oxidatively deficient mouse L cells and monocyte-derived macrophages from patients with chronic granulomatous disease were stimulated with soluble lymphocyte products . Despite no enhancement in oxidative activity, these cells displayed effective microbistatic activity against both T . gondii and C . psittaci . These results suggest a potential role for nonoxidative mechanisms in the mononuclear phagocyte's activity against intracellular pathogens, and indicate that lymphokines can regulate both oxygen-dependent and oxygen-independent antimicrobial responses.

Surg Gynecol Obstet, 1983 Jul, 157(1), 82 - 8
Topical therapy and the development of silver sulfadiazine; Fox CL Jr; Topical therapy is a selective approach to the prevention and treatment of infection in burns and other surgical wounds . Effective compounds possess certain chemical and physical properties . Prerequisites include low solubility, slow absorption, nonreactivity with wound exudates, proteins and ions and ability to achieve prolonged antimicrobial activity in the wound . These compounds yield much higher levels in the zone of infection than can be achieved by diffusion into the wound after systemic administration . The wide spectrum of antibacterial activity, the low toxicity, minimal tissue reaction, ease of application suggest that topical silver sulfadiazine therapy can safely be extended to other wound infections, wound covers and certain transplant materials.

J Lab Clin Med, 1983 Jul, 102(1), 78 - 87
Fluid spaces in normal and osteomyelitic canine bone; Quinlan WR et al.; When cortical bone is afflicted by an infectious process, significant alterations in the physiology and anatomy occur at the cellular level . Included in these alterations are modulations of the various fluid spaces of cortical bone . Volume of distribution studies with 14C-labeled sucrose and 99Tc-labeled red blood cells in an animal model of acute, subacute, and chronic osteomyelitis of the tibia were performed to quantitate the various fluid spaces in cortical bone . Additionally, the studies were performed in cortical bone from the radius and tibiae (following sham operations) to allow comparison with normal and control values . The total exchangeable water, vascular, and interstitial fluid spaces were increased in all three types of osteomyelitic bone . With one-way analysis of variance and Duncan's multiple range test, the alterations observed in each type of osteomyelitic bone (acute, subacute, or chronic) were statistically different from those observed in normal bone (p = 0.001) and controls (p less than or equal to 0.01) . The differences of the mean values observed among the three types of osteomyelitic bone were not statistically significant (p greater than 0.05) . These pathophysiologic alterations in osteomyelitic bone must be considered when one studies the ability of various antimicrobials to reach bactericidal concentrations in the interstitial fluid space, the primary site of drug-microorganism interaction.

Pediatr Med Chir, 1983 Jul-Aug, 5(4), 179 - 84
{Neonatal septic osteoarthritis}; Menchini M et al.; The Authors report their experience related to 15 cases of neonatal osteo-arthritis which have occurred in the last seven years in the neonatal intensive care unit . Besides the traditional clinical picture, it is stressed that neonatal osteo-arthritis has recently acquired new interest for an etiologic shift of the pathogens and for the availability of new antimicrobial agents . The rational antibiotic treatment and the role of the coordinated medical and orthopedic therapy have been essential for the benign clinical course and for the long-term prognosis . It is concluded that in order to reduce this serious disease it is necessary to avoid every potential risk factor, to operate in rigorous aseptic conditions and to improve the environmental conditions of the neonatal intensive care units.

J Infect, 1983 Jul, 7(1), 31 - 8
The value of initial laboratory investigations in the management of meningitis; Nye FJ; The results of cerebrospinal fluid (CSF) examination and other initial laboratory investigations have been analysed in one hundred and forty-nine patients with meningitis . The CSF differential leucocyte count clearly distinguished between bacterial and viral meningitis in 92 per cent of patients evaluated: CSF glucose and protein concentrations were less predictive by comparison . CSF glucose values were particularly unreliable because of hyperglycaemia in patients with bacterial meningitis and predictive accuracy increased when CSF levels were expressed as a percentage of blood glucose concentration . Results were not influenced by the age of the patients, and laboratory evidence of bacterial infection did not appear to be masked by prior antimicrobial therapy . A management algorithm based on the results of initial tests was applied retrospectively to the patients in whom Gram-stained CSF did not reveal bacteria . The algorithm indicated immediate antimicrobial therapy for all thirty patients with pyogenic infections, and for only one of sixty-three patients with a final diagnosis of viral meningitis.

Farmaco {Sci}, 1983 Jul, 38(7), 488 - 97
Synthesis of some 2- and 4-methoxyacetylaminobenzenesulphonylamino acid derivatives and their antimicrobial activity; El-Naggar AM et al.; The synthesis of a series of 3-acetylamino-4-methoxy-,2-acetylamino-4-methoxy- and 2-methoxy-5-acetylaminobenzenesulphonylamino acids, methyl esters, hydrazides and dipeptide methyl esters (IV-LXI) is described . Some o-, m- and p-anisidine and 2-aminopyridine derivatives have also been prepared by analogous procedure . Twenty of various by substituted acetylaminomethoxybenzenesulphonylamino acid and dipeptide derivatives were found to possess specific antimicrobial activities towards different microorganisms.

J Clin Periodontol, 1983 Jul, 10(4), 422 - 32
Antibiotic susceptibility testing of subgingival plaque samples; Walker CB et al.; The in vitro inhibitory effect of several antimicrobial agents was determined against dispensed dental plaque samples taken from periodontally diseased sites as an aid in the selection of antibiotics for adjunctive use in periodontal therapy . 2 groups of patients were sampled . 1 group of 10 patients with severely advanced disease had received periodontal treatment which included the frequent adjunctive use of an antibiotic . The second group consisted of 15 individuals with less severe periodontal disease; only 4 individuals had been previously treated with antibiotics for their periodontal disease . Bacterial samples of subgingival plaque were taken from each patient and tested against a battery of antibiotics to determine which agent was the most effective in suppressing bacterial growth . Each antibiotic was incorporated into Trypticase-soy blood agar at a concentration equivalent to that achieved in either gingival fluid or blood following recommended oral dosages . The inhibitory effect was determined by comparing the number of bacterial recovered on the antibiotic-containing medium to the total number of bacteria recovered on the basal medium . Penicillins, with the exception of cloxacillin, were the most effective in inhibiting bacterial growth . Benzylpenicillin consistently inhibited the growth of 90% of the isolates recovered on media free of antibiotics while ampicillin and amoxicillin frequently inhibited 99% or more of the bacteria recovered . Tetracycline was generally inhibitory for at least 90% of the isolates if the patients had not been previously treated with this agent . However, resistance to this drug was common in samples taken from patients previously treated with tetracycline . Doxycycline, a tetracycline derivative, did not inhibit significantly more isolates than tetracycline . Clindamycin was inhibitory for 90% or more of the organisms in most of the samples; and, was usually effective in inhibiting isolates in samples which exhibited large numbers of isolates resistant to tetracycline . Erythromycin was relatively ineffective against the isolates recovered from samples from the severely diseased group but was inhibitory to isolates in some samples taken from the more moderately diseased group . Metronidazole, at the concentration tested, was largely ineffective against the isolates in bacterial samples from both groups . No single antimicrobial agent was found to be inhibitory for greater than 90% of the bacteria recovered from all of the subgingival plaque samples with the possible exception of some penicillins.

Zentralbl Bakteriol Mikrobiol Hyg {A}, 1983 Jul, 255(1), 39 - 43
Heat treatment as an aid for the isolation of Legionella pneumophila from clinical and environmental samples; Groothuis DG et al.; The isolation of legionella's from clinical as well as environmental samples is hindered by the overgrowth of legionella's by the accompanying bacterial flora, which could not be sufficiently suppressed by adding antimicrobial drugs to the BCYA alpha . The effect of heat treatment on clinical samples and on water samples concentrated by filtration was investigated . Treatment of the samples for 30 minutes at 50 degrees C reduced the number of cfu of the accompanying flora by a factor 10(1.6)-10(3.9) depending on the number of contaminants, whereas the number of cfu of legionella was reduced only by a factor 1.05-1.44 . Higher or lower temperatures resulted in a too high reduction of the number of legionella's or an insufficient elimination of the accompanying flora respectively . The described method is less laborious and less critical than the earlier described low pH-treatment.

Mutat Res, 1983 Jul, 121(1), 53 - 7
The micronucleus test with mouse spleen cells; Shindo Y et al.; The results of this study show that the micronucleus test can be carried out with mouse spleen cells as well as with cells from bone marrow . Polychromatic erythrocytes occurred in the spleen at a frequency of about 9% of the whole spleen cells compared with about 13% in the bone marrow . 3 test compounds were used to compare the frequency of micronuclei in cells from the 2 tissues . Mitomycin C and cyclophosphamide induced micronucleated polychromatic erythrocytes in both spleen and bone marrow . Fosfomycin, an antibiotic having a broad spectrum of antimicrobial activities, did not induce micronucleated erythrocytes in either organ.

J Immunol, 1983 Jul, 131(1), 384 - 7
Suppression of macrophage antimicrobial activity by a tumor cell product; Szuro-Sudol A et al.; Medium conditioned by tumor cells (TCM) and certain nonmalignant cells contains a trypsin-sensitive factor that suppresses macrophage oxidative metabolism . Because the killing of intracellular pathogens such as Toxoplasma gondii and Leishmania donovani by macrophages is largely oxygen-dependent, we tested the effect of TCM on the antiprotozoal activity of mouse peritoneal macrophages . After 24 hr of cultivation with TCM, in vivo and in vitro activated macrophages could no longer kill toxoplasmas or inhibit their replication . In vivo administration of TCM resulted in similar impairment . The leishmanicidal activity of resident and activated macrophages, when measured 6 hr after infection, was markedly suppressed by in vitro exposure to TCM . The addition of exogenous H2O2 in the form of glucose-glucose oxidase reconstituted the capacity of TCM-exposed macrophages to kill L . donovani promastigotes as quickly as control cells . Thus, TCM appears to deactivate macrophages by the functional criteria of suppressed antitoxoplasmal and antileishmanial activity, as well as by the biochemical criterion of suppressed oxidative metabolism.

Vet Q, 1983 Jul, 5(3), 127 - 30
Keratoconjunctivitis infectiosa ovis (KIO), 'pink eye' or 'zere oogjes' (a survey); Konig CD; The occurrence of keratoconjunctivitis infectiosa ovis (KIO) in the Netherlands was reported by Hofland et al . in 1969 for the first time . At present the disease is well known in the Netherlands . Nevertheless there are still questions about the causative agent and the most effective and easiest therapy . Most authors suppose that the disease is caused by Colesiota conjunctivae, although others mention infections by other chlamydia, Mycoplasma conjunctivae, Mycoplasma ovipneumoniae, Acholeplasma oculi and a wide variety of bacteria . The diagnosis can be made on the basis of the symptoms and the detection of the agent in conjunctival scrapings . The bacilliform bodies can be found in conjunctival smears in the cytoplasm (Giemsa, Stamp) . Many therapies are used topically, parenterally or orally . Locally used eye-ointments must be effective against Colesiota; antimicrobial drugs administered by injection must be effective against the latter and also provide a sufficient cell tissue penetration with excretion into the lacrimal fluids . Injections have proved to be easier to administer, especially in serious outbreaks, but such outbreaks are exceptional (18) . Some therapies have been evaluated in small scale experiments (28) as well as in field trials (17).

J Nat Prod, 1983 Jul-Aug, 46(4), 532 - 6
Studies on iridoid-related compounds, II . The structure and antimicrobial activity of aglucones of galioside and gardenoside; Ishiguro K et al.; Enzymatic hydrolysis of galioside (1) and gardenoside (2), epimer of 1 at C-8 position, provided the antimicrobially active aglucone (3) and the inactive 6(a,b), while acid treatment of 2 gave scandoside methylester (8), deacetylasperulosidic acid methylester (9) and 10-dehydogeniposide (10).

J Clin Microbiol, 1983 Jul, 18(1), 43 - 8
Detection of bacteremia in patients receiving antimicrobial therapy: an evaluation of the antimicrobial removal device and 16B medium; Doern GV et al.; A total of 1097 blood specimens obtained from patients receiving antibacterial antimicrobial agents were processed by three blood culture systems: standard aerobic and anaerobic radiometric media, resin-containing radiometric medium (16B; Johnston Laboratories, Cockeysville, Md.), and aerobic and anaerobic radiometric media inoculated with blood processed in an Antimicrobial Removal Device (Marion Laboratories, Kansas City, Mo.) . A total of 73 cultures, representing 45 unique septic episodes, yielded 81 clinically significant organisms . Forty-six organisms (28 septic episodes) were recovered in standard radiometric medium . 16B medium yielded 63 organisms (37 septic episodes) . Sixty-nine organisms (42 septic episodes) were isolated from radiometric blood cultures inoculated with Antimicrobial Removal Device-processed blood . Contamination rates were not significantly different among the three systems . In comparison with standard radiometric blood cultures, the length of time to detection of positive blood cultures was shorter with both 16B medium and with Antimicrobial Removal Device-processed cultures . Comparison of the latter two systems suggested enhanced recovery of clinically significant organisms in radiometric blood cultures inoculated with blood processed in the Antimicrobial Removal Device . There was no difference in the length of time to detection of positive blood cultures.

Int J Clin Pharmacol Ther Toxicol, 1983 Jul, 21(7), 325 - 38
Chemotherapeutic agents: aspects of their activity on natural mechanisms of defense against infections; Fietta A et al.; This review summarizes the experience gained on interactions between antimicrobial agents and some reactions of the host defense system (adherence, chemotaxis, phagocytosis, microbicidal activity of leukocytes, complement system, antibody production, cell-mediated immunity) and attempts a critical evaluation . The data collected from the literature are often conflicting and there seem to be differences of behavior among derivatives belonging to the same family of antibiotics . Therefore it is quite difficult to draw a correct conclusion from these data . So far it has not been possible to understand the impact that the interference of antibiotics in natural and immunologic reactions of the host defense has on the outcome of chemotherapy, mainly in patients with some degree of immunodepression . In this instance, in fact, the interference with certain immunologic reactions could influence the therapeutic activity of specific antibiotics that are endowed with inhibitory activity . However, so far no controlled study or clear demonstration has shown that antibiotics with different activity on the immunologic reactions can have different efficacy in immunodepressed patients.

J Antimicrob Chemother, 1983 Jul, 12 Suppl A, 71 - 6
Perioperative use of ceftazidime as a prophylactic agent in transurethral surgery; Childs SJ et al.; Sixty-eight patients undergoing transurethral surgery were randomly assigned to receive either a single dose of ceftazidime (31 patients) preoperatively, or three doses of cefotaxime (34 patients) perioperatively, as prophylaxis . In this study, only 1/20 male patients (5%), and none of the female patients, developed an infection . We conclude that single-dose prophylaxis, with a safe, broad-spectrum antimicrobial, provides adequate protection against postoperative infection in genitourinary surgery.

J Clin Invest, 1983 Jul, 72(1), 32 - 44
Killing of intracellular Leishmania donovani by human mononuclear phagocytes . Evidence for oxygen-dependent and -independent leishmanicidal activity; Murray HW et al.; Human peripheral blood monocytes were cultivated for 1-30 d before assay for H2O2 release or challenge with Leishmania donovani promastigotes (LDP) or amastigotes (LDA) . 1-d cells readily generated H2O2 in response to both phorbol myristate acetate triggering (1,013 +/- 58 nmol/mg protein . 90 min) and LDP ingestion, and killed 50% of LDP within 6 h, and 90% by 24 h . In contrast, the same cells released little H2O2 during LDA ingestion, killed no LDA at 6 h and less than 30% by 24 h, and supported intracellular LDA replication . Monocyte-derived macrophages (cells first cultivated for greater than or equal to 7 d) generated less than 125 nmol H2O2/mg . 90 min after phorbol myristate acetate triggering, killed neither LDP nor LDA, and permitted both forms to replicate . The addition of mitogen- or antigen-stimulated lymphokines, however, prevented the decline in monocyte oxidative capacity, enhanced macrophage H2O2 release by more than sixfold, and, in parallel, induced 1-d monocytes to kill LDA and cultivated macrophages to display both promastigocidal and amastigocidal activity . In comparison to 1-d monocytes and lymphokine-activated macrophages from normal donors, the same cells from patients with chronic granulomatous disease (CGD) or normal cells whose oxidative activity had been impaired by catalase pretreatment or glucose deprivation exerted considerably less or no antileishmanial activity during the early (6-24 h) postphagocytic period . By 48 h after infection, however, 1-d CGD monocytes and oxidatively impaired normal cells killed 40 and greater than 80% of LDP, respectively . Although a longer period of lymphokine stimulation was required and the resulting antileishmanial effects were not as rapid as with normal cells, activated CGD monocytes and macrophages also eventually achieved promastigocidal and amastigostatic activity . These results indicate that human mononuclear phagocytes utilize both oxygen-dependent and -independent mechanisms to achieve activity against ingested Leishmania, and also demonstrate (a) the differential susceptibilities of the two forms of L . donovani to intracellular killing, (b) the key role of oxygen intermediates in effective mononuclear phagocyte antimicrobial activity, (c) the capacity of lymphocyte products to enhance oxygen-dependent as well as -independent pathways, and (d) the vulnerability of the monocyte-derived macrophage to Leishmania infection in the absence of lymphokine stimulation.

J Dent Res, 1983 Jul, 62(7), 837 - 41
A comparison of antimicrobial activity of four disclosant dyes; Baab DA et al.; Four disclosant dyes were tested for antimicrobial activity against 27 oral reference strains and five non-oral human pathogens . Erythrosine and fluorescein inhibited most gram-positive and gram-negative organisms associated with dental plaque, and were bactericidal to selected strains . Fast green and brilliant blue demonstrated little antimicrobial activity.

Vet Q, 1983 Jul, 5(3), 122 - 7
'Pink eye' or 'zere oogjes' or keratoconjunctivitis infectiosa ovis (KIO) . Clinical efficacy of a number of antimicrobial therapies; Konig CD; In a comparative study the clinical efficacy of five different treatments of keratoconjunctivitis infectiosa ovis (KIO) were tested, namely an intramuscular injection of chloramphenicol base (dosage 15 mg/kg), spiramycin base (Suanovil dosages 10 to 25 mg/kg), oxytetracycline (Engemycine Forte, Terramycin LA, dosages respectively 5 and 10 mg/kg), tiamulin (Dynamutulin, dosage 10 mg/kg) and subcutaneous injection of procaine penicillin G, benzathine penicillin G . and dihydrostreptomycin in the lower eyelid . It appeared from these field trials that spiramycin base, oxytetracycline and tiamulin had a clearly positive effect on the clinical course of 'pink eye', although with tiamulin there was only a temporary effect (high percentage of relapses) . In view of the field data the following dosage schemes are, for the time being, advised: spiramycin base (Suanovil), and oxytetracycline (formulation with a good biological availability) both 20 to 30 mg/kg and, if necessary, to be repeated on days 5 and 10 after the first intramuscular injection . The dosage scheme advised for tiamulin is 20-30 mg/kg to be repeated on day 3 and if necessary on days 6 and 9 after the intramuscular injection . In mild cases it is sufficient to rub the eyes with for example oxytetracycline eye-ointment, a few times a day.

J Antibiot (Tokyo), 1983 Jun, 36(6), 684 - 7
M-9337, a new antistreptolysin, produced by Streptomyces sp; Miyamura S et al.; A new biologically active substance, M-9337, was obtained from Streptomyces strain M-9337, a soil isolate . The producing organism was subsequently determined to be a new strain and named Streptomyces antihaemolyticus M-9337 . The active substance was prepared as white yellow powder from culture broth by solvent extraction and silica gel thin-layer chromatography . It showed no antimicrobial activity and potent inhibitory activity against streptolysin, a type of hemolysin.

Am J Hosp Pharm, 1983 Jun, 40(6), 995 - 7
Therapeutic use of restricted antibacterials in Czechoslovakia; Krcmery V et al.; The therapeutic use of restricted antibacterials in Czechoslovakia was studied . Data from 10 hospitals were collected over one year for approximately 10,000 therapeutic applications of eight restricted antibacterials to 8411 patients . The drugs monitored were oxacillin, kanamycin, gentamicin, carbenicillin, co-trimoxazole, colistin, cephalosporins, and lincomycin/clindamycin . Eighty-nine percent of the patients received the restricted antibacterials for therapeutic (rather than prophylactic) purposes . Approximately 16% of these patients received two or more of the drugs, and many of them received nonrestricted antibacterials concurrently . Patients on pediatric, newborn, and prematurely born wards received 55% of the restricted antimicrobials, where oxacillin and gentamicin were used most frequently . Therapy with these drugs was initiated without regard to bacteriological examination for causal bacteria and susceptibility in 7% of all cases, causal bacteria were not reported in an additional 10%, bacterial susceptibility was not determined in another 29%, therapy was administered in 7% of cases in which the bacteria were known not to be susceptible, and confirming susceptibility results were known in advance of therapy in only 30% of the cases . The restricted antibacterials were overused and were frequently prescribed for patients who may not have needed antibacterial therapy at all.

Obstet Gynecol, 1983 Jun, 61(6), 723 - 7
Serum gentamicin levels in patients with post-cesarean endomyometritis; Duff P et al.; Serum gentamicin levels were measured by agar diffusion bioassay in 38 patients undergoing treatment with clindamycin-gentamicin for post-cesarean endomyometritis . Patients received intravenous gentamicin in a dose of 1 mg/kg actual body weight every eight hours . All trough levels were less than 1 microgram/ml . The mean 30-minute postinfusion level was 5.78 +/- 2.43 micrograms/ml (mean +/- SD) . The range of postinfusion concentrations was 1 to 12 micrograms/ml . Postinfusion concentrations were less than 5 micrograms/ml in 13 patients, but none of these individuals experienced a clinical failure of antimicrobial therapy . There were no statistically significant differences in mean age, weight, hematocrit, serum creatinine, estimated creatinine clearance, or administered dose in patients with therapeutic gentamicin levels and patients with apparent subtherapeutic levels . The authors conclude that postinfusion gentamicin concentrations fluctuate widely in obstetric patients receiving 1 mg/kg/dose and that apparent subtherapeutic postinfusion levels still may be clinically efficacious, depending upon the antimicrobial susceptibility of the infecting microorganisms.

Antimicrob Agents Chemother, 1983 Jun, 23(6), 897 - 901
Comparison of the nephrotoxicity and auditory toxicity of tobramycin and amikacin; Gatell JM et al.; A total of 157 patients were treated with tobramycin or amikacin in a controlled prospective randomized trial . Dosages were adjusted to renal function according to a nomogram . Trough and peak aminoglycoside levels were available at the end of the trial . Of the above total, 113 recipients of nine or more doses of tobramycin or six or more doses of amikacin, without other apparent cause of renal failure, were evaluated for nephrotoxicity . Thirty-six patients were evaluated for auditory toxicity . The patients in groups evaluated for either nephrotoxicity or auditory toxicity were similar with respect to intensity and etiology of bacterial disease, concurrent exposure to other antimicrobial drugs, age and sex distribution, initial serum creatinine level, and total dose and duration of antimicrobial therapy . Nephrotoxicity of similar severity developed in 4 of 59 (6.8%) recipients of tobramycin and in 7 of 54 (13.1%) recipients of amikacin (P greater than 0.05) . Mild auditory toxicity developed in 3 of 19 (15.7%) recipients of tobramycin and in 2 of 17 (11.7%) recipients of amikacin (P greater than 0.05) . When patients with abnormally high mean trough or peak aminoglycoside levels were excluded from comparison, nephrotoxicity was 6.12 and 5.12% (P greater than 0.05) and auditory toxicity was 17.6 and 7.69% (P greater than 0.05) in the groups given tobramycin and amikacin, respectively . We conclude that the nephrotoxicity and auditory toxicity of amikacin and tobramycin are not significantly different and that such toxicities are indeed infrequent events when the dosages of these drugs are adjusted to hold blood levels within the safe boundaries suggested by the studies of others.

South Med J, 1983 Jun, 76(6), 800 - 3
Atypical Pneumocystis carinii pneumonia: the potential hazards of empiric treatment; Peters JW et al.; Pneumocystis carinii pneumonia occurred in two patients with unusual clinical findings . In one case, P carinii infection was diagnosed for the first time in a patient with Crohn's disease . Due to the lack of typical features in both cases an empiric trial of antimicrobial therapy could have delayed diagnosis and initiation of specific treatment for P carinii . Contrariwise, without histologic confirmation, specific therapy for P carinii pneumonia might have been mistakenly discontinued in the second patient . Empiric therapy with trimethoprim-sulfamethoxazole may cause rapid disappearance of P carinii cysts from pulmonary tissues and cause subsequent biopsies to be falsely negative in patients who fail to respond to treatment.

J Appl Bacteriol, 1983 Jun, 54(3), 417 - 23
The bactericidal, fungicidal and sporicidal properties of hydrogen peroxide and peracetic acid; Baldry MG; The antimicrobial properties of aqueous solutions of peracetic acid and hydrogen peroxide have been compared . Peracetic acid exhibited excellent antimicrobial properties, especially under acidic conditions . Reductions by a factor of 10(6) in the numbers of vegetative bacteria are obtained within 1 min at 25 degrees C using a solution containing 1.3 mmol/l of peracetic acid . Rapid activity against bacterial spores and yeasts also occurs . Hydrogen peroxide is more effective as a sporicide than as a bactericide, with sporicidal action being obtained using a solution containing 0.88 mol/l . Bactericidal action is poor but hydrogen peroxide was bacteriostatic at concentrations above 0.15 mmol/l.

Am J Vet Res, 1983 Jun, 44(6), 1154 - 8
In vitro action of combinations of antimicrobial agents and EDTA-tromethamine on Escherichia coli; Wooley RE et al.; Combinations of EDTA-tromethamine and 7 antimicrobial agents {chloramphenicol, nalidixic acid, oxytetracycline, penicillin, polymyxin B, streptomycin, and triple sulfa (sulfamethazine, sulfapyridine, and sulfathiazole}) were tested for synergistic activities against Escherichia coli . Three in vitro tests were used including minimal inhibitory concentrations of the drugs, a 2-dimensional microtiter checkerboard technique, and bacterial inhibition studies . A strong synergistic inhibitory action was observed with combinations of EDTA-tromethamine plus penicillin and EDTA-tromethamine plus oxytetracycline . Combinations of EDTA-tromethamine plus chloramphenicol also had a synergistic action, but to a lesser extent than that with penicillin and oxytetracycline . When streptomycin or nalidixic acid was mixed with EDTA-tromethamine, a slight synergistic action was noticed . There was no synergistic effect recorded with combinations of EDTA-tromethamine and triple sulfa . Combinations of EDTA-tromethamine and polymyxin B had an antagonistic effect.

Quad Sclavo Diagn, 1983 Jun, 19(2), 176 - 91
{Comparison of AMS and MS-2 in the identification and antibiotic sensitivity of clinically isolated bacterial strains}; Chiaradia V et al.; 282 clinical bacterial strains have been identified with AMS and MS-2 . Among biochemical tests only lysine, adhonitol , glucose did not show significant differences . The overall correlation has been 86.3% . The results of the susceptibility to antimicrobial agents on 98 bacterial strains revealed an overall agreement of 79.3%, an essential agreement of 91%.

Pediatr Ann, 1983 Jun, 12(6), 445 - 9
Management of infections; Whitley RJ et al.; Over the last decade, significant advances have been made in the management of bacterial and viral infections in the immunocompromised host . These advances have been achieved through carefully performed studies, addressing the need for early antimicrobial therapy . The utilization of the empiric antibacterial therapy has prompted a significant decrease in mortality and morbidity from life-threatening bacterial infections in the immunocompromised patients . Similarly, the development of antivirals for therapy of herpes virus infections in man is significantly changing our ability to improve survival in children who suffer from chickenpox and progressive herpes simplex virus infections . The future demands improved anti-bacterial agents as well as methods of prevention of viral infections in the immunosuppressed host . These latter avenues will take the form of live attenuated viral vaccines.

Ophthalmic Surg, 1983 Jun, 14(6), 502 - 5
Nocardia asteroides endophthalmitis; Chen CJ; A case of exogenous Nocardia asteroides endophthalmitis with impending corneal perforation was diagnosed by culture and successfully treated with vitrectomy, penetrating keratoplasty, and intraocular, topical, and systemic antimicrobial therapy . The patient regained excellent vision.

J Infect Dis, 1983 Jun, 147(6), 1006 - 10
Expression of cell-mediated antimicrobial immunity by mouse trophoblast monolayers; Pavia CS; Monolayers of mouse trophoblast cells were produced after short-term culture (two to four days) of ectoplacental cone cells derived from 7.5-day-old mouse conceptuses and were then tested for phagocytic activity . Following brief intervals of coincubation with the blood stage form of Plasmodium berghei, the parasite that causes rodent malaria, cultured trophoblast cells were found to phagocytose large amounts of parasitic material . In a manner similar to that of peritoneal macrophages, trophoblast cells ingested predominantly hemozoin pigment granules, while internalization of nonparasitized red blood cells occurred infrequently . Trophoblast-mediated phagocytosis was sensitive to the inhibitory effects of cytochalasin B . The expression of this form of immunelike function by midstage trophoblastic elements may play an important role during embryogenesis by protecting the fetoplacental unit from injury by invading microorganisms or by limiting congenitally acquired infections.

Antimicrob Agents Chemother, 1983 Jun, 23(6), 870 - 3
Ceftriaxone distribution between maternal blood and fetal blood and tissues at parturition and between blood and milk postpartum; Kafetzis DA et al.; The penetration of ceftriaxone into the fetus at parturition was studied in 17 subjects . Despite its high protein binding, ceftriaxone quickly reached the umbilical cord blood, amniotic fluid, and placenta, achieving substantial concentrations, which then disappeared, with elimination half-lives of approximately 6 h, identical to that of the mother . The elimination half-life of ceftriaxone of 5 to 6 h in these mothers was somewhat shorter than that reported for normal subjects . The concentrations of ceftriaxone achieved in fetal tissues were sufficient for therapeutic effects . The penetration of ceftriaxone into milk was studied 3 days postpartum in 20 other patients . This antimicrobial agent entered breast milk rapidly and disappeared with a half-life of 12 to 17 h . The concentrations achieved were only 3 to 4% of those in maternal serum and were most likely of little clinical relevance.

Pathol Biol (Paris), 1983 Jun, 31(6), 501 - 3
{Comparative in vitro effect of 7 quinolones on Ureaplasma urealyticum}; Cantet P et al.; Some new quinolones may be used for the treatment of gonococcal urethritis . U . urealyticum is considered as a potential agent of urethritis . This report describes the in vitro antimicrobial activity of seven quinolones against 45 clinical isolates of U . urealyticum . The MIC's geometric mean is (microgram/ml): rosoxacin (1,74), pefloxacin (4,6), oxolinic acid (9), flumequin (12,12), norfloxacin (15,75), nalidixic acid (27) . Pipemidic acid is constantly inactive (greater than 128 micrograms/ml) . The results of these susceptibility studies provide support for undertaking clinical evaluations of new quinolones against infections with U . urealyticum.

J Exp Med, 1983 Jun 1, 157(6), 1780 - 93
Interferonlike factors from antigen- and mitogen-stimulated human leukocytes with antirickettsial and cytolytic actions on Rickettsia prowazekii . Infected human endothelial cells, fibroblasts, and macrophages; Wisseman CL Jr et al.; Unique features of the primary site of rickettsial replication in typhus fevers, i.e., within the endothelial cells of small blood vessels in tissues, suggest that effector mechanisms, other than those dependent on phagocytosis by activated macrophages with enhanced microbicidal properties, most likely are necessary to explain the cell-mediated immune control of intracellular rickettsial replication in these sites . Theoretically, such mechanisms might involve contact between infected endothelial cells and activated T lymphocyte subpopulations or macrophages or immunologically induced soluble factors or lymphokines . Support for the existence of at least one of these alternative effector mechanisms is presented here for Rickettsia prowazekii . Cultures of human blood leukocytes, upon immunologically specific stimulation with R . prowazekii antigen or nonspecific stimulation with the mitogen phytohemagglutinin, produce soluble factor(s) in the supernatant fluid which, in culture, have (a) an intracellular antirickettsial action on R . prowazekii-infected human endothelial cells, fibroblasts, and macrophages, and (b) a specific cytolytic action on R . prowazekii-infected, but not uninfected bystander, human fibroblasts . Neither action is demonstrable in R . prowazekii-infected chicken embryo fibroblasts . The factor(s) has no direct antimicrobial action on extracellular rickettsiae and is inactivated by heating at 56 degree C for 1 h or by acid treatment at pH 2 . Expression of the antirickettsial action requires new host cell messenger transcription and protein synthesis, whereas the cytolytic action does not . The circumstances of production and action and the properties of the factor(s) responsible for the intracellular antirickettsial, and perhaps also the cytolytic action are consistent with those of immune interferon (IFN-gamma).

Hosp Formul, 1983 Jun, 18(6), 625 - 8, 631-5, 638
Drug usage in newborn intensive care units; Russell WL et al.; A national survey of neonatal intensive care units (NICUs) was undertaken to obtain information concerning drug usage, dosages, methods of administration, incidence of drug-induced phlebitis, and drug reference sources . Antimicrobial agents are the most frequently used drugs in NICUs . Dosages reported by NICUs generally agreed with dosage recommendations by the manufacturer and literature citations . A 10% estimate of phlebitis was the consensus report by NICUs . Calcium gluconate was implicated most often as causing phlebitis, and most NICUs reported that drugs are not mixed with hyperalimentation solutions . The Pharmacy and Therapeutic Committee should review drug dosages in neonates and establish policies for intravenous drug administration methods and rates to ensure uniform initial doses and to provide a consensus among clinicians using these medications.

Acta Chir Belg, 1983 May-Jun, 82(3), 222 - 6
{Appendicitis in children}; Hoekman P et al.; In 218 children of less than 16 years old appendectomy was performed . Presence of appendicitis was confirmed histologically in 199 cases . The ratio boys to girls was two to one . In one third the appendix had perforated . Administration of a combined Ampicillin-Metronidazole antimicrobial therapy, started during surgery, proved to be very efficacious in avoiding infectious complications . In this group the complication rate remained below 3%.

J Antimicrob Chemother, 1983 May, 11(5), 413 - 8
Susceptibility of Chlamydia psittaci (ovis) to antimicrobial agents; Johnson FW et al.; Minimum inhibitory (MIC) and minimal lethal (MLC) concentrations of 30 antimicrobial agents were determined for field strains and for the A22 EAE vaccine strain of Chlamydia psittaci (ovis) . No differences in susceptibility could be detected between strains . The antimicrobials could be divided into four groups . Group A had no effect on growth and development, Group B were bacteriostatic at concentrations in excess of 100 mg/l, Group C were bacteriostatic at concentrations of 10 mg/l or less but were bactericidal at concentrations above 10 mg/l and Group D were bactericidal at concentrations above 0.5 mg/l . The value of antimicrobials in aiding diagnosis and in the therapy of chlamydial abortion of ewes is discussed.

Contact Dermatitis, 1983 May, 9(3), 186 - 9
Is Cytox 3522 (10% methylene-bis-thiocyanate) a human skin sensitizer?
Andersen KE, Hamann K.
Methylene-bis-thiocyanate is an antimicrobial agent in Cytox 3522 (American Cyanamid Corporation) and Nalco 206 (Nalco Chemical Company) . Both are wide-spectrum industrial biocides . Cytox 3522 showed a strong sensitization potential in guineau pigs using the Guinea Pig Maximization Test and the Open Epicutaneous Test procedures . In spite of this, human sensitization has not been reported . This may be explained by several factors such as limited exposure, low-use concentration and a lack of diagnostic patch tests in selected patients.

Am J Pathol, 1983 May, 111(2), 224 - 33
Clinical and pathologic features of cyclic hematopoiesis in grey collie dogs; DiGiacomo RF et al.; Clinical and pathologic features of cyclic hematopoiesis in 18 grey collie dogs, aged 10 to 113 weeks, were reviewed . The dogs were grouped according to weeks of age: 10-16 (I), 17-21 (II), 30-35 (III), and less than 52 (IV) . Clinical illness occurring during each hematopoietic cycle was classified as none, mild, moderate, or severe, based on the neutrophil count, rectal temperature, clinical signs, and use of antimicrobial therapy . The dogs in Groups I, III, and IV had severe infections episodes during one-fourth of all hematopoietic cycles; whereas the dogs in Group II had severe infections during two-thirds of cycles . However, during the cycle prior to death, all groups were similar, each having two-thirds of clinical syndromes classified as severe and one-third as mild . More dogs died during the neutropenic phase of the hematopoietic cycle than during the nonneutropenic phase . Pathologic findings showed distinct patterns in relation to age . Younger dogs showed evidence of acute infectious processes, especially in the lungs, gastrointestinal tract, and kidneys; whereas older dogs had chronic inflammatory changes in those organs . Amyloidosis was a prominent finding in dogs over 30 weeks of age . These findings indicate that predictable age-related changes in tissues of grey collie dogs impair various organ systems and thereby contribute to morbidity and mortality in older dogs . consequently, future clinical and pathologic studies of grey collies should take into consideration the age of the dogs under study.

J Med Microbiol, 1983 May, 16(2), 175 - 82
Characteristics of motile curved rods in vaginal secretions; Sprott MS et al.; Motile curved rods seen in vaginal secretions have been isolated on Columbia agar supplemented with 5% human blood and vitamin K . Growth occurred anaerobically and in 5% oxygen but not in more aerobic conditions . There were two distinct groups of these organisms, distinguishable by morphology, biochemical activity and susceptibility to metronidazole . All isolates were sensitive to a wide range of antimicrobial agents, with the exception of nalidixic acid and polymyxin, but one group was resistant to metronidazole . There was little difference between the results of tests of susceptibility to aminoglycosides or to metronidazole performed in anaerobic and microaerophilic conditions . Motile curved rods were isolated from 18 of 80 patients with a clinical diagnosis of non-specific vaginitis, but from only two of 39 without the disease.

Pathol Biol (Paris), 1983 May, 31(5), 370 - 4
{Focus and value of the assay of 5 beta-lactams using high-performance liquid chromatography}; Jehl F et al.; Severe infectious diseases treatment often needs a frequent antimicrobial agent blood levels control . These controls are still performed by microbiological assay procedure . High performance liquid chromatography (HPLC) is now allowing a new kind of assay procedure and improves on speed, specificity and sensitivity . We developed a procedure allowing us to monitor every day by routine, five beta-lactam antibiotics with only one analytical column: benzylpenicillin, ampicillin, cloxacillin, mezlocillin and cefotaxime . A single extraction procedure suitable to the five beta-lactam antibiotics and to various body fluids and the use of three mobile phases, permit us to give a quick answer to the clinicians and thus to consider a rapid adaptation of the doses being administered . In consideration of the specificity, it is possible to control blood levels of each beta-lactam antibiotic even by associated antimicrobial treatment, what is sometimes impossible using the microbiological assay procedure . Cefotaxime is well separated from its active metabolite desacetyl-cefotaxime . The disparity of the levels obtained, for the same posology, essentially by prematures and new-borns, but also in case of massive infusions for endocarditis justify the use of a rapid and specific procedure like high performance liquid chromatography (HPLC).

Experientia, 1983 Apr 15, 39(4), 386 - 7
Peroxidase activity and thiocyanate accumulation in salivary glands; Bratt P et al.; Salivary glands with high, low, or no peroxidase activity do not differ in {S14CN-} after the i.v . injection of KS14CN, nor do the glands differ from blood and muscle in {S14CN-} . The content of SCN- in a salivary gland does not mirror the gland's participation in the peroxidase-mediated antimicrobial mechanism.

Clin Obstet Gynaecol, 1983 Apr, 10(1), 93 - 103
Pathophysiology of abscess formation; Bieluch VM et al.; Clinical and experimental data provide evidence for interactions between aerobic and anaerobic organisms in abscess formation . The organisms present represent a subset of those normally found at nearby mucosal surfaces . Certain organisms, most notably B . fragilis, emerge from the normal flora as important in abscess formation . Suspected virulence factors for B . fragilis include oxygen tolerance, capsular polysaccharide and the other enzymes produced by this organism . Other factors, as yet incompletely understood, probably play a role . In addition, the large number of organisms present in an abscess, the presence of antibiotic inactivating enzymes, the hostility of the anaerobic environment to antimicrobial activity and host defences, as well as the fibrous capsule surrounding an abscess, contribute to the persistence of infection despite antibiotic therapy and the need for drainage . The contribution of both aerobic and anaerobic organisms in the formation of abscesses must be remembered when one chooses antibiotic therapy for such infections.

Antimicrob Agents Chemother, 1983 Apr, 23(4), 531 - 5
Relationship between structure and antiplaque and antimicrobial activities for a series of bispyridines; Slee AM et al.; A series of bispyridines were examined for their bactericidal activities against in vitro, preformed, pure-culture plaques of selected oral plaque-forming bacteria . The antimicrobial activities of these agents were examined in relation to their molecular configurations . These studies demonstrated that the length of the interpyridine polymethylene group bridge and the length of the alkyl side chain were important determinants of antiplaque and antimicrobial efficacy . The most potent compounds of the bispyridine series were studied to determine the minimal conditions (concentration, duration, and frequency) of treatment required for likely clinical efficacy.

J Infect Dis, 1983 Apr, 147(4), 615 - 23
Selective antimicrobial modulation of the intestinal flora of patients with acute nonlymphocytic leukemia: a double-blind, placebo-controlled study; Guiot HF et al.; Thirty-three patients with acute nonlymphocytic leukemia were studied during remission-induction treatment in a double-blind, placebo-controlled, randomized study to ascertain the effect on the incidence of infection of an oral regimen of selective antimicrobial modulation (SAM) . A decrease in the number of major acquired infections was observed: three infections occurred in 16 patients receiving the SAM regimen compared with eight infections in 17 patients given the placebo . The reduction of infection was correlated with a reduction of fever, with a reduction of the frequency of administration of antimicrobial agents for the treatment of infection, and with the selective elimination of aerobic and facultative anaerobic gram-negative rods from the digestive tract . Substantial unfavorable side effects were not observed.

Mayo Clin Proc, 1983 Apr, 58(4), 246 - 8
Antimicrobial agents in patients with renal insufficiency; Van Scoy RE et al.; The dosage or the time interval of administration (or both) of many antimicrobial agents must be adjusted in anephric patients or those with compromised renal function . Antimicrobial agents that must be adjusted include most but not all of the penicillins, the cephalosporins, the aminoglycosides, vancomycin, and trimethoprim-sulfamethoxazole . The maximal doses of these agents should be decreased in proportion to the reduction of renal function . The dosage of chloramphenicol, clindamycin, rifampin, oxacillin, and nafcillin probably need not be adjusted if hepatic function is essentially normal . The suggested doses are relatively crude guidelines to initial antimicrobial therapy . Administration of the initial dose should be followed by serum antimicrobial assays for accurate adjustment of the dosage . The efficacy of therapy and the possible occurrence of toxicity should be carefully monitored in all patients but particularly in those with renal insufficiency.

Mayo Clin Proc, 1983 Apr, 58(4), 241 - 5
Prophylactic use of antimicrobial agents; Van Scoy RE et al.; A major shortcoming in many studies of prophylactic antimicrobial agents has been lack of adequate evaluation of potential advantages and disadvantages in prospective double-blind investigations . Recent data demonstrated that certain bowel preparations given orally and antimicrobial agents applied topically or given parenterally prevent postoperative infections . Several studies have shown that if topically and parenterally administered antimicrobial agents are used, they should be given only during the surgical procedure . Antimicrobial therapy initiated after an operation is generally not indicated for prophylaxis and, in fact, increases the potential disadvantages of prophylaxis . There is no evidence that combinations of orally, topically, and parenterally administered antimicrobial agents reduce infection rates below those achieved by the use of any one route of prophylactic antimicrobial administration.

J Infect Dis, 1983 Apr, 147(4), 758 - 64
Spectrophotometric assessment of dose-response curves for single antimicrobial agents and antimicrobial combinations; King TC et al.; The activity of single antimicrobial agents and antimicrobial combinations was examined by measuring their effects on the growth rate constant of a test strain of Escherichia coli . This spectrophotometric method provides a kinetic view of antimicrobial action and is sufficiently precise to define dose-response curves, in contrast to standard methods such as broth or agar dilution testing, which are static and measure only all-or-none responses . The results demonstrate that dose-response curves for single antimicrobial agents are logarithmic (rather than linear) and that the effects of antimicrobial combinations may be exquisitely concentration dependent . Although the results for some antimicrobial combinations were similar with the spectrophotometric and checkerboard methods, other combinations produced different results in the two systems . Additional studies will be necessary to determine whether one or the other of these methods more accurately predicts clinical outcome.

J Hyg (Lond), 1983 Apr, 90(2), 195 - 8
Drug resistance among Escherichia coli strains isolated from cerebrospinal fluid; Gross RJ et al.; One hundred and thirty-one strains of Escherichia coli isolated from the cerebrospinal fluid of patients in the United Kingdom were tested for resistance to 13 antimicrobial drugs . Sixty-four strains (49%) were resistant to one or more drugs and 44 (34%) were resistant to three or more drugs . Resistance to ampicillin, sulphonamides, streptomycin and tetracycline occurred most frequently.

Can J Comp Med, 1983 Apr, 47(2), 101 - 7
A mail survey of factors associated with morbidity and mortality in feedlot calves in southwestern Ontario; Hutchings DL et al.; The design and results of a mail survey of a simple random sample of southwestern Ontario feedlot owners are presented . The survey provided general data about management of feedlot calves and the association between a number of factors and disease and/or death rates . The number of calves purchased was related positively, in a linear manner, to mortality and morbidity rates . Increased levels of morbidity and mortality were noted when the ration was changed to corn silage from dry-hay within the first month after arrival . However, it was not clear whether the ration changes preceded or followed increased rates of morbidity and mortality . Prophylactic levels of antimicrobials in the water supply were associated with increased death losses . Shipping cattle by truck, rather than train, was associated with decreased rates of disease . Processing factors, including using vaccines against respiratory disease, were not associated significantly with mortality or morbidity . It was concluded that reducing the number of calves, to approximately 100 per group, not changing the ration to silage within the first month and not using antibiotics in the water supply on arrival could significantly reduce disease and death losses.

Pharmazie, 1983 Mar, 38(3), 172 - 3
Syntheses of some 4,4'-biphenylenedihydrazone-3-(3-methyl)-2-pyrazolin-4,5-dione derivatives and their antimicrobial potentialities; Metwally MA et al.; A new series of bispyrazolones were obtained upon treating the bishydrazone derivative 1 with dimethylsulphate, acetic anhydride, benzenesulphonyl chloride, piperidine, morpholine, N-methylaniline and formaldehyde respectively . A Mannich base was prepared from the interaction of 4-phenylhydrazone-3-methyl-2-pyrazolin-5-one and n-butylamine . The condensation of an N-hydroxy methyl derivative with ethyl acetoacetate and diethyl malonate led to the formation of the corresponding N-methyl derivatives . Some of the new bispyrazolones were screened to test their antimicrobial potentialities against Fusarium oxysporum fsp . hycopersici.

Farmaco {Sci}, 1983 Mar, 28(3), 167 - 72
{Hydrazines containing 1H-indene units}; Ferranti A et al.; Some derivatives of N'-(5-nitro-2-furoyl)-N2-(3-chloro-1H-indenyl-2-methylene)hydrazine (I) were synthesized and screened for in vitro antimicrobial activity . None was more active than the parent compound and the greater hydrophilic character was associated with loss of inhibitory activity against gram-negative bacteria.

Antimicrob Agents Chemother, 1983 Mar, 23(3), 440 - 9
Inhibition of lysosomal phospholipases by aminoglycoside antibiotics: in vitro comparative studies; Carlier MB et al.; Aminoglycoside antibiotics induce an early and characteristic lysosomal phospholipidosis in cultured fibroblasts and in kidney tubular cells . We have recently demonstrated an inhibition of lysosomal phospholipases A1 and A2 by gentamicin and amikacin in vitro . In vivo, gentamicin decreases the activity of phospholipase A1 (Laurent et al., Biochem . Pharmacol . 31:3861-3870, 1982) . In the present study, we examined 14 aminoglycosides for in vitro inhibition of phospholipases . To mimic the situation prevailing in lysosomes, the enzymatic activities were assayed with phospholipid vesicles (liposomes) with a composition similar to that of lysosomal phospholipids (phosphatidylcholine, sphingomyelin, phosphatidylinositol, cholesterol; 4:4:3:5.5, molar ratio) . We measured the hydrolysis of 1-palmitoyl-2-{1-14C}oleoyl phosphatidylcholine contained in the liposomes by a soluble fraction of highly purified lysosomes isolated from rat liver . Similar IC50S (concentrations causing 50% inhibition of enzymatic activity) were observed for dibekacin, gentamicin (with no major difference between C1, C1a, or C2), netilmicin, tobramycin, and kanamycin B . Sisomicin was slightly more inhibitory . Kanamycin A, N1-(L-4-amino-2-hydroxy-1-oxobutyl)dibekacin, and amikacin showed increasing IC50S . Streptomycin caused the least inhibition . Octa- and tetramethylkanamycin A are much less inhibitory than the parent drug . These results point to the number, the nature, and the respective positions of the cationic groups as essential determinants in causing inhibition of phospholipid breakdown . The binding of three aminoglycosides (gentamicin, amikacin, streptomycin) to the liposomes at pH 5.4 was also measured by gel permeation and was found to be related to the respective inhibitory potency of each drug . Insofar as lysosomal phospholipidosis is an early sign of intoxication by aminoglycosides, these results may serve as a basis for the development or screening of less toxic compounds in this class of antimicrobial agents.

Rev Infect Dis, 1983 Mar-Apr, 5 Suppl 1, S98 - 104
Selection of antimicrobial agents for treatment of infections of the female genital tract; Ledger WJ; Evaluation of the treatment of 501 patients with pelvic infections and a review of the literature indicate that prospects for clinical cure without surgical intervention are markedly better in women seen early in the course of infection than in those with well-established infections . Among hospitalized patients with early infections, treatment regimens of less than 10 days duration were successful . Traditional therapies (initial treatment with ampicillin, a first-generation cephalosporin, or a combination of penicillin and aminoglycoside, penicillin and tetracycline, or a cephalosporin and an aminoglycoside, followed by clindamycin or chloramphenicol if the patient remained febrile) were compared with new antibiotic regimens (initial treatment with second- or third-generation cephalosporins) . Among patients with an infected abortion, the results of treatment with traditional regimens were excellent . In patients with salpingo-oophoritis, the immediate cure rates with second- and third-generation cephalosporins were better than those with traditional regimens, but the long-term impact of these drugs on fallopian tube patency is not known . In women with postpartum endomyometritis following cesarean section, double-drug therapy with clindamycin and either gentamicin or ampicillin and single-drug therapy with a second- and third-generation cephalosporin were more effective than traditional therapy.

J Pharm Sci, 1983 Mar, 72(3), 221 - 4
Determination of antimicrobial preservatives in pharmaceutical formulations using reverse-phase liquid chromatography; Radus TP et al.; A specific stability-indicating reverse-phase high-performance liquid chromatographic analytical method has been developed to quantitate the antimicrobial preservatives methylparaben, propylparaben, butylparaben, sorbic acid, and benzoic acid in a series of typical pharmaceutical formulations . The mobile phase of this system is a water-acetonitrile mixture, modified by various acids and buffers . The proportions of water and acetonitrile as well as the type and amounts of modifiers are varied in order to achieve optimum chromatography . This method has been used successfully to quantitate preservatives in solutions, suspensions, creams, lotions, and ointments, and can be readily adapted to routine automated assays, either for routine product evaluation or stability programs.

Surg Gynecol Obstet, 1983 Mar, 156(3), 351 - 4
Intravenous prophylactic antimicrobial drugs in elective colorectal operations; Bell GA et al.; In a prospective, randomized, double blind study of 123 patients undergoing elective colorectal surgery, 61 received intravenously erythromycin gluceptate, and 62 received intravenously metronidazole perioperatively together with tobramycin . Three dosages of each drug were given . Eight patients in each treatment group had wound infections . Of these, only three in each treatment group were severe enough to require antibiotic therapy and to cause prolongation of hospitalization . Antibiotic levels in the serums of patients, in skin samples and in intestinal walls showed that metronidazole was most frequently detected at satisfactory concentrations in serum and that skin and the intestinal wall did not contain any detectable antibiotic.

J Bacteriol, 1983 Mar, 153(3), 1294 - 300
Mycobacteriocins produced by rapidly growing mycobacteria are Tween-hydrolyzing esterases; Saito H et al.; Smegmatocin, a protein produced by Mycobacterium smegmatis ATCC 14468, was found to have an esterase activity, hydrolyzing Tween 80, polyoxyethylene sorbitan monooleate, added to the assay medium for various "bacteriocins" from mycobacteria . Because M . diernhoferi ATCC 19340 (indicator strain for smegmatocin) is highly susceptible to oleic acid and smegmatocin requires Tween 80 for manifestation of its anti-M . diernhoferi activity, it is likely that smegmatocin-mediated antimicrobial action is caused by oleic acid generated by hydrolysis of Tween 80 by the inherent esterase action of smegmatocin . Other mycobacteriocins from rapidly growing mycobacteria also have inherent esterase activity against Tween 80 and require Tween 80 for expression of antimycobacterial action . Smegmatocin was found to hydrolyze various polyoxyethylene (sorbitan) fatty acyl esters but not sorbitan monooleate and glyceryl esters.

Diagn Microbiol Infect Dis, 1983 Mar, 1(1), 41 - 7
Considerations about the relationship of inhibitory concentrations and the pharmacologic and toxic properties of antimicrobial agents; Neu HC; Too little attention has been given to the correlation of antimicrobial susceptibility tests and the pharmacokinetics of antimicrobial agents . Ability to perform and provide reproducible, rapid, minimal inhibitory concentration data, combined with the knowledge of serum levels, can be used to yield inhibitory quotients which will improve the chemotherapy of serious infections . Antimicrobial susceptibilities have to be provided rapidly for the life-threatening infections that occur in certain clinical settings . Antimicrobial susceptibilities also must be provided in a manner that demonstrates that one may not be able to achieve therapeutic concentrations with certain drugs . We have reached an era in which knowledge of an organism being susceptible or resistant is no longer adequate.

Antimicrob Agents Chemother, 1983 Mar, 23(3), 500 - 2
Scarring as a factor affecting the eradication of microorganisms from the kidney in pyelonephritis; Miller T; The inability of antimicrobial agents to penetrate scarred renal tissue may explain some therapeutic failures . We examined the effect of scarring on antimicrobial therapy by using a unique animal model in which both kidneys were infected to the same degree but only one kidney was scarred . Scar formation could not explain the failure of ampicillin or nitrofurantoin to eradicate renal infection, but co-trimoxazole was less effective in the presence of tissue damage and scar formation than in their absence.

Diagn Microbiol Infect Dis, 1983 Mar, 1(1), 25 - 31
Discrepancies between in vitro activity of and in vivo response to antimicrobial agents; Washington JA 2nd; The correlation between in vitro antimicrobial activity and the in vivo response to antimicrobial therapy is affected by multiple host factors, the site and nature of the infection, and the pharmacokinetics of the antimicrobial and its penetration into areas of infection . In certain instances, discrepancies are also caused by methodologically-related variables of in vitro susceptibility tests . Examples of discrepancies between in vitro and in vivo response to antimicrobial are discussed.

Mech Ageing Dev, 1983 Mar-Apr, 21(3-4), 205 - 28
The reticuloendothelial system and aging: a review; Brouwer A et al.; This review represents an attempt to summarize and evaluate the literature data on the changes occurring in the reticuloendothelial system (RES) during aging . The RES is briefly introduced with emphasis on cellular composition, function, physiology, regulation and the methods employed for assessment of its functions . The age-related changes in the RES are discussed in terms of endocytotic capacity, antimicrobial and antitumor activity and morphology . In addition, the cooperation between the RES and the immune system in the defence of the body against disease agents is discussed in relation to the increased susceptibility to infectious diseases and tumorigenesis in both man and experimental animals during aging.

Rev Infect Dis, 1983 Mar-Apr, 5 Suppl 1, S21 - 31
Empiric treatment of infections in neutropenic patients with cancer; Klastersky J; Febrile episodes in neutropenic patients with cancer should be treated empirically with broad-spectrum antibiotics that are bactericidal and potentially synergistic against the presumed pathogens . At present, the combination of carbenicillin or ticarcillin and amikacin seems optimal . In patients whose fever responds to therapy but who remain neutropenic, the initial empiric regimen should be continued as long as neutropenia persists . The risk of superinfection associated with prolonged antimicrobial therapy in neutropenic patients should be investigated further . When a probable pathogen is isolated from an unresponsive patient, antimicrobial therapy should be adjusted in light of the in vitro sensitivity of the infecting microorganisms, the possibility of localized infection should be carefully investigated, and granulocyte transfusions should be considered . However, empiric administration of granulocytes is probably not indicated . In the group of neutropenic patients that is most difficult--those who have fever but whose infections cannot be microbiologically documented and who fail to respond to empiric antimicrobial therapy--the early administration of amphotericin B should be seriously considered, although there is no evidence that the drug modifies greatly the overall outcome in these patients . Whether granulocyte transfusions should be combined with administration of amphotericin B in these patients remains to be investigated further.

Jpn J Antibiot, 1983 Mar, 36(3), 537 - 46
{Experimental and clinical studies of cefotiam in thoracic surgery}; Matsuura Y et al.; The pharmacokinetics of intravenously administered cefotiam (CTM), using a two-compartment or three-compartment open model, have been investigated in patients undergoing thoracic surgery . Patients (Group 1) given 1 hour drip infusion of 1 g of CTM, had the peak serum level (32.8 micrograms/ml) at 1 hour, and the peak pleural effusion level (8.3 micrograms/ml) was achieved at 2.08 hours . Patients (Group 2) given an one-shot intravenous injection of 1 g of CTM, had the maximum pleural effusion concentration (8.35 micrograms/ml) at 2.67 hours . Patients (Group 3) given 1 hour drip infusion of 1 g of CTM, had the mean concentration (2.3--2.5 micrograms/g) in the pleural tissue for 2 to 3.5 hours . Clinical study comprising 20 patients was performed to evaluate the effects of CTM as a prophylactic antimicrobial agent in the thoracic surgery . Patients received intravenous administration of 4 g/day of CTM for 7--10 days . Each patients was evaluated daily for fever, signs of allergic reaction, and wound infection and so on . No infections occurred in these thoracic surgery except 1, and no serious side effects was observed in this study.

Infect Control, 1983 Mar-Apr, 4(2), 81 - 9
A prospective study of infectious diseases following bone marrow transplantation: emergence of Aspergillus and Cytomegalovirus as the major causes of mortality; Peterson PK et al.; We performed a prospective study of infections following bone marrow transplantation in 50 patients treated for aplastic anemia or hematologic malignancy . Early, continuous prophylaxis with trimethoprim/sulfamethoxazole and oral nystatin, and empiric intravenous antimicrobial therapy during febrile granulocytopenic episodes were standard treatment for all patients . The use of trimethoprim/sulfamethoxazole did not appear to adversely affect donor marrow engraftment . Serious gram-negative bacillary and systemic Candida infections were uncommon . Although gram-positive bacterial infections were frequent, they were rarely associated with mortality . Aspergillosis emerged as the single most important infection, contributing to the death of nine patients . Cytomegalovirus diseases developed in 13 patients, seven of whom died . Patient age and chronic myelogenous leukemia were risk factors for the development of fatal infections . This study demonstrates that although certain serious infections can be controlled, there is a critical need for effective measures to prevent and treat aspergillosis and cytomegalovirus disease in these seriously compromised hosts.

Int J Pept Protein Res, 1983 Mar, 21(3), 313 - 21
Studies of peptide antibiotics . XLIII . Syntheses of gramicidin S analogs containing D-serine or dehydroalanine in place of D-phenylalanine and asymmetric hydrogenation of the dehydroalanine residue; Ando S et al.; Gramicidin S (GS) analogs, {D-Ser4,4'}-GS and its precursor {O-benzyl-D-Ser4,4'}-GS, were synthesized by the conventional method in order to evaluate the role of the hydroxymethyl side chains in D-Ser at 4,4' positions on the biological activity . Another analog {L-Orn(delta-Boc)2,2',delta Ala4,D-Ser4'}-GS was prepared from {D-Ser4,4'}-GS by t-butyloxycarbonylation and successive dehydration using dicyclohexylcarbodiimide-CuCl as dehydrating reagent . The delta Ala residue was asymmetrically hydrogenated to D-Ala in the presence of Pd-black . On the microbial assays, {O-benzyl-D-Ser4,4'}-GS showed high antimicrobial activity as natural GS, but {D-Ser4,4'}-GS showed low activity; the structure-activity relationships of the analogs were discussed.

JAMA, 1983 Feb 25, 249(8), 1055 - 7
Failure of intensive care unit support to influence mortality from pneumococcal bacteremia; Hook EW 3rd et al.; One hundred thirty-four consecutive cases of pneumococcal bacteremia observed during a six-year period were evaluated . One hundred nineteen (89%) were associated with pneumonia . Factors associated with increased mortality were advanced age, a leukocyte count at admission of less than 5,000/cu mm, neoplastic disease, and involvement of two or more pulmonary lobes in patients with pneumonia . Mortality was 30.5% overall, and 76% in patients admitted to the intensive care unit with pneumococcal bacteremia . Pneumococcal infection continues to be an important cause of morbidity and mortality despite modern supportive care and antimicrobial therapy.

Cell Immunol, 1983 Feb 15, 76(1), 10 - 21
Colony-stimulating factors and regulation of macrophage tumoricidal and microbicidal activities; Ralph P et al.; Conditioned medium from antigen- or mitogen-stimulated spleen cells, lymphokines, contained factors that induced formation of granulocyte and macrophage colonies in cultures of bone marrow cells (CSF) . Lymphokines also contained factors that induced macrophage non-specific tumoricidal activity against fibrosarcoma 1023, antibody-dependent tumoricidal activity against lymphoma 18-8, and antimicrobial activities against amastigotes of the protozoan parasite, Leishmania tropica . The factors that regulated macrophage effector functions, however, were different from those that induced colony formation, and could be distinguished from CSF by Sephadex gel chromatography or heat sensitivity . To further analyze a role for CSF in induction of macrophage effector activities, conditioned medium from several nonlymphoid cell sources (L-929, WEHI-3, and endotoxin-treated lung cells) were assayed for CSF activities and capacity to induce tumoricidal and microbicidal activities . Conditioned medium that contained either macrophages CSF (CSF-1) or the factor that induced formation of both macrophage and granulocyte colonies failed to activate macrophages for effector activities against fibrosarcoma 1023, lymphoma 18-8, and L . tropica amastigotes (either resistance to infection or intracellular destruction) . These data suggest that CSF has no direct role in activation of macrophages for tumoricidal and microbicidal activities against these targets.

Z Hautkr, 1983 Feb 15, 58(4), 244 - 52
{Ureaplasma urealyticum in the male urethra . The assessment of the semiquantitative demonstration as exemplified in men with and without urethritis}; Hartmann AA; By means of wire-loops, smears were taken from the urethra of 117 male patients suffering from urethritis and of 236 healthy men . Ureaplasma urealyticum (U.u.) was isolated semiquantitatively on A7-medium agar . Large quantities of U.u . were found in 20.5% of the infected patients, but also in 7.6% of the healthy men; plenty of U.u . was isolated in 9.4% of the infected and in 7.2% of the healthy persons . U.u . could not be tracted out in 61% of the males suffering from urethritis and in 75.4% of those not infected . According to our findings, semiquantitative isolation of U.u . does not infer the etiopathogenetical role of U.u . in every single case . In addition, a broad spectrum of microbials, e.g . chlamydia trachomatis has to be excluded in order to be able to recognize U.u . as the cause for urethritis after successful antimicrobial therapy.

FEBS Lett, 1983 Feb 7, 152(1), 6 - 10
Seminalplasmin inhibits transcription and translation of phi80 DNA in vitro; Rao VN et al.; Seminalplasmin, an antimicrobial protein from bovine seminal plasma that has been earlier shown to inhibit transcription in whole cells and by purified RNA polymerase in vitro, but not translation in whole cells, is now shown to inhibit both transcription and translation independently of each other, in a coupled transcription-translation system from E . coli using phi80dphoAlacZ DNA as the template.

Pharmazie, 1983 Feb, 38(2), 105 - 7
{Antineoplastic and curative antileukemic activity of 1,4-benzoquinone guanylhydrazone thiosemicarbazone and its hydrochloride on in vivo murine models}; Gutsche W et al.; By means of four murine models, the authors demonstrated in vivo that 1,4-benzoquinone guanylhydrazone thiosemicarbazone (1), which is known to be antimicrobially active, and its hydrochloride (2) exert an antineoplastic effect . In leukaemia P 388 and leukaemia L 1210 both compounds had a curative action already after four oral administrations . The "cured" animals were resistant or cross-resistant to further transmissions of leukaemia . The resistance was transmissible by splenocytes.

J Pharm Sci, 1983 Feb, 72(2), 183 - 6
Evaluation of various N-substituted azaspiranedione derivatives as potential antimicrobial agents; Scott KR et al.; A series of N-substituted hydrazines were condensed with various spiro{4.5} and {5.5} anhydrides and the resultant N-substituted azaspiranediones were evaluated for antimicrobial activity . None displayed any significant activity in a variety of organisms tested.

South Med J, 1983 Feb, 76(2), 273 - 4
Tularemia complicated by acute renal failure; Tilley WS et al.; Acute renal failure has been a rare, uniformly fatal complication of infection with Francisella tularensis . The literature suggests that either acute tubular necrosis, interstitial nephritis, or glomerulonephritis may be responsible for this syndrome . We have described a patient with tularemia who had nonoliguric acute renal failure probably due to interstitial nephritis and who recovered slowly but spontaneously during antimicrobial therapy with doxycycline.

J Clin Microbiol, 1983 Feb, 17(2), 232 - 9
Evaluation of the cefonicid disk test criteria, including disk quality control guidelines; Barry AL et al.; Cefonicid (SKF 75073) is a second-generation cephalosporin which has a spectrum of antimicrobial activity similar to that of cefamandole, but cefoxitin (a cephamycin) and cephalothin have uniquely different spectra of activity . The second-generation cephalosporins tested displayed comparable susceptibility to beta-lactamases and inhibited type I beta-lactamases . Although cefonicid has a longer serum half-life (3 to 4 h) compared with the currently used drugs, the same minimal inhibitory concentration breakpoints separating susceptible and resistant categories were applied to tests with cefonicid, cefamandole, and cephalothin . Regression analysis of the disk diffusion test results confirmed the use of identical zone size breakpoints for 30-micrograms cefonicid, cefamandole, and cephalothin disks: all three produced similar parabolic regression lines . Further analysis of disk test data confirmed the fact that cefonicid and cefamandole disks might be used interchangeably . But for routine tests, cefonicid disks might be preferred in order to minimize the number of very major (false-susceptible) interpretive errors . Suggested cefonicid 30-micrograms disk interpretive criteria are: susceptible, greater than or equal to 18 mm (less than or equal to 8.0 micrograms/ml), and resistant, less than or equal to 14 mm (greater than 16 micrograms/ml) . Quality control zone diameter limits were calculated from data obtained in a multilaboratory collaborative study.

Biochem Pharmacol, 1983 Feb 1, 32(3), 449 - 53
Antimicrobial action of compound 48/80--II mechanism of action; Hall JB et al.; The mixture of compounds called compound 48/80 had been shown to have antimicrobial activity against a wide variety of microorganisms . In this paper it is shown that its primary site of attack appears to be on the membrane of the cell . In its presence, Tetrahymena became much more sensitive to osmotic stress, and alpha-methylglucose was rapidly released from preloaded Escherichia coli cells . The drug also had effects on cell viability, respiration, cell division, and the release of material absorbing at 260 nm . In general, its effects paralleled those of polymyxin B, although its structure is quite different except for the presence of amino groups and hydrophobic regions in both molecules . The activity of 48/80 was not due to detergent-like, surface-active properties and was antagonized by magnesium and other cations and by phosphatidylserine . Purification of the active principle might provide a relatively simple and readily modifiable probe of membrane function and possibly a new family of useful antimicrobial compounds.

Semin Arthritis Rheum, 1983 Feb, 12(3), 314 - 21
Hemophilus influenzae septic arthritis in adults; Ho G Jr et al.; Hemophilus influenzae is an important but uncommon cause of adult septic arthritis . We report two cases and review 23 previously published cases . Two-thirds of the patients had systemic diseases, local factors, or both which predisposed them to septic arthritis . The acute disease was monarticular in 48%, polyarticular in 24%, and accompanied by tenosynovitis and/or bursitis in 28% of cases . Extraarticular sites of H . influenzae infection were found in 60% of cases . These sites represented either likely portals of bacterial entry or foci of infection resulting from hematogenous dissemination of H . influenzae . The most characteristic synovial fluid finding was the presence of Gram-negative pleomorphic microorganism . However, misinterpretation of the Gram-stained smear was common and led to an erroneous initial diagnosis in several instances . Prompt sterilization of the infected synovial fluid was the rule once an appropriate antimicrobial agent was administered . A favorable outcome was reported in 88% of cases.

Antimicrob Agents Chemother, 1983 Feb, 23(2), 278 - 83
Genetic transfer of antimicrobial resistance and enterotoxigenicity among Escherichia coli strains; Wachsmuth K et al.; To understand the role of enterotoxin (Ent) plasmids in epidemics of enterotoxigenic (ET) Escherichia coli diarrhea in the United States, we studied the genetics of Ent plasmids in relation to E . coli serotypes and R plasmids . Twenty-nine ET E . coli strains, including all epidemic isolates available at the Centers for Disease Control, Atlanta, Ga . (CDC), were assessed for the ability to transfer antimicrobial resistances (if present) by conjugation, to mobilize a nonconjugative R plasmid, and to cotransfer enterotoxigenicity with R determinants . Of the 12 ET E . coli strains isolated in the United States, 5 were able to transfer R plasmids; one strain cotransferred detectable enterotoxigenicity . Another four U.S . isolates were able to mobilize plasmid DNA, but no toxin production was detected in transconjugants . Of 17 resistant ET E . coli from South Asia, 13 were able to transfer R plasmids; 5 of those 13 cotransferred detectable Ent plasmids . In all, 22 ET E . coli strains (76%) were able to initiate conjugation and genetic transfers . Six of these strains (20%) were able to cotransfer enterotoxigenicity with a conjugative R plasmid at a detectable frequency . One of the six strains transferred R and Ent determinants on a single plasmid . These data are addressed in relation to the observed immobility of Ent and R during outbreaks of ET E . coli, the efficacy of prophylactic tetracycline, and the worldwide occurrence of a limited number of ET E . coli serotypes.

Pediatr Clin North Am, 1983 Feb, 30(1), 93 - 102
Host factors influencing the response to antimicrobial agents; Leff RD et al.; When the desired clinical response to an antibiotic therapeutic regimen is not achieved, despite appropriate antibiotic selection and organism sensitivity, the clinician must be aware that several host factors exist that may influence the outcome . Examples of the influence of host-related factors on drug disposition have been briefly reviewed in this article . It should be noted, however, that further investigation is needed to determine whether these factors truly exert a significant influence on the outcome of antibiotic utilization.

Pediatr Clin North Am, 1983 Feb, 30(1), 121 - 34
Combination antimicrobial therapy; Shlaes DM et al.; In spite of a large volume of data regarding the in vitro activity of single and combined antimicrobial activity, the clinical relevance of these studies is unclear . Few comparative trials of combined and single antibiotic therapy of human infection have been performed . Synergistic combination therapy has been shown to be beneficial in a few specific circumstances . Antagonistic combinations should be avoided in the treatment of meningitis, endocarditis, and infections of immunocompromised patients . The bactericidal titer of serum or spinal fluid should reflect adequacy of therapy of meningitis, endocarditis, and osteomyelitis, and adjustments can be made accordingly.

Drug Intell Clin Pharm, 1983 Feb, 17(2), 83 - 91
Netilmicin (Netromycin, Schering-Plough); Guay DR; Netilmicin sulfate, the 1-N-ethyl derivative of sisomicin, is a new aminoglycoside recently released for use in Canada and not yet released in the U.S . Its place in therapeutics, compared with gentamicin (G), tobramycin (T), and amikacin (A), is not yet established . Preliminary work in animals has suggested a lower incidence of nephrotoxicity and ototoxicity than with other aminoglycosides, and in vitro work has suggested some activity against G/T-resistant organisms . However, netilmicin appears to be virtually identical to G,T, and A in antimicrobial spectrum (except for its poorer activity against P . aeruginosa), human toxicity, and clinical use . For G/T-resistant organisms, amikacin is still the aminoglycoside of choice . In summary, netilmicin has not been demonstrated to have significant advantages over other aminoglycosides (G,T,A), and it is more expensive; thus, its potential value is limited.

Curr Probl Surg, 1983 Feb, 20(2), 69 - 132
The prophylactic use of antimicrobials in surgery; Dipiro JT et al.; During the period August 1976 to June 1982, there were 98 reports of antimicrobial prophylaxis in human surgery that were judged unevaluable . Our review, coupled with that of Chodak and Plaut, identified studies of 126 antibiotic regimens that were considered evaluable and a total of 205 studies considered unevaluable . A decrease in infection rate in antibiotic-treated patients compared to non-antibiotic-treated patients was seen in 120 (95%) of the evaluable regimens . Ninety-nine (79%) of these 120 regimens produced statistically significant reductions in the infection rate (P less than .05, chi 2 analysis) . The majority of the antibiotic regimens were tested in procedures that were classified as clean-contaminated . Of the regimens that yielded a statistically significant reduction in infection rate with antimicrobial therapy, in 66 (67%) the agents were used for 24 hours or less . Five regimens were identified in which a higher infection rate occurred in specific patient groups when prophylactic antibiotics were used, but the differences were not statistically significant . In the overwhelming majority of evaluable studies, antibiotics decreased the incidence of surgical infection compared with non-antibiotic groups . The available data also support the effectiveness of short prophylactic antibiotic courses of 24 hours' duration or less . The duration necessary for antibiotic prophylaxis was specifically tested in nine regimens . In all nine, a short course (less than 24 hours) of antibiotic prophylaxis was as effective as longer periods of therapy (24 hours to 5 days) in preventing infection.

J Antibiot (Tokyo), 1983 Feb, 36(2), 155 - 60
Antibiotics from basidiomycetes . XVII . The effect of marasmic acid on nucleic acid metabolism; Kupka J et al.; From submerged cultures of Lachnella villosa, Lachnella sp . 541, and Peniophora laeta we isolated marasmic acid (1), a metabolite first described from surface cultures of Marasmius conigenus . The sesquiterpenoid exhibits potent antimicrobial and cytotoxic properties . In cells of the ascitic form of Ehrlich carcinoma RNA and DNA syntheses are preferentially inhibited . Marasmic acid inhibits RNA synthesis in isolated nuclei, but does not interfere with the transport of nucleoside precursors into the cells . RNA polymerase II and capping enzyme (mRNA guanylyltransferase), two enzymes of nucleic acid metabolism, are markedly affected after preincubation with marasmic acid . We assume that marasmic acid acts on nucleic acid syntheses by direct inhibition of some of the enzymes involved . This mode of action would also explain its mutagenic properties . The preparation and testing of two derivatives, 2 and 3, revealed that the alpha,beta-unsaturated aldehyde is essential for the antimicrobial and cytotoxic activity of marasmic acid.

Am J Vet Res, 1983 Feb, 44(2), 340 - 3
Modulation of early cellular events in wound healing in mice; Kenyon AJ et al.; Wound healing experiments were conducted in random-bred Swiss mice to determine the effect on antimicrobial surfactants and macrophage stimulators on wound measurements, histologic repair, and wound breaking strengths . In selection of mice, Sendai virus antibody-positive mice healed more slowly than did mice with no detectable titer to Sendai virus . Studies were conducted with Sendai virus-free mice that had C31G (an antimicrobial surfactant), alkyl amine oxide, zymosan, glucan, or phosphate-buffered isotonic saline solution instilled into full-thickness incised wounds . The early events in the repair process indicated a greater degree of inflammatory response comprised mainly of polymorphonuclear leukocytes with subsequent large numbers of monocytes in C31G and alkyl amine oxide-treated wounds . Although zymosan did not induce as large a number of monocytes, the degree of fibroplasia was as great as in wounds in which numbers were higher . The effect of zymosan could be blocked by the addition of N-alpha-p-tosyl-L-lysine chloromethyl ketone to wounds . Wound breaking strength 3 days after surgery was greatest for glucan-treated mice (134 +/- 37 g) whereas that in C31G-treated mice (77 +/- 31 g) was less than that of the controls (92 +/- 37 g) . By day 7, there was no significant difference in breaking strength between control and glucan-treated wounds; however, C31G-treated wounds remained substantially weaker than control wounds.

Hinyokika Kiyo, 1983 Feb, 29(2), 245 - 53
{Prophylactic and chemotherapeutic efficacy of pivmecillinam (PMPC) against infections after TUR-P and prostatectomy}; Maru A et al.; The prophylactic and chemotherapeutic efficacy of PMPC against infections after TUR-P has been investigated . Bacteriological evaluation: PMPC , 200-300 mg/day for 2-12 weeks, was administered to 49 patients, who had over 10(3)CFU/ml of microorganisms after CET or CEC treatment for 3-7 days . The eradication rate of microorganisms was 40.8% after 2 weeks, 52.2% after 4 weeks, 64.1% after 6 weeks, 65.0% after 8 weeks and 70.6% after 12 weeks . Effectiveness on pyuria : The improvement rate of pyuria against 59 patients who had over 10(5)/hpf of pyuria , was 15.3% after 2 weeks, 16.4% after 4 weeks, 25.4% after 6 weeks, 58.5% after 8 weeks, 72.7% after 10 weeks and 75.0% after 12 weeks . Overall clinical efficacy on PMPC was examined in 26 patients . The results of efficacy were 27.3% after 2 weeks, 48.0% after 4 weeks, 50.0% after 6 weeks, 69.2% after 8 weeks, 75.0% after 10 weeks and 77.0% after 12 weeks . The clinical response was evaluated according to a criterion for clinical evaluation of antimicrobial agent on chronic complicated UTI proposed by UTI committee in Japan . No severe adverse effect including allergic reaction was found . Following administration of PMPC , three patients experienced adverse gastric reactions, and drug administration was discontinued at week 6 or 8 . PMPC was effective as a prophylactic chemotherapeutic drug against infections after TUR-P and prostatectomy.

Schweiz Med Wochenschr, 1983 Jan 15, 113(2), 34 - 7
{What does the minimal inhibitory concentration of an antibiotic hide from the clinician? Experimental examples}; Gerber AU et al.; Examples are presented to demonstrate that in-vitro determinations of the minimal inhibitory concentration of antibiotics do not take into account factors of presumable in-vivo significance: pH and divalent cations in the medium, protein binding of antimicrobials, and the bacterial inoculum effect.

Padiatr Padol, 1983, 18(3), 291 - 3
{Treatment of burns in childhood}; Morger R et al.; Management of burns in children depends above all on infusion therapy, i.e . replacement of the plasma, water and electrolytes of which the circulation and tissue have been deprived as a result of exudation into the wound area, increased evaporation of water, and edema . The inexperienced therapist tends to underestimate these losses in the case of children . In infants and older children with burns covering upwards of 5% and 10% respectively of body surface there is a danger of shock developing, with peripheral vasoconstriction, acidosis, cerebral edema and renal failure . Infusion therapy should therefore be instituted as early as possible . Fusidic acid has proved very valuable in topical treatment of burns in children . Concomitant antimicrobial treatment can be dispensed with in the majority of patients . Keloid overgrowths are now more effectively prevented by means of Lycra pressure dressings.

J Infect, 1983 Jan, 6(1), 17 - 28
Hyperbaric oxygen treatment: 10 years' experience of a Regional Infectious Diseases Unit; Ellis ME et al.; Ten years' experience of a Regional Centre for Infectious Diseases in the use of hyperbaric oxygen in 87 patients have been reviewed . Its efficacy in the treatment of non-infectious cases has been confirmed . Fifty-eight (67 per cent) patients had anaerobic infections associated with peripheral vascular disease, limb trauma, abdominal surgery or occurred spontaneously . All patients had failed to respond to surgery and antimicrobial agents, and were transferred for hyperbaric treatment as the infection was progressive . Marked improvement in general condition, wound infection and limitation of extension of the anaerobic infection occurred following hyperbaric treatment . These improvements had benefits in terms of surgical risk, demarcation and mortality . Symptoms suggestive of oxygen toxicity occurred in up to 24 per cent of all patients, but in many this took the form of anxiety and anxiety-related symptoms . Despite the beneficial effects of hyperbaric oxygen, many surgeons appear to be unaware or sceptical of the facility . A prospective controlled trial is advocated.

Int Adv Surg Oncol, 1983, 6, 257 - 70
Indications and techniques for bowel preparation in colorectal cancer; Keighley MR et al.; A satisfactory bowel preparation is essential for adequate double contrast barium enema and colonoscopy . Efficient preparation is also important for reducing the risk of anastomotic dehiscence and sepsis in elective colorectal surgery . Traditional preparation by starvation, purgation and enemas is time consuming, unpleasant for patients, and in our experience results in a satisfactory preparation in only 23% of patients . Elemental diets are inefficient when used for only five days . Whole bowel irrigation with a nasogastric tube enables patients to be in hospital for only one day before operation and provides a satisfactory result in 61% of patients . Whole bowel irrigation is not recommended for stenosing tumours . Irrigation with saline causes sodium and water retention and the use of a balanced electrolyte solution (eg, Ringer's lactate) reduces the risk of these side effects . Oral mannitol has become popular but in our experience results in a satisfactory preparation in only 41% of patients . Mannitol is fermented by E coli to potentially explosive gas mixtures unless oral antimicrobials (neomycin and metronidazole) are used immediately before operation . Polyethylene glycol also causes osmotic catharsis without the risk of explosion . We currently favour nasogastric irrigation with polyethylene glycol and a balanced electrolyte solution, but there is still a place for traditional preparation over five days for patients with stenosing tumours of the left colon.

Am Rev Respir Dis, 1983 Jan, 127(1), 39 - 41
Endobronchial pH . Relevance of aminoglycoside activity in gram-negative bacillary pneumonia; Bodem CR et al.; The in vitro bactericidal activity of certain antimicrobials, especially aminoglycosides, is markedly diminished at an acid pH . In an attempt to correlate this factor with the poor response of gram-negative bacillary pneumonia to aminoglycoside therapy, the endobronchial pH of selected groups of subjects was measured via a bronchoscopically directed pH electrode . The average peripheral, i.e., subsegmental, endobronchial pH of normal persons, patients with chronic lung disease, and patients with pneumonia was 6.58 +/- 0.06, 6.62 +/- 0.10, and 6.61 +/- 0.06, respectively . The average central airway, i.e., major bronchi or tracheal, pH at 6.64 +/- 0.07 did not vary significantly from that of peripheral airways . The presence of pneumonia in individual bronchi was associated with a significantly lower pH than that in noninfected bronchi: 6.48 +/- 0.12 versus 6.69 +/- 0.13 (p less than 0.05) . This relatively acid environment appears exaggerated within pneumonic airways and may contribute toward decreasing the effectiveness of aminoglycosides and certain other antimicrobials used in treating lung infection.

Ann Microbiol (Paris), 1983 Jan-Feb, 134A(1), 73 - 8
In vitro susceptibility of Mycobacterium fortuitum to non-antituberculous antibacterial agents; Casal MJ et al.; A study was made of the in vitro susceptibility of 37 strains of Mycobacterium fortuitum to 14 antimicrobial agents using disc diffusion techniques on Mueller-Hinton agar plates . Nitro-5-hydroxy-8-quinoleine and pipemidic acid inhibited all strains, while furantoin, mandelamine, metronidazole, nalidixic acid, oxolinic acid and trimethoprim proved to be inactive . In addition, various sulphonamides inhibited 59% of the strains tested . Sulphadiazine inhibited 54.1%, sulphafurazole 64.9%, sulphamethizole 64.9%, sulphametoxypyridazine 62.2% and sulphisoxazole 59.5% . Trimethoprim-sulphamethoxazole was effective against 48.6% of the strains due to its sulph component . The sensitivity to sulphonamides varied in accordance with the origin of the strains, those of human origin being generally much more susceptible than those of non-human origin.

Scand J Infect Dis, 1983, 15(1), 87 - 90
Septicemia due to Mycoplasma hominis; Boe O et al.; Mycoplasma hominis was recovered from the blood of 7 patients with various underlying disorders . One patient had a legal abortion, another a Caesarian section, both followed by septicemia . Three patients had genital infections in pregnancy, followed by septicemia and spontaneous abortion . M . hominis was also recovered from cervix and urethra in 2 of these women . High serum antibody levels against M . hominis were demonstrated in 3 women . One female developed septicemia after cancer surgery, one male after heart surgery . In the first 6 patients described the septicemia was of short duration and self-limiting, in the 7th patient it was of long duration and appropriate antimicrobial treatment was required . From this patient M . hominis was also isolated from infected operation wounds.

J Am Coll Cardiol, 1983 Jan, 1(1), 280 - 91
Infective endocarditis--a 25 year overview of diagnosis and therapy; Brandenburg RO et al.; Diagnosis and management of infective endocarditis have significantly changed in the past 25 years . Improved bacteriologic techniques have allowed detection of cases of infective endocarditis caused by unusual organisms . Bactericidal therapy has become available for patients with gram-negative endocarditis and antimicrobial therapy has improved . Echocardiography has become an important diagnostic and management aid, and cardiac valve replacement has dramatically improved the outlook for many patients.

J Clin Microbiol, 1983 Jan, 17(1), 48 - 51
Enhanced detection of bacteremia with a new BACTEC resin blood culture medium; Appelbaum PC et al.; In this multicenter study, 621 sets of blood culture specimens were drawn from 280 patients who were suspected of being septic and who were receiving antimicrobial therapy . Equal volumes of each specimen were inoculated into BACTEC 6B and 16B media . The 16B medium contained adsorbent and cationic resins for neutralizing the effects of the drugs . Of the 621 sets drawn, there were 72 positive cultures in 16B and 52 positive cultures in 6B . In 23 cases the organism was detected only in the 16B medium, and in 3 cases the organism was detected in 6B only . The remaining 49 positives were detected in both culture bottles . In 13 of these 49 cultures, detection in 16B was made between 1 and 5 days earlier than in 6B, whereas 3 of 49 specimens were detected 1 day earlier in 6B; the remaining 33 cultures became positive at approximately the same time in both media . There were a total of 43 patients with positive cultures in this study . Of these patients, 28 had sepsis detected in both the 16B and 6B media . The 6B medium alone detected an additional three cases of sepsis, and the 16B resin medium alone identified 12 additional cases . Supplementary culturing of samples from patients receiving antimicrobial therapy significantly increased the number of positive cultures and positive patients, as well as significantly shortening the time to positivity in these cultures.

Equine Vet J, 1983 Jan, 15(1), 43 - 8
Serum concentrations of penicillin in the horse after administration of a variety of penicillin preparations; Love DN et al.; Twelve geldings were used to evaluate serum levels of penicillin following the intravenous (iv) and intramuscular (im) injection of benzylpenicillin, im procaine penicillin and im fortified benzathine penicillin, at a variety of dose rates . Blood samples were collected up to 7 h after iv and im benzylpenicillin, up to benzathine penicillin . Results were analysed using an analysis of variance and regression analyses were used to calculate the time taken for the serum penicillin concentration to decline to 0.5 micrograms/ml . As a result of the experiments the following dosage regimes could be recommended for each drug . Benzylpenicillin should be administered im at a dose rate of 10,000 iu/kg at the commencement of treatment . Procaine penicillin should be injected at a dose rate of 15,000 iu/kg every 12 h or 30,000 iu/kg every 24 h . In serious infections 10,000 iu/kg of benzylpenicillin im should be used concomitantly to begin therapy . Fortified benzathine penicillin appears to have little value for antimicrobial therapy in the horse.

Int Arch Allergy Appl Immunol, 1983, 70(2), 132 - 7
Detection and characterization of polymers in cephalothin by passive cutaneous anaphylaxis in mice; Iwata M et al.; Immunization of BALB/c mice by repeated injections of cephalothin (CET) - Ascaris suum extract conjugate resulted in formation of IgE antibodies, which were able to sensitize syngeneic animals for passive cutaneous anaphylaxis (PCA) . By means of high-pressure liquid chromatography, a fraction with extremely high PCA-eliciting activity, but without appreciable antimicrobial activity, was isolated from the CET preparation . Physicochemical analyses of the fraction identified the major component of polymer impurities as being a proteinaceous complex with a molecular weight of 6,580 . Very little cross-reactivity of CET and potassium benzyl penicillin (PcG) was noted when these antibiotics were used as the challenge antigens for PCA induced by corresponding murine antisera . The results of the inhibition studies indicated, however, that at least two antigens were involved in the PCA induced by anti-CET antibodies, one strictly specific for CET and another shared by PcG . Evidence was also presented that the nucleus structure and acyl side-chain structure of CET play the major role in the PCA elicited by the challenge with CET and its polymer, respectively.

J Membr Biol, 1983, 71(1-2), 119 - 30
Effect of 3-phenylindole on lipophilic ion and carrier-mediated ion transport across bilayer lipid membranes; Sinha BA et al.; The physical effects of 3-phenylindole, an antimicrobial compound which interacts with phospholipids, on ion transport across phosphatidylcholine-cholesterol bilayers have been investigated using three lipophilic ions and one ion-carrier complex . It was found that 3-phenylindole increased membrane electrical conductance of positively charged membrane probes and decreased electrical conductance of negatively charged probes . The enhancement of conductance detected by nonactin-K+ complex and tetraphenylarsonium+ was several orders of magnitude, whereas the suppression of conductance due to tetraphenylborate- and dipicrylamine- was less than a factor of ten . Presence of 3-phenylindole in aqueous phase slightly decreased adsorption of tetraphenylborate- and dipicrylamine- at the membrane surface . From the voltage dependence of the steady-state conductance it was shown that 3-phenylindole induced kinetic limitation of membrane transport of potassium mediated by nonactin . No such limitation was found in the case of tetraphenylarsonium+ transport . These results are shown to be consistent with the present concept of ion diffusion in membranes and the assumption that 3-phenylindole decreases the electric potential in the membrane interior . The asymmetry of the effect of 3-phenylindole on the magnitude of conductance changes for positively and negatively charged membrane permeable ions is also discussed as a reflection of the discreteness of both the absorbed 3-phenylindole and lipid dipoles.

Acta Otorhinolaryngol Belg, 1983, 37(1), 44 - 56
Management of chronic otitis media with effusion; Bluestone CD; Chronic otitis media with effusion ('secretory') is one of the most common diseases of childhood . Pathogenesis related to Eustachian tube dysfunction . Bacteria have been isolated from approximately 50 percent of chronic middle ear effusions . Diagnosis by pneumatic otoscopy or tympanometry, or both . Efficacy yet to be shown for antimicrobial therapy, decongestants, antihistamines, hydrocortisone, myringotomy with or without tympanostomy tubes, and adenoidectomy with or without tonsillectomy . However, a 10-day trial with an antimicrobial agent, such as amoxicillin (erythromycin and sulfonamide, trimethoprim-sulfamethoxazole, or cefaclor, are reasonable alternatives), should be prescribed before surgical intervention . Attendant conductive hearing loss may be related to abnormalities in cognition, language, and learning . Since the prevalence and incidence of otitis media decrease with advancing age, palliative management options would appear to be appropriate at present, reserving the more aggressive options for those infants and children who have frequently recurrent or chronic disease or the complications or sequelae of otitis media with effusion.

Med Prog Technol, 1983-84, 10(3), 161 - 9
Permeation of lipophilic drugs through synthetic elastomers; Bruck SD et al.; Permeability studies were carried out with three lipophilic drugs, namely, phenytoin and primidone (both widely used in the treatment of epilepsies and convulsive disorders), and dapsone (a sulfone antimicrobial agent used in the treatment of leprosy and to a lesser extent in dermatitis herpetiformis) through silica-filled poly(dimethyl siloxane) (Silastic) membranes, and anisotropic membranes of poly(ether-urethane)/poly(dimethyl siloxane) block copolymer (Avcothane, Cardiothane) . These polymers are used in medical implants and in various cardiovascular devices . While both polymers were permeable to the drugs, the transport properties differed significantly . In the case of the poly(dimethyl siloxane) there was an initial large burst effect, followed by an exponential decrease in the rate of drugs released through the polymer films, although with dapsone the release rate became essentially constant between 100-180 h at 37 degrees C . In the case of the anisotropic films of the poly(ether-urethane)/poly(dimethyl siloxane) block copolymer, the permeabilities were much higher . Significantly, phenytoin exhibited essentially constant rate (zero-order) kinetics between 25-150 h, showing only a moderate burst effect that is probably not significant therapeutically . Importantly, dapsone showed neither a burst effect nor any significant time lag, and the release followed constant rate (zero-order) kinetics between 12-80 h, followed by only a moderate decrease in drug concentration up to 140 h (the experimental end-point) . The diffusion coefficients calculated from initial desorption data at 37 degrees C for the poly(ether-urethane)/poly(dimethyl siloxane) block copolymer are as follows: phenytoin = 8.6 X 10(-9) cm2/s, primidone = 2.8 X 10(-9) cm2/s, and dapsone = 2.4 X 10(-8) cm2/s.(ABSTRACT TRUNCATED AT 250 WORDS)

Pediatr Pharmacol (New York), 1983, 3(3-4), 181 - 7
Antibiotic drug therapy in the newborn; Eichenwald HF; The use of antimicrobial agents in newborn infants has always been fraught with uncertainty . Because of the immature excretory and/or metabolic process of infants, it was recognized that detailed pharmacokinetic studies were necessary before these drugs could be used safely and effectively in young infants, but it was only with experience that it became obvious that toxicity remained relatively unpredictable . Babies were found to be more resistant to certain types of adverse reactions (eg, renal damage by aminoglycosides, bacitracin, methicillin, etc) but more susceptible to others (sulfonamides, chloramphenicol, tetracyclines, nitrofurantoin, and so forth) . In many instances, the toxic effects encountered could have been predicted on the basis of experimental data in animals, but in other cases, this was not possible . Thus, the use of new antimicrobial agents in babies may expose them to unpredictable dangers . For that reason, new drugs should only be administered to young infants if they clearly have a therapeutic advantage over older ones . Therapeutic trials must await adequate pharmacokinetic studies, and the investigator must be prepared to follow the treated infants (along with a group of matched control patients) for a sufficient length of time to be certain that any organ damage caused by the drug would have become clinically detectable . In some cases this requires a period of several years.

Infection, 1983, 11 Suppl 2, S97 - 101
Therapy with antibiotics in leukemic patients; Klastersky J; The recovery of an adequate granulocyte count after chemotherapy is the most important prognostic factor in neutropenic patients . In granulocytopenic patients, the risk of infection is very high and its course usually severe . Empiric antibiotic treatment must be started as soon as fever rises and blood cultures have been taken . The combination of an anti-pseudomonas penicillin with an aminoglycoside is presently the standard empiric therapy for febrile granulocytopenic patients . If the clinical response is inadequate, antimicrobial therapy should be adjusted to a bactericidal activity of greater than 1:16 in the serum . If antibiotic therapy fails, a fungal infection should be considered and amphotericin B added empirically . Patients must be closely supervised for superinfections . Therapeutic transfusions of granulocytes have proven useful in severe granulocytopenia and when antibiotic therapy has failed.

Infection, 1983, 11 Suppl 2, S90 - 2
Colonization pattern of the digestive tract by potentially pathogenic microorganisms: colonization-controlling mechanisms and consequences for antibiotic treatment; van der Waaij D; An outline is given of the various host-related and flora-related parts of the colonization resistance of the digestive tract . The host-related part of the colonization resistance has been found to be somewhat decreased by sublethal irradiation and leukemia (or chemotherapy), while treatment with antibiotics active against gram-positive flora may severely decrease the colonization resistance (depending on the antibiotic concentration established within the digestive tract during antibiotic therapy) . The flora-related part of the colonization resistance, which controls colonization by potentially pathogenic microorganisms, differs greatly from one individual to the next . This observation appears to be important for the host-related part of the colonization resistance . Finally, it is concluded that in the clinical situation preference should be given to antibiotics which do not affect the part of the flora constituting colonization resistance for two reasons: 1) to limit the spread of (multi-) resistant potentially pathogenic microorganisms and 2) for infection prophylaxis in immunocompromised patients . In the latter situation, the potentially pathogenic microorganisms in the flora are selectively eliminated from the digestive tract, provided the antimicrobial drugs used for selective decontamination are active against the endogenous potentially pathogenic microorganisms and given in sufficient (oral) doses.

Arkh Patol, 1983, 45(11), 14 - 22
{Polymorphonuclear leukocytes and macrophages in inflammatory and hypersensitive reactions}; Pigarevskii VE; The data of the author's own studies and those from the literature concerning morphological manifestations of antimicrobial activity of cation proteins of polymorphonuclear leukocytes (PNL) in phagocytosis and inflammation are summarized . A previously unknown type of secretion of PNL lysosomal proteins termed proexocytosis or pseudo-degranulation is characterized . A hypothesis on formation of nonphagocytic tissue resistance in inflammation foci is proposed . A lysosomal cation test expanding the possibilities for evaluation of the efficacy of treatment and prognosis of the course of diseases of the broncho-pulmonary system, purulent surgical diseases, infectious-inflammatory diseases of the urogenital organs, burn disease, parodontosis is proposed for the clinical practice . Ways for the development of methods for early diagnosis of hereditary lysosomal microdefects of PNL are outlined . Morphological manifestations of intracellular parasitising of microbes in macrophages are analysed . The problem of unity and interaction of granulocytic, macrophage, and lymphoid systems in hypersensitivity and inflammation is discussed.

Acta Microbiol Hung, 1983, 30(1), 75 - 7
Isolation and in vitro antimicrobial efficiency of Butea monosperma seed oil on human pathogenic bacteria and phytopathogenic fungi; Mehta BK et al.; The in vitro antimicrobial efficiency of seed oil of Butea monosperma was studied by the filter paper disk method against several human pathogenic bacteria and fungi . The oil showed a significant bactericidal and fungicidal effect.

Int J Immunopharmacol, 1983, 5(5), 377 - 89
Oxidative inhibition of polymorphonuclear leukocyte motility mediated by the peroxidase/H2O2/halide system: studies on the reversible nature of the inhibition and mechanism of protection of migratory responsiveness by ascorbate, levamisole, thiamine and cysteine; Jones PT et al.; The antimicrobial oxidative system (myeloperoxidase (MPO), H2O2 and a halide) produced by stimulated PMNLs is simulated in vitro using horseradish peroxidase (HRP), H2O2 and NaI . Ascorbate, thiamine, levamisole and cysteine prevent and reverse the PMNL motility inhibiting effects of the HRP/H2O2/NaI system . The ability of these agents to protect the PMNL specifically from the known iodinating and oxidising abilities of this system was investigated . All four agents protect the PMNL from iodination by HRP/H2O2/NaI . However, only ascorbate and thiamine are able to reverse this process after it has occurred . Thiamine is seen on thin layer chromatography followed by autoradiography to be iodinated by this system . Ascorbate, thiamine and cysteine are able to protect the neutrophil sulfhydryl groups from oxidation by the system . One can therefore conclude that ascorbate and cysteine protect neutrophil motility from inhibition by the HRP/H2O2/NaI system by acting as reducing agents which maintain the neutrophil sulfhydryl groups . Thiamine also acts as a reducing agent, though not as effectively as ascorbate or cysteine . In addition, thiamine protects the PMNL from iodination by a competitive mechanism . The mechanism of levamisole protection is less clear but may involve scavenging of free radicals generated by the HRP/H2O2/NaI system . Protease enzymes, glycolysis and adherence are found not to be target sites for the PMNL motility inhibiting effects of the HRP/H2O2/NaI system . Further, increasing concentrations of the synthetic leukoattractant FMLP were shown to increase the auto-iodination of PMNLs without addition of extraneous peroxidase or peroxide . This data was compared with optimal FMLP concentrations for chemotaxis.

Brain Dev, 1983, 5(4), 417 - 20
Hemorrhagic tendency as a complication of Moxalactam therapy in bacterial meningitis; Chan-Lui WY et al.; Moxalactam penetrates cerebral spinal fluid (CSF) and subdural fluid well enough to be a promising antimicrobial for enteric bacterial meningitis in neonates and infants . Clinical trials in adults and children have found few adverse effects . Prolongation of prothrombin time (PT) and partial thromboplastin time (PTT) with or without bleeding was reported in adults . This paper reports this complication in two infants occurring at a time of clinical improvement following addition of Moxalactam to other antibiotics to which the meningitis had failed to respond . It is not certain if this complication was related to the underlying meningitis, the use of Moxalactam together with other antibiotics, or a combination of many factors . Further observation, close hemostatic monitoring, and timely vitamin K administration during its use are warranted.

Clin Ther, 1983, 5(6), 617 - 23
Clinical evaluation of cefamandole in childhood infections; Paul RS et al.; Cefamandole was evaluated for the initial management of bacterial infections in 60 infants and children . Infections included cellulitis (22), pneumonia (21), cervical lymphadenitis (8), arthritis or osteomyelitis (6), otitis media (2), and epiglottitis 91) . Appropriate bacterial cultures and laboratory tests were performed for all patients . Cefamandole, 100 to 150 mg/kg/day divided into four doses given every six hours, was administered by the intravenous route . All bacterial isolates were sensitive to cefamandole, and all patients had good clinical and bacteriological responses . Duration of cefamandole therapy ranged between three and 30 days . Some of the patients' treatments were changed to specific narrow-spectrum antimicrobials after availability of the bacterial sensitivities . Cefamandole was tolerated well by most patients . Mild leukopenia and neutropenia developed in one patient and slight eosinophilia in four patients . These hematological abnormalities resolved spontaneously . These data suggest that cefamandole is an effective agent for the initial treatment of nonmeningitic infections in children.

Ann Acad Med Singapore, 1983 Jan, 12(1), 57 - 60
The isolation of H . ducreyi in Singapore; Rajan VS et al.; Using an enriched medium, H . ducreyi was isolated from 56 out of 670 patients with penile ulcers (8.3%) . Their clinical, epidemiological characteristics and treatment responses to streptomycin, cotrimoxazole and other antimicrobial agents are analysed . 51% failed to respond to streptomycin.

Antimicrob Agents Chemother, 1983 Jan, 23(1), 161 - 2
Susceptibility of Pseudomonas paucimobilis to 24 antimicrobial agents; Smalley DL et al.; Pseudomonas paucimobilis (group IIK, biotype 1) clinical isolates showed in vitro resistance to ampicillin, carbenicillin, cephalothin, cefoxitin, cefamandole, moxalactam, cefotaxime, cefoperazone, mezlocillin, azlocillin, piperacillin, and ticarcillin . Those agents to which the microbes were shown to be susceptible were tetracycline, chloramphenicol, gentamicin, tobramycin, kanamycin, amikacin, netilmicin, sisomicin, trimethoprim-sulfamethoxazole, ceftazidime, ceftriaxone, and ceftizoxime.

Scand J Infect Dis Suppl, 1983, 40, 81 - 4
Antimicrobial susceptibility of comma-shaped bacteria isolated from the vagina; Skarin A et al.; Comma-shaped bacteria isolated from the posterior vaginal fornix of women with foul-smelling discharge were tested for their antimicrobial susceptibility . The 20 strains studied were tested anaerobically, using agar dilution tests . They were highly susceptible to beta lactam antibiotics, clindamycin, doxycycline, erythromycin, gentamicin and thiamphenicol . On the other hand, the bacteria were relatively resistant to sulfamethoxazole, nalidixic acid and nitroimidazoles . A difference in susceptibility to nitroimidazoles between long and short variants of the comma-shaped bacteria was found; the former being more susceptible than the latter.

Wien Klin Wochenschr Suppl, 1983, 142, 11 - 5
{Pharmacokinetics and metabolism of the cephalosporins}; Graninger W; Apart from their antimicrobial activity pattern the cephalosporins differ by their pharmacokinetics . Most cephalosporins have a plasma half life of 30 to 120 minutes . Only ceftriaxon has a half life of about 8 hours, which implicates extended dose intervals . Cephalosporins are excreted renally . Cefoperazone and ceftriaxon, however, are excreted with the bile up to 30% . Cefalotin, cefacetril and cefotaxime are metabolized to a significant degree . Only the main-metabolite of cefotaxime shows mentionable antimicrobial activity . With regard to renal insufficiency (creatinine clearance greater than 5 ml/min) dose reduction is not necessary with cefoperazone and with ceftriaxon because of hepatic excretion and with cefotaxime because of metabolism.

Arch Oral Biol, 1983, 28(6), 517 - 25
Detection of the hypothiocyanite (OSCN-) ion in human parotid saliva and the effect of pH on OSCN- generation in the salivary peroxidase antimicrobial system; Pruitt KM et al.; Human whole saliva contains the hypothiocyanite ion (OSCN-) which is the principal antimicrobial product of the salivary peroxidase system . The peroxidase system requires a source of peroxide in order to produce OSCN- and in the human mouth this source has been assumed to be primarily the peroxidogenic oral bacteria . However, we report here studies which show that samples of stimulated human parotid saliva collected directly from Stenson's duct have concentrations of OSCN- which are similar to those found in human whole saliva . Thus, the peroxidogenic bacteria are not an absolute requirement for the generation of significant levels of OSCN- in the human mouth . Supplementation of human whole saliva with components {thiocyanite (SCN-), hydrogen peroxide (H2O2)} of the peroxidase system produces a 10-fold or greater increase in OSCN- concentration . However, the magnitude of this increase is critically dependent upon pH and upon the relative and absolute concentrations of SCN- and H2O2 . The pH dependence of OSCN- generation is similar for human whole saliva and for the lactoperoxidase/SCN-/H2O2 system . The optimum is in the range 6.5-7.0 . Samples of parotid saliva adjusted to pH 6.5 and supplemented with appropriate amounts of SCN- and H2O2 show increases in OSCN- concentrations which are similar to those observed with whole saliva . The results show that there is a significant source of H2O2 within the parotid gland, that the OSCN- generating potential of parotid saliva is similar to that of whole saliva and that the enhancement of OSCN- levels in saliva by addition of SCN- and H2O2 is critically dependent upon pH and upon the relative and absolute concentrations of H2O2 and SCN-.

Microbios, 1983, 37(149-150), 151 - 9
Antimicrobial activity of some thiol-containing heterocycles; Ghannoum MA et al.; The minimum inhibitory concentration values for a group of synthesized heterocyclic systems were determined for Gram-positive and Gram-negative bacteria, yeast and fungi . The active compounds were screened further against a number of yeast and yeast-like organisms and Gram-positive bacteria . The effect of two of these compounds on growth and mutagenicity was also tested . An attempt was made to correlate the structure of the compounds with their antimicrobial activity.

Microbios, 1983, 37(148), 73 - 85
Antimicrobial activity and physico-chemical properties of some alkyldimethylbenzylammonium chlorides; Daoud NN et al.; A series of alkyldimethylbenzylammonium chlorides have been synthesized with n-alkyl chain lengths of C1 leads to C18 . Octanol/water partition coefficients were determined and the antimicrobial activity assessed as the minimum growth inhibitory concentrations towards twelve strains of micro-organisms, representative of Gram-negative and Gram-positive bacteria, yeasts and fungi . The data were subjected to a numerical analysis . Antimicrobial activity of the compounds was found to be a parabolic function of their lipophilicity and maximized with n-alkyl chain lengths of between C12 and C16 . The data fit to quadratic functions estimated for low (C1-C7) and high (C8-C16) alkyl chain length compounds was better than for a single quadratic describing the activity of the complete series (C1-C18) . These maximized at log P values corresponding to alkyl-chain lengths of approximately C7 and C14 respectively, and were suggestive of low and high affinity binding sites upon the cell surface . The data analysis allowed the chain lengths of compounds with optimal activity towards the various groups of organisms to be determined . Generally yeasts and fungi were most sensitive towards C12, Gram-positive bacteria towards C14, and the Gram-negative bacteria towards C16 . Gram-negative cells were the most resistant towards all the compounds and Gram-positive cells the least.

Microbios, 1983, 37(147), 45 - 64
Local anaesthetics as antimicrobial agents: structure-action considerations; Fazly Bazaz BS et al.; The antibacterial activity of four local anaesthetics (LAs), amethocaine and procaine (esters), and cinchocain and lignocaine (amides), has been studied . All four LAs inhibited cell growth but only amethocaine and cinchocain had significant effects on cell viability and on the leakage of cellular constituents . Effects on growth inhibition were reversible . Concentrations causing marked loss in viability also caused the leakage of cellular constituents . Uptake isotherms for all four LAs by E . coli are presented and an attempt made to relate derived intracellular LA levels with effects on growth inhibition . Cultures of E . coli grown in the presence of low levels of LAs effects reflecting the relative hydrophilic-lipophilic nature of the individual LAs.

Nauchnye Doki Vyss Shkoly Biol Nauki, 1983, (3), 81 - 5
{Growth and antimicrobial activity of an association of an actinomycete and a green alga}; Zenova GM et al.; During joint cultivation of the actinomycetes Streptomyces griseus (strains 65 and 744) isolated from the soil and the green algae Chlorella vulgaris larger amount of biomass as compared with solitary axenic culture have been shown . The relation of biomass of actinomycetes S . griseus strain 65 and S . griseus strain 744 and algae in the lichen-like experimentally formed thallom make up 42:1 and 40:1 relatively, i . e . the mass of actinomycetes forms 97-98% from the mass of thalloms . Actinomycetes in the associations with the algae accumulate larger amount of biomass that in the axenic cultures on corresponding medium, whereas the algae produce the same amount of the biomass as the axenic culture under the same conditions . The associations have the antimicrobic properties differed from the axenic cultures established.

Biochem Soc Symp, 1983, 48, 117 - 32
A new era of exploitation of microbial metabolites; Demain AL; In the past history of the pharmaceutical industry, secondary metabolites have been screened almost exclusively for antimicrobial activities . This biased and narrow view has severely limited the potential application of microbial metabolites . Fortunately, this situation is changing and we are now entering into a new era in which microbial metabolites are being applied to diseases heretofore only subjected to synthetic compounds . This new approach is the application of microbial secondary metabolites to diseases that are not caused by other bacteria or fungi . For years, major drugs such as hypotensive and anti-inflammatory agents that are used for non-infectious diseases have been strictly synthetic products . Similarly, major therapeutics for parasitic diseases in animals (for example, coccidiostats and anthelminthics) resulted strictly from screens of chemically synthesized compounds followed by molecular modification . However, today fermentation products such as monensin and lasalocid dominate the coccidiostat market . The avermectins, another group of streptomycete products, have high activity against helminths and arthropods . Indeed, their activity appears to be an order of magnitude greater than previously discovered anthelminthic agents, the vast majority of which are synthetic compounds . Umezawa's group in Japan has isolated many microbial products with important pharmacological activities by screening with simple enzymic assays . There is much interest in a natural inhibitor of intestinal glucosidase, which is produced by an actinomycete of the genus Actinoplanes . The aim is to decrease hyperglycaemia and triacylglycerol synthesis in adipose tissue, liver and the intestinal wall of patients with diabetes, obesity and type IV hyperlipidaemia . Another natural compound of interest is mevinolin, a fungal product which acts as a cholesterol-lowering agent in animals . Mevinolin is produced by Aspergillus terreus . In its hydroxyacid form (mevinolinic acid), mevinolin is a potent competitive inhibitor of 3-hydroxy-3-methylglutaryl-coenzyme A reductase from liver . It is clear that, although the microbe has contributed greatly to the benefit of mankind, we have merely scratched the surface of the potential of microbial activity.

J Med, 1983, 14(4), 307 - 36
Recent developments in antimicrobial therapy with beta-lactam antibiotics; Beam TR Jr; There are three new penicillin and three new cephalosporin compounds available in the United States . All have been developed via biochemical manipulation of the beta-lactam ring and its adjacent chemical groups . The antibacterial spectrum of activity has been greatly expanded . Each of the six new agents has a unique antimicrobial profile which mandates independent evaluation . Therapeutic use of these drugs, particularly in treatment of gram-negative meningitis, has yielded success rates not previously witnessed . Application of these antibiotics as prophylactic agents for surgical procedures remains controversial . Guidelines are offered to distinguish one agent from another based on antimicrobial, pharmacokinetic and toxicologic properties.

Schweiz Med Wochenschr Suppl, 1983, 14, 58 - 63
Antibiotic combinations for the empiric treatment of the febrile neutropenic patient; Walsh TJ et al.; Empiric antimicrobial therapy in the granulocytopenic patient has traditionally consisted of a combination of an aminoglycoside plus a cephalosporin or aminoglycoside plus an antipseudomonal penicillin . These combinations have been proven reasonably effective and only moderately toxic . In some centers trimethoprim-sulfamethoxazole combined with an aminoglycoside or antipseudomonal penicillin has been used, again with good efficacy and minimal toxicity . The newer extended spectrum penicillins and cephalosporins has made possible two-drug combinations with aminoglycosides that provide double coverage of nearly all of the common bacterial pathogens while concurrently providing synergy against most of these same organisms . Further, it is now possible to have a double beta-lactam combination of a penicillin and cephalosporin which has the advantages of broad spectrum by both antimicrobials and, at times, synergistic activity but without the ototoxicity and nephrotoxicity of aminoglycosides . The double beta-lactam combination would be especially useful in the neutropenic patient with established renal insufficiency or a history of previous courses of aminoglycoside therapy . Care should be taken in choosing such a regimen, however, because some combinations demonstrate antagonism . There is increasing data to indicate that patients with profound (less than 100 microliters), persistent (greater than 14 days) granulocytopenia and concurrent gram-negative bacteremia respond best if treated with two active, bactericidal antibiotics, preferably synergistic in action . The potential for synergistic activity of the drugs selected should be, therefore, carefully considered . The duration of therapy should be adjusted according to the severity of infection, the response of the infection to antimicrobial therapy, and rate of recovery of the patient's granulocyte count.

Schweiz Med Wochenschr Suppl, 1983, 14, 49 - 57
Rational basis for the choice of regimens for empirical therapy of sepsis in granulocytopenic patients . A report of the EORTC International Antimicrobial Therapy Project Group; Gaya H; The three therapeutic trials of the EORTC International Antimicrobial Therapy Project Group are reviewed, demonstrating the efficacy of synergistic combinations of aminoglycosides with beta-lactam compounds in the initial empirical therapy of febrile episodes in granulocytopenic patients . Large numbers of patients are required in order to have sufficient evaluable cases in small but important sub-groups to draw any valid and statistically significant conclusions . At present this can be achieved only by co-operative groups engaging in multi-centre trials.

Q J Med, 1983 Summer, 52(207), 289 - 96
Complement-mediated leucoembolization: a mechanism of tissue damage during extracorporeal perfusions, myocardial infarction and in shock--a review; Jacob HS; The complement (C) system evolved as a beneficial antimicrobial system . However, when activated during extracorporeal perfusion as with haemodialysis or cardiopulmonary bypass modest pulmonary dysfunction associated with granulocyte aggregation and embolization can occur . When C activation is massive and prolonged, as with severe sepsis, trauma, or acute pancreatitis, severe pulmonary damage which is recognized as shock lung, or adult respiratory distress syndrome, may occur . Since ulcerating atherosclerotic plaques can also activate C, a mechanism by which myocardial infarcts may extend during the first few hours after infarction is also implied . Therapeutic ramifications of these conclusions are evident . Thus, high doses of corticosteroids or of nonsteroidal anti-inflammatory agents such as ibuprofen share the ability to prevent aggregation and embolization of stimulated granulocytes to patent vessels downstream and also inhibit their production of toxic oxygen radicals . These properties suggest the use of these agents in myocardial infarction and shock states, particularly shock lung, and appropriate clinical trials are awaited with interest.

Scand J Gastroenterol Suppl, 1983, 84, 111 - 7
Antimicrobial prophylaxis of travellers' diarrhoea: a summary of studies using doxycycline or trimethoprim and sulphamethoxazole; Sack RB; Antimicrobial therapy of travellers' diarrhoea with doxycycline or a combination of trimethoprim and sulphamethoxazole is effective only while the drugs are being taken . There is no evidence that sub-clinical infections or exposures leads to the development of immunity while the drugs are being taken . When the drugs are withdrawn, an increase in diarrhoea attack rate occurs in those persons who were previously taking the drug . Therefore, the drugs are only effective for short-term use and would not be indicated in persons travelling for long periods of time . Both drugs can be taken once a day, and are therefore convenient to use . There are adverse side effects with these drugs: the possibility of developing a skin rash with TMP-SMX or a photosensitivity reaction with doxycycline must be balanced against the protection afforded . Although both drugs have an effect on normal enteric flora there is no evidence to suggest that this renders the individual more susceptible to other enteric pathogens.

Zentralbl Gynakol, 1983, 105(15), 1011 - 3
{Infected scalp hematoma}; Handrick W et al.; In a newborn after delivery by vacuum extraction and after application of a scalp electrode for fetal monitoring a cephalhematoma followed by infection due to E . coli was observed.--It was treated by antibiotics and incision . In a brief review of the literature the problems of the origin, diagnostic, and therapy of infected cephalhematoma are discussed . For the detection of local infection and bacteremia the authors emphasize careful bacteriological examinations (aspirate from hematoma, blood culture) as well as radiographs of the skull . The treatment of infected cephalhematoma must consist of antimicrobial chemotherapy and incision of the local process.

Urol Res, 1983, 11(1), 1 - 5
Chronic bacterial prostatitis: theoretical and experimental considerations; Madsen PO et al.; The results of the treatment of chronic bacterial prostatitis are disappointing . The current status of antimicrobial and immunological research is described . While both a local and systemic antibody response is demonstrated in acute bacterial prostatis, only a local antibody production is found in chronic bacterial prostatis . This response as reflected in the expressed prostatic secretion is specific for the infecting organism and immunoglobulin A is the major antibody class involved . Drug penetration into the prostate has mainly been studied in dogs and the ideal drug appears to be a lipid-soluble base which will concentrate in the slightly acidic prostatic secretion because of ion-trapping . However, these results are not directly applicable to humans because of the slight alkalinity of human prostatic secretion, the localization of the chronic inflammatory process in the interstitium, and the evidence of an active secretory mechanism for trimethoprim . The clinical consequences of these findings are discussed in relation to several recent studies and the treatment with lipid-soluble bases with a low plasma protein binding over extended periods is recommended.

Pediatr Pharmacol (New York), 1983, 3(3-4), 313 - 20
Pharmacokinetics of antimicrobial drugs in the cerebrospinal fluid; Skopnik H et al.; The physicochemical properties of the blood-to-brain barrier, the cerebrospinal fluid (CSF) to brain barrier, and the blood-CSF barrier, including their specific transport mechanisms, are responsible for drug concentration time courses in the CSF, which increase slower and remain lower than in the serum . From the kinetic point of view the central nervous system (CNS) can be understood as a deep compartment in the organism . During the initial inflammatory phase of a bacterial meningitis, the penetration of antibiotics can be increased . Consequently, sufficient CSF concentrations should be achieved as soon as possible . To investigate the influence of the dosage regimen on the kinetic profile of antibiotics in the CSF, chloramphenicol and cefotaxim were measured using high pressure liquid chromatography (HPLC)-techniques . Five children had a bacterial meningitis and five an external ventricular drainage due to various diseases . Neither continuous infusion over a 12-24-hour-period nor four bolus-injections per day led to sufficient antimicrobial concentrations within the first hours after starting therapy . Using a loading dose of 40-50% of the daily dose administered over a 2-4-hour infusion period and followed by bolus injections, sufficient concentrations of chloramphenicol and cefotaxim could be achieved within a few hours . Besides an adequate choice of antibiotics, the special pharmacokinetic properties of the cerebrospinal membranes should not be neglected in the concept of the antibiotic therapy of meningitis.

Microbiol Immunol, 1983, 27(8), 649 - 54
New beta-lactamase-resistant cephem treatment of guinea pigs infected with Legionella pneumophila; Toro J et al.; The in vivo antimicrobial effect of seven new beta-lactamase-resistant cephems (cefotaxime, latamoxef, ceftazidime, ceftriaxone, cefotiam, cefbuperazone, and MT-141) on Legionella pneumophila (strain 81-066, serogroup IV) in guinea pigs was compared with that of erythromycin . As the minimal LD100 within one week was about 4.0 X 10(9) CFU/ml by intraperitoneal injection of the strain, the animals were inoculated with 2.0 ml of twofold dilutions of a suspension of this bacterium . The animals developed purulent peritonitis and systemic involvement demonstrated by the development of periangitis, pneumonia and pleuritis in the lungs . Three different doses of antibiotics were administered intraperitoneally immediately after the rectal temperature reached more than 40 C . Erythromycin had a significant therapeutic effect but none of the new cephems tested death of the infected guinea pigs.

Arzneimittelforschung, 1983, 33(8), 1084 - 6
HR 810, a new parenteral cephalosporin with a broad antibacterial spectrum; Seibert G et al.; 3-{(2,3-Cyclopenteno-1-pyridinium)-methyl}-7-{2-syn-methoximino-2-(2-aminothiazol-4-yl)-acetamido}-ceph-3-em-4-carboxylate (HR 810) is a new cephalosporin derivative with an extremely broad antimicrobial spectrum . It is active against all bacterial species of clinical relevance, including strains which are frequently resistant towards cephalosporins of the third generation.

Drug Metab Rev, 1983, 14(2), 137 - 68
Absorption from the vagina; Benziger DP et al.; PIP: Methods and results are reviewed of research on the permeability of the vagina to a wide variety of compounds including steroids, prostaglandins (PGs), antimicrobials, proteins, antigens, and hormones, nonoxynol-9, methadone, and inorganic compounds . Although the literature indicates that the vagina is capable of absorbing a wide variety of organic and inorganic compounds, quantitative data on the extent of absorption are often lacking . Most steroids were readily absorbed and their bioavailability after intravaginal instillation was greater than after oral administration because of a reduced first-pass effect . Natural and synthetic PGs were absorbed; the extent of absorption ranged from 10-43% of the dose . Penicillin and sulfanilamide exhibited extremely variable absorption from the vagina . In most women neither econazole, miconazole, nor clotrimazole were effectively absorbed . In 1943 it was demonstrated that proteins could be absorbed from the vagina . Data on human absorption of nonoxynol-9 are indirect but are consistent with absorption . Methadone, povidone-iodine, and potassium permanganate have also been shown to be absorbed through the vagina . The stage of the reproductive cycle may alter the extent of vaginal absorption, but this has been clearly demonstrated for only 1 substance in the rat .

Chemotherapy, 1983, 29(2), 104 - 10
In vitro activity of antifungal agents against yeast species; Bergan T et al.; The antimicrobial activity of 8 antifungal agents have been compared in vitro against 151 strains of yeast fungi and 2 of Geotrichum candidum . The drugs were the classical nystatin and amphotericin-B, 5-flucytosine, and 5 imidazoles, clotrimazole, econazole, ketoconazole, miconazole, and tioconazole . An agar dilution technique with incubation at 37 degrees C was used . By this procedure, econazole was the most active agent per weight basis among those suitable for topical therapy . Tioconazole had a wide spectrum and high activity . Ketoconazole had an antimicrobial activity which makes it an interesting agent considering its applicability in systemic therapy . The activity of 5-flucytosine surpasses that of other systemically applicable agents.

Infection, 1983, 11 Suppl 1, S54 - 6
Ceftazidime, ceftizoxime, cefotaxime and HR 221 in experimental chronic Escherichia coli pyelonephritis in rats; Marre R et al.; The therapeutic efficacy and pharmacokinetics of the cephalosporins ceftazidime, ceftizoxime, cefotaxime and HR 221 were studied in animal experiments . The animal model used was experimental estrogen-induced or non-induced chronic Escherichia coli pyelonephritis in rats . The animals were treated with 5 mg cephalosporin/kg twice daily for one week . Each of the cephalosporins tested led to a significant decrease in renal bacterial counts, in spite of the low doses given . Ceftazidime was significantly more active than HR 221 in both experimental models, although the serum levels of HR 221 were higher and were maintained for a longer period of time than those of ceftazidime . Differences in pharmacokinetic properties (influenced by metabolic stability and protein binding) could be the reason for the differences in therapeutic activity, since the in vitro antimicrobial activity of each of the cephalosporins tested was very similar against the test strain.

Ann Surg, 1983 Jan, 197(1), 57 - 62
Histoplasma infection of abdominal aortic aneurysms; Miller BM et al.; Fungal endarteritis resulting from progressive disseminated histoplasmosis may cause arterial aneurysms, or lead to infection of pre-existing aneurysms . Three patients with Histoplasma capsulatum infections of abdominal aortic aneurysms are reported . All had previous disseminated histoplasmosis and atherosclerotic peripheral vascular disease . All were considered cured of systemic infection when their aneurysms were discovered . Atherosclerotic vascular lesions may become infected during the course of systemic fungal disease and may serve as a haven for viable organisms in patients whose dissemination recurs despite seemingly adequate antifungal therapy . In treating these patients, resection of all infected arterial tissue, revascularization through uninfected tissues, and long-term antimicrobial therapy are recommended.

Antimicrob Agents Chemother, 1983 Jan, 23(1), 1 - 7
Mechanism of renal excretion of AM-715, a new quinolonecarboxylic acid derivative, in rabbits, dogs, and humans; Shimada J et al.; The mechanisms of the renal excretion of AM-715, a synthetic antimicrobial agent, were studied in rabbits, dogs, and humans . In both rabbits and humans, AM-715 clearance was greater than creatinine clearance and was profoundly decreased by the administration of probenecid . Thus, in these subjects, AM 715 was cleared by both tubular secretion and glomerular filtration . In dogs, however, the excretion ratio (close to unity), biological half-life, and stop-flow pattern of AM-715 were not affected by probenecid, indicating that the renal excretion of AM-715 took place mostly through glomerular filtration . These results suggest that renal excretion of AM-715 differs with animal species.

Mayo Clin Proc, 1983 Jan, 58(1), 21 - 32
The penicillins; Wright AJ et al.; The penicillins as a group are the most frequently and widely used of the antimicrobial agents because they are effective, low in toxicity, and relatively inexpensive . Effectiveness is due to the bactericidal action, the excellent distribution throughout the body spaces, and the wide spectrum of activity . Knowledge of the variation in spectrum of activity of the various types of penicillins is needed for effective use of the appropriate drug against individual infections . Allergenicity is the most frequent and serious problem associated with the use of penicillins . Individual penicillins, however, do have different side effects . The older penicillins are so inexpensive that the cost of their use need hardly be considered, whereas the newer penicillins are expensive and should be used only when they are clearly more effective for treatment than are drugs such as penicillin G.

Scand J Infect Dis Suppl, 1983, 39, 26 - 33
Treatment of otitis media with effusion; Bluestone CD; Otitis media is the most common disease of children who seek medical care . It is estimated that over 30 million visits to physicians are made per year, and that over one billion dollars are spent annually in the United States for the treatment of otitis media . More prescriptions are written for oral antimicrobial agents for otitis media than any other disease . Antimicrobial therapy is still the mainstay of treatment for children with acute otitis media . Myringotomy (and tympanocentesis) should also be performed when acute otitis media is associated with: severe otalgia, when otalgia or fever persists or recurs in spite of antimicrobial therapy, in the very young or immunocompromised host and when a suppurative intratemporal or intracranial complication is impending or present . Antimicrobial agents should be selected according to the incidence of bacteria prevalent in the community and should be altered depending upon the results of cultures obtained from middle ear aspirates in children who are not responding to the usual antimicrobial agents . Children who experience frequently recurrent acute otitis media (without a middle ear effusion between attacks) should be considered candidates for prophylactic antimicrobial therapy or tympanostomy tube insertion, or both . A middle ear effusion that has persisted for three months or longer should be considered chronic and active treatment should be instituted . A course of antimicrobial therapy should be tried, and if not effective, then a myringotomy with aspiration of the effusion is indicated.(ABSTRACT TRUNCATED AT 250 WORDS)

Comp Biochem Physiol C, 1983, 75(2), 311 - 5
The aerobic metabolism of metronidazole by Trypanosoma cruzi epimastigotes; Agosin M; Trypanosoma cruzi epimastigotes actively metabolize metronidazole under aerobic conditions to a polar compound tentatively identified as 2-methyl-5-nitroimidazole-1-yl-acetic acid . The rate of metabolite formation is increased by more than 50% by pretreatment with phenobarbital and inhibited by SKF-525A and metyrapone . The reaction is dramatically stimulated by the addition of flavone which suggests that the metabolite is produced via the cytochrome P-450 system . Apparently the nitro group in the metabolite is maintained intact . Detoxication reactions catalyzed by cytochrome P-450 appear to be more important than previously suspected as a basis to explain at least partially the resistance of these organisms to known antimicrobial agents . However, other factors such as the fate of nitro substituent in metronidazole require further evaluation.

J Antibiot (Tokyo), 1982 Dec, 35(12), 1675 - 82
Structure-activity studies among 16-membered macrolide antibiotics related to tylosin; Kirst HA et al.; Although a substantial number of 16-membered macrolides related to tylosin have now been isolated and evaluated as antibiotics, none appeared to be superior to tylosin in treating bacterial or mycoplasmal infections caused by sensitive organisms . Nevertheless, this comparison of the antibiotic activity of 16-membered macrolides clearly indicates that novel antibiotics with potentially useful activity can be obtained from mutant strains which have been blocked at various steps in their biosynthesis of antimicrobial agents . The novel compounds thus produced may also be used as starting materials for additional chemical and microbiological modification . Furthermore, the mutant strains which produced these novel compounds should be useful recipients for interspecific genetic recombination by protoplast fusion or gene cloning to yield hybrid antibiotics . Even greater exploitation of these methods will be required in the continuing search for new antibiotics and improved methods for producing them.

J Clin Hosp Pharm, 1982 Dec, 7(4), 251 - 60
The defined daily dose per 100 bed-days as a unit of comparison and a parameter for studying antimicrobial drug use in a university hospital . A retrospective study of the effects of guidelines and audit on antimicrobial drug use; Hekster YA et al.; Growing awareness of problems arising from over-use of antimicrobial agents has led to attempts to develop policies or guidelines for rational treatment . To follow the effects of guidelines, the percentage of patients receiving anti-microbial drug therapy, acquired from patient records, has been a frequently used parameter . In this paper the Defined Daily Dose (DDD) per 100 bed-days has been used instead . This parameter can be calculated by converting the number of units of antimicrobials, delivered to individual wards, to defined daily doses per bed-day . This parameter determines the probability of treating a patient with a particular drug, based on pooled data . The DDD per 100 bed-days has been used to follow changes in prescribing habits arising from the acceptance of and adherence to guidelines over a period of 5 years in a University Hospital.

Eur J Clin Microbiol, 1982 Dec, 1(6), 361 - 6
Evaluation of the Micur microdilution systems for antibiotic susceptibility testing of gram-negative and gram-positive bacteria; Kayser F et al.; Two commercial systems for testing the antimicrobial susceptibility of bacteria were evaluated in a collaborative study at two sites using 306 freshly isolated clinical strains . Gram-negative bacteria were tested with the Micur RST 02 and gram-positive bacteria with the Micur RST 03, systems for MIC titration . For categorization of bacterial susceptibility into sensitive, intermediate or resistant, the Micur ST 02 and 03 were used for gram-negative and gram-positive bacteria respectively . The broth microdilution technique served as reference method . A total of 3672 MIC pairs were determined . MICs obtained with the Micur RST 02/03 were found to be 96.9% in agreement (+/- one log2 dilution) with the reference method results . The inter-laboratory and intra-laboratory reproducibility for the Micur RST tested with four ATCC reference strains was 97.5% and 98.5% respectively . Categorization of bacterial susceptibility with the Micur ST 02/03 agreed with 94.9% of the Micur RST results and 91.6% of the reference method results . On account of their accuracy, reproducibility and long shelf-life the Micur RST and ST systems offer a convenient method for testing antimicrobial susceptibility of bacteria in the clinical microbiology laboratory.

J Trauma, 1982 Dec, 22(12), 1015 - 8
A clinical study of antimicrobial agents delivered to burn wounds from a drug-loaded synthetic dressing; Nathan P et al.; This report is of an investigation of the release of antimicrobial agents from a solid barrier dressing when applied to second- and third-degree burn wounds . The synthetic dressings were formed by a mixture of polyethylene glycol-400 (PEG), poly-2-hydroxethyl methacrylate (PHEMA) and one of the test drugs: silver sulfadiazine (AgSD), gentamicin, silver nitrate, or nitrofurazone . The dressings were formed directly on the burn wounds of 33 patients from a paste prepared from a mixture of PEG-PHEMA and drug . These dressings remained in place for 3 days, covering 12 to 64 square inches of the wound . In six patients, the entire burn wounds were covered with the dressings in which the treated areas were each about 200 square inches . The use of drug-loaded synthetic dressings extended to cover major portions of the burn wounds reduced the work required for nursing care and lessened patient discomfort.

Arch Intern Med, 1982 Dec, 142(13), 2299 - 308
Clinical aerosols II . Therapeutic aerosols; Lourenco RV et al.; The current uses of clinical aerosols such as water, saline, mucolytics, bronchodilators, cromolyn sodium, corticosteroids, and antimicrobials have been reviewed . The benefits of water, saline, and detergent aerosols continue to be surrounded by uncertainty and controversy . Aerosolized mucolytic and proteolytic agents have not been conclusively shown to be of substantial value in the improvement of respiratory disorders . Favorable bronchodilator therapy is achieved with aerosols of certain sympathomimetic and anticholinergic agents . However, successful therapy depends on the dose administered and the site of aerosol deposition in the lung . The prophylactic use of cromolyn sodium in patients with asthma is another useful application of aerosols . Topically active corticosteroid aerosols are increasingly being used since they may reduce risks of systemic effects from corticosteroids . Research on uncommonly aerosolized agents has widened the spectrum of therapeutic applications of aerosols.

J Pathol, 1982 Dec, 138(4), 353 - 64
Comparative histology of the mouse bladder following initial infection and re-infection with Escherichia coli; Sivan Y et al.; The present study continues our investigation of the bladder antimicrobial mechanisms following bacterial infection . Since the process of spontaneous clearance of bacteria (E . coli) from the mouse bladder is greatly accelerated upon re-infection, a histopathological comparison was made of initially infected (II) versus re-infected (RI) mice . It was reconfirmed that the spontaneous clearance upon re-infection is indeed much faster than after the initial infection . There were morphological differences between these two courses of infection, as well as in the localization and composition of the inflammatory response . Thus cellular infiltration was more evident in the epithelium of the II mice, whereas the RI animals displayed increased cellular exudation in the lamina propria . It was also found that the dominant cell in the II mouse is the granulocyte and in the RI mouse--lymphocytes, macrophages and plasma cells . This last finding is suggestive of a local immunological process . The overall results are consistent with the notion that a local immune response develops in the infected bladder and participates in the enhanced clearance in RI animals.

Am J Clin Pathol, 1982 Dec, 78(6), 853 - 6
Evaluation of the antimicrobial removal device when used with the BACTEC blood culture system; Strand CL; A study to determine the value of the Antimicrobial Removal Device (ARD) used in conjunction with radiometric detection of bacteremia using three media was conducted . During a 12-month period, 622 duplicate ARD/BACTEC blood-culture sets were collected . There were 88 positive cultures that yielded 68 pathogenic isolates and 28 probable contaminant isolates . When all patients were considered, 31 pathogenic isolates were detected by both systems, 25 pathogenic isolates were detected faster or only by the BACTEC system, and 12 pathogenic isolates were detected faster or only when the ARD was employed . This difference is statistically significant (P less than 0.05) . Thus, the standard BACTEC blood-culture system using three different media was superior to the same BACTEC system using ARD-processed blood specimens . When only patients receiving antimicrobial therapy were considered, there were more pathogenic isolates detected from unprocessed blood than from blood processed in the ARD; however, this difference was not statistically significant . In conclusion, there appears to be no advantage to using the ARD system in conjunction with the three-bottle BACTEC blood-culture system.

Chest, 1982 Dec, 82(6), 705 - 7
The use of tracheal and pulmonary aspiration to diagnose Legionella micdadei pneumonia; Wing EJ et al.; Legionella micdadei (Pittsburgh pneumonia agent) pneumonia was diagnosed in three patients by transtracheal aspiration and in a fourth patient by percutaneous lung aspiration on two occasions . The organism was identified by direct fluorescent antibody staining and by culture in each case . Diagnosis by aspiration of the respiratory tract was rapid, specific, and safe . This allowed early institution of specific antimicrobial therapy in a group of severely ill, immunocompromised patients . These techniques should be considered whenever the diagnosis of L micdadei pneumonia is likely.

J Biol Chem, 1982 Nov 25, 257(22), 13731 - 35
Oxidation of Escherichia coli iron centers by the myeloperoxidase-mediated microbicidal system; Rosen H et al.; Myeloperoxidase, HeO2, and a halide (chloride, bromide, iodide) constitute a powerful microbicidal system which is active against a wide variety of microorganisms and is believed to contribute to the antimicrobial activity of neutrophils . The precise mechanism by which this system exerts its toxicity is unknown . We report here that the microbicidal activity of the myeloperoxidase-H2O-chloride system on Escherichia coli is associated with the loss of iron into the medium as measured by the release of 59Fe from prelabeled organisms . Iron loss (but not bactericidal activity) was considerably increased by the addition of EDTA or other iron chelators; it was not associated with a corresponding release of protein with 14C-amino-acids . Iron loss was observed with chloride or bromide as the halide, but not when iodide was employed in microbicidal concentrations . Microbicidal activity was detected at an earlier time period and at a lower halide concentration than was iron loss . Analogous changes were observed when cytochrome c was oxidized by the myeloperoxidase H2O2-halide system . The initial response was a shift in the Soret maximum, followed by a fall in absorbance accompanied by the loss of iron . As with the intact organism, iron loss was evident with chloride and bromide, but not with iodide as the halide . These findings suggest that microbial iron centers are a target for the myeloperoxidase-mediated antimicrobial system and that their oxidation may contribute to microbicidal activity.

Biochemistry, 1982 Nov 23, 21(24), 6299 - 308
Myeloperoxidase-catalyzed incorporation of amines into proteins: role of hypochlorous acid and dichloramines; Thomas EL et al.; Myeloperoxidase-catalyzed oxidation of chloride (Cl-) to hypochlorous acid (HOCl) resulted in formation of mono- and dichloramine derivatives (RNHCl and RNCl2) of primary amines . The RNCl2 derivatives could undergo a reaction that resulted in incorporation of the R moiety into proteins . The probable mechanism was attack of RNCl2 or an intermediate formed in the decomposition of RNCl2 on histidine, tyrosine, and cystine residues and on lysine residues at high pH . Incorporation of radioactivity from labeled amines into stable, high molecular weight derivatives of proteins was measured by acid or acetone precipitation and by gel chromatography and electrophoresis . Whereas formation of RNCl2 was favored at low pH, the subsequent incorporation reaction was favored at high pH . Up to several hours were required for the maximum amount of incorporation, which was less than 10% of the label in RNCl2 . For the amines tested, incorporation was in the order histamine greater than 1,2-diaminoethane greater than putrescine greater than taurine greater than lysine greater than glucosamine greater than leucine greater than methylamine . Initiation of the reaction required HOCl, and oxidized forms of bromide, iodide, or thiocyanate did not substitute . Inhibitors of incorporation fell into three classes . First, ammonia or amines competed with the labeled amine for reaction with HOCl, so that larger amounts of HOCl were required . Second, readily oxidized substances such as sulfhydryl or diketo compounds or thioethers (methionine) reduced RNCl2 . Third, certain compounds competed with protein as the acceptor for the incorporation reaction . The amount required to block incorporation into protein depended on protein concentration . Among these inhibitors were imidazole compounds (histidine), phenols (tyrosine), and disulfides (glutathione disulfide, GSSG) . Low yields of derivatives of histidine, tyrosine, and GSSG were detected by thin-layer chromatography . Acid-precipitable derivatives were obtained by reacting RNCl2 with polyhistidine or polytyrosine, and to a lesser extent with polylysine at high pH, but not with other poly(amino acids) . Precipitable derivatives were also obtained by incubating MPO-containing extracts from leukocyte granules with hydrogen peroxide, Cl-, and labeled amines . The extracts were found to have a high content of substances with primary amino groups, which competed for incorporation . The results account for oxidative incorporation of amines into proteins in leukocytes and provide evidence that HOCl and nitrogen-chlorine (N-Cl) derivatives are formed in these cells . The characteristics of the incorporation reaction suggest that it would not contribute significantly to the antimicrobial activity of myeloperoxidase (MPO) . Nevertheless, the reaction may provide a sensitive method for studying MPO action in vivo.

J Antibiot (Tokyo), 1982 Nov, 35(11), 1561 - 4
Biological properties of ristocetin-ps-aglycone; Nielsen RV et al.; Ristocetin-ps-aglycone obtained by acid hydrolysis of ristocetin A, has a substantially greater antimicrobial activity against Gram-positive bacteria than the parent compound . None of the substances are active against Gram-negative bacteria, yeast or fungi . The ps-aglycone is several times more toxic than ristocetin A when administered intravenously . Both substances are well-tolerated when given subcutaneously, intraperitoneally and perorally . Both ristocetin A and the ps-aglycone have a very low absorption after oral administration . Plasma levels following intravenous administration of ristocetin A and the ps-aglycone are comparable, with both showing a rapid decline during the first 60 minutes followed by a somewhat slower elimination . The aggregating properties of the ps-aglycone could not be determined due to its low solubility at neutral pH.

Vestn Khir Im I I Grek, 1982 Nov, 129(11), 32 - 4
{Use of katamin AB in the preoperative treatment of the operation fields}; Kriukov SD; Under analysis were results of the application of an antiseptic drug katamin AB from the group of quaternary ammonium compounds for the treatment of the operation field in 435 patients . They have confirmed a high antimicrobial activity of the katamin AB, its continuous effect, simplicity, reliability and quick use . The author recommends it for the treatment of the operation field.

Rev Infect Dis, 1982 Nov-Dec, 4 Suppl, S720 - 6
A new generation of beta-lactam antibiotics: anticipating future developments and needs; Jackson GG; The development of a drug with the properties of moxalactam creates both a new class of beta-lactam antibiotics and potentially a new era in chemotherapy . The specific activity (antibacterial effect/mg), stability against enzymatic degradation, and pharmacologic advantages of moxalactam provide new promise for the treatment of some infections and for moving forward our understanding of bacterial properties and the processes of infection . Such conditions offer numerous opportunities for development of new knowledge and improved practices in antimicrobial therapy . As the quality of antibiotics is improved through modification by chemical synthesis, some biologic and clinical needs shift . Experience provides a basis for anticipation and recognition of some of the conditions that are most likely to occur . Physicians should be alert to these possibilities and to their opportunity for making observations that will establish the optimal use of moxalactam, the first of a new generation of beta-lactam antibiotics.

J Clin Pathol, 1982 Nov, 35(11), 1169 - 76
An antibiotic susceptibility testing trial organised as part of the United Kingdom national external microbiological quality assessment scheme; Snell JJ et al.; Organisms of known susceptibility to antimicrobial drugs were distributed for sensitivity testing to laboratories participating in the United Kingdom National External Microbiological Quality Assessment Scheme . The results obtained were correlated with the methods used . Laboratories differed in their standards of antimicrobial drug sensitivity testing . An association between error rates and particular methods and practices enabled recommendations to be made on disc content, method of methicillin testing, preparation of inoculum, use of controls and use of lysed blood for sulphonamide testing . Some media appeared significantly better than others but because of the many factors involved further information is being sought to clarify this.

J Periodontol, 1982 Nov, 53(11), 693 - 9
The development and in vitro evaluation of acrylic strips and dialysis tubing for local drug delivery; Addy M et al.; This study reports on the development of drug containing acrylic strips for delivering antimicrobial agents and compares the in vitro release pattern with dialysis tubing . Polyethylmethacrylic strips of suitable dimensions containing 10 to 50% chlorhexidine acetate, 40% metronidazole and 40% tetracycline were prepared . Daily release of the incorporated drugs into 1 ml aliquots was measured spectrophotometrically over a 14 day period . Similarly the release of chlorhexidine gluconate from various lengths of patent and heat sealed dialysis tubing was recorded for 4 days . At 30%, 40% and 50% admixtures the acrylic strips released chlorhexidine up to the 14 day period and a parallel bioassay confirmed the maintenance of antibacterial activity to this time . At the same admixture the release of metronidazole was greater than chlorhexidine and tetracycline . All drugs were released at high levels on day 1 followed by a marked fall in release by day 2 and progressive fall thereafter . The release from tubing was almost total within 24 hours and was independent of sealing the ends . The strips appear to have potential for prolonged drug delivery to periodontal pockets . Preliminary clinical use revealed no patient acceptability problems and alterations in subgingival flora were produced.

Int J Clin Pharmacol Ther Toxicol, 1982 Nov, 20(11), 514 - 6
Pharmacokinetics of ticarcillin during cisplatin chemotherapy; Higi M et al.; Cancer chemotherapeutic agents and antimicrobial antibiotics are often given concomitantly . Cisplatin, which has become increasingly important in cancer treatment, has shown nephrotoxicity as a dose-limiting feature . The alpha-carboxy-penicillin ticarcillin (tc) has a wide spectrum of antimicrobial activity, especially against Pseudomonas . The plasma half-life of tc is correlated with renal function . The combined use of cisplatin (20 mg/m2, days 1-5) and tc (3 X 5 g/24 h, days 1-5) with renal protection by vigorous hydration (2400 ml of 0.9% NaCl/24 h continuous infusion, days 1-5) in a group of 12 cancer patients did not alter the BUN and creatinine serum levels . The mean serum concentration of tc, which was monitored in a patient 15, 30, and 45 min after injection of 5 g on 4 consecutive days together with cisplatin, did not differ from the levels of tc reported when used without concomitant cisplatin therapy . Thus these preliminary data show that the pharmacology of tc may not be altered significantly when applied together with cisplatin and that cumulative nephrotoxicity must not be expected with this combination when sufficient hydration is used.

Drug Intell Clin Pharm, 1982 Nov, 16(11), 843 - 8
A biochemical approach to chemotherapy; Hitchings GH; A program in chemotherapy is described in which antimetabolites to constituents of nucleic acids were used as probes of enzymes and metabolic pathways . These studies led to a number of insights into nucleic acid biosynthesis and related biochemical fields . They also provided exploitable information that was developed into drugs for the treatment of leukemia, the prevention of rejection of organ transplants, and a new therapy for hyperuricemia and gout . Studies on infectious diseases provided insights into the modeling of inhibitor-enzyme complexes and led to new and effective antimicrobial and antiviral agents . Basic research and relative absences of specific targeting are shown to have greatly facilitated the progress of the program.

Farmaco {Sci}, 1982 Nov, 37(11), 728 - 39
1,2,3-Triazole derivatives of aryloxyalanoic acids; Da Settimo A et al.; Several 1,2,3-triazolederivatives of aryloxyalcanoic acids of general formula (II) were synthesized . Some derivatives were obtained by the cycloaddition reaction of 4-azidophenoxyacetic acid (III) to activated methylene compounds, but the largest part were prepared by nucleophilic substitution reactions of three new (4-hydroxyphenyl)triazole derivatives and alyphatic bromoesters . Some compounds, tested as prostaglandin-synthetase inhibitors of rat spleen in vitro, showed practically no activity; moderate activities as herbicides, insecticides and antimicrobials were detected.

Arch Intern Med, 1982 Nov, 142(12), 2157 - 9
Bacteremic Escherichia coli pneumonia; Jonas M et al.; Nine patients with bacteremia Escherichia coli pneumonia were studied, and 22 cases from the literature of the bacteremic and nonbacteremic variety were reviewed . The findings of this study indicate that E coli pneumonia most often occurs in persons who are elderly and have associated conditions that impair host defenses . Escherichia coli pneumonia is usually nosocomially acquired . The organism may reach the respiratory tract by aspiration of oropharyngeal secretions due to colonization or by hematogenous dissemination from a primary source in the gastrointestinal tract or the genitourinary tract . The clinical manifestation most often is that of pneumonia in the lower lobe, but the process can be roentgenographically variable . Sputum culture is usually positive in the bacteremic form of E coli pneumonia . The high morbidity found in this study, despite appropriate antimicrobial therapy, emphasizes the need for earlier recognition and infection prevention in predisposed groups.

Am J Med, 1982 Nov, 73(5), 706 - 18
Superinfection: another look; Sen P et al.; Superinfection in the compromised host often poses a diagnostic and therapeutic dilemma for the physician who is concerned that a perplexing array of microorganisms might be involved . We believe that the differential diagnosis list can often be narrowed considerably by separating superinfection in the compromised host into five convenient categories: (1) infections due to the underlying disease itself; (2) infections due to the underlying disease plus therapy for that disease; (3) infections due solely to medicaments, operations, or procedures; (4) infections increased in severity but probably not in incidence; and (5) societally related infections . Use of this or a similar categorization should result in a more rational approach to differential diagnosis, should encourage a more focused diagnostic work-up, whould reduce the necessity for invasive procedures, should provide the microbiology laboratory information about specific organisms that should be sought sedulously, and should permit the selection of a more rational antimicrobial regimen prior to the availability of definitive microbiologic information.

Jpn J Antibiot, 1982 Nov, 35(11), 2570 - 7
{Laboratory and clinical studies of cefmenoxime in the pediatric field}; Sekiguchi T et al.; Laboratory and clinical studies were performed on cefmenoxime (CMX), a new cephalosporin antibiotic, and the following results were obtained . 1 . Susceptibility of clinically isolated bacteria to CMX and cefotiam (CTM) or cefazolin (CEZ) Antimicrobial activity of CMX was compared with that of CTM and CEZ against S . aureus, S . epidermidis, S . pneumoniae, H . influenzae and E . coli . CEZ and CTM were more active than CMX against S . aureus, S . epidermidis and S . pneumoniae . But CMX was found to be more active by 1-10 tubes than CEZ and CTM against H . influenzae and E . coli . 2 . Clinical efficacy . CMX was intravenously administered to 19 patients; 3 with lacunar tonsillitis, 2 with acute bronchitis, 8 with bronchopneumonia, 3 with UTI, 1 with septicemia, 1 with acute panperitonitis, 1 with S.S.S.S . at daily doses of 30-115 mg/kg (64.6 mg/kg on an average) t.i.d . or q.i.d . for 3-17 days (6.1 days on an average) . The overall efficacy rate was 94.7%, i.e., efficacy was excellent in 10 cases (52.6%), good in 8 cases (42.1%), and poor in 1 case (5.3%) . Bacteriological efficacy was good, i.e . 16 of the 19 strains disappeared . Transient eosinophilia was observed in 1 patient, but no other laboratory abnormality was observed during treatment . The above results suggest that CMX is 1 of the useful antibiotics in treatment of pediatric infections, especially due to Gram negative bacteria.

Rev Infect Dis, 1982 Nov-Dec, 4 Suppl, S676 - 82
Moxalactam in the treatment of intraabdominal sepsis and other surgical infections; Busuttil RW et al.; Bacterial peritonitis, intraabdominal sepsis, and other surgical infections are frequently polymicrobial . Moxalactam, a new beta-lactam antibiotic, has been shown to be active in vitro against most bacterial pathogens commonly isolated from patients with surgical infections . This drug was therefore tested as the sole antimicrobial agent in the treatment of 32 surgical infections (25 cases of intraabdominal sepsis, 6 cases of wound infections, and 1 case of bacteremia) . Nearly all (91%) of the infections responded favorably; 66% were cured with moxalactam plus surgery, 16% were cured with moxalactam alone, and 9% improved . Moxalactam-resistant strains of bacteria were isolated from 18 infections but were associated with therapeutic failure in only two cases and with superinfection in three cases . On the basis of these data, we believe that moxalactam is an effective and safe antimicrobial agent for use alone in the treatment of serious intraabdominal infections.

Trop Doct, 1982 Oct, 12(4 Pt 2), 231 - 5
Drug usage in southern Brazilian hospitals; Victora CG et al.; A drug usage survey was carried out in 14 hospitals in the southernmost region of Brazil in the year 1979 . The average number of drugs prescribed per patient was 8.6, and antimicrobials, followed by analgesics, vitamins and sedatives-tranquilizers were the most often employed drug categories . Among the antimicrobials, ampicillin was the first, followed by chloramphenicol, but the overall leading drug was an analgesic-antipyretic, dipyrone . Some possible distortions in drug usage are discussed.

J Antibiot (Tokyo), 1982 Oct, 35(10), 1338 - 44
4-N-Aminoacylation of substances derived from lysinomicin; Kurath P et al.; The preparations of 4-N-glycyllysinomicin and several 4-N-aminoacyl derivatives of compounds prepared from lysinomicin are presented . The new substances have lower antimicrobial activities than the original 4-N-unsubstituted lysinomicin derivatives . This result indicates that the structure-activity relationship observed with fortimicin A and fortimicin B does not apply to the lysinomicin derivatives studied.

Can J Comp Med, 1982 Oct, 46(4), 341 - 9
Factors associated with mortality and treatment costs in feedlot calves: the Bruce County Beef Project, years 1978, 1979, 1980; Martin SW et al.; Three years of data on factors associated with death losses and health costs in Ontario feedlot calves were analyzed . The results support the previously reported findings; however, significant differences in the third year (1980-81) of the study were noted . Calf groups that were "mixed" after arrival in the feedlot or had a larger than average number of calves (means = 142) had increased death losses and health costs . Calf groups whose ration was changed from dry hay to hay silage or corn silage as the major component of the ration during the first month after arrival had higher death losses and health costs . Feeding grain (barley/oats/corn) prior to, or concurrent with, the change to silage appeared to decrease the harmful effects . Cattle groups vaccinated against respiratory disease within two weeks of arrival experienced increased death losses and health costs . These effects were ameliorated by delaying vaccination in groups switched to silage; however, no benefits from delaying vaccination were noted in dry hay fed groups . Prophylactic antimicrobials in the water supply during the first week after arrival appeared particularly deleterious to the health of calf groups . The effects of prophylactic antimicrobials in the starter ration were unclear . During 1980-81, there was a marked decrease in the relative importance of fibrinous pneumonia as a cause of death and the feeding of silage was not significantly associated with mortality . Both these events may have arisen from the drastic decrease in the percentage of groups fed silage by two weeks postarrival (from 32% in previous years to 7% in 1980-81).

J Clin Microbiol, 1982 Oct, 16(4), 697 - 9
Comparative study of selective media for isolation of Legionella pneumophila from potable water; Edelstein PH; A total of 100 water samples, 95% of which were taken from hospital potable water fixtures, were cultured on three different media used for the isolation of Legionella pneumophila . The media used were buffered charcoal-yeast extract medium (BCYE alpha medium), BCYE alpha medium with antimicrobial agents (BMPA alpha medium), and BCYE alpha medium with antimicrobial agents, glycine, and differential dyes (MWY medium) . An acid wash procedure was also used for specimens plated on BCYE alpha and BMPA alpha media . A total of 24 samples were culture positive for L . pneumophila by one or more techniques . MWY medium detected 92% of positive cultures, BCYE alpha medium with the acid wash detected 83% of positive cultures, BMPA alpha medium detected 79% of positive cultures . BCYE alpha medium detected 71% of positive cultures, and BMPA alpha medium with the acid wash detected 62% of positive cultures . MWY medium was the best medium for isolating L . pneumophila from potable water specimens and can probably be depended upon as the sole medium for this type of testing.

Clin Orthop, 1982 Oct, (170), 76 - 82
Medical and surgical treatment of the septic hip with one-stage revision arthroplasty; Miley GB et al.; Sepsis of the hip, particularly associated with total hip arthroplasty, can be treated successfully by an aggressive antimicrobial and surgical approach to accomplish a one-stage revision . Although this is a very acceptable alternative to Girdlestone arthroplasty, 13% (6 hips) of the septic total hip revisions failed . The possibility of hematogenous seeding of the total hip should be recognized by all health care professionals . Aggressive treatment of infections or potential infections is mandatory.

Blood, 1982 Oct, 60(4), 888 - 93
Glycogenolysis versus glucose transport in human granulocytes: differential activation in phagocytosis and chemotaxis; Weisdorf DJ et al.; Granulocytes depend primarily on anaerobic glycolysis to supply the necessary energy for locomotion and chemotaxis . Either transmembrane transport of extracellular glucose or catabolism of intracellular glucose can supply glycolytic substrate . In this report, using enzymatic analysis of granulocyte glycogen, we describe conditional requirements for glycogenolysis, namely phagocytosis . With abundant extracellular glucose, granulocyte glycogen content (12.2 +/- 1.6 micrograms/10(6) cells) is not depleted whether or not incubations include various soluble chemotaxins (e.g., FMLP, C5ades arg, arachidonic acid) . These chemotaxins accelerate transmembrane glucose uptake . With near complete absence (less than 6 mg/dl) of extracellular glucose, both resting and chemotaxin (FMLP, C5ades arg, arachidonic acid) stimulated granulocytes catabolize significant endogenous glycogen . Phagocytosis, however, fails to enhance glucose uptake and promotes glycogen consumption even with abundant extracellular glucose . Simple particle-phagocyte attachment without internalization (produced by cytochalasin-B) also promoted glycogen consumption, suggesting that this membrane deformation alone is a sufficient trigger for glycogenolysis . Resting or chemotactic granulocytes, therefore, can adapt their energy source pending extracellular glucose availability--often compromised at inflammatory sites-while phagocytic cells depend primarily, if not exclusively, on endogenous glycogen stores . This differential metabolic activation defends the granulocytes energy supply and may be critical in supporting antimicrobial activity in acute inflammation.

Antibiotiki, 1982 Oct, 27(10), 724 - 7
{Formation of antibiotic JI-20B by a culture of Streptomyces flavovirens}; Ivanitskaia LP et al.; An actinomycetous culture having an antibiotic action on gram-positive and gram-negative bacteria was isolated from a soil sample collected in the region of the Balaton Lake . As a result of the taxonomic study the culture was classified as Str . flavovirens . Waksman, Henrici (1948) . Examination of antimicrobial properties of the antibiotic and chromatographic and mass-spectroscopic studies allowed one to classify it as an aminoglycoside belonging to the gentamicin group . The antibiotic was designated as J120-B . Until recently such antibiotics were known to be produced only by Micromonospora.

AJR Am J Roentgenol, 1982 Oct, 139(4), 647 - 51
Pneumocystis carinii pneumonia in homosexual men; Gamsu G et al.; The clinical records and radiographs of 12 homosexual men with symptomatic biopsy-proved Pneumocystic carinii pneumonia were reviewed . At presentation, the most common radiographic finding in the chest was a diffuse, coarse, ground-glass pattern . Normal findings on chest radiographs or only minimal abnormalities did not preclude P . carinii pneumonia . Progression of the radiographic findings varied . Rapid development of diffuse consolidation in 2--5 days occurred most commonly . Thoracic lymphadenopathy and pleural effusions were each seen in two patients . Clearing of the lungs often took many weeks . Six of the 12 patients died in 2 weeks to 8 months . In the appropriate clinical setting, early transbronchial biopsy should be strongly advocated to ensure initiation of suitable antimicrobial therapy.

Zentralbl Bakteriol Mikrobiol Hyg {A}, 1982 Oct, 253(1), 61 - 75
{Identification of Gram negative rods and evaluation of their antibiotic sensitivity: comparison of the BIOTEST MHK/ID-system with the API 20E-system and the agar diffusion test}; Stanek G et al.; BIOTEST MHK/ID is a new system for the identification of gramnegative fermentative and non fermentative rods and for the simultaneous determination of the minimal inhibitory concentrations (MICs) against 15 antimicrobial drugs . Its identification system was compared with the API 20E kit . When the computer generated identification manuals for each of the systems were used 99.5% of the 190 strains tested were identified . Of these identifications 98.4% were identical . Comparing the results of altogether 16 biochemical reactions 92.3% (table 4) were conformable . Considering each single test low agreement was found with the results of the Citrate-, Urea-, Voges-Proskauer- and Arginindehydrolase-tests (76.8, 79.5, 85.3 and 86.8% agreement, respectively) . The BIOTEST MHK/ID system yielded more positive reactions . But despite of these differences there was no influence on the accuracy in identifying the species . Thus, both systems must be considered equally suited to identify gramnegative rods . The results of both BIOTEST MHK/ID system (MIC-values) and the agardiffusion test (inhibition zone sizes) were transferred into the interpretative criteria "sensitive", "intermediate" and "resistant" (table 1) and compared for each strain . The overall-agreement amounted to 93.0% (table 7) . With the MIC-test, however, more (7.2%) strains were found "intermediate" than with the agardiffusion test (3.1%, table 8).

Farmaco {Sci}, 1982 Oct, 37(10), 641 - 50
Novel rifamycins . I-Synthesis and antibacterial activity of 3-hydrazinorifamycin derivatives; Marsili L et al.; A number of semisynthetic rifamycin derivatives, modified at position 3, belonging to general structures (II), (III), (IV), (V), (VI), (VII) and (VIII) (see Scheme), have been prepared . The synthesis, structure, and antimicrobial evaluation of the new compounds are described . All the derivatives have in vitro antibacterial activities comparable with that of rifampicin.

J Antibiot (Tokyo), 1982 Oct, 35(10), 1319 - 25
Screening and some properties of new macromolecular peptide antibiotics; Miyashiro S et al.; In searching for macromolecular antitumor antibiotics of microbial origin, 2,875 kinds of Actinomycetes culture fluids were applied to a newly developed test system which consisted of antimicrobial assay using a macromolecule permeable mutant, DNA damage assay and mutagenicity test . As a result, 78 macromolecular antibiotics were found . Among them, 15 antibiotics precipitable with ammonium sulfate were macromolecular peptide antibiotics (protein antibiotics), of which molecular weight ranged from 10,000 to 14,000 . Macromolecular peptide antibiotics AN-1, -5 and -15, termed type I antibiotics, showed stronger growth inhibitory effect on the uvrA and recA mutants, as compared to the effect on their parent, MP2 . They also had mutagenic activity . AN-7, -9, -16, -18, -20, -22, -23, -25, and -26, termed type II, exhibited an increased inhibitory activity to a recA mutant but did not to an uvrA mutant . They all showed mutagenicity . AN-3, -11 and -13, type III antibiotics, gave similar influence on the DNA repair mutants, and on their parent, MP2 . They had no mutagenic activity . Except for AN-11 and -13 of type III antibiotics, all antibiotics were inhibitory to the cell growth of a cancer cell, L1210.

Ann Intern Med, 1982 Oct, 97(4), 509 - 15
Therapeutic granulocyte transfusions for documented infections . A controlled trial in ninety-five infectious granulocytopenic episodes; Winston DJ et al.; Patients with granulocytopenia (granulocyte count less than 0.5 x 10(9)/L) and a documented infection were randomized to receive or not to receive daily granulocyte transfusions in addition to antimicrobial therapy . Thirty-four of 47 control patients responded to therapy compared to 30 of 48 transfused patients (type 2 error, pneumonia, or a soft tissue infection, respective response rates for the control and transfused patients were 11 of 11 and 11 of 16 (Yates' corrected chi-squared test, p = 0.12) . Response rates for patients with gram-negative septicemia were lower but were influenced by recovery of bone marrow function . Eleven of 12 control patients and seven of seven transfused patients with recovery of marrow function survived the gram-negative septicemia . In contrast, 12 of 24 control patients and 12 of 25 transfused patients survived gram-negative septicemia and persistent granulocytopenia (type 2 error p = 0.13) . Two thirds of all fatal infections were associated with an underlying disease refractory to medical therapy . Therapeutic granulocyte transfusions had no substantial benefit over optimal antimicrobial therapy alone in managing infected patients with granulocytopenia.

J Exp Med, 1982 Oct 1, 156(4), 1262 - 7
The iron-H2O2-iodide cytotoxic system; Klebanoff SJ; A potent antimicrobial system is described which consists of ferrous sulfate (Fe2+), hydrogen peroxide (H2O2), and iodide in 0.02 M sodium acetate buffer pH 5.5 . H2O2 could be replaced by the H2O2-generating system glucose + glucose oxidase . This system, unlike the myeloperoxidase-H2O2-halide system, was ineffective when iodide was replaced by bromide, chloride, or thyroxine, and was inhibited by EDTA, the hydroxyl radical scavengers mannitol and ethanol, and phosphate and lactate buffers at the same concentration and pH as the acetate buffer used . The acetate buffer, however, could be replaced by water . It is proposed that Fe2+ and H2O2 (Fenton's reagent) generate OH X (or a closely related substance), which interacts with iodide to form one or more toxic species.

Eur J Clin Microbiol, 1982 Oct, 1(5), 298 - 300
In vitro activity of seventeen antimicrobial agents against Gardnerella vaginalis; Shanker S et al.; The in vitro activity of 17 antimicrobial agents was tested against 25 clinical isolates of Gardnerella vaginalis . Minimum inhibitory concentrations were determined by agar dilution . The isolates were sensitive to penicillin, ampicillin, ticarcillin, piperacillin, cephalothin, cefoxitin, cefotaxime, cefoperazone, N-formimidoyl-thienamycin, chloramphenicol, clindamycin and erythromycin . MIC90 for the beta-lactam antibiotics ranged from 0.12 mg/l for penicillin to 2 mg/l for ticarcillin . Cefoperazone was the most active cephalosporin, inhibiting all isolates at 1.0 mg/l . N-formimidoylthienamycin was the most active of the newer beta-lactam compounds inhibiting all isolates with a concentration of 0.5 mg/l . Clindamycin and erythromycin were highly active, inhibiting all isolates at 0.6 mg/l . Susceptibility to tetracycline, gentamicin, metronidazole and tinidazole varied between strains . All isolates were resistant to rosoxacin . The hydroxy-metabolites of metronidazole and tinidazole were more active than the parent compounds, inhibiting all isolates.

J Clin Hosp Pharm, 1982 Sep, 7(3), 195 - 203
Drug-related hospitalization in paediatric patients; Yosselson-Superstine S et al.; A survey, to estimate drug-related hospitalization, was conducted by a clinical pharmacist who participated in medical rounds on a paediatric ward . Data were collected from patients' medical charts and verified by the attending physicians and the patients and/or their guardians . Adverse drug reactions and inappropriate therapy were defined with criteria supported by medical publications . Approximately 18% of the 906 studied admissions were found to be drug-related; 11.0% as a result of inappropriate drug therapy, 3.4% as a result of patient non-compliance and 3.2% because of adverse reactions . Antineoplastic agents were responsible for most adverse reactions that led to hospital admission . They were followed by corticosteroids, antimicrobials and by anticonvulsants . The last two groups of drugs were also responsible for hospitalization because of inappropriate drug therapy and patient non-compliance . Adverse drug reactions were more prevalent in females, in 6-10-year-old children, in patients of Ashkenazic origin and in patients who have experienced similar reactions in the past . Non-compliance was more prevalent in patients of Sephardic origin.

Hautarzt, 1982 Sep, 33(9), 484 - 90
{Stevens-Johnson syndrome and toxic epidermal necrolysis following intake of sulfonamides}; Aberer W et al.; Sulfonamides, particularly in combination with trimethoprim, are among the most commonly prescribed antimicrobial chemotherapeutic agents since they are generally well tolerated and have a broad antibacterial spectrum . However, they are the most common cause of adverse cutaneous drug reactions, the most serious of which are the major variant of erythema multiforme, i.e . Stevens-Johnson-syndrome, and toxic epidermal necrolysis . In eight of 11 patients with Stevens-Johnson syndrome or toxic epidermal necrolysis seen in our department over a period of 4 years, sulfonamides were the most probable causative agent . The present report describes these eight patients and discusses the potential risks of sulfonamide therapy.

Pediatr Infect Dis, 1982 Sep-Oct, 1(5), 333 - 5
Trimethoprim-sulfamethoxazole treatment of persistent otitis media with effusion; Schwartz RH et al.; Persistent otitis media with effusion (POME) is found in 50% of young children after 10 days of antimicrobial therapy for acute otitis media . Pathogenic bacteria are present in at least 25% of such effusions . We studied the effect of a 2-week course of trimethoprim-sulfamethoxazole (TMP-SMX) administered to 33 children who had POME and compared the results obtained to those of a similar group of children with POME who did not receive drug therapy . This study was designed to answer two questions: (1) Would TMP-SMX promote the resolution of POME? (2) Would TMP-SMX prevent an attack of acute otitis media (AOM) superimposed on POME? The diagnosis of POME was validated by obtaining a type B tympanogram, and AOM was diagnosed according to strict criteria . Each child was randomly assigned either to a treatment group that received a 14-day course of TMP-SMX or to a control group that received no medication . TMP-SMX failed to promote resolution of POME but did prevent recurrent AOM . During the second 2-week (follow-up) phase of the study, when no antimicrobial was given to either subject group, the incidence of AOM was similar in both groups.

J Pharm Sci, 1982 Sep, 71(9), 1046 - 9
Synthesis of some benzofuran and furocoumarin derivatives for possible biological activity; Hishmat OH et al.; Condensation of 5-formyl-6-methoxy-2,3-diphenylbenzofuran (I) and 6-formyl-5-methoxy-2,3-diphenylbenzofuran (II) with aliphatic or aromatic primary amines led to the formation of the corresponding anils (IIIa-k and IVa-c) . The anils (IIIa,f,k or IVa-c) reacted with ethyl cyanoacetate, ethyl acetoacetate, or diethyl malonate to form the respective esters (Va-c or VIa-c) . When Va-c or VIa-c were treated with pyridine hydrochloride, demethylation occurred followed by cyclization to form the corresponding furocoumarins (VIIa-c or VIIIa-c) . Reduction of the anils using sodium borohydride furnished the corresponding Mannich bases (Xa-d and XI) . The antimicrobial activity of compounds IIIi, IVc, Va, VIa, and VIIIa was investigated.

J Assoc Off Anal Chem, 1982 Sep, 65(5), 1044 - 7
Inhibition of chlortetracycline activity by magnesium ions; Chiang T; Up to 50% of the antimicrobial activity of chlortetracycline (CTC) can be inhibited by the presence of MgSO4 in microbiological turbidimetric assays . From 50 to 200 mM MgSO4 inhibited CTC activity, and the relationship between CTC inhibition and MgSO4 concentration is linear . The possible mechanism of this inhibition and its potential implication are discussed.

AORN J, 1982 Sep, 36(3), 479 - 86
Antimicrobial therapy for surgical patients; Fernsebner B; The operating room nurse plays a critical role in the administration of antimicrobial therapy for prophylaxis and for treatment . When aminoglycosides are given, the fine line between a therapeutic and toxic dose presents an additional challenge . Timing is equally critical in administering a prophylactic dose of a cephalosporin; too early and it will be ineffective and too late, it may necessitate a full course of treatment rather than the one dose . Armed with the proper knowledge and skills, the operating room nurse will be able to provide the safe competent care that patients receiving antimicrobials should expect.

Infect Control, 1982 Sep-Oct, 3(5), 401 - 2
Recommended precautions for patients with Legionnaires' Disease; Jarvis WR; As diagnostic techniques for the identification of Legionella species have become readily available, recognition of the pneumonic form of Legionellosis has increased . In particular, cases of hospital-acquired Legionella pneumophila are being identified and this has led to concern over possible person-to-person transmission . In most epidemiologic investigations where a source has been identified, water has been implicated . Person-to-person transmission has not been convincingly documented . Therefore, we discourage expensive or inconvenient special precautions for patients hospitalized with Legionnaires' Disease . Rather, we recommend that such patients be placed in secretion precautions until effective antimicrobial therapy has eradicated the organism.

Antimicrob Agents Chemother, 1982 Sep, 22(3), 515 - 7
Gonococcal opacity variants: susceptibility to antimicrobial agents; Salit IE et al.; We tested the susceptibility of 34 pairs of isogenic opaque and transparent colony variants of gonococci to nine antimicrobial agents . Only 20% of the opaque and transparent minimal inhibitory concentrations were discordant, and the mean minimal inhibitory concentrations were not significantly different . Selection of opacity variants is, therefore, not necessary for routine susceptibility testing.

Inflammation, 1982 Sep, 6(3), 245 - 56
Granulocytes utilize different energy sources for movement and phagocytosis; Weisdorf DJ et al.; Granulocytes depend on anaerobic glycolysis for the energy required for chemotaxis, phagocytosis, and microbial killing . Two potential sources of the needed glucose are available: exogenous glucose and intracellular glycogen . These studies demonstrate that chemotaxin-induced movement of granulocytes induces accelerated uptake of exogenous glucose while phagocytosis does not, presumably utilizing instead the relatively slow process of glycogenolysis . As measured by incorporation of extracellular radiolabeled hexoses {1-14C}glucose or {3H}deoxyglucose), the soluble chemotaxin-aggregants of granulocytes, nF-met-leu-phe, C5ades arg, bacterial filtrate, or arachidonic acid all augment transmembrane hexose uptake . This insulin-like activity closely parallels the dose-related effects of these agents on induction of granulocyte aggregation and chemotaxis . Insulin, itself, affects glucose transport minimally and mainly at supraphysiologic concentrations . In contrast, phagocytic stimuli fail to enhance hexose uptake at all, despite stimulating catabolism of glucose, which in turn is probably generated by glucogenolysis . these data show that granulocytes, whose motile function occurs in glucose-rich milieu, alter in tandem their cellular glucose uptake with their movement response . For phagocytosis, which often occurs in hypoglycotic, purulent exudates, granulocytes depend on stored energy supplies--probably glycogen . This coordination may be crucial in supporting granulocyte antimicrobial activity during acute inflammation.

J Dent Res, 1982 Sep, 61(9), 1089 - 93
Effects of chlorhexidine and four antimicrobial compounds on plaque, gingivitis, and staining in beagle dogs; Yankell SL et al.; Solutions containing 0.2% of a bis-biguanide, chlorhexidine (positive control), and four bis-amidinourea antimicrobial agents were tested in beagle dogs in a 12-week study . The five agents significantly reduced clinical plaque and gingivitis scores, and gingival fluid volumes in treated dogs, compared with water . All compounds reduced the stain area scores compared to water controls . Stain intensity scores were higher for chlorhexidine than for the four new antimicrobial agents and the water controls . There were no overt behavioral changes . Histological examination of oral tissues revealed no irritation.

Postgrad Med, 1982 Sep, 72(3), 123 - 7
Culture-negative infective endocarditis; Agarwal AK; Culture-negative endocarditis is not uncommon; the most frequent causes of the culture negative state are prior antibiotic therapy and problems with or inadequacies in bacteriologic technique . In addition to blood culture, studies that can aid in substantiating a presumptive diagnosis of infective endocarditis include echocardiography . Immunologic tests, and cardiac catheterization . Empiric antibiotic therapy often is necessary and should not be delayed to await positive blood cultures and results of antimicrobial sensitivity studies.

Rev Infect Dis, 1982 Sep-Oct, 4 Suppl, S432 - 8
Clinical experience with cefotaxime in obstetric and gynecologic infections; Hemsell DL et al.; Infections in the upper genital tract continue to be one of the leading causes of serious morbidity for obstetric and gynecologic patients . The polymicrobial, mixed aerobic and anaerobic isolates recovered from women with such infections demand broad-spectrum antimicrobial activity . In the past, combination therapy has been given in order to attain this coverage . In a multicenter open study, cefotaxime was used for treatment of endomyometritis after cesarean section, pelvic cellulitis after hysterectomy, and acute pelvic inflammatory disease . The drug effected a clinical cure in 93% of 104 women . In a randomized comparative study conducted at one center, cefotaxime cured 97% of 36 cases of post-cesarean section endomyometritis; clindamyclin plus gentamicin cured 94% of 18 cases of the same infection . There was no evidence of significant alteration in hematopoietic, hepatic, or renal function with either regimen . Cefotaxime appears to be a safe, extremely effective antimicrobial drug that is ideally suited for single-agent treatment of serious soft-tissue pelvic infections in obstetric or gynecologic patients.

Rev Infect Dis, 1982 Sep-Oct, 4 Suppl, S288 - 99
Mechanisms of bacterial resistance to antimicrobial agents, with particular reference to cefotaxime and other beta-lactam compounds; Neu HC; Many mechanisms exist by which bacteria can become resistant to antimicrobial agents . Although mutational events are important in the development of resistance to some agents, by far the most important factor in resistance is extrachromosomal genetic material in the form of plasmids . Important mechanisms of bacterial resistance to antibiotics are interference with the transport of the antimicrobial agents into the bacterial cell, inactivation of the agent, and alteration of the target site or metabolic pathway by the microorganism . In order to affect bacteria, beta-lactam antibiotics must pass through proteins at the surface of the cell, must evade destruction by beta-lactamases, and must have an affinity for proteins involved in cell wall synthesis . A number of the new beta-lactam antibiotics, because of their great resistance to destruction by beta-lactamases and their high affinity for penicillin-binding proteins, have overcome many of the mechanisms bacteria have used in the past to resist beta-lactam drugs.

Otolaryngol Head Neck Surg, 1982 Sep-Oct, 90(5), 527 - 33
Dental and allergic aspects of sinusitis and nasal polyposis: a review; Fairbanks DN; The proximity of the maxillary sinus floor to the first, second, and third molar teeth predisposes it to contiguous dental disease . Infections of dental origin are usually mixed bacterial growth with anaerobic species predominating; extended-spectrum penicillins or cephalosporins are recommended . The patient with atopic allergy is susceptible to bacterial infection; combined therapy with antimicrobials, corticosteroids, and antihistamines is advised . The large solitary antrochoanal polyp is successfully managed with maxillary sinus surgery alone . Multiple ethmoidal polyps in children suggest cystic fibrosis, and in adults, the asthma triad syndrome . Thorough surgical management of the sinuses combined with antimicrobial and topical corticosteroid therapy is recommended.

Br Med J (Clin Res Ed), 1982 Aug 14, 285(6340), 472 - 3
Drug resistance among infantile enteropathogenic Escherichia coli strains isolated in the United Kingdom; Gross RJ et al.; Two hundred and thirty-two strains of Escherichia coli belonging to infantile enteropathogenic serotypes isolated in the United Kingdom during 1980 and 1981 were tested for resistance to 10 antimicrobial drugs . Resistance to one or more drugs was found in 134 (57.8%) of the strains, with resistance to sulphonamides, streptomycin, tetracycline, and ampicillin occurring most commonly . Resistance was transferable in 65 out of 104 resistant strains . These findings are a cause for concern because they indicate that the choice of treatment for severe illness is limited and suggest that a large pool of drug-resistant organisms exists in the community.

Radioisotopes, 1982 Aug, 31(8), 413 - 8
{Experimental studies on tissue distribution of 14C-labelled antimicrobial agent in the otorhinolaryngological field--application of macro-autoradiography}; Murai K et al.; The distribution of antimicrobial agents in infected target tissues would be essential for their application to treat the sites of infection . Taking accounts of the view point, we had reported the distribution of 3 nalidixic acid analogs in tissues which are related to otorhinolaryngology by macro-autoradiography and radiometry . We investigated here in the distribution of a nalidixic acid analog OPC-7241 . This agent is 9-fluro-5-methyl-8-(4-methyl-1-piperaginyl)-6, 7-dihydro-1-oxo-1H, 5H-benzo {ij}quinoligine-2-carboxylic acid supplied by Otsuka Pharmaceutical Co., Ltd . Autoradiography was performed 30 minutes after intravenous administration of 14C-OPC-7241 in 2.96 MBq(80.0 microCi)/12.5mg/kg to New Zieland White rabbit . Radiometry was performed 30 minutes, 1 hour and 3 hours after intravenous administration of 14C-OPC-7241 in 740 kBq (20.0 microCi)/10.0 mg/kg to NZW rabbits . Such care was taken in filling the carboxymethyl cellulose paste into the paranasal cavity, nasal cavity, oral cavity and external ear canal not to damage mechanically . Horizontal frozen sections parallel to mandibular basis were cut in 50 microns thickness in a cryostadt . Blackening of 14C-OPC-7241 was most significant in soft palate and its expanse which is apparently the same gland-like tissues as soft palate when stained with hematoxylin and eosin . Significant radioactivity was recognized in tonsils, the cartilage of external ear canal, septal cartilage, periodontal membrane, dental pulp, muscle and concha nasalis ventralis . The levels was low in ethmoid cells, mucosa of tympanic cavity, cochlea, maxillary sinus and bone . Quantitatively, the levels of 14C-OPC-7241 radioactivity were high in soft palate, mandibular gland and tonsils . Radioactivity was significant in tongue and concha nasalis ventralis . The levels were low in turbinates, ethmoid cells, maxillary sinus, septal cartilage, septal mucosa, cochlea, brain, optic nerve and lens . Thus radiometric results agreed with the above autoradiographic findings . Macro-autoradiography can be one of useful means for the evaluation chemotherapeutic agents for possible clinical application.

Eur J Clin Microbiol, 1982 Aug, 1(4), 204 - 11
Evaluation of the MS-2 automated antimicrobial susceptibility testing system: report of a European collaborative study; Johnston HH et al.; The MS-2 is an instrument for rapid automated testing of antimicrobial susceptibility . Its performance was evaluated by comparison with disc diffusion and MIC tests in a collaborative study in four European laboratories . Tests on independently isolated organisms showed the MS-2 to be in essential agreement with conventional methods in 94.8% of tests . A further series of 170 well-defined pathogens for which a reference antibiogram was available were tested by MS-2 and the manual methods in all of the participating laboratories . MS-2 results were in full accord in 90% of tests and in essential agreement in 94% . MS-2 results compared at least as well with the reference values as did either of the manual methods . Initial problems of false susceptibility results with erythromycin and penicillin were resolved by (1) the addition of small amounts of erythromycin which acted as an inducer and (2) by the use of a low content penicillin disc . MS-2 was found to be reliable and needed no attention following loading of the test cuvette cartridges . A print-out of the results was available 2-5 h after inception of the test.

Pharmazie, 1982 Aug, 37(8), 587 - 90
{On the antimicrobial activity of benzalkonium chloride in potential contact lens fluids}; Jira T et al.; To assess the suitability of benzalkonium chloride as a preserving agent for potential contact lens fluids, the authors tested its antimicrobial efficiency at various pH values, in the presence of viscosity modifiers (hydroxyethylcellulose, polyvinylpyrrolidone, polyacrylamide) and also in combination with other preserving agents . The diffusion test and the suspension test were used as test methods . The efficiency of benzalkonium chloride depends upon the pH value of the solution and upon the concentrations of the viscosity modifiers . No better results were achieved by combination with phenylethanol and chlorobutanol . Formulations for potential contact lens fluids were indicated, the appropiateness of which is viewed in microbiological perspective.

Antibiotiki, 1982 Aug, 27(8), 577 - 80
{Antibiotic properties of Pseudomonas cepacia}; Smirnov VV et al.; The antibiotic activity and some of the physicochemical properties of the pigment produced by P . cepacia 4137 were studied . The pigment was isolated from the medium with chloroform . Preparative chromatography on columns with silica gel and thin-layer chromatography on Silufol plates revealed red-orange and straw-yellow fractions in the composition of the antibiotic . The latter fraction showed a significant antimicrobial activity against gram-positive and gram-negative bacteria, fungi and yeasts . The red fraction was inferior to the yellow one with respect to its antimicrobial activity . Both substances could be stained with a butanol solution of FeCl3 . The absorption maxima of their methanol solutions were observed at 225, 325 and 455 nm with respect to the red fraction and at 220, 330 and 405 with respect to the yellow fraction . The elemental analysis of a more highly purified red fraction showed the following: C 54.10, H 6.85, N 7.93 and O 31.12 . It is suggested that the substances are derivatives of hydroxyphenazine carboxylic acids.

Arch Ophthalmol, 1982 Aug, 100(8), 1275 - 7
Laboratory studies in acute conjunctivitis; Stenson S et al.; In 84% of 700 consecutive cases of untreated acute conjunctivitis subjected to conjunctival cultures and scrapings, a presumptive etiologic diagnosis could be made based on standard microbiologic and cytologic criteria . Of these 583 cases, 264 were bacterial, 245 were viral, 51 were allergic, and 17 were chlamydial . In 75% of the cases, clinical impressions were consistent with laboratory findings . On the basis of these results, laboratory workup is recommended in (1) follicular conjunctivitis to differentiate viral from chlamydial processes, (2) purulent conjunctivitis to identify pathogens and decide on appropriate antimicrobial therapy based on sensitivity data, and (3) those cases in which the clinical picture is not sufficiently distinctive to suggest an etiologic diagnosis.

Am J Clin Pathol, 1982 Aug, 78(2), 173 - 7
The antimicrobial removal device . A microbiological and clinical evaluation; Wright AJ et al.; A parallel study of blood cultured conventionally and following processing in an Antimicrobial Removal Device (ARD) was conducted with patients suspected of being clinically bacteremic . Cultures yielded 205 isolates from 87 clinically bacteremic patients, of whom 28 were receiving antibiotics at the time their cultures were performed . Overall, ARD processing neither increased the isolation rate nor decreased the time interval required for detection of organisms compared with conventional processing . ARD processing was the only means of isolation of organisms from only seven of the 87 patients and three of the 28 receiving antibiotics, whereas conventional processing accounted for the only means of isolation of organisms from 17 of the 87 patients and nine of the 28 receiving antibiotics . ARD processing demonstrated no advantages over conventional processing of blood cultures.

J Dent Res, 1982 Aug, 61(8), 982 - 5
Peroxidase antimicrobial system of human saliva: hypothiocyanite levels in resting and stimulated saliva; Tenovuo J et al.; The antimicrobial oxidizing agent hypothiocyanite ion (OSCN-) was measured in resting (drooling) and stimulated (expectorated) whole saliva . Stimulation of the saliva flow rate resulted in a rapid decrease in OSCN- concentration, whereas the thiocyanate ion (SCN-) concentration and peroxidase activity were increased . The decrease in OSCN- levels was greater than could be accounted for by dilution of the whole saliva volume . Assuming that the antimicrobial activity of the salivary peroxidase system is proportional to OSCN- concentration, this system may be more effective in resting saliva than in stimulated saliva.

J Antibiot (Tokyo), 1982 Aug, 35(8), 957 - 62
C-19393 E5, a new carbapenem antibiotic . Fermentation, isolation and structure; Harada S et al.; A new carbapenem antibiotic, C-19393 E5, was isolated from the culture filtrate of Streptomyces griseus subsp . cryophilus C-19393 as a minor component . The chemical structure of the antibiotic was determined by comparing its spectral data with those of the known 5,6-cis carbapenem antibiotics and confirmed by partial synthesis from epithienamycin B as shown in Fig . 1 . The antibiotic has a broad antimicrobial spectrum and shows strong inhibitory activity against beta-lactamases.

QRB Qual Rev Bull, 1982 Aug, 8(8), 12 - 7
The effect of quality assurance review on implementation of an automatic stop-order policy; Zoebelein E et al.; Because of problems associated with overutilization of antimicrobial drugs, particularly antibiotics, Long Island Jewish-Hillside Medical Center, New York, conducted a hospitalwide study to ensure that physicians' orders for antimicrobial drugs complied with an automatic stop-order policy . The original study, conducted in 1980, revealed a compliance rate of only 18.5% for antibiotics . However, after implementation of an extensive educational program for physicians and nurses, a restudy, conducted one year later, showed that compliance with the automatic stop-order policy increased to 54%--a 300% improvement over the first study . In addition, the follow-up study also revealed a 6% decrease in the percentage of patients who received antibiotics.

Pharmazie, 1982 Aug, 37(8), 551 - 3
Azachalcones . Part 2: Reactions of 3,3-diazachalcones; Attia A et al.; 1,3-Di(3-pyridyl)-2-propen-1-one (1) react with malononitrile in presence of ammonium acetate to afford 2-amino-3-cyano-4, 6-di(3-pyridyl)pyridine (2), which was converted to the nicotinamide derivative 3 by hydrolysis with alkali . In a similar way, 1 react with ethyl cyanoacetate to give 3-cyano-4,6-(3-pyridyl)-2-pyridone (4) . Treating of 1 with hydroxylamine hydrochloride afforded the oxime 5 which upon reaction with alkyl- or aryl-isocyanates gave the oxime carbamates 6 . Reaction of thiourea and hydrazines with 1 gave the thiopyrimidine 7 and the pyrazolines 8, respectively . The structure of the obtained compounds was confirmed according to their IR and UV spectra . The antimicrobial activity of the synthesized compounds against several microorganisms is presented.

Arch Microbiol, 1982 Aug, 132(2), 194 - 6
Antibiotics from Basidiomycetes . XVI . Antimicrobial and cytotoxic polyines from Mycena viridimarginata Karst; Bauerle J et al.; Two new biologically active polyines were isolated from cultures of the fungus Mycena viridimarginata . Their structures were elucidated by spectroscopic and chemical methods as 10-hydroxy-undeca-2,4,6,8-tetraynamide (1) and 3,4,13-trihydroxy-tetradeca-5,7,9,11-tetraynoic acid-gamma-lactone (2) . The main component (1) is highly antibiotically active and cytotoxic.

Klin Wochenschr, 1982 Jul 15, 60(14), 720 - 6
Macrophage functions in antimicrobial defense; Schaffner T et al.; In the present short review article, we discuss some recent findings regarding the role of macrophages in antimicrobial defense . Problems that are briefly considered include the production of monocytes and its modification in infectious diseases; the role of circulating monocytes and "fixed" macrophages in the blood stream; emigration of monocytes from the vascular bed and their accumulation at sites of microbial attack; role of macrophages in immune responses; stimulation and activation of these cells including secretory functions; attachment to their surface and phagocytosis of microorganisms; microbicidal activities of macrophages; their role in granuloma formation; inherited and acquired deficiencies of macrophage functions . Emphasis is placed on currently unresolved problems.

Klin Wochenschr, 1982 Jul 15, 60(14), 731 - 4
Genetic disorders of leukocyte function: what they tell us about normal antimicrobial mechanisms of human phagocytic cells; Root RK et al.; Analysis of three inherited defects of granulocyte function (Chediak-Higashi Syndrome, CHS; Chronic Granulomatous Disease, CGD; Myeloperoxidase Deficiency, MPO) has highlighted critical events for the antimicrobial function of these cells and placed others in perspective . Prompt phagosomal fusion may be more important for digestion of organisms rather than killing as indicated by the mild bactericidal defects in the CHS . The formation of O2- and H2O2 during the phagocytic respiratory burst is central for the broad antimicrobial activity of granulocytes . MPO, on the other hand, while perhaps normally participating in granulocyte antimicrobial action, appears to be essential only for the effective killing of eukaryotic organisms such as certain fungal strains . While the non-oxidative killing mechanism of neutrophils have stimulated much recent interest and were the first to be defined no specific inherited defects have been discovered which are clinically important . Genetic disorders of macrophage effector function remain to be clearly defined as do those of eosinophils . The lessons learned from the study of the granulocyte defects discussed have provided both the technology and approach to the analysis of the antimicrobial and cytocidal mechanisms of these important phagocytic cells.

J Antibiot (Tokyo), 1982 Jul, 35(7), 771 - 7
Cyanocycline A, a new antibiotic . Taxonomy of the producing organism, fermentation, isolation and characterization; Hayashi T et al.; A new antibiotic, cyanocycline A, was isolated from the fermentation broth of Streptomyces flavogriseus strain No . 49, a soil isolate . The molecular formula of cyanocycline A was determined to be C22H26N4O5 . The antibiotic has a cyano group and a N-heterocyclic quinone moiety in its structure . Cyanocycline A was found to have broad spectrum antimicrobial and antitumor activity.

Farmakol Toksikol, 1982 Jul-Aug, 45(4), 70 - 3
{Cytochemical study of peroxidase activity and the peroxidase-endogenous hydrogen peroxide system in the peripheral blood neutrophils of mice exposed to prodigiozan and retabolil}; Golikov IuV et al.; The paper concerns changes in the activity of some enzymes of azurophil granules of mouse neutrophils under a single administration of the bacterial polysaccharide prodigiosan and the synthetic anabolic hormone retabolil . Prodigiosan increases 1.4-fold the activity of the peroxidase-hydrogen peroxide system in azurophil granules of intact mice . In mice with leukopenia, prodigiosan normalizes the leukocyte count after 24 hours . At the same time there is an increase in the activity of peroxidase . It is assumed that under the effect of the same drug the cells of the animals in different physiological conditions may show an activation of the different components of antimicrobial defence . Retabolil raises the activity of peroxidase 96 hours after the first administration . Following 192 hours the activity reduces to normal and remains unchanged after the second drug administration.

Am J Hosp Pharm, 1982 Jul, 39(7), 1180 - 3
Factors potentially influencing aminoglycoside use and expenditure; DiPiro JT et al.; Factors that may have influenced aminoglycoside use and expenditure in one hospital were examined . Factors that were evaluated as to their influence on aminoglycoside-use patterns were: (1) formulary status; (2) bacterial susceptibility patterns; (3) identified or perceived differences in toxicity; (4) changes in patient population; (5) price paid by the hospital for aminoglycosides; (6) distribution of newsletters or memoranda; (7) advertising and detailing; and (8) pharmacy policies . For FY 1976-77 to 1979-80, the largest proportion of aminoglycoside expense was for gentamicin . During FY 1980-81, the expenditure for gentamicin decreased and tobramycin accounted for the largest proportion of total expenditure . Monthly gentamicin use decreased 20% during FY 1980-81 from the previous year . Tobramycin use increased from January 1979 to November 1980 and decreased from December 1980 to June 1981 . Kanamycin use and amikacin use were fairly constant during the study period . Based on temporal relationships, the following factors appeared to influence aminoglycoside use and expenditure: (1) a study conducted at the institution from June 1977 to June 1979 comparing gentamicin and tobramycin nephrotoxicity; (2) a comparative nephrotoxicity study published in a widely circulated medical journal in May 1980; and (3) an intramural newsletter and memorandum distributed in March 1981 encouraging selective aminoglycoside use . The identification of factors that potentially influenced aminoglycoside use can be used to anticipate the future impact of similar events and to devise strategies to influence antimicrobial use.

J Clin Microbiol, 1982 Jul, 16(1), 181 - 5
Gluteal abscess caused by Phialophora hoffmannii and review of the role of this organism in human mycoses; Rinaldi MG et al.; Infections caused by members of the Phialophora hoffmannii (Beyma) Schol-Schwarz fungal aggregate (a group of related taxa, especially species of uncertain circumscription) are not reported frequently . This case report concerns the development of a gluteal abscess after multiple intramuscular injections of antimicrobial agents . Microbiological examination of the abscess material yielded a pure growth of the mold P . hoffmannii . Hyphal elements in the purulent exudate were only demonstrated when the specimen was digested by an N-acetyl cysteine-NaOH digestion-decontamination procedure or in stained paraffin block sections of the exudate . Other cases of disease caused by members of this fungal aggregate and the status of the mycology of this organism are reviewed.

J Clin Microbiol, 1982 Jul, 16(1), 153 - 63
Evaluation of the MICUR system for quantitative antimicrobial susceptibility testing: a multiphasic comparison with reference methods; Jones RN et al.; Four laboratories participated in a three-phase study to evaluate the MICUR antimicrobial broth microdilution system (Boehringer Mannheim Diagnostics, Inc., Houston, Tex.) . The dried-antimicrobial agent MICUR system was compared with a reference broth microdilution method (National Committee for Clinical Laboratory Standards) by using 304 recently isolated clinical strains and two collections of stock or challenge organisms . Of 7,092 minimum inhibitory concentration (MIC) datum pairs derived from the clinical isolates, 96.6% were within an acceptable (+/- 1 log2 dilution) range . MICUR MICs agreed with the reference broth microdilution method MICs in 95.3% of 6,840 MIC pair determinations performed on stock or challenge cultures . The MICUR intralaboratory reproducibility within +/- 1 log2 dilution step for the clinical isolates was 98.4% . The MICUR intralaboratory and interlaboratory reproducibilities for 26 stock cultures were 98.4 and 95.1%, respectively . For 180 challenge cultures (4,199 MIC pairs) which were included in the MICUR testing to provide a wide variety of antimicrobial susceptibility and resistance patterns, the results for 92.5% were in close agreement with the reference broth microdilution results . No specific resistance mechanism went unrecognized by this new commercial system . The MICUR system gives comparable MIC results when evaluated against the reference broth microdilution method, and it would be acceptable for use in clinical microbiology laboratories.

Am J Clin Pathol, 1982 Jul, 78(1), 127 - 30
Meningorectal fistula as a cause of polymicrobial anaerobic meningitis; Walsh TJ et al.; A 49-year-old diabetic woman developed polymicrobial anaerobic meningitis secondary to a meningorectal fistula one year after receiving neutron beam therapy for a rectal adenocarcinoma . The meningitis was refractory to chloramphenicol and penicillin but responded to oral metronidazole . Sustained eradication of meningitis was achieved with continued metronidazole for 51/2 months, despite persistence of the fistula . Metronidazole may be a superior antimicrobial agent for polymicrobial anaerobic meningitis, especially when caused by a large or continuing bacterial inoculum . This meningorectal fistula is the first of its kind to our knowledge to be demonstrated by microbiologic, radiologic, and pathologic studies.

Am J Clin Pathol, 1982 Jul, 78(1), 124 - 7
Brain abscess due to Nocardia caviae . Report of a fatal outcome associated with abnormal phagocyte function; Bradsher RW et al.; Nocardia is an uncommon cause of human disease . We report a patient with a fatal brain abscess who had abnormal phagocyte function as measured by neutrophile chemotaxis, adherence, phagocytic function, and chemiluminescence in vitro and by Rebuck skin window in vivo . Antimicrobial agar dilution susceptibility suggested minocycline was more active than sulfamethoxazole.

Am J Vet Res, 1982 Jul, 43(7), 1286 - 7
Enterotoxin production and resistance to antimicrobial agents in porcine and bovine Escherichia coli strains; de Lopez AG et al.; A select group of porcine and bovine Escherichia coli strains capable of causing diarrheal disease in neonatal pigs and calves, respectively, were tested for enterotoxin production and resistance to 23 different antimicrobial agents . Thirty-four of the 39 porcine strains tested were enterotoxigenic; that is, they synthesized heat-stable (ST), together with heat-labile (LT), enterotoxin; ST toxin alone, or LT toxin alone . Fourteen of the 15 bovine strains tested produced ST toxin only, whereas 1 strain elaborated LT toxin only . All of the strains were multiple drug resistant . Among the porcine strains, 2 were resistant to 6 of the antimicrobial agents, and 1 was resistant to 18 of the drugs . All of these strains were resistant to cloxacillin, lincomycin, and penicillin G . None of them was resistant to chloramphenicol, colistin, gentamicin, polymyxin B, or nalidixic acid . One of the bovine strains was resistant to 7 of the drugs, and 1 strain was resistant to 17 of these antimicrobial agents . All of the bovine strains exhibited resistance to cloxacillin, lincomycin, novobiocin, pencillin G, sulfathiazole, sulfamethizole, and triple sulfa (sulfadiazine, sulfamerazine, and sulfamethazine) . None of these strains showed resistance to gentamicin, nalidixic acid, nitrofurazone, or nitrofurantoin.

Obstet Gynecol, 1982 Jul, 60(1), 53 - 9
Continuing investigation of women at high risk for infection following cesarean delivery . Three-dose perioperative antimicrobial therapy; DePalma RT et al.; At Parkland Memorial Hospital a group of women at high risk for infection following cesarean delivery was identified . These included nulliparas who underwent cesarean section for cephalopelvic disproportion 6 or more hours following membrane rupture . During the puerperium, uterine infection developed in 85 to 95% of such women, and one third of this high-risk group had associated complications . The authors have previously reported the efficacy antimicrobial agents given to these women at the time of cesarean section and continued for 4 days . The present prospective study was designed to assess the efficacy of a shorter course of perioperative antimicrobial therapy for these high-risk women . Three doses of antimicrobial agents were given perioperatively to 305 women randomly assigned to 1 of 3 treatment regimens: 115 were given penicillin plus gentamicin, 82 received 2, 1, and 1 g of cefamandole, respectively, and the remaining 108 were given 2, 2, and 2 g of cefamandole, respectively . The incidence of uterine infection in these 305 women was 24% and associated complications were identified in 7% of all women . Based upon a comparison of results with the progenitor study, the authors conclude that 3-dose perioperative antimicrobial therapy is preferred to 4 days of treatment for women at high risk for infection following cesarean delivery.

Chest, 1982 Jul, 82(1), 76 - 83
Transpleural lung biopsy by the thoracoscopic route in patients with diffuse interstitial pulmonary disease; Dijkman JH et al.; Thoracoscopy was carried out in 81 cases of diffuse pulmonary disease in order to obtain lung tissue for biopsy . After we established artificial pneumothorax, the thoracoscope was introduced under local anesthesia, multiple biopsy specimens (theta 3 mm) were obtained under visual control, and an underwater sealed drain was left in place . The method was used to determine the cause of x-ray shadowing and respiratory distress in 26 immunocompromised patients . Within 2-48 hours, all biopsy specimens provided sufficient microbiologic and morphologic information to guide management, eg, specific antimicrobial drugs, decreasing or intensifying immunosuppression, or cytostatic therapy . Thoracoscopy was tolerated better than fiberoptic bronchoscopy, especially in hypoxic patients . Persisting or recurring pneumothoraces were seen in four patients and was not a major complication . In one very ill patient, the spleen was punctured accidentally before biopsy specimens were taken . Of 63 nonimmunocompromised patients, a histologic diagnosis was obtained in 57 (90 percent) . In most of these patients, previous biopsy procedures had produced inconclusive results . Also in this group persisting or recurring pneumothoraces were seen in four patients, but closed eventually in a conservative way.

Rev Belge Med Dent, 1982 Jul, 37(4), 178 - 80
{Microbial aspects of periodontopathies and implications for antimicrobial treatment}; Vande Velde FJ et al.; The development of periodontitis is always preceded by a gingivitis . Therefore, the studies of the etiological, histopathological, microbiological and therapeutic aspects of gingivitis form an essential contribution to the prevention of the major oral diseases . After 9-21 days without oral hygiene, in a previously healthy gingiva, a generalized mild gingivitis always develops . However, subclinical inflammation starts much earlier, obviously as a host reaction to the initial phases of plaque development . The development of gingivitis, and especially of peridontitis, is accompanied by a marked increase of anaerobic Gram-negative organisms and a decrease of aerobic Gram-positive organisms . However, their possible specific etiological role in the development of gingival inflammation is still unknown . On the other hand, the proliferation of the total mass of the original flora could be of importance, too . The actual treatment modalities of periodontal disease consist in a total non-specific elimination of the plaque, which imposes an intensive plaque control, independent of the individual tolerance level . Future bacteriological investigation will have to elucidate the pathogenic potential of specific micro-organisms.

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