Medicine (Baltimore), 1978 Jan, 57(1), 83 - 103 Anaerobic osteomyelitis; Raff MJ et al.; We have presented eight case histories of patients with anaerobic osteomyelitis and have reviewed an additional 193 cases from the world literature . The incidence, predisposing factors, clinical localization, bacteriology, modes of presentation and natural history of anaerobic osteomyelitis are discussed . This disease entity appears to be more common than has been previously recognized . Seven distinct clinical syndromes of anaerobic osteomyelitis are described and related to the anatomical locations in which they tend to occur . The signs and symptoms of these entities have been outlined to aid in their recognition by practitioners . An approach to the therapy of anaerobic osteomyelitis is outlined . Emphasis is placed on adequate surgical intervention combined with antimicrobial agents chosen for each particular clinical situation . The lack of definitive data upon which to base a decision regarding dosages and duration of antimicrobial therapy is discussed and the authors' own preferences enumerated. Arzneimittelforschung, 1978, 28(11), 2058 - 61 Fluorescent analogue of ampicillin; Kusnir J et al.; As the outcome of the reaction of ampicillin with 4-phenylspiro{furan-2(3H),1'-phthalane}-3,3'-dione (fluorescamine), the chemical analogue of ampicillin (F-AMPI) has been prepared . This preparation has manifested strong fluorescence in UV light . Some basic chemical and biological properties of this product such as chemical stability electrophoretic mobility, uniformity during thin-layer chromatography and ion-exchange chromatography, and antimicrobial activity were examined . The results were compared with values of the original antibiotic. Arzneimittelforschung, 1978, 28(4), 582 - 5 {Semi-quantitative determination of resistance in agar (author's transl)}; Marcenac FM et al.; The sensitivity of microorganisms to antimicrobial preparations is determined--using agar as the test medium--by means of a semi-quantitative method involving two concentrations, i.e . a low concentration relating to serum levels easily attained at the commonly used dosage level of the various antibacterially acting preparations, and a high concentration corresponding to serum levels attainable at increased dosage via the appropriate route of administration . The inoculum is distributed with a multi-inoculator making a simultaneous inoculation of 25 strains possible . For 25 antibiograms with 20 antibiotics 40 Petri dishes are required, inoculation take 15 min . The method described is suited above all for laboratories with large workload where a great number of resistance determinations must be carried out rapidly, precisely at a low cost. Arzneimittelforschung, 1978, 28(2), 232 - 4 {Determination of antimicrobial activity of a combination of acidamfenicol, clotrimazole and dexamethasone in vitro (author's transl)}; Poitschek C et al.; The in vitro antimicrobial activity of the antieczematic Bay f 4797 was studied . This combination drug contains the three active components acidamfenicol, clotrimazole and dexamethasone (prospective trade name: Baycuten) . Various bacterial and fungal species of importance in dermatology served as test organisms . All the bacterial strains examined were found to be moderately susceptible to acidamfenicol; clotrimazole showed good inhibitory values agaisnt all the fungal species and the gram-positive bacterial strains . Additionally it was checked whether a synergistic or antagonistic interaction occurs with respect to the antimicrobial activity . An interference which could lead to impairment of the therapeutic activity was not observed. Folia Microbiol (Praha), 1978, 23(1), 12 - 7 Influence of antimicrobial agents on contamination and chlortetracycline production; Welward L et al.; The possibility of shortening the thermal sterilization time for cultivating media was demonstrated in chlortetracycline fermentation with an industrial strain of Streptomyces aureofaciens . The medium was artificially contaminated with a mixture of eight strains of G+ and G- bacteria isolated from contaminated industrial fermentors, and the following chemical agents, either alone or in combination, were added: formaldehyde, phenol . dimethylformamide, p-aminosalicylic acid and nitrofurazone . Dimethylformamide was inhibitory even at 0.08% . formaldehyde concentrations higher than 0.05%, Nitrofurazone stimulated chlortetracycline production . The best combination was 0.01% formaldehyde added before, and 2.10-3% nitrofurazone added after short sterilization at 120 degrees C. Am Rev Respir Dis, 1978 Jan, 117(1), 153 - 60 Percutaneous drainage of lung abscess; Vainrub B et al.; The availability of effective antimicrobial agents has greatly decreased the need for surgical intervention in patients who have a pyogenic lung abscess . We describe 3 patients with lung abscesses caused by gram-negative bacteria who failed to respond to medical treatment and who were believed to be unable to withstand lobectomy . Percutaneous insertion of a drainage tube directly into the abscess brought about a dramatic clinical response, with prompt closure of the cavity . This procedure provides an alternative to thoracotomy and lobectomy in treating lung abscesses that fail to respond to medical therapy. Microbios, 1978, 23(92), 83 - 5 Phenols: a review of their history and development as antimicrobial agents; Hugo WB; Phenols were first isolated in crude form at the end of the eighteenth century . Pure phenol was isolated in 1834 and its structure proved in 1842 . In 1860 Kuchenmeister first used phenol as a wound dressing in Germany . Lister was to use it in his classical experiments in antiseptic surgery . Substituted phenols, and to some extent phenol itself, are still in use today as antiseptics, disinfectants and preservatives. CRC Crit Rev Microbiol, 1978, 7(1), 27 - 91 Cellular antimicrobial immunity; Collins FM; Acquired resistance to infectious disease may be expressed by a predominantly humoral or a cellular mechanism or, more frequently, by a combination of the two . The cellular interactions which are responsible for the induction of the immune response in the skin, lung, intestinal mucosa, genitourinary tract, conjunctiva, and peritoneal cavity are discussed and the role of living or dead vaccines in the induction of acquired resistance is outlined . The host response involves three different cell types: the phagocytic cell (polymorphs or macrophages), the thymus-dependent (T) lymphocyte, and the thymus-independent (B) lymphocyte-plasma cell line . The normal unstimulated phagocytic cell is capable of killing most nonpathogenic bacteria that gain entry to the tissues . However, the presence of opsonic antibodies and activated macrophages is required to eliminate the pathogenic intracellular parasites . Such immunological activation involves the presence of sensitized T-lymphocytes in the lesion . The cellular response is also characterized by the simultaneous development of a state of delayed-type hypersensitivity (DTH), along with the antimicrobial CMI response . A rising humoral response normally develops subsequently . Killed bacterial cells (except when incorporated into Freund's complete adjuvant) induce the humoral response without the CMI reaction so that such vaccines are not able to fully protect the host against the naturally acquired disease . With the development of cell fractionation methods as well as the identification of distinctive cell surface markers, suspensions of B- and T-cells and macrophages can now be prepared for use in increasingly sophisticated transfer and reconstitution studies . The role of the different cell types in the expression of humoral and cellular immunity has been determined, and the effect of various immunopotentiating and immunosuppressive regimens on the immune system as a whole has been evaluated quantitatively . These studies have led to an appreciation of the role played by suppressor B- and T-cells in the interplay of both humoral and cellular components of the host defense system during the development of immune tolerance, desensitization, anergy, autoimmunity, and the expression of an anamnestic immune response following reinfection. Z Allg Mikrobiol, 1978, 18(6), 389 - 98 Fermentation, isolation, and biological activity of maduramycin: a new antibiotic from Actinomadura rubra; Fleck WF et al.; In a continuing search for new antibiotics, the species Actinomadura rubra (Sveshnikova et al.) J . Meyer et M . Sveshnikova 1974 (strain IMET 13001) was found to produce a red pigment with indicator properties, designated maduramycin . The pigment (C28H22O10; m.w . 518 m/e-; m.p . 305--310 degrees C (dec.); UVmax 225.307 nm) possesses a strong antimicrobial activity against gram-positive bacteria, including strains which produce inactivating enzymes for some commercial antibiotics . Maduramycin forms a complex with serum albumin, but no complex formation with DNA was observed using absorption spectroscopic and polarographic methods . Maduramycin additionally inhibits the action of some enzymes . The LC50 of maduramycin in mice was greater than 250 mg/kg on intraperitoneal administration . Fermentation, isolation, and some of the chemical and biological properties of this new antibiotic are described. Scand J Infect Dis Suppl, 1978, (14), 251 - 60 Penetration of antimicrobials into tissue culture cells and leucocytes; Brown KN et al.; When exposed to HeLa cells in tissue culture for 72 hr., antimicrobials could be categorised into three groups characterised by cell associated concentrations much lower (ampicillin, cephalexin, cloxacillin, flucloxacillin, streptomycin and trimethoprim, all 14% or less), much higher (tetracycline and polymyxins) or approximating to those extracellularly (erythromycin, lincomycin, fusidic acid and gentamicin) . For kanamycin, neomycin and sulphonamides, cell associated levels were between 24 and 47% and for penicillin G and cephaloridine were 66% of those extracellularly . With mouse peritoneal macrophages and human peripheral blood leucocytes cell associated levels for representative antibiotics were all lower after 3 hr . exposure than in the tissue culture cells . However, studies on the rate of release of cell associated antibiotic and of the effects of surface active agents indicated that the differences between cell types were due to loss of cell association during washing procedures to remove extracellular antibiotic . The effects of bactericidal antibiotics on survival of bacteria phagocytosed by mouse macrophages suggested that the cell association observed in tissue culture cells represented true intracellular penetration rather than mere binding to the cell surface . Within families of antibiotics, alterations to the molecule change cell penetration and the variations observed can not be explained merely in terms of simple diffusion, molecular size, dissociation constants, lipid solubility or protein binding. Int J Vitam Nutr Res, 1978, 48(2), 159 - 64 Ascorbic acid, neutrophil function, and the immune response; Leibovitz B et al.; The role of ascorbic acid is reviewed with regard to antimicrobial activity, interferon production, and humoral and cellular immune responses . Ascorbic acid appears to play a role in a number of neutrophil functions including increased chemotaxis, increased particulate ingestion, enhanced lysozyme-mediated non-oxidative killing, protection against the toxic effects of superoxide anion radical, inhibition of the halide-peroxide-myeloperoxidase system without a pronounced bactericidal effect, and stimulation of the hexose monophosphate shunt. Annu Rev Med, 1978, 29, 129 - 36 E . coli meningitis: K1 antigen and virulence; Wilfert CM; It is clear from the preceding material that bacterial infection is a significant threat to the newborn infant . The most common gram-negative organism causing meningitis in the neonate is E . coli, and the invasive capacity of this organism is correlated with its polysaccharide antigen, K1 . Careful studies of supportive care and antimicrobial therapy of these infections are continuing . If antibodies could be generated which protect the infant, it would be theoretically possible to guard against infasive disease by conferring antibody positivity to the mother and hence to the infant . Investigations along these lines are continuing. Z Exp Chir, 1978, 11(1), 27 - 31 {Experimental studies on the antimicrobial effect of several butylcyanoacrylate tissue adhesives}; Uhlig R et al.; It is dealt with the effects of various butycyano-acrylate type surgical adhesives on gram-positive and gram-negative bacterial species . The experimental results show a growth-inhibiting effect on gram-positive germs . Gram-negative germs are not affected . The growth inhibition produced by SO2-containing adhesives is greater than that caused by SO2-free ones . As compared to Histoacryl blue, the Fimomed variants showed a broader spectrum . Furthermore, it was stated that the adhesive exerts its growth-inhibiting effect not only in the monomeric, but also in the polymeric state . A relationship between the gram-behaviour and the antimicrobic effect of the adhesive is taken into consideration. Am Surg, 1978 Jan, 44(1), 55 - 8 Does skin have antimicrobial properties? An in-vitro experiment and literature review; Szabo SE et al.; Skin grafts placed over burn wounds were first reported to reduce bacterial growth levels about 20 years ago . Recently, three separate groups of investigators have studied effects of skin in vitro in order to better understand the mechanism of this in vivo phenomenon . Although significant bacterial inhibition was not found, the interaction of host tissue factors with the skin which is possible in vivo was not included in these experiments . Hence, the question of in vitro activity of skin was still not resolved . In this experiment human and pig skin, fresh and preserved, intact and homogenated, were all tested separately with and without active serum against four representative bacteria and one fungus, individually and in mixed cultures . No growth inhibition was observed under any circumstances on daily review for up to three-week periods . In light of conflicting reports related to antibacterial effects of skin grafts used clinically, it now seems important to definitively clarify whether skin really possesses antibacterial properties in vivo. Arzneimittelforschung, 1978, 28(10), 1665 - 72 Biological assay of potential trichomonacides in vitro using a counter apparatus; Brotherton J; Utilising the accuracy and speed of a Coulter Counter for cell counting and sizing, a new method of antimicrobial assay has been developed in which the potency of inhibitors is calculated on a mol/cell basis . A total of 72 potential trichomonacides were screened against Trichomonas vaginalis and the ED50 value estimated for 27 of the most interesting and potent compounds . The ED50 value for metronidazole was a mean of 5.12 fmol/cell and only 6 compounds were more potent . After the nitroimidazoles, the acridines were the most potent group of compounds . Only chlortetracycline and gramicidin caused an increase in mean cell size. Scand J Infect Dis Suppl, 1978, (14), 92 - 9 Theory and practical impact of binding of antimicrobials to serum proteins and tissue; Craig WA et al.; Binding of antimicrobials to serum proteins and tissue affects their distribution, elimination and antimicrobial activity . Penetration of drugs into most tissues and interstitial and inflammatory fluids correlates with level of free drug in serum . Serum protein binding can increase or decrease the rate of drug elimination depending on whether total or free drug is available to the excretory or metabolic routes of elimination . Binding to soluble intracellular proteins (ligandin and fatty acid binding protein) appears to be important in the cellular transport and elimination of antimicrobials by renal tubular secretion and hepatic extraction . Although only free, unbound drug is antimicrobially active, the lack of well designed studies has prevented precise quantitation of the influence of binding on therapeutic efficacy in vivo . Pharmacokinetic considerations predict that serum binding greater than 80% would be necessary to significantly reduce free levels of drug in the body . However, extensive protein binding is often compensated for by greater intrinsic activity of lipophilic antimicrobials. Scand J Infect Dis Suppl, 1978, (14), 47 - 53 The penetration of antibiotics into bacterial cells: significance to antimicrobial action; Hare JD; The penetration of antibiotics into the microbial cell is reviewed from the standpoint of the structure and function of the several types of membranes which constitute permeability barriers to the passage of hydrophilic molecules . It is clear that little is actually known about the mechanisms by which the majority of antibiotics gain access to their site of action within the target cell . Sufficient evidece is at hand to indicate that resistance to several groups of antibiotics is determined by changes in the permeability of the cell membranes, the genes for which are often carried on R-plasmids . The importance of studies to determine the precise mechanisms by which each type of antibiotic permeates the membrane of the bacterial cell is stressed by a discussion of several approaches to enhancing antibiotic permeation through manipulation of either the drug or the target cell based on knowledge of the uptake mechanisms. Scand J Infect Dis Suppl, 1978, (14), 36 - 46 Kinetics of tissue penetration . Are high plasma peak concentrations or sustained levels preferable for effective antibiotic therapy? Bergan T. The experimental evidence and the theory of antibiotic transport into peripheral foci of infection have been discussed . Support is presented in favour of the concept that intermittent dosage with peak concentrations of sufficient size would seem preferable . The duration of plasma concentrations above certain thresholds is a basic requirement for successful antimicrobial therapy. Scand J Infect Dis Suppl, 1978, (14), 25 - 35 Significance of the pharmacokinetics of antimicrobial drugs; Hinderling PH; Administration of an active drug to the intact human body leads to a "drug-body" interaction: the drug exerts its effect on the body, the body disposes of the drug . Administration of an antimicrobial drug to a human body infected with pathogenic bacteria leads to a "drug-bacteria" interaction in addition to "drug-body" and "bacteria-body" interactions . Of these complex interacting mechanisms only the disposition effect of the human body on antibacterial drugs and the effect of antimicrobial agents on bacteria have been quantified, analyzed, and are thus predictable . Postulates have been derived from the findings of these studies and have given the rationale for proper antimicrobial therapy under clinical conditions: antimicrobial actions are functions of the duration and concentration of the active antimicrobial principle at the physiological site of action . Optimal therapeutic efforts consider the need for individual treatment with respect to the choice and type of dosage regimen of the antimicrobial agent administered. Scand J Infect Dis Suppl, 1978, (14), 239 - 44 Changes in protein binding during disease; Craig WA et al.; Disease states can alter protein binding of antimicrobials by either a reduction in the concentration of serum proteins or the accumulation of endogenous compounds, such as bilirubin and free fatty acids (FFA), that affect drug-protein interactions . In terms of protein concentration, extremely low levels of albumin (less than 2.5 m/100 ml) are required to markedly reduce binding of antimicrobials . In vitro addition of high concentrations of bilirubin and FFA to normal serum reduces binding of most antimicrobials . However, binding of some antibiotics appears to be enhanced at lower concentrations of FFA probably by an allosteric mechanism . These in vitro observations have been confirmed in sera from patients during heparin administration and patients with hyperbilirubinemia . Reduced protein binding of acidic antimicrobials in uremia appears to be associated with the accumulation of another, as yet unknown, endogenous binding inhibitor . Significant reduction in protein binding can affect the distribution of drugs and results of microbiologic assays. Scand J Infect Dis Suppl, 1978, (14), 233 - 7 Transfer of penicillin G and ampicillin into human skin blisters induced by suction; Schreiner A et al.; The antibiotic concentrations in untreated and endotoxin-treated suction blisters was studied in 15 healthy adults . In a pilot study, 2 mega units of penicillin G were given as an intravenous bolus injection to two subjects . For further studies, a single dose of 800 mg bacampicillin was given orally to 13 individuals . The penicillin G concentrations in the blister fluid were highest approximately 15 minutes after the dose, and exceeded that of serum after 1.5 hours . With ampicillin the blister fluid concentration reached maximum levels after approximately 2 hours, were equal to serum levels after 3 hours, and were later persistently in excess of serum levels . The ampicillin half-life was 136 and 100 minutes in the two types of blister fluid, as compared to 65 minutes for serum . A marked differences between the antibiotic concentrations in inflammatory and non-inflammatory blisters was seen in the pilot study with penicillin G . However, in the experiments with bacampicillin, no significant difference was demonstrated . This suction blister technique appears to be a useful method for studies on extravascular antimicrobial activity in man. Scand J Infect Dis Suppl, 1978, (14), 189 - 206 A review of models for the therapy of experimental infections; Bergeron MG; The advent of several new antibiotics able to counter drug-resistant bacteria, the problems in carrying out well-controlled clinical trials and the occasional disparity between in vitro and in vivo activity of antimicrobials compel us to resort to experiments using animal models in order to evaluate different therapeutic regimens . We wish here to discuss the prerequisites of a reliable animal model for the therapy of experimental infections and to analyze the influence of combined antimicrobial therapy on the outcome of non-human infections . The interaction between antibiotics and infected tissues will also be considered . Finally, we shall examine the interrelations between host defenses and antibiotics in models for experimental infections. Scand J Infect Dis Suppl, 1978, (14), 160 - 3 Factors influencing the penetration of antimicrobial agents into the cerebrospinal fluid of experimental animals; Sande MA et al.; Successful therapy of bacterial meningitis is dependent upon achieving adequate antibacterial activity in the CSF . The percent penetration (CSF concentration/serum concentration X 100) of various antimicrobial agents was determined in a rabbit model of bacterial meningitis . The percent penetration of the penicillin and cephalosporin derivatives was found to vary inversely with the protein binding of the respective drugs . Esterification of ampicillin increased its lipid solubility and likewise increased the penetration into the CSF . Probenecid competitively inhibits the active transport efflux of various organic acids from the CSF and increased the CSF concentrations of penicillin and cephalosporin derivatives . The percent penetration of all drugs was increased in the presence of the inflamed meninges. Scand J Infect Dis Suppl, 1978, (14), 109 - 17 A critique of animal models in antibiotic research; Barza M; The interactions between microbes and antimicrobial agents in vitro are often markedly different from those in vivo, presumably because of pharmacological factors and host defenses . Although animal models have long been used to evaluate the efficacy of chemotherapeutic agents, there are few guidelines for the conduct of these studies . Therefore, the results of these investigations must be assessed critically in terms of the balance between the infectious challenge and the therapeutic response, and in terms of their relevance to human disease . It has been clearly demonstrated that the "freshness" of the infecting organism, the interval between infection and therapy, the order of administration of drug combinations, and the presence of foreign bodies, may have a crucial impact upon the outcome of animal trials . Less well studied have been the influence of the quantity and growth phase of the infecting inoculum, the use of single- as opposed to multiple-dose therapy, and the anatomical and pharmacological attributes of the particular animal species . Greater understanding of these factors would resolve some of the apparently contradictory results of various investigations, and would permit more rational design of these studies in the future. Oral Surg Oral Med Oral Pathol, 1978 Jan, 45(1), 116 - 22 Antimicrobial effects of N2 in vitro; Broisman H et al.; The antimicrobial effect of the root canal filling material N2 has been studied in vitro . Pulverized as well as intact set N2 inhibited the growth of the mixed bacterial flora of saliva or pure cultures of S . mutants and A . viscosus on blood agar for at least 100 days . Intact set N2 transferred daily to blood agar inoculated with saliva lost its antimicrobial activity after nine transfers . The antimicrobial effect of N2 against S . mutants was found to be bactericidal . N2 also appeared to possess an antimicrobial "vapor effect". Scand J Infect Dis Suppl, 1978, (14), 135 - 42 The mini-pig as a model for penetration of penicillins; Bergan T et al.; To be active, antimicrobials must reach the bacteria in the infectious foci in adequate concentrations . Direct measurements of levels in the various foci are difficult to perform, but a number of animal models with artificial extravascular foci have been developed . In many ways, the physiology of pigs resemble that of humans . Consequently, it was thought that pigs might also parallel humans in the handling of penicillins . General pharmacokinetics of ampicillin and flucloxacillin and the penetration of the substances to subcutaneously implanted teflon tistisue chambers were investigated . Ampicillin was given intramuscularly, orally, and as the pro-drug bacampicillin. Infection, 1978, 6(2), 84 - 91 Immune competence in a patient with Hodgkin's disease and relapsing toxoplasmosis; Frenkel JK et al.; A 40 year old woman with Hodgkin's disease twice developed signs of encephalitis while being treated with prednisone and cyclophosphamide for 10 months . Since on both occasions her Toxoplasma dye test titer was 1 : 8000 or higher, she was treated on suspicion of toxoplasmosis with sulfadizine and pyrimethamine . Her tumor therapy was changed to bleomycin with lower doses of prednisone for 12 months . After death from central pontine myelinolysis, Toxoplasma and cytomegalovirus could be isolated, but no lesions attributable to these infectious agents were present . Maintenance of the patient's immune competence suggested an inquiry into the effects of the chemotherapeutic agents and of tumor infiltration for their respective interference with immunity . Using hamsters with chronic latent toxoplasmosis, it was found that both cortisone and cyclophosphamide caused recrudescence of chronic inapparent infection, that vinblastine and bleomycin interfered only slightly with the development of immunity, whereas in infiltrating lymphoma permitted immunity to develop normally . It is concluded that greater attention should be directed to the immunosuppressive effects of tumor treatment . By choice of an effective tumor therapy which is least immunosuppressive, and if necessary under cover of antimicrobial therapy, a patient with Hodgkin's disease can be aided in developing immunities which he may subsequently be able to maintain. Urol Res, 1978, 6(1), 35 - 42 The influence of pH on antimicrobial substances in canine vaginal and urethral secretions; Hoyme U et al.; Trimethoprim and rosamicin (a new basic macrolide antibiotic) were administered to normal and oophorectomised female dogs by constant intravenous infusion before and after oestrogen and androgen administration . Their concentrations in plasma and in urethral and vaginal secretions were determined by bioassay and correlated with the pH values of vaginal and urethral secretions . Both compounds were concentrated in the vaginal and urethral secretions in reverse correlation with the pH of these fluids . Trimethoprim and rosamicin have antimicrobial spectra well suited for the treatment of bacterial urethritis and vaginitis and require further clinical investigation. Arch Orthop Unfallchir, 1977 Dec 27, 90(3), 259 - 63 {Bone concentration of a new antimicrobial agent azlocillin (author's transl)}; Vent J et al.; The literature regarding bone level concentrations of different antimicrobial agents is reviewed . The investigation using Azlocillin shows a sufficiantly high concentration in human bone to include this agent among other semisynthetic penicillins. J Exp Med, 1977 Dec 1, 146(6), 1648 - 62 Hydrogen peroxide release from mouse peritoneal macrophages: dependence on sequential activation and triggering; Nathan CF et al.; Using a specific and sensitive fluorometric assay, the H2O2 release from as few as 2 X 10(5) mouse peritoneal macrophages could be detected continuously and quantitated . It is emphasized that the assay measured H2O2 release, not production . Induction of H2O2 release required sequential application of two stimuli: the administration of an activating agent to the mice from 4 days to 10 wk before all harvest, and the exposure of the cells in vitro to a triggering agent . BCG was most effective as an activating agent, resulting in peritoneal macrophages which could be triggered to release H2O2 almost as copiously (8 nmol/10(6) macrophages per 5 min) as mouse peritoneal PMN (9 NMOL/10(6) PMN per 5 min) . Casein and C . parvum could also serve as activators, but thioglycollate and FCS were ineffective after single injections . PMA was a potent triggering agent, resulting in a maximal rate of H2O2 release after a latency of about 40 s for cells in suspension . Other triggering agents included the ionophore A23187, concanavalin A in the presence of cytochalasin B, and phagocytosis . H2O2 release could be attributed to macrophages and PMN in peritoneal cell suspensions or in preparations of adherent peritoneal cells, but not to lymphocytes . Indirect evidence suggested that the H2O2 detected was formed from superoxide anion . These observations appear to justify renewed interest in the idea that H2O2 may be important in macrohpage antimicrobial and antitumor mechanisms. Jpn J Antibiot, 1977 Dec, 30 Suppl, 246 - 61 Modern instrumental methods for identification of antibiotics; Mitscher LA et al.; Modern screening for antimicrobial agents and the characterization of their transformation products are not only extremely competitive but highly labor intensive activities . The use of specialized instrumental techniques for rapid identification of molecular species shows promise of becoming an essential part of this process . At the earliest stages, microseparation methods coupled with modern methods of ion production are particularly useful . Applications of various methods of chromatography, including high performance liquid chromatography, with various methods of ion production using mass spectrometers, particularly under computer control, are exceptionally powerful, though expensive, means of addressing this problem . Some present and potential uses of this technique are discussed along with a consideration of the strengths and weaknesses now apparent and a projection is made of the future of this method . A brief review of the use of a variety of physical methods of structural characterization for a variety of specialized purposes is also given along with a bibliography of recent applications to specific antibiotics . The scope and limitations of these methods is also treated. Am J Clin Pathol, 1977 Dec, 68(6), 769 - 777 Laboratory evaluation of an automated antimicrobial susceptibility system; Stubbs KG et al.; A newly introduced automated method for antibiotic susceptibility testing, AUTOBAC 1, has been evaluated by comparison with the disk agar diffusion method (Bauer-Kirby) . A total of 2,518 strains of gram-positive (540) and gram-negative (1,978) organisms isolated from clinical specimens was examined by both methods with eight or ten antibiotics, including Tobramycin . An overall agreement of 97.4% was obtained when results were compared by individual antibiotic . However, many discrepancies were observed when individual genera or species were analyzed . Of 2,518 strains examined, 651 (26%) showed discrepancies in response to one or more antibiotics . Strains, showing discrepancies were re-examined by the broth dilution susceptibility method . The results obtained favored the disk agar diffusion method . Reproducibility experiments revealed a greater inconsistency in the AUTOBAC 1 system than in the agar diffusion test . It is concluded that although a rapid automated system for antibiotic sensitivity testing is desirable, the conventional disk agar diffusion method is easier to perform, more reliable, and a less expensive procedure for antibiotic sensitivity determination. J Trauma, 1977 Dec, 17(12), 968 - 71 Rupture of the thoracic esophagus from blunt trauma; Chilimindris CP; A young man with severe multiple injuries following a motorcycle accident was admitted with head and mandible fractures, coma, fracture dislocation at C5-C6 resulting in total leg paralysis, partial paralysis of the right arm and intercostal muscles, and closed chest injury with possible pulmonary contusion . On the fourth day he developed fulminating mediastinitis and massive empyema, and was found to have a ruptured esophagus . Recovery became possible with surgical drainage of the pleural cavity and mediastinum, proximal and distal decompression of the esophagus, antimicrobial therapy, irrigation of the pleural cavity, complete intravenous hyperalimentation, and infusions of salt-poor albumin . The patient was discharged after 95 days, and 7 months after injury is neurologically intact except for a partial right wrist drop . This rare esophageal rupture should be suspected in any chest injury patients, especially those characterized by extreme cyanosis, dyspnea, shock, and prostration incompatible with thoracic cage injury. Arq Neuropsiquiatr, 1977 Dec, 35(4), 346 - 53 {Bacterial meningitis in the newborn . Study of 20 cases}; Moura Ribeiro V et al.; The cases of 20 patients admitted with purulent meningitis in the neonatal period are reported . The authors analyse the importance in recognizing the minimal signals and symptoms, as weel as the clinical patterns of the manifested disease; Some considerations are draw about the values of the early diagnostic before the high incidence of mortality and the gravity of sequaele that occur besides the high doses and long term antimicrobial therapy. J Clin Periodontol, 1977 Dec, 4(5), 136 - 43 Outlook for Hibitane in dental caries; Emilson CG; The association between S . mutans and dental caries in humans has focused the interest on the possiblity to suppress or eliminate this microorganism from the oral cavity . In this respect chlorhexidine seems to be a valuable adjunct, since S . mutans is highly sensitive to the drug . In hamsters and rats infected with S . mutans topical applications of chlorhexidine have been highly effective in lowering the caries activity . In long-term studies in students, a certain caries inhibiting effect has also been demonstrated . The decrease in the prevalence of S . mutans by chlorhexidine treatment suggests that the drug can be used for directed and controlled antimicrobial therapy in subjects highly infected with S . mutans. Am J Med, 1977 Dec, 63(6), 914 - 25 Pulmonary disease caused by Candida species; Masur H et al.; Candida species are often found in sputum specimens . Their role as a possible cause of pulmonary disease is a frequent consideration, particularly in patients receiving immunosuppressive or long-standing antimicrobial therapy . At Memorial Hospital and New York Hospital, 30 patients with histologic evidence of Candida pulmonary infection were identified over a two year period . These infections reached the lungs by hematogenous spread in 10 patients and by aspiration in 16 patients . Most the patients had malignant neoplastic disease . The Candida pulmonary disease appeared to be significant clinical factor in only three cases . Experience from our institutions and from the literature indicates that Candida species rarely cause significant pulmonary disease . When such involvement is extensive, the patient is usually terminally ill from multiple other factors. J Antibiot (Tokyo), 1977 Dec, 30(12), 1087 - 92 Disruption of the Escherichia coli outer membrane permeability barrier by immobilized polymyxin B; Rosenthal KS et al.; One of the apparent roles of the outer membrane system in gram-negative bacteria is to function as a selective permeability barrier . A number of antibiotics active against gram-positive bacteria are relatively ineffective against gram-negative bacteria presumably because of the implied barrier function of the outer membrane . This interpretation has been strengthened by studies demonstrating synergism between outer membrane perturbing agents such as EDTA or polymyxin B and specific antibiotics . In the case of polymyxin B, it is not totally clear that synergism with other antimicrobials is due to disruption of the outer membrane permeability barrier or to interactions with the inner membrane . In order to resolve this question, polymyxin B was covalently attached to agarose in order to limit interactions with the outer surface of E . coli . These studies demonstrate that immobilized polymyxin B acts synergistically with bacitracin, rifampicin, or lysozyme . It is proposed that synergistic effects exhibited by polymyxin B are due to its interaction with the outer membrane system. J Gen Microbiol, 1977 Dec, 103(2), 367 - 74 The mode of action of N-(n-Dodecyl)diethanolamine with particular reference to the effect of protonation on uptake by Escherichia coli; Lambert PA et al.; In a homologous series of N-(n-alkyl)diethanolamines antimicrobial activity was related to surface activity and increasing octanol-water partition coefficient . Maximum activity was exhibited by the dodecyl-, tetradecyl- and hexadecyl-derivatives . Dodecyldiethanolamine (DDE) displayed a broad spectrum of activity . Towards Escherichia coli NCIB8277, its bacteriostatic and bactericidal activity increased as the degree of protonation lessened, and may have been influenced by the formation of micelles . Uptake of DDE by washed suspensions of E . coli was more rapid and more extensive at pH 7.0 than pH 4.0 . Within this pH range, bacterial uptake, the octanol-water partition coefficient (lipid solubility) and the proportion of unprotonated DDE all increased . Uptake isotherms at pH values in the range 4.0 to 8.0 are interpreted as signifying different uptake mechanisms for the protonated and unprotonated forms. Am Fam Physician, 1977 Nov, 16(5), 167 - 72 Outpatient management of minor burns; Miller SF; The overwhelming majority of burns are minor and can be treated on an ambulatory basis if hospitalization is not indicated . Recommended are topical antimicrobial agents in the acute phase and pressure garments after wound healing . Sound principles of burn wound management determine the ultimate outcome of treatment, the degree of function and the cosmetic appearance of the healed wound. Antibiotiki, 1977 Nov, 22(11), 970 - 4 {Component composition and admixtures of related compounds in commercial preparations with an erythromycin base}; Zak AF et al.; Chromatographic purity of erythromycin base preparations manufactured in the USSR with various technological procedures and those of 4 foreign firms was studied . All the preparations studied in addition to the main component of erythromycin A contained 5 to 7 per cent of erythromycin C and about 1.5 to 3.5 per cent of a non-identified component possessing a somewhat lower chromatographic mobility than erythromycin C . The admixture of 0.5--1 per cent of anhydroerythmycin was found in many erythromycin preparations . The preparations of some foreign firms contained also a number of additional substances . It was shown that the antimicrobial activity of anhydroerythromycin was 50-60 times lower than that of erythromycin . Direct correla;ion between the level of the antimicrobial activity of the market prepaetions of erythromycin and the level of its chemical purity was noted. J Antibiot (Tokyo), 1977 Nov, 30(11), 908 - 16 New antitumor antibiotics, OS-4742 A1, A2, B1 and B2 produced by a strain of Streptomyces; Omura S et al.; New antibiotics, OS-4742 A1, A2, B1 and B2, were isolated from the culture broth of the strain OS-4742, which was designated as Streptomyces matensis subsp . vineus . These compounds have anthracycline chromophores and sugar moieties, but do not contain nitrogen . They possess antimicrobial activities against Gram-positive bacteria and antitumor activities against S-180 solid tumor on mice. Res Vet Sci, 1977 Nov, 23(3), 340 - 3 Therapeutic responses of piglets to experimentally induced colibacillosis; Dey BP et al.; The purpose of these experiments was to determine the effects of prior exposure to antimicrobials on subsequent treatment of artificially induced colibacillosis in pigs . One- to two-week-old piglets were given 10(7) multiple antibiotic resistant Escherichia coli orally . Two groups of the piglets received priming doses at different levels of the antimicrobial preparation, ASP-250 before challenge . The remaining group received no antimicrobial . Piglets ill as a result of the challenge were treated with chloramphenicol of chlortetracycline, or received no treatment . Chloramphenicol was significantly more effective than chlortetracycline in terminating colibacillosis in the primed and unprimed groups . There were fewer deaths and relapse cases in those groups which received chloramphenicol treatment . Results in piglets treated with chlortetracycline were not significantly better than those which received no treatment. Am Rev Respir Dis, 1977 Nov, 116(5), 847 - 51 Detection of penumococcal antigens in the sputum in pneumococcal pneumonia; Leach RP et al.; Forty-seven patients with bacterial pneumonia were grouped by use of clinical criteria according to the relative certainty of a diagnosis of pneumococcal pneumonia . Sputums were tested for pneumococcal antigens by counterimmunoelectrophoresis with polyvalent pneumococcal antiserum . Antigens were detected in the sputum of 29 of 39 patients with evidence of pneumococcal pneumonia, and there was good correlation between the detection of antigens and the degree of certainty of the clinical diagnosis . Antigens persisted briefly in the sputum during therapy with antimicrobial drugs and could be detected during the first 48 hours of therapy in most cases of pneumococcal pneumonia . Pneumococci were isolated from the sputum in only 18 of 39 cases of pneumococcal pneumonia, and sputum cultures did not correlate as well as counterimmunoelectrophoresis with clinical diagnoses . In studies of 27 patients with chronic bronchitis without pneumonia, pneumococci were isolated from sputum in 10 cases, whereas counterimmunoelectrophoresis was positive in 5 cases . Counterimmunoelectrophoresis provides a simple and rapid method for detecting pneumococcal antigens in sputum, and it appears to be more reliable than sputum cultures in establishing a presumptive diagnosis in pneumococcal pneumonia. South Med J, 1977 Oct, 70 Suppl 1, 8 - 14 Microbiologic basis for the rational use of prophylactic antibiotics; Moellering RC Jr et al.; Appropriate use of antibiotics is enhanced by the effective application of data on antimicrobial susceptibility . A number of methods are currently available for routine determination of susceptibilities, including agar dilution, broth dilution, agar diffusion, and several semiautomated methods . If susceptibility testing is properly done, it can serve as the basis for the generation of statistical data of use to the clinician . Periodically updated tables detailing the antimicrobial susceptibilities of commonly isolated organisms enable the physician to make appropriate choices of antibiotics for prophylaxis and for the initial treatment of serious infections, before the susceptibilities of the infecting organisms are known . With computer assistance, it is possible to use susceptibility data for quality control and for more sophisticated epidemiologic purposes . For the past several years, we have studied a number of potential uses of computer-generated data at the Massachusetts General Hospital . Several of these applications, especially as they might relate to the prophylactic use of antibiotics, are discussed in this paper. Arch Surg, 1977 Oct, 112(10), 1192 - 7 Pulmonary aspiration: an update; Stewardson RH et al.; Pulmonary aspiration of foreign material occurs in many situations . The morbidity of pulmonary aspiration is astounding . even more staggering is the mortality of massive aspiration of gastric contents . Bewilderment exists among most physicians concerning the treatment of this lethal event . The use of corticosteroids in pulmonary aspiration has received much attention and no data exist to advocate their continued employment . Knowledge of the bacteriology of aspiration has resulted in more judicious use of antimicrobial agents . The most significant advance in the treatment of pulmonary aspiration has been the development of positive end-expiratory pressure as an adjunct to mechanical ventilation . Pulmonary aspiration in hospitalized patients is an entirely preventable disease . All physicians must be made aware of the multitude of instances in which aspiration may occur if any hope of averting this disaster exists. South Med J, 1977 Oct, 70 Suppl 1, 35 - 7 Gastric surgery; Stone HH; In a prospective, double-blind, randomized study of patients subjected to gastric surgery, parenteral cefazolin begun before operation significantly reduced the would infection rate . Infection developed only when incisional contamination occurred during operation and either when the antibiotic was not present in the tissues of the wound at the time of inoculation or when the offending bacteria were already resistant to the antimicrobial used . To be reliably effective, antimicrobial prophylaxis should always be instituted preoperatively in patients at high risk of infection, ie, those with conditions not associated with gastric hyperacidity . On the other hand, since patients with duodenal ulcer disease and resulting gastric hypersecretion usually have a relatively sterile stomach lumen, antibiotic prophylaxis for gastric operations in these cases is probably not indicated. Mayo Clin Proc, 1977 Oct, 52(10), 616 - 24 The penicillins; Wilkowske CJ; 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 proper drug against individual infections . Allergenicity is the most frequent and serious problem associated with the use of penicillins . However, individual penicillin drugs do have other toxic 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. Am J Med, 1977 Oct, 63(4), 511 - 6 Atypical herpesvirus hominis type 2 infection in uremic patients receiving immunosuppressive therapy; Stone WJ et al.; In four uremic patients (three renal transplant recipients and one with idiopathic thrombocytopenia), painful, initially vesicular lesions developed in the anogenital region while they were receiving immunosuppressive drug therapy . These lesions enlarged, coalesced and ulcerated, presenting a puzzling diagnostic problem . Initial misdiagnoses often resulted in inappropriate antimicrobial therapy . Routine cultures, histologic sections and Tzanck preparations were seldom helpful . The correct diagnosis of herpesvirus hominis (HVH) infection was established within 18 to 48 hours by viral culture of swab or biopsy material . Subsequent identification of isolates as HVH type 2 was confirmed by neutralization kinetics, infectivity titers and ability to plaque in chick embryo cells . Various therapeutic regimens were ineffective . Clinical improvement best correlated with decrease in dosage of immunosuppressive agents. South Med J, 1977 Oct, 70(10), 1215 - 24 Recent advances in antimicrobial therapy; Pickering LK et al.; Metronidazole is a relatively nontoxic, oral agent which may prove to be useful in the treatment of infections caused by susceptible anaerobic organisms . Use of metronidazole to treat anaerobic infections presently is investigational. Wien Klin Wochenschr, 1977 Sep 30, 89(18), 632 - 4 {A new type of ointment base: investigations on its antimicrobial properties (author's transl)}; Wewelka G et al.; A new ointment base (PEN 32) consisting of polyalcohols prevents the growth of bacteria and fungi in concentrations above 25% (mg/mg) . In a concentrated form the ointment base exhibited excellent bactericidal and fungicidal effects in vitro . This property enables the ointment base to be employed without preservatives. Med Klin, 1977 Sep 9, 72(36), 1451 - 4 {Filtration and irradiation of the dialysis fluid to prevent bacteriemia during hemodialysis (author's transl)}; Tolon M et al.; For prevention of bacteriemia caused by contaminated dialysis fluid it is necessary to protect the dialysator by decontamination of the fluid immediately before entering the dialysator . Using filters with a pore size of 0.2 micrometer or 0.45 micrometer sterile samples of dialysis fluid could be obtained, but flow rate and pressure of the fluid could not be kept constant, when the resistance of the filter increased during use . With UV-lamps no problems concerning flow rate or pressure were encountered, but really satisfying results emerged only in laboratory experiments . This was due to causes which can be influenced by technical improvements of the irradiation unit, while the use of filters implies additional measures at the monitor unit to control flow rate and pressure . The success of the applied antimicrobial techniques should be monitored for not inducing a false conviction of safety. J Antibiot (Tokyo), 1977 Sep, 30(9), 691 - 7 Cephalosporins . I . Cephaloglycin analogs with six-membered heterocycles in the C-3 side chain; Naito T et al.; Cephaloglycin analogs with six-membered heterocycles in the C-3 side chain have been prepared by nucleophilic substitution of 7-aminocephalosporanic acid with appropriate azine thiols followed by 7-N-acylation with phenylglycine by the mixed anhydride method . Seventeen thiols of non-substituted or substituted pyridines, pyridazines, pyrimidines, pyrazines and triazines were used as the S-nucleophiles . In general, pyridazine thiols gave cephalosporins processing good antimicrobial activity against both gram-positive and gram-negative bacteria . Among them 6-hydroxypyridazine-3-thiol gave the most active compound of this series, BB-S 118 (1f), which was significantly more active than cephalexin and cephaloglycin in vitro against gram-positive and gram negative bacteria. Arch Dis Child, 1977 Sep, 52(9), 740 - 1 Anaerobic infection in a neonate . Early detection by gas liquid chromatography and response to metronidazole; Rom S et al.; A case of presumptive anaerobic infection in a neonate is described to illustrate the use of gas-liquid chromatography in the early detection of these potentially serious pathogens . Metronidazole is suggested as a possibly useful antimicrobial agent in these infections. Antibiotiki, 1977 Sep, 22(9), 832 - 7 {Actinomyces chromogenes var . graecus var . nov., a producer of a new hexaene antibiotic}; Barashkova NP et al.; Actinomycete LIA-O832 was isolated from a soil sample of Greece . By its antimicrobial spectrum, morphological and cultural properties the actinomycete was most close to Act . chromogenes but differed from the latter by the antibiotic and physiological properties . The actinomycete was classified as Actinomyces chromogenes var . nov . The culture produced an antibiotic complex including 4 antibiotics, i.e . a tetraen antibiotic primaricin, a new hexaen named grecomycim and 2 non-polyenic antibiotics, one of which was close to kikumycin and the other was close to aksenomycin . The physico-chemical characteristics of the antibiotics are presented. Farmaco {Sci}, 1977 Sep, 32(9), 650 - 64 Synthesis and biological activities of some 7-(1,2,4-oxadiazolylacetylamino) cephalosporins; Malabarba A et al.; The synthesis and the physico-chemical properties of cephalosporin derivatives carrying an (1,2,4-oxadiazol-3-yl)- or (1,2,4-oxadiazol-5-yl)acetylamino moiety in position 7 are described . The effects of the presence of an amino or hydroxyl group on the oxadiazole ring are examined . Selected heterocyclicthiomethyl substituents are also introduced in the 3 position of the cephalosporin nucleus . In vitro antimicrobial activity and effectiveness in protecting against bacterial infection in the mouse are evaluated . Only compound (V b) was found to have slight activity when compared with cephalosporins in clinical use. Acta Paediatr Scand, 1977 Sep, 66(5), 605 - 10 Treatment of septicaemia in the newborn infant: choice of initial antimicrobial drugs and the role of exchange transfusion; Tollner U et al.; The therapeutic success of antibiotics used at the beginning of treatment and the effect of exchange transfusion in cases of septicaemia were tested in 22 newborn infants . The clinical course of these patients was compared with the outcome of 11 newborn infants who received antibiotic treatment without exchange transfusion . The following results were obtained: 1) All 6 patients initially receiving antibiotics, which were ineffective in vitro, died . In this group of patients the incidence of septic organ involvements (meningitis, ventriculitis, peritonitis) was significantly increased . 2) Following exchange transfusion, an impressive clinical improvement was consistently observed . 3) In patients who had initially received effective antibiotics and exchange transfusion, the lethality was significantly lower than in patients without exchange transfusion . 4) Our bacteriological findings show that continuous monitoring of cultures from blood, CSF and stool is necessary to choose the most effective antibiotic in the prevailing nosocomical circumstances. Arch Neurol, 1977 Sep, 34(9), 560 - 2 Neonatal meningitis . The ventricle as a bacterial reservoir; Gilles FH et al.; We reviewed autopsies of neonates who had died of meningitis . Plexitis and ventricular exudate were usually present . While the pathogenetic relationship between these two phenomena is uncertain, it is possible that the glycogen-rich choroid plexus of the lateral ventricles not only facilitates local bacterial growth but also acts as a bacterial reservoir relatively resistant to antimicrobial agents . We suggest that more drastic approaches than parenteral antimicrobial therapy may be indicated to reduce further the morbidity and mortality of neonatal meningitis. Lipids, 1977 Sep, 12(9), 753 - 9 Antimicrobial lipids: natural and synthetic fatty acids and monoglycerides; Kabara JJ et al.; Over 40 natural or synthetic lipophilic compounds were screened for antimicrobial activity . Gram (+) bacteria and yeasts but not Gram (-) bacteria were affected by these agents . Epimino and selena fatty acids are more active than their corresponding straight chain unsubstituted fatty acids . The position of selenium influenced the antimicrobial activity of the fatty acids . The presence and position of a double or triple bond, usually an important factor in long chain fatty acids (greater than C14) had little or no effect in C11 fatty acids . Optimum antimicrobial activity was found for fatty acids and their corresponding monoglycerides when the chain lenght was C12 . The dilaurin derivative was not active. Am J Pathol, 1977 Sep, 88(3), 711 - 25 Clinical conditions associated with defective polymorphonuclear leukocyte chemotaxis; Quie PG et al.; Impressive numbers of clinical conditions are associated with defective leukocyte chemotaxis . In many, this cellular dysfunction is associated with other abnormalities of the immune response, but in others abnormal chemotactic responsiveness of leukocytes is the only abnormality of function identified in the laboratory . Patients are usually selected for study because of unusually severe, recurrent infections or poor response to antimicrobial agents, and therefore a frequent association between abnormality of chemotaxis and infection would be expected . Many patients demonstrate abnormal chemotaxis during remissions as well as during infections, and there seems little doubt that abnormality of chemotaxis is related to susceptibility to infections . Partial classification of disorders of chemotaxis was attempted . Major abnormalities are found when there is a primary cellular disorder or cell-directed inhibitors of chemotaxis are found . Less marked abnormalities are found when chemotactic factors are deficient. South Med J, 1977 Sep, 70(9), 1098 - 102 Hemophilus endocarditis: new cases, literature review and recommendations for management; Johnson RH et al.; Rarely is endocarditis attributed to the species of Hemophilus . Most frequently implicated are H aphrophilus and H parainfluenzae, but H influenzae also is seen . We report six cases of endocarditis due to H aphrophilus or H parainfluenzae and review the literature . Emboli to skin, lungs, kidneys, spleen, brain, and other organs are common complications, and acute glomerulonephritis and meningitis often occur . Ampicillin is the mainstay of antimicrobial therapy for patients whose isolates are sensitive to it, but the duration of antimicrobial therapy necessary for eradication of the infection is not clear . Studies of antimicrobial synergism are warranted in instances of endocarditis caused by ampicilin- or penicillin-resistant strains of Hemophilus, or when patients are allergic to penicillin; in these instances, combination antimicrobial therapy must be given when bactericidal synergism can be demonstrated . Intensive management of complications caused by embolization is crucial to patient survival. Dtsch Zahnarztl Z, 1977 Sep, 32(9), 760 - 2 {Antimicrobial properties of cements with and without copper content}; Schmalz G et al.; Copper-containing cements seem to inhibit bacterial growth better than copper-free materials . Twenty-four hours after insertion, a statistically significant difference is noted . The initial bactericidal effect of copper-free cements declines considerably as compared to copper-containing cements . The results obtained largely correspond to those given in the literature . The method used of including bacterial suspension in a liquid medium is suitable to establish dose-reaction curves for dental materials. Lloydia, 1977 Sep-Oct, 40(5), 508 - 14 Alkaloids of Thalictrum . XXII . Isolation of alkaloids with hypotensive and antimicrobial activity from Thalictrum revolutum; Wu WN et al.; Sixteen alkaloids were characterized from Thalictrum revolutum DC., namely; thalidasine, O-methylthalmethine, O-methylthalicberine, thalrugosaminine, thalicarpine, thalmelatine, pennsylvanine, palmatine, berberine, thalifendine, columbamine, jatrorrhizine, deoxythalidastine, thalphenine and magnoflorine . The structure of thairugosaminine (1) a bisbenzylisoquinoline type which was previously proposed on partial data was completely established, including the absolute configuration as S,S . Thalphenine, thalidasine, O-methylthalicberine, thalicarpine, thalrugosaminine and thaliglucinone were found to possess hypotensive activity in rabbits . Thalrugosaminine, thalicarpine, thalmelatine, O-methylthalmethine, pennsylvanine and thalphenine were found to be active against Mycobacterium smegmatis. Blut, 1977 Aug 29, 35(2), 143 - 53 Allogeneic bone marrow transplantation in conventional mice: I . Effect of antibiotic therapy on long term survival of allogeneic chimeras; Heit H et al.; In the present communication the beneficial effect of long term antimicrobial treatment with poorly absorbable antiboitics on the survival of allogeneic bone marrow chimeras was investigated . The combination of C57Bl mice as bone marrow donors and CBA/CA mice as irradiated recipients (800 rad) was used because of their strong histoincompatibility on the H-2 loci . All allografted recipients received 10 X 10(6) bone marrow cells . The majority of the recipients, which were rendered gnotobiotic by an antimicrobial treatment, achieved stable long term chimerism . In contrast, the conventional chimeras died from secondary disease within 9 weeks after transplantation . As early as 14 days after allogeneic bone marrow grafting the gnotobiotic recipients tolerated the reassociation with a conventional microflora without a change in the rate of mortality . Bone marrow cells (8 X 10(6) i.v.) and spleen cells (2 X 10(6) i.v.) collected from allogeneic chimeras failed to induce graft-versus-host-reaction (GVH) in a second lethally irradiated host . The data indicate, that the high rate of mortality in murine allogeneic bone marrow chimeras results from delayed GVH-reaction and systemic infection . The marrow graft, once established seems to exert tolerance against the allogeneic host . The pathogenesis of the systemic infection has not yet been worked out . It is assumed that it originates from bacteremia, induced by radiation dependent lesions of the epithelial integrity and defected lymphatic tissue in the gut. Z Gesamte Inn Med, 1977 Aug 15, 32(16), suppl 249 - 50 {Allergic side-effects of antimicrobial chemotherapy and possibilities in their diagnosis}; Stiller D et al.; In antimicrobial chemotherapy the allergic reactions are in the first place of the side-effects appearing . The most frequent cause of the iatrogenic contact eczema antimycotics and chloramphenicol are to be taken into consideration . Penicillin and its derivations and chloramphenicol form the main proportion of the allergic in systematic administration . The serologico-nephelometric two-step-method and the lymphocyte transformation test are useful methods for the diagnostics of drug allergies . In a use adequate to indication they are valuable adjuvants in the hand of the clinician. Science, 1977 Aug 12, 197(4304), 674 - 6 Interferon: an inducer of macrophage activation by polyanions; Schultz RM et al.; Purified mouse fibroblast interferon (IF) directly rendered resting macrophages tumoricidal . The physicochemical properties and species specificity of the stimulatory agent fall within the present definition of IF . Since a number of polyanions induce macrophage IF, the antitumor and antimicrobial activities may result from the ability of newly released IF to modify macrophage activity. Am J Hosp Pharm, 1977 Aug, 34(8), 835 - 8 Antimicrobial drug use monitoring by a hospital pharmacy; Greenlaw CW; An antimicrobial drug use monitoring program which also provides clinical pharmacy services in a 635-bed hospital is described . The program includes culture sensitivity monitoring, antimicrobial use monitoring, aminoglycoside monitoring, physician consultation and reporting of results to the medical staff . It requires 34 hours of pharmacist time per month, at an estimated annual cost of #4,100. J Pharm Sci, 1977 Aug, 66(8), 1198 - 200 Factors affecting serum oxytetracycline levels in beef calves; Mercer HD et al.; Fifteen Aberdeen Angus steers, 295-364 kg, were dosed with either 4.4 or 11 mg of oxytetracycline hydrochloride/kg im . The antimicrobial activity of the serum was determined periodically, and the resulting data were treated statistically to determine the sources of variation . Variance in serum levels of oxytetracycline activity was attributed to dose, time of bleeding, order of dosing, animal, and assay . The total variance component was proportionately greater for the 11-mg/kg dose than for the 4.4-mg/kg dose . Animal variance increased with the higher dose level of oxytetracycline . The influence of dose on serum level was tested by applying a t test to the mean serum levels and their standard deviations at each bleeding time . The 4.4- and 11-mg/kg serum levels were significantly different (p less than 0.01) at all bleeding times . The 4.4-mg/kg serum levels mutliplied by 2.5 were not significantly different (p less than 0.05) from the 11-mg/kg serum levels at all bleeding times. Am Rev Respir Dis, 1977 Aug, 116(2), 325 - 6 Failure of a "prophylactic" antimicrobial drug to prevent sepsis after fiberoptic bronchoscopy; Robbins H et al.; A 53-year-old patient with lymphoblastic lymphoma developed progressive interstitial pulmonary infiltrates . The patient was believed to have Pseudomonas bronchitis and was given parenteral gentamicin . Transbronchial lung biopsy performed through a fiberoptic bronchoscope was complicated by the development of Pseudomonas septicemia . The organism isolated on blood culture, like the one isolated on sputum culture, was fully susceptible to gentamicin in vitro . A prophylactic antimicrobial drug did not prevent bacteremic Pseudomonas infection in our immunosuppressed patient with pre-existent Pseudomonas bronchitis. Z Gesamte Inn Med, 1977 Aug 1, 32(15), Suppl 233 - 5 {Chemotherapy of microbial diseases of the respiratory tract}; Anger G; It is given a survey on the chemotherapy of the microbial diseases of the respiration tract . A chemotherapy is taken into consideration only for such cases in which a bacterial etiology is ascertained or is assumed with a great probability . The antimicrobial chemotherapy is of particular importance for the acute and chronic bronchitis, bronchiectases, pneumonias, pulmonary abscess and empyema of the pleura . The author deals with the special problems of bacteriological findings of the respiratory tract . The choice of the chemotherapeutic remedy is done in most cases according to the empirical points of view, in which cases development of resistance, side-effects and changing of the infection must be taken into consideration . Apart from the otherwise usual oral and parenteral application special forms of application, such as aerosol therapy and intrapleural instillation are used . It is referred to atypical pneumonias, such as the mycoplasma pneumonia which gives a good response to tetracyclines . Apart from the sulphonamides and trimethoprim penicillins, chloramphenicol, tetracyclines, cephalosporines, more rarely streptomycin and linkomycin are the most important antimicrobiotics. Am J Clin Nutr, 1977 Aug, 30(8), 1236 - 47 Magnitude of the host nutritional responses to infection; Beisel WR; This review describes the scope, complexity, and magnitude of host nutritional responses throughout the course of an infectious process . These responses include prominent changes in nitrogen and protein metabolism, altered rates of carbohydrate and lipid production and utilization, and changes in mineral, electrolyte, trace element, and vitamin metabolism . It is postulated that these responses develop in a relatively predictable sequence which is influenced by the adequacy of host antimicrobial defense mechanisms, the severity and duration of illness, and specific localization of an infectious process within the body . In addition to hormonal regulatory effects, the metabolic and nutritional responses of the host are also influenced by biologically active substances released when host cells participate in phagocytic activity and local inflammatory responses. An Esp Pediatr, 1977 Aug-Sep, 10(8-9), 641 - 54 {Antimicrobial factors in milk and colostrum: their importance for the newborn infant (author's transl)}; Brock JH; The antimicrobial activity of various proteins and other substances in milk and colostrum is discussed . These factors include antibodies, complement, lactoferrin and transferrin, lactoperoxidase and lysozyme . The possible importance of these factors in protecting the newborn infant against infectious diseases is discussed. Am J Clin Pathol, 1977 Aug, 68(2), 279 - 83 A method for determining in-vitro drug susceptibilities of some Nocardiae and Actinomadurae: results with 17 antimicrobial agents; Carroll GF et al.; A simple timesaving method for determining drug susceptibilities in vitro of isolates of Nocardia and Actinomadura is reported . An isolate is considered "susceptible" when the quantity of drug required for inhibition of growth is that concentration which might be obtained in serum by conventional therapy . Sulfonamides remain the drugs of choice for treating disease due to Nocardia species . Although doxycycline and minocycline appear to be very effective against Nocardia species, susceptibility testing may be desirable when a physician is considering substitution of an antibiotic for a sulfonamide . Susceptibility testing also may be desired before a drug is selected for treating disease due to Actinomadura madurae. JAMA, 1977 Aug 1, 238(5), 408 - 10 Thrombotic thrombocytopenic purpura-like syndrome associated with infective endocarditis . A possible immune complex disorder; Bayer AS et al.; A thrombotic thrombocytopenic purpura (TTP)-like syndrome was the chief presenting feature in two patients with infective endocarditis . Clinical and laboratory aberrations of the syndrome were rapidly reversed by specific antimicrobial therapy . Hypocomplementemia and high levels of circulating immune complexes were detected initially in both patients . Because these returned to normal as the TTP syndrome abated, an immunopathologic mechanism may have been operative. Z Gesamte Inn Med, 1977 Jul 15, 32(14), Suppl: 209 - 14 {Classes of antibiotics and their mechanisms of action}; Thrum H; The antibiotics used in the chemotherapy of microbial infections are considered with respect to their antimicrobial spectra and their mechanisms of action, respectively . The sites of action of the different groups of antibiotics interfering with the same cellular processes are discussed . According to their primary actions on sensible cells the antimicrobial antibiotics are divided into four groups: 1 . Inhibitors of the biosynthesis of the bacterial cell wall 2 . Inhibitors of the bacterial protein synthesis 3 . Inhibitors of the nucleic acid metabolism 4 . Membrane-active antibiotics. J Pharm Sci, 1977 Jul, 66(7), 1009 - 12 Reactions of benzenesulfonohydrazides and benzenesulfonamides with hydrogen chloride or hydrogen bromide in acetic acid; Yung DK et al.; Benzenesulfonohydrazides capable of yielding a sulfinic acid intermediate by virtue of a basic nitrogen atom in the second position of the hydrazide moiety produced thiosulfonates when treated with 1 N hydrogen chloride in acetic acid and produced disulfides when treated with 1 N hydrogen bromide in the same solvent . In two cases, a crystalline mixture of P-nitrophenyl p-nitrobenzenethiosulfonate and bis(p-nitrophenyl) disulfide was isolated from the hydrogen chloride reactions . No reaction product was obtained from either the hydrogen chloride or hydrogen bromide reaction with benzenesulfonohydrazides that were unable to form a sulfinic acid intermediate . Reduction of benzenesulfonamides to disulfides appeared to be possible only with hydrogen bromide in acetic acid . No thiosulfonate was isolated from the treatments of benzenesulfonamides with 1 N hydrogen chloride in acetic acid . p-Nitrophenyl p-nitrobenzenethiosulfonate and p-bromophenyl p-bromobenzenethiosulfonate exhibited some antimicrobial activities against Gram-positive bacteria . The latter compound also showed analgesic properties in the phenylquinone test. Chest, 1977 Jul, 72(1), 92 - 3 Pulmonary mucormycosis: another cure; Hauch TW; Pulmonary mucormycosis in an ill patient with poorly controlled chronic lymphocytic leukemia was diagnosed with open lung biopsy without excision . He improved on medical management and became ambulatory . At autopsy one year later, no residual mucormycosis was present . Better control of leukemia and more specific antimicrobial therapy are discussed as potentially important factors in patient management. Am J Ophthalmol, 1977 Jul, 84(1), 112 - 9 Pseudomonas-induced corneal ulcers associated with contaminated eye mascaras; Wilson LA et al.; Seven Pseudomonas-induced corneal ulcers were associated with the use of four brands of mascara contaminated with P . aeruginosa . In laboratory studies, preservative systems of three of the four brands were inadequate in comparison with a control mascara of known antimicrobial activity . If the corneal epithelium is scratched during the application of mascara, particularly if the applicator is old, the cornea should be treated immediately and the mascara cultured to detect Pseudomonas . The high incidence of recurrent corneal ulceration in cases of Pseudomonas-induced keratitis indicates that initial chemotherapy should be intensive and maintained until the lesion stabilizes. J Clin Microbiol, 1977 Jul, 6(1), 46 - 9 Automated, rapid identification of bacteria by pattern analysis of growth inhibition profiles obtained with Autobac 1; Buck GE et al.; A scheme for identifying bacteria has been devised which utilizes the inhibition patterns obtained by Autobac 1 with routine and unusual antimicrobial agents and with other differentially inhibitory chemical compounds . Over 600 compounds were initially identified from the literature, and over 125 of these were selected for further testing on the basis of antibacterial activity most conducive to the instrument-generated differential scheme . Numerical growth index information derived by light scatter comparisons from the instrument were analyzed by computer, utilizing the quadratic discriminant function statistical technique . In comparison with conventional methods, accuracy for the 10 bacterial genera studied was 95% or greater . Results indicate a potential for both bacterial identification and antimicrobial agent susceptibility testing in the clinical laboratory within 3 to 5 h when using this automated approach. J Reprod Med, 1977 Jul, 19(1), 21 - 30 Diagnosis and treatment of acute salpingitis; Sweet RL; PIP: This paper discusses the problem of acute salpingitis, one of the most common gynecologic problems . The goal in management of this problem is to prevent sequelae such as infertility and chronic residual of inflammation . Thus, in management it is important that proper diagnostic methods and appropriate treatment based on microbiologic data be developed and utilized . Presently, culdocentesis is the only practical and reliable means of obtaining meaningful microbiologic data in cases of acute salpingitis . Microorganisms such as N . gonorrhea have been implicated in the etiology of salpingitis . It is clear that sexual transmission is involved in the pathogenesis of gonococcal salpingitis . It is unclear how the gonococci get to the endosalpinx from the endocervix; however, it is possible that menstruation plays a part in the breakdown of local host defense mechanisms which prevent the ascent of microorganisms from the endocervix . The pathogenesis of nongonococcal salpingitis is not yet clearly understood . While antibiotics have helped to alter the prognosis for infertility significantly, more must be done . Previous investigations indicate that the effectiveness of therapy is dependent upon the interval between onset of symptoms and the initiation of treatment . The treatment regimen must also take into account the polymicrobial etiology of acute salpingitis . Most cases are treated on an outpatient basis and the Center for Disease Control has promulgated a set of recommendations for the outpatient treatment of acute salpingitis . Treatment is briefly described . It has come to the attention of researchers recently that the presence of an IUD may ultimately lead to pelvic infection and increased risk of acute salpingitis . However, no particular type of IUD has been associated with an increased risk of pelvic infection in nonpregnant women . More research must be initiated to determine the role of IUDs in pelvic infection and to discover the true microbiologic etiology of salpingitis . Ann Sclavo, 1977 Jul-Aug, 19(4), 864 - 75 {Basic procedure for blood cultures (author's transl)}; Magliano EM; The Author summarizes the basic routine procedure for blood cultures first examining different factors that can influence it (blood coagulation, antimicrobial agents, natural bacterial inhibitors of blood cell wall deficient bacteria) and then describing culture media, atmospheric conditions, incubation time, and modalities for inspection, staining of cultures and subcultures . Finally new rapid automated methods are briefly pointed out. Arzneimittelforschung, 1977 Jul, 27(7), 1391 - 2 1-Methyl-2-nitroimidazol-5-yl derivatives . IVth Communication; Cavalleri B et al.; The chemico-physical data and antimicrobial activities are described of a new series of 2-nitroimidazole derivatives prepared by condensing 1-methyl-2-nitroimidazole-5-carboxaldehyde with N-substituted hydroxylamines, N-aminopiperazines and N-aminopiperidines. Lloydia, 1977 Jul-Aug, 40(4), 384 - 94 Alkaloids of Thalictrum . XXI . Isolation and characterization of alkaloids from the roots of Thalictrum podocarpum; Wu WN et al.; Thirteen alkaloids, hernandezine, thalidezine, N-desmethylthalidezine, isothalidezine, thalistyline, thalistyline methodiiodide, N-desemethylthalistyline, berberine, columbamine, jatrorrhizine, palmatine, thalifendine, magnoflorine and the artifact, 8-trichloromethyldihydroberberine were isolated from the roots of Thalictrum podocarpum Humb . In addition, oxyberberine and thaliglucinone were obtained in very minor amounts and identified by tlc . Of these compounds, N-desmethylthalidezine and isothalidezine are new bisbenzylisoquinoline alkaloids . Sucrose was isolated from the alcoholic extract . Hernandezine, thalistyline, thalidezine, thalistyline methodiiodide and N-desmethylthalistyline were found to possess antimicrobial activity against Mycobacterium smegmatis at concentrations of 100 microgram/ml or less. Am J Med Technol, 1977 Jul, 43(7), 683 - 92 Enteric pathogens: use of flow diagrams for identification; Pezzlo M et al.; A protocol is presented for the cultural processing of stool specimens . Flow diagrams were developed which allow all stool cultures to be processed in a consistent and efficient manner . Criteria have been established to indicate when definitive identification and antimicrobial susceptibility testing are required . A review of the food-poisoning syndrome and infective gastrointestinal disease due to bacterial agents is included. J Am Geriatr Soc, 1977 Jul, 25(7), 308 - 13 Incidence of polypharmacy in a long-term care facility; Kalchthaler T et al.; The incidence of polypharmacy was investigated in a 200-bed long-term care facility . One hundred residents were drawn at random for the study . The average number of drugs prescribed per patient was 3.33, and the average number of pills was 6.34 daily . The most frequently prescribed drugs were the analgesics, followed in order by antihypertensive agents, cardiotonic preparations and antimicrobials . The literature is reviewed with respect to the incidence, causes and end-results of polypharmacy . It is recommended that long-term care facilities develop enlightened and aggressive pharmacy committees to monitor and evaluate drug use routinely in an institutional setting. Jpn J Antibiot, 1977 Jul, 30(7), 505 - 10 {The combination effect of ampicillin and dicloxacillin on the strains of Bacteriodes fragilis isolated from clinical specimens (author's transl)}; Okada J et al.; The antimicrobial activities of ampicillin (ABPC) and dicloxacillin (MDIPC) alone were tested in 100 strains of B . fragilis isolated from clinical specimens, and combined activity of ABPC and MDIPC was investigated employing a chequer board titration method (Box method) with agar plates and liquid media . The following results were obtained . 1 . Of the 100 strains tested, approximately 33% were shown to have MICs of ABPC greater than 100 mcg/ml, whereas 92% of strains were greater than 100 mcg/ml to MDIPC . 2 . In the combination, antimicrobial activities were demonstrated additive or synergistic action in almost strains tested . 3 . A combined effect of these drugs was proved by agar dilution method for the strains, for which the same effect was shown by the tube dilution method . 4 . For ABPC-resistant strains, no increase in antibacterial activity of these drugs by combination was demonstrated. Blood, 1977 Jul, 50(1), 65 - 70 Myeloperoxidase--H2O2--halide system: cytotoxic effect on human blood leukocytes; Clark RA et al.; Myeloperoxidase, H2O2, and a halide form a potent antimicrobial and cytotoxic system of the polymorphonuclear leukocyte . A cytotoxic effect of this system on human blood leukocytes is demonstrated, employing 51Cr release and dye exclusion assays . Cytotoxicity is dependent on enzymatically active myeloperoxidase, H2O2, or a peroxide-generating enzyme system and either chloride or iodide . Cell damage is rapid, with maximal levels of 51Cr release occurring within 30--60 min . Approximately equal sensitivity to the peroxidase system is observed for polymorphonuclear leukocytes and mononuclear leukocytes . Since myeloperoxidase and H2O2 are released from polymorphonuclear leukocytes under certain conditions, such as during particle ingestion, it is suggested that peroxidase-mediated leukocyte injury may be an important feature of the inflammatory response. Lancet, 1977 Jun 25, 1(8026), 1351 - 3 Prophylactic antimicrobial drug therapy at five London teaching hospitals . A report by the Study Group on the Use of Antimicrobial Drugs; Kensit J et al.; We report some findings of a survey of antimicrobial prophylaxis in 5 London teaching hospitals . It is practised predominantly in surgical patients, both before and after operations, penicillins being by far the commonest drugs . Striking differences were found, particularly in the duration of treatment in different hospitals in the same specialty, and also between consultants in the same hospital . The findings raise important questions that need to be answered by clinical trials. Br Med J, 1977 Jun 18, 1(6076), 1561 - 3 Use of medicines in general practice; Skegg DC et al.; The prescriptions issued by general practitioners to a population of about 40 000 people were studied . During one year 53-8% of all males and 65-7% of all females had at least one drug dispensed . The proportion receiving medicines increased with age and was higher among females at all ages . Psychotropic drugs were prescribed more often than any other group and accounted for almost one-fifth of all prescriptions . Altogether 9-7% of the males in the population and 21-0% of the females received at least one psychotropic drug during the year . Among women aged 45-59 33-0% received a psychotropic drug, and 11-2% were given an antidepressant . Althoug antimicrobial drugs were prescribed less often than psychotropic drugs, they were given to more people. Pharmazie, 1977 Jun 6, 32(6), 323 - 5 Synthesis of some N-substituted salicylamides structurally related to certain antimicrobials; Soliman LN et al.; The condensation of 5-nitrosalicoylchloride and 5-sulphamoylsalicylic acid with certain amines is described . Reacting the acid chloride with 3-amino-2-oxazolidone, 4-aminophenazone, thiosemicarbazide, 1-aminohydantoin and 2-aminopyridine yielded the correspondong N-substituted 5-nitrosalicylamides (1a-c), while with semicarbazide a disubstituted product type 2 was obtained . On the other hand, when 5-sulphamoylsalicylic acid was condensed with o-chloroaniline, m-chloroaniline and 4-aminophenazone in the presence of phosphorus trichloride, instead of affording the expected condensation products type 3, it yielded N1N5-disubstituted 5-sulphamoylsalicylamides (4a-c) . The synthesized compounds were screened for antimicrobial activity. Int J Dermatol, 1977 Jun, 16(5), 413 - 7 New uses for benzoyl peroxide: a broad-spectrum antimicrobial agent; Kligman AM et al.; Benzoyl peroxide is a useful agent in the treatment of acne, chronic ulcers, tinea pedis, and tinea versicolor, probably because of its antimicrobial power . 2.5% concentration is almost as active as 5% . Although potential irritancy and allergic reaction have not been a problem on the face, benzoyl peroxide should be used judiciously in chronically inflamed or ulcerated skin . Several potential uses are mentioned. Arch Surg, 1977 Jun, 112(6), 699 - 704 A trial of silver-zinc-allantoinate in the treatment of leg ulcers; Margraf HW et al.; Three hundred thirty-nine of 400 chronic cutaneous ulcers in 264 patients (including some with multiple or bilateral ulcers of both) were healed with silver-zinc-allantoinate creamed (AZAC 1%) . Some of the patients treated had failed to respond to medicated wrappings, saline dressings, and various other therapeutic agents, including antibiotics . In one week of treatment with AZAC 1%, bacterial counts were reduced on the average from approximately 2 X 10(7) to 2 X 10(5) (99%) . Silver-zinc-allantoinate cream also demonstrated a wide spectrum of antimicrobial activity . It did not give rise to resistance by the infecting organisms, was nonallergenic, debrided necrotic tissue, and stimulated healthy granulation . Treatment was well tolerated, side effects being limited to a burning sensation in three patients . Most patients cared for themselves at home with minimal interference in their usual daily activities. J Pediatr, 1977 Jun, 90(6), 965 - 70 Amniotic fluid infections in an African city; Naeye RL et al.; PIP: Congenital pneumonia, originating in an amniotic fluid bacterial infection, is a common cause of perinatal death in industrial societies . A study of perinatal mortality was undertaken in Addis Ababa, Ethiopia, in 1974-1975 in the hospitals and clinics affiliated with the Addis Ababa University Faculty of Medicine . 72% of the perinatal deaths had postmortem examinations and the pregnancies associated with the 1019 autopsied infants were compared with 586 systematically selected successful pregnancies drawn from a cross section of the delivery population by using the 1st deliveries after 7:00 a.m . each day . Hospital and clinic records in conjunction with a detained maternal interview and physical examination on the day following delivery provided 124 separate items of information for analysis . Autopsy prosections and gross placental examinations were performed by 1 Ethiopian and 4 US medical students . Amniotic fluid infection syndrome was identified as the prime diagnosis responsible for deaths in 339 cases for a frequency of 21.8/1000 live births . The fatal disorder had a frequency of 0.10%/week at midgestation with little subsequent change until 39 weeks when it markedly increased . 69% of the deaths were stillborn and the rest neonatal . 76% of lung and 66% of placental cultures were positive for 1 or more organisms in the amniotic fluid infection cases . Only 17% of the placentas from control cases had positive cultures . Fatal amniotic fluid infections had a frequency of 1.75% in single born infants and 12.9% in twins . The fatal infections had a frequency of 1.2% when women made clinic visits for prenatal medical care, and 4.2% when they made no such visits . The disorder was 5 times more frequent in the gravid women who had no education than in those who had 12 or more years of education . The influence of mother's education on the frequency of the fatal infections was largely independent on the influence of poverty . There was an excessive frequency of the fatal infections when women reported prior fetal losses . Acute inflammation of the extraplacental fetal membranes was present in 31% of the control cases, acute funisitis in 11%, and acute inflammation of the chorionic plate of the placenta in 13% . Among the perinatal deaths attributed to amniotic fluid infections, all had congenital pneumonia, 86% acute inflammation of the extraplacental fetal membranes, 61% acute funisitis, and 84% acute inflammation of the chorionic plate of the placenta . Acta Ophthalmol (Copenh), 1977 Jun, 55(3), 539 - 47 Toxoplasmic chorioretinitis affecting the macula; Saari M; To study macular changes in toxoplasmic chorioretinitis 41 patients with ocular toxoplasmosis were reviewed . Of the 41 patients, seven had central, large, deep, pigment ringed scars of congenital toxoplasmosis with poor central vision; squint was seen in two and nystagmus in two; 32, including 11 cases with a macular lesion, had recurrent active toxoplasmic chorioretinitis with a focal, yellowish-white, elevated lesion with indistinct borders mostly at the margin of an old scar and associated with vitreous opacities in all, secondary anterior uveitis in 28, macular oedema in 22, papilloedema in 14, and retinal perivasculitis in 16 cases; two had rare acquired toxoplasmic chorioretinitis affecting the macula . The results show that active toxoplasmic chorioretinitis often causes a widespread intraocular inflammation with vitritis, macular oedema, papilloedema, retinal perivasculitis and secondary anterior uveitis, and suggest a combined treatment of active lesions with antimicrobial agents and corticosteroids. J Gen Microbiol, 1977 Jun, 100(2), 283 - 98 The mechanism of action of nitro-heterocyclic antimicrobial drugs . Metabolic activation by micro-organisms; Goldstein BP et al.; Although the target of the antimicrobial drug 1-methyl-2-nitro-5-vinylimidazole (MEV) has been shown to be DNA (Goldstein et al., 1977) the drug was ineffective in cell-free systems because it was not activated . Both the rate of metabolic activation of MEV and its antibacterial activity were increased when bacteria were grown in limiting oxygen . Mutants of Escherichia coli which were conditionally resistant to nitroimidazoles and nitrofurans were defective in drug activation . The activities of these drugs against E . coli correlated with their rates of metabolism . The antimicrobial spectrum of the drugs appeared to be related to their reducibility by different species. J Gen Microbiol, 1977 Jun, 100(2), 271 - 81 The mechanism of action of nitro-heterocyclic antimicrobial drugs . Primary target of 1-methyl-2-nitro-5-vinylimidazole is DNA; Goldstein BP et al.; The antimicrobial drug 1-methyl-2-nitro-5-vinylimidazole (MEV) preferentially blocked DNA synthesis, was mutagenic and induced coliphage lambda in Escherichia coli . The antibacterial effects of MEV are the consequences of repairable damage to DNA, as shown by hypersensitivity of recA and uvr strains to MEV and related drugs, stimulation by MEV of DNA turnover which was dependent on the product of the uvrA gene, and the presence of cross-links in DNA from MEV-treated bacteria. Am J Hosp Pharm, 1977 Jun, 34(6), 621 - 9 Antimicrobial spectrum, pharmacology and therapeutic use of antibiotics . Part 3: cephalosporins; Barza M et al.; Various aspects of the cephalosporin antibiotics are reviewed, including mode of action and mechanisms of bacterial resistance, antibacterial activity, clinical pharmacology, adverse reactions, and therapeutic use . There are no important therapeutic differences between the two oral agents, cephalexin and cephradine . For intramuscular injection, cephaloridine has largely been replaced by cefazolin which is equally well tolerated and not as nephrotoxic; further, cefazolin has a relatively long half-life which permits its administration three or four times daily . There are no substantial therapeutic differences among the cephalosporins most commonly used intravenously--cephalothin, cefazolin and cephapirin . However, cefazolin is administered in a lower dosage and somewhat less frequently. J Lab Clin Med, 1977 Jun, 89(6), 1198 - 1207 Immunologic studies in pneumococcal disease; Dee TH et al.; Many patients die from pneumococcal disease despite the availability of effective antimicrobial agents . Immunologic studies including detection, typing, and quantitation of serum pneumococcal capsular polysaccharide (PCP) antigen by counterimmunoelectrophoresis (CIE), quantitation of PCP antibody by radioimmunoassay (RIA), and quantitation of serum complement components C3, C4, and C3PA and serum immunoglobulins IgG, IgM, and IgA by the radial immunodiffusion technique of Mancini were performed with the sera of 18 patients . Five patients died (group I), and 13 survived (group II) pneumococcal infection . Both groups were comparable in age, underlying disease, and leukopenia on admission . All patients of group I and 10 of 13 (77%) of group II patients were bacteremic . Two patients in each group had an extrapulmonary focus infection . PCP antigen was detected in the sera of all group I and nine of 13 group II patients . PCP antigen levels were larger than or equal to 15 microng/ml in four of five group I and two of 13 group II patients (p = 0.022) . Levels of antibody to PCP exceeded 100 ng/ml of antibody nitrogen (AbN) in 10 of 12 group II and one of five group I patients (p = 0.027) during the course of illness . All group I patients and three of 12 group II patients had decreased levels of one or more complement components on admission (p less than 0.01) . One or more complement components remained decreased until death in four group I patients but returned to normal or elevated levels in all group II patients . No difference in serum immunoglobulin concentrations were found. Am J Obstet Gynecol, 1977 May 15, 128(2), 187 - 9 Failure of bacterial growth inhibition by amniotic fluid; Tafari N et al.; The bactericidal properties of amniotic fluid normally protect fetuses from late gestational infections by bacteria . Recently, such infections were found responsible for nearly a third of the perinatal deaths in Addis Ababa, Ethiopia . This prompted an analysis of the antimicrobial activity of amniotic fluid in patients in that city . The antimicrobial activity of fluid from 53 women, collected at term, was measured by a semiquantitative plate-count technique . Only one of the fluid samples was bactericidal, 12 were bacteriostatic, and 40 were noninhibitory to bacterial growth. Fortschr Med, 1977 May 5, 95(17), 1118 - 24 {Pulmonary mycoses; laboratory diagnosis, antimycotic therapy}; Bartmann K; The microscopic, cultural and serological techniques for the diagnosis of European and non-European systemic mycoses involving the respiratory tract are reviewed . The antimicrobial, therapeutic and toxic properties of those antimycotic drugs are discussed, which can be used in the treatment of pulmonary mycoses . Data on biotransformation, kinetics and dosage are reported. Br J Surg, 1977 May, 64(5), 315 - 21 Prevention of wound sepsis in gastro-intestinal surgery; Keighley MR; After gastro-intestinal operations wound infection is usually caused by the inoculation of bacteria present within the intestinal tract into the incision during the surgical procedure . In theory, wound sepsis may be minimized by the following methods: (a) avoiding intestinal contamination of the incision; (b) altering the normal flora of the intestinal tract by adding oral antimicrobials to bowel preparation; (c) using topical or systemic prophylactic antibiotic administration for certain high-risk patients . The relative importance of these methods of prophylaxis is described. Am Rev Respir Dis, 1977 May, 115(5), 777 - 82 Diagnostic accuracy of transtracheal aspiration bacteriologic studies; Bartlett JG; The diagnostic accuracy of transtracheal aspiration bacteriologic studies was examined in 488 patients . Twenty-three patients had bacteremic pneumonia, and in each instance the blood culture isolate was also recovered from the transtracheal aspirate . Clinical correlations in 119 patients with negative cultures of transtracheal aspirate indicated that 71 had an alternative diagnosis to explain an abnormal chest radiograph, and 44 appeared to have a bacterial infection but had received antimicrobial drugs before specimen collection . According to clinical parameters and final diagnosis, the incidence of false-negative cultures was 1 per cent among patients sampled before administration of antimicrobial drugs, and the incidence of false-positive cultures was 21 per cent. J Pediatr, 1977 May, 90(5), 703 - 6 Outcome of unsuspected pneumococcemia in children not initially admitted to the hospital; Bratton L et al.; The records were reviewed of 97 episodes of unsuspected pneumococcemia in children not initially admitted to the hospital . Antimicrobial agents were prescribed at the first visit for 46 children; at the second visit 37 of them were improved and nine were not . No antimicrobial agents were prescribed at the first visit for 51; at the second visit 16 of these patients were improved and 35 were not . Pneumococcemia persisted in two treated children and in 13 untreated children . Meningitis was identified later in four children (two treated and two untreated) . Although pneumococcemia in children may be a transient event, it may also persist or result in meningitis or other localized infections. Surg Gynecol Obstet, 1977 May, 144(5), 668 - 72 Topical chemotherapy for burns using cerium salts and silver sulfadiazine; Fox CL Jr et al.; These experimental data indicate that cerium compounds exert a measurable antimicrobial action in vitro . In vivo the simultaneous use of cerium sulfadiazine and silver sulfadiazine was more effective than silver sulfadiazine alone or the combination of cerous nitrate and silver sulfadiazine . When cerous nitrate was used clically, gram-positive bacteria predominated . In contrast, wounds exposed to silver salts alone harbor a predominately gram-negative flora . The combination of cerous nitrate and silver sulfadiazine appears to provide a broad spectrum inhibitory to both types of organisms . It is apparent that a sampling problem exists in any attempt to monitor wounds that may exceed a square meter in extent . These bacteriologic data pertain only to the surface flora . The need to culture tissue samples of burn wounds has been emphasized . Our experience, however, is that invasion of deep tissue without dense surface colonization, greater than 10(5), is infrequent . Furthermore, fragments of eschar were submitted regularly for culture; those results confirmed the surface culture findins . The characteristic yellow-green color of cerium nitrate treated eschars may results from oxidation of trivalent cerium to yellow ceric ions . Free silver and sulfadiazine ions are available also in small amounts because of limited ionization of the highly insoluble silver sulfadiazine . This might promote the in vivo formation of cerous sulfadiazine and would provide a continuous source of ionic cerium for microbial inhibition . The modification of silver sulfadiazine cream by incorporating cerous nitrate into it strikingly enhances its topical antiseptic effect in burn wounds without increasing toxicity. J Med Chem, 1977 May, 20(5), 732 - 6 Structure-activity relationships among the O-acyl derivatives of leucomycin . Correlation of minimal inhibitory concentrations with binding to Escherichia coli ribosomes; Omura S et al.; The synthesis, antimicrobial activity, and binding to ribosomes of leucomycin and leucomycin derivatives are described . In general, the binding of the leucomycins and the leucomycin derivatives to ribosomes correlated with their antimicrobial activity . Some 2'-O-acyl derivatives apparently underwent gradual hydrolysis during antimicrobial assays, for their binding to ribosomes was poor compared to their relatively good antimicrobial activies . Correlation between antimicrobial activity and binding to ribosomes, their molecular site of action, provides some insight into the nature of the active molecular moieties. Am J Surg, 1977 May, 133(5), 609 - 11 Antimicrobial prophylaxis of contaminated tissues containing suture implants; Rodeheaver G et al.; Neomycin sulfate was the only antibiotic tested that significantly reduced the incidence of infections around suture implant sites . The therapeutic efficacy of this antibiotic was related to the chemical and physical configuration of the sutures. Laryngoscope, 1977 May, 87(5 Pt 1), 792 - 816 Physiological principles of therapy in head and neck cutaneous wounds; Simpson WR; It is essential that surgeons treating soft tissue wounds about the head and neck have a basic understanding of skin anatomy and physiology . The quality as well as the rate of healing is usually dependent on the type and extent of the original injury . Having a practical working knowledge of the pathophysiology of the various types of head and neck soft tissue injuries allows an intelligent choice of the most appropriate approach to a particular wound . The best functional and cosmetic results routinely are achieved by the wound's undergoing primary healing . Skin tapes and various sutures each exhibit certain benefits and disadvantages in primary closure of wounds . Skin tapes cause less inflammatory reaction but fail to close the subepithelial wound spaces . The inflammatory reaction and subsequent scarring caused by the various sutures depends upon the size of the suture needle, the diameter of the suture material and whether it is a monofilament or a woven suture . The essential nutrition of the wound must be maintained with the body providing adequate amounts of carbohydrates, proteins, trace elements and vitamins . The lack of adequate wound tissue perfusion by a normal or reversed oxygen gradient will lead to tissue necrosis and infection . The size of the inoculum of micro-organisms, the virulence of the organisms and host antimicrobial defense mechanisms determine if an infection will develop . The pharmacological action of each antibiotic must be understood in order to choose the proper antibiotic, its route of administration and to avoid unwanted side effects . Crushing tissue injuries, high velocity projectile tissue injuries and major burns of tissue may require several days to exhibit the true scope of the original injury . Most of these injuries must be treated by the open delayed method of wound treatment until the proper tissue conditions exist for healing . The proper timing and correct choice of autografts and tissue flaps from the surgeon's personal experience, study and conferring with other qualified surgeons . Upon gaining insight into the cellular and humoral antimicrobial defense system, the surgeon is able to provide the best conditions to allow these systems to function properly . Studies in the ultrastructures of skin along with the recently developed microbioassay techniques will allow a closer monitoring during the process of wound healing that will provide the basis for future techniques in the beneficial manipulation of wound healing. J Pharm Sci, 1977 May, 66(5), 702 - 5 Antimicrobial action of compound 48/80 against protozoa, bacteria, and fungi; Lenney JF et al.; Compound 48/80 inhibited the growth of protozoa, bacteria, and fungi but had no effect on the multiplication of viruses . All susceptible organisms were inhibited by 10 microgram/ml of crude compound 48/80, and some were inhibited by as little as 0.1 microgram/ml . Against Tetrahymena pyriformis, this drug was seven times more potent than quinine . Separation of compound 48/80 into different fractions indicated that some antimicrobial activity could be separated from the histamine-liberating activity . It was found that compound 48/80 is not surface active at 500 microgram/ml. J Med Chem, 1977 May, 20(5), 656 - 60 Synthesis and biological activity of some vinyl-substituted 2-nitroimidazoles; Cavalleri B et al.; In previous studies 1-methyl-2-nitro-1H-imidazole-5-carboxaldehyde and 1-methyl-2-nitro-5-vinyl-1H-imidazole were found to posses interesting antimicrobial activities . We have now prepared some 2-nitro-1H-imidazoles in which the 5-vinyl chain bears selected functional groups (CHO, COCH3, NO2) as well as nitrogen-condensation derivatives of the carbonyl functions . Furthermore, 5-methyl-2-nitro-1-vinyl-1H-imidazole has been synthesized . All the compounds, and some intermediates, have been assayed for antimicrobial activity . Several of them exhibited significant antibacterial and antitrichomonal activity in mice. J Clin Microbiol, 1977 Apr, 5(4), 481 - 4 Allescheria (Petriellidium) boydii sinusitis in a compromised host; Gluckman SJ et al.; The first case of Allescheria (Petriellidium) boydii sinusitis is reported . The organism was isolated from the maxillary sinus in an elderly, diabetic, chronic alcoholic man on maintenance hemodialysis who developed a syndrome resembling mucormycosis . Infections with A . boydii are infrequent and are most commonly limited to Madura foot . In addition, several cases of pulmonary and central nervous system involvement have been described . There is no established therapy for A . boydii, since the published data on antimicrobial sensitivity are limited . Our organism was inhibited by 1.25 mg of amphotericin B per ml and 0.15 mg of miconazide per ml. Jpn J Antibiot, 1977 Apr, 30(4), 285 - 94 The clinical effect of antibiotics in the macrolide family on bronchial asthma . Non-antimicrobial actions of oleandomycin {author's transl}; Mizutani A et al.; Non-antimicrobial actions of oleandomycin (triacetyloleandomycin and oleandomycin phosphate) were studied in patients with bronchial asthma . Twenty-one cases of the disease without associating infections entered the study, and they were given 750mg of oleandomycin or triacetryloleandomycin in three divided doses daily for two weeks . Clinical manifestations and laboratory findings were compared to assess the effectiveness of the antibiotic therapy between the three 2-week periods before, during and after the therapy . Improvements in clinical manifestations were attained in 11 of 21 cases (52.3%), and last after discontinuance of the therapy in 8(38.1%) . The blood level of 11-OHCS as determined by the Demoorr's fluorescence method increased by greater than 20% at the end of thearpy in 7 of 18 cases (38.9%) . In 5 of the 7 cases favorable responses were seen clinically to the oleandomycin therapy . The serum IgE level determined by the radioimmunosorbent test was compared before and after the therapy to reveal that oleandomycin caused decrease of IgE in 10 and increase in 9 of 20 cases examined . The oleandomycin therapy resulted increases by greater than 20% of the vital capacity and FEV 1.0 in 2 and 3, respectively, of 15 cases . Jaundice in association with elevations of the GOT, GPT and alkaline phosphatase developed in one patient, and generalized skin eruption in another . Both of these cases were given triacetyloleandomycin. J Antibiot (Tokyo), 1977 Apr, 30(4), 275 - 82 A new alkaloid AM-2282 OF Streptomyces origin . Taxonomy, fermentation, isolation and preliminary characterization; Omura S et al.; AM-2282, a new alkaloid has been isolated from cultures of Streptomyces sp . AM-2282 by solvent extraction and silica gel chromatography . The compound exhibits a strong absorption maximum at 292 nm and shows antimicrobial activity against fungi and yeast . The LD50 of its hydrochloride (i.p . in mice) is 6.6 mg/kg . The molecular formula of AM-2282 has been determined as C28H26N4O3 . The producing strain, AM-2282 was classified as a new species and the name, Streptomyces staurosporeus AWAYA, TAKAHASHI and OMURA, nov . sp . is proposed. Can J Comp Med, 1977 Apr, 41(2), 166 - 8 Susceptibility of Fusobacterium necrophorum to antimicrobials . Part I: as determined by the disc method; Simon PC; The susceptibility of 25 isolates of Fusobacterium necrophorum to 37 antimicrobials was tested using the disc method . F . necrophorum was susceptible to 15 antimicrobials, resistant to 12 . To the remaining ten antimicrobials some isolates were completely resistant whereas others showed partial resistance. J Clin Microbiol, 1977 Apr,