A Pilot Study of 0.4% Povidone-Iodine Nasal Spray to Eradicate SARS-CoV-2 in the Nasopharynx.

Purpose: This study aimed to evaluate the virucidal efficacy of 0.4% povidone-iodine (PVP-I) nasal spray against SARS-CoV-2 in the patients' nasopharynx at 3 minutes and 4 hours after PVP-I exposure. Patients and Methods: The study was an open-label, before and after design, single-arm pilot study of adult patients with RT-PCR-confirmed COVID-19 within 24 hours. All patients received three puffs of 0.4% PVP-I nasal spray in each nostril. Nasopharyngeal (NP) swabs were collected before the PVP-I spray (baseline, left NP samples), and at 3 minutes (left and right NP samples) and 4 hours post-PVP-I spray (right NP samples). All swabs were coded to blind assessors and transported to diagnostic laboratory and tested by RT-PCR and cultured to measure the viable SARS-CoV-2 within 24 hours after collection. Results: Fourteen patients were enrolled but viable SARS-CoV-2 was cultured from 12 patients (85.7%). The median viral titer at baseline was 3.5 log TCID50/mL (IQR 2.8-4.0 log TCID50/mL). At 3 minutes post-PVP-I spray via the left nostril, viral titers were reduced in 8 patients (66.7%). At 3 minutes post-PVP-I, the median viral titer was 3.4 log TCID50/mL (IQR 1.8-4.4 log TCID50/mL) (P=0.162). At 4 hours post-PVP-I spray via the right nostril, 6 of 11 patients (54.5%) had either the same or minimal change in viral titers. The median viral titer 3 minutes post-PVP-I spray was 2.7 log TCID50/mL (IQR 2.0-3.9 log TCID50/mL). Four hours post-PVP-I spray the median titer was 2.8 log TCID50/mL (IQR 2.2-3.9 log TCID50/mL) (P=0.704). No adverse effects of 0.4% PVP-I nasal spray were detected. Conclusion: The 0.4% PVP-I nasal spray demonstrated minimal virucidal efficacy at 3 minutes post-exposure. At 4 hours post-exposure, the viral titer was considerably unchanged from baseline in 10 cases. The 0.4% PVP-I nasal spray showed poor virucidal activity and is unlikely to reduce transmission of SARS-CoV-2 in prophylaxis use.

Prevalence and factors associated with COVID-19 among healthcare workers at a university hospital in Thailand.

Globally, healthcare workers (HCWs) have a high risk of SARS-CoV-2 infection, but less is known about healthcare workers in Thailand. We estimated the prevalence and risk factors for COVID-19 among HCWs in Bangkok, Thailand. A retrospective cohort study was conducted at a large tertiary care academic hospital in Thailand from May 2020 to May 2021. HCWs that presented with fever and/or acute respiratory tract symptoms who tested with RT-PCR were identified, and their clinical data were collected. There were 1432 HCWs with fever and/or acute respiratory tract symptoms during May 2020 and May 2021. A total of 167 patients were front-line HCWs and 1265 were non-front-line HCWs. Sixty HCWs (4.2%) developed COVID-19; 2 were front-line and 58 were non-front-line HCWs. The prevalence of COVID-19 in front-line HCWs was 1.7% (2/167), and 4.6% (58/1265) in non-front-line HCWs (P = .04). In addition, non-front-line HCWs, non-medical staffs, history of contact with a confirmed COVID-19 case at home/family, unvaccinated status, fair compliance to personal protective equipment (PPE) standard, and initial presentation with pneumonia were significantly more common in HCWs with COVID-19 than those without COVID-19 (P < .05). Front-line HCWs, history of contact with a confirmed COVID-19 case at the clinical care areas in the hospital, vaccinated status, good compliance to PPE standards, and initial presentation with upper respiratory infection were significantly more common in HCWs without COVID-19 than those with COVID-19 (P < .05). Multivariate analysis revealed history of exposure with confirmed COVID-19 case at home or in family, unvaccinated status, non-frontline-HCWs, non-medical staffs, and fair compliance to PPE standard to be independent factors associated with COVID-19 in HCWs. COVID-19 was more common in non-front-line HCWs at this tertiary hospital. Thai guidelines on infection prevention and control for COVID-19 seem to be effective in preventing SARS-CoV-2 transmission. Therefore, the adherence to these recommendations should be encouraged.

Need for Internal Medicine Subspecialists in Thailand.

Background: Matching supply side of the Internal Medicine (IM) subspecialists to the demand for complex medical care at referral medical centers would lead to more efficient health system management and ultimately optimal clinical outcome. The second decade of the universal health coverage policy in Thailand has raised the awareness on how to reach equitable utilization goals of good quality medical services, while barriers of accession have been removed. More accurate evidence-based human resource planning is timely needed. Objective: To estimate the number of the ten subspecialists in internal medicine (neurologist, cardiologist, endocrinologist, gastroenterologist and hepatologist, nephrologist, hematologist, oncologist, rheumatologist, pulmonologist, and infectious disease specialist) needed for complex medical care based on the workload in the year 2013. Material and Method: The present study applied a needs assessment model with evidence-based approach. Claimed data of inpatients in the year 2013 from the three government insurance schemes (the Civil Servant Medical Benefit, the Social Security and the Universal Health Coverage schemes), and out-patient data from Universal Coverage System were used to estimate demand for subspecialists. The Human Resource Working Group of the Royal College of Physicians of Thailand agreed on the conceptual framework to estimate the need for ten subspecialists based on clinical activities of outpatient consultations, inpatient ward rounds and non-operating room procedures on medical cases of respective diagnosis related group with severe and catastrophic comorbidities and complications by the Thai-DRG version 5. Representatives from the Associations of IM subspecialties approved the lists of ICD-10 diagnosis and ICD-9-CM procedure codes specific to each subspecialist care and proposed assumptions on rates of consultations from other specialists. Surveys were done to subspecialists in 6 major provincial clusters and representatives from IM subspecialty Associations asking time spent on main activities of patient care. The number of full-time-equivalent (FTE) subspecialists needed was calculated by multiplying the clinical workloads measured in minutes spent for each activity (ward round, ward work, inpatient and outpatient consultations) to get the total time needed, then divided by the available time for clinical activity of one subspecialist. Results: From 5.9 million inpatient discharges in the year 2013, primary responsibility of patients in respective severe and catastrophic DRGs related to specific subspecialist workloads were summed up for teaching hospitals and regional hospitals ranging from as lowest the 2,849 cases for rheumatology to the highest 24,610 cases for gastroenterology and hepatology. The number of inpatient non-operating room procedures by ICD-9-CM as listed by IM subspecialty Associations ranged from 8 times for endocrinologists to 22,927 times for cardiologists for the whole year. Of ten subspecialists, the estimated numbers of cardiologist, nephrologist, neurologist, gastroenterologist and hepatologist, endocrinologist, oncologist, rheumatologist, hematologist, pulmonologist and infectious disease subspecialist needed at teaching and regional hospitals were 516, 241; 345, 144; 312, 143; 195, 124; 189, 45; 137, 170; 90, 47; 96, 111; 203, 87 and; 129, 44 respectively according to the workload recorded in the year 2013. The forecast FTE found the overall gap of discrepancy at 7 percent. If the distributions of these subspecialists in public and private hospitals were taken into account, the gap of discrepancy in public hospitals increased to 47 percent. Conclusion: The demand-based forecast for the number of subspecialist needed was made possible with assumptions on conceptual framework for case selection, the rates of consultation and time-spent related to activities of patient care. The estimated numbers of subspecialists were anticipated far from optimum since the workload in the year 2013 was derived as a consequence of pre-existing suboptimal infrastructure of healthcare system. In addition, the deficit of subspecialists may increase in the near future when highly efficient, non- or mildly invasive, time-consuming procedures of acute illness increase. Sustainable matching demand and supply of human resource for health needed further validations of these assumptions.

Impact of inappropriate empiric antimicrobial therapy on mortality of septic patients with bacteremia: a retrospective study.

Background. Inappropriate empiric antimicrobials could be a major cause of unfavorable mortality rates in co-morbid patients. This study aimed to assess the prevalence and impact of first-dose and 24-hour inappropriate antimicrobials on mortality rates of bacteremic septic patients. Methods. A retrospective cohort study was employed. Case record forms of patients diagnosed as sepsis, severe sepsis, or septic shock with positive hemoculture during 2009 were retrieved from the medical wards, Siriraj Hospital. Demographic data, antimicrobial use, types of bacteria isolated from blood and susceptibilities, patients' comorbidities, 28-day and overall mortality rates were collected and analyzed. Results. There were 229 cases, mean age (SD) of 63.5 (17.2) years and mean (SD) APACHE II score of 24.7 (6.8). The prevalence of first-dose and 24-hour inappropriate antimicrobials was 29.7% and 25.3%, respectively. The 28-day and overall mortality rates between first-dose inappropriate and appropriate antimicrobial were 67.6% versus 60.2% (P = 0.301) and 75.0% versus 68.3% (P = 0.345), consequently. Patients with septic shock and inappropriate first-dose antimicrobials significantly had higher 28-day mortality rate (61.6% versus 41.9%; P = 0.017). Conclusion. Higher mortality rates in bacteremic septic patients were substantially associated with inappropriate first-dose antimicrobials and 3-hour delayed antimicrobial administration after sepsis diagnosis.

Gonococcal subcutaneous abscess and pyomyositis: a case report.

Disseminated gonococcal infection (DGI) is an uncommon complication of Neisseria gonorrhoeae infection, its manifestation varies from a classic arthritis-dermatitis syndrome to uncommon pyogenic infections of several organs. Herein, we reported atypical presentation of DGI with subcutaneous abscess of right knee, pyomyositis of right lower extremity, and subsequently complicated by Escherichia coli pyomyositis. This infection responded to appropriate antimicrobial therapy and prompt surgical management with good clinical outcome.

Three-day unrecognized cefazolin anaphylaxis in a case undergoing coronary bypass graft surgery.

Cephalosporin anaphylaxis is rare but the diagnosis is usually not delayed when the catastrophic reaction occurs shortly after cephalosporin injection. The authors wish to report a patient who had never had a history of beta-lactam hypersensitivity and developed the first episode of cefazolin anaphylaxis during coronary artery bypass surgery. Hypotension developed during the operation but it was immediately corrected by volume infusion and inotrope administration. Shaking chills, drenching sweats, and tingling sensation on the head developed when she regained consciousness from general anesthesia. The adverse reaction disappeared soon and was thought to be the side effects of anesthetic drugs, morphine administrations, and/or blood transfusion. Similar reactions, together with hypotension and oxygen desaturation, recurred each time cefazolin was infused but it took three days and doses of 12 grams of cefazolin administration before a correct diagnosis was reached. The present case report would remind surgeons and anesthesiologists of cefazolin as a potential cause of anaphylaxis during peri- and post-operative periods.

Antibacterial activity of carbapenem-based combinations againts multidrug-resistant Acinetobacter baumannii.

BACKGROUND: Multidrug-resistant (MDR) Acinetobacter baumannii are increasingly encountered and frequently susceptible only to colistin with their MIC values close to resistance breakpoint. Antibacterial activity of two carbapenem-based combinations were explored in order to overcome the bacterial resistance. MATERIAL AND METHOD: Thirty clinical isolates of MDRA. baumannii were employed to assess in vitro antibacterial activity of two carbapenem-based regimens. Imipenem combined with colistin and meropenem combined with colistin and sulbactam were the first and second regimens, respectively. All isolates were resistant to imipenem (MIC range: 8-128 microg/ml) and meropenem (MIC range: 64-256 microg/ml) but still susceptible to colistin (MIC range: 0.5-2 microg/ml). The MIC range of sulbactam was 4-64 microg/ml. None of the isolates produced metallo-beta-lactamase. RESULTS: Synergistic antibacterial effect of imipenem combined with colistin was observed against 100 percent of A. baumannii isolates by the checkerboard microdilution panel method. In a subsequent time kill study, the most active concentration of this regimen was the combination of imipenem at the fixed concentration of 32 microg/ml and colistin at the 1/4 of the MIC values of each isolate that exerted significantly higher bactericidal activity than imipenem at 32 microg/ml alone and colistin alone at the 1/4 of the MIC values. The scanning electron micrographs demonstrated major cell morphological change and cell wall destruction after 2-hour exposure to this combination. The triple combinations of meropenem, sulbactam and colistin showed synergy against 96.7 percent of MDR A. baumannii while double combinations of either meropenem and sulbactam, meropenem and colistin, and sulbactam and colistin showed synergy effects of 70%, 73.3% and 53.3%, respectively The time kill study using ten isolates also showed better killing effect by the triple combination than any of the double combinations. CONCLUSION: Antibacterial activity against MDR A. baumannii of imipenem plus colistin was superior over any single of the two agents. The addition of sulbactam to meropenem and colistin may further improve their antibacterial activity. The double or triple carbapenem-based combinations offer promising alternatives in the treatment of infections due to MDR A. baumannii.

Bioequivalence, antibacterial activity and therapeutic outcome of a generic meropenem (Mapenem).

BACKGROUND: The authors aimed to compare the bioequivalence and antibacterial activity of a generic meropenem with the original meropenem and studied its preliminary therapeutic outcome. MATERIAL AND METHOD: A randomized, open-label, crossover study was employed to assess the bioequivalence and antibacterial activity. Twenty-six healthy males were recruited at Siriraj Hospital, Thailand and randomized to firstly receive either a single intravenous 30-minute infusion of a generic (Mapenem) or original meropenem (Meronem) and vice versa for the second period. The washout period was one week. Ten milliliters of blood samples were collected before meropenem infusion and at 0, 10, 15, 30, 45, 60, 90, 120, 150, 180, 240, 360, 470 and 480 minutes after the beginning of the drug infusion. Blood samples were coded and separated into plasma and serum samples. Plasma samples were used to determine drug concentrations by HPLC-UV detector and the data were analyzed for Cmax, AUC0-t and AUC0-inf. Serum samples were assayed in triplicate for measuring generic and original meropenems' inhibitory activities of a meropenem-susceptible E. coli ATCC 25922 in the same agar plate. An open-label design was used to preliminarily study of the therapeutic outcome and adverse effects of the generic meropenem in 30 patients. RESULTS: All enrolled twenty-six volunteers completed the whole study. The statistical analysis of 90% confidence interval of Cmax, A UC0-t, and AUC0-inf of the generic and original meropenems were 87.7 to 101.7%, 96.3 to 102.4% and 96.3 to 102.3%, respectively. The results were within the standard range of bioequivalence acceptance criteria (80-125%) and the powers of the test were greater than 80%. Using E. coli ATCC 25922 in the blind assay of serum inhibition activity, the inhibitory zone sizes (mm) of the generic compared to original meropenems were not statistically different with respect to every time points of blood collections (p < 0.05). Correlation of mean values of serum meropenem levels and the widths of inhibitory zone sizes of the same samples collected at the same intervals showed good linear relationship with r = 0.891; R2 = 0.794 (p < 0.01) for the generic meropenem and r = 0.885; R2 = 0.784 (p < 0.01) for the original meropenem. The therapeutic result with the generic meropenem for various indications was successful or improved in 24 cases from 30 cases (80%) and the bacterial cure rate was 23 in 30 clinical isolates (76.7%). Adverse reactions probably related to the study medication were rash and elevated liver enzymes in 1 and 3 patients, respectively, and all resolved spontaneously. CONCLUSION: In the present study, the generic meropenem exhibited indifferent bioequivalence and antibacterial activity compared to the original meropenem. There was also a good correlation between serum levels and inhibitory zone sizes produced by the same serum samples in every periods of blood collection. Clinical efficacy of the generic meropenem was shown to be satisfactory without notable severe adverse reaction.

Fulminating influenza pneumonia in the elderly: a case demonstration.

An 82-year-old male Bangkokian with hypertension, diabetes mellitus, end-stage renal disease, and coronary artery disease for many years, was hospitalized due to deterioration of a 3-day influenza-like-illness with one-day chest oppression and respiratory failure. At the emergency room, oxygen saturation was 79% on room air Chest X-ray revealed bilateral diffuse pulmonary infiltrates. He was intubated and hemodialysis was initiated. Emergency coronary angiography revealed patent coronary artery. Sputum gram stain revealed numerous leukocytes with no bacteria. On day three of hospitalization, empiric treatment with oseltamivir and clarithromycin was administered Seventy-two hours later his clinical condition began to improve and fever subsided 7 days later Rapid test of tracheal secretion with immunofluorescence assay was positive for moderate amount of influenza A virus. Viral isolation yielded influenza A virus subtype H1N1. Review of in-patient records at this hospital using ICD-10 codes as J10 and J11 during 1995-2005, discovered 32 cases with claim diagnosis of influenza. However this is the first case with proven influenza pneumonia that was given empiric oseltamivir. Rapid deterioration of influenza-like illness due to human influenza virus in the elderly and pathogenesis of pulmonary in this case are discussed to alert physicians to recognize this dreadful illness and treat it in timely fashion.

Micafungin versus liposomal amphotericin B for candidaemia and invasive candidosis: a phase III randomised double-blind trial.

BACKGROUND: Invasive candidosis is increasingly prevalent in seriously ill patients. Our aim was to compare micafungin with liposomal amphotericin B for the treatment of adult patients with candidaemia or invasive candidosis. METHODS: We did a double-blind, randomised, multinational non-inferiority study to compare micafungin (100 mg/day) with liposomal amphotericin B (3 mg/kg per day) as first-line treatment of candidaemia and invasive candidosis. The primary endpoint was treatment success, defined as both a clinical and a mycological response at the end of treatment. Primary analyses were done on a per-protocol basis. This trial is registered with ClinicalTrials.gov, number NCT00106288. FINDINGS: 264 individuals were randomly assigned to treatment with micafungin; 267 were randomly assigned to receive liposomal amphotericin B. 202 individuals in the micafungin group and 190 in the liposomal amphotericin B group were included in the per-protocol analyses. Treatment success was observed for 181 (89.6%) patients treated with micafungin and 170 (89.5%) patients treated with liposomal amphotericin B. The difference in proportions, after stratification by neutropenic status at baseline, was 0.7% (95% CI -5.3 to 6.7). Efficacy was independent of the Candida spp and primary site of infection, as well as neutropenic status, APACHE II score, and whether a catheter was removed or replaced during the study. There were fewer treatment-related adverse events--including those that were serious or led to treatment discontinuation--with micafungin than there were with liposomal amphotericin B. INTERPRETATION: Micafungin was as effective as--and caused fewer adverse events than--liposomal amphotericin B as first-line treatment of candidaemia and invasive candidosis.

Pneumococci: drug susceptibilities and preliminary epidemiological studies by penicillin binding protein genotyping.

A collection of 307 pneumococcal isolates form 84 children and 223 adults admitted to Siriraj Hospital were separated into two groups, penicillin-susceptible (PSSP) and penicillin-nonsusceptible (PNSP). Each group was tested for susceptibilities to 12 drugs (cefuroxime, amoxicillin, chloramphenicol, tetracycline, cefotaxime, ceftriaxone, imipenem, meropenem, ciprofloxacin, ofloxacin, erythromycin and co-trimoxazole). PSSP were susceptible to cefuroxime (87.5%), amoxicillin (100%), chloramphenicol (84.7%), tetracycline (45.8%), cefotaxime (99%), ceftriaxone (99%), imipenem (99%), meropenem (100%), ciprofloxacin (76%), ofloxacin (99%), erythromycin (94.8%) and co-trimoxazole (61.5%). PNSP were resistant to most drugs, except for amoxicillin (99%), ofloxacin (99%) and ciprofloxacin (86.3%). Twenty-two pneumococcal isolates belonging to the three most common serotypes (6, 19, 23) were randomly selected for studies of the pbp2b gene with RFLP. There were 7 distinct pbp2b RFLP patterns. RFLP pattern 1 was the most predominant resistant pattern. The RFLP pattern 2 was found only in PSSP.

Etiologies of acute undifferentiated febrile illness in Thailand.

BACKGROUND: Acute pyrexia of unknown origin (Acute PUO) was reported to affect approximately 200,000-400,000 patients each year reported by the national Annual Epidemiological Surveillance Report. The patients usually present with fever of less than two-week duration and non-specific symptoms such as malaise, myalgia, headache and loss of appetite. Its mortality rate is less than 0.02 percent. It would be interesting to find the etiologies and propose a management plan if the etiologies are discovered. OBJECTIVE: This prospective epidemiologic study aimed to discover the etiologies of acute undifferentiated febrile illness in a tropical region like Thailand. SUBJECTS AND METHOD: Ten community-based hospitals were chosen as representatives in each part of Thailand to enroll patients into the study. Patients aged over two years old who presented with fever at the participating hospitals during year 1991-1993 were eligible for the study. Entry criteria of acute undifferentiated febrile illnesses (AUFI) included oral temperature over 38.3 degrees C within the last 24 hours, duration of fever ranging from 3-14 days, no specific single organ involvement by history taking and physical examination, normal or non-specific results of the following investigations: complete blood count, thick film for malaria, urinalysis and chest roentgenogram. The patients were hospitalized and a preset diagnostic protocol was performed. Other diagnostic procedures deemed necessary by attending physicians were perform. Patients were followed up within one month after hospital discharge. RESULTS: 1,240 patients were enrolled but only 1,137 case records and results of the serological tests were available for analysis. Etiologies could be found in 471 cases (38.7%). Primary bacteremia was detected in 36 cases (3.2%). E. coli, streptococci, salmonella, Enterobacter spp. and S. aureus were the five most common blood isolates. Serological studies revealed positive results for scrub typhus (7.5%), influenza (6.0%), dengue fever (5.7%), murine typhus (5.3%), enteric fever (1.9%), chikunkunya infection (1.1%), leptospirosis (1.1%) and melioidosis (0.9%). Thirteen cases succumbed (1.1%) in this study. CONCLUSION: The etiologies in the majority (61.3%) of AUFI remained unknown. Rickettsial infection, influenza and dengue fever are the most common identifiable diseases in a tropical country like Thailand especially during the rainy season. A management guideline for diagnosis and treatment of the AUFI with emphasis on primary bacteremia and antimicrobial-treatable AUFI was proposed.

Bacterial isolation with on-site inoculation of ascites fluid into hemoculture bottle in spontaneous bacterial peritonitis.

OBJECTIVE: To compare the on-site bacterial inoculation of ascites fluid into hemoculture bottle with routine method in the patients who were preliminary diagnosed of SBP. MATERIAL AND METHOD: A retrospective analysis of case records during January-December 2001. RESULTS: A total of 673 specimens from 325 patients were retrieved from the data records at the Department of Microbiology, Siriraj Hospital in 2001. The neutrocytic ascites were found in 163 specimens (94 patients). The routine method and on-site inoculation into the hemoculture bottle were employed in 107 and 56 specimens respectively. Culture-positive neutrocytic ascites was found in the routine method 16 (14.9%) specimens and in the on-site inoculation 26 (46.4%) specimens (p < 0.0001). Among these samples, the two methods were simultaneously performed in 42 specimens of which 18 paired specimens were eligible for analysis. Positive culture was found in 2 samples in which the routine method and in an additional 5 samples in which on-site inoculation into hemoculture bottle method. Using Kappa analysis (e score = 0.328, 95% CI = -0.172 to 0.829) that can be interpreted the on-site inoculation method had a higher yield than the routine technique. Moreover, 21 cases also had their blood and ascites samples simultaneously collected and cultured. 4 of ten (19%) and 5 of eleven (23.8%) cases were found in the routine and on-site and direct inoculation groups respectively. These finding suggested that the severity of infection in among two groups were similar and unlikely to be the cause of the difference of the positive isolation rate in both groups. CONCLUSION: The on-site and direct inoculation of ascites into hemoculture bottle method had a significantly higher isolation rate than routine method (i.e. 46.4% versus 14.9% p < 0.0001) either with separated or paired samples of ascites.

Recent development in melioidosis.

PURPOSE OF REVIEW: Burkholderia pseudomallei, the causative agent of melioidosis and a potential biological weapon, is still unfamiliar in some areas where sporadic cases are being reported among travelers. This review highlights findings in 2002-2003 and is an extension of a recent review by Dance. RECENT FINDINGS: The allele profiles of B. pseudomallei are distinguishable from avirulent Burkholderia thailandensis, but Burkholderia mallei is a clone of B. pseudomallei. Capsule and a type III protein secretion apparatus enable B. pseudomallei to survive intracellular killing and facilitate intercellular spread. A strong antibody response to infection is useful for monitoring disease activity. A mutant that is auxotrophic in the branched chain amino acid biosynthetic pathway has been found to be attenuated and protective. A new selective media is useful for isolation from contaminated specimens and the environment. Molecular techniques have been developed to distinguish B. pseudomallei from B. thailandensis and B. mallei as well as for serological diagnosis. Classification of the clinical manifestation is proposed to facilitate global communication, and will be useful to compare the efficacies of new regimens and adjunctive immunomodulatory therapies, such as granulocyte colony-stimulating factor and activated protein C for septicemic melioidosis. SUMMARY: Study of pathogenesis and intracellular survival of B. pseudomallei is advancing and may lead to better methods of therapy and vaccine production. New antimicrobial agents and immunomodulators are being studied to shorten the duration of treatment in the acute and maintenance phases, reduce the high mortality rate in septicemic melioidosis, and prevent relapses.

Therapeutic Efficacy of Oral Ofloxacin in Acute Diarrhea and Dysentery.

The efficacy of 200mg oral ofloxacin given twice daily for 3 days was evaluated in 98 hospitalized cases with acute diarrhea or dysentery. Sixty cases were female, most of whom were laborers.Vibrio cholerae, Vibrio parahaemolyticus, Shigella flexneri, Shigella boydii, Shigella sonnei, Aeromonas hydrophila, Aeromonas spp., and Plesiomonas shigelloides were isolated from fecal samples in 36 of 86 cases (42%) with diarrhea and 5 of 12 cases (46%) with dysentery.E. coli agglutinated with various E. coli polyvalent antisera were found in another 25 cases (26%). With the exception of E. coli, most of the clinical isolates were highly susceptible to ofloxacin and norfloxacin with minimal inhibitory concentrations (MIC90) of 0.047-0.38 and 0.016-0.25mg/L, respectively. A total cure was achieved in 96.5% of cases with diarrhea and in 100% of cases with dysentery. There was a delayed response in two cases and only one case clinically failed to respond.V. cholerae was repeatedly isolated on day 3 in another case who had recovered on day 2, and 1 case developed gangrenous cholecystitis and ischemic enteropathy after an initial response to ofloxacin.