[Treatment with antibacterial chemotherapy]. / Zum Umgang mit antibakterieller Chemotherapie.

The importance of a true indication of antimicrobiological chemotherapy is discussed on beginning of the paper. A correct choice of antibiotics and proper strategy of therapy will be demonstrated. Additionally essential antibiotics are presented.

[Current status and change in infectiology]. / Zur gegenwärtigen Situation und zum Wandel in der Infektiologie.

Clinical infectiology had passed through a marked transformation in the past, it is changing in the present time and will do so in the future. The most important factors for these changes are: the change of the living standard of the people, the increased number of persons with dispositions for infections, a better knowledge about the microbial etiology of infections and new possibilities of diagnostics and therapy of infectious diseases. The importance of these changes are in Germany inadequately reflected not only in the clinical practice but also in medical teaching and research. The reintegration of the infectiology as an important medical specialty in the Germany's medicine is urgently indicated.

[Diagnosis and therapy of urinary tract infections]. / Diagnostik und Therapie von Harnwegsinfektionen.

Urinary tract infections (UTI) are one of the most frequent indications for antibacterial chemotherapy. We must be differentiate between complicated and uncomplicated as well as between upper and lower UTI. Regarding the definition of significant bacteriuria (> or = 10(5) CFU/ml), some relativations are necessary. Dip-slide techniques proved to be very useful for bacteriological diagnosis. The calculated therapy depends upon age and sex and is different for community-acquired and nosocomial infections. Further items are the selection of antibacterial agents, the duration of chemotherapy, the role of asymptomatic bacteriuria and reinfection prophylaxis.

[Effective microbiologic spectrum of gyrase inhibitors--indications and contraindications]. / Mikrobiologisches Wirkungsspektrum der Gyrasehemmer--Indikationen und Kontraindikationen.

Ciprofloxacin is an essential enrichment of the antibacterial therapy. The activity spectrum comprises enterobacteria, haemophiliacs and Neisseriae, furthermore Legionellae and species of Pseudomonas (except Ps. maltophila). In the gram-positive area staphylococci, Listeriae and corynebacteria are covered, whereas species of streptococci including pneumococci are only moderately sensitive or resistent. Infections of the urinary tract, of the respiratory tract and the biliary tract as well as enteral infections are the main indications. Furthermore, an application in osteomyelitis and arthritis, in chlamydial infections and mycoplasmal infections, in legionellosis and for the selective decontamination in threatening granulocytopenia is justified. Pregnancy, period of growth and cerebral convulsive disorders are contraindications.

[Antimicrobial chemotherapy of cholecystitis and cholangitis]. / Antimikrobielle Chemotherapie bei Cholezystitis und Cholangitis.

Antibacterial chemotherapy of cholecystitis and cholangitis is of limited value, i.e. as a supportive measure. Early cholecystectomy and endoscopic-invasive procedures (in the case of cholangitis) are indicated primarily. If causal therapy is not possible long-term suppressive antimicrobial chemotherapy should be tried. Microbiological diagnosis is difficult. Therefore chemotherapy in most cases is done on empirical basis. Blood cultures are useful as well as quantitative cultures of duodenal secretions (in cases of cholangitis only). The most frequently used chemotherapeutics are discussed. Single dose chemoprophylaxis (bactericidal substances) is effective.

[Microbiologic diagnosis of diseases of the lung, bronchi and pleura]. / Mikrobiologische Diagnostik bei Erkrankungen der Lunge, Bronchien und Pleura.

Microbiological examination of sputum specimens is of limited value and may give misleading results. On the other side, knowledge of aetiologic agents and corresponding antibiograms may be life-saving in nosocomial pneumonias, for instance. Bronchoalveolar lavages and invasive diagnostic procedures are necessary to obtain microbiological materials without contamination by oral germs. Blood cultures and pleural effusions are useful too. Further informations are given by CF, immunofluorescence (antibody or antigen), ELISA, CIE, latex-agglutination and other modern techniques. Bacterial bronchitis should be treated on the base of calculated chemotherapy. Microbiological procedures are indicated only in the case of repeated therapeutic failure. Invasive diagnostic measures should be avoided in the case of bronchitis. Calculated chemotherapy is sufficient in most cases of community-acquired pneumonias too. Nosocomial pneumonias have a high mortality which only can be reduced by rapid aetiologic diagnosis. All efforts in this direction are of considerable value. Special problems are connected with aspiration pneumonia, atypical and viral pneumonias and pleural empyema. Besides pleural exudate pleural biopsies are useful to demonstrate some special microbes.

[Principles of modern antibiotic therapy in the general practice and clinic. Discussion of the contribution by Walter Siegenthaler and Gertrude Siegenthaler-Zuber published in Z. gesamte inn. Med. 42 (1987) 614-618]. / Grundsätze moderner Antibiotikatherapie in Praxis und Klinik. Diskussion zur Arbeit von Walter Siegenthaler und Gertrud Siegenthaler-Zuber erschienen in Z. gesamte inn. Med. 42 (1987) 614-618.

W. Siegenthaler's and G. Siegenthaler-Zuber's opinion, according to which in the majority of infections in practice an etiological (microbiological) diagnosis may be renounced and the guiding slogan "before therapy the gods have placed the diagnosis" should be relativized for the situation in the practice in contrast to the situation in the clinic, is opposed. Microbiological findings represent an unrenouncable basis for a rational antimicrobial chemotherapy in practice and clinic. In the individual case this does not exclude a calculated chemotherapy on account of a clinical and microbiological tentative diagnosis made by the physician in charge. But at the latest when the empiric therapy fails an efficient microbiologic diagnostics must be at our disposal.

[Microbiologic and clinical significance of cefotiam]. / Zur mikrobiologischen und klinischen Bedeutung des Cefotiams.

Modern cephalosporins are of considerable importance for the therapy of severe infections by multiresistant organisms. According to in-vitro-findings on ampicillin-resistant E. coli as well as Klebsiella spp., Proteus spp., and serratia spp., altogether 159 strains, instead of cefotaxime nearly always also cefotiam can be used. The two remedies are clearly superior to cephalothin. cefotiam is ineffective to Pseudomonas aeruginosa. But in this case also cefotaxime is clearly inferior to azlocillin. In 6 of 7 casuistic instances the clinical effectiveness of cefotiam could be confirmed with good tolerability. The contemporary establishment of staph. aureus in mixed infections of serratiastaphylococci proved as as particular advantage. A primary therapeutic failure referred to a necrotizing pancreatitis, when no causative organism was proved, in which case also cefotaxime remained without any effect. Despite the improved individual medical possibilities the control of the infectious hospitalism by critical administration of antibiotics and improved hospital hygiene, particularly strict non-infection, must remain the pre-eminent task.

[Bacampicillin in urinary tract infections tolerance in patients with impaired kidney and liver function]. / Bacampicillin bei Harnwegsinfektionen--Verträglichkeit bei gestörter Nieren- bzw. Leberfunktion.

The evaluation of a 10-day 3 x 800 mg dosage regimen was equivalent for bacampicillin to oral ampicillin therapy (using 3 or 4 g respectively per day) in patients with primary UTI (n = 50) in clinical and bacteriological respect. The cure rate amounted to 69 and 68,4% respectively 2 days after therapy. No differences could be assessed after a 2-, 4- and 6-week period. Frequency of diarrhoea was 3 times as high in the ampicillin group as in the bacampicillin group. The rate of exanthema was also 2,5 times as high. No differences existed between eosinophilia and pain complaints in the upper gastrointestinal tract. 10 patients with liver function disturbances and renal impairment respectively tolerated well bacampicillin treatment. Only in the patients with impaired liver function rise of BUN and urea was found in 3 cases, not related to rise of creatinine.

[Damage caused by antibiotics and chemotherapeutic agents]. / Schädigungen durch Antibiotika und Chemotherapeutika.

Side effects of antibiotics are based on direct toxic effects, depending on dose and excretion function, on allergico-immunological reactions and on interactions with other pharmaca. Furthermore the falsification of laboratory parameters and the disturbance of the microecology are significant. World-wide clinical observations lasting for decades are the basis of the knowledge about frequent and infrequent side effects. As to the most frequently used remedies from the groups of the antibiotics, antimicrobial chemotherapeutics and systemic antimycotics, these side effects were described in detail.

[The value of fosfomycin]. / Zur Bedeutung des Fosfomyzins.

After description of the most important properties of fosfomycin including pharmacokinetics, antibacterial activity and hitherto got clinical experiences the determinations of the resistance on frequent clinical pathogenic agents are reported. They were performed in the diffusion test in a platelet content of 20 micrograms with admixture of glucose-6-phosphate. High sensitivity rates showed E. coli, P. mirabilis, hemophiliacs and above all Staph. aureus, but also a large part of the Klebsiella and the Pseudomonas strains could be classified as sensitive. Streptococci, pneumococci and enterococci mostly proved as resistant. Thus, in an oral therapy the spectre is smaller than in a highly dosed parenteral supply. Nevertheless, fosfomycin in the two forms of application is to be regarded as an enrichment of the therapeutic possibilities and further should be tested clinically.

[Experiences with the Antibody-coated Bacteria Test in the diagnosis of urinary tract infections]. / Erfahrungen mit dem Antibody-Coated-Bacteria-Test bei der Diagnostik von Harnwegsinfektionen.

We examined 67 cases with significant bacteriuria for the presence of antibody-loaded bacteria which shall refer to an infection of the upper urinary tract. With the help of this method we could diagnose 43 of the 45 cases with acute and chronic pyelonephritis. Three of the 22 cases with a bacteriuria of other genesis proved as falsely positive. The antibody-coated-bacteria-test should be used as diagnostic remedy in infections of the urinary tract as well as for course controls and as screening test in the clinic.