An open study of ceftazidime in the treatment of serious bacterial infection.

Ceftazidime, a new parenteral cephalosporin, was given by intravenous bolus injection to 50 patients admitted to hospital with a variety of serious infections. These included septicaemia, bronchopulmonary, urinary, gastro-intestinal and soft tissue infections. The drug proved to be effective against a wide range of organisms, notably opportunistic Pseudomonas aeruginosa infections. In the 32 patients with positive cultures there was a cure rate of 85%. All Ps. aeruginosa infections were eradicated, but two relapsed post treatment in patients with recurrent urinary infections related to indwelling catheters. The drug was well tolerated and no serious side effects occurred. Two patients with salmonella septicaemia relapsed after an initial clinical response, and one of these died.

Salmonella virchow: a cause of significant bloodstream invasion.

Salmonella virchow, a food poisoning strain previously only sporadically responsible for disease, has recently been isolated with increasing frequency in Scotland. The experience of infections due to this organism in 1980 in an infectious diseases unit is reported. Nine of 15 patients consecutively admitted with infection due to this organism were found to be septicaemic on blood culture thus highlighting the invasive propensity of this serotype.

Clostridium difficile in association with sporadic diarrhoea.

A total of 154 patients admitted to an infectious diseases unit were included in a year's prospective survey of sporadic diarrhoeal disease. Stools from 19 of them yielded Clostridium difficile, generally on more than one occasion. Twelve of these patients were assessed as having a severe or moderately severe gastrointestinal illness: Cl difficile was the only pathogen isolated from 10 of them, and two had an associated salmonella infection. Seven had had a recent course of antibiotics, but five had not taken antibiotics. Faeces from seven patients with moderate or mild gastrointestinal illness yielded Cl difficile, and two of these patients also had an associated salmonella infection. Two patients in this group had no antibiotic history. From these findings, the occurrence of C difficile in faeces could not be described as antibiotic-associated. Faecal Cl difficile cytotoxin was detected in only six patients, and generally at low levels. In such patients a more relevant pathogenic index might take account of the numbers of Cl difficile present and of their toxigenic potential.

Infectious mononucleosis in the elderly.

Infectious mononucleosis (IM) was diagnosed in four patients over the age of 50 years. Their age, absence of splenomegaly, lack of significant lymphadenopathy in three and an atypical presentation in one all contributed to a delay in the diagnosis. In two patients, in whom complications occurred, the Paul-Bunnell test was repeatedly negative. Confirmation of the diagnosis was made by the measurement of the Epstein-Barr virus IgM using differential sucrose gradient centrifugation. Because the presentation and clinical features of IM can be misleading in the elderly, we believe that a significant number of cases may go unrecognized.

Renal mobility in women attending a pyelonephritis clinic and in controls.

The range of vertical renal mobility was established in a group of 129 healthy female subjects and compared with the range of mobility observed in 236 female patients attending a pyelonephritis clinic. The mobility was significantly greater on the right side in both groups and both kidneys moved significantly more in the patient group than in the controls. Excessive mobility could not be directly related to bacteriologically confirmed infection, renal pain or IVP abnormality. Nephroptosis remains an enigma and excessive renal mobility must not be interpreted in isolation.

The effects of pre-admission antibiotics on the bacteriological diagnosis of pyogenic meningitis.

To assess the effects of pre-admission antibiotics on the accuracy of bacterial diagnosis in pyogenic meningitis, the case records of 154 patients admitted to an infectious diseases unit during a 10-year period (1966-1975) were reviewed. The causative organism was identified in 140 patients (91%). Although 63 patients had received antibiotics before admission, a bacteriological diagnosis was still possible in 57 of these (90%).

Antibacterial drugs today. I.

Since the development of the sulphonamides in the 1930s and the subsequent development of antibiotics from the 1940s onwards, there have now been many drugs developed which are capable of chemotherapeutic activity in a patient infected by a susceptible micro-organism. This review is concerned with precise descriptions of important groups of antimicrobial drugs, with emphasis being placed on the more recently developed drugs. With each group of drugs the pharmacology, major therapeutic indications, dosages and adverse reactions are discussed. Part I of the article discusses the sulphonamides, the natural and semi-synthetic penicillins, cotrimoxazole, chloramphenicol, tetracyclines, the macrolides, lincomycin and clindamycin, fusidic acid, and the urinary antiseptics. The place of each in therapy is defined.

Antibacterial Drugs today: II.

Since the development of the sulphonamides in the 1930s and the subsequent development of antibiotics from the 1940s onwards, there have now been many drugs developed which are capable of chemotherapeutic activity in a patient infected by a susceptible micro-organism. This review is concerned with precise descriptions of important groups of antimicrobial drugs, with emphasis being placed on the more recently developed drugs. With each group of drugs the pharmacology, major therapeutic indications, dosages and adverse reactions are discussed. Part II of the review discusses the cephalosporins, polymyxins and aminoglycosides. The place of each in therapy is defined.