Fewer bacterial relapses after oral treatment with norfloxacin than with ceftibuten in acute pyelonephritis initially treated with intravenous cefuroxime.

This double-blind, multicentre study was performed at nine centres on a total of 171 patients who presented with fever (> 38.5 degrees C) and signs of acute pyelonephritis. All were initially treated with intravenous cefuroxime. After 2-3 d, when the fever had subsided and urinary culture had revealed growth of Gram-negative bacteria ( > 10(7) colony-forming units per litre), treatment was changed to oral administration of ceftibuten 200 mg b.i.d. or norfloxacin 400 mg b.i.d. for 10 d. The patients were followed for signs of bacterial or clinical relapse 7-14 d after the end of treatment. The initial clinical and bacteriological cure was excellent in both groups, but there were significantly fewer bacterial relapses after oral treatment with norfloxacin than with ceftibuten in acute febrile pyelonephritis initially treated with intravenous cefuroxime. The causal strain was eradicated in 75% of patients (73% of males, 76% of females) in the ceftibuten group and in 89% of patients (94% of males, 85% of females) in the norfloxacin group. The relative frequency of eradication was 0.84 (p < 0.05; 95%, confidence interval 0.74-0.97). Adverse events were reported by 47% of the patients in the ceftibuten group and by 38% in the norfloxacin group. This difference was not significant, but diarrhoea or loose stools occurred more frequently in the ceftibuten group.

Aminoglycosides do not improve the efficacy of cephalosporins for treatment of acute pyelonephritis in women.

A prospective, coordinated, randomized multicentre trial was conducted to determine whether tobramycin 160 mg intravenously (i.v.) once daily for 2 days would improve the efficacy of cefotaxime 1 g i.v. twice daily for 2 days followed by a 10-day course of oral cefadroxil 1 g twice daily, in the treatment of community-acquired acute pyelonephritis in women. Of 73 patients enrolled in the study, 51 could be evaluated according to the protocol. There were no significant differences in bacteriological cure rates between the combined treatment with tobramycin/cefotaxime and cefotaxime alone, either at short-term follow-up (63.0% vs 59.1%; 95% confidence interval (CI) for difference in proportions -23.4% to 31.2%), or up to 7 weeks after cessation of treatment (42.9% vs 52.2%; 95% CI, -18.0% to 36.6%). A modified intention-to-treat analysis showed no difference in clinical efficacy between the two regimens (68.6% vs 69.2%; 95% CI, -22.9% to 24.1%). Tobramycin seemed to enhance the resolution of inflammation by a more rapid decline in C-reactive protein levels. The high recurrence rates after treatment with beta-lactam antibiotics in this and previous studies of acute pyelonephritis may be explained by adverse ecological effects rather than failure to eradicate the infection.

Efficacy and safety of amikacin in systemic infections when given as a single daily dose or in two divided doses. Scandinavian Amikacin Once Daily Study Group.

Two hundred and twenty patients with serious infections verified or suspected to be of Gram-negative aetiology were treated in an open randomized comparative multicentre trial with amikacin 15 mg/kg/day given either as a single dose or in two divided doses at 12-h intervals. Amikacin was administered as a short-term iv infusion. When additional therapy was considered necessary piperacillin or ampicillin was recommended. The trial continues and an interim report on data from the 12 participating Scandinavian hospitals is presented. One hundred and forty-four patients have been evaluated for efficacy and 213 patients for safety. There were no significant differences between the two dosage regimens regarding efficacy and safety. A satisfactory clinical response was recorded in 129 (90%) of the evaluable patients. One serious adverse reaction was seen in a patient in the once-daily group. This was ototoxicity which was superimposed on a long standing hearing defect possibly caused by previous streptomycin therapy.

Isolation of fungi in blood cultures. A review of fungal infections in the western part of Sweden 1970-1982.

Relevant data were analysed from 185 patients treated for various diseases in the Göteborg area, Sweden, between 1970 and 1982 and in whom fungi were isolated in blood cultures. The increase in isolations during the first part of the study seemed to coincide with extended use of central venous catheters. However, with greater awareness of factors contributing to yeast colonization, the annual incidence fell during the latter part of the period. A disseminated fungal infection was found in 45% of cases, with a mortality of 58%. 4/42 patients with transient fungemia died; 3 from concomitant bacterial septicemia. The mortality rate was 30% in patients with antimycotic treatment because of disseminated infection. Candida albicans, followed by C. glabrata, were the most commonly isolated strains (70% and 13%, respectively). C. albicans predominated in patients with fungal endophthalmitis (100%) and in neonatal infections (95%).

Ceftazidime in clinical practice.

In an open trial, the efficacy of intravenously administered ceftazidime was evaluated in 106 adult patients with urinary or respiratory tract infections, soft tissue infections, osteitis and septicaemia. The most commonly isolated pathogens were Escherichia coli, Pseudomonas spp. and Staphylococcus aureus. Of 85 organisms isolated before treatment, 79% were cleared and 15% were cleared but later relapsed often because of the underlying conditions. Clinical cure was achieved in 70%, improvement occurred in 25% of the patients and 6% failed to respond. Marked increases in serum creatinine occurred in three patients with pre-existing renal impairment treated with ceftazidime in unmodified dosage. Exanthema, diarrhoea or local thrombophlebitis was noted in 13 patients.

Pasteurella multocida osteomyelitis caused by cat bite.

A previously healthy 15-year-old girl was bitten by a cat in her left thumb. Despite initial treatment with penicillin she developed osteomyelitis after a period of four months. Pasteurella multocida was cultured from the necrotic bone. The infection showed low activity and was successfully treated with surgery combined with penicillin.

Isolation of Chlamydia in acute salpingitis.

In 22 patients with acute salpingitis, verified by laparoscopy, samples for attempted isolation of bacteria, Mycoplasma and Chlamydia were drawn from aspirates and cervical smears. CF-antibodies to Chlamydia were measured to acute and convalescent phase sera. Anaerobic bacteria were isolated from tubal secretions in two patients and Mycoplasmas in one patient. In two patients Chlamydia were recovered from the Fallopian tube. The serological investigation indicated Chlamydia infection in 6 patients.

Recurrent toxoplasmosis.

A case of recurrent toxoplasmosis in a previously healthy 34-year-old woman is reported. Although she was treated 3 times with co-trimoxazole, which in our experience has been efficient in the treatment of toxoplasmosis, and responded to treatment clinically and serologically, she relapsed with clinical symptoms and rise of anti-toxoplasma titres. Hypothetically, toxoplasmosis is a latent infection which can be activated by other diseases and by immunodepression.

Treatment of toxoplasmosis with trimethoprim-sulphamethoxazole.

Toxoplasmosis is known to complicate diseases with impaired cellular immunity. For treatment of toxoplasma infections atoxic drugs should be used to avoid depression of the bone marrow. The hitherto recommended treatment, pyrimethamine in combination with sulphonamides, is often associated with severe side-effects. The present study presents the results of treatment with trimethoprim and sulphamethoxazole in 7 patients, clinically and serologically diagnosed as having toxoplasmosis. Good therapeutic results were observed in 5 patients with lymphoglandular toxoplasmosis and a significant reduction of the dye test titres were found in 6 patients. In one patient, however, a relapse of clinical symptoms and a reversion to high dye test titres were observed 6 1/2 months after the end of the treatment. Treatment had to be discontinued in one patient due to an allergic reaction.