Timentin in the treatment of symptomatic complicated urinary tract infections in adult patients.

The safety and effectiveness of Timentin were evaluated in 34 adult patients with symptomatic complicated urinary tract infections, principally due to multiply-drug-resistant bacteria. Although a wide variety of organisms, particularly gram-negative bacilli, were found, Escherichia coli was the most frequent, accounting for 14 of 45 (31 percent) pathogens isolated. Ten (22 percent) isolates were Pseudomonas aeruginosa; 11 (24 percent) were Proteus or Morganella species; three (7 percent) were Citrobacter; one (2 percent) was Klebsiella pneumoniae; two (4 percent) were Staphylococcus aureus; and two (4 percent) were enterococci. Ninety-three percent of all pathogens isolated produced a beta-lactamase. Eight (24 percent) infections were polymicrobial; seven (21 percent) were associated with bacteremia. Clinical improvement occurred in 30 of 34 (86 percent) patients. All bacteremias were cured. Although bacteriologic cure occurred in only 32 percent of patients, control of sepsis and temporary eradication of bacteria (bacteriologic improvement) occurred in 96 percent. Not surprisingly, the rates of relapses and reinfections were high. It was concluded that Timentin is a useful agent in the management of complicated urinary tract infection and offers clinicians an alternative to more toxic antibiotics, such as aminoglycosides.

In-vitro studies with SF 86-327, a new orally active allylamine derivative.

SF 86-327 (Sandoz Forschungsinstitut) is an orally active allylamine derivative related to naftifine. The antifungal activity of SF 86-327 was compared in vitro with those of naftifine, ketoconazole, and itraconazole (R 51,211, Janssen Pharmaceutica) by agar dilution. 120 fungal isolates were tested. Also, the antifungal activities of SF 86-327 and naftifine against 18 dimorphic pathogens were assayed in vitro by broth dilution. Results of these studies support claims that SF 86-327 is a broad spectrum antifungal agent. Results of the broth dilution studies also revealed that SF 86-327 was both fungistatic and fungicidal in vitro for isolates of Blastomyces dermatitidis, Histoplasma capsulatum and Sporothrix schenckii at concentrations as low as 0.05 micrograms ml-1 (18 isolates tested, MIC90 = 0.39 micrograms ml-1, MFC90 = 12.5 micrograms ml-1).

Primaxin in the treatment of acute bacterial pneumonia in adults.

Imipenem (N-Formimidoyl thienamycin) (MK-0787) is a new beta-lactam carbapenem antibiotic. When it is combined with the renal dipeptidase inhibitor cilastatin (MK-0791) the combination is known as primaxin. In this study 28 adult patients (24 males and 4 females) with acute bacterial pneumonia were treated with primaxin. Twenty-one patients were evaluable and 20 (95%) were clinically cured of their pneumonia. Bacteriological cures were demonstrated in 84% of the cases. One patient with a susceptible Pseudomonas aeruginosa failed. Major complications or toxic reactions included antibiotic associated diarrhoea in one patient; hypotension in one patient; increased grand mal seizures in one patient and elevated liver function studies in one patient. Results of this study suggest that primaxin will be useful in the treatment of a variety of serious Gram-positive and Gram-negative pneumonias. The true incidence of possible toxic reactions with this drug is not known at this time and awaits further experience.

In vitro studies with R 51,211 (itraconazole).

The in vitro activity of R 51,211 (itraconazole, accepted generic name; Janssen Pharmaceutica, Beerse, Belgium), a new orally active triazole, was compared with those of two existing orally active azoles, ketoconazole and BAY n 7133, and a topical agent, Ro 14-4767/002. An agar dilution procedure (Kimmig agar) was performed with 148 isolates of pathogenic fungi. Incubation was at 30 degrees C from 48 h to 7 days. R 51,211 was dissolved in 0.2 N HCl in absolute ethanol, ketoconazole was dissolved in 0.2 N HCl alone, BAY n 7133 was dissolved in absolute ethanol, and Ro 14-4767/002 was dissolved in dimethyl sulfoxide. R 51,211 and Ro 14-4767/002 were the most active drugs against isolates of Histoplasma capsulatum, and R 51,211 showed the greatest activity in vitro against isolates of Blastomyces dermatitidis and Cryptococcus neoformans. Ro 14-4767/002 was the most active drug against 30 isolates of dermatophytes, followed by R 51,211, ketoconazole, and BAY n 7133. R 51,211 showed the best activity in vitro against 19 isolates of Aspergillus fumigatus and Aspergillus flavus, as well as 19 isolates of dematiaceous fungi. All four drugs had 90% MICs of greater than or equal to 16 micrograms/ml when tested with isolates of zygomycetous fungi.

In vitro susceptibility studies with oxiconazole (Ro 13-8996).

Oxiconazole (Ro 13-8996) is a recently described imidazole derivative intended for topical use. 128 isolates of pathogenic fungi were tested in vitro against oxiconazole, miconazole, and ketoconazole using an agar dilution method. Results indicated that miconazole was markedly more active than either oxiconazole or ketoconazole against Candida albicans while ketoconazole was the more active compound against Candida parapsilosis. A species specific difference in the susceptibilities of isolates of Aspergillus fumigatus and Aspergillus flavus to all three imidazoles with A. flavus being more susceptible was noted. Both Mucor and Rhizopus were more susceptible to oxiconazole than to either miconazole or ketoconazole. There were no noticeable differences among the dermatophytes in tests with the three drugs with all geometric mean minimum inhibition concentrations (MIC) being less than 1.0 micromilligram-1. The dematiaceous fungi also demonstrated no major differences in susceptibility to the three drugs. One isolate of Pseudallescheria boydii was relatively resistant to all three drugs (MIC greater than or equal to 16 micromilligrams-1).

Chronic active hepatitis and cirrhosis in Wilson's disease.

A 32-year-old woman was found to have chronic active hepatitis and cirrhosis after exploratory celiotomy resulted in hepatic decompensation. Subsequent investigation confirmed the diagnosis of Wilson's disease. This case demonstrates that Wilson's disease may manifest itself as chronic active hepatitis as late as the fourth decade of life without neurologic symptoms or findings. Wilson's disease should be actively considered in patients with chronic active hepatitis or cirrhosis, even in older age groups and despite the absence of central nervous system manifestations.

Group Y meningococcal disease in United States Air Force recruits.

Between 1971 and 1974, group Y meningococcal disease developed in 88 Air Force recruits; 68 had primary bacterial pneumonia. None of the patients with primary pneumonia had the stigmata of meningococcemia or meningitis. Patients with pneumonia responded well to small doses of parenteral penicillin. Ten patients had meningococcemia, and six had meningitis. Pneumonia, therefore, predominated over meningococcemia and meningitis 4:1. Skin lesions were rare in patients with meningococcemia but frequent in those with meningitis; otherwise, these clinical syndromes were similar to group B and C meningococcal disease. There was only one death, a patient with known preexisting leukopenia.