Therapeutic progress. IV: Treatment and prophylaxis of Pneumocystis carinii infection.

Co-trimoxazole presently remains the first choice for prophylaxis and treatment of Pneumocystis carinii infections. The high incidence of adverse reactions experienced by patients taking co-trimoxazole has led to a number of trials comparing it with other antipneumocystis agents. Adjuvant therapy with corticosteroids may benefit patients with severe P. carinii pneumonia. This paper reviews the standard treatments for P. carinii pneumonia, some of the newer agents such as atovaquone, recently licensed in the U.K., and a variety of novel agents being assessed for treatment and prophylaxis. Current recommendations may change over the new few years.

The value of surveillance cultures on neonatal intensive care units.

Nosocomial infections on neonatal intensive care units (NICUs) have been a recognized cause for concern for many years. It is the endeavour of the doctors caring for these children to identify and treat such infections as early as possible in an effort to reduce morbidity and mortality to a minimum. A high percentage of babies on NICU become colonized with Gram-negative bacilli (GNB) with increasing length of stay on the unit. Those babies that remain on NICU for prolonged periods, and who become colonized, tend to be the most premature and sickest infants, and therefore are most at risk of becoming septic. The use of surface cultures in predicting the organisms responsible for sepsis is inefficient and not cost-effective. There is some evidence that endotracheal aspirate cultures in ventilated neonates may be helpful in identifying the pathogens responsible for perinatal pneumonia. Most NICUs have an antibiotic policy for the blind treatment of sepsis which covers the most common organisms responsible, and it is likely that antimicrobial treatment is rarely altered as a result of pathogens isolated from surface cultures. Again this makes the collection of surface cultures a wasteful and costly use of resources. In the light of the increasing incidence of Gram-positive infections on NICUs, antibiotic policies may have to be altered to accommodate these pathogens. As well as continued attention to good infection control measures, it remains with the clinician to be alert to the onset of sepsis in neonates and institute broad spectrum antimicrobial cover after collecting blood and cerebrospinal fluid cultures as indicated.(ABSTRACT TRUNCATED AT 250 WORDS)

Audit of the use of erythromycin in the treatment of community-acquired lower respiratory infections.

The British Thoracic Society (BTS) guidelines for the treatment of community-acquired pneumonia recommend initial therapy with a betalactam antibiotic, with the addition of erythromycin if there are features of an atypical pneumonia. To see if these guidelines were being followed, a prospective study was undertaken of all adult patients admitted to hospital over a 3-month period who were given erythromycin for a community-acquired lower respiratory tract infection. Erythromycin was given to 62 patients who could be fully assessed. Continued prescription of erythromycin was justified in 10 (16%)--two patients with penicillin allergy, two with M. catarrhalis infection and one patient with legionnaires disease. Five patients had infections severe enough on admission to warrant combined therapy in line with the BTS recommendations. Five patients had erythromycin stopped on day 2. Erythromycin was prescribed on admission and continued unnecessarily in 47/62 patients, showing that the BTS recommendations are not being followed correctly.