Short course quinolone therapy of typhoid fever in developing countries.

A 14-day course of chloramphenicol or cotrimoxazole has been standard chemotherapy for uncomplicated salmonella enteric fever for several decades. The new fluoroquinolones show in vitro minimum inhibitory concentrations against Salmonella spp. ranging from 0.003 to 0.25 mg/L. Early clinical trials with 14-day courses of ciprofloxacin, ofloxacin or pefloxacin given orally achieved cure rates of 100%. Subsequent trials with 7- to 10-day courses of these fluoroquinolones also consistently yielded cure rates of 100%, whereas more recent trials of 3- to 6-day courses reported preliminary cure rates of 67 to 99%. At present, it appears that fluoroquinolone therapy for at least 7 days is a cost-effective substitute for the standard drugs in uncomplicated salmonella infections resistant to cotrimoxazole and/or chloramphenicol. The use of shorter 3- to 6-day courses of fluoroquinolone therapy needs further study, in view of lower cure rates reported in preliminary clinical trials.

Monotherapy with pefloxacin in multidrug-resistant nosocomial gram-negative bacteraemia.

Twenty patients who developed nosocomial Gram-negative bacteraemias in the medical or surgical intensive care units were treated with pefloxacin. All organisms were susceptible to pefloxacin and had not responded to previous antimicrobial therapy. The bacteraemias were eradicated in 16 of the 20 patients, all of whom tolerated the therapy without adverse effects.

Treatment of community-acquired lower respiratory tract infections with oral cefuroxime axetil.

The subjects were adult hospitalized patients, 12 with pneumonia and eight with acute bronchitis. The patients with pneumonia received 500 mg of cefuroxime orally twice daily and the patients with bronchitis received 250 mg twice daily. Treatment lasted for ten days in responsive patients. The pathogens identified in the patients' sputum were Streptococcus pneumoniae, Klebsiella pneumoniae, Haemophilus influenzae, Enterobacter aerogenes, Staphylococcus aureus, or Branhamella catarrhalis. Clinical and bacteriologic cures were achieved in 11 of the 12 patients with pneumonia and in seven of the eight patients with bronchitis. It is concluded that cefuroxime axetil is safe and effective in the treatment of community-acquired pneumonia or acute bronchitis.

Ofloxacin treatment of nongonococcal urethritis. A multi-center study in Asia.

Ofloxacin, a new quinolone antibacterial agent, is active in vitro against gonococcal and nongonococcal urogenital pathogens. Chlamydia trachomatis infection is the most common cause of nongonococcal urethritis. In a multicenter study in seven Asian countries, 105 mal patients with chlamydial urethritis and 46 male patients with nongonococcal and nonchlamydial urethritis were treated with oral ofloxacin at a dosage of 200 mg twice daily for 5 to 10 days. The evaluation performed at day 5 and/or day 10 after treatment revealed good results in 58.2% and 96.8% of the chlamydial urethritis group, and 73.1% and 79.4% of the nongonococcal, nonchlamydial urethritis group, respectively. No severe side effects were observed. Ten-day treatment with ofloxacin showed good clinical efficacy on nongonococcal urethritis.

Comparison of once-daily and thrice-daily netilmicin regimens in serious systemic infections: a multicenter study in six Asian countries.

Patients with serious systemic infections admitted to eight medical centers in six Asian countries were treated with 300 mg of netilmicin given once daily (group A: 92 patients) or 100 mg of netilmicin given three times daily (group B: 93 patients). Netilmicin was administered by intramuscular injection or slow intravenous infusion until clinical, laboratory, and bacteriologic measures were normalized and for not more than two additional days. A clinical cure was achieved in 88% of the patients from group A and in 68% from group B. The causative micro-organisms were eliminated or infection site healed in 90% of group A and in 88% of group B. The mean treatment duration was 6.9 days in group A and 8.8 days in group B. Two patients in each group developed symptoms of nephrotoxicity; the pretreatment serum creatinine levels in all four patients were in the high borderline range. No other serious side effects were found. It is concluded that netilmicin administered once daily is safe and more effective than netilmicin administered three times daily.

Ceftazidime versus a combination of amikacin and ticarcillin in the treatment of severe infections.

Hospital patients with severe gram-negative bacterial infections were randomly assigned to treatment with ceftazidime (2 gm every eight or 12 hours) or a combination of amikacin (500 mg every 12 hours) and ticarcillin (3 gm every six or eight hours). The clinical and bacteriological responses to treatment were satisfactory in most of the patients in both treatment groups. Clinical cure was achieved in 18 of the 20 patients treated with ceftazidime and in 17 of the 20 treated with amikacin-ticarcillin. The bacterial eradication rate was 19 of 21 pathogens in the ceftazidime group and 17 of 20 pathogens in the amikacin-ticarcillin group.

Treatment of uncomplicated gonorrhoea in women. Comparison of rosoxacin and spectinomycin.

A comparative study of the new antibacterial agent, rosoxacin, a quinoline derivative, with spectinomycin was made in women with uncomplicated cervical, urethral, pharyngeal, and rectal gonorrhoea. Rosoxacin was given in three oral regimens: 200 mg in a single dose, 300 mg in a single dose, and 300 mg in two doses of 150 mg four hours apart. All culture results 72 hours after administration were negative for Neisseria gonorrhoeae in all 81 women compared with 107 of 109 who received 2 g spectinomycin intramuscularly. Thirty-five of the women successfully treated with rosoxacin harboured penicillinase-producing strains of N gonorrhoeae (PPNG) and 46 non-penicillinase-producing (non-PPNG) strains. Fifty of the women treated with spectinomycin had PPNG strains and 59 non-PPNG strains. Mild self-limiting side effects, principally dizziness, occurred in varying frequency with rosoxacin, but these were difficult to evaluate owing to the characteristics of the patient population and the conditions under which the study was conducted.

Single oral dose rosoxacin in the treatment of gonorrhoea in males.

A study of the new anti-bacterial agent, rosoxacin, a quinoline derivative was made in male subjects with uncomplicated acute gonorrhoea using a single oral dose of 200 mg and a single dose of 300 mg. Of the eight patients who received a single dose of 200 mg, post-treatment urethral smears and cultures for N. gonorrhoeae were positive in all and these subjects were considered as treatment failures. In contrast, a single dose of 300 mg was highly effective as all twenty-four who received this dose were cured as judged by negative urethral smears and cultures on the 7th post-treatment day. Of the thirty-eight isolates of M. gonorrhoeae obtained in the study, fifteen (39.5%) were penicillinase-producing, indicating that rosoxacin is effective in treating penicillin-resistant gonorrhoea. Mild to moderate dizziness and/or drowsiness was experienced by four of twenty-nine patients evaluated for safety on the 300 mg single dose, giving an incidence of side-effects of 14%. The symptoms were of brief duration and were self-limiting. A single oral dose of this drug appears to be an ideal treatment for the rapid cure of acute gonorrhoea.

Occurrence of infection with group B coxsackievirus in rheumatic and nonrheumatic Filipino children.

The pathogenesis of rheumatic fever has been linked to various immune mechanisms involving streptococcal antibodies and heart tissue antigens. Latent myocarditis due to group B coxsackievirus has also been considered as a possible conditioning factor. The validity of the role of infection with group B coxsackievirus in rheumatic fever was tested by determining the incidence of type-specific neutralizing antibodies in sera of Filipino children. Analysis of the results by means of a normal Z-test showed that the incidence in rheumatic children was not statistically significant in comparison to the incidence in asymptomatic children.