Effective postcoital quinolone prophylaxis of recurrent urinary tract infections in women.

A total of 33 sexually active, premenopausal and postmenopausal women, suffering from recurrent urinary tract infections was randomized to receive postcoital prophylaxis with a dose of either 100 mg. ofloxacin (12), 200 mg. norfloxacin (11) or 125 mg. ciprofloxacin (10). While 130 urinary tract infections occurred in these patients during a mean of 8 months before postcoital quinolone prophylaxis, only 1 occurred during a mean of 15 months following prophylaxis. This difference was statistically highly significant. Each of these patients ingested a mean of 117 quinolone doses per year of postcoital prophylaxis. Before prophylaxis 74% of the introital cultures yielded gram-negative enterobacteria (mainly Escherichia coli), whereas only 11% yielded the same bacteria following prophylaxis. Postcoital oral prophylaxis with minimal quinolone doses is highly effective in the prevention of recurrent urinary tract infections in women, because it achieves high urinary bactericidal concentrations, and clears the majority of the introital and urethral Enterobacteriaceae without inducing resistance to the quinolones despite long-term treatment. This prophylaxis is highly recommended because of its ease of compliance, preservation of drug efficacy, lack of toxicity and cost-effectiveness. Postcoital quinolone prophylaxis is as good as or better than daily quinolone prophylaxis and uses only a third of the amount of drug consumed in daily prophylaxis.

Single dose quinolone treatment in acute uncomplicated urinary tract infection in women.

A total of 125 ambulatory women (85 premenopausal and 40 postmenopausal) who experienced 174 acute urinary tract infections with mainly gram-negative bacteria (99%) was randomized to receive a single dose, 2-tablet treatment with either ofloxacin (400 mg.), norfloxacin (800 mg.) or ciprofloxacin (500 mg.). Cure was achieved in 163 of the 174 acute episodes (94%). More specifically, the cure rates were 97% (57 of 59 infections) with ofloxacin, 96.5% (56 of 58) with ciprofloxacin and 88% (50 of 57) with norfloxacin. While the initial cure rate of the acute urinary tract infections was 96% (112 of 117) in the premenopausal group, it reached only 90% (51 of 57) in the postmenopausal group. The 17 urinary tract infections that followed the initial 2-tablet quinolone treatment were cured by either an additional single dose, 2-tablet treatment with a different quinolone in 6 cases, a 1-day treatment with other adequate antibacterials in 9 and a 7-day treatment in 2. The 2-tablet quinolone treatment proved to be an effective, easy and cost-effective treatment for acute urinary tract infections in premenopausal and postmenopausal women.

Effective prophylaxis for recurrent urinary tract infections during pregnancy.

Effective prevention of recurrent urinary tract infections (UTIs) and possible acute pyelonephritis is of major importance during pregnancy. During 39 pregnancies, 33 women with a history of recurrent UTIs (and, in some instances, pyelonephritis) received postcoital prophylaxis consisting of a single oral dose of either cephalexin (250 mg) or nitrofurantoin macrocrystals (50 mg). While 130 UTIs occurred during a mean observation period of 7 months before prophylaxis, only a single UTI occurred during pregnancy after prophylaxis; this difference was highly significant. Thus the use of one of these effective regimens is strongly recommended for any pregnant woman with a history of recurrent UTIs. The treatment's effectiveness can be explained by two features of the two antibacterial agents involved: both reach high bactericidal concentrations in the urinary tract and induce no (or minimal) resistance in the introital gram-negative bacterial flora.

Chronic recurrent multifocal osteomyelitis: report of a case.

We describe a case of a young adult who had chronic recurrent multifocal osteomyelitis that was diagnosed by exclusion and review the distinct clinical course of this disease. It is important to make a correct diagnosis so that unnecessary repeated invasive diagnostic procedures and prolonged use of antibiotics, steroids, or other chemotherapeutic agents can be avoided.

Effective prophylaxis of recurrent urinary tract infections in premenopausal women by postcoital administration of cephalexin.

A total of 31 sexually active premenopausal women, prone to have recurrent urinary tract infections but who otherwise were healthy, underwent postcoital prophylaxis consisting of a single oral dose of 250 mg. cephalexin. While 127 urinary tract infections occurred in these patients during a mean of 6 months before treatment, only 1 occurred during a mean of 12 months after postcoital cephalexin prophylaxis. This difference was statistically highly significant. Each of these patients ingested approximately 120 cephalexin tablets per year of postcoital prophylaxis. Postcoital oral cephalexin prophylaxis is highly effective in the prevention of recurrent urinary tract infection in the nonpregnant as well as pregnant premenopausal women because of easy compliance, the high urine concentration achieved and the minimal induction of resistance to cephalexin in the introital gram-negative bacterial flora. Postcoital cephalexin prophylaxis achieves identical results to daily cephalexin prophylaxis but uses only a third of the tablets required in the daily regimens. Finally, cephalexin represents an additional valuable antibacterial drug in postcoital prophylaxis along with cotrimoxazole, nitrofurantoin and cinoxacin.

Randomised study of myringotomy, amoxycillin/clavulanate, or both for acute otitis media in infants.

In a prospective study, 105 infants aged 3-12 months with acute otitis media were randomly assigned to one of three treatment groups: amoxycillin/clavulanate ('Augmentin') alone (36 patients), myringotomy plus placebo (35 patients), or augmentin plus myringotomy (34 patients). The last two groups were double-blinded. Bacterial pathogens, mainly Haemophilus influenzae (of which 20% were beta-lactamase producers) and Streptococcus pneumoniae, were isolated from 60% of the ear exudates and all isolates were sensitive to augmentin. Most of the infants improved clinically within 3-6 days irrespective of the treatment protocol. As judged by otoscopy, 60% of the patients receiving augmentin, with or without myringotomy, recovered completely compared with 23% of patients treated with myringotomy plus placebo. Treatment with augmentin was also more effective than myringotomy with regard to persistence of ear infection. In the myringotomy plus augmentin group closure of the incision and resolution of the discharge from the incision site was faster than in the myringotomy plus placebo group. The addition of myringotomy to augmentin did not seem to affect either the persistence of the infection after treatment or the residual middle ear effusion.

Prevention of recurrent urinary tract infections in premenopausal women by post-coital administration of cinoxacin.

A total of 21 sexually active premenopausal women, prone to recurrent urinary tract infections but who otherwise were healthy, underwent post-coital prophylaxis consisting of bladder voiding and a single 250 mg. tablet of cinoxacin. While 94 urinary tract infections occurred during a mean of 7.5 months before treatment, only 8 occurred during a mean of 12.5 months after prophylaxis. This difference was statistically highly significant. A mean of 106 cinoxacin tablets per patient were administered during post-coital prophylaxis. Cinoxacin represents an additional valuable and effective antibacterial in post-coital prophylaxis of recurrent urinary tract infection in otherwise healthy premenopausal women, although it is slightly less effective than cotrimoxazole or nitrofurantoin. Effective post-coital prophylaxis requires the use of much smaller quantities of antibacterial agents than the daily use of a single tablet and in women with a high incidence of recurrent urinary tract infections it is superior to intermittent self-administered antibacterial therapy.

A multivariate analysis of risk factors for acquiring bacteriuria in patients with indwelling urinary catheters for longer than 24 hours.

Data related to risk factors for catheter-acquired bacteriuria were collected prospectively on 112 patients consecutively catheterized for greater than 24 hours at the Hadassah University Hospital. Logistic regression analysis indicated that factors independently associated (p less than or equal to 0.05) with a higher risk of catheter-acquired bacteriuria were as follows: hospitalization in orthopedics or urology, ethnic origin (Arabs greater than Jews), insertion of a catheter after the sixth day of hospitalization, catheterization outside the operating theatres, lack of administration of systemic antibiotics, unsatisfactory catheter care, and prolonged duration (greater than or equal to 7 days) of catheterization before infection occurred. The risk associated with catheterization outside the operating theater could be explained by its correlate, that is, catheterization for incontinence/obstruction as opposed to output measurement. Life-table analyses demonstrated that the daily risk for acquiring bacteriuria during the first six days of catheterization was higher among patients ultimately catheterized for greater than or equal to 7 days than among those ultimately catheterized for less than 7 days (P less than 0.05).

A randomized comparison of 1-day versus 10-day antibacterial treatment of documented lower urinary tract infection.

We randomized 58 women with lower urinary tract infection diagnosed on bilateral ureteral catheterization studies to a 1-day or 10-day treatment regimen. The study revealed that 1-day adequate antibacterial treatment was as effective as 10-day treatment for lower urinary tract infection. Sterile urine was obtained in all 27 women (100 per cent) given 1-day treatment and in 30 of 31 (97 per cent) given 10-day therapy. Three weeks after the 1-day treatment significantly more postmenopausal women had infected urine than premenopausal women. This difference was not seen in the 10-day group. We conclude that 1-day treatment is sufficient for the cure of lower urinary tract infection in women.

Multivariate analysis of determinants of postoperative wound infection in orthopaedic patients.

In a prospective study of 376 orthopaedic patients, the relative contribution of host factors and patient-care variables to the risk of postoperative wound infection was evaluated. Host factors studied were age, sex, ethnic origin and diagnosis. The number of operations, the insertion of an open drain, the use of prophylactic antibiotics and the length of the operation were the patient-care variables studied. Of the risk factors identified, the performance of more than one operation during an admission had the highest risk coefficient, followed by the presence of an open drain, internal fixation of a fracture, and spine fusion. Within the group of operations for internal fixation, those for fractures of the femur had the highest risk of infection. In spine fusions those operations lasting 5 or more hours were associated with a high risk of infection. The length of stay of infected patients was on average 17.9 days longer than that of their individually-matched non-infected controls.

Determinants of wound infection after colon surgery.

Over a period of 54 months, every patient undergoing colon surgery at the Hadassah University Hospital in Jerusalem was followed up prospectively by the same nurse epidemiologist. A total of 403 patients completed the analysis. Risk factors for postoperative wound infection were explored in an epidemiological study, using both single and multivariate analysis. Of the 13 potential risk factors investigated, the four showing the highest association with wound infection were: the performance of more than one operation during a single admission; Arab ethnicity; the use of open drains; and the performance of a colostomy. In patients undergoing more than one operation, the risk for infection was greater if the second operation followed a surgical complication than if it was performed as an elective second procedure; whether the first operation was elective or not did not affect the infection rate. Second operations performed within 7 days of the first carried a higher risk for infection than those performed later. The different prophylactic protocols used during the period of investigation did not have an independently significant contribution to the risk of infection.

In vitro susceptibility of mycobacteria species other than Mycobacterium tuberculosis to amikacin, cephalosporins and cefoxitin.

The susceptibility of different species of mycobacteria, other than M. tuberculosis, to a range of cephalosporins and to amikacin was studied. Susceptibility patterns varied with species. M. fortuitum, M. marinum and M. szulgai were the most susceptible species to amikacin and to cefoxitin, where as M. kansasii, M. scrofulaceum and MAIS complex the most resistant. Cefoxitin appears to be much more active against mycobacteria than the other cephalosporins used in this study. Most of the cefoxitin-sensitive mycobacteria were inhibited by concentrations which can be easily attained in serum on standard dosage schedules.

Infections in the surgical departments of a teaching hospital in Jerusalem.

Surveillance of hospital-associated infections at the Hadassah University Hospital has been carried out since 1970. Criteria for infection were defined and were monitored by trained nurse-epidemiologists, with the cooperation of the surgical staff. This report deals with the results of a prospective study of infections present on admission, and those acquired during hospitalization, in six surgical departments between January 1972 and June 1973. Of the 7,339 patients discharged, 7.5% acquired an infection in hospital, while 10.6% were admitted with an infection. Several important factors appeared to increase the risk of acquiring an infection in hospital. These include advanced age, certain surgical procedures, such as gallbladder and small and large bowel operations, and the presence of infection on admission. Most of the latter occurred at the site of the proposed operation, and thus increased the risk of development of postoperative wound infection.

Antimicrobial activity of human peritoneal fluid.

Cell free peritoneal fluids from 23 normal women had antimicrobial activity which was directed against gram-positive and gram-negative bacteria and also against yeasts. The activity was bacteriostatic or bactericidal and seemed to be due to the presence of a variety of factors which varied in their heat stability and dependence on complement. Lysozyme was present in the fluids but was not responsible for all the antimicrobial activity.