A comparative study of gentamicin and netilmicin in the treatment of gram-negative infections.

Netilmicin is active in vitro against a wide variety of gram-negative bacteria, including certain gentamicin-resistant isolates, and Staphylococcus aureus. This study presents the results of a prospective, randomized, double-blinded protocol designed to determine the relative efficacy and toxicity of netilmicin and gentamicin in the therapy of gram-negative infections. The demographic make-up of both treatment groups was similar. Cure rates were 96.7 percent with netilmicin and 94.4 percent with gentamicin. Possible transient nephrotoxicity developed in nine patients receiving netilmicin and in eight patients receiving gentamicin.

Meningitis in an adult caused by Hemophilus influenzae, biotype III.

An elderly woman had an abrupt onset of symptoms consistent with bacterial meningitis without an obvious source of infection. The organism, isolated from the blood and CSF, was a nonserotypeable Hemophilus influenzae, biotype III. To our knowledge, this is the first reported case of meningitis caused by this organism.

Cefoxitin therapy in aerobic, anaerobic, and mixed aerobic-anaerobic infections.

Cefoxitin, a new beta-lactamase-resistant cephamycin, was evaluated in 66 patients for clinical and bacteriological efficacy, serum levels, tolerance, and toxicity. Seventeen patients had soft tissue infections, 14 had pleuropulmonary infections, 14 had intraabdominal infections, 13 had pelvic infections, and 8 had urinary tract infections. Among the 66 patients, 62 were cured and 4 could not be evaluated. Twelve patients had hospital-acquired infections, 31 had underlying disease, and 45 required a surgical procedure. Isolates included 116 aerobic and 72 anaerobic bacteria. Cefoxitin was more active than cephalothin against facultative and obligate anaerobic gram-negative organisms isolated from these patients. Mean peak cefoxitin levels in sera were 52 micrograms/ml after a 2-g infusion and 30 micrograms/ml after a 1-g infusion. Phlebitis occurred in two patients, eosinophilia in one, rash in two, vasculitis in one, and transient rises in SGOT and SGPT in two. Cefoxitin appears to be a safe and effective drug for the treatment of many aerobic, anaerobic, and mixed aerobic-anaerobic infections.

Use of cefamandole in the treatment of soft tissue and skeletal infections.

In review of our data, 12 of 38 patients (31.5 percent) had adverse drug reactions, a somewhat bothersome factor. Disturbing side effects of leukopenia and pancytopenia were seen in two patients, respectively, who were receiving cefamandole 12 g/d. Other cephalosporins, including cephalothin and cefazolin, have been reported to cause leukopenia. Eosinophilia and elevations of alkaline phosphatase and SGOT levels were noted with other cephalosporins. We observed no adverse clinical reactions associated with these findings. Although our study was able to demonstrate the therapeutic effectiveness of cefamandole in the treatment of soft tissue and skeletal infections, it should be reemphasized that cefamandole should be used only as an alternative treatment for the penicillin-allergic patient. In reality, a first-generation cephalosporin should be used for gram-positive organisms if one is required in soft tissue infections.

Legionnaires' disease. Report of a case with unusual manifestations.

The multisystem involvement in Legionnaires' disease commonly includes pulmonary, renal, hepatic, gastrointestinal tract, and neurologic manifestations, but except for the lung the mechanism of disease has not been defined. Circulating toxins are most commonly implicated. A nonfatal case is reported here that had unusual renal and neurologic findings. The renal failure was associated with urinary findings indicative of a glomerulitis, and the major neurologic manifestation was a polyneuropathy. The complications in this case suggest an immunologic mechanism for the extrapulmonary manifestations of Legionnaires' disease.

Endocarditis caused by Moraxella nonliquefaciens.

We have described a case of endocarditis caused by Moraxella nonliquefaciens on a prosthetic Hancock valve, which was cured with a six-week course of ampicillin and gentamicin therapy. Cases of Moraxella septicemia or endocarditis are uncommon, and this apparently represents the first case of Moraxella nonliquefaciens endocarditis on a prosthetic valve. The fastidious growth characteristics of this and similar species may require prolonged incubation of blood cultures and development of different methods for testing the bactericidal activity of the patient's serum.

Cephalexin and cephaloglycin activity in vitro and absorption and urinary excretion of single oral doses in normal young adults.

A large number of recently isolated bacterial pathogens were tested for susceptibility to cephalexin and cephaloglycin by the replica inoculating method. Strains of group A hemolytic streptococci, viridans (alpha and gamma) streptococci, pneumococci, gonococci, meningococci, and penicillin G-sensitive Staphylococcus aureus were all moderately to highly susceptible to both of these cephalosporin analogues, nearly all of the strains being two to eight (median four) times more susceptible to cephaloglycin than to cephalexin. The penicillin G-resistant, penicillinase-producing strains of S. aureus varied in their susceptibility; many were moderately resistant to both analogues, particularly to cephalexin. Strains of enterococci, Haemophilus influenzae, and most of the common gram-negative bacilli were moderately to highly resistant. Reducing the size of the inoculum had variable effects on inhibition by these drugs, depending on the species or strain. The activity of cephalexin was very little affected by pH of the medium within the clinical range or by incubation at 37 C in broth for up to 24 hr. In contrast, cephaloglycin in broth deteriorated rapidly at 37 C, and its activity was markedly reduced in alkaline medium. Both cephalexin and cephaloglycin were rapidly absorbed and excreted into the urine after single oral doses of 500 mg. Much higher levels were achieved and sustained with the former. Absorption of both analogues was delayed when taken with food, and the levels in the serum were significantly higher and better sustained when probenecid was also given. Very high concentrations of cephalexin were excreted into the urine during the first 4 hr, and the levels were still high in the 4- to 8-hr collection. The concentrations of cephaloglycin in the urine at these times were much lower. An average of 80 to 93% of the dose of cephalexin and 25 to 30% of the cephaloglycin were accounted for as active drug in the urine collected in 8 hr. Both analogues were well tolerated.