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Biomedical subjects

W Brumfitt

Publications and source records attributed to W Brumfitt.

At least 127 records · Page 7Linked to original sources

Pivmecillinam in complicated urinary infections failing to respond to conventional therapy.

Forty-three patients with a history of recurrent urinary infections, many of whom had renal involvement and had recently failed treatment, were then treated with pivmecillinam (400 mg 8-hourly for seven days). One week after the end of treatment the bacteriological cure rate was 72.1%. During the following four weeks, however, several of the cured patients relapsed, so that the cure rate five weeks after the end of treatment was only 46%. Thus, it is recommended that such patients should begin prophylactic treatment if found to be abacteriuric after the one week follow-up. Pivmecillinam was extremely well tolerated.

Adult↗

Anaerobic periurethral flora of healthy women and women susceptible to urinary-tract infection.

The anaerobic periurethral microbial flora of 25 healthy women was compared with that of 29 women attending the urinary-tract-infection clinic at the Royal Free Hospital. The latter group consisted of 19 patients receiving long-term prophylactic antimicrobial therapy and 10 with proven recurrent urinary-tract infection not receiving prophylactic treatment. The numbers and species of anaerobes isolated from each group were similar. Lactobacillus spp. were the most frequently isolated organisms in each group and the most numerous. Bacteroides spp. were the next most frequently isolated. In any one subject, the anaerobic flora varied considerably during the study period of approximately 6 months. Thus, the anaerobic flora is not affected by recurrent urinary-tract infection in the past nor by the use of prophylactic chemotherapy. It does not appear to exert a protective role against the initiation of urinary-tract infection.

Adult↗

A concise biotyping system for differentiating strains of Escherichia coli.

A six test biotyping system comprising fermentation of dulcitol, sorbose, raffinose, and 5 ketogluconate, motility and production of beta-haemolysis was used to obtain biotype profiles for 514 strains of Escherichia coli isolated from the urinary tract. This profile was suffixed to the API-20E code, recorded when the strains were originally identified. An expanded and reliable biotyping system was thus created giving a greater number of possible biotypes than with either system alone. The sensitivity in terms of distinguishing the organisms studied was therefore greatly increased. The use of O-serotyping in combination with biotyping is discussed. Biotyping can also be usefully supplemented by the determination of the eight commonest E coli O-serotypes. This is of value in many clinical situations where differentiation of organisms is vital to the proper analysis of results.

Bacteriological Techniques↗

Biophotometric comparison of cephalexin and cephradine against gram-positive bacteria.

We have compared the antibacterial activities of cephalexin and cephradine against Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus saprophyticus (Micrococcus spp. type III), and group B streptococci (35 strains in total), using the Biophotometer. Analysis of growth curves obtained in the presence of various concentrations of the antibiotics revealed little difference between the activities of the two cephalosporins. However, both antibiotics showed maximal activity at 8-16 microgram/ml, and increasing the concentration past this point resulted in a reduced antibacterial effect. Unlike the other species tested, streptococci were not lysed by cephalexin or cephradine.

Cephalexin↗

A pilot study of 'Augmentin' in lower respiratory tract infections: pharmacokinetic and clinical results.

Thirteen patients with a mean age of 67 years admitted to hospital with signs and symptoms of lower respiratory infections were treated with 'Augmentin' (500 mg amoxycillin + 250 mg clavulanic acid) given orally every 8 hours, for 7 days. The clinical response was 'good' in ten cases and one 'failed'. Two patients could not be assessed. Side-effects were not serious: only one patient had to stop treatment (due to diarrhoea). The pharmacokinetic results show that peak levels of amoxycillin and of clavulanic acid in the blood and in sputum are achieved at a later time in the patients studied than occurs in healthy volunteers.

Adult↗

Lactobacilli do not cause frequency and dysuria syndrome.

Mid-stream specimens (MSU) of urine were collected from 142 healthy women (pregnant and non-pregnant) and cultured for lactobacilli and other fastidious bacteria. The latter either require CO2 or are obligate anaerobes. Lactobacilli were present in counts of 10(4)/ml or more in 34.8% of the women, and in counts of 10(5)/ml or more in 20.2%. Besides lactobacilli, which were the bacteria most frequently isolated, anaerobic gram-positive cocci (peptococci and peptostreptococci) were often found. This flora is typical of that of the lower vagina, and none of these women had either symptoms of urinary infection of pyuria. Therefore, the bacteria isolated were commensals or contaminants. Cultures of MSUs taken from 26 women with symptoms of dysuria and/or frequency, but without significant numbers of conventional pathogens such as Escherichia coli, contained commensals and contaminants of the same variety and in similar numbers. Urine samples from 50% of these patients contained at least 10(4) lactobacilli/ml and 27% had 10(5) or more/ml. Lactobacilli were absent from the suprapubic urine specimens cultured from a further 44 women. There was no significant difference between the isolation rate of lactobacilli in urine cultures from healthy women and the rate in women with dysuria and frequency.

Chlamydia Infections↗

Prevention of recurrent urinary infections in women: a comparative trial between nitrofurantoin and methenamine hippurate.

We treated 99 female patients suffering from recurrent urinary infections with either 1 gm. methenamine hippurate every 12 hours or 50 mg. nitrofurantoin every 12 hours for intervals of up to 1 year. Monthly microbiological and clinical surveillance was done. Both treatments were effective in reducing the incidence of symptomatic attacks, with nitrofurantoin being more effective. The protective effect of prophylaxis continued after treatment had stopped, suggesting that a permanent beneficial action had been produced. Especially during the first month of treatment methenamine hippurate was tolerated better than nitrofurantoin: 28 per cent discontinued therapy with the latter owing to nausea.

Adult↗

Activity of ceftazidime (GR 20263) against nosocomially important pathogens.

Ceftazidime was considerably more active than cefuroxime against 180 strains of resistant species of nosocomial gram-negative bacteria. In terms of antibacterial spectrum and intrinsic activity, ceftazidime is an improvement upon existing beta-lactam antibiotics in clinical use and can be regarded as a possible alternative to gentamicin.

Anti-Bacterial Agents↗

Role of urease in the formation of infection stones: comparison of ureases from different sources.

Bacterial and vegetable ureases were found to differ in certain important respects. For maximal clinical relevance, in vitro studies on the pathogenic role of urease should use whole bacterial cells of Proteus spp., and urease inhibitors should be assessed without preincubation of enzyme with inhibitor. Urease from Proteus morganii was very different from ureases of other species of Proteus; this factor should be taken into account when infections with P. morganii are being treated.

Calculi↗

Resistance to trimethoprim in 1978-79 compared with 1973-75.

The incidence of resistance to trimethoprim among urinary isolates between October 1978 and November 1979 was 11.5%, more than double the figure found April 1973 and October 1975. Of the resistant strains, 60% had a minimum inhibitory concentration in excess of 1 mg/ml. Escherichia coli and Proteus mirabilis showed the greatest increase in resistance since the previous study. Rather wide fluctuations occurred in the incidence of resistance for various species when the figures were analysed over two-month periods, hence studies of short duration must be interpreted with caution. There are not yet enough data from this or other studies for the cause of the increased incidence of resistance to trimethoprim to be determined.

Bacteria↗