Relapse and reinfection in chronic bacteriuria. II. The correlation between site of infection and pattern of recurrence in chronic bacteriuria.
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A total of 120 patients, including 53 pregnant women with significant bacteriuria, received 163 7-day courses of oral antimicrobial agents allocated in a randomised manner. The cure rates after 6 weeks' follow-up ranged from 73% to 86%, and there was no statistical difference between preparations of ampicillin, carbenicillin indanyl easter, and 2 different formulations of nifuratel. Side-effects occurred in 30% to 40% of the courses of penicillin drugs, but in under 15% of the course of nifuratel. It is concluded that the new oral preparation of carbenicillin is a useful addition to the list of antimicrobial agents which are effective in the treatment of urinary infections in domiciliary patients. Furthermore, nifuratel has been confirmed as a highly active non-toxic drug which is valuable in the treatment of urinary infections.
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Gentamicin was of value in the treatment of chronic urinary tract infections caused by multiresistant bacterial strains for which no atoxic antibiotic was available. The treatment was carried out after alkalinization of the patient's urine. With the dosage given, gentamicin gave a low serum and a relatively high urine concentration. Excretion of active gentamicin in the urine was high even in patients with impaired renal function. The results of treatment of complicated chronic urinary tract infections with initial gentamicin and following long-term therapy showed negative urinary cultures in 12 out of 24 patients within one to 14 months of follow-up time. To reduce the risk of toxic side effects the dosage was adjusted according to the patient's kidney function. No development of resistance was demonstrated in the bacteria.
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Reccurrent abnormalities of polymorphonuclear leukocyte and monocyte bactericidal activity were demonstrated in a patient with sarcoidosis. Defective function occurred during hypercalcemia complicating recovery from Listeria meningitis, and during separate, unrelated episodes of erythema nodosum, staphylococcal cellulitis, and pneumococcal pneumonia. Leukocyte morphology, oxidative metabolism, degranulation, and content of myeloperoxidase and lysozyme were normal, but low leukocyte alkaline phosphatase activity was demonstrable on one occasion. Despite defective bactericidal function of monocytes, the patient's macrophages killed bacteria normally. The relationship between an intermittent leukocyte bactericidal defect and sarcoidosis is unclear; however, further studies of leukocyte function in sarcoidosis patients with opportunistic infection are indicated.
This report evaluates the effectiveness of cephalexin in the treatment of bacteriuria in 93 children. Cephalexin therapy eradicated sensitive organisms in 97 per cent of the cases regardless of recurrence, structural abnormality, or status of renal function. Nevertheless, recurrences with a new, resistant organism occurred significantly in certain patients, expecially those with major anatomic abnormalities, during a six-week follow-up period. The incidence of drug reactions was low.
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Clinical findings from 76 patients (median age 67 years) with gram-negative bacteremia were analysed and related to the sensitivity of the blood isolates to the bactericidal activity of normal human serum. 28 strains (37%) were resistant, an equal number intermediately sensitive and 20 markedly sensitive (26%). No correlation was found between serum sensitivity and origin of the bacteremia, presence of fever or blood granulocyte count. The frequency of shock in immunocompromised patients with serum-resistant strains was 60% (6/10); in those with intermediately or markedly sensitive strains it was 44% (8/18). In the non-immunocompromised patients with resistant strains the frequency of shock was 33 (6/18) versus 10% (3/30) in those without such strains. Thus the risk of developing shock with gram-negative bacteremia seems to depend on both parasite and host factors, although in this study only the latter were statistically significant. We conclude that serum-sensitive strains can invade the blood stream in spite of the serum bactericidal activity and cause severe disease in some patients.
With the necessity not only of differentiating between effectiveness and non-effectiveness, as in the earlier phases of chemotherapy, but also of detecting graduated differences in effect quantitatively, animal experiment and clinical trial have been shown to be no longer adequate. In a correlating comparison of antibacterial activity with the drug level in vivo as the two decisive basic elements of chemotherapeutic effect, new and interesting possibilities arise for the evaluation of antibiotics. In a comparative evaluation of nine different cephalosporin antibiotics, not only the objective antibacterial and pharmacokinetic properties are taken into consideration, but also the dosage recommendations of the manufacturers as subjective factors. The result is that the cephalosporins in the treatment of gram-positive infections (except enterococci) are almost equivalent. In the gram-negative field, there are marked differences which produce a different species-dependent therapeutic value for the various preparations. A fundamentally superior "universal" cephalosporin for all bacterial infections does not exist.