Experience of the diagnosis and epidemiology of Clostridium difficile in Sweden is reviewed. Samples from 5885 patients have been investigated at the National Bacteriological Laboratory in Stockholm from 1978-1983. Patients originate from all parts of the country and their number continues to increase. Cl. difficile seem to be of growing importance, especially in nosocomial infections. Most patients with antibiotic-associated diarrhoea and colitis (AAD/AAC) and Cl. difficile in their stools were above 60 years of age (63%) and there was a significant preponderance of females over males in the age groups 21-50 and above 60 years of age. The antibiotics most commonly associated with Cl. difficile enterocolitis (CDE) were penicillins, cephalosporins and clindamycin/lincomycin. On the basis of consumption clindamycin/lincomycin and cephalosporins are associated 70 and 40 times, respectively, more often than penicillins in CDE. Diagnosis of CDE relies mainly on detection of the cytotoxin (toxin B) in stool specimens. It was present in 873/4793 (18.2%) patients whereas the bacterium was found in only 12%. An immunoassay for detection of the enterotoxin (toxin A) of Cl. difficile seems to be a useful alternative to the cytotoxin assay, but some stool specimens with a low toxin B titre were negative. Five specimens negative for toxin B were positive for toxin A and came from patients where additional information suggested CDE. A serological assay for demonstration of circulating antibodies to Cl. difficile toxins has also been evaluated and is positive in about half of the cases of CDE. Antibody response seems to be absent or delayed in patients with relapse of colitis after antibiotic treatment.
The in vitro activities of two investigational quinolones, sparfloxacin (previously designated AT 4140) and PD 127391, were determined for 30 strains each of Mycoplasma pneumoniae, Mycoplasma hominis, and Ureaplasma urealyticum and compared with those of ciprofloxacin, tetracycline, clindamycin, and erythromycin. Erythromycin was the most active compound against M. pneumoniae (maximum MIC, less than 0.008 microgram/ml). PD 127391 (MICs, less than 0.008 to 0.031 microgram/ml), sparfloxacin (MICs, less than 0.008 to 0.25 microgram/ml), clindamycin (MICs, less than 0.008 to 0.5 microgram/ml), and tetracycline (MICs, 0.063 to 0.25 microgram/ml) were superior to ciprofloxacin (MICs, 0.5 to 2 microgram/ml). Sparfloxacin and PD 127391 were active against M. hominis (MICs, less than 0.008 to 0.031 microgram/ml for each) at concentrations comparable to those of clindamycin (MICs, less than 0.008 to 0.063 microgram/ml) and at concentrations lower than those of ciprofloxacin (MICs, 0.125 to 0.5 microgram/ml). As expected, M. hominis was resistant to erythromycin (MICs, 32 to greater than or equal to 256 micrograms/ml). For U. urealyticum, PD 127391 (MICs, 0.031 to 0.5 microgram/ml) and sparfloxacin (MICs, 0.063 to 1 microgram/ml) were superior to erythromycin (MICs, 0.25 to 4 micrograms/ml), ciprofloxacin (MICs, 0.5 to 8 micrograms/ml), and clindamycin (MICs, 0.25 to 64 micrograms/ml. Both new quinolones were equally active against tetracycline-susceptible as well as resistant strains of M. hominis and U. urealyticum. The possible influence of medium components and/or pH on MICs was evaluated by testing a Staphylococcus aureus reference strain with each antibiotic in SP-4 broth and 10-B broth and comparing the results with published MICs for this strain. MICs determined in 10-B broth for erythromycin were affected most. This study shows that the activities of sparfloxacin and PD 127391 are similar to one another and comparable or superior to those of other drugs used to treat mycoplasmal infections. The MICs of both new quinolones were consistently 2 to several dilutions lower than those of ciprofloxacin for each species.
We reviewed data on the treatment of bacterial vaginosis published from 1993 through 1996. For nonpregnant women, we recommend use of metronidazole (500 mg orally twice daily for 7 days), clindamycin vaginal cream (2%, once daily for 7 days), or metronidazole vaginal gel (0.75%, twice daily for 5 days) as the preferred treatment for bacterial vaginosis. For pregnant high-risk women (women with a prior preterm birth), the objective of the treatment is to prevent adverse outcomes of pregnancy, in addition to relief of symptoms. Thus, systemic therapy for possible subclinical upper tract infection as well as medication that has been studied in pregnant women are preferable. Therefore, we recommend metronidazole (250 mg orally three times a day for 7 days). For pregnant low-risk women (women without a prior preterm birth) with symptomatic disease, the main objective of the treatment is to relieve symptoms. We recommend metronidazole (250 mg orally three times a day for 7 days). Data do not support routine treatment of male sex partners.
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The incidence of bacteraemia in the control, amoxicillin/clavulanate, amoxicillin, clindamycin and azithromycin groups was: 96%, 0%, 50%, 87% and 81%, respectively, at 30 s; 65%, 0%, 10%, 65% and 49% at 15 min; and 18%, 0%, 4%, 19% and 18% at 1 h. Streptococci were the most frequently identified bacteria. The percentage of positive blood cultures at 30 s post-extraction was lower in the amoxicillin/clavulanate group than in the amoxicillin group (P < 0.001). The incidence of bacteraemia in the clindamycin group was similar to that in the control group.
Ten healthy volunteers received on separate days the following regimens: imipenem 500 mg, clindamycin 600 mg, latamoxef 1 g, and metronidazole 500 mg. The antibiotics were given intravenously as an infusion over 15 min. Blood samples were obtained before and 30 min, 1 and 6 h after the start of the infusion. Serum bacteriostatic and bactericidal activities were measured against the following strains of strict anaerobes: two strains of Bacteroides fragilis, one strain each of B. vulgatus, B. thetaiotaomicron, B. oralis, Fusobacterium symbiosum, Eubacterium lentum, Clostridium perfringens, and Peptostreptococcus magnus. Sera from patients receiving clindamycin showed the highest inhibitory and bactericidal activities except against B. thetaiotaomicron and F. symbiosum. Imipenem had similar inhibitory and bactericidal activity to that shown by latamoxef. Metronidazole had a moderate activity against all strains although the activity persisted for 6 h. Latamoxef was the most active antibiotic against the test strain of C. perfringens.
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Widespread antibiotic use has been associated with increases in both bacterial resistance and nosocomial infection.
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Emergence of multidrug-resistant Staphylococcus aureus has triggered a reassessment of fusidic acid (CEM-102, sodium fusidate).
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Randomised double-blinded trials were included.
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Calcium ions that have been preloaded into isolated SR subfractions in the presence of ATP and pyrophosphate may be released upon addition of a large number of diverse pharmacologic substances in a manner that is effectively blocked by ruthenium red and other organic polyamines. Effective blocking substances include certain antibiotics (neomycin, gentamicin, streptomycin, clindamycin, kanamycin, and tobramycin), naturally occurring polyamines (spermine and spermidine), and a number of basic polypeptides and proteins (polylysine, polyarginine, certain histones, and protamine). These agents have only one feature in common: the presence of several amino groups. Ruthenium red, neomycin, spermine, and protamine all appear to act by blocking SR Ca2+ channels since unidirectional 45Ca2+ efflux from the vesicles is strongly inhibited by these agents. Functions ascribable to the SR Ca2+ pump are largely unaffected by these agents. Since inositol 1,4,5-trisphosphate is ineffective at inducing Ca2+ release under these conditions, we conclude that these polyamines may directly block SR Ca2+ channels at very low concentrations by a mechanism unrelated to effects on inositol 1,4,5-trisphosphate production.