Erythromycin treatment of acute and chronic urethritis, prostatitis and colpitis caused by Ureaplasma urealyticum and Chlamydia trachomatis.

This report concerns the treatment of 250 patients with acute or chronic urethritis or urethro-adnexitis which was caused by Ureaplasma urealyticum or Chlamydia trachomatis. The patients were treated with 2 x 1 g erythromycin daily for a period of 3 weeks and were examined 8 days after discontinuing treatment. The MIC and MBC values against erythromycin were determined in some of the isolated Ureaplasma and Chlamydia strains. For Ureaplasma urealyticum the MIC is approximately 0.5 mcg/ml and for Chlamydia trachomatis approximately 2.0 mcg/ml. The report covers therapeutic responses, the benefit of and reasons for long-term treatment, relapses and patients who did not respond to treatment.

Erythromycin infusions for treatment of infections in the ear, nose and throat region.

Sixteen adult male patients (aged between 20-38 years) with ear, nose and throat infections, caused by bacteria sensitive to erythromycin, received daily infusions of 2 x 1 g erythromycin for 48 hours. The duration of infusion was 30 or 60 minutes, administered at intervals of 12 hours between infusions. Symptoms of intolerance such as nausea, retching, feeling of pressure in epigastric angle as well as abdominal cramps occurred as side-effects in many cases. A spasmolytic was given intravenously to twelve patients; it rapidly eliminated the symptoms. However, these side-effects were considered insignificant compared to the excellent clinical results obtained during infusion therapy. We, therefore, believe that 2 x 1 g/day erythromycin per infusion can be regarded as the drug of choice in chronic and acute ear, nose and throat infections. The rapid resolution of infections, which are otherwise difficult to treat, and the concomitant decrease in confinement to bed by about 8 to 10 days are the most important results in this study.

[European Association of Urology guidelines on urinary and male genital tract infections]. / Synoptische Leitlinie der sexuell übertragbaren Erkrankungen (STD) mit Primärsymptomen im männlichen Genitale (S1). Leitinien der Deutschen Gesellschaft für Urologie.

Today, the classical bacteria that cause venereal diseases, e.g. gonorrhea, syphilis, chancroid and inguinal granuloma, only account for a small proportion of all known sexually transmitted diseases (STDs). Other bacteria and viruses as well as yeasts, protozoa and epizoa must also be regarded as causative organisms of STD. Taken together, all sexually transmitted infections comprise more than 30 relevant STD pathogens. However, not all pathogens that can be sexually transmitted manifest diseases in the genitals and not all infections of the genitals are exclusively sexually transmitted. Concise information and tables summarising the diagnostic and therapeutic management of STDs in the field of urology allow a synoptic overview, and are in agreement with the recent international guidelines of other specialist areas. Special considerations (i.e. HIV infection, pregnancy, infants, allergy) and recommended regimens are presented.

[Mycoplasma-induced urethritis]. / Die mykoplasmenbedingte Urethritis.

Abacterial urethritis and colpitis in man and woman is frequently produced by Ureaplasma urealyticum and Mycoplasma hominis. These agents are transmitted by sexual intercourse and they have to be classified as facultative pathogenic. The clinical value and the therapeutical necessity depend on the clinical picture as well as on an exactly follow up microbiological and immunological diagnosis. As in all sexually transmitted diseases the sex-partner too should be examined and given a corresponding therapy. For general treatment of genital Mycoplasma infections tetracyclines are usually employed, whereas for Ureaplasma infections erythromycin has been very successful too. To prevent reoccurrence treatment should be consequently executed for 14 days up to three weeks.

Complement C3, coeruloplasmin and PMN-elastase in the ejaculate in chronic prostato-adnexitis and their diagnostic value.

The clinical differential of chronic prostatitis and psycho-vegetative urogenital syndrome with objective laboratory tests is very difficult. 265 ejaculates with possible chronic prostatitis were bacteriologically examined (including the search for STD agents). To verify an inflammatory process in the prostate and adnexae, we tested the C3 complement, coeruloplasmin and PMN-elastase levels in ejaculate. In addition, semiquantitative leucocyte counts in stained smears of the ejaculate were carried out. 185 of 265 patients had C3 complement below detection levels or in the normal range excluding inflammation of prostate or adnexae. 16.8% of the C3-negative ejaculates showed an elevated PMN-elastase level associated with urethritis anterior and/or posterior caused by STD agents. 80 patients showed elevated C3 levels; 38.8% with elevated coeruloplasmin and PMN-elastase levels. The semiquantitative leucocyte count in the stained smear proved the least sensitive method for verifying an inflammation. Enterococci (55.3%), Mycoplasma (18.8%) and Escherichia coli (16.5) were the dominant pathogens of chronic prostatitis present in number of 10(2) cfu/ml or greater than 10(5) cfu/ml. A correlation to the intensity of the inflammation was not found. These results show how important it is to realise a complete bacteriological examination as well as to determine the C3 complement, coeruloplasmin and PMN elastase.

[The effectiveness of ciprofloxacin in bacterial skin infections]. / Zur Wirksamkeit von Ciprofloxacin bei bakteriellen Hautinfektionen.

Ciprofloxacin in a low dosage of 250 mg twice a day was applied in the treatment of bacterial infections of the skin. All cultured staphylococci, streptococci, and pseudomonas proved to be highly sensitive to ciprofloxacin. The cases of pyoderma showed quick healing, but there were relapses of Lyme borrelia within 6 weeks. As the titers of IgM and IgG steadily increased during the following months, additional therapy was necessary. The tolerance of ciprofloxacin was generally very good.

[Haptoglobin phenotypes and liver cirrhosis. I (author's transl)]. / Haptoglobintypen bei chronischen Lebererkrankungen. I. Haptoglobintypen und Lebercirrhosen.

The distribution of haptoglobin phenotypes (Hp) 1--1, 2--1 and 2--2 in 174 patients suffering from liver cirrhosis was determined and compared with a reference group consisting of 194 healthy subjects. The study revealed a high frequency of the Hp 1--1 phenotype (32%) in the patients as compared with the control group (14%). This difference is statistically highly significant (p less than 0.00025). It was calculated that in individuals of type Hp 1--1, the risk of liver cirrhosis is 4.3-fold higher than in persons with the phenotype Hp 2--2.

[Demonstration of a tetracycline-resistance factor in a genital Mycoplasma strain. Clinical and molecular biology aspects of Ureaplasma coinfected penicillin and tetracycline-resistant gonorrhea]. / Nachweis eines Tetracyclin-Resistenzfaktors bei einem genitalen Mykoplasmenstamm. Klinische und molekularbiologische Aspekte einer mit Ureaplasmen mischinfiziertem penicillin- und tetracyclineresistenten Gonorrhoe.

We report a male patient with severe penicillin-resistant gonococcal urethritis, coinfected with a tetracycline resistant strain of ureaplasma urealyticum. Ureaplasmas are frequently involved in gonococcal urethritis and commonly this organism may persist after the penicillin therapy causing a "post-gonoccal-urethritis" (PGU). Additional treatment with tetracyclines prove to be successful in most of these patients except in cases of tetracycline resistance in ureaplasma urealyticum. In a case like this erythromycin may be useful, a drug to which these isolates are sensitive. The microbiological and genetic feature of a tetracycline resistant strain of ureaplasma urealyticum is presented in detail. The clinical and epidemiological importance of these results are discussed and compared with the literature.

[Erythromycin versus amoxicillin for the treatment of pneumonia in children (author's transl)]. / Erythromycin versus Amoxicillin bei kindlichen Pneumonien.

Following a study in which the etiology of nearly 70% of 142 cases of pneumonia in children could be determined using a combination of bacteriological and serological methods, the effect of erythromycin ethylsuccinate was compared with that of amoxicillin in a randomized study on 120 cases of pneumonia. We first examined the tracheal secretion microbiologically and determined other serological parameters and clinical data. The tracheal secretion was sterile in only 19% of the cases. We were able to identify the etiology in 64% of the cases using a combination of microbiological and serological methods. A discontinuation of therapy and acceptable side-effects were considerably more frequent with amoxicillin than with erythromycin ethylsuccinate (75 mg/kg body weight). The advantages of erythromycin, especially for the initial therapy of pneumonia, and the improvements in diagnosis resulting from the examination of the tracheal secretion will be discussed.

[Fluorescent antibody technique in identification of Neisseria gonorrhoeae-microcolonies grown on membrane filters (author's transl)]. / Fluoreszenzserologischer Nachweis von Neisseria gonorrhoeae-Mikrokolonien auf Membranfiltern.

Filter membranes (Nucleopore, No. N060, CPR 01300, pore size 0.6 mu) are inoculated with a pure suspension of N. gonorrhoeae or a Urethral smear from patients suffering from gonococcal urethritis. The membranes are placed on chocolate agar and incubated for three hours. After fixation in formaldehyd, grown microcolonies of N. gonorrhoea are detected microscopically after incubation of the membranes with a fluorescein-isothiocyanate labeled gonococcal antiserum (Difco, charge no. 605907) (Fig. 3--5). The high specificity of the antiserum was shown by lack of reaction with various other neisseriae (except for N. meningitidis, which showed a weak positive reaction) or other bacteria, respectively (table 1). To investigate the reliability of the new method urethral smears of 23 patients suffering from acute or chronic gonorrhoea were examined by culturing for gonococci in the conventional way and by means of the new technique. In all cases gonocococci were detected with both methods. This suggests that the fluorescent antibody technique has at least the same sensibility as the conventional one, and has the advantage that the result is obtained within one day.

[Gonorrheal urethritis--frequently a mixed Chlamydia and Mycoplasma infection. Results in 143 male patients with acute gonorrhea]. / Gonorrhoische Urethritis--häufig eine Mischinfektion mit Chlamydien und Mykoplasmen. Untersuchungsergebnisse bei 143 männlichen Patienten mit akuter Gonorrhoe.

Chlamydia trachomatis, Ureaplasma urealyticum and Mycoplasma hominis are frequently demonstrated in cases of acute gonorrhoeic urethritis. Among 143 males (average age 22.5 years) Chlamydia was demonstrated in 29%, U. urealyticum in 34% and M. hominis in 13%. Penicillin treatment of gonorrhoea does not affect Chlamydia and Mycoplasma so that these organisms will persist in the lower urogenital tract. Generally postgonorrhoeic urethritis is associated with Chlamydia or Mycoplasma infection. Nearly all patients were cured by tetracyclin or erythromycin administration. Incidence and complications of gonorrhoea co-infected with Chlamydia and Mycoplasma should be taken into account in its diagnosis and treatment.

Evaluation of plasmids in tetracycline resistant strains of Neisseria gonorrhoeae and Ureaplasma urealyticum in a case of severe urethritis.

A young man who acquired gonococcal urethritis in the Far East was not cured by repeated i.v. treatment with a broad-spectrum penicillin. Cultures of pre- and post-treatment urethral specimens grew tetracycline-resistant penicillinase-producing Neisseria gonorrhoeae (PPNG) and tetracycline-resistant Ureaplasma urealyticum. The patient was successfully treated with erythromycin, to which both isolates were sensitive. The strain of N. gonorrhoeae carried a novel plasmid of 10.5 Md molecular mass in addition to plasmids previously observed in this organism. The strain of U. urealyticum carried two distinct plasmids, one with mass 4.9 Md and the other one with mass 8.1 Md. This report demonstrates that ureaplasmas can contain plasmids and raises the question if tetracycline resistance is controlled by plasmids or by the chromosome.

[Possibilities of differenciating mycoplasma serologically and by protein analysis (author's transl)]. / Serologische und eiweissanalytische Differenzierungsmöglichkeiten von Mykoplasman

The problem of serological differentiation of the various mycoplasma strains and their demarcation from the L-phase variants of bacteria are based on the fact that it is difficult to obtain highly purified antisera which are only directed towards the cell membrane. For this reason an attempt was made by means of diselectrophoresis to determine the plasma and membrane proteins of various mycoplasma strains and L-phase variants and to evaluate them from differential diagnostic point of view. The results suggest that an unequivocal and rational differentiation is possible by this method of examination.

[Concentrations of erythromycin and amoxicillin in tonsil and sinus tissues of patients with tonsillitis and sinusitis. A comparison (author's transl)]. / Vergleich von Erythromycin- und Amoxicillin-Konzentrationen im Tonsillen- und Sinusgewebe bei Patienten mit Tonsillitis und Sinusitis.

Thirty male patients with chronic tonsillitis and 30 male patients with chronic Sinusitis maxillaris were pre-treated for four days with either 2 X 1 g erythromycin daily per os or 3 X 0.75 g amoxicillin daily per os in an open and randomised comparative study. MIC values for the relevant bacteria were determined beforehand. The intended tonsillectomy or radical operation was performed on the third day of pre-treatment, circa 1.5 h after the final administration of antibiotics. The tonsils or the sinus membrane were examined bacteriologically; the concentrations of erythromycin or amoxicillin were determined. At the same time, the concentration of the antibiotic administered was determined in the serum. The average concentration of erythromycin in the tonsil tissue was 1.24 micrograms/g; it was 1.21 micrograms/g in the sinus membrane. Amoxicillin was found at a concentration of 0.17 microgram/g in the tonsil tissue, and 0.1 microgram/g in the sinus membrane. While the levels of erythromycin in the tissue generally equalled or exceeded the MIC value for the pathogen in question, the levels of amoxicillin only reached the relevant MIC value for the given pathogen in a few cases since the concentration in the tissue was insufficient. The clinical tolerance of both antibiotics was good.

The importance and frequency of mixed infections with Chlamydia trachomatis and mycoplasmas in acute gonococcal urethritis.

Chlamydia trachomatis, Ureaplasma urealyticum and Mycoplasma hominis are frequently involved in gonococcal urethritis. We investigated 143 male White and Black patients with gonococcal urethritis (average age 22,5 years). Of these 29% had coexisting Chlam. trachomatis infection, 34% U. urealyticum infection and 13% Mycoplasma hominis infection. Conventional penicillin therapy did not affect Chlam. trachomatis, U. urealyticum or Mycoplasma hominis, which persisted in the lower urogenital tract, causing a so-called 'post-gonococcal urethritis.' Additional therapy with tetracycline or erythromycin was successful in most cases.

[Treatment of chlamydial urethro-adnexitis with erythromycin]. / Behandlung von Chlamydien-Urethro-Adnexitiden mit Erythromycin.

Besides mycoplasmas and ureaplasmas chlamydias are able to cause an urethro-adnexitis in men. Jeasts, trichomonas and herpes-viruses are in our patients of less importance. Therapy with erythromycine of chlamydial urethroadnexitis is successful.

Human antibody response to immunization with 17D yellow fever and inactivated TBE vaccine.

The antibody response against flaviviruses tick-borne encephalitis (TBE), Kyasanur Forest disease (KFD), Murray Valley encephalitis (MVE), West Nile fever (WNF), Japanese B encephalitis (JE), dengue 2 (DEN-2), and yellow fever (YF) was studied in humans after administration of an inactivated TBE virus vaccine. Individuals were either prevaccinated with 17D yellow fever (experimental group) or without any previous exposure to flaviviruses (control group). The appearance of serum titres of homologous and heterologous haemagglutination inhibition (HI) antibodies, heterotypic DEN-2 neutralizing antibodies, and TBE enzyme-linked immunosorbent assay (ELISA) antibodies were examined. Individuals prevaccinated with the 17D yellow fever developed an antibody pattern that contrasted with that of the control group. This pattern was characterized as follows: (1) Predominantly anti-TBE IgG antibodies appeared earlier and in higher titres than in the control group, (2) heterologous HI antibodies cross-reacting with the WN flavivirus subgroup preceded the appearance of homologous HI antibodies, (3) a broad spectrum HI response was observed against all flaviviruses tested, and (4) low titre heterotypic DEN-2 neutralizing antibodies were formed in about half of the cases. These observations are discussed in the context of cross-reactivity, cross-protection and virus infection enhancement.

[Evaluation of infectious, inflammatory external eye diseases]. / Zur Abklärung infektiöser, entzündlicher äusserer Augenerkrankungen.

Over a period of 4 months the authors observed 240 outpatients with 302 "red eyes." Oculogenital strains of Chlamydia trachomatis were diagnosed in 12.5% of these cases. Bacterial monoinfections were found in 13.9%, coinfections in 63.9%. The remaining 9.7% included Candida sp. (4%) and Herpes I (1.4%) infections, while 4.3% remained unidentified. Allergic conjunctivitis and "dry eye" syndromes were not considered separately in this study. Specific antibiotic therapy improved the clinical condition due to "saprophytic" bacterial coinfections, indicating the pathogenic importance of this type of infection.

An assessment of temafloxacin in the treatment of chronic bacterial prostatitis.

Based on its in-vitro activity against the majority of organisms associated with bacterial prostatitis and its excellent penetration into prostatic tissue, prostatic secretions and seminal fluid, temafloxacin appears to be a suitable agent for the treatment of prostatic infections. The efficacy and safety of temafloxacin 400 mg bd for 28 days were assessed in 61 patients from ten centres in Germany with symptomatic bacterial prostatitis diagnosed by segmented localizing cultures. Urine and prostatic secretions were obtained for culture. Clinical signs and symptoms were evaluated at two weeks during treatment, and at 5 to 9 days and 26 to 30 days after treatment. Safety was monitored during and at the end of treatment. Escherichia coli and Enterococcus spp. were the most frequent pathogens. In 41 clinically and bacteriologically evaluable patients, 37 (90%) were successfully treated at 5 to 9 days; four of these patients did not return for follow-up at the final visit and the remaining patients (33) continued to be clinically cured or improved. Thirty-seven patients (90.2%) had eradication of pre-treatment pathogens at 5 to 9 days after treatment; three of these patients did not return for this final follow-up visit. There were six patients with persistent or recurrent pathogens isolated and six patients with reinfecting pathogens. Thus, 26 of 38 (68%) evaluable patients at visit 5 were free from infection (from either a pre-treatment pathogen or any subsequent new infecting pathogen) up to 26 to 30 days after treatment. One clinically evaluable but bacteriologically non-evaluable patient was classified as a therapeutic failure after nine days of treatment and was not included in the final assessment. Improvement in the severity of specific signs and symptoms was observed in greater than 90% of cases. Mild to moderate adverse events, mostly occurring during the first or second weeks of long-term therapy, were reported in 11.5% of patients. Temafloxacin 400 mg bd, for four weeks was very effective and well tolerated by the majority of patients with documented bacterial prostatitis.