Comparison of once-daily cephalosporin regimens for community-acquired lower respiratory tract infections in patients with chronic lung disease.

The efficacy of cefonicid and of ceftriaxone, administered once daily for the treatment of lower respiratory tract bacterial infections (pneumonia or bronchitis), was evaluated and compared in 118 patients with chronic lung disease. The patients were randomly assigned to receive 1 gm of either drug, intravenously or intramuscularly, daily for three to 11 days (mean, seven days). Pathogenic bacteria were isolated from sputum in 59% of patients; Haemophilus influenzae and Streptococcus pneumoniae predominated. Clinical cure or improvement was noted in 95% and 93% of patients treated with cefonicid and ceftriaxone, respectively, and bacteriologic cure or improvement in 69% and 81% (the differences were not significant). Side effects were infrequent and similar in the two treatment groups, except that diarrhea was more common in the ceftriaxone group (11%, versus 4.4% in the cefonicid group). It is concluded that patients with chronic lung disease who experience acute exacerbations associated with infection caused by H influenzae or S pneumoniae, or other susceptible organisms, can be effectively treated with once-daily administration of either cefonicid or ceftriaxone.

Legionella longbeachae species nova, another etiologic agent of human pneumonia.

A new species of bacteria that is an etiologic agent of human pneumonia has been isolated and characterized. Clinical symptoms of infection with this organism are not readily distinguishable from those caused by Legionella pneumophila infection. The organism was isolated from respiratory tract specimens from four patients. Two cases of infection apparently originated in California and one in Georgia, and a fourth was of unknown geographic origin. The name Legionella longbeachae species nova is proposed for this organism. The type strain of L. longbeachae is Long Beach 4 (= American Type Culture Collection 33462).

Susceptibility and synergy studies of methicillin-resistant Staphylococcus epidermidis.

Methicillin-resistant Staphylococcus epidermidis is an important cause of cerebrospinal fluid shunt infections and prosthetic valve endocarditis. Agar dilution minimum inhibitory concentrations were determined for 100 strains of methicillin-resistant S. epidermidis which were isolated from clinical specimens. Vancomycin inhibited all 100 strains at /=3.12 mug/ml. Of the five cephalosporins and one cephamycin tested, cefamandole was the most active in vitro, inhibiting 97 strains at /=10(2) kill by the combination over the most effective single antibiotic at 24 h) was demonstrated with vancomycin (1.56 mug/ml) plus cefamandole (6.25 mug/ml) in 14 of 14 strains, vancomycin plus cephalothin (6.25 mug/ml) in 14 of 14 strains, vancomycin plus rifampin (0.008 to 0.012 mug/ml) in 6 of 12 strains, rifampin plus cefamandole in 9 of 12 strains, and rifampin plus cephalothin in 10 of 12 strains. The emergence of populations of bacteria resistant to 0.2 mug of rifampin per ml developed in three of five methicillin-resistant S. epidermidis strains tested. The addition of either vancomycin, cephalothin, or cefamandole to the rifampin prevented the emergence of resistance in these three strains. Clinical trials of synergistic antibiotic combination therapy for serious methicillin-resistant S. epidermidis infections are indicated.

Anaerobic bacterial meningitis.

Anaerobic meningitis occurred in four patients in whom anaerobic bacteria had not been suspected as a possible cause. The predisposing conditions were typical of those seen in patients previously reported to have this infection and included chronic otitis media with mastoiditis, chronic sinusitis, recent craniotomy and abdominal trauma. Two of the patients had undergone immunosuppression (immunosuppressed patients); a compromised immune system may facilitate the development of anaerobic meningitis in patients with the appropritate underlying conditions. Head and neck neoplasms, head trauma, suppurative pharyngitis and laminectomy wounds are additional situations in which anaerobic meningitis occurs. Anaerobic bacterial meningitis probably occurs more often than is recognized. The cerebrospinal fluid should be transported and cultured anaerobically when meningitis develops in a patient with a predisposing condition.

Allergic bronchopulmonary aspergillosis-like syndrome consequent to aspergilloma.

Two patients who represent the first well-documented cases of an allergic bronchopulmonary aspergillosis-like syndrome developing consequent to an aspergilloma are reported. These patients experienced both subjective and objective evidence of improvement after the initiation of corticosteroid therapy. Literature relevant to the combined occurrence of aspergilloma and allergic bronchopulmonary aspergillosis and their immunology is reviewed.

Combined clinical and laboratory studies with carbenicillin and ticarcillin: use in infections involving anaerobic bacteria.

Eleven patients with serious infections involving anaerobic bacteria were treated with carbenicillin (four patients) or ticarcillin (seven patients). All patients were cured clinically and bacteriologically of their infections. An in vitro study testing 157 recently isolated anaerobic organisms against 11 antibiotics showed chloramphenicol, carbenicillin, and ticarcillin at blood level concentrations to be inhibitory to more anaerobic strains than the other eight antibiotics tested. Ticarcillin and carbenicillin appear to be safe and effective and deserve further consideration for use in the therapy of anaerobic infections.