A prospective study of neutropenia induced by high doses of beta-lactam antibiotics.

A prospective study on the effect of beta-lactam antibiotics on granulopoiesis was carried out in 29 consecutive patients with bacterial endocarditis. Fourteen patients received a high dose of benzylpenicillin, up to 18 g/day, but in only three of them could the treatment be fulfilled as planned, for a mean time of 25 days. In 11 benzylpenicillin treated patients treatment had to be discontinued because of fever, rash or neutropenia. Neutropenia appeared in seven patients after 14-24 (mean 22) days. No superinfection occurred during the neutropenic phase which lasted 2-12 days. Patients with neutropenia differed significantly from others in having a lowered pretreatment neutrophil count (3.2 vs 10.4). In 15 patients treated with other beta-lactams, three cases of fever and rash and one case of neutropenia were seen in patients treated with cloxacillin 12 g daily. It was concluded that a daily dose of 18 g of benzylpenicillin is too high for longer treatment periods and that patients with initial low counts of neutrophils have an increased risk of developing neutropenia.

Short-term self-treatment of travellers' diarrhoea with norfloxacin: a placebo-controlled study.

In a randomized, double blind, placebo-controlled, multicentre trial, 447 travellers to Africa, Asia or Latin America started three days treatment with norfloxacin 400 mg bd or placebo within 24 h after the onset of travellers' diarrhoea. One hundred and four subjects developed diarrhoea and of those 94 (46 in the norfloxacin group and 48 in the placebo group) could be analysed for efficacy. By the last treatment day, 34 patients in the norfloxacin and 18 in the placebo group were cured (P = 0.0001), four and three improved and five and 19, respectively, were failures. Recurrences were seen in three patients on norfloxacin and eight on placebo. The mean time to cure was 3.2 days in the norfloxacin group and 4.4 days in the placebo group (P less than 0.005). The number of loose stools was significantly lower in the norfloxacin group. Nine adverse events were reported; seven in the placebo and two in the norfloxacin group. Pre- and post-travel faecal samples were studied in 19 patients treated with norfloxacin, 21 treated with placebo and 21 untreated subjects without diarrhoea. In treated subjects, increased frequencies of Escherichia coli resistant to ampicillin, co-trimoxazole, doxycycline and chloramphenicol were found in both groups, though more frequently in the placebo one. No subject had norfloxacin resistant Esch. coli pre- and post-travel.

The use of doxycycline in nervous system Borrelia burgdorferi infection.

Alternatives to high dose benzylpenicillin treatment are sought for in patients with mild Borrelia burgdorferi nervous system infection. Doxycycline 100 mg twice daily for 10-20 days was used in nine patients with radicular pains, vertigo or weakness in the legs caused by B. burgdorferi infection. The patients had suffered from neurologic symptoms for a median time of five months. In eight patients doxycycline was orally administered and in one intravenously. All nine patients had remission of radicular pain and vertigo during the treatment period. Two patients with weakness in the legs improved slowly in muscle strength over a three month period. The doxycycline concentration in the cerebrospinal fluid was 0.2-1.0 mg/l and in serum 1.9-7.1 mg/l after five days treatment. Doxycycline treatment was found successful in our patients with mild tick borne neuroborreliosis.