Clinical efficacy of ciprofloxacin therapy for gram-negative bacillary osteomyelitis.

The efficacy and toxicity of ciprofloxacin, an orally administered fluoroquinolone, were evaluated in 24 infections in 23 patients with osteomyelitis caused by aerobic gram-negative bacilli. The diagnosis was confirmed by surgical findings and the results of bone biopsy and culture of bone or deep soft tissue. The aerobic gram-negative bacilli were Pseudomonas aeruginosa (15 isolates), Serratia marcescens (five isolates), Escherichia coli (three isolates), Enterobacter species (three isolates), Proteus mirabilis (one isolate), Pseudomonas fluorescens (one isolate), and Klebsiella pneumoniae (one isolate). Minimal bactericidal concentrations (MBCs) were 1.56 micrograms/ml or less for all but one isolate. Nine infections were polymicrobial, involving aerobic gram-positive cocci or anaerobes in addition to aerobic gram-negative bacilli. Additional antibiotics to which the aerobic gram-negative bacilli were resistant were given when the additional organisms were resistant to ciprofloxacin. Patients received 750 mg of ciprofloxacin twice daily for a mean of 62 days. Peak serum levels of ciprofloxacin were at least threefold higher than the MBCs in 20 of 24 patients. Twenty of 22 infections in which a full course of therapy was completed were without evidence of active disease at one to 17 months posttreatment. A sternotomy wound infection relapsed after eight weeks of therapy with a newly resistant S. marcescens strain, and an infection of a compound fracture relapsed two months posttreatment with a still sensitive P. aeruginosa strain. Toxicity was minimal in most patients: eosinophilia (six patients), nausea (eight patients), mild elevation in transaminase levels (three patients), pruritus (one patient), diarrhea (two patients), thrush (two patients), rash (two patients), and mild leukopenia (one patient). Two additional patients had severe side effects (vertigo in one and acute renal failure in another) that required discontinuation of ciprofloxacin therapy. Overall, ciprofloxacin is a promising agent for the oral treatment of gram-negative bacillary osteomyelitis.

Total nitrogen and electrolyte levels in colostrum and transition human milk.

The objective of this research was to study the composition of human milk in terms of protein levels and levels of the electrolytes sodium, potassium, calcium, magnesium, phosphorus and chloride in colostrum 48-72 hours post-partum, and in the transition milk (96 +/- 9 hours, 120 +/- 9 hours and 144 +/- 9 hours post-partum) of mothers who had fullterm and pre-term deliveries. The mothers were kept in the hospital with the objective to control a few important lactation parameters such as exercising or resting conditions, sleep, nutrition and suckling stimulation. Only low socioeconomic level mothers took part in the study. The initial period of lactation was studied because this is the time when secretion suffers rapid changes, going from colostrum to transition milk, and then to mature milk. The results observed for the different times and for the two groups were compared both within and between groups. No significant differences were obtained for any of the comparisons, except for transitory oscillations in potassium, calcium, chloride and phosphorus levels observed within groups. In general, it can be said that there was no variation between colostrum and transition milk for the mothers who delivered at full term or pre-term. No differences were found either when the groups were compared at the different times post-partum. This means that, under the conditions used in this study, milk did not vary as its type naturally changed (from colostrum to transition milk) for the two groups and that the levels of the constituents studied also remained unchanged when studied as a function of full-term or pre-term delivery.(ABSTRACT TRUNCATED AT 250 WORDS)

Gonococcal endocarditis in a patient with mitral valve prolapse: study of host immunology and organism characteristics.

The first case of gonococcal endocarditis on a prolapsing mitral valve is reported. The organism was found to be highly sensitive to penicillin G, Arg- Hyp- Ura-, and sensitive to the bactericidal action of normal serum. This combination of characteristics in a strain of Neisseria gonorrheae causing systemic disease is distinctly unusual. With high dose penicillin therapy the immunologic parameters returned to normal and the patient made an uneventful recovery. High levels of circulating immune complexes were detected in the patient's serum.

In vitro activity of cefaclor, a new orally administered cephalosporin antibiotic.

The in vitro antibacterial activity of cefaclor, cephalothin, and cephalexin against 261 clinical isolates of Staphylococcus aureus and Enterobacteriaceae was compared. Cefaclor and cephalexin were about equally active against S. aureus. Cefaclor was the most active cephalosporin against Escherichia coli, Proteus mirabilis, and Klebsiella pneumoniae. The effect on the antimicrobial activity using a relatively high and low inoculum was pronounced for cefaclor when compared with that of cephalothin.