Abuse of antibiotics. A study of patients attending a university clinic.

Self-treatment with antibiotics was evaluated among patients at a university health service in an 18-month period. Sixty-two students ingested antibiotics, usually tetracycline (40%) or penicillin (21%), for varying intervals before seeking medical care. Respiratory symptoms were the most common reason (40%). The most frequent drug source was residual medication obtained by prescription from a private physician for a prior illness (43%). Although self-therapy was of short duration, the negative bacteriologic cultures obtained on our evaluation in all but four patients challenged precise diagnosis. The findings indicate that inappropriate use of antibiotics by patients would be curtailed by prescribing only the exact amount needed for a given illness and by emphasizing the need for completion of the course of therapy.

Decreased T cell levels in patients with warts.

Thymus-derived lymphocyte (T cell) levels were determined in 72 healthy patients who had viral warts, in 21 healthy patients who had been cured of warts from one to 15 years previously, and in 35 age-matched normal controls who had no history of warts. The mean percentage of lymphocytes that formed rosettes with sheep erythrocytes was less in patients with warts and patients previously cured of warts than in normal controls (P less than .001 and P less than .001, respectively). The number of total T cells/cu mm was decreased in untreated patients with warts (P less than .01) but was normal in patients cured of warts for more than one year. In addition, the morphology of the rosettes in the two patient groups differed from the controls; 32% had small numbers of sheep erythrocytes bound loosely to T cells compared with a rosette of numerous erythrocytes closely adherent to the T cell in 91% of the controls. The results suggest a defect of cellular immunity in many healthy patients with warts.

How frequent is bacterial superinfection of the pharynx in infectious mononucleosis? Observations on incidence, recognition, and management with antibiotics.

Throat cultures from 133 patients with infectious mononucleosis were compared with cultures from 2,881 patients who were seen during the same period because of pharyngitis. Less than 3 per cent of the cultures from each group contained Group A beta hemolytic streptococci. The inflamed pharynx and necrotic tonsils of infectious mononucleosis are seldom subject to bacterial superinfection, either initially or during the course of the illness. There is no indication for routine use of antibiotics when infectious mononucleosis is diagnosed. Should, however, a throat culture indicate presence of a bacterial pathogen, any appropriate antibiotic except ampicillin may be used without increasing the incidence of skin rash.

Rubella: pattern of outbreak in a university.

During the spring term of 1975, rubella was diagnosed in 23 students at Georgetown University in Washington, DC. The cases were concentrated among students from the School of Foreign Service and their close contacts; outbreaks did not appear in other divisions of the university. Rubella immunization of susceptible female college personnel is recommended.

Predictors of the duration of infectious mononucleosis.

The clinical course of infectious mononucleosis was monitored in 122 patients to determine predictors of duration of illness. Gastrointestinal symptoms and palatal petechiae were associated with a prolonged recovery period. Multiple regression analysis of quantitative data identified the number of days from onset of symptoms to diagnosis as the only statistically significant indicator. Liver enzymes, white blood cell count, percentage atypical lymphocytes and heterophil titer had no prognostic value for the length of illness.

Efficacy of undecylenic acid-zinc undecylenate powder in culture positive tinea pedis.

One hundred fifty-one patients with tinea pedis participated in a double-blind study to assess the efficacy and safety of a powder containing undecylenic acid 2% and zinc undecylenate 20% versus a placebo powder. Patients were assigned to apply twice-daily applications of either active powder or placebo for a period of 4 weeks. Trichophyton rubrum or Trichophyton mentagrophytes were isolated from pretreatment cultures of 85 patients. Of these, 88% treated with active powder had negative cultures after 4 weeks compared with 17% of those treated with placebo powder (p less than 0.001). Fungus was identified in potassium hydroxide (KOH) treated skin scrapings of all 151 patients before treatment. Of those treated with active powder, 80% were KOH negative after 4 weeks compared with 49% of those treated with placebow powder (p = 0.001). Erythema and scaling were significantly improved by therapy with active powder, as were subjective evaluations of itching and burning. There were no side-effects or adverse reactions to undecylenic acid and its zinc salt.