Value of oral antibiotic prophylaxis in colorectal surgery.

A total of 169 patients undergoing colorectal surgery were randomly allocated to receive either gentamicin plus metronidazole or oral ciprofloxacin plus metronidazole as prophylaxis; they were also allocated to receive cover for 1 or 3 days. Twenty-eight patients (17 per cent) developed postoperative wound infections. The proportion of patients with wound infections and other infective complications was significantly less (P < 0.02) in those receiving oral ciprofloxacin. Cover for 3 days was no better than that for only 1 day. Oral ciprofloxacin for prophylaxis may offer advantages in efficacy and ease of administration compared with parenteral antibiotics.

Oral ciprofloxacin as prophylaxis in gastroduodenal surgery.

One hundred and fifty patients undergoing gastroduodenal surgery were randomly allocated to receive intravenous (iv) cefuroxime, iv ciprofloxacin or oral ciprofloxacin as prophylaxis. There were no differences in the incidence of postoperative infection complications or duration of stay among the three groups. Oral ciprofloxacin offers obvious advantages in terms of ease of administration and cost.

The value of oral antibiotic prophylaxis in biliary tract surgery.

In this study the relationship between the presence or absence of organisms in bile or on closing wound swabs and the subsequent development of wound sepsis was confirmed. There was no significant difference in the incidence of septic complications among three treatment groups in which cefuroxime (iv) and ciprofloxacin (iv or oral) were administered. Consideration of costs attributable to the choice of antibiotic prophylaxis suggests that oral ciprofloxacin in biliary tract surgery may offer significant advantages.

Single dose aztreonam in treating gonorrhoea.

Of 108 consecutive patients with urogenital gonorrhoea treated with a single 1 g intramuscular dose of aztreonam, 102 were suitable for evaluation. There was 100% cure at urogenital sites but treatment failed at three of 14 (21%) rectal or pharyngeal sites. In vitro resistance to aztreonam was not noted.

Outbreak of Legionnaires' disease in Glasgow Royal Infirmary: microbiological aspects.

The bacteriological investigation of an outbreak of Legionnaires' disease in Glasgow Royal Infirmary affecting 16 patients is described. Most of the patients had been treated in high-dependency areas on two floors of the hospital supplied by the same two air-conditioned ventilation systems. The source of infection was traced to contamination of a cooling tower from which a plume of spray discharged into the intake vents of the two ventilation systems. Rubber grommets within the cooling tower probably provided a nidus of infection there. The control and management of the outbreak are discussed: a policy of frankness about the course and progress of the investigations was adopted and helped to allay anxiety on the part of both staff and media.

Prophylaxis with tinidazole of infection in major head and neck surgery for malignant disease.

In a double-blind study, 20 patients undergoing surgery for the removal of an oropharyngeal squamous carcinoma received tinidazole either as a single perioperative prophylactic dose of 2 g or as a treatment course of 8 g given over a 7 day period. The wounds were assessed daily and specimens of fluid from the upper neck drain were submitted for culture. Four patients, two in each group, developed complications that might have been associated with infection (flap necrosis, fistula formation or both). There was no significant difference in the efficacy of these two regimens and single dose prophylaxis with tinidazole is advocated.

Augmentin (amoxycillin-clavulanic acid) compared with amoxycillin alone in the treatment of urinary tract infections in the elderly.

Sixty-seven patients (mean age 82 years) with urinary tract infection were treated with either Augmentin or amoxycillin in a double-blind randomised trial. Of the 52 patients who completed 5 days treatment, 21/24 (87.5%) responded to Augmentin but only 12/28 (43%) responded to amoxycillin. Five of eight patients who had failed to respond to amoxycillin responded to Augmentin.

Lung tissue penetration of temocillin.

Eight patients about to have the whole or part of a lung resected were given a 2g bolus dose of temocillin. A series of serum samples and a piece of peripheral lung tissue were collected and assayed for temocillin concentration. 30 minutes after drug administration, the mean serum and tissue concentrations were 172 mg/L and 45 mg/kg respectively.

Temocillin in the treatment of chest infections.

In our study, 16 patients with acute infection complicating severe respiratory disease were treated with temocillin 2g or 3g daily for 5 to 10 days. In 10 patients, a recognised respiratory pathogen, either Haemophilus influenzae (temocillin-sensitive) or Streptococcus pneumoniae (temocillin-resistant), was isolated from sputum before the start of treatment. 13 patients improved clinically but 5 subsequently relapsed. Two patients failed to respond, and 1 died of respiratory failure. There was no clearcut relationship between the clinical progress and sensitivity of the isolated pathogen to temocillin, and there were no adverse effects associated with the administration of temocillin.

Netilmicin sulfate prophylaxis in the surgical treatment of renal stones.

The role of short course (three doses) and single dose peroperative antibiotic (netilmicin sulfate) prophylaxis were studied in 42 patients undergoing removal of renal calculi. In an untreated group, the urine sample taken preoperatively was infected in 37.5 per cent, but the removed stone demonstrated significant bacterial growth in 67 per cent, with a wound complication rate of 25 per cent. Use of antibiotic prophylaxis reduced the wound complication rate to 5 per cent. Satisfactory serum levels of the antibiotic were achieved during the operative period, with an acceptable rate of clearance of netilmicin sulfate from the blood stream.

Streptococcal infection in a regional burns centre and a plastic surgery unit.

An outbreak of infection due to group A streptococci of M-type 49 involved first a regional burns centre followed by spread to the intensive care ward of the plastic surgery unit in an associated hospital. Eleven patients and two staff were involved: two of the infected patients developed septicaemia. Serological tests demonstrated marked antibody response to DNAase B(ADB) and there were lesser reactions to other extracellular streptococcal products. Screening of patients and staff identified the likely source of the epidemic which was rapidly controlled by penicillin prophylaxis and other measures.

Successful prophylaxis with tinidazole of infection after major head and neck surgery for malignant disease.

A prospective double-blind trial of tinidazole was carried out in a group of 8 patients, each undergoing radical surgery for the removal of a large squamous cell carcinoma (SCC) of the oropharynx. In the 4 patients given tinidazole there was no wound infection, wound healing was more rapid and the foul odour associated with infection in such patients was eliminated. Post-operatively, 3 of the 4 patients given the placebo developed wound infections. Mixed cultures of gram-negative anaerobic bacilli, predominantly bacteroides, were grown from the upper drain fluids of the infected patients. Anaerobes were not isolated from the drain fluids of patients receiving tinidazole. The efficacy of tinidazole was demonstrated in these patients who are at high risk of acquiring infection because of the extensive surgery required for tumour removal and the inevitable contamination of the tissues with the diverse, resident oral flora.

Endotoxaemia in septic shock: clinical and post mortem correlations.

The Limulus amoebocyte lysate assay was used as one of a series of laboratory and clinical investigations on a group of 31 patients suffering from septic shock in order to assess the clinical significance of this assay for the detection of circulating endotoxin in clinical gram-negative sepsis. Four patients with cardiogenic shock served as controls. Endotoxin was detected in the bloodstream of all patients with septic shock during the 24 h following referral and was not detected in the control patients. Eventual clinical recovery was associated with the disappearance of endotoxin from the peripheral blood. Blood cultures were unhelpful as a prognostic indicator in these critically ill patients. A quantitative assay of endotoxin in blood may allow a more precise relationship with the clinical manifestations of major sepsis.