Penicillins and macrolides in the treatment of community-acquired respiratory tract infections.

The use of penicillins and macrolides in the management of community-acquired respiratory tract infections is evaluated in relation to such factors as antimicrobial activity, stability, pharmacokinetics and adverse reactions. Attention is directed to the side effects of drugs, e.g. to the clear advantages of 16 (e.g. spiramycin) vs. 14 (e.g. erythromycin)-membered ring macrolides, and examples are drawn to illustrate the tactics of antimicrobial therapy in the management of pneumonias.

[Management of foreign tourists' diseases at the American Hospital in Neuilly]. / Prise en charge des touristes étrangers malades à l'Hôpital américain de Neuilly.

More and more foreign tourists are being treated at the American Hospital of Paris. The main reasons for this are the presence of a 24 hour medical and dental emergency service, in addition to the availability of MRI, CT scan and comprehensive laboratory facilities. The hospital is multidisciplinary, where short stay hospitalizations are the rule. English is the second most commonly used language. There is a permanent Japanese language service for Japanese patients. Qualitative data is presented concerning the management of patients according to specialty and nationality. American and Japanese patients admitted to the hospital in 1997 are surveyed according to their mean age, reasons for admission and appropriate specialty as well as mean length of stay noted. The greatest number of hospitalizations in decreasing order and according to nationality are as follows: American, Japanese, Moroccan Egyptian and Saudi Arabian. The consultations and hospitalizations of Japanese patients between 1990 and 1997 are compared.

[Acquired immunodeficiency syndrome and related syndromes. Critical analysis of biological tests of cell-mediated immunity]. / Syndrome d'immunodéficit acquis et syndromes apparentés. Analyse critique des examens biologiques de l'immunité à médiation cellulaire.

In order to assess the actual value of the in vitro tests of cellular immunity performed to provide diagnostic evidence for acquired immune deficiency syndrome (AIDS) or related syndromes, we have evaluated T-lymphocyte subsets and in vitro proliferative responses. The respective profiles of 44 symptom-free homosexual men, 30 patients with AIDS and 42 patients with lymphadenopathy were compared with each other and with profiles of blood bank volunteers, using stepwise discriminant analysis. At first investigation, control homosexuals, AIDS patients and lymphadenopathy patients displayed varying degrees of the same type of immunological abnormalities. The percentage of OKT4+ cells was the most discriminant variable between blood donors and control homosexuals, AIDS or lymphadenopathy patients. The latter differed from homosexuals by a higher percent of OKT8+ cells and from AIDS patients by a lesser reduction in T-lymphocyte counts. OKT4+ cell counts differentiated AIDS patients from control homosexuals. However, none of these major discriminant variables could classify correctly more than 70% of subjects in the homosexual and in the two patient groups. Thus, a single investigation of T-lymphocyte immune parameters does not provide substantial diagnostic and prognostic evidence.

[Group A beta-hemolytic Streptococcus: an unusual etiology of perianal dermatitis in an adult?]. / Le streptocoque beta-hémolytique du groupe a: une étiologie exceptionnelle de dermite péri-anale chez l'adulte?

BACKGROUND: Perianal dermatitis usually occurs in children between 1 and 8 years of age. We report a sixth case in an adult. CASE REPORT: A 33 year-old woman complained of perianal itching which quickly extended to the vulva and persisted in spite of anti-hemorrhoid and anti-fungal treatments. After 12 days, she had painful defecation, a well demarcated perianal and vulvar erythema and anal collection. Culture from a perianal swab isolated group A beta-hemolytic Streptococcus (ABHS). After surgical treatment of the collection and a 7 days oral amoxicillin regimen, the patient recovered with no recurrence. DISCUSSION: Symptoms of perianal dermatitis are unspecific, leading to delayed diagnosis and underestimated frequency. Symptoms consist in perianal erythema. Swab culture shows ABHS. The mechanism of colonization of perianal area is not well defined. Although treatment with oral penicillin is usually effective, failures and relapses have also been reported. Complications such as deep infection or abcess formation are infrequent. A bacterial swab should be made in patients with persisting perianal erythma.

[The choice of a prophylactic antibiotic by the surgeon]. / Choix d'un antibiotique prophylactique par le chirurgien.

The difficult problem of the choice of antibiotic, when treatment is assumed to be necessary for prevention of postoperative infection, is discussed in relation to published data and the rules for prescribing antibiotics. Complications of antibiotic therapy are summarized, and the principal etiologic bacteria, as a function of the type of operation, are described. Surgical acts can be grouped in four categories as a function of the frequency with which they are followed by infection. Criteria of choice of antibiotic and the advantages and inconveniences of preventive antibiotic treatment are outlined. Results of the main controlled studies are reviewed in relation to the type of surgery performed, and an attempt made to choose from among the most effective products. As the ecological risk appears to be of primary importance, narrow spectrum antibiotics are preferred, as they have the minimum effect on host flora. These include penicillin G for certain gynecological operations, as well as in ENT surgical procedures, and metronidazole (Flagyl) for lower digestive tract surgery or gynecological procedures.

Effects of hyperosmolality on candidacidal activity of human neutrophil polymorphonuclear leukocytes and on clumping of Candida albicans by human serum.

Hyperosmolalities comparable to those of the renal medulla did not altered the clumping of C. albicans by human serum but diminished ingestion and evenmore the killing of C. albicans by human polymorphonuclear leukocytes (PMN).

[Fungicidal and phagocytic activity against "Candida albicans" of human neutrophils in serum depleted in C3 and C4 (author's transl)]. / Pouvoirs phagocytaire et fongicide envers Candida albicans des polynucléaires neutrophiles humains en présence de sérum dépourvu de C3 et C4

Cases of systemic infections caused by C. albicans are increasing in number and the kidney appears to be involved more often than any other tissue. The renal medulla is especially susceptible to infection by C. albicans and by bacteria - Previous works has showed that this is essentially due to hyperosmolality and to inactivation of the complement system. Polymorphs are one of the main host defense mechanisms against C. albicans and the authors have studied their power of phagocytosis against Candida and fongicidal activity in serum depleted in C3 and C4. Both are found to be normal.

[Immunosuppressive therapy and candidacidal activity of human neutrophils (author's transl)]. / Agents immunodépresseurs et pouvoir fongicide des polynucléaires neutrophiles humains

Human neutrophils incubated with 8 immunosuppressive agents ingest and kill normally C. albicans and C. pseudotropicalis. It agrees with previous studies of living microorganism phagocytosis. The decreased resistance to infection of patients treated with immunosuppressive agents seems not to be due to impaired granulocyte phagocytosis.

[Spiramycin ; therapeutic value in humans. (author's transl)]. / La spiramycine. Utilisation en thérapeutique humaine.

Spiramycin gives high tissue levels and has very-few side-effects. It is one of the best antibiotics in infections of the upper and lower respiratory tract and of the oral cavity. It is probably one of the most effective antibiotics against chlamydia. Spiramycin is useful when toxoplasmosis occurs during pregnancy or results in severe diseases in non-immunodepressed patients. For the reasons listed above, we believe that spiramycin has been underestimated. This is the result of assessing its value according to its rather high MIC rather than to it's effectiveness against infection in animals and humans.

[Antibiotic prophylaxis in surgery (author's transl)]. / Antibiothérapie prophylactique en chirurgie.

Post-operative infections are of course due to bacterial contamination, but also to local conditions favourable to bacterial growth, and to lowering of host defences. Antibiotic prophylaxis is indicated in "clean-contamined" surgery, in surgery on immunodepressed patient and in bone prosthesis. The risk is mainly ecological. Antibiotics are useless when administered after the first post-operative day. The results of well-conducted controlled studies demonstrating, for instance, the value of metronidazole in surgery of the large bowel and appendix are reported.

Administration of levodopa for relief of herpes zoster pain.

Forty-seven outpatients with herpes zoster, seen within five days of onset of the eruption, received ten days' administration of oral levodopa and benserazide or placebo in a double-blind controlled study. Both the total patient group and high-risk group, eg, those with either ophthalmic zoster or those older than 65 years, were analyzed. Both groups were comparable in terms of demographic and pathological criteria. Vomiting was the only side effect observed in both groups. A significant decrease in intensity of pain was seen in the group receiving levodopa from the third day, and complete cessation of both pain and sleep disturbances was more frequent in the patients. Two months later, postherpetic neuralgia was also less frequent in the group that received levodopa.

Acute bronchopulmonary infections: treatment with i.v. spiramycin.

This paper reports the results of an open study to assess the efficacy (433 patients) and tolerance (453 patients) of spiramycin adipate given by slow intravenous infusion to treat severe acute bronchopulmonary infections in adults. Efficacy was good in 80.4% of patients. More specifically, high efficacy was obtained in 76.5% of 85 pneumococcal respiratory infections, 72% of 50 Haemophilus influenzae and H. parainfluenzae infections, 100% of 18 Mycoplasma infections, 100% of 16 Chlamydia infections and 93% of 14 Legionella infections. Tolerance was good in 83.5% of patients, moderate in 15.4% and poor in 6%. Venous irritation was the most frequent complication, observed in 16.3% of patients. No serious complication or sequel was observed. The authors conclude that spiramycin adipate constitutes an appropriate first-line treatment of acute bronchial and/or pulmonary infections in adults. While inferior to benzylpenicillin against Mycoplasma, Chlamydia and Legionella, spiramycin is as active as, and better tolerated than, erythromycin.