Distressing side-effects of minocycline hydrochloride.

Minocycline hydrochloride is a tetracycline derivative that has been advocated as the drug of choice in the treatment of meningococcal carriers. Recently, we studied a group of 30 patients who experienced a large number of side-effects after receiving minocycline for treatment of meningococcal meningitis. Twenty-seven of 30 (90%) suffered from dizziness, vertigo, ataxia, weakness, nausea, and vomiting. These symptoms appeared within the first 72 hours of taking minocycline, and disappeared within 48 hours of stopping the medication.

Contraception and cervical colonization with mycoplasmas and infection with cytomegalovirus.

The relationship of cervical colonization of genital mycoplasmas and infection with cytomegalovirus (CMV) was studied in 66 intrauterine device (IUD) users as contrasted to 60 patients using oral contraception and 50 patients using neither an IUD nor oral contraception. No significant increase in colonization or genital mycoplasmas or infection with CMV was noted in IUD users. No CMV was isolated from users of the cooper-t IUD. It is unlikely that genital mycoplasmas are related to either the increased immunoglobulin levels seen in patients using the IUD or the antifertility effects of the IUD.

PIP: An ivestigation based on the hypothesis that the IUD might induce an endometritis related to a nonbacterial infection was undertaken in 66 IUD users and contrasted to 60 oral contraceptive (OC) users and 50 nonusers of OCs and IUDs. The relationship of cervical colonization of genital mycoplasmas and infection with cytomegalovirus (CMV) was studied yielding the following information: 1) Genital mycoplasma colonization among the groups studied differed insignificantly; 2) An insignificant increase in colonization of genital mycoplasmas or infection with CMV was noted in IUD users; 3) There were no CMV isolates from the group using the Copper T IUD; 4) CMV infection did not appear to be significantly increased by IUD presence; and 5) The overall rate of 5.2% of CMV infection was comparable with that of other studies. Results indicated the unlikelyhood that genital mycoplasmas are related to either the increased immunoglobulin levels noted in patients using the IUD or to the IUD's antifertility effects.

Vancomycin for treatment of bacterial meningitis.

Clinical experience with vancomycin for the treatment of bacterial meningitis has not been extensive. Presently available data indicate that when meningeal inflammation is present intravenously administered vancomycin penetrates into cerebrospinal fluid and therapeutically effective levels of drug therein are frequently attained. Treatment of meningitis with vancomycin has been effective in clinical situations that precluded the use of the commonly administered agents, i.e., in infections due to resistant strains or to unusual organisms, in patients allergic to penicillin, and in patients for whom therapy with a first-choice antibiotic has failed. When response to intravenously administered vancomycin was unsatisfactory, the addition of intrathecal therapy resulted in a favorable outcome in some patients. Combination therapy with agents that act synergistically with vancomycin has been beneficial. Vancomycin warrants serious consideration as a useful alternate antibiotic for the treatment of bacterial meningitis.

Legionnaires' disease and fever of unknown origin.

In a patient with fever of unknown origin and granulomas of the liver extensive serological testing revealed a significant rise in antibodies only to Legionella pneumophila despite the fact that he never was shown to have pneumonia. Absorption studies yielded additional evidence that this immunological response was specific for L. pneumophila. Bacteremia and extrapulmonary involvement, including the liver, has been shown with L. pneumophila, but never without pneumonia. Furthermore, granulomas of the liver have not been described in connection with legionellosis. This patient is regarded as a case of fever of unknown origin related to L. pneumophila infection.

Chloramphenicol: an impatient study of use and abuse.

During a six-month period, chloramphenicol was administered systemically to 100 patients and topically to 24 patients who were admitted to the Medical Center Hospital of Vermont, Burlington, Vermont. Seventy-nine percent of the patients receiving the drug systemically were on surgical services, 13% were on the pediatric service, and 8% were on the medical service. In this group, chloramphenicol was administered appropriately in 60.4% of cases as follows: 57.5% on the surgical, 50% on the medical, and 84.6% on the pediatric services. In 19 of 35 instances of inappropriate use on the surgical services, a potentially less toxic antibiotic could have been chosen. Eight cases were treated inappropriately because of dosage errors, and in seven cases no antibiotic should have been used. On the medical services all inappropriate use was due to underdosage, and on the pediatric service there was one case of incorrect dosage and one instance in which a less toxic antibiotic could have been chosen. Ophthalmological use of the drug accounted for all topical use. Of 24 patients treated, 21 received the drug for prophylaxis and three for therapy.

Pulmonary infections due to Legionella in immunocompromised patients.

At present, 11 different species of Legionella have been implicated in human disease. It has become apparent that disease caused by Legionella is acquired from a variety of environmental sources and that water is the factor that links many of them. Patients who are immunosuppressed, such as individuals receiving cancer chemotherapy or therapy designed to prevent organ rejection, are particularly susceptible to such environmental sources. It appears that intact cell-mediated immunity is more important in host defense than are adequate numbers of granulocytes or immunoglobulin concentrations. Diagnostic steps should be undertaken in all patients developing nosocomial pneumonia who present with a picture suspicious for this disorder. In the meantime, appropriate antimicrobial therapy with erythromycin and rifampin should be begun. If clusters of cases are detected in a hospital, immediate steps should be taken to attempt to isolate the organism from any aqueous environmental sources, and if found appropriate, steps taken. Awareness of the threat of legionnaires' disease must be maintained among clinicians and hospital epidemiologists because it is unlikely that the problem of nosocomial legionnaires' disease will disappear.

Activity of cefoperazone and two beta-lactamase inhibitors, sulbactam and clavulanic acid, against Bacteroides spp. correlated with beta-lactamase production.

A total of 102 isolates of Bacteroides spp. were studied for beta-lactamase production and susceptibility to cefoperazone alone or in combination with either of the beta-lactamase inhibitors sulbactam and clavulanic acid. The geometric mean minimal inhibitory concentration of cefoperazone alone was 31.5 micrograms/ml and when combined with 10 micrograms of sulbactam per ml or 2 micrograms of clavulanic acid per ml was reduced to 5.4 and 9.2 micrograms/ml, respectively. When bacterial suspensions were tested for beta-lactamase production with nitrocefin, 91 (89.2%) of these isolates produced the enzyme. The geometric mean minimal inhibitory concentrations of cefoperazone rose only slightly for isolates with low or intermediate enzyme activity but rose significantly for those with high activity. The addition of EDTA to cefoperazone significantly more frequently enhanced the activity of cefoperazone against beta-lactamase-negative as opposed to beta-lactamase-positive isolates. Furthermore, EDTA resulted in synergistic activity of the cefoperazone-sulbactam combination on beta-lactamase-positive isolates for which the combination had previously not shown a synergistic effect. This study demonstrates the relationship between beta-lactamase production and the resistance of Bacteroides spp. to cefoperazone and shows that inhibition of these enzymes can reverse this resistance.

Severe Mycoplasma pneumoniae pneumonia.

Four cases of severe Mycoplasma pneumoniae infection are reported which were treated in a single hospital over the course of 4 years. The difficulties in the diagnosis of M. pneumoniae infections are eminently demonstrated by these cases. Because of the fact that it generally takes 2-o weeks to make this diagnosis, the physician must utilize clues of limited reliability. If gram stains and culture of sputum fail to demonstrate any bacterial pathogen and the patient has a chest X-ray compatible with this diagnosis as well as a white blood count less than 15,000/mm3, M. pneumoniae infection may be present. A good antimicrobial choice in such a situation is erythromycin.