Twenty-eight-day courses of antibiotics for urinary tract infection.

A prospective double-blind study was performed in which 30 adult patients with recurrent urinary tract infections due to Escherichia coli, and Proteus mirabilis organisms were treated by twenty-eight-day courses of either ampicillin, 500 mg. four times a day, or trimethoprim-sulphamethoxazole, 2 tablets twice a day. In terms of freedom from infection fifty-six days after the cessation of treatment in both complicated and uncomplicated infections, trimethoprim-sulphamethoxazole yielded results superior to those of ampicillin. In comparing the results of this study with those of a similar study in which the same agents were given for ten-day courses it appears that only in the complicated infection is there an advantage in giving a prolonged course of trimethoprim-sulphamethoxazole. This study did not generate any evidence to support the extension of ampicillin therapy for urinary tract infection beyond ten days.

Septic arthritis due to pseudomonas in heroin addicts.

Ten cases of septic arthritis due to Pseudomonas occurred in users of heroin. Nine cases were monarticular, two each occurring in the sternoclavicular and the sacro-iliac joints. Review of the literature suggests that the incidence of Pseudomonas septic arthritis is increasing, especially among heroin addicts. The reported cases in adults suggest a predilection for the sternoclavicular joints (eight of forty-one) which is even more pronounced among addicts (seven of twenty-four). Pseudomonas infection associated with drug abuse should be suspected in cases of isolated sternoclavicular inflammation. The drugs used for treatment of septic arthritis due to Pseudomonas should include gentamicin and carbenicillin, in conjunction with adequate drainage by aspiration or surgery.

The early management of open joint injuries. A prospective study of one hundred and forty patients.

A study of open joint injuries treated at the Los Angeles County-University of Southern California Medical Center from July 1969 through July 1973 showed that the vast majority of these injuries were at the knee. Three types of injury were identified: those associated with fractures, injuries without fracture, and gunshot wounds. All patients were treated with antibiotics, surgical débridement and irrigation, and installation of polyethylene tubes into the joint as a system of postoperative closed irrigation. The over-all infection rate was 2.1 per cent. The results of treatment indicate that the irrigation system can be a source of contamination. Our recommended treatment for open wounds in joints is wide-spectrum systemic antibiotics, surgical débridement, irrigation of the joint and soft tissues, and primary closure. Prolonged suction-irrigation treatment postoperatively should only be done for specific indications: excessive contamination or excessive tissue damage when the wound to the joint should be closed primarily.

Antibiotic and bacteriologic considerations in open fractures.

A prospective study involving 581 open fracture wounds was conducted to evaluate the antibiotic and bacteriologic considerations in the treatment of open fractures. Multiple cultures were taken of each wound, and each wound had formal surgical irrigation and debridement. An organism was present in at least one of the multiple cultures in 62.1% of the cases. Open fractures should be considered as contaminated wounds, and antibiotics are given for treatment rather than prophylaxis.

The effect of antibiotics, primary and secondary closure on clostridial contaminated open fracture wounds in rats.

In a study of experimentally induced open tibial or femoral fractures in rats, after either closing or leaving the wounds open, the animals were given: no antibiotic, cephalothin (Keflin), or penicillin. The rats with wounds closed primarily and receiving no antibiotics had the highest mortality rate (11 of 25) from experimentally produced clostridial myonecrosis. The lowest overall mortality rate (5 of 99) was found in the penicillin-treated groups. The higher mortality rate in the femur fracture groups was probably because of the large muscle mass of the thigh. The importance of ideal anaerobic conditions for producing experimental clostridial myonecrosis is emphasized.

Gonorrhea screening program in a women's hospital outpatient department: results and analysis of risk factors.

Endocervical cultures for Neisseria gonorrhoeae were taken from 4,285 new patients attending the emergency room and outpatient clinics at Women's Hospital, Los Angeles County-University of Southern California Medical Center. Of these, 144 (3.4%) were positive. Clinic-specific rates were: emergency room 9.0%, family planning clinic 2.3%, therapeutic abortion clinic 2.2%, and prenatal clinic 1.0%. An additional 70 return patients were cultured because of history, symptoms, or signs suggestive of gonorrhea; 14% of these "nonscreen" cultures were positive. Rates for the emergency room and nonscreen category were significantly greater than rates from the clinics. A questionnaire was used to determine patient characteristics in an attempt to identify a high-risk population. Variables of age, race, marital status, history of previous veneral disease or pelvic infection, number of sexual partners, and suspicion of venereal disease were significantly related to the incidence of positive cultures. Obstetrical history and symptoms of cramping or discharge were not related.