The influence of physician specialty on housecalls.

Despite growing numbers of frail elderly, physicians make housecalls infrequently. We surveyed 1000 primary care physicians from Virginia regarding their attitudes and knowledge about housecalls, and 389 completed questionnaires (response rate, 52%): 185 family physicians, 36 general practitioners, 101 general internists, and 63 subspecialists. Despite similar proportions of homebound patients and practice demographics, family physicians (69%) and general practitioners (63%) were significantly more likely than either internists (53%) or subspecialists (37%) to make routine housecalls. Although all four groups thought the fee was rarely a motivation, internists and subspecialists suggested larger increases. Also, internists and subspecialists were less likely than family physicians or general practitioners to increase housecalls with increased payment. Internists and subspecialists also were more likely than family physicians or general practitioners to report that housecalls were often unnecessary, not "enjoyable," "inefficient," and unimportant. While improved reimbursement may lead to increased housecalls by family physicians, future strategies should include efforts to change internists' attitudes.

Clinical evaluation of piperacillin therapy for infection.

Piperacillin sodium, a semisynthetic penicillin that inhibits many Klebsiella and Pseudomonas aeruginosa organisms resistant to carbenicillin, was used to treat 41 episodes of infection in 35 patients. Infectious sites included lungs, urinary tract, and tissue, including peritonitis. Seven patients had bacteremia. Clinical and bacteriological cures were achieved in 85% of infections. Cure was achieved with piperacillin in patients infected with carbenicillin-resistant P aeruginosa and Klebsiella organisms. Adverse effects were minor and included rash in two patients. Serum levels were easily maintained above the inhibitory levels for susceptible organisms. Piperacillin was a safe, well-tolerated, and effective antimicrobial agent.

Kinetics of mezlocillin and carbenicillin.

The kinetics of mezlocillin, a semisynthetic acylureido penicillin, more active than carbenicillin against many gram-negative bacteria, were compared with those of carbenicillin. Following an intravenous infusion of 4 gm in 5 min to 8 normal men there was an average serum level of 294 microgram/ml for mezlocillin and 365 microgram/ml for carbenicillin. The t1/2 for mezlocillin was 47 min and that for carbencillin was 70 min. The apparent volume of distribution was 13.4 L for mezlocillin and 14.4 L for carbenicillin. The mean urinary recovery of mezlocillin was 72% and that for carbenicillin was 92%. Constant infusion of 5 mg of mezlocillin over 2 hr gave steady-state levels of 234 microgram/ml. Half-life, apparent volume of distribution, and serum and renal clearance of mezlocillin after constant infusion were in the same range as those after rapid infusion.

Mezlocillin in the therapy of serious infections.

Mezlocillin, a new semisynthetic penicillin chemically related to ampicillin which is more active than carbenicillin against Ps. aeruginosa, B. fragilis and Strep. faecalis and which inhibits many Klebsiella, was evaluated in the therapy of 34 episodes of infection in 26 patients. Infection sites included pulmonary, urinary tract and tissue infections, including peritonitis. Seven patients had bacteremia. Clinical cures were achieved in 83 per cent and bacteria cures in 76 per cent of infections. Cure was achieved with mezlocillin in patients with infections caused by carbenicillin-resistant species. Adverse effects of therapy were minimal, one rash and one episode of reversible neutropenia. Serum and body flevels of susceptible organisms.uid levels were easily maintained above the inhibitory levels of susceptible organisms. Mezlocillin was a safe, well tolerated and effective antibiotic in the treatment of infections due to susceptible organisms.

Aminoglycoside antibiotics in clinical use.

Aminoglycosides are among the most used antibiotics despite competitive pressure from newer beta-lactam agents. The activity profile, pharmacology, toxicity potential, and methods of toxicity prevention of aminoglycosides are well appreciated after three decades. Nephrotoxicity, ototoxicity, and the added costs of drug level monitoring limit wider usage, but great activity against highly antibiotic resistant gram negative bacteria often outweigh these disadvantages and will likely keep aminoglycosides available for the foreseeable future.

Brief report: bacteriological sampling of telephones and other hospital staff hand-contact objects.

In an acute-care general hospital, 114 telephones, intercoms, dictaphones, and bedpan flusher handles were sampled in patient-care areas for type of bacterial contamination. Nine of these (7%) demonstrated potentially pathogenic bacteria including Klebsiella, Enterobacter, Pseudomonas and Aeromonas. Inanimate, environmental, staff hand-contact objects were only lightly contaminated, did not represent a significant reservoir of gram-negative organisms, and therefore, would be unlikely to be a vehicle of transmission of gram-negative bacteria from the hands of one staff member to another under routine circumstances. Surveillance and disinfection of telephones and related hand-contact items in the hospital appear unnecessary.

Effect of trimethoprim and trimethoprim-sulfamethoxazole on development of drug-resistant vaginal and fecal floras.

Trimethoprim-sulfamethoxazole (TMP-SMX) or trimethoprim (TMP) alone was given on a random double-blind basis to 26 young women to treat urinary tract infections. Fecal and introital aerobic bacterial floras were identified at 1, 7, 14, and 42 days to analyze changes in these floras or development of resistance to TMP or TM-SMX. Neither TMP alone nor the TMP-SMX combination administered for 2 weeks selected a resistant fecal or introital flora. In the few individuals who had strains resistant to TMP or TMP-SMX before initiation of therapy, these organisms did not persist once therapy began. Both programs effectively cleared the introitus and rectal areas of Enterobacteriaceae. Concentrations of TMP adequate to inhibit the majority of Escherichia coli strains causing urinary tract infections were found in the vaginal secretions.

Factors associated with the frequency of house calls by primary care physicians.

OBJECTIVE: To evaluate factors associated with the frequency of house calls by primary care physicians. DESIGN: A cross-sectional design with a self-administered mailed survey. SITTING/PARTICIPANTS: 751 primary care physicians who care for Medicaid patients in Virginia. RESULTS: Among 389 physician respondents (52%), regular house callers (n = 216) were compared with occasional house callers (n = 162). Among physician characteristics, specialty and practice duration were associated with house call frequency. Regular house callers also more often cited chronic illness (67% vs. 20%, p less than 0.01) and terminal illness (67% vs. 40%, p less than 0.01) as indications for house calls, compared with occasional house callers. Use of visiting nurses to substitute for physician house calls was less often considered appropriate by frequent house callers (7% vs. 24%, p less than 0.01), and regular house callers were less likely to report being "too busy" to make house calls (71% vs. 29%, p less than 0.01). Multivariate analysis confirmed the association of these attitudes with house call frequency. CONCLUSION: These data suggest that specific attitudes among primary care physicians are associated with house call frequency.