An outbreak of infection caused by a strain of Staphylococcus aureus resistant to gentamicin and tobramycin and other antibiotics occurred in two wards in a hospital. Eight patients were colonized, of whom six had clinical infections. Previous administration of gentamicin appeared to predispose the patients to infection with the strain. Restriction of the use of gentamicin and tobramycin is essential to preserve their value in serious infections.

Three-hundred and twelve episodes of fever in 234 neutropenic patients with haematological malignancies were treated empirically with either imipenem or a combination of piperacillin and gentamicin. There were no significant differences in the percentages of patients responding to therapy at either 72 h (59% and 56% of assessable episodes in the imipenem and combination groups respectively) or at the end of treatment (55% and 53% of assessable episodes in the imipenem and combination groups respectively). Patients in the piperacillin plus gentamicin group experienced significantly more renal tubular damage whereas those who received imipenem suffered more nausea or vomiting. We conclude that imipenem monotherapy represents an acceptable alternative to piperacillin plus gentamicin as empirical therapy of the febrile neutropenic patient.

No abstract

A comparative trial of pivmecillinam and ampicillin was performed on 100 women with bacteriuria of pregnancy. They received either 400 mg pivmecillinam four times daily or 500 mg ampicillin four times daily for seven days. Cure rates at two weeks were 88% in the pivmecillinam group and 85% in the ampicillin group. At six weeks the respective rates were 76% and 64%. Failure of therapy was not associated with the appearance of bacterial resistance in either treatment group. Side-effects, particularly vomiting and premature cessation of therapy, were significantly more frequent in the pivmecillinam group. No significant effects on liver function were found. In subsequent patients treated in a non-comparative manner with 200 mg pivmecillinam three times daily, the incidence of side effects was markedly reduced with no loss of efficacy.

A comparative clinical trial of amoxicillin-clavulanic acid and cephalexin was carried out in 80 women with bacteriuria of pregnancy. Treatment was randomly aUlocated and consisted of either one tablet of amoxicillin plus clavulanic acid (250 and 125 mg, respectively) three times daily or cephalexin (250 mg) three times daily for 7 days. Overall bacteriological cure rates at 2 weeks were 77% in the amoxicillin-clavulanic acid group and 74% in the cephalexin group. At 6 weeks the respective rates were 76 and 60%. Twenty-five episodes of infection were with ampicillin-resistant strains; cure rates were 82% (2 weeks) and 80% (6 weeks) in the amoxicillin-clavulanic acid group and 85 and 64%, respectively, in the cephalexin group. Differences in cure rates were not statistically significant. No significant difference in the rate of side effects was found. In particular, no toxicity to the fetus was seen which could be ascribed to either drug. Amoxiciflin-clavulanic acid would appear to be a safe and effective treatment for bacteriuria of pregnancy.Ampicillin and amoxicillin are popular choices for the treatment of bacteriuria of pregnancy. They are active against the majority of commonly isolated infecting organisms and enjoy a low incidence of unwanted effects in the mother, with the further advantage that there is no evidence of toxicity to the developing fetus. Resistance to ampicillin, however, is increasing both in hospitals and in the community; in the main, this is due to plasmid-directed production of P-lactamase. There is therefore a need for antimicrobial agents possessing the same properties as ampicillin and amoxicillin but with activity against 3-lactamase-producing organisms resistant to these antibiotics.Clavulanic acid is an inhibitor of several of the more usual plasmid-mediated P-lactamases (7,8). It has been shown in vitro that this agent will render an ampicillin-resistant organism susceptible to ampicillin if resistance is due to production of a P-lactamase which is inhibited by clavulanic acid (1,5,10,12). This in vitro effect has been confirmed in vivo in several trials of a combination of amoxicillin with clavulanic acid in the treatment of urinary tract infections (1,3,4,6 Growth from this specimen was regarded as significant if it yielded more than 105 CFU/ml of a single species. Significant pyuria was defined as -20 pus cells per ,ul. Patients with significant growth from this specimen were entered into the trial, but a second MSU was taken before treatment was started; only if the result of this specimen confirmed that of the first were data from that patient used in assessing efficacy. Patients were excluded from the trial if they were known to be hypersensitive to the penicillins or cephalosporins, if the infection was caused by an organism resistant to one of the trial drugs, or if the patient was already taking an antibiotic or had taken one since the first MSU was collected.Sensitivity testing to cephalexin was carried out by the breakpoint method (11), using diagnostic sensitivity te...