In our study of outpatient treatment of acute uncomplicated pyelonephritis in women, a 7-day ciprofloxacin regimen was associated with greater bacteriologic and clinical cure rates than a 14-day trimethoprim-sulfamethoxazole regimen, especially in patients infected with trimethoprim-sulfamethoxazole-resistant strains.

This study was designed to determine whether Staphylococcus saprophyticus was an important cause of urinary tract infection (UTI), as has been reported by European, but not by American, investigators, S. saprophyticus was the second most common cause of UTI in young (mean age, 20 years), sexually active female outpatients without known preexisting kidney disease or preceding manipulation of the urinary tract. Most cases presented as acute cystitis, but frank pyelonephritis and UTI in pregnant females were observed. The organism was rarely found as a contaminant in urine cultures. When present in the mucocutaneous flora of the anal-urogenital area, the organism was significantly associated with UTI by the same organism. These results show that S. saprophyticus should be accepted as an important urinary tract pathogen of young female patients in the United States. A simple adequate laboratory identification may be based on resistance to novobiocin (disk diffusion test), absence of hemolysis and coagulase, and intense pigment production (65% of strains yellow, 35% white).

The therapeutic antitumor effect of clarithromycin (CAM) was examined with the 13762NF mammary adenocarcinoma and F-344 rat system. When CAM treatment at a dosage of 2 mg/kg of body weight orally for 21 days was commenced after inoculation of the tumor, no significant decrease in death rate was observed, although the loss in body weight was less than that in the untreated group. When tumor-bearing (TB) rats were treated with CAM in combination with carboplatin or cyclophosphamide, a significant decrease in the death rate was obtained, although neither treatment alone proved to be effective. A beneficial effect was also observed when CAM treatment was combined with surgical treatment. CAM showed no direct cytotoxicity to this tumor in vitro according to the MTT (3-[4, 5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide) assay. Spleen cells obtained from TB rats receiving CAM treatment showed a stronger tumor-neutralizing activity than those from rats which had not received CAM treatment (Winn assay). Enhanced induction of cytotoxic cells to allogeneic tumor was also observed in rats immunized with allogeneic tumor cells together with CAM treatment (51Cr release assay). The 13762NF tumor produces transforming growth factor-beta (TGF-beta), tumor necrosis factor alpha, and matrix metalloproteinase-9, and treatment of tumor cells with CAM in vitro for 24 h significantly inhibited the expression of the genes coding for these proteins (reverse transcription-PCR). Levels of expression of the TGF-beta and interleukin-6 genes of spleen cells obtained from CAM-treated TB rats were both significantly lower than those of spleen cells from CAM-untreated TB rats. This study suggests that CAM has biological response modifier activities resulting in a beneficial therapeutic antitumor effect and might be useful for the treatment of human cancers.

In a double-blind randomized study, amoxicillin-clavulanic acid (AM-CL) was compared with cefaclor for the treatment of acute urinary tract infections in 107 college women. A total of 53 patients received amoxicillin (250 mg) and clavulanic acid as the potassium salt (125 mg), and 54 received cefaclor (250 mg); each drug was administered every 8 h for 10 days. The cure rates at 1 and 4 weeks after treatment were 96 and 78%, respectively, in the AM-CL group and 92 and 75%, respectively, in the cefaclor group (P > 0.10). After AM-CL treatment, the prevalence of amoxicillin-resistant Eschenichia coli significantly increased in the rectal flora. Also, the frequency of bacterial resistance to amoxicillin, AM-CL, and cefaclor increased among the urinary pathogens causing subsequent urinary tract infections (P< 0.05). There were no adverse reactions in the cefaclor group; however, six patients in the AM-CL group (12%) experienced diarrhea, nausea, or vomiting (P< 0.05). Elevated transaminase enzyme levels were observed in 23% of the patients in the AM-CL group and in 6% of the patients in the cefaclor group (P< 0.05). Symptomatic Candida vaginitis developed in 16 and 13% of the patients in the AM-CL and cefaclor groups, respectively (P > 0.10).Bacterial resistance to the P-lactam antibiotics is largely due to the production of a ,-lactamase (1,5,20). Clavulanic acid inhibits many of these enzymes (16). A combination of amoxicillin (AM) and clavulanic acid (CL) is effective against a variety of ,-lactamase-positive bacteria (2, 4, 10, 12, 15). The purposes of this study were (i) to compare the efficacy and safety of AM-CL with the efficacy and safety of cefaclor in the treatment of acute urinary tract infections (UTIs) in young women, (ii) to relate therapeutic responses to the results of the antibody-coated bacteria test (ACBT), and (iii) to assess the emergence of resistant members of the Enterobacteriaceae in the rectal and urogenital areas after treatment. MATERIALS AND METHODSPatient criteria. The study group consisted of college women who came to the Kidney Clinic of the University of Florida Student Health Services with symptoms of acute UTIs. The criteria for inclusion were as follows: (i) symptoms such as dysuria, urgency, and suprapubic or flank pain; (ii) at least one bacterium in each random high-power microscopic field of an unstained and uncentrifuged urine specimen; and (iii) 2105 CFU of a bacterium per ml in each of three consecutive urine specimens. Initially, 111 patients entered the study, but 4 had negative urine cultures and did not qualify, leaving 107 patients in the study. Excluded from the study were pregnant or lactating women and women with impaired renal or liver function, radiographically proven obstructive uropathy, or a history of allergy to penicillins or cephalosporins. Patients who had received antimicrobial agents during the preceding week were also excluded.Collection, processing, and analysis of specimens. A specially trained nurse instructed each patient to submit three * Correspond...