One hundred ten patients were randomized to receive one of the following antibiotic combinations: aztreonam + clindamycin, tobramycin + clindamycin, or amikacin + mezlocillin for the treatment of lower respiratory tract infections (LRTI) caused by gram-negative bacilli. Of the 68 patients who received aztreonam + clindamycin, 60 were clinically evaluable and 50 were bacteriologically evaluable. Of the 60 clinically evaluable patients, 54 were cured and 5 were treatment failures or died during the study period. Of the 50 bacteriologically evaluable patients, 46 were cured and 3 failed to respond to therapy. Of the 26 clinically evaluable patients in the tobramycin + clindamycin group, 22 were cured and 4 either failed to respond or died during the study period. Of 18 bacteriologically evaluable patients in this group, 16 were cured and 2 failed to respond. In the amikacin + mezlocillin group, 14 of the 15 clinically and bacteriologically evaluable patients were cured, and 1 failed to respond. The most commonly isolated pathogens were Klebsiella pneumoniae, Escherichia coli, and Pseudomo-nasaeruginosa. The very few adverse drug reactions that were seen were transient and comparable in all three groups except for renal function parameters, which deteriorated in 6–8% of patients receiving the aminoglycoside combination. All three antibiotic combinations were similar in effectiveness and safety.

A total of 80 patients were randomized to receive either aztreonam or tobramycin for the treatment of lower respiratory tract infections caused by gram-negative bacilli; all these patients received clindamycin concomitantly. A total of 53 patients were randomized to receive aztreonam-clindamycin; of these, 46 were clinically evaluable and 39 were bacteriologically evaluable. Of the 46 clinically evaluable patients, 41 were considered cured, 3 failed to be cured, and 2 died during the study period of unrelated causes. Of the 39 bacteriologically evaluable patients, 36 were considered cured, and 3 failed to be cured. There were 26 clinically evaluable patients in the group randomized to receive tobramycin-clindamycin. Of them, 22 patients were considered cured, 3 failed to be cured, and 1 died of unrelated causes during the study period. There were 18 bacteriologically evaluable patients in the tobramycin-clindamycin group; 17 were cured, and 1 failed to be cured. The most common pathogens isolated from the patients were Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa. All of the isolated organisms were susceptible to both tested antibiotics, except for a strain of Pseudomonas cepacia resistant to both tested antimicrobial agents and a strain of Enterobacter aerogenes and one of P. aeruginosa that were resistant to aztreonam. Very few adverse reactions related to the antibiotics were seen. These effects, when present, were transient and comparable in both studied groups, except for renal-function tests, which were altered in 7.7% of the patients randomized to receive tobramycin-clindamycin and in none of the patients randomized to receive aztreonam-clindamycin. Aztreonam-clindamycin is safe and effective for the treatment of lower respiratory tract infections caused by aerobic gram-negative bacilli when the organisms are susceptible.

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The levels of cefmetazole in plasma and tissue were determined after injection of a dose of 30 mg/kg into the zone of the wound of each of 15 patients undergoing appendectomy. The mean plasma levels of cefmetazole at the start and end of surgery (8.9 ± 2.4 and 31.7 ± 6.4 min after dosage) were 21.1 and 59.0 ,ug/ml, respectively; concentrations of the drug were 14.6 and 4,486.9 ,ug/g in skin, 9,165.0 and 1,756.4 ,ug/g in subcutaneous tissue, and 8,669.6 and 2,022.9 lug/g in muscle.Infection of surgical wounds, above all in gastrointestinal tract operations, is undoubtedly endogenous in origin (2). According to Davidson et al., the most important pathogenetic factor is the presence of bacteria in the incision itself at the moment of suturing the wound (1). Even though intravenous administration of antibiotics has proved efficient, significantly reducing the incidence of infection in surgical wounds, prophylactic measures, including topical application of antibiotics (2) to achieve high local drug concentrations, have also been useful. The aim of the present study was to determine whether peri-incisional administration of cefmetazole would produce sufficiently high levels of the drug in tissue to guarantee clinical efficiency.The tissue penetration of cefmetazole was studied in 15 adult patients with acute appendicitis (5 males, 10 females) with an age range of 14 to 37 years and a weight range between 47 and 71 kg. The concentrations of urea, creatinine, glucose, proteins, and albumin were measured in all patients; no additional diseases to that responsible for the operation were found. Patients with a history of allergy to the penicillins or cephalosporins, as well as those who had received any medication during the 7 days before the operation, were excluded from the study. Informed consent was obtained previously in all cases.Cefmetazole was administered at a dose of 30 mg/kg (1 g/10 ml). After anesthesia, the skin and subcutaneous tissue at the projected incision site (3 to 5 cm) were infiltrated with the antibiotic. The incision was performed, the time elapsed was noted, and samples of skin, subcutaneous tissue, and blood were taken immediately. Infiltration of the muscle layer was carried out after opening the fascia. The same sampling procedure was repeated, after removal of the appendix, and the time elapsed after infiltration was noted. column (Waters Associates) with a mobile phase of 10 to 15% acetonitrile in 0.005 M citrate buffer (pH 5.4). The flow rate was maintained at 1.0 ml/min, and all operations were carried out at room temperature. Calibration of cefmetazole levels was performed based on the peak height ratio of cefmetazole to the internal standard.All the results obtained from the concentrations in plasma and tissue at the start and end of the operation, as well as the relationships of the respective values at the start and end, were subjected to Student's t test (4) to check the possible existence of statistically significant differences. Table 1 shows the concentrations of cefmetazole in plas...

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