We performed a meta-analysis of randomised clinical studies in which the efficacy and toxicity of the same total daily dose of aminoglycosides administered once-daily was compared with multiple divided daily dosing for treating human infections. Of twenty-eight publications identified from a literature search using Medline 19 publications of 20 study comparisons involving 2881 patients met the criteria for analysis. Netilmicin was investigated in 11 studies, amikacin in seven studies and gentamicin in two studies but no studies of tobramycin met the inclusion criteria. The meta-analysis showed that there was a small, statistically significant difference in clinical efficacy of 3.5% (95% confidence intervals 0.5% to 6.5%, P = 0.027) in favour of once-daily administration but no significant differences in bacteriological efficacy or nephrotoxicity were detected. Auditory and vestibular toxicity rates were low for all agents and no differences in these toxicities were identified between once-daily or multiple-dose administration regimens either clinically or by audiometry or electronystagmography. Aminoglycosides can be given once-daily without loss of efficacy or increased toxicity offering greater simplicity and potentially improved cost-effectiveness than can be achieved by giving these drugs in divided doses.

Objective To assess the clinical outcome and pharmacokinetics of therapy with cefazolin for patients with cellulitis in a hospital‐in‐the‐home (HIH) program. Design Observational study with outcome data compared with previously published reports of therapy for cellulitis. Setting: A university teaching hospital and HIH unit, July 1996 – December 1997. Participants Patients with cellulitis were eligible for inclusion provided their medical condition was stable, they did not require surgical intervention, and their social circumstances allowed home‐based therapy. Intervention Cefazolin 2g intravenously twice daily, with regular nursing and medical assessment. Main outcome measures Clinical efficacy; peak and trough serum concentrations of cefazolin. Results Fifty‐seven patients (37 were men) with a mean age of 48 years (range, 18–90 years) had 61 episodes of moderate to severe cellulitis (41, lower limb; 17, upper limb; and three, face). They received a median of 11 doses of cefazolin (range, 3–27 doses). Clinical outcomes were: cure in 54, improvement in one, treatment failure in three, and in the remaining three episodes the outcome was indeterminate. Cefazolin concentrations were measured in 27 patients. All peak concentrations were more than 40μg/mL, while trough concentrations were all above the MIC90 of the expected pathogens: median, 3.2μg/mL (range: 0.4–18.5 μg/mL). Cefazolin was well tolerated. Conclusions Twice‐daily cefazolin 2g intravenously is a convenient and effective option for home‐based treatment of patients with cellulitis. Its clinical efficacy is comparable with other treatment regimens.

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Australia has a long association methicillin-resistant Staphylococcus aureus (MRSA). Its unique geographic and demographic features have led to the emergence and spread of three types of MRSA over 35 years. Classical multiresistant hospital-acquired MRSA were first noted in Australia in 1965. By the end of the 1970s, strains of this type of MRSA were well established in the complex tertiary care hospitals in the capital cities on the eastern seaboard of mainland Australia. Characterized by resistance to /3-lactams, erythromycin, tetracycline, gentamicin, and trimethoprim-sulfamethoxazole, these strains have persisted and diversified genetically and have acquired a variety of new resistances. They have proven pathogenicity and are a prominent cause of hospital infection in the endemic institutions. More recently they have become endemic in some central state tertiary care hospitals. Community-acquired strains of MRSA first appeared in the north of Western Australia in the mid-1980s. Strains have subsequently appeared in the south of the state and in the two adjacent central states, and are more frequently isolated from Aboriginal patients. Although harboring few or no additional resistances apart from resistance to )3-lactams initially, these strains are also accumulating additional resistances. A different variety of community-acquired MRSA has recently been noted in eastern Australia. It has a similar antibiogram to the western strains, but an entirely different epidemiology, resembling that currently being experienced in parts of New Zealand, and associated with patients of south Pacific island origin. GEOGRAPHIC AND DEMOGRAPHIC FACTORSAustralia is a physically large industrialized country (7.7 million km2) with a small population (about 19,000,000). Despite the international image as a community with a strong rural focus, 86% of the population live in major urban centers, 54% live in eight national, state, and territory capital cities, and about 85% live within 50 km of the coast. As a consequence, very large urban centers are separated by great distances compared to interurban distances in Western Europe and the United States (Fig. 1). Of all developed countries, only Canada has similar demographic properties. These properties have had a significant impact on the prevalence and spread of MRSA through different centers.Ethnicity has also played a role in the spread of community-