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Patients with primary biliary cirrhosis have marked disturbances of humoral and cellular immunity, but an increased susceptibility to infection has not been described previously. We have observed, however, that patients with primary biliary cirrhosis have a high incidence of bacteriuria. This increased susceptibility to urinary infection has been studied and our findings are repoated. Methods PATIENTSPatients with primary biliary cirrhosis were diagnosed by the usual criteria,1 and classified into prefibrotic (stage 1 and 2) and fibrotic disease (stage 3 and 4). Women with other forms of chronic liver disease (non-primary biliary cirrhosis) confirmed by liver biopsy, and women with rheumatoid arthritis,

Observations of synergy between nisin and ramoplanin against MRSA and VRE offer a promising approach to the concept of combining nisin with inhibitors of cell wall peptidoglycan. Further investigations are needed in order to develop this approach as a clinical possibility.

Twelve male subjects, aged 19 to 40 years, shown to be healthy by examination and laboratory tests, took 500 mg of ciprofloxacin every 12 h for 7 days. After the first and the last dose, blood and urine samples were taken and drug concentrations were determined by bioassay. There was a significant buildup in mean concentrations in serum from day 1 to day 7; mean peak levels (attained after 1 to 2 h) were 1.9 and 2.8 ,ug/ml, respectively. The terminal half-life was 3.5 to 4 h. About 40% of the drug was excreted into the urine during the 12-h period after dosing; minimum mean concentrations in urine were 105 ,ug/ml on day 1 and 174 ,ug/ml on day 7. Considerable amounts of ciprofloxacin were found in the feces on day 7 (185 to 2,220 ,Lg/g). Marked changes in the aerobic part of the fecal flora were observed as a result of taking ciprofloxacin: coliforms were absent on day 7, and concentrations of streptococci and staphylococci were significantly reduced. There was no overgrowth by yeasts. One week later the fecal flora had returned to a state similar to that found before treatment. Anaerobes were little affected quantitatively but acquired resistance to ciprofloxacin. Side effects were mild and transient.

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SUPPURATIVE ARTHRITISB _JOU pus from three of these joints produced a pure culture of Staph. aureus resistant to penicillin, streptomycin, and tetracycline.We are grateful to Dr. H. S. Barber for allowing us to publish details of the two patients who were under his care. We thank the members of the medical and nursing staff of the Manchester Royal Infirmary who have helped in the diagnosis and care of these difficult cases, and the members of the laboratory staff for much technical assistance. REFERENcES

To the Editor: Because methicillin-resistant Staphylococcus aureus (MRSA) has been identified in retail meat worldwide (1-4), the potential exists for its transmission to humans. Of