Use of antibiotics. Antifungals.

Abstract

aborting. Hence the incidence of post-abortion sensitisation probably cannot be eliminated. Nevertheless, much can be done to reduce the number of cases appreciably. Surprisingly, many doctors are still unaware that anti-D immunoglobulin should be administered in these cases. Occasionally it is difficult to pinpoint the time of the abortion. Samson and Mollison,5 however, found that administering anti-D immunoglobulin up to 13 days after an injection of Rh-positive cells was effective in preventing sensitisation. Anti-D immunoglobulin should be given even at this late stage after a possible abortion. Roughly 20 cases a year of post-abortion or administrative failures of protection occur in the Yorkshire region-that is, a third of all new cases. If this region is typical eliminating these cases would greatly reduce the total incidence in Great Britain.Primigravidae who are sensitised before anti-D immunoglobulin is normally administered make up most cases of socalled failures of protection. Several centres have instituted a programnme of antenatal administration of anti-D immunoglobulin, which is also being actively considered in Great Britain. Regimens vary from one dose, usually at 28 weeks, as in the Hamilton (Canada) series and a Swedish series, to a twodose regimen usually at 28 and 34 weeks in an Australian programme and the Manitoba project (unpublished data). Preliminary results suggest that antenatal administration of anti-D immunoglobulin reduces the incidence of antibodies detected at six months after delivery, but it is too early to be certain that it reduces the number of sensitised mothers in subsequent pregnancies. If it is shown that antenatal injection does reduce the incidence of sensitisation the incidence in the Yorkshire region would decrease by 20 to 30 cases a year. If this again is typical it would mean a decrease of 300-400 cases a year in Great Britain. Nevertheless, it would entail administering three times as much anti-D immunoglobulin as at present, a costly enterprise. Moreover, the number of new cases might be similarly reduced by administering anti-D immunoglobulin after all Rh-negative deliveries and after every abortion.One of our findings is of theoretical as well as practical interest. The fall in the incidence of Rh antibodies in Rhnegative women was 700/ ; the fall in the incidence of Rhpositive mothers with antibodies was 19O0, which presumably reflects the fall in the number of women having babies. Nevertheless, the fall in the number of Rh-negative women with nonRh antibodies was 3500. This suggests that anti-D immunoglobulin may have a non-specific effect, and supports the thesis of Woodrow and others in Liverpool6 that the mechanism of anti-D immunoglobulin protection is not antigen-specific. More data on this topic are needed.We thank all obstetricians in the region for their help and cooperation, and for willingly making available the notes ofthe patients concerned; and the clerical staff for patiently obtaining the information required.

Effect of simultaneous oral and vaginal treatment on the rate of cure and relapse in vaginal candidosis.

“…This is in accordance with the findings of Velupillai and Thin (1977), who detected no significant difference between the effect of combined local and oral nystatin treatment compared with local nystatin treatment alone. The oral treatment regimen adopted in this investigation has been recommended for the treatment of patients with long-standing vaginal candidosis (Nicol, 1971;Cartwright, 1978), but it failed to eradicate faecal colonisation in a substantial proportion of our patients. It is interesting that the number of patients with positive faecal culture results in the group treated with pessary alone decreased during treatment.…”

“…Oral treatment with nystatin has been shown to reduce intestinal colonisation with C. albicans (Seelig, 1968). For this reason, such treatment is often recommended as an adjunct to vaginal treatment in patients with recurrent genital infection (Nicol, 1971;Cartwright, 1978). In fact, it has not been proved that simultaneous treatment of the intestinal tract prolongs freedom from reinfection, and it has not been established that the intestinal tract is recolonised once oral treatment is discontinued.…”

Clinical Pharmacokinetics of Systemic Antifungal Drugs

“…F1ucytosine is competitively inhibited by cytarabine (cytosine arabinoside) [Cartwright, 1978] and should therefore not be used in patients receiving the latter drug.…”

“…The pharmacokinetic characteristics of these drugs are the subject of the present review. Their pharmacology and therapeutic use have been reviewed by Bennett (1974), Cartwright (1978), Hoeprich (1978), Meade (1979), Sarosi et a1. (1979), Heel et a1.…”

Μικροβιολογικος Ελεγχος Αντιμικροβιακων Παραγοντων

“…Η δράση τους περιορίζεται σε Gram-αρνητικά βακτήρια και φαίνεται ότι η ευαισθησία των τελευταίων σχετίζεται με το ποσό των φωσφολιπιδίων που περιέ χουν στην κυτταροπλασματική μεμβράνη τους (Brown, Wood, 1972) Η νυστατίνη και η αμφοτερικίνη Β δρουν κατά παρόμοιο μη χανισμό όπως και τα προηγούμενα φάρμακα, όμως στην περίπτωση αυτή συνδέονται με τις στερόλες της κυτταροπλασματικής μεμ βράνης διαταράσσοντας την διαπερατότητα της τελευταίας. Αυτές οι στερόλες ανευρίσκονται μόνο στην κυτταροπλασματική μεμβρά νη των μυκήτων και όχι των βακτηρίων, γεγονός που εξηγεί την εκλεκτική του δράση επί των μυκήτων (Cartwright, 1978).…”