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A lady with recurrent urinary infection associated with sexual intercourse with her husband is described. The source of the infection was from the husband's chronically infected prostate.

Twenty patients undergoing allogeneic bone marrow transplantation and 39 patients receiving remission induction chemotherapy for acute leukaemia were entered into a double blind, placebo controlled stratified trial of acyclovir prophylaxis against herpes group virus infections. Within the transplant group intravenous acyclovir 5 mg/kg twice daily given throughout the period of granulocytopenia completely prevented oropharyngeal herpes simplex virus infection compared with a 50% incidence in the placebo arm (p = 0.033). The acyclovir group also had fewer days of fever during the trial and a shorter duration of leukopenia, possibly because of the prevention of herpes simplex virus infections. There was a high incidence of herpes infections after the trial in patients who received either acyclovir or placebo. In the non-transplant group there was also a significant reduction of herpes simplex virus infection in the oropharynx and oesophagus (two out of 19 patients as compared with 10 out of 20; p = 0.018). Herpes simplex virus was isolated in the acyclovir arm within a day after starting the trial in one patient, and the other failure was due to a virus with reduced sensitivity to acyclovir in a patient who had had several previous courses of the drug. The incidence of herpes infections after stopping treatment was low. The influence of acyclovir on excretion of Epstein-Barr virus in saliva in either group was inconclusive. One patient (transplant group) developed a cytomegalovirus infection while receiving acyclovir. Acyclovir provides effective prophylaxis against oropharyngeal and oesophageal herpes simplex virus infection in severely immunocompromised seropositive (greater than or equal to 1/8) patients. In patients given bone marrow transplants this may have the additional benefit of reducing the time to recovery of an adequate blood count and the number of days of fever.

The bacterial flora of the female periurethral area was studied by impression cultures taken by polystyrene sponges, the results being recorded by photographic contact printing. With this technique it is possible to observe the preferential colonisation of different areas by different organisms and to detect persistent colonisation by pathogens. In assessing the possible aetiological importance of these results, and especially in comparing them with the findings of other workers, it is essential to use correct anatomical nomenclature.

Tobramycin and amikacin are new aminoglycoside antibiotics which resemble gentamicin and kanamycin respectively in pharmacokinetic, toxicological, and some microbiological respects. Minimum inhibitory concentrations for these four antibiotics have been determined against 393 bacterial strains (13 species from eight genera) isolated from clinical materialKanamycin was the least active, 89% of the Pseudomonas aeruginosa strains being resistant. Resistance was also found in 21% of the Klebsiella aerogenes, 16% of the indoleproducing Proteus species, 4% of the E. coli and 3% of the Enterobacter spp. tested. Providenca stuartii strains were often resistant to gentamicin and tobramycin.Apart from these exceptions, however, all the organisms tested were sensitive to all four compounds, gentamicin and tobramycin usually showing the highest intrinsic activity.Amikacin was the most active compound against a selection of strains chosen because of their resistance to one or more of the aminoglycosides. Thus, amikacin represents a significant advance over kanamycin and seems to be superior to gentamicin in terms of its in-vitro properties. This is especially the case in those unusual circumstances when gentamicin-resistant strains are a problem. We suggest that amikacin warrants further investigation since it may prove to be a valuable alternative to gentamicin in the treatment of life-threatening infections.

The activity of cefoxitin was compared with that of cephalothin against 229 bacterial strains. Cefoxitin was more active against most Gram-negative strains, notably against indole-producing Proteus spp., which are usually resistant to the cephalosporins. Cefoxitin was not susceptible to any significant extent to degradation by beta-lactamases produced by Gram-negative organisms. Against Gram-positive organisms, however, cefoxitin was considerably less active than cephalothin, but minimum inhibitory concentrations for Staphylococcus aureus were well within therapeutically attainable blood levels.Pharmacokinetic studies in 18 volunteers showed a higher and longer sustained antibiotic activity in serum and urine after injections of cefoxitin than after equal doses of cephalothin. Urinary recovery of cefoxitin activity was also much higher than that of cephalothin. No evidence of toxicity due to cefoxitin was found. Cefoxitin was slightly less painful after intramuscular injection than cephalothin.

In order to test their value in urinary infection a double-blind trial was carried out using ampicillin, cephalexin, trimethoprim-sulphamethoxazole (co-trimoxazole), and trimethoprim. Eighty-three courses of treatment were given to hospital patients, 149 to pregnant women, and 107 to patients with dysuria and frequency seen in domiciliary practice. Thus infections of varying severity in defined groups of patients caused by organisms with different antibiotic sensitivities were treated.Analysis of the overall results (339 courses) was compared with those from the individual groups and considerable variation in response was found. In domiciliary infections and bacteriuria in pregnancy trimethoprim alone proved to be at least as effective as the other three compounds and caused fewer than half the number of side effects. In the hospital patients co-trimoxazole was superior to trimethoprim.The overall results for ampicillin and cephalexin were similar although cephalexin proved to be inferior in treating symptomatic domiciliary infections.

Trimethoprim is inhibitory for a wide range of bacteria, and when used in combination with a sulphonamide marked synergy has been reported.In order to test its value in the treatment of urinary infections 154 hospital patients with infections of varying severity and due to a wide range of organisms were treated with combinations of sulphamethoxazole and trimethoprim. Combinations of these substances in two different ratios (2:1 and 10:1) were used in 113 patients, and one week after the end of treatment about three-quarters were cured by both combinations. In a second study 106 patients were treated with a sulphamethoxazole-trimethoprim combination (5:1), ampicillin, or sulphadimidine. The cure rate with the 5:1 combination was higher than that found with ampicillin or sulphadimidine both one week after finishing treatment (sulphamethoxazole-trimethoprim 85%, ampicillin 70%, sulphadimidine 40%) and at the fourth- to fifth-week follow-up (sulphamethoxazole-trimethoprim 67%, ampicillin 52%, sulphadimidine 15%).The results obtained with the various sulphamethoxazole-trimethoprim combinations did not indicate that a particular ratio was superior for treating urinary infections in general or for those caused by any particular species of organism.Laboratory studies showed that many bacteria causing urinary infections in hospital were sensitive to trimethoprim, and the therapeutic results could have been largely predicted from a knowledge of the in-vitro sensitivity tests to trimethoprim alone. For example, sulphamethoxazole-trimethoprim in the treatment of Proteus mirabilis infections was less successful than in those due to Escherichia coli, and this finding was clearly reflected in the higher minimal inhibitory concentrations for trimethoprim of Pr. mirabilis.The sulphamethoxazole-trimethoprim combination was simple to administer, free from side-effects, and gave satisfactory results in the treatment of urinary infections that occurred in hospital patients.