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The influenza vaccine was underused in Switzerland in 1996, as less than half of people at risk for the disease were vaccinated. We performed this study in 1997 to determine (1) the immunisation rate in the patients admitted to the internal medicine ward of the Cantonal Hospital, Fribourg and in those seen by family physicians, (2) the reasons underlying the decision of the physician to vaccinate their patients or not, (3) the physicians' opinion of the vaccination. The study was retrospective and included 383 patients hospitalised in the medicine ward between October 15 and November 25, 1997. 249 of them (65%) had an indication for vaccination against influenza according to the recommendations of the Federal Office of Public Health. Only 20 patients (8%) were vaccinated during their hospital stay. 86 family physicians (83%) answered the questionnaire concerning 141 patients (57%) whom they examined after their hospital discharge. Of these patients, 77 (55%) were vaccinated by the family physician. The main reason for not vaccinating the patients was the patient's refusal (33%). The effectiveness of the vaccine was considered to be very good (effectiveness > 80%) by 40% of the family physicians and good (effectiveness 60-80%) by 50%. The local and systemic side effects were reported to be rare (incidence < 5%) by 55% and 71% of family physicians respectively. The cost and the route of administration were not felt to have any effect on acceptance of the vaccine. In decreasing importance the family physicians considered the recommendations of the Federal Office of Public Health useful for (1) chronic pulmonary disease, (2) immunosuppression, (3) chronic cardiac disease, (4) chronic renal insufficiency and residency in homes or institutions, (5) diabetes, (6) age over 64, (7) health care workers. In conclusion, the influenza immunisation rate in Fribourg was very low at the hospital but was higher than the Swiss figures for the family physicians. Patient's refusal was the main reason for non-vaccination. The family physicians have a favourable opinion of the effectiveness and tolerance of the influenza vaccine.

The efficacy of oral bactericidal antibiotics in the treatment of osteomyelitis is analyzed retrospectively by a review of 9 cases histories. The first patient was treated in 1982. Clinical and laboratory controls were reviewed up to 1.1.1995. In 6 patients S. aureus was isolated, while in 3 patients the organism could not be cultured but gram + cocci were almost likely. 5 cases of osteomyelitis were acute, 4 were chronic and in one case there was an infection of an artificial knee prothesis. The isolated S. aureus were sensitive to the antibiotics prescribed. 8 patients received a combination of flucloxacillin (2-4 g/day) and rifampicin (600 mg/day); one patient was treated with the combination amoxicillin/clavulanic acid (1500/425 mg/day) followed by ofloxacin (400 mg/day) and finally co-trimoxazole (320/1600 mg/day). 3 patients received all antibiotics orally; in 6 patients oral administration followed a short intravenous course of the antibiotic combination. The duration of treatment varied between 6 and 23 weeks. Follow-up extended over 9 months (n = 1), 14 months (n = 3), 4-7 years (n = 3), and 10-12 years (n = 2). In 8 cases the osteomyelitis was cured (89%). In our view, a combination of bactericidal oral antibiotics with good penetration into bone tissue can be prescribed in selected cases of osteomyelitis to shorten or even avoid the standard intravenous therapy of acute or chronic diseases.

Ofloxacin and amoxicillin in the treatment of 121 bronchopulmonary infections were compared in a randomized, open clinical trial. 64% of the infections were pneumonias. S. pneumoniae, H. influenzae and B. catarrhalis accounted for 76% of the etiologic agents. The clinical and bacteriological responses were positive in more than 90% of the patients and comparable in both groups. None of the isolated agents was resistant to ofloxacin, whereas 21% were amoxicillin-resistant. Ofloxacin was used without randomization in the treatment of 26 atypical pneumonias and opportunistic infections, all of which were cured or improved. Occurrence of side-effects was rarely observed in either treatment group.