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Of 1017 patients admitted to the Royal Perth Hospital Diabetic Survey 142 were found to have significant bacteriuria. In these bacteriuric patients serum pyridoxal concentrations were significantly reduced (P = less than 0.001) when compared with 142 diabetic patients matched for age (+/- 5 years) and sex but without infection of the urinary tract. Measurements were repeated up to 6 mth after antibacterial treatment and serum pyridoxal concentrations were still low. Pyridoxal has a role in immunological competence, and it is possible that the increased incidence of urinary tract infection in patients with diabetes reflects impaired immunological competence due to pyridoxal deficiency.

In 12 Ethiopian men probenecid given with dapsone caused a significant reduction in urinary excretion of acid-labile dapsone metabolites, and to a lesser extent free dapsone, and also raised the blood-levels of dapsone. The method of estimating serum-levels of dapsone by Schiff-base formation was modified for use with urine.

In twenty-two cases of lepromatous leprosy with acute reaction, flufenamic acid had a significant antipyretic effect, with an accompanying fall in the erythrocyte-sedimentation rate. Erythema nodosum leprosum subsided in 23 out of 25 episodes, and the signs and symptoms of acute leprosy iridocyclitis and neuritis were relieved. High-dosage, short, tapered courses of flufenamic acid, up to 25 mg. per kg., were the most effective, and were well tolerated. One patient given up to 28 mg. per kg. of flufenamic acid had neutropenia but 10 days after therapy, his leucocyte-count had returned to normal.

Patients admitted to the neurosurgical wards of Royal Perth Hospital to undergo elective craniotomy who normally receive antibiotics to prevent post-operative infection were given intravenous cotrimoxazole, and specimens of cerebrospinal fluid were obtained one or two days after the start of treatment. Nine patients received 2 ampoules twice daily; each ampoule contained trimethoprim 80 mg and sulphamethoxazole 400 mg. From 6 of these patients CSF obtained 4-8 h after the dose was found to contain low concentrations of trimethoprim 0.2-0.6 mg/l and sulphamethoxazole 5-33 mg/l. Such concentrations would not be inhibitory for Strep, pneumoniae for which the minimum inhibitory concentration of trimethoprim is 1 mg/l; for coliforms the MIC of trimethoprim is 0.4-1.6 mg/l. Forty-three patients received 4 ampoules twice daily, and CSF specimens obtained 4-7 h after the dose contained trimethoprim 0.7-3.6 mg/l and sulphamethoxazole 10-104 mg/l; in the serum, trimethoprim concentrations were 2.8-12.4 mg/l. Two specimens of CSF were taken 11 h after administration of 4 ampoules and neither drug was found in the specimen. Therefore we conclude that for treating an infection in the CSF 4 ampoules 8-hourly would be required. Thrombophlebitis occurred only in 2 patients. The length of treatment was usually 3 or 4 d, but for patients given the drug for longer periods of 2 or 3 wk the haematological parameters did not show any toxic effects. Four ampoules can be diluted in 250 ml and administered during 1 1/2 h. We conclude that intravenous cotrimoxazole must be given in a dose of 4 ampoules to achieve therapeutic concentrations in the CSF. The wide antibacterial spectrum of cotrimoxazole has resulted in its replacing chloramphenicol on nearly all occasions in the neurosurgical unit. Four ampoules thrice daily have been used to treat successfully Nocardia infection in the vitreous, and systemic infection with Pseudomonaspseudomallei. The latter patient developed a thrombocytopenia after 3 d treatment, and the cotrimoxazole was stopped; but he became febrile again and after 5 d cotrimoxazole 4 ampoules t.d.s. was restarted and his platelet count remained normal.