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In 98 patients undergoing elective vascular surgery, specimens for bacterial cultures were obtained from urine, ischaemic ulcers, incisional wounds and the implanted grafts. Wound and graft infections were registered and compared with the results of these cultures and suspected risk factors in an attempt to find the source of infections. Antibiotic prophylaxis with cefuroxime was given for 24 h beginning at the start of surgery. Patients with ischaemic ulcers also received "spread prophylaxis", directed against isolated bacteria, for ten days. Three cases of graft infection and twelve cases of wound infection occurred. Positive postoperative cultures from wounds did not correlate with pre- or peroperative cultures. Peroperative cultures revealed small numbers of staphylococcus epidermidis in eleven patients, and none of them developed graft infection. Ischaemic ulcers, diabetes or re-do procedures were not accompanied by a significantly increased frequency of wound or graft infection, although each of three patients with graft infection had one of these risk factors. Bacteria, sensitive to cefuroxime, were found in one graft infection, six wound infections, and in two patients with urosepsis, whereas cefuroxime resistant organisms were isolated from one graft infection and three infected wounds. One of the three graft infections was probably caused by bacteria originating from the patient's ischaemic ulcer. In the other two patients the source of bacteria could not be determined. Cefuroxime seems to be an adequate alternative for prophylaxis of vascular graft infection, but in some patients with bacteriuria or indwelling catheters, a one day regimen may be too short.

Spiramycin was administered to healthy carriers of meningococci in doses of 1.5 g twice daily or 2.5 g once daily for 3 days, or 1.5 g once daily for 10 days. Meningococci were eliminated from the nasopharynx and throat in approximately 50% of the carriers with all dose schedules. In the remaining carriers only a temporary suppression of the strain was achieved. Elimination occurred only in carriers where spiramycin saliva concentrations reached or surpassed the MIC value of respective strain for 42 h or more. Evidence of reinfection from close contacts was not obtained. Due to side effects the dose of spiramycin could not be increased. Further trials with spiramycin as the sole agent for eliminating meningococci in carriers do not seem warranted.

Patients with acute laryngitis following an upper respiratory tract infection are often treated with antibiotics for their voice complaints, although, to our knowledge, the effect of such therapy has not been examined. In the present study, comprising 100 adults with laryngitis, the rate of resolution of vocal symptoms, as estimated from voice recordings or subjectively by the patients, was the same in patients who received penicillin V (pcV) as in those who received placebo. Similarly, the degree of rhinorrhea/nasal congestion and cough was not significantly influenced by pcV treatment. At the acute visit, nasopharyngeal cultures revealed Branhamella catarrhalis in 50%, Hemophilus influenzae in 15% and Streptococcus pneumoniae in 1% of the patients; the rate of elimination of these bacteria was the same in the pcV as in the placebo group. Thus, while suggesting that B catarrhalis and H influenzae are important for the pathogenesis of the disorder, our results do not provide support for the use of pcV in acute laryngitis.

At reoperation of 7 patients with “late reactions” following total hip arthroplasty according to Charnley, specimens were taken from the tissue around the prosthesis and examined for presence of aerobic and anaerobic bacteria. Obligate anaerobic bacteria were isolated from 4 of the patients. Staph. epidermidis (albus) was isolated in 1 additional patient. Two of the patients from whom no bacteria were isolated were on ***antibiotic therapy at the time of reoperation. In 3 of the 4 patients from whom anaerobic bacteria were isolated a significant decrease in the titre of agglutinating antibodies against the patient's own strain was observed 6 months after reoperation and antibiotic treatment.

The occurrence of beta-lactamase production in Haemophilus influenzae, Branhamella catarrhalis and Moraxella nonliquefaciens was compared in 191 healthy children attending day nurseries in 2 municipalities differing with regard to the prescription rate of beta-lactam antibiotics. A significantly higher frequency of beta-lactamase production was recorded in M. nonliquefaciens isolated in the municipality with the higher prescription rate. A corresponding difference was not recorded for H. influenzae or B. catarrhalis. Approximately 75% of the nasopharyngeal pathogens H. influenzae, B. catarrhalis and Streptococcus pneumoniae, as well as the commensal M. nonliquefaciens, were eliminated and often replaced by other strains of either species over a period of one month. Although none of the children were on antibiotics a substantial proportion of the acquired strains produced beta-lactamase. This suggested that the carrier rate of beta-lactamase producing strains of the respiratory tract is not only related to the effect of recent antibiotic treatment but also to the prevalence of such strains in the population.

22 patients with various gram-negative infections were treated with tobramycin at a dose of approximately 3 mh/kg body weight/24 h for 7 to 53 (mean 16) days. Therapy was monitored with determinations of drug serum concentrations and renal and audio-vestibular function tests. In 16 patients either cure of clinical improvement were achieved. Two patients did not improve. In another 4 patients the effect of tobramycin therapy could nto be evaluated. One patient exhibited a subclinical vestibular dysfunction and one patient experienced transient tinnitus. In one patient, slight but clinically significant renal impairment occurred.

76 patients with acute maxillary sinusitis were treated with oral erythromycin stearate (500 mg twice or 3 times a day for 10 days). The mean concentration of erythromycin in the sinus secretion after 3-5 days' treatment was 0.6 mug/ml with the lower dosage and 1.3 mug/ml with the higher. The concentration of erythromycin in the sinus secretion was, on the average, 10-20 times higher than the minimum inhibitory concentration (MIC) for group A streptococci and pneumococci, and reached MIC values for 15-30% of 100 examined strains of Haemophilus influenzae. 81% of the patients given the smaller and 94% of those given the larger dose improved or recovered. Radiological improvement was demonstrated in both groups. The infections with H. influenzae tended to respond somewhat less to the treatment than those with pneumococci. Comparisons of the roentgen findings and the findings at aspiration showed good agreement. An extra projection taken with the patient recumbent and the affected side downwards gave no information above that obtained from the routine projections. The large dose caused side effects more often (in 17/41 patients) than the smaller one (4/35 patients). In 10 patients treatment was discontinued because of side effects; 8 of them had received the larger dose.

The combination sulfamethoxazole/trimethoprim (SMX/TMP) was given orally to 4 healthy adult volunteers in mean daily doses of 23.0/4.6 mg/kg body weight for 6 days. The serum and saliva concentrations of the drugs were assayed on days 1, 3 and 6. On the first day (0-12 h) there was no measurable concentration of SMX in the saliva. On days 3 and 6 the mean peak levels of SMX in saliva were 7.8 and 9.8 micrograms/ml, i.e. 8-9% of the corresponding mean peak serum levels. In contrast, the concentrations of TMP in saliva were more than twice as high as those in serum. The mean SMX/TMP ratios in saliva days 3 and 6 were 1.3 and 1.4, respectively, i.e. approximately one-twentieth of the mean SMX/TMP ratios in serum. SMX/TMP was also administered to children with serous otitis media. The drug concentrations in saliva were assayed 2-3 h after administration on days 6 and 9 of a 10-day course, with a mean daily dose of 34.5/6.9 mg/kg body weight. The mean saliva concentration of SMX in the children was slightly higher than in adults and the mean TMP concentration about half of that in adults. The mean SMX/TMP ratio in the children's saliva was 4.2. The in vitro activity of SMX/TMP 20:1 and 4:1 was determined against H. influenzae, D. pneumoniae, B. catarrhalis and group A streptococci. H. influenzae, D. pneumoniae and group A streptococci were found more susceptible to TMP than to SMX, while the reverse was true for B. catarrhalis. In the 3 former, the potentiation of SMX by TMP was more pronounced than was the potentiation of TMP by SMX, while the opposite was recorded for B. catarrhalis. The most beneficial effect of the SMX/TMP combination against nasopharyngeal pathogens was recorded for B. catarrhalis and the weakest effect for H. influenzae and group A streptococci. With the exception of B. catarrhalis, the administration of TMP alone to adults may be just as effective against nasopharyngeal pathogens as is the SMX/TMP combination in children.

The in vitro susceptibility to penicillin V of Haemophilus influenzae was determined for strains from cases with acute otitis media that healed on penicillin V treatment and from cases in which such treatment failed. No difference in susceptibility could be demonstrated between strains from healed cases and from cases with therapeutic failure.

From 75 children with primary acute otitis media middle ear exudate was collected by needle aspiration through the tympanic membrane and investigated with respect to the presence of bacteria, bacterial L forms and mycoplasmas. In 60 cases (80%) bacteria were found by cultivation. Diplococcus pneumoniae was isolated in 50.7%, Haemophilus influenzae in 14.7%, group A streptococci in 5.3% and Neisseria catarrhalis in 9.3%. From 2 cases D. pneumoniae was isolated only on media designed for the isolation of L forms. In 5 of the 15 cases with negative culture findings, evidence for a bacterial infection was obtained by microscopic examination of the exudate. Mycoplasma was not demonstrated in any of the exudates. The bacterial findings from the throat were of little value in assessing the aetiology of otitis media. On the other hand, the bacterium isolated from the middle ear exudate was isolated from the nasopharynx in all but one case. The bacterium that was isolated from the middle ear exudate was re...

Of 185 Haemophilus influenzae strains from children with acute otitis media, 28 (15.1%) were typable. The overall frequency of therapeutic failure with penicillin V therapy at a daily dosage of 50 mg/kg body weight was about 5% in the 2–9 year age group and 30% in the 0–1 year group. Infections with typable strains gave rise to therapeutic failure about 3 times as often as infections with non-typable strains. In the 0-1 year group all infections with typable strains gave rise to therapeutic failure.

The in vitro sensitivity of 108 strains of Neisseria catarrhalis to ampicillin, penicillin G, penicillin V, erythromycin and oxytetracycline was determined. The strains were isolated, inter alia, from ear exudate of children with acute otitis media. Ampicillin was more active than penicillin G, which was followed by erythromycin, penicillin V and oxytetracycline. In acute otitis media caused by N. catarrhalis, an effect could probably be expected of ampicillin and of penicillin V treatment with daily dosages of 50 mg per kg body weight. Erythromycin would be preferred to oxytetracycline in those instances in which penicillins are contraindicated.