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To survey antibiotic use in general practice, questionnaires were sent to 1160 practitioners in the Canton of Zurich. 510 (44%) were returned. Antibiotics had been administered for respiratory tract infections in 60% and urinary tract infections in 20% of cases. Sulfamethoxazole/trimethoprim, followed by oral penicillin, tetracycline and aminopenicillin were prescribed most frequently. Adverse side effects do not appear to be significant in general practice. Guidelines for the diagnosis and treatment of the most frequent infectious diseases occurring in an outpatient population are presented.

Erythromycin is regarded more and more as the primary therapy for community-acquired pneumonia. In a prospective study, treatment with erythromycin was evaluated in cases of community-acquired pneumonia requiring hospitalisation. Therapy was started intravenously with 1 g erythromycin lactobionate b. i. d., followed by 1 g erythromycin ethylsuccinate b. i. d., administered orally, until the patient had definitely recovered. Twenty-four patients with documented pneumonia were admitted to the study; five were excluded since the infections were caused by bacteria which were not susceptible to erythromycin. Nineteen patients responded well to therapy. No severe side-effects could be observed. Erythromycin (1 g b. i. d.) appears to be an effective, well-tolerated regimen for severe community-acquired pneumonia.

An exact history was taken and clinical, endoscopic and histologic studies were performed in 14 family members of a case of Gardner's syndrome with triple symptomatology documented with biopsy and autopsy findings. Among the symptom-free probands five cases of colonic polyposis and three cases with gastric polyps were found. All polyps were histologically adenomatous. Dysplasias grade I and II were found repeatedly, in one 16-year-old adolescent there was already severe dysplasia within the gastric mucosal polyps. A warning is given against sub-classification of familial colonic polyposis and other syndromes within the definition of Gardner's syndrome. In future during diagnostic investigations for cases of Gardner's syndrome isolated gastric polyposis should be sought for as well as monosymptomatic colonic polyposis. Diagnostic procedures and treatment should depend on endoscopic and histological findings. Regular follow-up with endoscopic biopsies are to be encouraged not only in the diseased cases but also in all family members available.

Antibiotics are administered prophylactically before operation (at induction of anesthesia) in order to achieve sufficient tissue concentrations when contamination happens. Antibiotic prophylaxis is usually given as a single dose. It is clearly indicated in abdominal surgery. It is also recognized in association with the use of prosthesis in cardiac, vascular, and bone surgery although there is no proven benefit. According to definition, administration of antibiotics in a perforated hollow viscus or an open fracture is not a prophylaxis. First and second generation cephalosporines are recommended for prophylactic use. In abdominal surgery, aminoglycosides too, combined with a drug directed against anaerobic bacteria are widely used.

In a randomized study the clinical and bacteriologic effectiveness of imipenem was compared with the classical combination of netilmicin with clindamycin in patients who had surgery for an intraperitoneal infection, localized or generalized, with positive bacteriologic findings of the specimen taken at surgery. Excluded were all patients who received other antibiotics before surgery, or who died within 3 days after antibiotic therapy was started. Imipenem was given at a dose of 500 mg t.i.d., clindamycin 600 mg t.i.d., and netilmicin according to serum levels. The diagnoses ranged from postoperative peritonitis, gallbladder empyema, perforated gastroduodenal ulcer, small bowel perforation with and without obstruction, and perforated appendicitis to perforation of the colon. The bacteriologic work-up included examination of the primary specimen (aerobic and anaerobic), the urine, feces, and serologic testing for Candida albicans once or twice a week and after the course of antibiotic therapy. In addition, pH measurements of abscesses and drainage fluids were performed. Ninety-three patients entered the study. Forty-seven patients were treated with imipenem (test group), and 46 patients were treated with the combination therapy (control group). The two groups did not show significant differences in age, sex, diagnostic groups, risk factors, primary bacteriology, and duration of therapy (mean: 6.7 days). Thirty-eight patients (80.9%) treated with imipenem were cured, six patients (12.8%) were improved, and there were three (6.4%) failures. The respective numbers for the control group were 31 (67.4%), 10 (21.7%), and 5 (10.9%). The mean duration of hospitalization was 19 days for the test group and 24.5 days for the control group. There were four wound infections in the test group and 11 wound infections in the control group. Imipenem is at least as effective in the adjuvant therapy of intra-abdominal infections as the combination of netilmicin with clindamycin.

Four methods were used to assess gentamicin concentrations in 37 sera of patients treated with gentamicin. It was shown that the bioassay (agar diffusion) and the enzyme immunoassay correlated well, and the latex agglutination inhibition test badly, with the radioenzyme assay which was used as the reference method. Among presently available methods only the bioassay can be performed with relatively little equipment.