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We conducted a randomized trial with ceftazidine alone or associated with amikacin or vancomycin to investigate the efficacy of the daily 3 g dosage of ceftazidime and the efficacy of monotherapy with ceftazidime and to determine if vancomycin should be added empirically.Patient inclusion criteria were: age over 10 years, therapeutically-induced neutropenia and fever for at least three hours above 38.5 degrees C in absence of a clear non-infectious aetiology. Patients were randomized into three groups: group C, ceftazidime alone 3 g/day; group CA, ceftazidime 3 g/day plus amikacin 15 mg/kg/day; or group C, ceftazidime 3 g/day plus vancomycin 1.5 g/day.Results from one hundred and two episodes of fever were analyzed. The underlying diseases were haematological malignancies (89 patients) and solid tumours (13 patients). The median duration of neutropenia (0.5 x 10(9) PMN/L) was 18 days and the minimum duration of 7 days. The main criterion for the analysis of efficacy was the onset of a major infectious event, i.e. death related to documented or suspected infection and any infectious event considered life-threatening or hindering future treatment of the underlying disease. Eight (22%) patients in group C developed major infectious events compared with four (13%) in group CA and none in group CV (p0.01). Major infectious events were mainly due to Gram-positive organisms, particularly Streptococcus species.We conclude that: 1) ceftazidime alone and in association with amikacin is effective in preventing Gram-negative major infectious events; and 2) vancomycin should not be added only when a Gram-positive infection is documented, but used empirically.

When healthy volunteers were given a daily dose of 3 x 10(8) life-dehydrated Saccharomyces cerevisiae cells for 5 days, the volunteers excreted 10(5) living yeast cells per g of feces at first, but the yeast cells disappeared within 5 days of the end of treatment. In gnotobiotic mice, S. cerevisiae administered alone colonized the intestinal tract but did not interfere with previous or subsequent colonization by a variety of potentially enteropathogenic microorganisms. When these microorganisms were present, the intestinal counts of S. cerevisiae were greatly reduced.

Resume Le Cefotaxime est une nouvelle cephalosporine semi-synthetique, administrable par voie parenterale. Le pic serique moyen est voisin de 25 mcg/ml et la demi-vie de 90 minutes apres injection intramusculaire de 1 gramme. L'elimination urinaire de l'antibiotique est comprise entre 50 et 60 %, la liaison proteique du Cefotaxime est de 40 %. Utilise du fait de son spectre antibacterien tres large dans des cas d'infections urinaires et septicemiques severes dues dans la majorite des cas a des enterobacteries multiresistantes le Cefotaxime a obtenu la guerison dans 66 % des cas, ce qui represente un excellent resultat. La tolerance clinique et biologique a ete bonne.

Le but de cette etude a ete de comparer la repartition de l'activite antibiotique dans le serum, la bile et les urines, apres injection intramusculaire d'Ampicilline ou de Metampicilline. La transformation de la Metampicilline en Ampicilline (2) en milieu acide nous a incites a effectuer cette etude par voie intramusculaire. Nous n'avons pas effectue de controle apres prise orale.

Intestinal colonization by highly erythromycin-resistant members of the family Enterobacteriaceae was surveyed for 4 years in a hematology-oncology unit. Fifty-four of 555 patients (9.7%) were colonized, each with a different strain. The incidence of intestinal carriage was not correlated with erythromycin consumption in the ward but was strongly associated with individual exposure to erythromycin.

Resume La numeration des Enterobacteriaceae et Pseudomonas aeruginosa , sensibles et resistants aux antibiotiques, qui colonisent le tube digestif, a permis une comparaison avec les souches isolees par hemoculture chez des patients leucemiques en aplasie. 45 fois sur 55 (82%) le clone fecal dominant de ces bacteries dans les 5 jours precedant la bacteriemie etait responsable de celle-ci. La translocation de ces bacteries du tube digestif dans la circulation sanguine est fortement correlee a une granulopenie 3 (p

It was shown that a strain of Serratia liquefaciens harbors a conjugative R-plasmid responsible for reistance to the following 14 antibiotics: ampicillin, carbenicillin, cephalothin, butirosin, neomycin, paramomycin, kanamycin, lividomycin, gentamicin, tobramycin, streptomycin, tetracycline, sulfonamide, and chloramphenicol, which belong to five families, the beta-lactamines, the aminoglycosides, the tetracyclines, the sulfonamides, and the phenicols. Resistance to th 14 antibiotics was cotransferred by in vitro conjugation between S. liquefaciens and strains of Escherichia coli. Mating between S. liquefaciens and E. coli also occurred in vivo, in the digestive tract of axenic mice and gnotobiotic mice associated with the whole human fecal flora. It was also shown that mating between these two strains occurred even when the donor S. liquefaciens strain was only transient in the digestive tract of the gnotobiotic host animals. A dense population of Bacteroides (10(10) viable cells per g of fresh feces) did not hinder this mating. All the matings occurred in the absence of an antibiotic selection pressure, and the resulting transferred strain of E. coli did not have the same colonizing capacity as the recipient parental strain. However, during antibiotic administration to mice, and even after the end of the drug intake, the transconjugant became established in the dominant population and replaced the parental recipient strain.

Intestinal colonization by members of the family Enterobacteriaceae resistant to cefotaxime was surveyed for 3 years in a hematology-oncology unit. Of 416 patients, 66 (15.9%) were colonized, each with a different strain. The incidence of intestinal carriage was not correlated with cefotaxime consumption in the ward but was strongly associated with individual exposure to cefotaxime.

The considerable activity of cefotaxime on enterobacteriaceae is especially useful in neutropenic patients who are particularly at risk of septicaemia complications. The rapidly fatal development of this type of infections necessitates the use of a presumably efficacious therapy even before the result of blood cultures are obtained. The in vitro activity of cefotaxime in enterobacteriaceae has been compared to that of cephalothin, cefazolin, cefamandole, cefoxitin and cefuroxime.

The effect of erythromycin base was studied on intestinal resistance to colonization of gnotobiotic mice inoculated with a human fecal flora and challenged with six microbial strains potentially pathogenic for immunocompromised patients. Fecal concentrations of erythromycin were greater than 1,000 micrograms/g in the human donor and in mice. Total intestinal bacterial counts were not significantly different in the human donor and in the recipient mice and were not affected by erythromycin treatment. Strains of various species from the dominant flora (greater than 10(9) colony-forming units/g) and resistant to greater than 1,000 micrograms of erythromycin/ml were present before and persisted during treatment. Strains sensitive to such concentrations - particularly all enterobacteria-were eliminated. Treatment did not reduce colonization resistance against Candida albicans, Clostridium perfringens, and erythromycin-sensitive Escherichia coli. It reduced but did not eliminate some colonization resistance against Pseudomonas aeruginosa, Clostridium difficile, and erythromycin-resistant E coli.

The authors report a case of anuria which lasted 3 months in a patient with sub-acute streptoccocal endocarditis. The investigations led to the discovery, at the level of the kidneys, of arterial aneurysms, renal infarction and diffuse endo-capillary proliferative glomerulonephritis, with deposits of complement and immunoglobulin and finally, interstitial nephritis, perhaps of metastatic origin, which was probably the lesion responsible for the renal failure. Renal function progressively improved and hemodialysis was stopped at the 6th month after correction of the mitral and aortic valve disease.

The authors report 6 cases of tuberculosis of the bone marrow, in which the diagnosis was made by biopsy. Three of these cases, included peripheral blood abnormalities, such as pancytopenia, whereas in the three other, nothing special was found on routine blood examination. All the patients, except one who died from intercurrent infection, became cured thanks to anti-tuberculosis treatment. Marrow biopsy thus permits early diagnosis, miliary tuberculosis, even when usual radiological and bacteriological investigations are negative.

The interest of tobramycin, studied here in 63 cases of severe infection, is due to several factors: --its ease of use including in cases of renal insufficiency; --the efficiency of subcutaneous administration, of particular interest to patients on anticoagulants; --its action on multi-resistant Enterobacteria and those not responding to gentamicin. Antibiotherapy is however only one of the elements of success in the treatment of severe infections, beside two factors which are often linked and determining: early treatment and the development of foci resistant to antibiotics.

The effectiveness of nanoparticle-bound ampicillin was tested in the treatment of experimental Listeria monocytogenes infection in congenitally athymic nude mice. Nanoparticles of polyisohexylcyanoacrylate (PIHCA) 187 +/- 13 nm in diameter were bound to ampicillin at an ampicillin/PIHCA ratio of 0.2:1. The proportion of ampicillin bound was 90% +/- 3%. After adsorption onto nanoparticles, the therapeutic activity of ampicillin increased dramatically over that in the free state. Thus, 2.4 mg of nanoparticle-bound ampicillin (three doses of 0.8 mg each) had a greater therapeutic effect than 48 mg of free ampicillin (three doses of 16 mg each). These results might provide an incentive for further development of intracellular targeting of antibiotics on biodegradable polymeric carriers.

In order to determine the effect of parenteral antibiotherapy on the fecal flora in patients with profound and prolonged granulocytopenia, we initiated a prospective study of 62 cases of autologous bone marrow transplantation following high-dose chemotherapy. All patients were children from 2 to 18 years old, isolated in a protective environment, receiving a diet low in viable microbial content but no oral non-absorbable prophylactic antibiotics to decontaminate the gastrointestinal tract. Bacteriological analysis of fecal flora was conducted at least once a week before and during parenteral antibiotherapy, administered at the first greater than 38 degrees C febrile episode in these granulocytopenic patients (granulocyte count less than 0.5 X 10(9)/l). The 58 evaluable patients fell into three groups with regard to the systemic antibiotherapy: group A (n = 16): moxalactam + mezlocillin; group B (n = 15): moxalactam + tobramycin; and group C (n = 27): cefotaxime plus gentamicin. Fecal flora suppression was observed in 51/58 cases (88%) (group A: 15/16, group B: 13/15, group C: 23/27). It always occurred within 5 days of initiating parenteral antibiotherapy and persisted in 88% of the 51 patients over the whole period of systemic antibiotherapy. During the latter, fecal recolonization was observed in seven cases (12%), always by Enterobacteriaceae sensitive to the prescribed systemic antibiotherapy, never responsible for septicemia. Since parenteral antibiotherapy alone was able to suppress the gastrointestinal tract flora, the effects of this treatment should be considered in all trials of digestive tract decontamination.

In C3H gnotobiotic mice, no significant difference was observed between the translocation of nine clinical isolates of enteropathogenic Campylobacter spp. and that of seven nonisogeneic Escherichia coli strains with or without various determinants of pathogenicity. In addition, there was no correlation found between the intensity of translocation of Campylobacter strains and the signs of invasiveness in the patients from whom the strains had been isolated.

Traveller's diarrhea is mostly due to aerobic Gram-negative bacterial species, especially enterotoxigenic Escherichia coli. Until today no fully satisfactory prophylactic regimen has been designed. We have previously reported that erythromycin can eliminate Enterbacteriaceae from the human faecal flora during several weeks without recolonization by highly resistant Gram-negative aerobic organisms. This effect has been reproduced in 17 out of 18 volunteers taking 1, 2 or 3 g per day of oral erythromycin base during 5 days. This effect is due to the very high faecal concentrations of the antibiotic (2,000-4,000 micrograms/g) compared to the MIC of erythromycin on aerobic Gram-negative species (10-500 micrograms/ml). MIC of erythromycin on bacterial species which cause traveller's diarrhea are within the same range. These considerations led us to perform a double-blind, randomized, placebo-controlled clinical trial of the efficacy of 1 g daily intake of erythromycin base in preventing traveller's diarrhea. Fourty-eight US citizens travelling to Acapulco (Mexico) were enrolled in the study. Mean duration stay was 5.87 days. Seven out of 24 subjects of the placbo group experienced diarrhea and non (p=0.0047) in the treated group. Study should be undertaken to evaluate the efficacy of oral erythromycin in preventing traveller's diarrhea in other parts of the world.

Resume Le dosage de Gentamycine est pratique par la methode de diffusion en gelose. Le germe-test : Enterobacter cloacae P 99 est parfaitement resistant a toutes les B-lactamines. Leur presence n'apporte aucune modification au resultat. La methode est simple et suffisamment precise et rapide pour surveiller, en pratique courante, les concentrations de Gentamycine en cas d'association therapeutique avec une B-lactamine.