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Bacterial infections are not uncommon in hospitals and are an important cause of death. Gram-negative bacteria may infect the bloodstream of from 10 to 15 per 1,000 hospital patients; these bacteria contain complex substances called endotoxins in their cell walls which induce complex and dangerous responses in the patient. Such Gram-negative infection of the blood, also called Gram-negative bacteremia, is fatal in from 21 to 31 percent of cases. It has always been considered possible to neutralize the effects of endotoxins with antibodies. However, until the advent of monoclonal antibody techniques, there has been no large-scale source of such antibodies. A study was undertaken to determine if monoclonal antibodies, obtained from mouse cells, may prove clinically useful in neutralizing endotoxin. Three hundred sixteen patients developed Gram-negative sepsis over a 30-day period (in sepsis, the endotoxin is present in the blood, regardless of whether the bacteria are detectable in the blood or not). Patients were randomly assigned to receive either the mouse antibody or placebo, in addition to their other treatment. Among the patients who had already gone into toxic shock, the antibody treatment provided no significant benefit. However, among the 137 patients who were not in shock, the patients receiving the antibody had 2.3 times less risk of dying than the patients who received placebo. Organ failure is a common complication of Gram-negative sepsis. Among the patients not in shock, organ failure resolved in 19 of 35 patients treated with the antibodies and in only eight of 27 patients receiving placebo. The results of the study indicate that if a patient with Gram-negative sepsis has not yet gone into shock, antibodies against endotoxin provide a superior level of protection. (Consumer Summary produced by Reliance Medical Information, Inc.)

The efficacy and safety of cefmetazole and cefoxitin were compared in a randomized open-label parallel trial in 68 hospitalized adult patients with lower respiratory tract infections. Of 40 patients evaluable for efficacy, 23/25 (92%) in the cefmetazole group and 13/15 (87%) in the cefoxitin group demonstrated a favourable clinical response. The causative bacteria were eradicated in 30/32 (94%) and 13/14 (93%) of isolates in the cefmetazole and cefoxitin groups, respectively. A total of 51 adverse events was noted in 68 patients: 36 in 26 patients (55%) in the cefmetazole group and 15 in 12 patients (57%) in the cefoxitin group. These events were reversible, and except in one patient who was treated for oral candidiasis, did not require any therapeutic intervention or prolonged hospitalization. Cefmetazole appears to be as safe and effective as cefoxitin in the treatment of lower respiratory tract infections of hospitalized patients. [ABSTRACT FROM PUBLISHER]

The appropriate dose of clindamycin in patients with liver disease has not been determined. There are reports of progressive liver disease with the recommended doses of the drug. Fifteen patients without ascites or biliary obstruction were given intravenous clindamycin for a variety of infections and had serum concentrations of the drug determined by the agar diffusion method at 2 and 3 h post-infusion. The half-life of the drug (½) which represents the ability of the liver to eliminate the active form of the drug in each patient was correlated with his serum liver profile: SGOT, SGPT, albumin, globulin, alkaline phosphatase, total bilirubin, and indirect bilirubin. The ½ varied from 0.63 to 4.7 h The correlation coefficients for alkaline phosphatase, SGPT, total bilirubin, and indirect bilirubin were −0.61, −0.6l, 0.86 and 0.925 respectively. The best estimate of clindamycin ½ was by the equation: ½=3.2 (indirect bilirubin)+0.48. No correlation was found with SGOT, albumin, or globulin. The use of the above equation should help in calculating the dose of the drug in patients with liver disease but without ascites or biliary tract obstruction. [ABSTRACT FROM PUBLISHER]

Eubacterium is a commensal of the human gastrointestinal tract. In rare instances this organism can become blood-borne. Nine cases of bacteremia were described and eight cases were found in the medical literature. Thirteen of the 17 cases (76%) had active gastrointestinal disease leading to the Eubacterium bacteremia. It is suggested that recovery of Eubacterium in blood culture should alert the clinician to the possibility of active gastrointestinal disease including occult neoplasms. [ABSTRACT FROM AUTHOR]

Presents information on a study which assessed the efficacy of adjunctive monoclonal antibody antiendotoxin immunotherapy in patients with gram-negative sepsis. Study design; Patient demographics; Analysis of patients with gram-negative sepsis based on the presence or absence of shock at study entry; Safety analysis.