Flucloxacillin compared with cefazolin in short-term prophylaxis for clean orthopedic surgery

Two-hundred and fifty-two patients were included in a prospective, randomized, double-blind trial comparing the efficacy of flucloxacillin with that of cefazolin for clean orthopedic surgery. The preventive antibiotic regimen consisted of three 1-g injections perioperatively. There were 126 patients in each group, and the follow-up period was at least 6 months. Two deep (1.6%) and five superficial (4.0%) infections occurred in the flucloxacillin group. Three deep (2.4%) and five superficial (4.0%) infections developed in the cefazolin group.

Cephradine and flucloxacillin in the prophylaxis of infection in patients with open fractures

A comparison of prophylactic antibiotic cover of cephradine or flucloxacillin in sixty patients with open fractures is reported. There were more infections in the flucloxacillin than in the cephradine group and gastrointestinal side-effects were more common. The overall incidence of infection in the whole group, two out of 60 or 3.3%, was acceptably low.

Staphylococcus epidermidis endocarditis and mitral valve prolapse

Staphylococcus epidermidis is an infrequent cause of native valve endocarditis. We describe two cases associated with mitral valve prolapse, and discuss the significance, diagnosis and management of this condition.

Streptococcus pyogenes bacteraemia: an old enemy subdued, but not defeated

Bacteraemia with Streptococcus pyogenes (Group A haemolytic streptococci) was reviewed in patients admitted to University Hospital, Nottingham over a period of 7 years. Altogether, 40 cases were encountered, representing 2% of all cases of bacteraemia. Mortality was 35%. Most cases were community-acquired and 28% of patients were less than 40 years of age. A third of the patients were previously fit. The most common sources of bacteraemia were the skin and soft tissue (23 patients) and the respiratory tract (eight patients). Shock was recorded in 40% of cases and carried a 60% mortality. This feature of streptococcal bacteremia has not received sufficient attention in the past. Despite its unique susceptibility to penicillin, S. pyogenes continues to pose a challenge to the physician.

Outbreak of staphylococcal scalded skin syndrome among neonates

Over a period of 2 months, 12 babies born in the maternity unit at Guy's Hospital developed staphylococcal scalded skin syndrome in two distinct outbreaks. Staphylococci isolated from the babies, together with those from the mothers and attending medical staff were phage-typed. All isolates from the babies were of type 3A/3C. During the first outbreak only one carrier of the epidemic strain (a paediatrician) was found but a further 12 persons were identified as possible carriers during the second outbreak. In order to confirm the link between outbreaks, all phage group II isolates were subjected to reverse phage-typing, testing for metal-ion resistance, plasmid profiling and in-vivo testing for production of epidermolytic toxin. It was shown that the same epidemic strain of toxin-producing Staphylococcus aureus was responsible for both outbreaks. The affected neonates responded rapidly to a short course of intravenous flucloxacillin. The outbreak ceased after appropriate treatment of all carriers and the implementation of an extensive disinfection policy within the maternity unit.

Systemic antibiotic prophylaxis and reconstructive ear surgery

This paper reports a multicentre, controlled, blind, prospective, randomized study into the use of prophylactic systemic antibiotics in myringoplasty surgery. Seventy-one individuals were clinically and bacteriologically assessed both preoperatively, and for a period of 8 weeks postoperatively. The results showed that antibiotic prophylaxis did not eradicate bacterial pathogens already present in preoperative ears, nor did it prevent their development during the postoperative period. The observation that an ear was wet or dry gave no indication of the actual presence or absence of pathogenic organisms.

A controlled trial of nebulized aminoglycoside and oral flucloxacillin versus placebo in the outpatient management of children with cystic fibrosis

Six children with cystic fibrosis who had persistently had Pseudomonas aeruginosa isolated from their respiratory tract, completed a double-blind cross-over comparison of oral flucloxacillin and nebulized aminoglycoside versus double placebo. The patients had higher FEV1 results at the end of the month of active treatment than after the month of placebo.

Flucloxacillin in chronic leg ulcers. Penetration of flucloxacillin into chronic leg ulcer exudate and the effect on the bacteria

The penetration of flucloxacillin into ulcer exudate was investigated in six patients with chronic leg ulcers. The flucloxacillin dosage used was 1 g orally three times daily for three days, and the serum and exudate concentrations were measured repeatedly during a 10 h-period following the first and the seventh dose. All the ulcers were contaminated with (S. aureus) Staphylococcus aureus either in pure culture (three ulcers) or in culture mixed with Gram-negative bacteria (three ulcers). Bacterial counting in the ulcers was performed twice before and twice during the antibiotic treatment. The flucloxacillin concentrations measured in the ulcer exudate were found to be lower than the corresponding serum concentrations. However, the exudate concentrations were found to be above the minimum inhibitory concentration (MIC) for the contaminating S. aureus during an average of 7 h after each dose, and the number of S. aureus during the treatment period was reduced to less than 0.01% of the initial number. The Gram-negative bacteria were not susceptible to flucloxacillin. The number of these bacteria decreased before flucloxacillin treatment but increased again during treatment, probably owing to the changed conditions in the ulcers following the marked decrease in the number of S. aureus.

A three-year study of impetigo in Sydney

Two hundred and forty-three cases of impetigo, which were seen in children in Sydney in the three-year period from July, 1983 to June, 1986, were studied. The great majority of cases was seen in summer and autumn, and over half the cases occurred in the preschool age group. Staphylococcus aureus was grown from 86% of the cases; in 69% of cases it was the only organism to be found, indicating the predominant importance of this organism in impetigo in Sydney in the 1980s. Antibiotic-sensitivity testing of the staphylococci that were cultured demonstrated that fewer than 2% of strains were sensitive to penicillin and fewer than 50% of strains were sensitive to erythromycin. Our experience suggests that flucloxacillin is the antibiotic agent of choice in the treatment of impetigo in children in Sydney.

The influence of flucloxacillin and amoxicillin with clavulanic acid on the aerobic flora of the alimentary tract

In a randomized study, 42 patients undergoing extensive maxillo-facial surgery (correction of the position of the mandible or maxilla by using autologous bone transplants) received prophylactically ten-day courses of either flucloxacillin or amoxicillin with clavulanic acid. Patients were comparable with regard to age and type of surgery. During the prophylactic treatment the effect of antibiotics used on the microbial flora of the alimentary tract was studied. Patients receiving flucloxacillin showed increased numbers of Klebsiella spp. isolated from the faeces (59% of the patients versus 19% of the patients receiving amoxicillin with clavulanic acid). Patients receiving amoxicillin with clavulanic acid showed higher colonization rates of oropharynx with Enterobacteriaceae than patients receiving flucloxacillin (ten patients versus five patients). 60% of those strains isolated from patients receiving amoxicillin with clavulanic acid were resistant to this combination, as compared to 20% of gram-negative bacilli isolated from patients receiving flucloxacillin. In 50% of patients receiving amoxicillin with clavulanic acid, colonization of the gut with yeast occurred, as compared to 18% of patients receiving flucloxacillin. Only one infection leading to a partial loss of the graft was seen in the group of patients receiving flucloxacillin.

The effect of antibiotic prophylaxis and topical antiseptics on the bacterial flora of the skin after cardiac surgery

A controlled trial of antibiotic prophylaxis in cardiac surgery compared a two-dose regimen of teicoplanin with a longer conventional course of flucloxacillin and tobramycin. In 12 patients the susceptibility of the bacterial skin flora of four different sites to each of the three antibiotics was determined and the results are reported here. Less than 1% of the Gram-positive colonies showed reduced sensitivity to teicoplanin (MIC greater than or equal to 4 mg l-1). Before operation, 99% inhibition of Gram-positive growth was achieved at 26 (54%) of 48 sites by 1 mg l-1 of flucloxacillin and 13 (27%) sites by 2 mg l-1 tobramycin. By the 7th day after operation there was a significant reduction in the number of sites showing similar sensitivity to flucloxacillin [16 (33%) sites, P less than 0.05]. The use of teicoplanin was not associated with the emergence of Gram-negative skin flora but tobramycin promoted acquisition of aminoglycoside-resistant strains.

Prophylactic antibiotic treatment prevents infection after cardiopulmonary bypass: a study in dogs

The effect of two prophylactic antibiotic regimens during cardiopulmonary bypass (CPB) was investigated in dogs. Airborne contamination was determined by spraying two different bacterial strains (Staphylococcus aureus and Serratia marcescens) into the air of the operating room. Dogs were operated on and underwent CPB with a bubble oxygenator. Pericardial suction, either conventional (blood-air) or selective (only blood), was used. Particularly in the first situation, an impaired humoral host defense is induced. In dogs given the regimen consisting of penicillin G (benzylpenicillin), gentamicin sulfate, and flucloxacillin, the number of contaminated sites for both bacteria was reduced (p less than .01) compared with those given cefuroxime. The effectiveness of the combined antibiotic regimen could be ascribed to increased serum bactericidal activity and polymorphonuclear leukocyte (PMN) killing capacity. Cefuroxime enhanced the PMN respiratory burst. As a result, two weeks postoperatively the rate of infection was small in both groups. We conclude that prior to CPB, antibiotics should be administered prophylactically to overcome a period of impaired humoral host defense during CPB.

Early termination of a prospective, randomized trial comparing teicoplanin and flucloxacillin for treating severe staphylococcal infections

In a prospective, randomized trial, teicoplanin (at a 400-mg intravenous loading dose followed by 200 mg/day intravenously or intramuscularly) was compared with flucloxacillin (8 g/day) in patients with severe staphylococcal infections. Teicoplanin proved unsatisfactory for the following reasons: failures or relapses were more frequent in the teicoplanin group, and blood levels were difficult to predict and tended to be low 24 hr after the loading dose. Future trials with this agent should use much-higher doses.

Successful non-surgical management of pyogenic liver abscess

A 5-month-old infant presented with high fever, irritability, and poor feeding. Examination revealed an enlarged liver and neutropaenia. Ultrasonography was unhelpful, but a diagnosis of liver abscess was confirmed by computed tomography on day 4 of the illness. Gallium scan was normal on day 4 but showed a resolving liver abscess on day 6. Staphylococcus aureus was grown in blood culture. The infant recovered with antibiotic treatment alone.

Cutaneous mucormycosis: a rare cause of leg ulceration

Cutaneous mucormycosis followed trivial injury to the leg of a 72-year-old man. The lesion progressed rapidly requiring above-knee amputation.

Antibiotic prophylaxis in pacemaker surgery: a prospective double blind trial with systemic administration of antibiotic versus placebo at implantation of cardiac pacemakers

In a double blind clinical trial, 106 consecutive patients scheduled for pacemaker implantation were randomly assigned either to a systemic prophylaxis group (SPG) (to be given flucloxacillin) or to a control group who would be given a placebo (CPG). The SPG group received 2 g IV flucloxacillin 1 hour before the operation, then 1 g perorally every 8 hours for the next five days. In the CPG group, placebo infusions and tablets were given at the same schedule. There were a total of 106 patients (SPG 52, CPG 54) who met the criteria of the study. Of these, 102 patients (SPG 50, CPG 52) completed a follow-up of 7-35 months. Infection of the pacemaker system was not diagnosed in any patient in either group. Tissue fluid was drawn 24 hours postoperatively from the pacemaker pocket for culture and for determination of pocket antibiotic concentration. The mean flucloxacillin concentration of pocket fluid from 23 patients in the SPG was 7.5 micrograms/ml. The bacteriological cultures were positive in 9/32 patients in the SPG group and in 10/34 patients in the CPG group. This study suggests that antibiotic prophylaxis need not routinely be given at implantation of permanent pacemaker systems.

[Clinical evaluation of flucloxacillin in the treatment of serious staphylococcal infections in children]

A total of twenty-nine children were admitted to the paediatric unit with confirmed or presumed staphylococcal infection and subsequently treated with the narrow spectrum antibiotic--flucloxacillin. Despite the gravity of their condition all but two patients made a satisfactory recovery. There were no side-effects associated with this treatment.

[Toxic shock syndrome]

A 23-year-old woman developed mitigated toxic shock syndrome while using intravaginal tampons during menstruation. The Staphylococcus aureus strain isolated from the vaginal epithelium produced the responsible exotoxin (TSST-1).

Wound infection after mandibular reconstruction with autogenous graft

An investigation on the fate of bone grafts in 38 patients, who had been subjected to a partial resection of the mandible for benign and malignant tumours, is presented. Apart from thorough drainage, meticulous suturing and gastric tube feeding, high and prolonged administration of antibiotics was practised to prevent infection. The basic antibiotic coverage in most patients consisted of 4 X 3 grams of flucloxacilline intravenously during ten days. After this period revascularization of a bone graft may be assumed to have progressed to such a degree, that thereafter the graft can "defend itself" against invading micro-organisms, if necessary supported by further lower dosage antibiotic treatment. In 28 patients no complications were encountered. Ten patients showed signs of infection, leading to complete loss of the graft in 3 patients. Incision, drainage, removal of sequestra and further antibiotic treatment resulted in preservation of the major part of the grafts in the other 7 patients. No correlation of infection with type of fixation, extent of soft tissue resection or time at which the reconstruction was done (primary or secondary) was found. The basic difference of maxillo-facial bone grafting as compared to bone grafting in other areas of the body is stressed, massive primary contamination combined with dead space and maybe dehiscence of the oral wound margins being mainly responsible for the relatively unfavourable conditions for grafting in this region.

Failure to culture bacteria in groin lymph nodes during arterial reconstruction

A prospective trial was undertaken to establish if infection of groin lymph nodes was a significant risk factor in postoperative wound infection in patients undergoing groin dissection for arterial reconstruction surgery. In a series of 32 patients there was no growth on culture of any lymph nodes biopsied. None of the cases developed a post-operative infection discharging pus. In five cases minor superficial infections occurred from which bacteria were cultured. All resolved rapidly. All patients received prophylactic systemic antibiotics. We conclude that our present direct approach via a short vertical incision carries no increased risk of infection and has the advantage of speed and simplicity. It is unnecessary to make any special more complicated incision designed to avoid lymphatics.

A clinical trial of teicoplanin compared with a combination of flucloxacillin and tobramycin as antibiotic prophylaxis for cardiac surgery: the use of a scoring method to assess the incidence of wound infection

A prospective randomized clinical trial is in progress to compare the efficacy of teicoplanin with flucloxacillin and tobramycin in the prevention of endocarditis and wound infection following cardiac surgery. To date, 198 patients have completed the trial, of whom 95 have received teicoplanin and 103 flucloxacillin and tobramycin. One patient developed prosthetic valve endocarditis 3 months after surgery covered by flucloxacillin and tobramycin. There was no significant difference in the incidence of sternal wound infection (P = 0.15). Severe sternal sepsis occurred in four patients in the teicoplanin group and two in the flucloxacillin/tobramycin group. There were more postoperative urinary tract infections among those given teicoplanin (15 of 95 patients compared to six of 103 patients P less than 0.05). The trial continues.

Efficacy of penicillin G, flucloxacillin, cefazolin, fusidic acid, vancomycin, rifampicin and fosfomycin in muscular infections in mice due to Staphylococcus aureus

Two strains each of sensitive, penicillinase-producing, methicillin-resistant and "tolerant" Staphylococcus aureus were used to infect mice intramuscularly. The mice were then treated with three doses each of fosfomycin, vancomycin, rifampicin, fusidic acid, penicillin G, flucloxacillin or cefazolin intravenously. Infections due to sensitive strains were effectively treated with all antibiotics investigated except fusidic acid. Fosfomycin, vancomycin, rifampicin and flucloxacillin showed the best activity against penicillinase-producing strains. Fosfomycin and vancomycin were equally effective against infections due to methicillin-resistant S. aureus. Infections caused by "tolerant" strains again responded best to fosfomycin, vancomycin and rifampicin.

A comparison of the new topical antibiotic mupirocin ('Bactroban') with oral antibiotics in the treatment of skin infections in general practice

A trial was carried out in general practice in 200 patients presenting with skin infections to compare topical antibiotic treatment with mupirocin ointment with orally administered flucloxacillin or erythromycin. Patients were assigned at random to receive 4 to 10 days' treatment with either mupirocin applied 3-times daily or one of the oral antibiotics in the dosage normally used by the general practitioner for skin infections. The majority of infections were impetigo and infected wounds/lacerations; the main organisms isolated initially from 127 of the patients were either Staphylococcus aureus or beta-haemolytic Group A streptococci. Clinical response to mupirocin ointment (86% cured, 13% improved) was significantly better than that seen with erythromycin (47% cured, 26% improved) and similar to that with flucloxacillin (76% cured, 23% improved). Treatment outcome was not related to treatment duration with either the topical or oral preparations. Post-treatment samples from 76 patients showed that in the mupirocin group all the pathogens originally isolated were eliminated, including Gram-negative organisms.

Predisposing factors, bacteriology and antibiotic therapy in 35 cases of septic bursitis

In a retrospective study the etiology was verified in 35/52 patients with suspected septic prepatellar or olecranon bursitis. Staphylococcus aureus was the most common pathogen and 86% of them were penicillinase-producing. Other strains were streptococci. Mean age was 47 (18-83) years and males predominated (91%). Predisposing factors were seen in most cases. Preceding trauma was found in 27 and/or associated diseases (e.g. diabetes mellitus) in 11 patients. Hyperglycemia was found in 38% of the patients. Treatment with antimicrobial agents, mostly penicillins, and bursal drainage were successful in 32 cases. Two patients had local spread of the infection and 1 patient chronic bursitis.

A randomized prospective study of ceftazidime versus ceftazidime plus flucloxacillin in the empiric treatment of febrile episodes in severely neutropenic patients

In a prospective, randomized study, ceftazidime monotherapy was compared with a combination of ceftazidime and flucloxacillin in 100 febrile neutropenic patients. Thirty-four bacteriologically documented infections, of which 26 were bacteremias, in 51 patients were treated with ceftazidime alone. Thirty-four bacteriologically proven infections, of which 29 were bacteremias, in 49 patients were treated with a combination of ceftazidime and flucloxacillin. The clinical response rate for ceftazidime monotherapy was 80%; the bacteriological cure rate was 90%. Efficacy against gram-negative pathogens appeared to be excellent, achieving a 100% cure rate. The clinical response and bacteriological cure rates for the combination were 76 and 86%, respectively. Three superinfections were registered in the ceftazidime group, and four, involving six pathogens, were registered in the combination group. Other side effects of ceftazidime were minimal. It is concluded that ceftazidime is an effective drug for the empiric treatment of febrile neutropenic patients. It offers the opportunity to avoid the aminoglycosides in first-line treatment. It may be appropriate to combine ceftazidime with cephalothin or vancomycin or to modify therapy if resistant gram-positive strains are encountered.

Sulbactam/ampicillin: effects on glucose metabolism in diabetics with soft tissue infection

Rats and dogs chronically treated with high doses of sulbactam are known to sequester protein-bound glycogen in their hepatocytes. As a result, previous UK studies of sulbactam/ampicillin excluded patients suffering from diabetes mellitus. This study examined the effects of sulbactam/ampicillin compared to flucloxacillin/ampicillin on diabetic control, the ability to mobilize glycogen and the pancreatic beta cell response to glucagon, in diabetic patients suffering from soft tissue infection. There was no significant effect between treatment groups on any of these parameters. Sulbactam/ampicillin is unlikely to have an adverse effect on diabetic control in clinical practice when used short term in the doses employed in this study.

Antibiotic-laden cement tubes in the treatment of bone and soft tissue infection

We describe a simple, adaptable and effective system that delivers antibiotics locally to sterilize infected tissues.

The role of piperacillin therapy in pulmonary exacerbations of cystic fibrosis: a controlled study

Piperacillin was evaluated as an antipseudomonas antibiotic in a double-blind controlled trial involving 18 pulmonary exacerbations of cystic fibrosis. Standard antibiotic treatment (flucloxacillin plus tobramycin) was compared with standard treatment plus intravenous piperacillin administered according to two regimens. No added benefit from piperacillin was demonstrable on the basis of improvement in symptoms, physical signs, weight gain, pulmonary function tests, radiologic signs, or sputum Pseudomonas bacterial counts. Some patients experienced sensitivity reactions to piperacillin. In vitro, piperacillin was a potent antibiotic against all beta-lactamase-producing mucoid strains of Pseudomonas aeruginosa; however, in spite of the fact that adequate serum antibiotic concentrations were achieved, sputum bacterial counts did not correlate with either the clinical status or the use of piperacillin therapy.

Flucloxacillin concentration in serum and wound exudate during open heart surgery

Per-operative serum and wound fluid concentrations achieved by two flucloxacillin dosage regimens were measured in twelve patients undergoing open heart surgery. One 500 mg bolus dose given after the induction of anaesthesia in six patients resulted in adequate serum concentrations (means decreasing from 69 to 9 mg/l) during surgery, but low wound fluid concentrations (mean 4.6 mg/l, range less than 2-7.8 mg/l) at the time of closure. An additional 500 mg bolus dose given after bypass in six further patients gave more satisfactory wound concentrations (mean 16 mg/l, range 8.6-22.5 mg/l). Disc absorption is a useful technique for assaying antibiotics in wound fluid, but the results are difficult to interpret since they represent a sum of concentrations in a complex and changing mixture of interstitial tissue fluid, blood and cardioplegia solution.

Abscess of the nasal septum after trauma

Although the disorder is said to be uncommon, three cases of abscess of the nasal septum, two in adults, one in a child, were seen during a period of four months. Each patient had a recent history of nasal trauma and presented with severe nasal obstruction. In each case, the septal cartilage was also found to be extensively destroyed when the abscess was drained. Staphylococcus aureus was isolated in the two adult patients, Haemophilus influenzae and Streptococcus pneumoniae in the child. When two of the three patients were examined a few months later, the septal cartilages appeared to have completely regenerated. In all cases of nasal trauma, the septum must be examined to exclude a haematoma or abscess which, if detected, must be treated urgently with antibiotic therapy and drainage to prevent nasal and intracranial complications.

Experimental and preliminary clinical experience with absorbable calcium phosphate granules containing an antibiotic or antiseptic for the local treatment of osteomyelitis

Experimental studies on dogs with staphylococcal osteomyelitis showed that it is possible to reduce florid bone suppuration by the use of hydroxyapatite granules containing an antibiotic or antiseptic. In our series the use of flucloxacillin hydroxyapatite granules was superior to other treatment methods. Twelve patients were treated with thorough sequestrectomy, reliable wound closure and suitable stabilization supplemented with an implant of antibiotic or antiseptic hydroxyapatite granules, and an autologous spongiosa graft for large bone cavities or for discontinuity between the bone ends. The results of this preliminary study showed the treatment to be effective.

Pharmacokinetics and distribution of flucloxacillin in pacemaker patients

The pharmacokinetics of flucloxacillin in plasma and tissue fluid after i.v. infusion of 1 g was analyzed according to an open two-compartment model in 19 patients with bradyarrhythmias (mean age 70.8 years) admitted for implantation or replacement of a permanent pacemaker system. After the first infusion of flucloxacillin (5 min), the distribution phase was rapid (t 1/2 alpha = 0.13 h). The plasma half-life of elimination (t 1/2 beta) was 1.51 h, which is almost twice as long as reported in healthy volunteers. Total plasma clearance (93.1 ml/min) was also lower than is usually found in healthy individuals, due to low renal clearance of flucloxacillin (60.2 ml/min). The total apparent volume of distribution during the beta-phase (Vdarea) was 0.172 l/kg and distribution in the central compartment (Vc) 0.064 1/kg. In each patient plasma protein binding and drug distribution to plasma water, proteins and blood cells in whole blood were determined. Binding in plasma to proteins was 91.0% and distribution to blood cells in whole blood 13.8%. The mean distribution volume of free flucloxacillin during the beta-phase (Vd beta free) was 2.18 1/kg, which exceeds total body water, suggesting possible intracellular distribution and substantial tissue binding. Plasma concentrations of flucloxacillin after the fourth dose (1 g t.i.d.) were very similar to those obtained after the first infusion and those predicted from the single dose kinetics. The concentration of flucloxacillin in fluid from the pacemaker pockets in 5 patients averaged 12.1 micrograms/ml and 9.5 micrograms/ml at 1 and 5 h, respectively, which was more than ten times the MIC-values for Staphylococcus aureus and S. epidermidis.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute calcific periarthritis in a child

We wish to present an account of a child who developed acute calcification in his thenar eminence to highlight the difficulty in differentiation between calcific periarthritis, acute infection, on clinical grounds. Calcific periarthritis is due to hydroxyapatite crystal deposits in bursae, tendons and ligaments (Bonavita 1980) with characteristic radiographic appearances of opacities of variable density and shape around joints (Hitchcock 1959). The condition was first described in the shoulder, by Duplay in 1870 (Sandstrom 1938) and this remains the most commonly affected site. The hip, elbow, wrist, knee and ankle may also be involved but involvement of the hand is uncommon. Involvement in this site was first described in 1924 by Cohen (Carroll 1955). The previously reported age span ranged from thirteen years upwards, with an average of forty-five years, both sexes being equally affected (Currey 1970, Hitchcock 1959, Bonavita 1980).

Erythromycin compared with a combination of ampicillin plus flucloxacillin for the treatment of community acquired pneumonia in adults

Erythromycin was compared with a combination of ampicillin plus flucloxacillin for treating adults admitted to hospital with community acquired pneumonia. A satisfactory clinical response to a seven day course of antibiotics was observed in 29 of 36 patients (81%) in the erythromycin group and 35 of 39 patients (90%) treated with ampicillin plus flucloxacillin, as judged by a fall in temperature, improvement in the general condition, diminution of respiratory symptoms and radiographic improvement. Streptococcus pneumoniae was the causative organism most commonly detected and a satisfactory outcome of treatment of diagnosed pneumococcal pneumonia cases was observed in 16 of 18 patients (89%) treated with erythromycin compared with 20 of 22 patients (91%) treated with ampicillin plus flucloxacillin. These results indicate that erythromycin has similar clinical efficacy to ampicillin plus flucloxacillin, given as a seven day course, for the treatment of community acquired pneumonia in adults.

Wound infection following renal transplantation

A retrospective survey of wound infection following renal transplantation in 100 consecutive patients after the introduction of pre-operative antibiotic prophylaxis is reported. There was one wound haematoma but no wound infection in the 100 primary transplant wounds, and one haematoma which was followed by secondary infection in the 23 patients in whom transplant nephrectomy was performed. There were no other major wound complications. It is concluded that careful surgical technique and antibiotic prophylaxis can virtually eliminate the potentially grave complication of wound infection in this high risk group of patients.

A clinical appraisal of flucloxacillin in the management of skin and soft tissue infections in Nigeria

The resolution of skin and soft tissue infections following a single course of treatment with flucloxacillin was assessed in 235 patients recruited by nineteen physicians. In all, 88.5% of patients were completely cured or showed a highly satisfactory improvement after 3 to 12 days' treatment. Only three patients failed to show any improvement at all. Side-effects were limited to twelve patients (5.1%) all of whom were able to complete their course of treatment.