Minocycline: old and new therapeutic uses

Since the introduction of minocycline HCl in the late 1960's, it has been used for disease states that have ranged from typical community-acquired infectious diseases to others that are non-infectious, such as resistant rheumatoid arthritis. Owing to its high penetration characteristics throughout the body, minocycline can be used in the treatment of a wide variety of extracellular and intracellular pathogens. This review examines the known and potential therapeutic uses of minocycline in a clinical setting.

The emergence of erythromycin resistance in Streptococcus pyogenes in Fremantle, Western Australia

Erythromycin resistance in Streptococcus pyogenes is unusual except in Japan. Since January 1, 1985, a dramatic increase has occurred in the prevalence of erythromycin-resistant Strept. pyogenes infections in the outpatients who have presented to Fremantle Hospital, Western Australia. In 1985, 1% of isolates of Strept. pyogenes was erythromycin-resistant. This had risen to 9.1% of isolates in 1986 and to 17.6% of isolates in 1987. Several M- and T-types of Strept. pyogenes were involved. Treatment failure now can be expected when erythromycin is prescribed for the treatment of common infections in outpatients at this hospital. Laboratories that use disc methods of antimicrobial susceptibility testing may not detect erythromycin resistance in these organisms.

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.

Comparison of the clinical significance of methicillin‐resistant and methicillin‐sensitive Staphylococcus aureus isolations

A prospective study of the incidence and clinical significance of Staphylococcus aureus isolations in patients undergoing surgery in a 600-bed hospital has disclosed that methicillin-sensitive organisms are more likely to be associated with severe infections (36%) than methicillin-resistant organisms (26%), and that resistant organisms are present as a colonization more often (54%) than sensitive organisms (42%). However, once a severe infection has become established, that with a methicillin-resistant organism is associated with an increased length of stay in hospital, and a greater risk of death.