[Efficacy of Lactobacillus Rhamnosus GR-1 and of Lactobacillus Reuteri RC-14 in the treatment and prevention of vaginoses and bacterial vaginitis relapses]

AIM

The aim of this study was to investigate the efficacy of the use of Lactobacillus rhamnosus GR-1 and of Lactobacillus reuteri RC-14 administrated orally in the treatment and prevention of vaginoses and bacterial vaginitis relapses.

METHODS

The study enrolled 50 women in good health, aged between 18 and 48 years, with assessed diagnosis of bacterial vaginosis and vaginitis. The women were randomized in two groups: group A comprised 25 patients with bacterial vaginitis and group B comprised 25 patients with vaginosis. Each patient was administered an antibiotic therapy and subsequently a therapy with Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 (Dicoflor Elle, Dicofarm, Roma, Italy) with two tablets daily for 15 days. After one week from the end of the therapy all patients have been controlled by vaginal swab and microscopic analysis of vaginal secretion.

RESULTS

At the end of the study 46 patients had a complete Lactobacilli recolonization, two patients had no colonization and two dropped out. The results showed that 92% of the enrolled patients benefited from the treatment.

CONCLUSION

The results of the present study shows that Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14, taken orally, were helpful in vaginosis and bacterial vaginitis treatment and in relapse prevention, as they can re-establish the vaginal ecosystem remarkably.

Activity of Berberis aetnensis root extracts on Candida strains

The antifungal activity of methanolic extract and alkaloidal fraction of Berberis aetnensis against Candida species was investigated. The crude extract was active against Candida species, this activity being higher than that of the alkaloidal fraction and berberine.

Antibacterial activity of propolis and its active principles alone and in combination with macrolides, beta-lactams and fluoroquinolones against microorganisms responsible for respiratory infections

Propolis is produced by bees and is reported to have several pharmaceutical properties. Its antibacterial activity against strains causing upper respiratory tract infections is particularly important: propolis might be used as a therapeutic agent to prevent the bacterial infections that sometimes overlap viral infections. In this study the in vitro activity of both an alcoholic solution and a hydroglyceric extract of propolis, as well as its active principles, was tested against bacteria responsible for respiratory infections (Streptococcus pneumoniae, Haemophilus influenzae, Haemophilus parainfluenzae, Moraxella catarrhalis and Streptococcus pyogenes). We also evaluated the in vitro activity of a combination of propolis and its active principles and some beta-lactams, macrolides and fluoroquinolones. Our results, though not demonstrating a clearly synergistic activity between antibiotics and propolis and its constituents, show the possibility of using natural preparations, due to their antimicrobial and anti-inflammatory properties, to enhance antibacterial therapy.

An outbreak of Q fever in a prison in Italy

We observed an outbreak of Q fever in a prison population. Overall, 65 of the 600 prison inmates developed the disease. The location of the prison cells had no apparent effect on the risk of infection. The outbreak was probably due to exposure to dust contaminated by a passing flock of sheep, which at the time of the outbreak was engaged in lambing. These findings highlight the possible emergence of Q fever in settings and populations not normally thought of as being at risk of exposure to the infection.

[A case of total spinal block during epidural anaesthesia]

Most cases of total spinal block have been reported in the literature. The displacement of the catheter and the consequent dural perforation are the causes in large percentage of the patients (75%). The Authors describe this case for the importance of the causes and outcome of the patient. A 48 years old woman presented for hysterectomy for uterine fibromas. After having individualized the L3-L4 interspace, a test dose of 3 ml carbocaine 2% was injected. After that, the spinal block was obtained using ropivacaine 0.75% (total dose = 10 ml) injecting slowly, in following times, 5+5 ml of anaesthetic solution. The patient, perfectly conscious at first, presented a gradual increase of the difficulty in talking and breathing. Subsequently she showed a complete paralysis with loss of the consciousness, respiratory arrest, bilateral and symmetrical midriasis, as well as total areflexia. Endotracheal tube was placed. After eighty minutes from the end of the administration of the local anesthetic, spontaneous thoracic excursions appeared, even though of moderate ampleness, midriasis reduced. The patient recovered consciousness and sufficiently ventilated; therefore the endotracheal tube was removed.

Faropenem, a new oral penem: antibacterial activity against selected anaerobic and fastidious periodontal isolates

The in vitro activity of faropenem, an oral penem, was compared with those of penicillin, co-amoxiclav, cefoxitin, clindamycin, erythromycin and metronidazole against 106 isolates of anaerobic pathogens involved in systemic infections. The organisms tested comprised Porphyromonas gingivalis (29), Prevotella spp. (eight), Prevotella melaninogenica (seven), Prevotella intermedia (five), Actinomyces spp. (25), Fusobacterium nucleatum (14), Peptostreptococcus spp. (11), Bacteroides ureolyticus (five) and Bacteroides forsythus (two). The antimicrobial properties of faropenem were investigated by studying MICs, MBCs, time-kill kinetics and post-antibiotic effect (PAE). Faropenem was highly active against all the anaerobes tested (MIC(90) < or = 0.5 mg/L) and was bactericidal against both beta-lactamase-positive and -negative anaerobes, with a maximum bactericidal effect at 10 x MIC at between 12 and 24 h. In addition, faropenem had an in vitro PAE on all the tested isolates and this was not influenced by beta-lactamase production. Faropenem may be useful for treating infections caused by periodontal bacteria or oral flora.

The Italian Epidemiological Survey 1997-1999. Antimicrobial susceptibility data of Haemophilus influenzae, Haemophilus parainfluenzae and Moraxella catarrhalis in Italy

The Italian Epidemiological Survey began a surveillance study with the aim of monitoring the antimicrobial resistance of respiratory pathogens. From 1997 to 1999, 2028 strains of Haemophilus influenzae and 523 strains of Haemophilus parainfluenzae were collected from 59 Clinical Microbiology Laboratories distributed throughout Italy. In 1998, the study was extended to include Moraxella catarrhalis and a total of 360 isolates were collected. There was a significant increase in the beta-lactamase production both for H. influenzae (from 5% in 1997 to 16% in 1999) and for H. parainfluenzae (from 5% in 1997 to 22% in 1999). Beta-lactamase production in M. catarrhalis was 84% in 1998 and 87% in 1999. Beta-lactamase production affected the susceptibility to unprotected penicillins (87% in H. influenzae, 85% in H. parainfluenzae and 34% in M. catarrhalis), and in part the susceptibility to cefaclor (about 98%). Amoxycillin/clavulanate, cefixime, ceftriaxone and ciprofloxacin were active against all strains of H. influenzae, H. parainfluenzae and M. catarrhalis.

Minimal inhibitory concentrations and time-kill determination of moxifloxacin against aerobic and anaerobic isolates

Moxifloxacin is a new oral 8-methoxy-quinolone with a wide spectrum of activity against Gram-negative and anaerobic bacteria, atypical micro-organisms and multi-resistant Gram-positive bacteria. This study was designed to assess the in vitro activity of moxifloxacin against Gram-positive bacteria with different resistance patterns, anaerobes and atypical micro-organisms such as Chlamydia and Mycoplasma. Moxifloxacin had good activity against Streptococcus pneumoniae with all strains inhibited by < or =0.12 mg/l. The minimal inhibitory concentrations (MICs) of moxifloxacin for Streptococcus pyogenes and Streptococcus agalactiae ranged from 0.03 to 0.5 mg/l while those of ciprofloxacin were about two- to four-fold higher (MICs=0.12-1 mg/l). Moxifloxacin was poorly active against enterococci but its activity against Clostridium and Bacteroides spp. was in the same range as that of metronidazole and superior to that of clindamycin. Moxifloxacin was substantially more active than both ciprofloxacin and sparfloxacin against Chlamydia.

Association study of a promoter polymorphism of UFD1L gene with schizophrenia

Schizophrenia or schizoaffective disorders are often found in patients affected by DiGeorge/velo-cardio-facial syndrome (DGS/VCFS) as a result of hemizygosity of chromosome 22q11.2. We evaluated the UFD1L gene, mapping within the DGS/VCFS region, as a potential candidate for schizophrenia susceptibility. UFD1L encodes for the ubiquitin fusion degradation 1 protein, which is expressed in the medial telencephalon during mouse development. Using case control, simplex families (trios), and functional studies, we provided evidence for association between schizophrenia and a single nucleotide functional polymorphism, -277A/G, located within the noncoding region upstream the first exon of the UFD1L gene. The results are supportive of UFD1L involvement in the neurodevelopmental origin of schizophrenia and contribute in delineating etiological and pathogenetic mechanism of the schizophrenia subtype related to 22q11.2 deletion syndrome.

[Plasma substitutes: strategies for use in intensive therapy to maintain a correct ratio between therapeutic efficacy and costs]

BACKGROUND

The coice of one product rather than another in clinical practice is based on two main criteria: therapeutic efficacy and the cost of the product in question. However, if therapeutic efficacy is equal, the choice of a less expensive product is not necessarily the right option. We compared the costs and therapeutic efficacy of two products used in plasma replacement therapy in order to identify which would be the most advantageous.

METHODS

A total of 126 patients due to undergo major abdominal surgery were recruited and, having been duly informed, they were divided into two random groups. One group was treated with a solution of hydroxyethylamide 6% with an intermediate molecular weight (MW 200 kDa SD 0.5), and the other was treated with a solution of modified fluid gelatine (MFG) at 4% (MW 30 kDa). The solutions were administered to patients at the start of surgery until the morning of the first postoperative day in order to maintain mean arterial pressure (MAP) greater than 60 mmHg and central venous pressure (CVP) between 10 and 14 mmHg. Moreover, the costs of the two products and their additional charges were taken into consideration, taken from the supply lists provided by the pharmacy in the hospital where the study was carried out.

RESULTS

No significant differences were found between the two groups in terms of therapeutic efficacy. In economic terms, the cost of the entire infusion treatment was comparable between the two groups in spite of the higher cost of hydroxyethylamide.

CONCLUSIONS

The higher cost of hydroxyethylamide was compensated by the fact that a smaller amount of the solution is required to obtain the same hemodynamic parameters guaranteed by gelatine. Moreover, no adverse reactions were reported in this study to either compound. In the international literature, gelatine is associated with adverse reactions in a greater number of cases than hydroxyethylamide. This study shows that when proposing strategies of use, a simple cost analysis of the products used is not sufficient for a correct decision.

[Clinical pathways and case management in anesthesiology]

Clinical Pathways and the Case Management represent clinical and management tools for organizing patient care. These tools focus on results and use a multi-disciplinary approach, with the goal of providing high quality, cost effective care. Both systems require the care providers to interact with the institution or the health care network. As health care is part of a refund system, the specialist must cooperate with personnel of other disciplines as a member of a team which works together to improve the quality of health care, while containing the costs. The Clinical Pathways and the Case Management are two tools for achieving these goals. The most important limit of a cost control system is the division split of health care into single components instead of considering the entire diagnostic course. Without doubt, the Disease Management appears to be the most effective control system of health care costs now available.

Molecular mechanisms of resistance in Pseudomonas aeruginosa to fluoroquinolones

Pseudomonas aeruginosa is important in the field of infectious disease especially with respect to its role in nosocomial infections. Infections with P. aeruginosa may be a problem as the organism has intrinsic resistance to several antibiotics and a capability in acquiring resistance during antibiotic therapy. Fluoroquinolones are sometimes used during antibiotic therapy of P. aeruginosa infections even though resistance to fluoroquinolones may develop. Six strains of P. aeruginosa were studied in an attempt to elucidate the mechanisms of resistance to fluoroquinolones. These included the electrophoresis patterns of the outer membrane proteins (OMPs), random amplified polymorphic DNA (RAPD) and polymerase chain reaction (PCR) analyses. A method is described that improved the clarity of the OMP gels. Resistance in these P. aeruginosa strains could depend not only on DNA-gyrase modifications but also on membranes alterations and on the presence (qualitative and quantitative) of the efflux pump formed by three subunits.

Antimicrobial activity of quinupristin/dalfopristin, a new injectable streptogramin with a wide Gram-positive spectrum

Quinupristin/dalfopristin (Synercid) is a new injectable streptogramin antibiotic proposed for the treatment of severe antimicrobial infections, that has been shown to be active against Gram-positive, multi-resistant cocci. We compared the in vitro activity of quinupristin/dalfopristin with that of amoxycillin, ampicillin, penicillin, cefixime, ceftriaxone, clindamycin, erythromycin, imipenem, meropenem, oxacillin, piperacillin/tazobactam, teicoplanin and vancomycin. The susceptibility of 37 Staphylococcus aureus (14 MS, 23 MR), 26 Staphylococcus epidermidis (16 MS, 10 MR), 20 Streptococcus pneumoniae, 33 Group A Streptococcus pyogenes, 15 Streptococcus agalactiae, 10 Enterococcus faecalis (1 vancomycin-resistant), 15 Enterococcus faecium (9 van A) was evaluated. Quinupristin/dalfopristin was active against all Gram-positive species tested, including met-R S. aureus (MIC < or = 2 mg/l), met-R S. epidermidis (MIC < or = 2 mg/l), S. pneumoniae (MIC < or = 1 mg/l), ery-R and ery-S streptococci (MIC < or = 1 mg/l). The strains of E. faecalis were generally less susceptible. Time-kill studies confirmed that quinupristin/dalfopristin at 4 x MIC concentration showed a complete bactericidal effect (3 log reduction) in about 4 6 h against all strains tested. A post-antibiotic effect (PAE) of 3.9-5.2 h was observed at 4 x MIC concentration of quinupristin/dalfopristin against staphylococci. A prolonged PAE was obtained for S. pneumoniae (8 h), S. pyogenes (9 h) and S. agalactiae (7 h), while the shortest PAE was seen for E. faecalis and E. faecium (about 4 h).

Deoxyspergualin neither counteracts lipopolysaccharide (LPS) or Staphylococcus aureus enterotoxin-B (SEB) induced lethality in mice nor does it modulate the release of tumor necrosis factor-alpha

To gain further insights into the immunopharmacological mode of action of the immunosuppressant antibiotic deoxyspergualin (DSP), its effects were evaluated in murine lethal endo- and exotoxemia. These are two cytokine-mediated macrophage and T cell dependent immunoinflammatory conditions that can be induced in D-Galactosamine (D-Gal) presensitized mice by the injections with either LPS or SEB, respectively. The results show that prophylactic treatment with DSP (2.5 or 5 mg/kg bd.wt. 48, 24 and 2 h prior to challenge) neither improved the rate of survival, nor influenced the massive increase in the blood levels of tumor necrosis factor-alpha which followed the challenge with LPS or SEB. In sharp contrast, these clinical and seroimmunological events were both markedly counteracted by prophylactic treatment with sodium fusidate, another immunosuppressive agent used as control.

In vitro activity of cefdinir against respiratory pathogens isolated in Sicily with reference to beta-lactamase production

The in vitro activity of cefdinir (CI-983, FK-482), an orally absorbed aminothiazolyl cephalosporin, was evaluated against all 287 strains of Haemophilus influenzae, Haemophilus parainfluenzae, Moraxella catarrhalis, Streptococcus pneumoniae and Streptococcus pyogenes in comparison with cefaclor, cefuroxime, amoxicillin, amoxicillin-clavulanic acid, erythromycin and cotrimoxazole. The bactericidal activity of cefdinir, cotrimoxazole, amoxicillin-clavulanic acid and erythromycin was determined against H. influenzae, M. catarrhalis and S. pneumoniae. With the exception of one beta-lactamase negative ampicillin-resistant strain of H. influenzae (resistant to all antibiotics tested), no resistance to cefdinir was observed (MIC < or = 1 mg/l). Cefdinir was active against H. influenzae, H. parainfluenzae and M. catarrhalis regardless of whether or not they produced beta-lactamase. In general, the inhibitory concentrations of cefdinir against H. influenzae, H. parainfluenzae and M. catarrhalis were similar to those of amoxicillin/clavulanic acid, one or two dilutions lower than those of cefuroxime and four dilutions lower than those of cefaclor and cotrimoxazole. Against S. pneumoniae and S. pyogenes cefdinir had the same activity as cefuroxime and amoxicillin but was more effective than the other antibiotics tested. Kinetic studies showed that cefdinir was rapidly bactericidal at concentrations 2 and 4 times the minimum inhibitory concentration (MIC): a reduction of 99.9% in CFU values was generally observed after 6-8 h.

Cefetamet pivoxil: comparable evaluation with other orally available antibiotics against selected species of respiratory pathogens

Cefetamet pivoxil, the prodrug ester of cefetamet, is a new third-generation cephalosporin with a broad spectrum of activity. The in vitro activity of cefetamet was superior to that of cefaclor, ceftibuten, amoxicillin plus clavulanic acid, and amoxicillin alone when tested against 403 strains of freshly isolated upper and lower respiratory tract pathogens. Cefetamet killed 100% Haemophilus influenzae and H. parainfluenzae, including beta-lactamase-producing strains, at < or = 0.25 mg/l, Streptococcus pyogenes and S. pneumoniae at < or = 0.5 mg/l, S. agalactiae at < or = 0.1 mg/l, and streptococci at < or = 2.0 mg/l. Moreover, at < or = 4 mg/l (breaking point), cefetamet was also highly effective against Escherichia coli (94%), Klebsiella pneumoniae (92%), K. oxytoca (91%) and, at 1 mg/l, against Moraxella catarrhalis (90%), including beta-lactamase-producing strains. Furthermore, time-killing analyses at 4 x MIC demonstrated that cefetamet was bactericidal against beta-lactamase-producing H. influenzae, M. catarrhalis, and K. pneumoniae within 6 h and S. pneumoniae within 4 h. Hydrolysis studies confirmed cefetamet's stability to TEM1 and SHV1, the most common enterobacterial beta-lactamases.

Bactericidal kinetics and postantibiotic effect of sparfloxacin against selected species of respiratory pathogens

We determined the bactericidal kinetics and postantibiotic effect (PAE) of sparfloxacin against Haemophilus influenzae, Moraxella (Branhamella) catarrhalis, Klebsiella pneumonia, Streptococcus pneumoniae, and Staphylococcus aureus. Time-kill studies were performed by using 1 x and 4 x the minimum inhibitory concentrations (MICs) of sparfloxacin, ciprofloxacin, co-trimoxazole, amoxicillin/clavulanic acid and erythromycin (inoculum 10(5) and 10(7) CFU/ml). The PAE was induced by exposing the strains to 1xMIC and 4xMIC of sparfloxacin and ciprofloxacin for 1 h. Sparfloxacin was the most bactericidal of all the antibiotics tested, being active against Gram-positive and Gram-negative isolates with a 99.9% reduction within 3 to 6 h of exposure, depending upon strain, inoculum and concentration. The PAE of sparfloxacin against all species tested ranged from 1.1 to 2.6 hours; the most notable PAE occurring with M. catarrhalis.

Synthesis and pharmacological evaluation of thieno[2,3-d]pyrimidin-2,4-dione and 5H-pyrimido [5,4-b]indol-2,4-dione derivatives

Two series of novel derivatives based on the thienopyrimidine and pyrimidoindole ring systems, both N-substituted in position 3, have been synthesized. The compounds were obtained by reaction of N-amino groups of 5,6-dimethyl-thieno[2,3-d]pyrimidin-2,4-dione and of 5H-pyrimido[5,4-b]indol-2,4-dione with aromatic aldehydes. Some of these substances showed an appreciable analgesic activity, a good antiinflammatory activity, a low acute toxicity with an optimal gastric tolerance.

Bronchial reactivity to methacholine in HIV-infected individuals without AIDS

To evaluate bronchial reactivity to methacholine in human immunodeficiency virus (HIV) infection, we submitted 25 HIV-seropositive subjects without full-blown AIDS and 25 HIV-seronegative subjects, all inmates in a drug rehabilitation center for previous intravenous drug abuse, to interview and to bronchial challenge with methacholine. Four (16 percent) HIV-seropositve and three (12 percent) HIV-seronegative subjects noted bronchospastic symptoms. Baseline FEV1 and MEF50 percent were within the normal range in every patient. Bronchial hyperreactivity to methacholine (PD20FEV1 < 1,400 micrograms) was found in two (8 percent) HIV-seropositive and in four (16 percent) HIV-seronegative subjects, with no significant difference in the frequency between the two groups. We conclude that HIV infection without AIDS in intravenous drug users does not appear to be associated with an increased frequency of bronchospastic disorders and to bronchial hyperreactivity to methacholine.

Clarithromycin-ciprofloxacin-amikacin for therapy of Mycobacterium avium-Mycobacterium intracellulare bacteremia in patients with AIDS

A combination of clarithromycin, ciprofloxacin, and amikacin for the treatment of Mycobacterium avium-Mycobacterium intracellulare bacteremia was evaluated in 12 AIDS patients. Mycobacteremia cleared in all patients by 2 to 8 weeks of treatment, and symptoms resolved. Four patients died; all had negative blood cultures until death, and disseminated M. avium-M. intracellulare complex infection was not considered the primary cause of death.

Effect of a broad-spectrum cephalosporin on the oral and intestinal microflora in patients undergoing colorectal surgery

The influence of ceftriaxone on oral and intestinal flora was investigated in 10 patients undergoing colorectal surgery. Ceftriaxone was given intravenously in one 2g dose before anesthesia. Saliva and feces samples were collected and analyzed on day 0, 3, 5, 14 and 28 after drug administration. All specimens were cultured quantitatively for aerobic and anaerobic microorganisms; representative colonies of each morphologic type of organism cultured were identified. The oral aerobic flora was somewhat affected by the administration of ceftriaxone. In all patients the number of Streptococci, Staphylococci and Neisseria decreased during the 5 days after ceftriaxone administration. No significant changes in the number of anaerobic commensal occurred. The oral microflora of all patients after 14 days had returned to normal. The aerobic fecal flora was considerably affected: in all patients enterobacteria were eliminated or strongly suppressed. Only minor changes in the number of aerobic gram-positive bacteria were observed, and the anaerobic intestinal flora showed only minor alterations. On day 28 the intestinal flora were normalized in all respects. No new colonizing microorganisms were isolated during the investigation period and no colonization with ceftriaxone-resistant bacteria was observed. No postoperative infection occurred and no adverse effects were registered.

Epidemiology of antibiotic resistance in human isolates of Enterobacteriaceae in Sicily

The authors have studied the antimicrobial susceptibility of 1073 clinical isolates of various genera of Enterobacteriaceae (collected during the period July-December 1988) to ampicillin, piperacillin, cefotaxime, ceftazidime, ceftriaxone, aztreonam, imipenem, gentamicin, amikacin, netilmicin, norfloxacin, and ciprofloxacin. Antimicrobial susceptibility was determined by Bauer-Kirby disk diffusion method. Of 1073 tested bacteria, 704 (65.6%) produced beta-lactamase detectable by nitrocefin test. The highest percentage of resistant strains occurred with ampicillin (70%) followed by piperacillin (24%) and cefotaxime (19%). Lower percentages of resistant strains were found for gentamicin (10%), aztreonam (8%), netilmicin (7%), norfloxacin (5%) and amikacin (4%). Two percent of the strains were resistant to ciprofloxacin and 0.5% to imipenem. The incidence of resistance in Klebsiella sp., Enterobacter sp., E. coli and Proteus sp. was compared to that found among 872 strains isolated during July-Dec. 1984. In all the Enterobacteriaceae, mainly Enterobacter sp., the increase in the resistance was high for ampicillin, piperacillin and cefotaxime and lower for gentamicin.

Measurement of urinary estriol glucuronides during the menstrual cycle by high-performance liquid chromatography

A simple high-performance liquid chromatographic (HPLC) method for measuring estriol-3-glucuronide (E3-3-G) and estriol-16-glucuronide (E3-16-G) in the urine of non-pregnant women is described. Estriol conjugates were extracted from 4 ml of urine with a small cartridge of graphitized carbon black (Carbopack B). After washing, E3-3-G and E3-16-G were desorbed separately by a two-step elution system. After solvent removal, the two glucuronides were quantified by isocratic ion-suppression HPLC with fluorimetric detection. The analytical recovery of the two estriol metabolites was about 95%. The detection limit of the method was 0.6 ng/ml for both analytes in urine, which is well below the concentrations of clinical interest, and the method is not susceptible to substantial interferences. Data relative to urinary levels of E3-3-G and E3-16-G measured by this method on a daily basis in early morning samples from nine women during their menstrual cycles were compared with those reported in the literature and obtained by radioimmunoassay techniques. Moreover, the potential use of defined changes in the concentrations of the two conjugates for predicting the fertile period of women was assessed.

Further characterization of the in vitro and in vivo activity of ciprofloxacin against mycoplasmas

The aim of this study was the evaluation of some parameters which might better characterize ciprofloxacin: the influence of inoculum, serum and medium. Resistance development, hamster protection and mycoplasmacidal concentrations were also investigated. Ciprofloxacin showed moderate antimycoplasmal activity, both in vitro and in vivo. The minimum inhibitory concentrations (MICs) for Ureaplasma urealyticum, if compared to those shown by erythromycin, are lower, but higher than those obtained with tetracyclines. Unlike the macrolides, ciprofloxacin suffers from change of inoculum size, but no single step resistance induction was reported both in ureaplasmas and mycoplasmas. If Mycoplasma pneumoniae pneumonia or genital infections due to U. urealyticum carry out gram-negative rod isolation, ciprofloxacin can be considered a valid therapeutic agent for these mixed infections.

The sensitivity of gram-negative and gram-positive bacteria to ofloxacin

The in vitro antimicrobial activity of ofloxacin, a new fluorinated quinolone, was evaluated against 165 gram-negative rods, both fermentative and non-fermentative and against 57 gram-positive strains (coagulase-positive and -negative, staphylococci both methicillin-resistant and susceptible and Streptococcus faecalis). Minimal inhibitory concentrations were determined by using the macrodilution test and activity was compared with nalidixic acid, norfloxacin, ampicillin, piperacillin, ceftazidime and gentamicin for gram-negative rods, norfloxacin and gentamicin for Staphylococcus strains, and norfloxacin, ampicillin, piperacillin and gentamicin for enterococci. Ofloxacin inhibited all fermentative gram-negative bacteria tested, in a range of 0.05-3.12 micrograms/ml. It also had good antimicrobial activity against non-fermentative gram-negative strains: in fact it inhibited 90% of Acinetobacter and 80% of Pseudomonas aeruginosa tested at 3.12 micrograms/ml. Ofloxacin had good antimicrobial activity against Staphylococcus and Enterococcus tested.

In vitro activity of imipenem towards gram-negative bacilli

The authors studied the in vitro antimicrobial activity of imipenem towards 355 gram-negative bacterial strains, taking into particular consideration unusual or dangerous species. The study was carried out on a comparative basis with piperacillin, cefotaxime, ceftazidime and gentamicin. Ninety percent of the fermentative gram-negative strains were inhibited at concentrations less than or equal to 2 mg/l. Imipenem inhibited 100% of strains of Alcaligenes faecalis, Alcaligenes denitrificans, Flavobacterium odoratum, Acinetobacter lwoffii, Acinetobacter anitratum, Pseudomonas fluorescens, Pseudomonas stutzeri and 90% of strains of Pseudomonas aeruginosa and Pseudomonas putida. The excellent bactericidal activity of imipenem was indicated by its minimum bactericidal concentrations equal to or slightly greater than its minimum inhibitory concentrations (MIC). As far as the other parameters were concerned (influence of the dimensions of inoculum and culture medium on MICs), imipenem confirmed its excellent in vitro microbiologic characteristics.

In vitro activity of ciprofloxacin against aminoglycoside-sensitive and -resistant gram-negative rods

Ciprofloxacin's activity against 233 clinically isolated strains of both fermentative and non-fermentative bacilli was tested. In particular the authors studied the sensitivity of aminoglycoside-resistant gram-negative bacilli to ciprofloxacin. The results showed that all fermentative gram-negative bacteria were sensitive to ciprofloxacin (MICs range less than or equal to 0.02 - 1.56 mg/l). Among the non-fermentative bacilli, Pseudomonas were generally susceptible to ciprofloxacin (MIC90 less than or equal to 1.56 mg/l) except for P. cepacia and P. fluorescens (MIC90 less than or equal to 3.12 mg/l). The best antibiotic activity was shown against Moraxella, A. xylosoxidans and A. hydrophila (MICs less than or equal to 0.09 mg/l). MICs for Acinetobacter and A. faecalis were less than or equal to 1.56 mg/l while Flavobacterium were more resistant (range 1.56-3.12 mg/l). Furthermore, ciprofloxacin showed good activity against 44 aminoglycoside-resistant isolates, showing a very low (13%) incidence of resistance.

Enhancing detection of gonococcus in ejaculates of adult males using sperm dilution

Specific cultures were used to detect growth of Neisseria Gonorrhoeae (NG) in 90 ejaculates of partners of childless marriages. Although no gonococcal growth was observed in undiluted semen, 9 out of 68 subjects with silent infection presented growth of NG in seminal plasma after dilution 1:2 with saline. It is concluded that semen dilution increases the chances of detection of NG in semen samples of asymptomatic gonococci carriers.

Estriol and its conjugates in late pregnancy determined by extraction with Carbopack B and liquid chromatography with fluorometric detection

We report a method for measuring estriol and its intact conjugates in urine, serum, and amniotic fluid. A single assay can be done within about 50 min, eight samples assayed in less than 5 h. A 70-microL urine sample is diluted and the estriol conjugates are adsorbed from it onto graphitized carbon black (Carbopack B, Supelco). After two washings, the analytes are desorbed with chloroform/methanol (60/40, by vol) containing tetrapropylammonium bromide. After solvent evaporation, the residue is redissolved in 100 microL of water/acetonitrile and 20 microL is injected into the chromatograph. Or 1 mL of serum or 0.5 mL of amniotic fluid is deproteinized with cold methanol, then passed through the Carbopack column. After three washings, the estriol and its conjugates are desorbed and treated as for urine. Mean analytical recoveries of the analytes in any of these body fluids were within about 92-98%, except for estriol-3-sulfate-16 alpha-glucuronide in serum (mean recovery 88.3%). The limit of sensitivity is well below the concentrations of clinical interest, and the method is not susceptible to substantial interferences.

Estriol and its conjugates in late pregnancy determined by extraction with Carbopack B and liquid chromatography with fluorometric detection

We report a method for measuring estriol and its intact conjugates in urine, serum, and amniotic fluid. A single assay can be done within about 50 min, eight samples assayed in less than 5 h. A 70-microL urine sample is diluted and the estriol conjugates are adsorbed from it onto graphitized carbon black (Carbopack B, Supelco). After two washings, the analytes are desorbed with chloroform/methanol (60/40, by vol) containing tetrapropylammonium bromide. After solvent evaporation, the residue is redissolved in 100 microL of water/acetonitrile and 20 microL is injected into the chromatograph. Or 1 mL of serum or 0.5 mL of amniotic fluid is deproteinized with cold methanol, then passed through the Carbopack column. After three washings, the estriol and its conjugates are desorbed and treated as for urine. Mean analytical recoveries of the analytes in any of these body fluids were within about 92-98%, except for estriol-3-sulfate-16 alpha-glucuronide in serum (mean recovery 88.3%). The limit of sensitivity is well below the concentrations of clinical interest, and the method is not susceptible to substantial interferences.