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Infectious Diseases Annual Review of Significant Publications Hobart A Postgrad Med J: first published as 10.1136/pgmj.42.486.247 on 1 April 1966. Downloaded from POSTGRADUATE MED. J. '(1966), 42, 247 Annual Review INFECTIOUS DISEASES ANNUAL REVIEW OF SIGNIFICANT PUBLICATIONS HOBART A. 'REIMANN, M.D. Hahnemann Medical College and Hospital, Philadelphia, Pa. 19102, U.S.A. KNOWLEDGE of infectious diseases advanced as be the agent of choice for meningitis caused by usual during 1965. Evaluation of many newly pneumococci, H. influenzae and meningococci"l. introduced antimicrobic drugs continued. Their Trhe proper use of the new penicillins was out- great number, however, confuses physicians as lined,,a. Cephalothin l(Keflin) was active against to which ones to use, and some of them are no nonindole-producing Proteus, less so against better than the older ones. Much antimicrobic Klebsiella, Esch. coli and paracolon bacilli. therapy still is misapplied. An anthelmintic Pseudomonas was resistant. Seventy-six per cent agent successfully controlled a number of of patients infected by pneumococci, strepto- diseases. Antiviral drugs were sought. Attention cocci, nonpenicillinase-producing staphylococci, was given to rubella, its effect on the fetus and and the sensitive gram-negative just named were its persistence in the body. Hemorrhagic fevers successfully treated. A rash occurred in three of in Asia and South America received intensive 103 patients7. The drug has no particular advan- investigation. The causal relation of viruses, tage over other agents8. 'Motile strains of mycoplasmas and toxoplasmas to cancer and Klebsiella-Aerobacter were resistant to cephalo- leukemia in man remained obscure. Electron thin and cephaloridine, but sensitive to many microscopy disclosed new information in micro- other antimicrobics. Tihe opposite applied to biology and disease. The importance of urinary non-motile strains. The bacilli rapidly acquired copyright. tract infections at all stages of life was re- resistance9. Colistin sulfate failed to rid sal- emphasized. 'Recognition of infections caused monellas from 40 per cent of carriers. Bacilli by "atypical" *tubercle bacilli that resist anti- were suppressed duriing therapy'0. Colistin is microbic therapy served to extricate them fronm potentially nephrotoxic. Lincomycin was effec- classic;tuberculosis. Disturbed faunal and avian tive against staphylococci, pneumococci and ecology incident to population shifts in some hemolytic streptococci and is usefull against regions favoured an increase in the incidence of bacteria resistant to penicillin or erythromycin, encephalitis, hemorrhagic fever and Rocky and for patients allergic to those agents. Entero- Mountain spotted fever. Inapparent attacks of cocci, meningococci, gonococci and gram nega- http://pmj.bmj.com/ several epidemic diseases were observed and tive bacilli were unaffected by lincomycin". their significance was recognised. A vibrio Lincomycin was said to be as effective as peni- different from V. comma caused epidemics in cillin for the treatment of streptococcal pharyn- the Far East. gitiS12. Nalidixic acid (Negram) is effective for the treatment of urinary tract infections caused Antimicrobic Agents by Esch. coli., Proteus and other gram nega'tive bacilli. Resistance to it develops'3. on October 1, 2021 by guest. Protected New Antimicrobic Agents. Nafcillin' and Thliabendazolle, a broad spectrum anthelmin- cloxacillin2 were as effective as methicillin, tic, was effective for the treatment of infections oxacil!in, and cephalosporin in the treatment of caused by Strongyloides, Enterobius, Ancylo- staphylococcal infections. Nafcillin was used stoma, Ascaris, and Necator, without serious successfully in many cases of staphylococcal toxic effects'4. Successful treatment of cutaneous pneumonia, sepsis, arthritis and 'pyelonephritis larva migrans was described in four papers in in oral dosage of 4 to 8 grams daily.3 The over- the May 1965 issue of Archives of Dermatology. all death-rate of patients treated with nafcillin It was ineffective for Taenia solium or saginata was 38 per cent. All strains of staphylococci and weakly effective in trichiuriasis'5. Borrelidin were sensitive. Cloxacillin was not active against and vivomycin derived from streptomycin were enterococci. AmpiciHin was not as effective as said to be antiviral agents'6. Cycloguanil pamo- chloramphenicol for treating typhoid.4 The drug ate '(Camolar) was said to have been successful was as good as tetracyline for the prolongedl in the treatment of 26 of 30 patients with dermal treatment of chronic bronchitis5 and was said to leiishmaniasisl7. Postgrad Med J: first published as 10.1136/pgmj.42.486.247 on 1 April 1966. Downloaded from 248 POSTIGRADUATE MEDICAL JOURNAL April, 1966 Antimicrobic Therapy and Prophylaxis. A Penicillin G is 'the most active, cloxacillin, oxa- physician recommended the intravenous injec- cillin, cephalothin, and erythromycin less so, tion of 10 million units of penicillin every two and ampicillin and nafcil'lin the least30. In hours -to prevent surgical wound infectionsl8. England, 31 per cent of strains of hemolytic Should this be done, from 20 to 40 million units streptococci resisted tetracycline, particularly (12 to 24 grams) would be administered in a those present in aural and wound exudates and short period, mostly unnecessarily. Year-around dermal infections. Indiscriminate use of the administration of single injections of ,benzathine drug may have induced resistance'1. In a survey penicillin to new recruits satisfactorily controlled of Philadelphia hospitals, I ascertained what hemolytic streptococcalinfections and prevented huge amounts of antimicrobic drugs are dis- ensuing rheumatic fever'9. Should this plan be pensed. In an average month in one 500-bed applied routinely to all civilians, question arises hospital, 12 pounds of penicillin were prescribed if the harm therefrom, as yet inapparent, would -and the total cost per month of all antimicrobics overbalance the prevention of the few instances was about $16,000 (f5,714). 'Much effort is of rheumatic fever that occur and if such wasted by requesting unnecessary tests for general prophylaxis is justifiable. For example. microbic sensitivity. The reported results may after an epidemic of streptococcosis in 1953, be misleading or erroneous especiaUly from an only one case of acute rheumatic fever was over-burdened laboratory32 and poor submitted detected, -and none of the victims 'had evidence specimens. of chronic nephritis20. Many physicians still are concerned with the Antimicrobic agents are of no value for "blood-brain-barrier" and the small amount of prophylaxis against bacterial invasion during drug that enters spinal fluid. It i's far more acute viral respiratory tract infections2' 22 nor important, however, for the agent to attack the in unconscious patients23. As examples of un- microbe in 'the meninges, not in the spinal fluid, necessary prophylaxis and therapy, "vigorous" for which intravenous or intramuscular injection antimicrobic therapy was applied in a patient is necessary. copyright. with esophageal stricture caused by an escha- Antimicrobic-sensitive bacteria may acquire rotic24 and in a patient with massive epistaxis. resistance by growth in the presence of other Prophylactically -administered agents rarely pre- resistant ones. Apparently, resistance may be vent bacterial superinvasion, and that which "caught" by exposure. Whether the change does occur may be even more difficult to treat22. can occur in vivo is unknown. Sixty-one per In guinea pigs injected with 50,000 units of cent of 450 strains of Salmonella resisted one or penicillin, the cecal flora was greatly reducedt more antimicrobic agents33. within 12 hours but later, a 10-million-fold The occasional beneficial effect of antimicro- increase in coliform bacteria occurred acoom- bic therapy in addition to the administration of http://pmj.bmj.com/ panied by severe cecitis, ileitis and lymphadeni- folic acid suggested that infection may play a tis and ibacteremia. This is an example of super- role in the cause of -tropical sprue4. infection resulting from disturbed normal A symposium on antimicrobic drugs was flora25. published in the November, 1965 issue of the A protracted outbreak of multiple drug-resis- American Journal of Medicine. tant Salmonella edinburgh infection iamong in- Harmful Ef#ects of Antimicrobic Drugs. fants was ascribed to previous unwise routine doses of Large penicillin caused anemia 'by on October 1, 2021 by guest. Protected use of antimicrobics26. Strains of staphylococci destroying erythrocytes35. Penicillin and its have become resistant to neomycin and bacitra- homologues caused nephropathy35a. Anaphylac- cin. These antimicrobics when used topically toid shock after oral therapy resulted in severe may induce microbic resistance27. neurologic residua.3 . After therapy for three Penicillin remains the drug of choice for months, oxacillin depressed the marrow and pneumococcoses. If the patient is sensitive there- caused hepatic dysfunction37. Chloramphenicol to, erythromycin is indicated. Cephaloridine, in dosage more than 50 mg./Kg./day regularly ampicillin, nafcillin, oxacillin, cephalothin, caused toxic amounts to accurmulate in the cloxacillin and tetracycline also are effective in blood. Depression of the.bone marrow occurred that order28. The method of treatment of when 25 jLg./ml. were attained. In two of 20 staphylococcosis was outlined in detail by Fin- patients, daily doses of two 'to six grams caused land29. Hemolytic streptococci have not
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