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Infectious Diseases Annual Review of Significant Publications Hobart A Postgrad Med J: first published as 10.1136/pgmj.41.479.536 on 1 September 1965. Downloaded from POSTGRAD. MED. J., (1965), 41, 536 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. VIRUSES and viral diseases were the subjects chemically from penicillin and can be used of continued intensive study in the past year. against penicillin-resistant staphylococci, and Attempts to prepare vaccines for the prevention for patients sensitive to penicillin. It is not of specific infections, especially of the res- absorbed when given orally. Neutropenia may piratory tract, have not had much success be induced2. because of the complexities involved. No Sodium colistimethate (Coly-mycin) 2 to 2.5 important curative agents were discovered, nor mg./kg. every 12 hours injected intravenously has a causal relation of viruses to cancer in cured five of eight patients infected with man been proved. Many new antimicrobic Pseudomonas. Smaller dosage was necessary agents, or old ones with new names, were tested. when the renal function was impaired. It may As causes of disease and death, gram negative be neurotoxic, cause apnea and must be used bacillary infections now displace those formerly with caution in the presence of chronic caused by gram cocci, as a result of disease, renal positive debilitating impairment, hypoxicProtected by copyright. iatrogenic impairment of host-resistance and states, and if muscle relaxants, corticosteriods, other factors. The incidence of venereal diseases narcotics or sedatives are given at the same and of tuberculosis increased. Meningococcal time4. meningitis, the one disease for which anti- The activity of nafcillin, ancillin, and microbic prophylaxis seemed to have the most cloxacillin was reduced in media containing value, caused serious epidemics despite efforts serum, but cephalosporin was unaffected5. to control it. Several observers found no differences in the Antimicrobics results of therapy with ampicillin, nafcillin, New Antimicrobics. According to Garrod, oxacillin, methicillin and cephalothin. The there is little to be gained by the increasingly action of lincomycin and pristinomycin was unprofitable search for new antimicrobics from said to be similar to that of ostreogramin, natural sources. Some of the recently advertised streptogramin, spectinomycin, synergistin and ones are the same as, or similar to, ones in use'. mikamycin 6, 7. An antagonism between lin- or ones hold more comycin and erythromycin interfered with their Synthetic semisynthetic may http://pmj.bmj.com/ promise. effect on staphylococci8. Lymecycline was said Two new broad spectrum antimicrobics to be as effective as tetracycline for treating especially for the control of gram negative chronic bronchitis. Hamycin was active against bacillary infections were discussed in three Cryptococcus neoformans and H. capsulatum papers in the Journal of the American Medical in inoculated mice'0. Ethambutol may be Association of September 14th, 1964. Gent- effective against tubercle bacilli refractory to amycin is active against Pseudomonas, less so other agents". Several years must pass before again Proteus and Staphylococcus. It resembles the value of any of these agents can be judged. on September 28, 2021 by guest. streptomycin, neomycin, kanamycin and paro- As if the names for new products mentioned so momycin chemically, its antibacterial action is far are not confusing enough, these also have about the same and it occasionally causes been coined: quinacillin, everinomycin, almar- deafnessla. Cephalothin (Keflin), a semisynthetic cetin, pediamycin, viractin, monicamycin, broad spectrum agent has a similar range of enteromycin, seligomycin, xanthomycin, rubi- action and is less toxic even in patients with flavin, antimycin, oligomycin, tolfanate and renal failure. It was ineffective against others'2. There is no limit for new alphabetic Pseudomonas and enterococci. It differs combinations. Antimicrobic It is regretted that reprints of this article are not Therapy. The administration available. Copies of the Journal can be obtained of huge amounts of antimicrobics given "just price 10s. 6d. post free from the publishers or usual to be sure" is deprecated. But recent studies agents. showed that penicillin in doses of 20 to 60 Postgrad Med J: first published as 10.1136/pgmj.41.479.536 on 1 September 1965. Downloaded from September, 1965 REIMANN: Infectious Diseases 537 million units (12 to 36 grams) a day given occasionally were found. Other untoward intravenously cured many gram negative effects also occur. The subject was discussed bacillary infections. The amount in the serum in two papers in the Annals of Internal reached 737 units/ml. Cerebral irritation Medicine of August, 1964. Actinomycin D was occurred in patients with renal failure or central teratogenic in rats23. neural disease. Obviously, the sensitivity of Broad spectrum antimicrobics decrease the gram negative bacilli to penicillin should be rate at which colon bacilli are killed by human determined. Those inhibited by 78 units/mi. serum, probably by inhibiting bacterial meta- or less are classed as sensitive; resistant ones bolism and impairing the lytic action of serum. resist 625 units/mi. and are uncontrollable'3. The matter may be of therapeutic import24. Thirteen patients with bacterial endocarditis The same amount of antimicrobics entered the were treated successfully with propicillin blood after intraperitoneal injection as from (phenoxypenicillin) or ampicillin given orally. injection by other parenteral routes. The Infections with Str. viridans responded better method may be used in place of intravenous than those caused by Str. fecalis4. Penicillin and intramuscular injection25. given prophylactically during cardiac cathe- In regard to indiscriminate antimicrobic terization had no influence on the incidence therapy, Harris wrote that something has of subsequent bacteremia. Its use therefore is weakened clinical judgment: physicians who unwarranted'5. prescribe digitalis or quinidine (which are The therapeutic effect of penicillin combined poisons) with the utmost caution, pounce avidly with sulfonamides is unpredictable. Increased, on chloramphenicol and other antimicrobics for indifferent or decreased antimicrobial effect may minor illnesses. They would always make tests follow. If the combination is used, full doses of sensitivity before injecting tetanus antitoxin, of each are indicated. Semisynthetic penicillin but not before giving penicillin whose danger Protected by copyright. alone or combined with penicillin G and other in causing a reaction is as great26. Antimicrobic- antimicrobics was said to be of therapeutic induced diseases were described in a book27. value against infection with isoniazid-resistant Viral Infections tubercle bacillil7. Respiratory Tract Infections. Sir Christopher Acute pericarditis occurred as a hypersen- Andrewes, who with Smith and Laidlaw, dis- sitive reaction to penicillin'8, and oxacillin covered the virus of influenza in 1933, has also caused hepatitis'9. Huge doses of penicillin contributed to the knowledge of common colds. caused severe anemia in two patients20. In a review, he points out the complex, poorly Pencilloyl-polylysine introduced as an agent to understood epidemiology of these ubiquitous detect sensitivity to penicillin, itself caused a infections. Respiratory tract viruses no doubt generalized eruption after the injection of a spread from person to person by the airborne skin-test dose21. route, but various determinant factors operate Airborne contamination with penicillin of to cause seem made in epidemics. Meteorologic changes many products large pharmaceutical to be important at times, but a wide range of http://pmj.bmj.com/ plants is a serious problem. It would be stresses, including chilling, may disturb the difficult to recall such products now on the host-parasite relationship enough to permit the market and to destroy the ones in reserve. invasion of microbes. The operation of viral Chloramphenicol suppressed the formation interference and of interferon itself probably of antibodies in vitro and in experimental play a role28. By indirect methods, droplets animals. Therapeutic doses in eight patients bearing the viruses were expelled in greatest suppressed antibody formation after the amount by sneezing. Most of them fell to the injection of tetanus toxoid in six and was ground and about 10% were small enough to be on September 28, 2021 by guest. hemotoxic in four22. Chloramphenicol applied airborne. Saliva contained very little virus. to the conjunctiva caused pancytopenia in a Viruses die soon after shedding29. Four papers patient whose niece had succumbed to aplastic on airborne infections pertaining especially to anemia after oral therapy23. The reason for the those acquired in laboratories and in hospitals topical use of the agent is unclear. appeared in the October, 1964, American Amphotericin B should be used only when Journal of Public Health. Methods for their actually needed. The blood urea was increased control were outlined. in amount in 93% of 81 patients during treat- Rhinoviruses. Fifty-three types of rhinovirus ment. The renal function was persistently are known and there are many others. Rhino- reduced in 7 of 16 patients who received more viruses of 46 types were isolated from 10% than 4 g., and in six of 36 who were given less. of infected adults and from 5% of children.
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