Antibiotic prophylaxis of hematogenous bacterial arthritis]

The outcome of bacterial arthritis is generally poor: the mortality is 10-15% and there is loss of joint function in 25-50% of the survivors. Adverse prognostic factors are advanced age, a pre-existent joint disease and an infection of a prosthetic joint. The incidence of bacterial arthritis is low: 2-6 per 100,000 persons per year. Risk factors are advanced age, a joint disease--especially rheumatoid arthritis--diabetes mellitus and presence of a prosthetic joint. Situations that can lead to bacterial arthritis are mainly skin infections of the feet and only rarely invasive medical or dental procedures. Because of the severity of the disease, antibiotic prophylaxis of haematogenous bacterial arthritis in patients with prosthetic joints is advocated in guidelines. However, because of the rarity of the disease it is unclear whether the advantages of prophylaxis outweigh the disadvantages of the large-scale use of antibiotics, such as side effects, costs and increased resistance of bacteria. In a decision analysis of a large group of patients with joint diseases, antibiotic treatment of skin infections appeared to be (cost-)effective in the prevention of haematogenous bacterial arthritis, mainly in high-risk patients. On the other hand, prophylaxis around medical or dental procedures was not (cost-)effective, except possibly in a small group of patients with increased risk.     

Hygienic evaluation of new light sources for prophylaxis of ultraviolet deficiency]

The effectiveness of new fluorescent lightings, which generated visible and UV-light for the UV-deficiency prophylaxis was demonstrated.     

Clinical, bacteriological and cost-saving effects of antibiotic prophylaxis in craniotomy]

Objective of the study. To investigate the effect of antibiotic prophylaxis on the incidence of infections, on the bacterial flora of wounds and on the health-care costs. A retrospective study disclosed an incidence of infection of 8.1% in patients who underwent craniotomy. Methods. Double-blind, placebo-controlled study of the effects of cloxacillin (4 x 1 gr intravenously during 24 h, perioperatively) in 310 patients who had to undergo a craniotomy. Results. In the cloxacillin group significantly fewer infections occurred than in the placebo group, 6 infections in 156 and 20 infections in 154, respectively. In the cloxacillin group significantly fewer samples contained micro-organisms than in the placebo group. Cloxacillin prophylaxis reduces the cost of patient care by about 20%. Conclusion. Cloxacillin prophylaxis in craniotomy cases reduces the percentage of infections, the percentage of positive cultures of the wound, and the costs of patient care.     

Tetanus prophylaxis. Proposed rationalization of procedure in the occupational field]

After a recent increase in cases of tetanus in Italy, the Ministry of Health has proposed vaccination of the entire population, inviting local physicians to cooperate towards this end. The author suggests periodic dosage of tetanus antitoxin antibodies as the most economic and efficient method of identifying workers who are not protected by vaccination.     

Proguanil-sulphonamide for malaria prophylaxis

There are few safe, effective chemoprophylactic regimens for preventing Plasmodium falciparum infection in south-east Asia. In two randomized placebo-controlled trials, combinations of proguanil and sulphonamide were tested for chemoprophylactic activity in schoolchildren, aged 6-15 years, living near the Thai-Burmese border. Proguanil at an equivalent adult dose of 200 mg/d was combined with sulphafurazole (= sulfisoxazole) at 25 mg/kg/d or sulphamethoxazole at 25 and 10 mg/kg/d. Combinations of daily proguanil/sulphafurazole and proguanil/sulphamethoxazole were equally effective (greater than 75%) against both falciparum and vivax malaria when the sulphonamide component was used at 25 mg/kg/d. Proguanil and sulphamethoxazole at 10 mg/kg/d was ineffective. Approximately 1% of the children had sulphonamide-related skin rashes which resolved when treatment stopped. Proguanil/sulphonamide is a possible alternative chemoprophylactic regimen in areas with multiple drug-resistant P. falciparum.