Report of a symposium on use and abuse of antibiotics worldwide

A collaborative symposium of the Quality of Care and Technologies Programme of the World Health Organization's Regional Office for Europe and the Department of Hospital Epidemiology of the University Hospital, Freiburg, was held in Freiburg, FRG, in September 1988 to consider the use and abuse of antibiotics worldwide. Participants from developing countries provided estimates of use of antibiotics and problems of resistance in their countries. Because much of the information either is anecdotal or may not be representative of the vast, heterogenous populations in these countries, it is difficult to provide exact guidelines for the use of antibiotics. There is a need for better etiologic definition of the causes of acute respiratory tract infection and diarrheal disease and for surveillance of resistant bacterial strains. Because of the difficulty of making an etiologic diagnosis, a set of empiric guidelines has been developed for diagnosis and management of common conditions. Recommendations for the use of antibiotics must take into account the economics, medical manpower, social constraints, and emergence of resistant bacteria in both developed and developing countries. There is a need to establish a coordinated, worldwide network to obtain representative data and to organize clinical trials pertinent to the conditions of both developed and developing countries to define the best antimicrobial agent(s), the dosage, and duration of treatment for specific conditions.     

Usefulness of early serial measurement of specific and total immunoglobulin E in the diagnosis of gastro-allergic anisakiasis

BACKGROUND: Sensitization to Anisakis simplex (A. simplex) has been documented to produce severe allergic reactions following ingestion of mainly raw or under-cooked parasitized fish. False positive skin prick tests (SPT) or specific IgE against this nematode and cross-reactivity restricts diagnosis. Gastric anisakiasis and gastro-allergic anisakiasis occur if fish is parasitized by live A. simplex OBJECTIVE: To investigate if serial serological analysis could be useful in the diagnosis of acute parasitation by this nematode. METHODS: We included 41 patients who experienced an allergic reaction and/or abdominal symptoms after ingestion of raw or undercooked fish and displayed specific IgE against A. simplex. Total and specific IgE were determined two times: in the 24-h period after onset of clinical symptoms and after 1 month. SPTs were performed against A. simplex and implicated fish. A fibre optic gastroscopy was performed in 22 patients. RESULTS: Median total IgE was 80.0 (Interquartile range [IQR] 41.5-186.5) kU/L in the first evaluation and 247.0 (IQR 96.5-649.5) kU/L after 1 month. Median specific IgE against A. simplex was 11.4 (IQR 7.1-33.5) kU/L in the first 24 h and 36.8 (IQR 19.5-79.5) kU/L after 1 month. A rise of total IgE was observed in 35 of 41 patients (P<0.00001) and a rise in specific IgE against A. simplex in 37 of 41 patients (P<0.00001). Mean percentage increment was 392% (215-571%; 95% confidence interval [CI]) for total IgE and 339% (177-502%; 95% CI) for specific IgE. In nine of 22 gastroscopic examinations at least one larva, identified as A. simplex, could be detected by our microbiology service. In this group (n = 9) a rise of total and specific IgE was detected in eight patients (89%) (P = 0.02). CONCLUSIONS: We consider a rise of total and specific IgE in the first month after an allergic reaction as a useful tool in the diagnosis of gastro-allergic anisakiasis (together with patient's history), even if the parasite cannot be seen with fibre optic gastroscopy. The important rise of total and specific IgE against A. simplex can be considered as a reaction induced by the live parasitizing larva in the context of a polyclonal immunological stimulation.     

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In vitro combination effects of cefsulodin, moxalactam and cefoperazone with four aminoglycosides on nonfermenting nosocomial gram-negative bacteria

The activity of moxalactam, cefsulodin and cefoperazone on 67 non-fermenting gram-negative bacterial strains isolated from patients with nosocomial infections was tested either alone or in combination with gentamicin, tobramycin, amikacin and netilmicin, respectively, by use of the checkerboard agar dilution technique. Cefsulodin was most active against Pseudomonas aeruginosa, cefoperazone was the most active cephalosporin tested against Pseudomonas fluorescens-putida and Acinetobacter antitratus. Cefoperazone-aminoglycoside interactions were found to be synergistic in only 2--5% of all strains, cefsulodin and moxalactam in combination with aminoglycosides were most potent against P. aeruginosa. Cefsulodin-gentamicin interactions were superior to other cephalosporin-amino-glycoside combinations.