Two-day cefamandole versus five-day cephazolin prophylaxis in 965 total hip replacements. Report of a multicentre double blind randomised trial

The aim of this trial was to compare a 5-day course of cephazolin with a regimen of 2 days of cefamandole in 965 total hip replacements (488 in the cefamandole group and 477 in the cephazolin group). The effect of the prophylactic antibiotic on the bacterial colonization of drains (mean duration of drainage: 3.2 +/- 0.3 days) and on the susceptibility of colonizing organisms was assessed. No significant difference was observed in the percentage of infected drains between the two groups. The cefamandole group had a lower rate of Gram-negative organisms (23% versus 44%, p less than 0.01). The rate of deep infections within one year after operation was 0.7% in the cefamandole group versus 0.5% in the cephazolin group, and the difference is not significant. Cefamandole given for two days appears to be an effective prophylaxis against sepsis in total hip replacements.

Ulceroinfiltrative syphilitic gastropathy: silver stain diagnosis from biopsy specimen

A 34-yr-old woman had clinical, radiological, gastroscopic, and histological evidence of infiltrative and erosive gastritis involving the antrum. Positive serological tests for syphilis suggested gastric lues. This diagnosis was confirmed by demonstrating spirochetes in gastric mucosa by silver impregnation.

[Comparison of 3 antibiotics, cefaclor, josamycin and penicillin V in the treatment of acute throat infections. A multicenter study: 581 cases]

Five hundred and eighty one patients, both adults and children, of either sex, with acute throat infections, with or without associated pharyngitis, were randomized into three groups comparable as to age, general condition and temperature before treatment, previous infectious episodes, history of allergy and underlying conditions. Cefaclor was administered to the first group (C), josamycin to the second group (J) and penicillin V to the third group (V); duration of therapy was practically the same, respectively 8.41, 8.20 and 8.14 days. Concurrent administration of paracetamol was allowed and was comparable for all three groups. Response was assessed on the basis of clinical criteria only, including onset of apyrexia in particular. In group C apyrexia was obtained within 48 hours or less in 54.4% of the patients versus 35.7% only in Group J (p less than 0.001) and 41.5% in group V (p less than 0.02). Onset of overall clinical improvement was 3 days or less in 69.5% of the patients receiving C versus 50.3% for those receiving J (p less than 0.001) and 57.2% for those receiving V (p less than 0.02). Adverse reactions were significantly more frequent in the josamycin group (p less than 0.001) and penicillin group (p less than 0.05) than in the cefaclor group. The most common type of adverse reactions was gastrointestinal upsets in the josamycin (43/49) and the cefaclor group (9/10) and skin reactions in the penicillin group (9/20).

[Treatment of septicemia with latamoxef. Multicentric study of 60 cases]

Sixty patients including forty two males and eighteen females, age range: 18-87 years, received antibacterial single drug treatment with latamoxef for septicemia. Forty nine patients had underlying conditions including multiple trauma, neoplasm, cardiovascular, metabolic and respiratory tract diseases. Causative pathogens were isolated in all cases. The predominant isolates were E. coli (thirty), Klebsiella pneumoniae (tent) and Enterobacter (seven). A single organism was isolated in fifty seven cases; in the other three cases two organisms were isolated from blood cultures. Mean daily dosage was 46.6 +/- 6.1 mg . kg-1 (range: 14-113 mg . kg-1). In the majority of cases (fifty two) dosage was 3 g . d-1 or less; in thirty cases it was no higher than 2 g . d-1. Duration of therapy ranged from six to thirty eight days. Serum titer was measured in many cases and latamoxef blood levels were assayed in nine patients. A satisfactory clinical response was achieved in fifty eight cases and fifty eight bacteriological cures were also obtained. There was no statistically significant difference in therapeutic response between the 2 g and 3 g daily dosage groups. Tolerance was very good; untoward effects were few and required drug discontinuation in one case only.