Patients' Interviews and Misuse of Antibiotics

To better evaluate patient contribution in antibiotic use, we questioned 5379 subjects from 9 countries. Antibiotics are perceived as strong, efficient drugs, but they are believed to undermine immunity. Interviewees believe that most respiratory infections, except the common cold, require antibiotic therapy, and 11% of them had to exaggerate their symptoms to get an antibiotic prescription from their physician. About 1 patient in 4 saved part of the antibiotic course for future use. Sixty-nine percent of the patients claimed to have taken the course until the end (United Kingdom, 90%; Thailand, 53%), and 75% claimed that they actually took all the daily doses. In all countries, it was possible to get antibiotics from a pharmacist without a medical prescription. This study shows that patients exert pressure on their doctors to get antibiotics and should allow a design for precise educational action aimed at the public for better control of antibiotic use in the communit

Laboratory Survey of Fluoroquinolone Activity

Fluoroquinolones are active against a wide variety of bacteria. The antibacterial spectra of fluoroquinolones encompass staphylococci, Bacillus species, and Corynebacterium species implicated in infections of the immunocompromised host; Enterobacteriaceae; most intestinal pathogens; and many gram-negative organisms commonly causing nosocomial infections. Haemophilus influenzae, Haemophilus ducreyi, Neisseria gonorrhoeae, Neisseria meningitidis, and Branhamella catarrhalis are highly susceptible to this class of drugs. Because of their ability to penetrate into phagocytes, fluoroquinolones have been tested against intracellular pathogens: Legionella species, Rickettsia conorii, Rickettsia rickettsii, and Brucella melitensis are very sensitive; Chlamydia trachomatis and the mycoplasmas are borderline; and some antimycobacterial activities deserve further investigation. Species that are generally resistant include Pseudomonas maltophilia, Pseudomonas cepacia, Pseudomonas pseudomallei, Alcaligenes species, Nocardia species, Bordetella bronchiseptica, and most anaerobe

In-vitro toxoplasmacidal activity of cationic electron carriers

Exposing murine macrophages infected th the protozoan parasite Toxoplasma gondii to micromolar concentrations of some cationic electron carriers (dyes), resulted in complete killing of the intracellular parasites at concentrations at which these compounds did not seem toxic for the macrophages. The 50% inhibitory concentrations (with 95% confidence limits) were calculated as 0·26 (0·18-0·37), 1·35 (1-2·25), 0·45 (0·13-1·50), and 1·52 (0·91-2·53) μM for crystal violet, phenazine methosulphate, methylene blue and brilliant cresyl blue, respectively. The effects of these electron carriers did not appear to be the result of an enhancement of the natural antitoxoplasmic activity of the macrophages. None of the tested compounds was active against extracellular Tox. gondii as measured by ability to reinfect murine macrophages; thus, these dyes seem to act primarily on actively metabolizing, intracellular, Tox. gondii. Our data also suggest that the killing effect of the electron carriers was not related to the generation of reactive oxygen intermediates as judged by the inability of scavengers of these intermediates to block the activity against intracellular Tox. gondii. Further studies with related redox compounds would have an interesting chemotherapeutic perspective for treating toxoplasma infection

Development of resistance during ceftazidime and cefepime therapy in a murine peritonitis model

Resistance emerging after ceftazidime or cefepime therapy was investigated in a peritonitis model. Mice were given a peritoneal challenge (102 cfu plus talcum) and treated by either antibiotic (50 mg/kg/dose, which produced similar antibiotic concentrations in peritoneal fluid in both cases). After one or three doses, resistance never developed in Serratia marcescens or Citrobacter frnouiii infections. After Enterobacter cloacae and Pseudomonas aeruginosa challenge, ceftazidime selected more resistance (21/36 cases) than did cefepime (1/36 cases). In mice challenged with resistant strains selected by ceftazidime therapy, cefepime (six doses) successfully treated 7/18 E. cloacae infections but 0/18 P. aeruginosa infections; ceftazidime was never effective. Neither cefepime nor ceftazidime cured mice infected with the resistant strain selected by cefepime. MICs were poor predictors of further emergence of resistance in mice inoculated with strains classified as susceptible, but antibiotic-containing agar gradients plated with a high inoculum (102 cfu) allowed better prediction. In selected clinical situations, cefepime may be preferable because it may be associated with less frequent emergence of resistanc

Activity of roxithromycin against Toxoplasma gondii in murine models

Investigations into the activity of roxithromycin against murine toxoplasma infections are reviewed. Roxithromycin is an active drug against murine toxoplasmosis after intraperitoneal challenge with the RH strain of Toxoplasma gondii. Roxithromycin protected 100% of mice after five daily doses of 540 mg per kg administered by gavage. The cure rate after treatment of peritoneal infections seemed to be related to the length of the therapy. Roxithromycin also decreased the number of toxoplasma cysts, after intracerebral infection with the C56 strain and showed synergistic activity when combined with gamma interferon. Thus, roxithromycin could be a worthwhile alternative to current therapy against toxoplasma infections. Clinical studies on its activity and safety, especially in pregnancy, are warrante

Activity of spiramycin against Toxoplasma gondii in vitro, in experimental infections and in human infection

The in-vitro, experimental and clinical activities of spiramycin against Toxoplasma gondii have been reviewed. In mammalian cells infected by T. gondii as in various experimental models, spiramycin definitively exerts an inhibitory antitoxoplasmic effect which, clinically, seems useful for preventing congenital toxoplasma infection during pregnancy or for reducing the inflammation in toxoplasmic chorioretinitis. However, spiramycin does not kill the parasite efficiently, and cannot be recommended for eradicating the most severe forms of toxoplasmosi