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One hundred and twenty Spraque Dawley rats were divided into eight groups. Three groups were used as controls; intraperitoneal (i.p.), subcutaneous (s.c.) and i.p. and s.c., respectively. Group 4 was treated with Dfx, Group 5 with vitamin E and Group 6 with antibiotics. Group 7 was treated with vitamin E in combination with antibiotics, and Group 8 with a combination of antibiotics and Dfx. The rats were studied for 14 days following treatment, and survivors then humanely dispatched. Post-mortem examination was undertaken on all the rats studied.
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The aim of this study was to analyse how the results of Gram-staining vaginal smears correlated with the clinical criteria for determining the existence of bacterial vaginosis (BV) and, in particular, how the category defined as 'intermediate' or Gram grade II did so and its significance. Women attending an antenatal clinic with an abnormal vaginal flora, that is those who had Gram-stains of grades II or III, the latter considered to equate with BV, were given clindamycin or a placebo intravaginally and examined again on up to three occasions. Gram-stain readings of grade III correlated with the clinical criteria for BV on 356 (91.7%) of 388 occasions. Grade II readings covered the spectrum of clinical criteria and correlated with those for BV on 35 (37.2%) of 94 occasions. Grade I, recorded 231 times and seen usually after clindamycin treatment, was associated with BV only once. The sensitivity, specificity, positive predictive value and negative predictive value of the Gram stain for the diagnosis of BV, based on a combination of grades II and III, were 99.7%, 71.6%, 81% and 99.6%, respectively; based on grade III only, the values were 99.7%, 87.7%, 91.6% and 99.6%, respectively. Women reported a malodorous vaginal discharge on 49.2% of the occasions a grade III flora was seen and 13.3% of the times grade II was recorded. It was not associated with grade I and would seem a useful adjunct to the accepted clinical criteria for diagnosing BV. Each of the clinical criteria was found in about equal proportions (87%-91%) for women whose Gram grade was III. For grade II, an increased discharge was noted most often (76.5%) and 'clue' cells least often (24.5%). A positive amine test was the most specific, being associated with <1% of grade I smears. Of women with grade III status, 91% reverted to grade I after treatment with clindamycin for three days. In contrast, of women with grade II status, 53% reverted to grade I, as did 47% of those who were given a placebo. The 'intermediate' (grade II) category is a Gram-stain diagnosis and not one that can be made clinically. It is important to recognize as a distinct entity not only because amalgamation with grade III diminishes the specificity and positive predictive value of the Gram-stain for diagnosing BV, but also because women of grade II status usually fail to respond to clindamycin treatment, whereas those of grade III do not.
The colonization rate was 10.6% and 22 women (66.7%) had both positive vaginal and rectal cultures. Rates of GBS colonization were significantly lower in patients aged 24 years or older and in those with a third or later pregnancy. None of the isolates were resistant to penicillin and ampicillin, whereas 21.2% and 9.1% showed resistance to erythromycin and clindamycin, respectively.
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Clindamycin, a lincosamide antibiotic with a good penetration into bone, is widely used for treating bone and joint infections by Gram-positive pathogens. To be active against Staphylococcus spp, its concentration at the infection site, C, must be higher than 2× the minimal inhibitory concentration (MIC). The aims of the work were to study the determinants of plasma clindamycin trough concentration, C min, especially the effect of co-treatment with rifampicin, and the consequences on clinical outcome.
The resistance of Campylobacter jejuni strains to the fluoroquinolones is increasingly frequent, and in our area it reaches nearly 50%. We studied the susceptibilities of 60 of these strains to 11 oral antibiotics. All strains except one were susceptible to the macrolides tested, with azithromycin being the most active agent tested. Of the rest of the antibiotics studied, amoxicillin-clavulanic acid, clindamycin, and fosfomycin displayed good in vitro activities. Knowledge of the susceptibilities of these microorganisms to a varied group of oral agents is necessary in view of the appearance of multiresistant strains, such as those included in our series.
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Seventy-six percent (73/96) of specimens contained Ureaplasma spp., while 39.7% (29/73) of Ureaplasma positive specimens were also positive for M. hominis. Susceptibilities of Ureaplasma spp. to levofloxacin and moxifloxacin were 59% (26/44) and 98% (43/44) respectively. Mixed isolates (Ureaplasma species and M. hominis) were highly resistant to erythromycin and tetracycline (both 97% resistance). Resistance of Ureaplasma spp. to erythromycin was 80% (35/44) and tetracycline resistance was detected in 73% (32/44) of Ureaplasma spp. Speciation indicated that U. parvum was the predominant Ureaplasma spp. conferring antimicrobial resistance.
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A new differential and selective medium for the isolation of members of the Proteeae, PIM (Proteeae isolation medium) agar, was developed and evaluated. The medium relies on the ability of all members of the Proteeae (with the exception of a very few Morganella morganii strains) to produce a dark brown pigment in medium containing DL-tryptophan. An additional differential property, tyrosine degradation, was also demonstrated by the medium. Members of the Proteeae appeared as dark brown colonies with a halo of clearing of fine tyrosine crystals when cultured on PIM agar. Occasional strains of Citrobacter sp. and Pseudomonas aeruginosa may degrade tyrosine, but none has the ability to produce dark brown pigmentation on PIM agar. Quantitative recovery studies showed that the addition of 5 mg of clindamycin per liter suppressed gram-positive bacteria without inhibiting any strains of the Proteeae. The addition of 100 mg of colistin per liter made the medium highly selective for strains of the Proteeae, but approximately 10% of the strains were not isolated, thus making this formulation unsuitable for general surveys of the occurrence of members of the Proteeae. PIM agar should aid the investigation of episodes of cross infection caused by members of the Proteeae and the isolation of the new species of the Proteeae recently described.