Antero Kasanen

Effect of Trimethoprim on the Occurrence of Drug-Resistant Coliform Bacteria in the Faecal Flora

The occurrence of drug-resistant coliform bacteria was studied in the faecal flora of 30 persons receiving for 3 weeks either trimethoprim alone, a combination of sulphamethoxazole and trimethoprim, or a combination of sulphamethoxydiazine and sulphamethoxazole. Bacterial sensitivity was tested against trimethoprim, sulphamethoxazole-trimethoprim, sulphamethoxazole, and sulphaisodimidine. After treatment with trimethoprim alone, no increase in the occurrence of strains resistant to either trimethoprim or sulphonamides was observed. After treatment with sulphamethoxazole-trimethoprim, the faecal flora contained an increased percentage of sulphonamide-resistant coliforms but significantly less than found after treatment with sulphamethoxydiazine-sulphamethoxazole. In the persons receiving the sulphonamides only, a rapid increase in sulphonamide-resistant coliforms was observed. During the whole study, only one trimethoprim-resistant coliform strain was detected.

Sulfadiazine-Trimethoprim Combination in the Treatment of Urinary Tract Infections

In a clinical double-blind study on 198 patients with a urinary tract infection, no differences were found between comparable groups treated with either sulfadiazine (SD) 1,000 MG/trimethoprim (TM) 320 mg or sulfamethoxazole (SM) 1,600 mg/trimethoprim 320 g daily for 2 weeks. The favorable results were obtained according to the bacteriological control in 85 and 79%, respectively. Also the incidence of side effects was the same (22 and 24%, resp.). The number of cases within which the treatment had to be discontinued did not differ percentually, either (6.6 and 8.4%, resp.). Based on the bacteriological sensitivity tests and the clinical trial, the authors conclude that TM can be combined with SD as well as with SM. Pharmacokinetic advantages, like a lower protein-binding and a lesser metabolism, may even make SD more preferable.

Permanent Renal Lesions After Severe Preeclampsia and Eclampsia

Although pregnancy causes tremendous changes in the female organism these are generally limited to the period of gestation. Dieckmann (1952) mentioned, by way of illustration, that no extraordinary changes were found in the function of the vasculorenal system of women who had had ten or more pregnancies. If pregnancy is complicated by toxzmia there is, at least theoretically, a greater chance of a permanent lesion originating. Opinions differ greatly on this point. Dieckmann (1952) collected data from the literature on the occurrence of a permanent renal lesion (“chronic nephritis”) in toxzmic patients. According to him, an average of 12 per cent of eclampsia patients were found to have chronic nephritis at follow-up, the percentages ranging from o to 42 per cent. In patients who had non-convulsive toxzmia, chronic nephritis was established in an average of 8 per cent (range 0--74 per cent). Dieckmann considered that two conclusions could be drawn from the fact that the next pregnancy is normal in the majority of patients who have had toxzmia: (i) that pre-eclampsia seldom causes vasculo-renal lesions ; (ii) that there are two types of pre-eclampsia which cannot be told apart clinically but later show differing courses, viz. (a) no permanent vasculo-renal lesion; (11) permanent vasculo-renal lesion. Dieckmann held that the latter hypothesis was incorrect and

Ceftazidime in the treatment of urinary tract infection

Twenty-nine patients with urinary tract infection were treated with ceftazidime intramuscularly, at a dosage of 1000 mg twice daily for 7 days. The patient series was predominantly geriatric, with a mean age of 70.9 years and including 17 patients over 75 years. Nine had an in-dwelling catheter and azotaemia was found in 14 cases. In this clinically difficult group, a positive bacteriological response to treatment was obtained in 72.9% and, if patients with in-dwelling catheters are excluded, 90% were cured. Ceftazidime-resistant Streptococcus faecalis was cultured before treatment in 6 of the 8 unsuccessful cases. In the remaining 2 treatment failures, Streptococcus faecalis was isolated immediately after treatment. In terms of clinical response to therapy all patients were cured or improved. Treatment with ceftazidime was well tolerated. No subjective side-effects occurred. One patient developed a distinct but transient elevation of liver enzymes, and in 2 cases a negative direct Coombs test was temporarily positive.