Roger J. Bulger

Impaired Leukocyte Function in Patients with Poorly Controlled Diabetes

In order to assess the influence of poor diabetes control on function of leukocytes, polymorphonuclear leukocytes (PMNs) from patients with poorly controlled but nonketotic disease were studied before and after therapy. Before treatment, phagocytosis was significantly reduced (p < .001) and, consequently, the rate of killing the test organism (type 25 pneumococcus) was decreased (p < .01). Following antidiabetes therapy phagocytosis improved significantly; while microbicidal rates also improved, they remained less than control values (p < .01). Serum from the untreated diabetics uniformly reduced phagocytosis and microbicidal rates of control granulocytes; serum from controls improved phagocytosis by the diabetic PMNs, but restored normal microbicidal rates in only half of the patients. This transferable inhibitory effect of hyperglycemic diabetic serum on control granulocytes was abolished by dilution, and was reproduced in normal serum by the isosmotic addition of glucose. These studies suggest that (1) PMN function may be impaired during periods of poor diabetes control, as has been shown previously in ketoacidosis, and (2) hyperglycemia or a closely related factor may contribute to the defect.

Reversible abnormalities in phagocytic function in poorly controlled diabetic patients.

Phagocytic function was compared in nondiabetic control and 11 poorly controlled diabetic subjects before and after treatment. Prior to therapy, the rates at which the type-25 pneumococcus employed as the test organism was killed by whole blood were significantly reduced (p<.01) in the diabetic grou

Cloxacillin, a New Oral Synthetic Penicillin. Comparisons with Oxacillin.

With antibiotics, as with other drugs, minor alterations in chemical structure are often responsible for significant differences in pharmacologic activity. In the present study, cloxacillin, differing in the addition of a single chloride atom, gave much higher blood levels following oral administration than those obtained with oxacillin. Other characteristics of the two compounds, including in vitro activity, development of resistance, and binding to serum proteins, were remarkably similar for the two compounds. The significantly higher blood levels obtained with cloxacillin suggest that this compound represents a useful advance in the oral therapy of infectiOns caused by penicillin G‐resistant staphylococci.

Antimicrobial Therapy in Patients With Renal Insufficiency

Infection in a patient with renal insufficiency can be very difficult to treat. Antimicrobial agents that are not excreted by the kidneys to a significant degree may be given in full dosage but may be ineffective against the causative organisms. Other drugs whose toxicity is increased in the presence of renal insufficiency sometimes must be used in reduced dosage. Recommended dosage schedules are presented.

Why bacteriuria in pregnancy should be treated.

There seems to be no question that significant bacteriuria occurring during pregnancy should be treated whether or not it is symptomatic. The most accurate means of identifying significant bacteriuria is the quantitative colony count. As tests for this purpose become more sophisticated, let us not forget that old-fashioned microscopic examination of the urine is an inexpensive, reliable way of obtaining a great deal of information.