A cell suspension of a Klebsiella pneuntoniae strain was given on a monolayer of HeLa cells, then adsorption of the strain in the cells was tested. In these experiments, 10⁴-10⁶CFU were adsorbed within 3 hours if the cell suspension contained less than 10⁶CFU. When AMK was added at concentrations of 10 or 100 MIC, no multiplication of the organisms was noted after 18 and 6 hours, respectively, when tested by solid medium. When tested by a broth medium, however, the organisms were detected even 18 hours later in 100 MIC. Similar results were obtained with DOXY at 6 hours in 100 MIC. With P-lactam antibiotics 10²-10⁵ CFU and 10⁴-10⁵ CFU of the organisms were observed using solid and broth media, respectively.
Concerning the morphological features of the organisms, no change was observed at 100 MIC of AMK when viewed under the light microscope. By scanning electron microscopy, cellular damage was observed both in the bacterial and HeLa cells, and recovery of morphological alteration was shown by the removal of AMK. Also, when treated with β-lactam antibiotics, elongation of cells and discharge of intracellular substances were observed by light microscopy.

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Monitoring the serum concentration of netilmicin (NTL) should be helpful in maintaining optimal therapeutic ranges and avoiding undesirable side-effects. Namely, blood-drug monitoring of a critically ill individual early in the therapy, for example at the end of the first or second day of treatment, should be utilized to ensure the presence of adequate therapeutic drug concentrations, since underdosing rather than overdosing is a common prescribing error.
Dried blood spots can easily and safely be obtained by venipuncture. This is an adequate method of specimen collection even from pediatric patients.
We developed a therapeutic drug monitoring method for NTL blood concentration by dried blood spot (DBS) method. By this method, NTL blood concentrations were monitored in 7 patients and the pharmacokinetic parameters were calculated for 4 patients after drip infusion. The pharmacokinetic parameters obtained were: T_max (h): 0.77-0.98, K_el.(h^-1): 0.039-0.119, T_1/2 (h): 5.84-17.72, V_d (l/g): 0.316-0.545, Cl (l/h): 0.012-0.072, C_max (μg/ml): 3.70-6.27 (administration range: 1.78-2.16 mg/kg).

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Cefotaxime (CTX) was dissolved in 10% glycerol, and drug concentrations in blood and cerebrospinal fluid (CSF) were measured serially to determine whether concomitant use of 10% glycerol would increase the migration of antibiotics into CSF. The results showed significantly higher CSF concentrations for the glycerol group over the controls.
Method: Subjects were 6 cases of aneurysmal clipping and cisternal drainage among patients with ruptured aneurysm. A dose of 2 g of CTX was dissolved in 200 ml of 10% glycerol and administered over 30 minutes. Blood and CSF were sampled 6 times (before administration and at 0.30 minutes and 1, 2, and 4 hours after administration), and the concentrations of CTX, des-CTX (a metabolite of CTX), and glycerol were measured. After 12 hours 2 g of CTX was dissolved in 100ml of physiological saline and administered. Blood and CSF were then sampled according to the same protocol and used as controls. Measurement of CTX and des-CTX was conducted with HPLC, while glycerol was measured with a kit from Boehringer Co.
Results: Blood concentrations of CTX and des-CTX reached their maximum values immediately after dosing, then decreased exponentially. The changes of CTX and des-CTX concentrations in CSF were slower than in blood, reaching their peaks after 1 or 2 hours, followed by a gradual decrease. In migration of CTX to the CSF the glycerol group showed significantly higher values immediately after dosing (STUDENT'S t-test), while in migration of des-CTX to the CSF the glycerol group scored significantly higher after 30 minutes and 1 hour.
Conclusion: Concomitant use of glycerol was very useful in facilitating the migration of cefotaxime to the cerebrospinal fluid.

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We studied the effect of aztreonam (AZT) on the fecal flora, PIVKA-II in plasma and γ-carboxyglutamic acid (Gla) in urine of seven children, 2 months to 2 years old. Daily doses of AZT were 60-80 mg/kg. Stool specimens were obtained before treatment, on days 3 to 5 of AZT use, and 3 to 5 days after the cessation of treatment. The counts of Enterobacteriaceae decreased, but those of Streptococcus increased during AZT treatment. There was no marked change in anaerobic bacteria, especially Bifidobacterium. PIVKA-II and Gla were investigated before and during treatment with AZT. PIVKA-II was not detected in the six cases examined. The mean values of Gla before treatment was 87.6±18.5 nmole/mg creatinine and that during treatment was 99.6±26.9nmol/mg creatinine. There was no significant difference.

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We report here thirty-one cases with clinical or serological evidence of psittacosis between 1981 and 1986 and a study of the efficacy of antimicrobial agents on chlamydial pneumonia.
The following results were obtained.
1. We treated all patients except two with TCs, MLs and finally new quinolones.
Efficacy was as follows: MINO 18/21 cases, (85. 7%), LCM 2/2. IM 1/1, and OFLX 1/1.
2. Response to CEPs, PCs, AGs, carbapenems and monobactams was poor except in two cases.
3. The mean time from onset of symptoms to initiation of therapy was 7. 9 days. If treated with effective drugs, the mean time from onset of symptoms to improvement in clinical symptoms and laboratory findings, such as CRP or neutrophilia, was about 20 days. We therefore recommend a 2-week course of treatment.
4.γ-globulin was useful only when used in combination with TCs or MLs.

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1) The MICs (10⁶ cells/ml) of CFTM, CEX, CCL, CFT, ABPC were determined against S. aureus isolated from the lesions of skin infections. MICs of CFTM were more than 3.13μg/ml for all strains and its MIC₅₀ was 6.25μg/ml, whereas the MICs of CEX were more than 1.56μg/ml for all strains and its MIC₅₀ was 6.25μg/ml. The MICs of CCL were 0.78-100μg/ml for all strains, those of CFT were 0.78-25μg/ml for all strains, and those of ABPC distributed wider than oral cephems and its MIC₅₀ was 3.13μg/ml.
2) Serum and skin levels of CFTM after oral administration (CFTM-PI 50 mg/kg) were determined in rats. Serum levels were 5.20, 5.45, 7.53 and 2.49μg/ml, and the corresponding skin levels were 0.69, 0.99, 0.87 and 0.37μg/g (wet skin) at 0.5, 1, 2 and 4 hours after administration, respectively (n=4).
3) CFTM-PI was used clinically in 26 cases of skin infection and the following results were obtained: excellent in 10 cases, good in 10, fair in 4, and poor in 2. As to side effects and abnormal laboratory findings, diarrhea and elevated S-GOT/S-GPT were observed in 1 case each.

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We eompared the clinical efficacy, safety and utility of ciprofloxacin (CPFX) in the treatment of patients with obstetrical and gynecological infections with those of cefroxad ine (CXD) in a doubleblind study. As both drugs are oral antimicrobials, the target diseases were intra-uterine infection, adnexitis, bartholinitis and Bartholin's abscess. Patients were given either 200 mg of CPFX or 500 mg of CXD three times a day for 7 days. A total 253 patients were entered into this study and 209 patients were evaluated for efficacy by the committee. The following results were obtained.
1. The clinical efficacy rate on the basis of committee judgement was 79.8%(83/104) in the CPFX group and 75.2%(79/104) in the CXD group. The difference between the groups was not significant. In adnexitis there was a tendency to better results with the CPFX group than the CXD group (p<0.10).
2. The bacteriological eradication rate was 80. 3%(49/61) in the CPFX group and 80. 7%(46/57) in the CXD group. This difference was not significant.
3. Overall clinical efficacy was assessed by the committee on the basis of clinical efficacy and bacteriological response. The overall clinical efficacy rate was 79. 8%(83/104) in the CPFX group and 75.2%(79/105) in the CXD group. Again, this difference was not significant. Classified by diagnosis, the rate in adnexitis was 81.8%(27/33) in the CPFX group and 59. 3%(16/27) in the CXD group. This difference was significant (p<0.05). In intra-uterine infection, the rate was 85.4%(35/41) in the CPFX group and 89.1%(41/46) in the CXD group, and in bartholinitis and Bartholin's abscess it was 70.0%(21/30) in the CPFX group and 68.8%(22/32) in the CXD group. These differences were not significant.
4. The clinical improvement rates according to the doctors in charge were high in both the CPFX group 88.5%(92/104) and the CXD group 83.8%(88/105).
5. Adverse reactions were observed in 2 out of 124 patients (1.6%) given CPFX and in 2 out of 128 patients (1.6%) given CXD. Abnormal changes in laboratory findings were noted in 3 patients (2.5%) on CPFX and in 3 patients (2.3%) on CXD. However no serious adverse reactions or abnormal changes in laboratory findings were observed.
6. The utility rates according to the doctors in charge were satisfactory in both the CPFX group 88.6%(93/105) and the CXD group 83.8%(88/105), There was no significant difference between the groups. In adnexitis, there was a tendency to better results in the CPFX group than the CXD group (p<0.10).
From these results, we conclude that CPFX is useful in the treatment of patients with obstetrical and gynecological infections.

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