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Aminoglycosides are potent water-soluble antibiotics, with peak concentration-dependent bactericidal activity against many pathogenic aerobic Gram-negative bacilli and Staphylococcus aureus: they exhibit enduring antibacterial activity many hours after tissue concentrations become negligible and appreciation of this postantibiotic effect is leading to replacement of conventional multiple daily doses by large once-daily doses. Cotreatment with betalactams is commonly employed in order to exploit a synergism between these antimicrobial agents, particularly in severe Gram-negative sepsis. Resistance to aminoglycosides may be observed at several levels and is generally high when due to the acquisition of aminoglycoside modifying enzymes which may be plasmid-borne or transferred by transposable elements. Tobramycin is more effective than gentamicin and the other aminoglycosides against Pseudomonas aeruginosa and is less nephrotoxic than gentamicin. Higher serum tobramycin concentrations at the peak are associated with a longer postantibiotic effect and increased bactericidal activity. A longer dosage interval may decrease the risk of nephrotoxicity because higher transient serum aminoglycoside levels appear to be less nephrotoxic than lower but more persistent serum concentrations. Once-daily administration may also reduce the risk of ototoxicity through a similar mechanism. In a multicenter Italian study of 104 adult patients with severe bacterial lower respiratory tract infections, the safety and efficacy of a regimen of high dose, once-daily tobramycin alone or in combination with antipseudomonas betalactams was assessed. The overall bacteriological response was an elimination of the original pathogen in 70% of the patients while the clinical response mirrored the bacteriological results with a successful clinical outcome in 78% of patients. Adverse experiences were, in general, few and mild without oto- or nephrotoxicity. The once-daily, high dose regimen of tobramycin proved to be a safe and efficacious therapy for severe lower respiratory tract infections in adult patients.

The Authors report two cases of acute osteomyelitis, in a newborn and in an infant. Bone and joint sepsis in the first years of life is rare. The metaphases of long bones are the most common sites of hematogenous osteomyelitis. The hip and the knee are especially at risk. The patients were treated with pharmacologic and orthopedic therapy. The Authors describe the clinical features, radiographic changes, the diagnosis and management of this disease.

Forty-eight children aged from 4 to 11 months, affected by Congenital Nasolacrimal Duct Obstruction (CNDO), treated successfully by local hydrostatic massage, were retrospectively included in two groups: Group A treated by massage and antibiotic eye drops, Group B treated by massage only. The comparison shows a quicker resolution of the CNDO when antibiotic eye drops are administered. The Author stresses the utility of topical antibiotic therapy regardless of the presence of mucopurulent discharge.

The Authors describe a rare case of Yersinia Enterocolitica (Y.E.) infection in a child affected by thalassemia. The onset of the disease was that of an acute enteritis with diarrhea, fever, vomiting and abdominal pain which subsequently evolved in a picture consistent with an acute appendicitis. Laparotomy was then performed and showed a marked suppurative mesenterial lymphadenitis with mild appendicular inflammation and Y.E. infection was suspected. Culture from lymphonodes confirmed the presence of Y.E. sensitive to tobramicin and CTM. The use of these chemiotherapic agents has been followed by a rapid clinical improvement. Our recent experience could suggest some practical considerations: 1) Culture of Y.E. should be routinely performed in all children affected by acute gastroenteritis and particularly in those, above 5 years of age, in which the infection can simulate acute appendicitis. 2) Special attention should be carried out in children affected by thalassemia who can easily present more serious disease often complicated by septicemia. 3) Therapy depends on the form and severity of the disease and should be always guided by in vitro sensitivity test because of the possibility of resistence of Y.E. against the most frequently used antibiotics in septicemia.

In the treatment of infections arisen in neoplastic patients without neutropenia, 2 antibiotic combinations (aztreonam + oxacillin vs tobramycin + cefoxitin), have been compared with regard to therapeutic effectiveness and tolerability. Twenty patients (age: 30-75) have been studied. Tolerability of both combinations was excellent. Results of this study showed a lower percentage of superinfections and a higher percentage of cure in patients treated with the combination aztreonam + oxacillin, even if the data were not statistically significant.

A total of 122 children, from one to twelve years old, with suspected bacterial conjunctivitis, were treated with Tobramycin 0.3% eye drops. The follow up control was at the 3d (+2), the 7th (+2) day and a third control was performed around the 15th day, in case of a longer therapy. All patients showed a significant remission of the sign and symptoms already at the first control. No local or systemic side effect was noticed. Locally the product was well tolerated.

Results of the comparison between tobramicine and ceftriaxone (new long-acting 3rd generation cephalosporin) in the treatment of pediatric acute respiratory tract infections are referred. Treatment with ceftriaxone is judged more advantageous both for efficacy and for saving the number of administered doses.

The results of microbiological research carried out on haematological patients admitted to the same ward are reported. The pathogenic flora observed consisted mainly of gram-negative germs (60%). Pseudomonas infections represented the most important problem because of their frequency and the consequent clinical problems. The in vitro sensitivity of 306 strains of gram-negative germs to 11 different antibiotics has been analysed. Amikacin proved to be easily the most effective antibiotic against isolated pathogens.

Between April 1977 and April 1981, three schedules of prophylactic antibiotic therapy using four different antibiotics -- Cefaloridine, an association of Tobramycin-Lincomycin, and Ribostamycin -- have been employed in the surgical treatment of a series of patients. clinical experiments were carried out administering the dose of chosen antibiotic one hour before and a few hours after surgery, without prior selection of patients and without considering what type of surgery they were to undertake. The clinical series presented was submitted to statistical analysis for the purpose of monitoring the effectiveness of the therapeutic programmes adopted to prevent postoperative infections of the surgical focus and of the skin wound, comparisons also being made of the different types of drug. The high number and variability of the factors affecting this type of experiment are attributed equally to the patient's physiological and metabolic features and to the types of lesions and surgical intervention carried out. The rationality of these therapeutic solutions are assessed by comparison with traditional programmes of antibiotic administration carried out solely in the postoperative period for a prolonged time. Practicality, cost and incidence of side effects (infrequent) and the absence of serious toxic consequences are also discussed.

Changes in susceptibility to four aminoglycosides (gentamycin, amikacin, tobramycin, sisomicin) of bacterial strains, isolated from in-patients with urinary tract infections at the "Santa Maria della Scala" Hospital of Siena, in the period January-April in three consecutive years (1980, 1981, 1982) were studied. The change susceptibility patterns were related to the use of the four antimicrobial drugs in the same periods. Emergence of antibiotic-resistant strains was seen after a wider use, whereas an increasing number of susceptible strains was observed after reducing use of antimicrobial drugs.

The clinical and bacterial efficiency of tobramycin sulphate administered once a day (150 mg/day) in the prevention of pleural cavity and bladder infections was evaluated by considering 30 surgical patients fitted with thoracostomic tubes or bladder catheters. Pleural cavity sterility was maintained in 74% of cases and bladder sterility was maintained or obtained in 100% of cases. These results confirm the success of the treatment.