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A 19-year-old man, who was a soft contact lens wearer for correction of myopia, presented with right corneal ulceration. The diagnosis of Acanthamoeba polyphaga infection was made by culture and serology. In-vitro sensitivity tests suggested that the organism was sensitive to Neosporin (polymyxin, neomycin and gramicidin) and natamycin. Topical therapy with these agents resulted in complete healing of the corneal ulcer in two months. To our knowledge, our patient is the only case of successful medical treatment of this condition that has achieved a good visual result.

Gastrointestinal complications, including diarrhea, may occur with virtually all antimicrobial agents. Such diarrhea may represent either a common, nonspecific adverse effect, or it may be one of the manifestations of antimicrobial-associated colitis (AAC), a potentially fatal complication. Clostridium difficile and a cytotoxin neutralized by Clostridium sordellii antitoxin has been isolated from the stools of nearly all patients with antibiotic-associated pseudomembranous colitis, many patients with AAC, and approximately 20% of those with antimicrobial-induced diarrhea. Demonstration that C. difficile is responsible for cytotoxin production has allowed for specific therapy for these disorders. General treatment measures include discontinuation of the causative antimicrobial agent(s), bowel rest, and supportive care with fluids, electrolytes and colloids, if necessary. Antiperistaltic agents and corticosteroids are not recommended. Various antimicrobials demonstrate potential efficacy in treating AAC in humans. Oral vancomycin is the most widely tested and is currently the treatment of choice. It achieves high concentrations in the feces and is very active against C. difficile in doses of 125-500 mg by mouth every six hours. Other potentially useful but inadequately tested antimicrobials include metronidazole (500 mg by mouth every eight hours) and bacitracin (25,000 units by mouth every six hours). Tetracycline has been employed with some success in nonspecific antibiotic-associated diarrhea, although it is as yet untested in humans with AAC and may induce diarrhea itself. Both miconazole and rifampin are highly effective against C. difficile in vitro but have not been evaluated in AAC. Anion-exchange resins bind the cytotoxin found in stools of patients with AAC. Cholestyramine has been used with variable response in oral doses of 4 g every six to eight hours. Since these resins may also bind vancomycin, resulting in lowered vancomycin concentrations in the stool, combination therapy should be used cautiously. With specific therapy directed against the toxin and aggressive supportive therapy, surgical intervention is rarely necessary. More recently, investigations have been directed at using bacterial preparations to suppress C. difficile by restoring the normal flora. The development of immunological agents (i.e., vaccines, toxoids, antitoxins) for the prevention or treatment of AAC would be a significant advance in therapy.

A patient had corneal infection with Staphylococcus aureus after keratoplasty from tissue preserved in McCarey-Kaufman medium. The small, successfully treated corneal infection was from the same organism cultured from the tissue culture medium at the time of transplantation. Possible sources of donor-tissue contamination included the increase in ocular flora seen in postmortem eyes, blood-borne bacteria, lack of sterile technique in securing donor tissue, inadequate irrigation of the tissue, and inadequate use of topical antibiotics on the tissue. Preservation medium and specimens from medium-preserved and refrigerated corneas should be cultured before and during surgery.

An increase in the number of cases of gram-negative ventriculomeningitis in patients followed with intracranial pressure monitors when compared with patients with craniotomy alone was revealed by routine surveillance data. A study was undertaken at four area institutions to describe the infections, risk factors, and management. Two hundred fifty-five patients with diagnoses of intracerebral hemorrhage (n = 86), closed trauma (n = 66), open trauma (n = 21), tumor (n = 66), and miscellaneous other conditions were compared with their nonmonitored counterparts for type of intracranial pressure monitor used, use of drains, prophylactic antibiotics, and steroids, and remote presence of infection. The presence of intracranial pressure monitor with craniotomy was associated with an 11 percent infection rate whereas craniotomy alone demonstrated a 6 percent rate. Of the intracranial pressure monitors used, the subarachnoid screw was associated with the lowest infection rate (7.5 percent) followed by the subdural cup catheter (14.9 percent) and the ventriculostomy catheter (21.9 percent). Regardless of the monitor used, infection was twice as likely to develop in patients with open trauma or hemorrhage. The use of bacitracin flush solutions for maintenance of lumen patency was more often associated with infections. Use of prophylactic antibiotics did not significantly influence outcome.

Anterior nares cultures from 664 hospital personnel identified 165 (24.8%) as carriers of Staphylococcus aureus. Persistent carriers (17.8%) were identified and randomly assigned to one of four treatment groups: rifampin (600 mg once a day for 5 days), bacitracin ointment (topically applied three times a day for 10 days), combined rifampin and bacitracin, and control (no treatment). Bacitracin ointment was ineffective in eliminating S. aureus from the anterior nares and had a postreatment carrier rate equal to the control rate. Rifampin therapy caused a highly significant reduction (79%) in carriage; however, combined therapy was not as effective as treatment with rifampin alone. Of 132 strains of staphylococci isolated before and after treatment, all were susceptible to less than 0.016 micrograms of rifampin per ml. This study demonstrates that rifampin may be an effective antistaphylococcal antibiotic and could be used to control the carrier state in high-risk situations.

In 10.4% of conjunctival scrapings received from 1731 patients with conjunctivitis during the years 1970 through 1980, basophilic cytoplasmic inclusions of unknown etiology were found in the epithelial cells when Giemsa stained. These "blue-bodies" differed in morphology from bacteria, chlamydia, and other frequent cytoplasmic inclusions. By electron microscopy, they consisted of a variety of dense bodies and phagolysosomal vacuoles containing complex lipids, indicating injury to the epithelial cells. The presence of these inclusions had a statistically significant association with the use of topical medications, especially Neosporin. Administration of other antibiotics and medications was less frequently related. Patients with the most prolific "blue-body" inclusions usually showed a clinical picture of subacute to chronic conjunctivitis or blepharoconjunctivitis thought to represent hypersensitivity. Recognizing the nature of these easily seen inclusions is important to distinguish them from infectious organisms, and may also support the diagnosis of a drug-related reaction.

All antibiotics, except parenteral aminoglycosides, sulfonamides and vancomycin, can induce pseudomembranous colitis. The worst offenders are clindamycin, ampicillin, amoxicillin and the cephalosporins. The cytotoxin produced by Clostridium difficile has been identified as the cause of pseudomembranous colitis. Treatment includes an antimicrobial to eradicate the organism and cholestyramine or colestipol to bind the toxin.

Wound infection, cerebrospinal fluid leak, and meningitis are serious potential complications of neurotologic procedures that transgress the posterior cranial fossa dura. A study of 236 patients was made to determine the effect of perioperative intravenous antibiotics and topical bacitracin irrigation on the incidence of these complications. Of the 236 patients, 170 (72%) underwent translabyrinthine resection of acoustic tumors, while 66 (28%) underwent retrolabyrinthine vestibular nerve section. Patients were divided into four groups: those who received no antibiotics, those who received perioperative intravenous antibiotics only, those who received topical bacitracin irrigation only, and those who received a combination of perioperative intravenous antibiotics and topical bacitracin irrigation. There were no untoward effects of either perioperative intravenous antibiotics or topical bacitracin. The results indicate that bacitracin irrigation reduced the incidence of wound infection from 9% to 2% (p less than 0.05); of cerebrospinal fluid leak from 12% to 5% (p less than 0.04); and of all targeted complications combined from 22% to 9% (p less than 0.006). Furthermore, the topical bacitracin irrigation only group showed a statistically significant reduction in wound infections compared to the perioperative intravenous antibiotic only group (p less than 0.02). The incidence of meningitis was statistically unaffected by any of our treatment protocols.

White soft paraffin has been shown to inhibit the development of the isomorphic response (Kobner phenomenon) in psoriasis. The possible reasons for this are discussed and it is suggested that this finding has implications which should lead to a greater understanding of the nature of psoriasis.

Two experiments were performed to study the effect of dietary antibiotics on percent daily weight change, mortality and gross cecal pathology in chickens during the critical phase of Eimeria tenella infection. In the first experiment, chickens were continuously fed ration containing thiopeptin, 2 mg/kg.; bacitracin, 20 mg./kg.; penicillin, 12 mg./kg.; or chlortetracycline, 22 mg./kg. One day after antibiotic fed was given, each bird received an oral inoculation of 30,000 sporulated oocyts. In the second experiment, chickens were consecutively fed ration containing amprolium plus ethopabate, 125 plus 8 mg./kg., and a combination of the coccidiostat and one of 4 antibiotics; thiopeptin, bacitracin, penicillin, or chloretracycline. One day after medicated feed was given, birds were each given an oral inoculation of 30,000 amprolium plus ethopabate-resistant E. tenella oocysts. The experiments were terminated 7 days after coccidia exposure. In both experiments, E. tenella infection resulted in depression in all birds of infected groups. Average percent weight change of infected birds was significantly lower than that of uninfected unmedicated control between 4 and 5 days after infection. Significantly greater number of birds died of cecal coccidiosis in group fed dietary bacitracin than that of other infected groups. Dietary antibiotics did not reduce gross cecal lesions.

Sixty-five patients were treated with oral vancomycin for Clostridium difficile colitis associated with treatment of infection by antibiotics. Colitis was confirmed by endoscopy in patients with diarrhoea and positive tests on diarrhoeal stools for Cl. difficile and/or its cytotoxin or, if endoscopy could not be performed, by the presence of fever and peripheral or faecal leucocytosis. Vancomycin dosage ranged from 125 to 500 mg four times daily for an average of about ten days. The mean duration of diarrhoea after starting therapy was four days; abdominal pain and fever usually resolved in two or three days. Post-treatment carriage of Cl. difficile was common. Eighteen per cent of patients developed a recurrence of colitis after treatment was discontinued, but responded to treatment with oral vancomycin, metronidazole, or bacitracin. After comparison of our results with those reported by others we concluded that vancomycin remains the treatment of choice for patients who are acutely and severely ill with Cl. difficile.

A program of antimicrobial prophylaxis for neurosurgical patients was implemented at three community hospitals after review of the previously recorded cases of postoperative sepsis and the antibiotic sensitivity of the prevailing pathogen, Staphylococcus. No primary wound infections occurred in a series of 1000 consecutive operations. The rational basis for prophylactic antibiotics is discussed.

Two patients with antibiotic-associated pseudomembranous colitis, and stool positive for Clostridium difficile cytotoxin were successfully treated with oral bacitracin. One patient had previously suffered two relapses of pseudomembranous colitis following successful treatment with vancomycin and one patient was allergic to vancomycin. Bacitracin appears to be a reasonable choice to treat patients with antibiotic-associated colitis who are allergic to vancomycin. Further studies comparing vancomycin and bacitracin are needed.

The rates of colonization and infection of newborns with coagulase-positive staphylococci were studied during five sequential periods using various modes of skin care in the nursery. Colonization and infection were low during the baseline period when total body bathing with 3% hexachlorophene was employed (period 1), but increased dramatically (80% colonization, 9.5% infection) when hexachlorophene was discontinued and replaced by Ivory Soap baths (period 2). Reinstitution of hexachlorophene (period 3) reduced both colonization and infection, but not to the low levels seen during period 1. A second Ivory Soap period (period 4) resulted in a return to high colonization (77%) and infection (11.5%) rates. During period 5, daily Ivory Soap baths were continued and bacitracin ointment was applied to the umbilical area at least three times daily. Colonization was reduced to 10% and infection to 3.0%. Bacitracin could not be detected in serum in 15 infants studied. Colonization with gram-negative enteric bacilli was highest while using hexachlorophene or Ivory-bacitracin, but no increase in gram-negative infections was seen. Colonization of newborns with non-group A beta-hemolytic streptococci was not influenced predictably with various modes of skin care. The local application of bacitracin is a safe and effective method of controlling staphylococcal colonization and disease for infants in nurseries.

In a prospective randomized, blind trial, three groups of patients undergoing elective colonic surgery were compared for frequency of surgical wound infection, intra-operative wound contamination and other postoperative infections. All patients allotted to the three groups received whole gut irrigation (101 balanced salt solution) by gastric tube on the evening before surgery and were treated as follows. Group A: no antibiotics; Group B: neomycin (1 g/l) + bacitracin (50,000 IU/l) + clindamycin (900 mg/l), contained in the last 31 of irrigation fluid; Group C: mezlocillin (4 g) + oxacillin (2 g) intravenously (iv) at induction of anaesthesia, followed by two identical doses at 8 and 16 h. The rate of postoperative wound infection was highest in A (38 per cent) and much lower in B (3.3 per cent, P less than 0.002) and C (6.9 per cent, P less than 0.004). The difference between B and C was statistically not significant. In A a correlation was established between the degree of wound contamination and the occurrence of wound infection. Intra-operative wound contamination was lowest in B (30 per cent), equal in A (58.1 per cent) and B (55.2 per cent). Other infections were least frequent in group C (four of 29 patients), but were not significantly different to groups B (six of 30) and A (nine of 31). It is concluded that antibiotics together with an effective mechanical preparation considerably reduce the rate of wound infection in colonic surgery.

Methicillin-resistant Staphylococcus aureus was thought to be the cause of 10 cases of antibiotic-associated diarrhoea observed over a 12-month period at The Royal Melbourne Hospital. Each patient had significant underlying disease, and all had been treated with multiple, broad-spectrum antibiotic agents. The diagnosis was made on the distinctive Gram-stain appearance of faecal smears, the heavy predominant growth of methicillin-resistant Staph. aureus from stool cultures, and the absence of other bowel pathogens, including toxigenic Clostridium difficile. Diarrhoea usually responded to treatment with vancomycin or bacitracin, and, in patients whose condition improved, the stools cleared of staphylococci. Patients with staphylococcal diarrhoea present a significant crossinfection risk, and early diagnosis, treatment, and isolation are essential.

This paper presents in large part the author's views on the treatment of a variety of bacterial infections of the eye. Emphasis is placed on the management of bacterial corneal ulcers and endophthalmitis.

For post-Mohs surgical defects of the head and neck, the width of the defect is the best predictor of the length of that time it will take the wound to heal. This conclusion is based on a multivariate analysis, testing the effect of the following factors on wound-healing time: (1) age, (2) sex, (3) sound location, (4) wound width, (5) wound length, and (6) wound length X wound width. After accounting for wound width, none of the other factors significantly influenced the rate of wound healing. The 64 wounds evaluated were dressed daily with one of five bandages. When compared with the controls, and after correcting for wound width, each of the test bandages shortened wound-healing time. Among the treatment groups, no significant differences were found in the cultures or in the appearance of the wounds.

The authors described their experience with the use of prophylactic antibiotics in children with compound depressed skull fractures. The analysis of the results of the treatment of patients with or without systemic antibiotics and with or without the replacement of the bone fragments showed no difference in the infection rate, any one was the method used.

In an attempt to reduce post-cystoscopy urinary tract infection half-strength Polybactrin Soluble GU solution was used as the bladder irrigating fluid. Although the infection rate was markedly reduced, this just failed to be significant. However, it is believed that with a better combination of antibiotics the incidence of post-cystoscopy urinary tract infection can be significantly reduced.

A comprehensive review of the factors responsible for postoperative wound sepsis is discussed, along with the experimental basis for the use of prophylatic antibiotics and a review of the results of the use of systemic and topical antibiotics on the incidence of surgical wound infections. Based on the data presented, suggestions are made which should minimize the development of postoperative wound infections.

The experience of this laboratory with the treatment of Clostridium-induced colitis in experimental animals and in patients was reviewed. Optimal results in hamsters were achieved with the antibiotics vancomycin, metronidazole, and tetracycline. Cholestyramine was less effective. The outcome for animals given corticosteroids and Clostridium sordellii antitoxin systemically was not different from that for untreated control animals. The second facet of the study was a retrospective review of therapy in 272 patients with C. difficile-induced diarrhea or colitis. No specific therapy was given to 56 patients who had mild symptoms or were improving at the time the toxin was detected. The therapy most frequently used was oral vancomycin, which was given to 189 patients, including 100 with confirmed pseudomembranous colitis. The response rate was 97%, but 46 patients (24%) relapsed when treatment was discontinued. Response to cholestyramine was favorable in 12 of 19 patients. The results with metronidazole and bacitracin were uniformly good, although the experience was limited.

Ring-shaped keratitis appeared in the left eye of a 37-year-old woman who had worn soft contact lenses for more than five years. The corneal ring began to appear within seven days of a central corneal abrasion. Gram staining of the patient's contact lens cleaning solution showed many gram-negative rods, and microbiologic investigations of the patient's soft contact lens and contact lens case disclosed Pseudomonas aeruginosa. There was no clinical or laboratory evidence of an infectious process. Prompt treatment with polymyxin B-bacitracin ointment and prednisolone acetate 1% eyedrops led to resolution of the opacity and a return to the patient's normal visual acuity. The P. aeruginosa endotoxin may have been transferred through the epithelial break into the superficial corneal stroma, leading to ring formation via endotoxin-initiated, properdin-mediated, antibody-independent complement activation.

A controlled prospective trial was carried out on 100 cases of appendicectomy for a suppurative or perforated apendix, 153 operations on the biliary tract and 25 abdominal colon and rectum resections. The topical administration of Polybactrin aerosol, sprayed once into the open laparotomy wound produced a significant reduction in postoperative wound infection.

The present study was undertaken in order to compare the effect of different antimicrobial regimens on the incidence of postoperative wound infections after elective colorectal surgery. The series consists of 84 patients, randomized in the following three groups: Group I was treated with bacitracin/neomycin tablets during the 3 days immediately prior to operation. Group II received doxycycline 200 mg orally 12-18 hours preoperatively and 200 mg intravenously during the subsequent 4 days. Group III is identical with group II, but in addition, 2 grams of tinidazole were given orally as a single dose 12-18 hours preoperatively. The ordinary preoperative treatment with low residue diet and bowel cleansing was the same for all groups. The wound infection rate was 37% (10 patients) in group I, 18.2% (6 patients) in group II, and 8.3% (2 patients) in group III. No serious side effects were observed in any of the groups.

Four cases of antibiotic-associated colitis and diarrhea caused by Clostridium difficile were successfully treated with oral bacitracin, 25,000 units four times daily for 7-10 days. Diarrhea resolved in all of the cases, in 2 days, with disappearance of Clostridium difficile toxin in the stools in 3 out of 4 patients so measured. Two of the patients treated had relapses after vancomycin, while the other 2 were experiencing the first episodes. One patient relapsed after bacitracin treatment, but was treated successfully with vancomycin. Our preliminary experience indicates that bacitracin, being less expensive and more readily available world-wide than vancomycin, could be used as an alternative drug for toxin-induced colitis or diarrhea.

A randomized, controlled, trial of a topical antibiotic preparation (neomycin, bacitracin, and polymyxin B) was performed in 30 patients with homozygous sickle cell (SS) disease and chronic leg ulceration. Over a period of 8 weeks, the reduction in ulcer size was significantly (P less than 0.05) greater in the treatment group than in the control group. The results suggest that these topical antibiotics may contribute to the therapy of chronic leg ulceration associated with sickle cell disease.

From the clinical point of view an ointment containing retinol, thiamine hydrochloride and calcium pantothenate (Regepithel) seems to be of benefit in the treatment of various corneal diseases. The influence of Regepithel on healing time after superficial corneal injuries in rabbits is demonstrated on the basis of comparative histological findings.

The effectiveness of a ten-day course of either oral bacitracin or oral vancomycin hydrochloride for treatment of Clostridium difficile-induced antibiotic-associated diarrhea was compared in a randomized double-blind study. Bacitracin was as effective as vancomycin in resolving diarrhea; most patients responded within five days of therapy with either drug. Three patients receiving bacitracin worsened during therapy; two of these were considered treatment failures. Neither C difficile nor its toxin was detected in stool samples collected on the final day of therapy in 71% of patients (10/14) receiving vancomycin and in 30% (3/10) receiving bacitracin. Five patients receiving bacitracin and three receiving vancomycin had at least one recurrence. Low but nontoxic concentrations of bacitracin were detected in serum samples collected from 11 patients. Oral bacitracin at this dosage level was as effective as vancomycin in resolving the symptoms of C difficile-induced antibiotic-associated diarrhea in most patients but was less effective in eradicating C difficile and its toxin from patients' stools.