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The problem of solid waste management presents an issue of increasing importance in many low-income settings, including the progressively urbanised context of Kenya. Kisumu County is one such setting with an estimated 500 t of waste generated per day and with less than half of it regularly collected. The open burning and natural decay of solid waste is an important source of greenhouse gas (GHG) emissions and atmospheric pollutants with adverse health consequences. In this paper, we use system dynamics modelling to investigate the expected impact on GHG and PM2.5 emissions of (i) a waste-to-biogas initiative and (ii) a regulatory ban on the open burning of waste in landfill. We use life tables to estimate the impact on mortality of the reduction in PM2.5 exposure. Our results indicate that combining these two interventions can generate over 1.1 million tonnes of cumulative savings in GHG emissions by 2035, of which the largest contribution (42%) results from the biogas produced replacing unclean fuels in household cooking. Combining the two interventions is expected to reduce PM2.5 emissions from the waste and residential sectors by over 30% compared to our baseline scenario by 2035, resulting in at least around 1150 cumulative life years saved over 2021–2035. The contribution and novelty of this study lies in the quantification of a potential waste-to-biogas scenario and its environmental and health impact in Kisumu for the first time., Graphical abstract Unlabelled Image, Highlights • We present a system dynamics study of solid waste management in Kisumu, Kenya. • Scenarios involve a waste-to-biogas initiative and a ban on open burning in landfill. • Combined scenario generates 1.1m tonnes cumulative GHG savings by 2035. • Largest contribution (42%) is from biogas substituting traditional cooking fuels. • Combined scenario may save 1,150 cumulative life years by 2035, plus ~220 more p.a.

The proportion of hospital-acquired infections in a university health centre varied between 0.03 and 26.8%. The average rate of hospital infection was 4.37%. Highest infection rates were found in surgical departments, newborn and premature baby units and in intensive care units. Urinary tract infections, wound infections, pneumonia, infections of the skin, subcutis and mucous membranes, as well as septicaemia, were found most commonly. Staphylococcus aureus was the most frequently found agent of hospital-acquired infections. The incidence of these infections can be markedly reduced by making use of specially trained hygiene staff and by intensive measures to control spread of infections.

Infections linked in time and space with Yersinia enterocolitica (serovar 0 : 9, biotype 2, lysotype X3) were observed in 6 cases within one university hospital. After a hospital epidemic in Finland in 1973 (involving 7 persons) this is the 2nd such observation. The spread was demonstrated in two areas. The probable source of infection of one patient group (n = 3) was a 48-year-old dialysis patient admitted with a febrile condition without enteritic symptoms. Pathogens could be demonstrated in his faeces by direct culture, in two contact persons cultivation was possible only with cold enrichment. Blood cultures of the first patient were negative. At about the same time 3 further infections with Yersinia enterocolitica of the same characteristics were observed in hospital personnel from different units. Frequent exchange of staff and patients among affected wards increases likelihood of cross-infection. A dialysis nurse with Yersinia arthritis was the possible link between patients and personnel. Transference of infection from one person to another can be assumed in the above cases.

Using a 1% aldehyde disinfectant the bacterial count was reduced by 84% by scrubbing the floor, by 60% with a wet mop and by 50% with a dry mop. However, two hours after floor disinfection the bacterial count was nearly back to pretreatment when walked on again. Disinfectant mats did not decrease bacterial count on the surface behind them. Plastic overshoes did not influence floor contamination. There was no significant difference regarding the infection rate, in an intensive care unit during a six-month period, between routine floor disinfection and cleaning without disinfectant. It is possible that by doing without routine floor disinfection something like 20 million DM can be saved per year. The World Health Organisation also recommends floor disinfection only immediately after contamination of the floor by infectious secretions.

Nosocomial infections of 1356 mothers and their newborn have been analyzed and compared in three different regimens for postnatal care of newborn (rooming-in service, mixed service and central newborn nursery). The average nosocomial infection rate of mothers was significantly lower in the rooming-in service as compared to the newborn nursery. Most common nosocomial infections of mothers were urinary tract infections, endometritis, wound infection, enteritis and mastitis; in newborn enteritis, oral candida infections, panaritium, conjunctivitis and staphylococcus skin infections. Staphylococcal infection of newborn were higher in the newborn nursery as compared to the rooming-in service. Epidermic nosocomial infections (e.g. enteritis, candida infections) occurred more often in the newborn nursery as compared to the mixed system and rooming-in service. There was an increased risk of cross infections from mothers with wound infection, endometritis and mastitis to their children.

The in vitro effects of Bay k 4999 in combination with gentamicin, tobramycin, amikacin sisomicin and netilmicin in bacteriostatic (MIC) and bactericidal (MBC) concentrations were compared using the checkerboard dilution technique against 20 different strains of Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae and indole-positive-negative Proteus species. On average 63% of Bay k 4999-aminoglycoside (AG) combinations inhibited Pseudomonas, Proteus and Klebsiella strains additively and/or synergistically in bacteriostatic as well as in bactericidal concentrations as compared to only 14% additive or synergistic activity on E. coli. 35% of the combinations tested proved to be synergistic in K. pneumoniae, 20% in Proteus, 13% in Pseudomonas, but only 5% in E. coli. No significant differences between various Bay k 4999-AG combination effects could be demonstrated.

The incidence of nosocomial infections and antimicrobial resistance rates of nosocomial pathogens vary considerably among countries and even among intensive care units (ICUs) within one hospital. Such differences might be partly due to the selection pressure exerted by certain antibiotics, since intensive care patients are given more antimicrobials than any other group of patients. We therefore compared resistance rates of four important nosocomial pathogens (Staphylococcus aureus, E. coli, Klebsiella pneumoniae, Pseudomonas aeruginosa) isolated from patients in general wards and ICUs. There were few trends toward higher resistance of ICU isolates, and most differences were found with Klebsiella pneumoniae.We also tried to relate antibiotic use in ICUs and frequency of antibiotic resistance of five selected nosocomial pathogens. The ampicillin and cephalosporin resistance of E. coli and Klebsiella pneumoniae arose along with an increase in usage of both drugs. Decreasing prescription of cotrimoxazole was not reflected by decrease in resistance of Staphylococcus aureus and Staphylococcus epidermidis. Increasing prescriptions of tetracyclines were followed by an increasing resistance of E. coli, but not of Staphylococci. The oxacillin resistance of Staphylococcus epidermidis almost paralleled the consumption, the opposite was true for Staphylococcus aureus. There seemed to be a rather close relationship between the incidence of resistant Staphylococcus aureus, Staphylococcus epidermidis and Pseudomonas aeruginosa strains and the quantities of gentamicin, tobramycin and azlocillin prescribed.The increase or decrease of prescriptions of certain antimicrobials increased or decreased their resistance rate to the respective drugs of only certain bacterial strains in one ICU, but not in the other. The findings in our hospital cannot necessarily be applied to other hospitals. Restriction of antimicrobial usage however decreased resistance rates in most situations.

Between March 1971 and April 1976 37 patients were seen with manifest bacterial endocarditis. The main signs were high temperature and cardiac murmurs whereas other "classical" signs such as splenomegaly, anaemia, leucocytosis, and positive anti-streptolysin titres were much less frequent. In 35 cases bacteriological proof was possible. As causative organism a total of 30 gram-positive organisms (of which 15 were Streptococcus viridans and 8 were Staphylococcus species) and 10 gram-negative bacteria (4 of which were Pseudomonas aeruginosa) could be demonstrated. Treatment was mainly with beta-lactam and/or aminoglycoside antibiotics. Use of the combination of penicillin and streptomycin or gentamicin was based on the results of in-vitro bactericidal activity. The main complications were emboli, penicillin allergies, pulmonary involvement and cardiac complications. 13 patients died; the main cause was cardiac failure which was irreversible even despite operative valve replacement during the acute infection in two cases.

Experiments were performed to modify the influenza virus-induced pyrogenicity by varying the milieu in which the virus is suspended. The results show that lysozyme and aristolochia acid in afebrile dosages enhance the virus pyrogenicity in rabbit pyrogen test. It is supposed that this stimulating effect is due to a promoting virus phagocytosis. Mixtures of lysozyme and aristolochia acid do not lead to a higher enhancement of virus pyrogenicity but, on the other hand, often induce an effect somewhat less than that of lysozyme or aristolochia acid alone. Detergents such as sodium deoxycholate and vitamin A on the contrary suppress the pyrogenic activity of influenza virus particles probably by delaying virus phagocytosis. The same result is to be observed with sucrose and polymyxin B in certain dosages. It must be emphasized that the presence of the substances just mentioned can possibly be a source of error in performing the usual rabbit pyrogen test. In addition to our findings further recommendations for a useful application of lysozyme and aristolochia acid for instance in practical treatment of viral diseases are given since these substances may shorten the viraemic phase.

Liquor- und Urinproben von Patienten mit und ohne Meningitis wurden auf ihren Lysozymgehalt hin untersucht. Die Untersuchungs-methode basierte auf der Fahigkeit von Lysozym, den Mikrococcus lysodeikticus aufzulosen. Die Durchfuhrung erfolgte mit Hilfe eines einfachen Plattentestes. Dabei ergab sich ein erhohter Lysozymspiegel bei Patienten mit Meningitis. Die hochsten Werte fanden sich bei bakterieller Meningitis. Gleichzeitig konnten Lysozymtiterbewegungen im Verlaufe des Krankheitsprozesses beobachtet werden. Eine Korrelation zwischen Lysozymtiter und Zahl der Leukocyten bestand nicht. Es ergibt sich somit, das die Lysozymbestimmung im Liquor bei meningealen Erkrankungen als zusatzliches empfindliches diagnostisches Hilfsmittel gelten kann.

Es wird eine verbesserte i.v. Injektionstechnik beim embryonierten Huhnerei beschrieben. Sie besteht darin, die Injektionsnadel wahrend der gesamten Nachbebrutungszeit (meist 24–48 Std) in dem Blutgefas zu belassen. Dadurch konnen haufig auftretende Nachblutungen vermieden werden.

Infections linked in time and space with Yersinia enterocolitica (serovar 0 : 9, biotype 2, lysotype X3) were observed in 6 cases within one university hospital. After a hospital epidemic in Finland in 1973 (involving 7 persons) this is the 2nd such observation. The spread was demonstrated in two areas. The probable source of infection of one patient group (n = 3) was a 48-year-old dialysis patient admitted with a febrile condition without enteritic symptoms. Pathogens could be demonstrated in his faeces by direct culture, in two contact persons cultivation was possible only with cold enrichment. Blood cultures of the first patient were negative. At about the same time 3 further infections with Yersinia enterocolitica of the same characteristics were observed in hospital personnel from different units. Frequent exchange of staff and patients among affected wards increases likelihood of cross-infection. A dialysis nurse with Yersinia arthritis was the possible link between patients and personnel. Transference of infection from one person to another can be assumed in the above cases.

Catheters for cardiovascular and other angiographic investigations can be resterilized by ethyl-oxide. The procedure of sterilisation has to be controled permanently. Reapplicability of catheters has become quite common because of the high price of new catheters. In spite of optimal resterilisation and permanent controll some patients still get fever attacks, because endotoxins cannot be eliminated by this method.

A total of 142 gram-positive and 161 gram-negative bacterial strains were tested by an agar diffusion method using antibiotic disks (30 microgram/ml) and the broth dilution method in order to establish a relationship between zone diameter and minimal inhibitory concentration. Mueller-Hinton and DST-Oxoid agars were both evaluated to assess their effects on zone diameters. Computer programmed regression lines of the first and second order were determined, as well as the correlation coefficient of both regression lines. Acceptable correlation coefficients (R = 0.84-0.92) were achieved. The regression lines of the first and second order showed differences, which fell into the category of resistant/susceptible. The DST agar appeared to be better suited than the Mueller-Hinton agar (using the Bauer-Kirby method of the agar diffusion test) to show the differences in the breakpoints.

Using a 1% aldehyde disinfectant the bacterial count was reduced by 84% by scrubbing the floor, by 60% with a wet mop and by 50% with a dry mop. However, two hours after floor disinfection the bacterial count was nearly back to pretreatment when walked on again. Disinfectant mats did not decrease bacterial count on the surface behind them. Plastic overshoes did not influence floor contamination. There was no significant difference regarding the infection rate, in an intensive care unit during a six-month period, between routine floor disinfection and cleaning without disinfectant. It is possible that by doing without routine floor disinfection something like 20 million DM can be saved per year. The World Health Organisation also recommends floor disinfection only immediately after contamination of the floor by infectious secretions.

26 strains of obligate anaerobic bacteria, which had been isolated from clinical specimens, were tested for their survival on artificially contaminated cotton swabs after storage. All strains could hardly if at all be cultivated, if the cotton swabs had been stored in empty test tubes at 4 degrees C for 48 hrs. In contrast to that it was possible to cultivate all strains without significant reduction of their number from swabs, which were stored at 4 degrees C for 48 hrs in test tubes containing Stuart's transport medium. The necessity of an improvement of techniques and transport-methods to isolate anaerobic bacteria is discussed. The use of a special transport medium is recommended as an important aid to the early recognition of anaerobic infection.

Hospitalepidemiology means surveillance, prevention andocntrol of nosocomial infections. Trying to succeed he has to search for possiblities which are both practical as well as efficient: 1. The infection control nurse (one for 300 beds), 2. a bacteriological labor is for the epidemiologist, which is able to perform routine control on certain areas in the hospital (kitchen, sterilisation etc.), 3. encironmental examinations if necessary to find sources and for teaching purposes, 4. training of hospital personal in prevention, recognizing nosocomial infections, performing methods of desinfections etc., 5. trying to cooperate with the clinician in chemotherapy (selection of antibiotics, prophylaxis etc.), 6. to develop a programm to collect datas about nosocomial infections by a computer and to analyse those datas afterwards, 7. collaborativ work in a infection control commitee.

The in vitro effects of Bay k 4999 in combination with gentamicin, tobramycin, amikacin sisomicin and netilmicin in bacteriostatic (MIC) and bactericidal (MBC) concentrations were compared using the checkerboard dilution technique against 20 different strains of Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae and indole-positive-negative Proteus species. On average 63% of Bay k 4999-aminoglycoside (AG) combinations inhibited Pseudomonas, Proteus and Klebsiella strains additively and/or synergistically in bacteriostatic as well as in bactericidal concentrations as compared to only 14% additive or synergistic activity on E. coli. 35% of the combinations tested proved to be synergistic in K. pneumoniae, 20% in Proteus, 13% in Pseudomonas, but only 5% in E. coli. No significant differences between various Bay k 4999-AG combination effects could be demonstrated.

Die antibiotische Therapie von Hospital-Infektionen ist in den letzten Jahren haufig zu einem Problem wegen der ungunstigen Resistenzentwicklung der zugrundeliegenden gram-negativen Bakterien geworden. Zwei neu entwickelte Ureido-Penicilline, Mezlocillin und Azlocillin, zeigen in vitro gunstige antibakterielle Hemmwerte gegen humanpatho-gene, gram-negative Erreger. Azlocillin weist signifikant niedrigere MIC-Werte gegen Pseudomonas aeruginosa im Vergleich zu Carbenicillin und Ticarcillin auf. Mezlocillin bietet gunstigere Hemmwerte gegen die meisten Enterobacteriaceae als Ampicillin und Cefalothin.

Die durch rektale Palpation gestellte Verdachtsdiagnose eines Prostata-Karzinoms bedarf vor Beginn einschneidender therapeutischer Masnahmen der histologischen oder zytologischen Sicherung. An unserer Klinik hat sich die transrektale Stanzbiopsie mit der Tru-Cut-Nadel gegenuber der Saugbiopsie aufgrund falsch positiver zytologischer Befunde durchgesetzt [9].

One thousand post-mortem reports were analysed retrospectively to see whether the patient had had a nosocomial or community-acquired infection and whether this led directly to or contributed to the patient's death. In 7.4% of all autopsies nosocomial infection was the direct cause of death. In 6.3% of the patients, nosocomial infection was a contributory factor leading to death. The most common hospital infections were pneumonia, septicaemia, peritonitis, meningitis, and hepatitis B. Most infections which led to or contributed to death were acquired in surgical wards. Patients with nosocomial infections, however, were more endangered by factors predisposing to infections (1.8 factors per patient) than patients without nosocomial infections (0.67 factors per patient). Sixty-three patients acquired an infection outside the hospital; in 70% of these patients, the infection was the main or contributory cause of death.

The subspecies intestinalis and fetus of Campylobacter fetus are opportunistic pathogens in humans. So far, some 200 types of disease due to these pathogens have been reported from all over the world, and six new diseases are briefly described in this paper. The most frequent disease is sepsis, followed by meningitis. While ticarcillin, erythromycin, clindamycin and tetracycline are the antibiotics which show activity against these species, a large degree of resistance is seen against cephalothin, cefazolin, cefuroxime, cefoxitin and cefotaxime. There is a moderate degree of sensitivity to gentamicin. The epidemiology of the disease is not clear, and about twice as many men are affected as women. Subspecies intestinalis was isolated in 95% of all diseases. Antibodies to Campylobacter fetus were detected in 3.9% of the population.

The in vitro efficacy of piperacillin in combination with gentamicin, tobramycin, amikacin and netilmicin against 57 nonfermenting gram-negative bacterial strains was compared by use of the checkerboard agar dilution technique. On average 34% of all nonfermenting strains were inhibited by additive, 13% by synergistic piperacillin-amino-glycoside combinations. Great variation occurred between the different bacterial species. Piperacillin-aminoglycoside combinations were most active on Pseudomonas aeruginosa and least potent on Pseudomonas cepacia. Piperacillin was highly active against P. aeruginosa, P. cepacia, Pseudomonas fluorescens-putida and Acinetobacter species.

With the help of equivalence transformations known from high level programming language implementation techniques sound and relatively complete partial correctness proof calculi for ALGOL 68-like programs are developed the functions and procedures of which have finite modes and simple side effects only. Special consideration is devoted to the relation variable elimination and separation rules and their exchangability.

Auf Grund der bakteriellen Resistenzentwicklung bedeuten heute Infektionen mit gram-negativen Erregern oft chemotherapeutische Probleme. Die Entwicklung eines neuen Aminoglykosid-Antibiotikum, des Sisomicins, mit gunstigeren antibakteriellen in vitro Hemmwerten und besseren Wirkungen in Tierinfektionsmodellen [1,67] konnte daher eine Erweiterung der antibiotischen Behandlungsmoglichkeiten dieser gram-negativen Infektionen bedeuten. Gegenstand der vorliegenden Untersuchungen war die vergleichende Pharmakokinetik von Sisomicin und Gentamycin sowie die Prufung der Wirksamkeit, der Vertraglichkeit und der klinischen Einsatzmodalitaten des Sisomicins bei stationaren Patienten.

The average nosocomial infection rate during a four year prospective study period was found to be 26.4%. Most common hospital acquired infections were urinary tract infections, pneumonia, septicemia, infections of the skin and wound infections. The most common isolated organisms were: Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Enterococci and Klebsiella pneumoniae. Infection control programs reduced the infection rate by 32%.

The pharmacokinetic data of amikacin were determined after a 1 hr constant infusion with a dosage of 7.5 mg/kg body weight in 12 healthy test subjects. Microbiological bioassay was performed by the agar diffusion test. After the infusion, the mean amikacin serum concentration was 37.5 mug/ml and, 8 hours later, decreased to an average of 1.3 mug/ml. The biological half-life amounted to a mean of 114.2 min, the area below the concentration-time-curve was calculated to an average of 140.4 hr - mug/ml. The renal clearance of amikacin was determined during a 4 hr constant infusion in 3 test individuals; the average clearance was 84.3 ml/min - 1.73 m2. 38 patients with severe bronchopulmonary, urinary and peritoneal infections were treated with an average daily dose of 10-15 mg of amikacin per kg body weight during a mean period of 10 days. 32 patients showed clinical improvement, 17 of them with complete elimination of the pathogenic bacteria.

576 serum levels at peak and before the next dosage (end level) were determined during clinical treatment conditions using radioimmunoassay in 131 patients treated with tobramycin or amikacin because of life-threatening infections. Only 42.8% of tobramycin serum peak levels were within the therapeutic range. 3.6% were potentially toxic, however, 53.6% were in a subtherapeutic range. After amikacin administration only 25% of serum peak levels were in a subtherapeutic range. 54.2% were therapeutic and 20.8% were potentially toxic. The main reason for increased peak and end serum levels was diminished renal function. Infusion treatment with more than 3 1/24 hrs lowered serum peak levels of tobramycin by 38% and of amikacin by 31%. Single doses of 80 mg of tobramycin lead to subtherapeutic concentrations too frequently, whereas single doses of 500 mg of amikacin too frequently lead to potentially toxic serum levels. Control of serum levels during aminoglycoside treatment is recommended particularly in patients at risk with life-threatening infections.

Ticarcillin concentrations in serum, muscle, and fat were determined simultaneously in 23 patients after the intravenous injection of a single dose of 5 g. The mean concentrations of ticarcillin in serum, muscle, and fat were, respectively, 185 microgram/ml, 18 microgram/g, and 32 microgram/g at 1.0 to 1.5 h after the injections, declining to levels of 11 microgram/ml, 2 microgram/g at 6 to 7 h after the injections. There was no significant difference between the serum tissue ratios at these time periods.

The in vitro activity of enoxacin was tested in 14 German microbiological centers shortly after the introduction of the drug in Germany. 2748 unselected clinical isolates including 15 bacterial species were analysed using microtiter plates. The MIC90-values were as follows: Staphylococcus aureus 4 mg/l, Enterococcus faecalis 16 mg/l, Enterobacteriaceae 0.5 mg/l, Pseudomonas aeruginosa 8 mg/l. There is good correlation between these results and those of former investigations. It is known that quinolones are only moderately active against enterococci. 8.5% of S. aureus, and 1.4% of Enterobacteriaceae were found to be resistant (MIC greater than 4 mg/l). As to P. aeruginosa, the study revealed that despite a generally low rate of resistance in specific clinical settings, specific problems can arise: in one institution, the MIC90 of P. aeruginosa was 32 mg/l, with a resistance rate of 56.1% (n = 57). In the other centers the MIC90 was 2 mg/l and the resistance rate 5.0% (n = 302). In the first center, many of the isolates were from paraplegic patients or patients with cystic fibrosis pretreated with quinolones. This study will be repeated in two years' time in order to determine an eventual change in resistance.

Nosocomial infections of 1356 mothers and their newborn have been analyzed and compared in three different regimens for postnatal care of newborn (rooming-in service, mixed service and central newborn nursery). The average nosocomial infection rate of mothers was significantly lower in the rooming-in service as compared to the newborn nursery. Most common nosocomial infections of mothers were urinary tract infections, endometritis, wound infection, enteritis and mastitis; in newborn enteritis, oral candida infections, panaritium, conjunctivitis and staphylococcus skin infections. Staphylococcal infection of newborn were higher in the newborn nursery as compared to the rooming-in service. Epidermic nosocomial infections (e.g. enteritis, candida infections) occurred more often in the newborn nursery as compared to the mixed system and rooming-in service. There was an increased risk of cross infections from mothers with wound infection, endometritis and mastitis to their children.

The pharmacokinetic parameters of two new ureido-penicillins (azlocillin and mezlocillin) were determined in 12 healthy subjects after a half-hour continuous infusion of 5,000 mg. The agar diffusion test (test strain Bacillus subtilis ATCC 6633) was used for the microbiological assays. The mean azlocillin serum concentration after the half-hour infusion was 431.0 +/- 75.0 microgram/ml; after eight hours it had fallen to a mean value of 4.7 +/- 2.6 microngram/ml. The mean elimination half-life was 77.5 +/- 10.4 minutes, and the relative distribution volume was 19.4 +/- 1.9% of the bodyweight. At the end of the infusion, mezlocillin showed a mean serum concentration of 426.0 +/- 61.0 microgram/ml and after eight hours an average of 1.1 +/-0.9 microgram/ml; the half-life was shorter (56.9 +/- 9.9 minutes) and the distribution volume lower (14.8 +/- 3.1%) than that of azlocillin. The renal clearance values measured in three subjects during a four-hour continuous infusion were: azlocillin 111.6 ml/min/1.73 m2, mezlocillin 121.5 ml/min/1.73 m2. The kinetic behaviour of the two ureido-penicillins was essentially very similar to that of ampicillin and carbenicillin, 38 patients with bronchopneumonia, cholangitis or urinary tract infections, which in some instances were severe, were treated for an average of 10 days with an average daily dosage of 3X4.0 g azlocillin or 3X5.0 g mezlocillin. 30 patients showed clinical improvement, and in 17 of these the pathogen was eliminated. These therapeutic results appear more favourable than those obtained with the newer aminoglycoside antibiotics (amikacin, sisomicin); in particular the drug was well tolerated.

Between March 1971 and April 1976 37 patients were seen with manifest bacterial endocarditis. The main signs were high temperature and cardiac murmurs whereas other "classical" signs such as splenomegaly, anaemia, leucocytosis, and positive anti-streptolysin titres were much less frequent. In 35 cases bacteriological proof was possible. As causative organism a total of 30 gram-positive organisms (of which 15 were Streptococcus viridans and 8 were Staphylococcus species) and 10 gram-negative bacteria (4 of which were Pseudomonas aeruginosa) could be demonstrated. Treatment was mainly with beta-lactam and/or aminoglycoside antibiotics. Use of the combination of penicillin and streptomycin or gentamicin was based on the results of in-vitro bactericidal activity. The main complications were emboli, penicillin allergies, pulmonary involvement and cardiac complications. 13 patients died; the main cause was cardiac failure which was irreversible even despite operative valve replacement during the acute infection in two cases.

In a randomized study of 12 healthy subjects the pharmacokinetics of gentamicin, sisomicin and tobramycin were determined after a one-hour infusion of each drug (1.0 mg/kg body-weight) four weeks apart. There were no pharmacokinetic differences of therapeutic significance between the three drugs. The mean serum concentrations at the end of infusion were 3.85 mug/ml for gentamicin and 4.66 mug/ml for sisomicin, falling to 0.12 and 0.26 mug/ml, respectively, after eight hours. The biological half-life varied between 96 and 122 min and the apparent volumes of distribution corresponded closely tothe size of the extracellular space. The antibacterial effectiveness, tolerance and modes of application were studied in 24 patients, most of them with urinary infection, at a dosage of 1.0 mg per kg body-weight two to three times daily. Good clinical results were achieved in 15, satisfactory ones in three, and in 16 the causative bacteria were eradicated. Sisomicin was well tolerated, except for minor and reversible renal (2 patients), hepatic (3 patients), and hearing (1 patient) disturbances.