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Biomedical subjects

D McGhie

Publications and source records attributed to D McGhie.

At least 19 recordsLinked to original sources

Cross-infection by non-encapsulated Haemophilus influenzae.

From October, 1988, to January, 1989, 18 patients admitted to an acute medical chest ward were infected with an ampicillin-resistant beta-lactamase-producing strain of Haemophilus influenzae. All 18 isolates were non-encapsulated strains of biotype III and showed identical cell envelope protein profiles, as judged by sodium dodecyl sulphate-polyacrylamide gel electrophoresis. The organism was not isolated from repeated environmental samples but there was strong circumstantial evidence that a spirometer was a common iatrogenic source of the cross-infection.

Bacterial Outer Membrane Proteins↗

The presence of M proteins in outbreak strains of Streptococcus equisimilis T-type 204.

Cultures of Streptococcus equisimilis (Lancefield group C) from three outbreaks of illness were found to carry the T-protein antigen 204. Strains of this type were not otherwise represented in a collection of 743 cultures of these 'pyogenes-like' streptococci isolated from other outbreaks of infection or as random isolates. Two of the three outbreaks were of pharyngitis. The third arose in a maternity unit where the organism was isolated from mothers with puerperal fever, from staff and also from the environment. Representative strains were found to carry M-protein antigens as judged by their ability to survive and multiply in fresh normal human blood. Comparison of absorbed rabbit antiserum to the M antigens in opsonic and precipitin tests showed that a distinct M antigen was present on isolates from one outbreak of sore throat and that all cultures from the other two incidents shared a common M antigen. Samples of serum were also available from patients in the outbreak of puerperal sepsis. Most patients developed antibodies to one or more streptococcal antigens including the M protein, streptolysin O, streptokinase and the hyaluronidase specific for strains of group C and group G streptococci.

Antigens, Bacterial↗

A randomised, prospective, single-blind comparison of cefadroxil and amoxycillin in the treatment of acute exacerbations of chronic bronchitis.

Cefadroxil 1 g twice daily and amoxycillin 500 mg three times a day were compared in 111 patients suffering from acute exacerbations of chronic bronchitis. Treatment was for seven days. Excellent or good clinical responses were found in 85 per cent of cases receiving cefadroxil and 81 per cent of patients taking amoxycillin. However, residual symptoms of cough and rhonchi were present to a statistically significantly greater extent in the amoxycillin group. Tolerance of both drugs was good with mild to moderate side effects reported in seven of 54 patients in the cefadroxil group and six of 56 patients taking amoxycillin. Severe nausea and vomiting in two cases in the amoxycillin group resulted in discontinuation of therapy. Microbiological examination of sputum samples showed pathogenic bacteria in 16 per cent, principally Haemophilus influenzae. Amoxycillin 500 mg tds and cefadroxil 1 g bd were equally effective in the treatment of acute exacerbations of chronic bronchitis.

Adolescent↗

The relevance of Chlamydia trachomatis in acute epididymitis in young men.

Young men presenting to a General Surgical Unit with acute epididymitis underwent microbiological investigation, including culture for Chlamydia trachomatis. The results were compared with similar investigations in an asymptomatic control population and with patients presenting to the Department of Genito-urinary Medicine with urethral discharge. Chlamydia trachomatis was cultured from 15% of patients with acute epididymitis and a further 15% had serological evidence of exposure to Chlamydia. Nearly 50% of patients attending the Genito-urinary clinic grew Chlamydia from the urethra. The background prevalence of Chlamydia in the control population was low. It is necessary to identify the significant minority of young men with acute epididymitis associated with chlamydial infection, because of the risk of pelvic inflammation and infertility in their female partners. At present this can only be achieved by submitting all young men with acute epididymitis to full microbiological investigation.

Acute Disease↗

A comparative study of Miraxid (pivmecillinam plus pivampicillin) and Augmentin (amoxycillin plus clavulanic acid) in the treatment of lower respiratory tract infections in general practice.

Two treatments, pivmecillinam 200 mg plus pivampicillin 250 mg (Miraxid) given twice-daily and amoxycillin 250 mg plus clavulanic acid 125 mg (Augmentin) given three times daily were compared in two parallel groups of 388 general practice patients with acute bronchitis or acute exacerbations of chronic bronchitis. Patients with acute bronchitis (140 on Miraxid, 144 on Augmentin) received a 7-day course of treatment and those with acute exacerbations of chronic bronchitis (55 on Miraxid, 49 on Augmentin) a 10-day course of treatment. Both treatments were equally effective, with 99 (71%) patients with acute bronchitis being successfully treated with Miraxid and 107 (74%) with Augmentin. In acute exacerbations of chronic bronchitis, Miraxid was successful in 29 (53%) patients and Augmentin in 24 (49%) patients. Side-effects were reported by 26 (12%) of patients in both treatment groups. This single blind multicentre general practice study comparing twice-daily Miraxid with 3 times daily Augmentin demonstrated that both treatments were equally effective clinically and equally well tolerated.

Adult↗

The aetiology and management of acute epididymitis.

The aetiology of acute epididymitis presenting to a surgical unit in a District General Hospital is presented. Patients over 45 years old frequently have a coliform urinary tract infection which may be associated with bladder neck obstruction. These patients require treatment with a suitable antibiotic (Co-trimoxazole) and further investigation. This condition occurs more commonly in patients under 45 years old in whom it is not associated with urinary tract infection. We have not demonstrated significant chlamydial infection and in a double blind study the antibiotic Co-trimoxazole did not hasten recovery. In this group the aetiology remains obscure.

Acute Disease↗

A comparison of pivmecillinam/pivampicillin and co-trimoxazole in hospitalized patients with acute exacerbations of chronic bronchitis.

Forty-nine hospitalized patients with acute exacerbations of chronic bronchitis were randomly allocated a ten-day course of either pivmecillinam/pivampicillin or co-trimoxazole. Both treatments were equally effective clinically (pivmecillinam/pivampicillin successful in 72% of cases; co-trimoxazole in 70%) and in their ability to eradicate pus from sputum (pivmecillinam/pivampicillin 84%; co-trimoxazole 74%). One patient taking co-trimoxazole ceased therapy because of persistent nausea and vomiting. No side-effects were observed in the pivmecillinam/pivampicillin group.

Acute Disease↗

Studies with cefuroxime and cefoxitin.

We have studied cefuroxime, a new beta-lactamase resistant cephalosporin, and cefoxitin, the first cephamycin antibiotic, which is also resistant to many beta-lactamases. Both of these antibiotics have been shown to be microbiologically superior to the "first generation" cephalosporins, cefuroxime having notable activity against Haemophilus influenzae, and cefoxitin against Bacteroides fragilis. Neither antibiotic is absorbed from the gut but, following parenteral administration, serum, urine and bile concentrations are high. Clinical trials have been conducted on both cefoxitin and cefuroxime. The results of these have been satisfactory and untoward side-effects minimal. We suggest that cefoxitin will be particularly valuable in the management of abdominal sepsis and cefuroxime in infections caused by H. influenzae.

Bacterial Infections↗

Cefoxitin: a hospital study.

Cefoxitin is a new cephamycin antibiotic that has recently become available for clinical trial. We report here the results of an uncontrolled trial of cefoxitin treatment in 31 hospital patients with various acute infections, 20 of whom were cured. Serum, urine, and bile concentrations of cefoxitin greatly exceeded the minimum inhibitory concentration (MIC) required for clinically important Gram-negative organisms. We conclude that cefoxitin will have a place in the management of serious infections, particularly in the abdominal cavity and renal tracts.

Acute Disease↗

Infective endocarditis caused by Streptococcus mutans.

Members of the viridans group of streptococci are the commonest causes of bacterial endocarditis. However, Streptococcus mutans, a member of this group associated with dental caries which might be expected to be commonly associated with endocarditis, has only rarely been reported. This is possibly because of difficulties in isolation and identification. Differing blood culture media may affect the chances of isolation of these organisms, and, though brain-heart infusion, thiol, tryptic soy, and glucose-brain infusion broths have all proved satisfactory, subcultures may require increased CO2 concentrations for growth. Plemorphism in the resultant colonies and in the individual organisms may give rise to a hazardous misinterpretation of this appearance as contamination. Strep. mutans and the similarly penicillin sensitive Strep. bovis may be differentiated from the penicillin resistant enterococci by their lincomycin sensitivity and intolerance of 6-3 per cent sodium chloride. Precise differentiation of streptococci in bacterial endocarditis is of value both epidemiologically and in the management of the disease.

Adult↗

Further studies on the reliability of the bacitracin inhibition test for the presumptive identification of Lancefield group A streptococci.

The reliability of the bacitracin inhibition test to differentiate between 125 Lancefield group A and 122 non-group A beta-haemolytic streptococci was studied. Bacitracin discs containing 0-02, 0-04, or 0-1 international units and the conditions recommended by both the Association of Clinical Pathologists and the Federal Drug Administration for routine sensitivity testing were used. The results suggest that the presence or absence of a zone of inhibition around a 0-04 unit disc can be used routinely for the presumptive identification of group A streptococci and that a specific zone size can be used for reading the test only with a 0-1 unit disc.

Bacitracin↗