Table Of ContentAntibiotics
and Chemotherapy
Current Topics
Antibiotics
and Chemotherapy
Current Topics
Edited by
R. N. Griineberg
MTP!it
LIMITED
International Medical Publishers
Published by
MTP Press Limited
Falcon House
Lancaster, England
Copyright © 1980 MTP Press Limited
Softcover reprint of the: h2n1cover ht aiition 1980
First published 1980
All rights reserved. No part of Ihis publication
may be reproduced, stored in a retrieval
system, or transmitted in any form or by any
means, electronic, mechanical, photocopying,
recording or otherwise, without prior
permission from the publishers.
British Library Cataloguing in Publication Data
Antibiotics and chemotherapy: current topics -
(Current status of modern therapy; vol. 4)
I. Antibiotics
I. Gruneberg, R N II. Series
615'.329 RM267
ISBN 978·94-011.7196-0 ISBN 978-94-011.7194·6 (eSook)
DOIIO.IOO7ll7S-94-011.7194-6
Phototypesetting by Swiftpages Limited, Liverpool
and printed by
Clarke-Constable Ltd, Edinburgh
Contents
List of Contributors vii
Consultant Editor's Note ix
Preface Xl
The chemotherapy of infective endocarditis
D. C. SHANSON
2 Prophylactic antimicrobial drug therapy 33
M. W. CASEWELL
3 The cephalosporin group of antibiotics 63
R. J. WILLIAMS and J. D. WILLIAMS
4 Anaerobic infections and their treatment 113
R. WISE and M. N. LOGAN
5 The chemotherapy of gonorrhoea and non-specific genital infections 139
G. L. RIDGWAY
6 Combinations of antibacterial drugs 157
N. A. SIMMONS
7 Antibiotic policies 193
J. B. SELKON
8 Antibiotic IJrescribing policies: a personal view 203
R. N. GRVNEBERG
Index 213
v
List of Contributors
M. W. CASEWELL, BSc, MD, MRCPath
Senior Lecturer and Honorary Consultant Microbiologist, St
Thomas' Hospital, London, SEI 7EH
R. N. GRVNEBERG, MD, MRCPath
Consultant Microbiologist, University College Hospital, London,
WCIE 6AU
M. N. LOGAN, MB ChB
Department of Medical Microbiology, Dudley Road Hospital,
Birmingham, Bl8 7QH
G. L. RIDGWAY, MD, BSc, MRCPath
Consultant Microbiologist, University College Hospital, London,
WCIE 6AU
J. B. SELKON, TD, MBChB, FRCPath, DCP
Director, Regional Public Health Laboratory, Newcastle General
Hospital, Newcastle-upon-Tyne, NE4 6BE
D. C. SHANSON, MB, MRCS, MRCPath
Consultant Microbiologist, St Stephen's Hospital, Chelsea, Lon
don, SWlO 9TH, and Senior Lecturer in Medical Microbiology,
Westminster Hospital Medical School, London, SWIP 2AR
N. A. SIMMONS, MD, MRCS, FRCPath
Consultant Clinical Microbiologist, Guy's Hospital, London, SEI
9RT
vii
viii Antibiotics and Chemotherapy
J. D. WILLIAMS, BSc, MD, MRCPath
Professor of Medical Microbiology, The London Hospital Medical
College, London, EI 2AD
R. J. WILLIAMS, BSc, PhD
Lecturer in Medical Microbiology, The London Hospital Medical
College, London, E I 2AD
R. WISE, MRCPath
Department of Medical Microbiology, Dudley Road Hospital,
Birmingham, BI8 7QH
Consultant Editor's Note
Current Status of Modern Therapy
J.
Series Editor: Marks~ Girton College~ Cambridge
The Current Status of Modern Therapy is a major new series fromMTP
Press with the purpose of providing a definitive view of modern
therapeutic practice in those areas of clinical medicine in which
important changes are occurring. The series consists of monographs
specially commissioned under the individual editorship of inter
nationally recognized experts in thei! fields. Their selection of a panel of
contributors from many countries ensures an international perspective
on developments in therapy.
The series will aim to review the growth areas of clinical phar
macology and therapeutics in a systematic way. It will be a continuing
series in which the same subject areas will be covered by revised editions
as advances make this desirable. .
The literature on antibiotics and chemotherapy is very extensive and
it could be held adequately covers the field. A search however shows
that advances are still being made in this research area.
Dr Grlineberg who has worked and published extensively on an
tibacterial therapy has followed the guidelines for the series excellently
in the selection of topics and authors for this fourth volume in the series:
Antibiotics and Chemotherapy. He has selected the interesting growth
areas and contentious topics and then invited acknowledged experts to
present their views. The volume will I am sure be widely valued for its
practical approach to these problems.
ix
Preface
The purpose of this book is to provide reviews of various antibiotic
topics which will be of interest to practising clinicians and to
microbiologists. It is hoped that enough references have been provided
to enable the enthusiast to immerse himself in the source literature.
No attempt has been made to cover the whole field, which is well
catered for in the numerous works on the subject. Rather, the intention
has been to select a number of topics in which there has been a great deal
of change in recent years, and to ask an appropriate authority to review
the subject. Since I chose the topics, it may be supposed, quite correctly,
that I have identified subjects in which I felt myself to require some
postgraduate education. The process was something like the well known
radio programme in which a castaway is allowed to select a number of
gramophone records to take with him to a desert island. I hope that
readers will share my interest in the contributions from a number of
distinguished contributors to the field of antibiotic chemotherapeutic
research.
Although I have had the privilege of editing this volume it will be
understood that the views expressed by the authors are their own and
have not been the subject of editorial review. I am grateful to all the
collaborators in this volume, and to the publishers, MTP Press, for their
help, and for asking me to undertake the task.
R. N. GRVNEBERG
xi
1
The chemotherapy of infective endocarditis
D. C. Shanson
INTRODUCTION
The incidence of infective endocarditis in recent years is similar to that
noted in 1939'. The overall mortality has fallen from 100% before the
age of chemotherapy to about 30% 30 years ago but has not been further
reduced'
2.
The pattern of the disease has significantly changed during the last 30
years in respect of the ages of the patients, the causative organisms, the
predisposing factors and the clinical modes of presentation In
1-3.
particular (a) the disease affects more elderly patients than in the past,
with a preponderance of patients over the age of 50 years; (b) there is a
wider range of causative organisms than before and a somewhat
decreased incidence of cases where alpha-haemolytic viridans strep
tococci are the causative organisms; (c) rheumatic heart disease is less
important than in the past .but congenital heart disease is more impor
tant; (d) other important predisposing factors now include cardiac
surgery to insert prosthetic valves, drug addiction and aortic
atherosclerotic valve disease; (e) pyrexia, heart murmurs and cardiac
failure are still important clinical features but ;n many more patients
than previously the symptoms are minimal at the time of first presenta
tion.
A rational approach to the chemotherapy of infective endocarditis is
dependent on a knowledge of the current aetiology of the disease. At all
stages in the management of patients with suspected endocarditis, there
should be the closest collaboration between the clinician and
microbiologist.
1
R. N. Grüneberg (ed.), Antibiotics and Chemotherapy
© MTP Press Limited 1980
2 Antibiotics and Chemotherapy
AETIOLOGY
Bacteria (over 100 different species), fungi, the rickettsia-like organism
Coxiella burnetti and Chlamydia psittaci may cause infective endocar
ditis. The most frequently occurring causative organisms in endocar
ditis patients who have not had previous heart surgery are included in
Table 1, in patients who have had previous heart surgery in Table 2, and
in patients who are main line drug addicts in Table 3.
Table 1 Some organisms causing endocarditis in patients who have not had heart
surgery
Organism Positive blood culture Author references
cases(%)
Streptococci
'Streptococcus viridans' 44-73 2,33,111,117,118
Streptococcusfaecalis 7-18 2,27,40
f3 .... haemolytic streptococcus 7 2
Anaerobic streptococcus 2
Staphylococci
Staphylococcus aureus 9-17 2,24,119
Staphylococcus epidermidis 0--5 2,33
Haemophilus spp.
Haemophilus injluenzae }
Haemopnilus parainjluenzae 1-3 19,54,70,120
Haemophilus aphrophilus
Streptococci
Over 30 years ago'S treptococcus viridans' caused more than 85% of cases
of endocarditis which mainly occurred in adults less than 40 years of age
with rheumatic heart disease4• Althougli viridans streptococci cause
endocarditis less frequently than in the past they are still the most
common cause of endocarditis (Table 1). Most cases of endocarditis in
patients who have had previous heart surgery are of late onset and in
