Faculty Bibliography

A prospective survey of liver function during oxacillin sodium therapy revealed five cases of drug-related abnormalities among 41 patients. In each instance, the serum transaminase level was increased from normal to greater than 100 units. The serum alkaline phosphatase level was mildly elevated and bilirubin levels remained normal. All of the patients were asymptomatic. Hepatic dysfunction was reversible on withdrawal of oxacillin therapy and substitution of a cephalosporin or clindamycin. The observed abnormalities in liver function were associated with a daily oxacillin sodium dose of greater than or equal to 12 gm as well as with heroin addiction and staphylococcal endocarditis

Klebsiella ozaenae and Klebsiella rhinoscleromatis are uncommon organisms usually associated with granulomatous or necrotizing disease of the upper airways. Seven patients are described, non of whom had characteristic clinical manifestations of infection with these species. The organisms were recovered from mixed wound infections or sputum of five patients, and from the blood of three patients. Antibiotic sensitivity patterns were unusual and included susceptibility to both ampicillin and carbenicillin.

Amikacin sulfate was administered to 18 patients for the treatment of 19 severe infections. Seventeen infections were caused by gentamicin-resistant Gram-negative bacilli, and 13 patients were bacteremic. Bacteriologic cure was attained in all but one instance, and effective serum, bile, and pleural fluid drug levels were demonstrated. Drug-related fever occurred in one patient, and another experienced a maculopapular rash and monilial intertrigo. In three patients, reversible renal toxicity developed, but none had clinical evidence of ototoxicity. Amikacin sulfate in a dose of 15 mg/kg/day is an effective antibiotic for the treatment of serious Gram-negative infections, particularly those due to gentamicin-resistant organisms