We have studied the concentrations of ciprofloxacin in serum, bronchial mucosa, lung parenchyma, ... more We have studied the concentrations of ciprofloxacin in serum, bronchial mucosa, lung parenchyma, and pleural tissue after a single intravenous dose of 200 mg in 20 patients subjected to lung surgery. The concentrations of ciprofloxacin in the tissues exceeded that in the serum by 3-fold to 7-fold: serum 0.6 micrograms.ml-1, bronchial mucosa 1.9 micrograms.g-1, lung parenchyma 3.4 micrograms.g-, and pleural tissue 1.7 micrograms.g-1. The achievable concentrations of ciprofloxacin in the tissues of the lower respiratory tract are above the MICs for most lung pathogens.
SUMMARYWe determined the prevalence of anti-hepatitis B surface antibodies (anti-HBs) among child... more SUMMARYWe determined the prevalence of anti-hepatitis B surface antibodies (anti-HBs) among children and adolescents vaccinated for hepatitis B virus in infancy as part of the routine vaccination programme. A representative serum sample of the Israeli population age 0–19 was tested. In a separate pilot study, a booster dose of hepatitis B vaccine was administered to 31 candidates for national service, who were fully vaccinated in infancy and tested negative for hepatitis B surface antibodies at age 17–19 years and anti-HBs antibodies were assessed 8 weeks later. Of the 1273 samples tested, 631 (49·6%) were positive to anti-HBs antibodies. Seropositivity rates were 89·5% among infants aged 6–12 months and declined significantly with age to 20·7% at age 19 years. No differences in seropositivity rates were observed between Jews and Arabs, males and females and those born in Israel and in other countries. Seroconversion rate among the 31 individuals who received a booster dose was 90·3...
Recent exposure to azoles is an important risk factor for infection with fluconazole-resistant Ca... more Recent exposure to azoles is an important risk factor for infection with fluconazole-resistant Candida spp., but little is known about the role of antibacterial drug exposure in the emergence of drug-resistant Candida . We did a prospective nationwide surveillance study of candidemia in Israel and analyzed the propensity score-adjusted association between antifungal and antibacterial drug exposure and bloodstream infection with C. glabrata and fluconazole-resistant Candida isolates. Four hundred forty-four episodes of candidemia (450 Candida isolates, 69 [15%] C. glabrata isolates, and 38 [8.5%] fluconazole-resistant isolates) from 18 medical centers in Israel were included. C. glabrata bloodstream infection was strongly associated with recent metronidazole exposure (odds ratio [OR], 3.2; P < 0.001). Infection with a fluconazole-resistant isolate was associated with exposure to carbapenems, trimethoprim-sulfamethoxazole, clindamycin, and colistin (odds ratio, 2.8; P = 0.01). The ...
Sexually transmitted infections represent an worldwide challenge for the public health. According... more Sexually transmitted infections represent an worldwide challenge for the public health. According to WHO estimates, approximately 330 million people are infected annually by curable sexually transmitted infections (AIDS excluded). and their incidence has been increasing, particularly in high-risk populations. Like in other developed countries, the occurrence of venereal diseases in Israel has been increasing recently. In addition, a sharp rise has been observed in the resistance rate of gonococci to fluoroquinolones. The purpose of the present review is to update the information on the epidemiology, diagnosis, therapy and prevention of sexually transmitted diseases (STDs) in Israel. In response to the reemergence of these diseases in Israel, it was decided in the Ministry of Health to open for the first time ever STD clinics in the two cities with the highest disease burden, namely Tel Aviv and Haifa. These clinics are staffed with a multidisciplinary group of specialists, including...
A sharp increase in the incidence of gonorrhea has been observed in Tel Aviv, Israel, since 1999.... more A sharp increase in the incidence of gonorrhea has been observed in Tel Aviv, Israel, since 1999. Almost one half of interviewed patients admitted contracting the infection from a sex worker. In two thirds of the cases, oral sex (fellatio) was the most probable route of acquiring the disease. In the current study, we assessed the prevalence of pharyngeal gonorrhea among sex workers in Tel Aviv and evaluated the efficacy of a single 2-g dose of azithromycin in eradicating the infection. Throat specimens were obtained for gonococcal culture from 301 female sex workers practicing in brothels. A questionnaire covering demographic and sexual behavior information was administered to all participants, and a single 2-g dose was administered orally under supervision. Women with positive cultures were reexamined a week later for eradication of Neisseria gonorrhoeae. N gonorrhoeae was isolated from 27 women (9%). The median age of women with pharyngeal gonorrhea was 23 years (range, 18-32 years); 85% were born in former Soviet Union (mostly Russia, Ukraine, Moldavia). Regular condom use in vaginal sex was reported by 88% of the participants, whereas only 60% reported always using condoms in oral sex. All isolates were susceptible to azithromycin (MIC &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 0.5 microg/ml). Gonococci were eradicated in 20/21 individuals (95%). A high carriage rate of gonococci in the throat and a low rate of condom use in oral sex were documented among sex workers in Tel Aviv. A single 2 g dose of azithromycin was very effective in eradicating gonococci from the throat.
MICs for penicillin, tetracycline, ceftriaxone, ciprofloxacin, spectinomycin, and azithromycin we... more MICs for penicillin, tetracycline, ceftriaxone, ciprofloxacin, spectinomycin, and azithromycin were determined by the Etest method for 406 gonococcal strains obtained in 2002-2007 from an STI clinic and a general microbiology laboratory in Central Israel. A total of 27.1% were resistant to ciprofloxacin, with increasing resistance over the years All isolates remain susceptible to ceftriaxone and spectinomycin.
To explore knowledge, attitudes and sexual practices of male sex workers (MSW) in Tel Aviv in com... more To explore knowledge, attitudes and sexual practices of male sex workers (MSW) in Tel Aviv in comparison with men who have sex with men (MSM) classified by their risk behaviours and to outline attributes related to sexually transmitted infections (STI)/HIV prevalence. MSW were recruited for this cross-sectional study from designated street venues and gay-dating internet site. MSM were recruited from gay-related venues and divided into high-risk MSM (HRMSM) if they performed unprotected anal intercourse in the last 6 months with an HIV-discordant/unknown partner and to low-risk MSM (LRMSM). Each participant completed a questionnaire and was tested for STI/HIV. Of 87 MSW and 635 MSM approached, 53 (60.9%) and 235 (37.0%) participated, respectively. Street-MSW (N=32) had more female sex partners and were more drug dependent than internet-MSW (N=21). No differences were found in their knowledge regarding STI/HIV transmission, practices and STI/HIV burden. Compared with HRMSM, MSW had different demographic attributes and demonstrated more realistic perception regarding the risk to getting STI/HIV, while no differences were found in their knowledge and sexual practices. STI burden among MSW, HRMSM (N=119) and LRMSM (N=116) were 28.3%, 23.5% and 10.3% (p=0.009) and HIV burden among MSW, HRMSM and LRMSM were 5.6%, 9.2% and 0%, (p=0.001), respectively. Multivariate models evaluating attributes associated with HIV/STI diagnosis did not find sex work to be significant if the variable used was MSW versus HRMSM, regardless of the adjustments performed. However, when MSW versus LRMSM was used in the model, sex work was associated with STI/HIV diagnosis. Street-MSW and internet-MSW, similar to all MSW and HRMSM, had comparable sexual practices and had no difference in their STI/HIV prevalence.
Only a few studies have investigated the etiology of acute pelvic inflammatory disease (PID) in l... more Only a few studies have investigated the etiology of acute pelvic inflammatory disease (PID) in laparoscopy-proven cases using pelvic samples for culture. Most of these studies were conducted in North America and Scandinavia. To study the microbial etiology of laparoscopy-proven acute pelvic inflammatory disease in Israeli women. A prospective survey of women admitted to a hospital for treatment of acute pelvic inflammatory disease. All diagnoses were laparoscopy confirmed. Specimens for culture were obtained from the pelvic cavity via the laparoscope, and two serum samples were sent for serologic studies. Forty patients were studied. Their mean age was 34.4 years of age, and 27.5% had a history of PID. Chlamydia trachomatis infection was diagnosed in 14 (35%) patients (group A). Facultative and/or anaerobic bacteria were isolated from pelvic specimens of 7 (17.5%) patients (group B), one of these patients also had positive chlamydial serology. Mycoplasma hominis was cultured from a pelvic specimen of one woman, and herpes simplex virus grew from a pelvic sample of another patient in whom C. trachomatis was also found. In 19 (47.5%) women, the microbial etiology could not be determined (group C). In no case was Neisseria gonorrhoeae isolated. Stage I (mild) PID was diagnosed most often in group A (75% vs. 14% in group B [P &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.02]), whereas the opposite was true for stage III (severe) PID (71.4% in group B vs 25% in group A [P = 0.07]). Tubal abscess was mainly diagnosed in group B patients (57% vs 16.6% in group A [P = 0.09]). In Israel, C. trachomatis is the most common cause of PID, while gonococci are rarely involved in this infection.
The total and differential leukocyte count of 4 groups of patients, admitted to the hospital beca... more The total and differential leukocyte count of 4 groups of patients, admitted to the hospital because of acute gastroenteritis was evaluated. The 4 groups included: (a) 131 adult patients with positive stool culture for shigella; (b) 23 children (age less than 15 years) with positive stool culture for shigella; (c) 52 adult patients with positive stool culture for salmonella; (d) 43 adult patients with negative stool culture for bacterial pathogens. The total leukocyte count did not contribute to the differential diagnosis between shigella gastroenteritis and gastroenteritis of other etiology. However, the absolute band count was significantly higher in adults with shigella gastroenteritis. Moreover, a band to total neutrophil ratio further increased the diagnosis specificity. The differential leukocyte count can contribute to early diagnosis of shigellosis in adult patients.
In a prospective study, Cryptosporidium oocysts were detected in seven (3.25%) immunocompetent ch... more In a prospective study, Cryptosporidium oocysts were detected in seven (3.25%) immunocompetent children with diarrhoea. The predominant clinical features were watery diarrhoea and vomiting. The patients&amp;amp;amp;amp;amp;amp;#39; mean age was 19 years and infection was more common in late summer-autumn than in the rest of the year. This first survey on cryptosporidiosis in Israeli children has shown a prevalence similar to that observed in other developed countries.
Although norfloxacin is the first fluoroquinolone antimicrobial agent released for clinical use, ... more Although norfloxacin is the first fluoroquinolone antimicrobial agent released for clinical use, information on its distribution into different tissues is somewhat limited [1]. Because of its broad spectn~m of activity against gram-negative bacilli, norfloxacin may be a valuable agent for prophylaxis and treatment of surgical wound infections. No data is available regarding the concentration of norfloxacin in the muscle tissue. Eight adult patients (six females and two males) scheduled for elective laparotomy were studied. The mean patient age was 62 years (range 40 to 79 years) and mean body weight was 72 kg (range 46 to 110 kg). Serum creatinine concentrations were < 12 mg~ in all instances. None of the patients had received antacids or antimicrobial agents in the preceeding 72 h. Each patient received norfloxacin as a single oral dose of 400 mg 3 to 6 h before Surgery. At the time of surgery a muscle tissue sample was obtained from the abdominal wall and blood was drawn concomitantly. Tissue and serum specimens were immediately frozen and stored at 7 0 ° C until the time of assay. Tissue samples were homogenized in a microhomogenizer with antibiotic free pooled human serum. All specimens were analyzed by a standard bioassay using a clinical isolate of Enterobacter cloacae known to be sensitive to norfloxacin (MICs 0.015 to 0.030 rag/l). 'The assay was sensitive to a minimal concentration of 0.1 mg/l. Standards for serum and tissue assay were prepared in pooled human serum. The study protocol was approved by the Institutional Review Board of the E. Wolfson Hospital and informed consent was obtained from all patients. The results are displayed in Table 1. Concentrations of norfloxacin in the abdominal wall muscle tissue ranged from < 0.1 to 2.3 mg/kg (mean 0.87 + 0.27 mg/kg). Mean concomitant serum level was L09 + 0.15 mg/1 (range 0.35 to 1.76 mg/1). The mean ratio of muscle tissue/serum concentration was 0.8. At present, the only known indication for prophylactic use of norfloxacin is prevention of gram-negative bacterial infections in patients with acute leukemia and granulocytopenia [2]. The efficacious suppression of gastrointestinal tract colonization by aerobic bacteria achieved with oral administration of norfloxacin [2] and the adequate concentration of this agent in the abdominal wall muscle tissue (as reflected in our results) should prompt its evaluation for prophylaxis in abdominal surgery. Norfloxacin is active against most gram-negative bacilli associated with postoperative wound infections, with reported MICs for members of the family Enterobacteriaceae in the range of 0.06 to 0.25 mg/l [3]. The mean concentration of norfloxacin in abdomTable 1: Muscle tissue and serum concentrations of norfloxacin following a single oral administration of 400 mg.
We have studied the concentrations of ciprofloxacin in serum, bronchial mucosa, lung parenchyma, ... more We have studied the concentrations of ciprofloxacin in serum, bronchial mucosa, lung parenchyma, and pleural tissue after a single intravenous dose of 200 mg in 20 patients subjected to lung surgery. The concentrations of ciprofloxacin in the tissues exceeded that in the serum by 3-fold to 7-fold: serum 0.6 micrograms.ml-1, bronchial mucosa 1.9 micrograms.g-1, lung parenchyma 3.4 micrograms.g-, and pleural tissue 1.7 micrograms.g-1. The achievable concentrations of ciprofloxacin in the tissues of the lower respiratory tract are above the MICs for most lung pathogens.
SUMMARYWe determined the prevalence of anti-hepatitis B surface antibodies (anti-HBs) among child... more SUMMARYWe determined the prevalence of anti-hepatitis B surface antibodies (anti-HBs) among children and adolescents vaccinated for hepatitis B virus in infancy as part of the routine vaccination programme. A representative serum sample of the Israeli population age 0–19 was tested. In a separate pilot study, a booster dose of hepatitis B vaccine was administered to 31 candidates for national service, who were fully vaccinated in infancy and tested negative for hepatitis B surface antibodies at age 17–19 years and anti-HBs antibodies were assessed 8 weeks later. Of the 1273 samples tested, 631 (49·6%) were positive to anti-HBs antibodies. Seropositivity rates were 89·5% among infants aged 6–12 months and declined significantly with age to 20·7% at age 19 years. No differences in seropositivity rates were observed between Jews and Arabs, males and females and those born in Israel and in other countries. Seroconversion rate among the 31 individuals who received a booster dose was 90·3...
Recent exposure to azoles is an important risk factor for infection with fluconazole-resistant Ca... more Recent exposure to azoles is an important risk factor for infection with fluconazole-resistant Candida spp., but little is known about the role of antibacterial drug exposure in the emergence of drug-resistant Candida . We did a prospective nationwide surveillance study of candidemia in Israel and analyzed the propensity score-adjusted association between antifungal and antibacterial drug exposure and bloodstream infection with C. glabrata and fluconazole-resistant Candida isolates. Four hundred forty-four episodes of candidemia (450 Candida isolates, 69 [15%] C. glabrata isolates, and 38 [8.5%] fluconazole-resistant isolates) from 18 medical centers in Israel were included. C. glabrata bloodstream infection was strongly associated with recent metronidazole exposure (odds ratio [OR], 3.2; P < 0.001). Infection with a fluconazole-resistant isolate was associated with exposure to carbapenems, trimethoprim-sulfamethoxazole, clindamycin, and colistin (odds ratio, 2.8; P = 0.01). The ...
Sexually transmitted infections represent an worldwide challenge for the public health. According... more Sexually transmitted infections represent an worldwide challenge for the public health. According to WHO estimates, approximately 330 million people are infected annually by curable sexually transmitted infections (AIDS excluded). and their incidence has been increasing, particularly in high-risk populations. Like in other developed countries, the occurrence of venereal diseases in Israel has been increasing recently. In addition, a sharp rise has been observed in the resistance rate of gonococci to fluoroquinolones. The purpose of the present review is to update the information on the epidemiology, diagnosis, therapy and prevention of sexually transmitted diseases (STDs) in Israel. In response to the reemergence of these diseases in Israel, it was decided in the Ministry of Health to open for the first time ever STD clinics in the two cities with the highest disease burden, namely Tel Aviv and Haifa. These clinics are staffed with a multidisciplinary group of specialists, including...
A sharp increase in the incidence of gonorrhea has been observed in Tel Aviv, Israel, since 1999.... more A sharp increase in the incidence of gonorrhea has been observed in Tel Aviv, Israel, since 1999. Almost one half of interviewed patients admitted contracting the infection from a sex worker. In two thirds of the cases, oral sex (fellatio) was the most probable route of acquiring the disease. In the current study, we assessed the prevalence of pharyngeal gonorrhea among sex workers in Tel Aviv and evaluated the efficacy of a single 2-g dose of azithromycin in eradicating the infection. Throat specimens were obtained for gonococcal culture from 301 female sex workers practicing in brothels. A questionnaire covering demographic and sexual behavior information was administered to all participants, and a single 2-g dose was administered orally under supervision. Women with positive cultures were reexamined a week later for eradication of Neisseria gonorrhoeae. N gonorrhoeae was isolated from 27 women (9%). The median age of women with pharyngeal gonorrhea was 23 years (range, 18-32 years); 85% were born in former Soviet Union (mostly Russia, Ukraine, Moldavia). Regular condom use in vaginal sex was reported by 88% of the participants, whereas only 60% reported always using condoms in oral sex. All isolates were susceptible to azithromycin (MIC &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 0.5 microg/ml). Gonococci were eradicated in 20/21 individuals (95%). A high carriage rate of gonococci in the throat and a low rate of condom use in oral sex were documented among sex workers in Tel Aviv. A single 2 g dose of azithromycin was very effective in eradicating gonococci from the throat.
MICs for penicillin, tetracycline, ceftriaxone, ciprofloxacin, spectinomycin, and azithromycin we... more MICs for penicillin, tetracycline, ceftriaxone, ciprofloxacin, spectinomycin, and azithromycin were determined by the Etest method for 406 gonococcal strains obtained in 2002-2007 from an STI clinic and a general microbiology laboratory in Central Israel. A total of 27.1% were resistant to ciprofloxacin, with increasing resistance over the years All isolates remain susceptible to ceftriaxone and spectinomycin.
To explore knowledge, attitudes and sexual practices of male sex workers (MSW) in Tel Aviv in com... more To explore knowledge, attitudes and sexual practices of male sex workers (MSW) in Tel Aviv in comparison with men who have sex with men (MSM) classified by their risk behaviours and to outline attributes related to sexually transmitted infections (STI)/HIV prevalence. MSW were recruited for this cross-sectional study from designated street venues and gay-dating internet site. MSM were recruited from gay-related venues and divided into high-risk MSM (HRMSM) if they performed unprotected anal intercourse in the last 6 months with an HIV-discordant/unknown partner and to low-risk MSM (LRMSM). Each participant completed a questionnaire and was tested for STI/HIV. Of 87 MSW and 635 MSM approached, 53 (60.9%) and 235 (37.0%) participated, respectively. Street-MSW (N=32) had more female sex partners and were more drug dependent than internet-MSW (N=21). No differences were found in their knowledge regarding STI/HIV transmission, practices and STI/HIV burden. Compared with HRMSM, MSW had different demographic attributes and demonstrated more realistic perception regarding the risk to getting STI/HIV, while no differences were found in their knowledge and sexual practices. STI burden among MSW, HRMSM (N=119) and LRMSM (N=116) were 28.3%, 23.5% and 10.3% (p=0.009) and HIV burden among MSW, HRMSM and LRMSM were 5.6%, 9.2% and 0%, (p=0.001), respectively. Multivariate models evaluating attributes associated with HIV/STI diagnosis did not find sex work to be significant if the variable used was MSW versus HRMSM, regardless of the adjustments performed. However, when MSW versus LRMSM was used in the model, sex work was associated with STI/HIV diagnosis. Street-MSW and internet-MSW, similar to all MSW and HRMSM, had comparable sexual practices and had no difference in their STI/HIV prevalence.
Only a few studies have investigated the etiology of acute pelvic inflammatory disease (PID) in l... more Only a few studies have investigated the etiology of acute pelvic inflammatory disease (PID) in laparoscopy-proven cases using pelvic samples for culture. Most of these studies were conducted in North America and Scandinavia. To study the microbial etiology of laparoscopy-proven acute pelvic inflammatory disease in Israeli women. A prospective survey of women admitted to a hospital for treatment of acute pelvic inflammatory disease. All diagnoses were laparoscopy confirmed. Specimens for culture were obtained from the pelvic cavity via the laparoscope, and two serum samples were sent for serologic studies. Forty patients were studied. Their mean age was 34.4 years of age, and 27.5% had a history of PID. Chlamydia trachomatis infection was diagnosed in 14 (35%) patients (group A). Facultative and/or anaerobic bacteria were isolated from pelvic specimens of 7 (17.5%) patients (group B), one of these patients also had positive chlamydial serology. Mycoplasma hominis was cultured from a pelvic specimen of one woman, and herpes simplex virus grew from a pelvic sample of another patient in whom C. trachomatis was also found. In 19 (47.5%) women, the microbial etiology could not be determined (group C). In no case was Neisseria gonorrhoeae isolated. Stage I (mild) PID was diagnosed most often in group A (75% vs. 14% in group B [P &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.02]), whereas the opposite was true for stage III (severe) PID (71.4% in group B vs 25% in group A [P = 0.07]). Tubal abscess was mainly diagnosed in group B patients (57% vs 16.6% in group A [P = 0.09]). In Israel, C. trachomatis is the most common cause of PID, while gonococci are rarely involved in this infection.
The total and differential leukocyte count of 4 groups of patients, admitted to the hospital beca... more The total and differential leukocyte count of 4 groups of patients, admitted to the hospital because of acute gastroenteritis was evaluated. The 4 groups included: (a) 131 adult patients with positive stool culture for shigella; (b) 23 children (age less than 15 years) with positive stool culture for shigella; (c) 52 adult patients with positive stool culture for salmonella; (d) 43 adult patients with negative stool culture for bacterial pathogens. The total leukocyte count did not contribute to the differential diagnosis between shigella gastroenteritis and gastroenteritis of other etiology. However, the absolute band count was significantly higher in adults with shigella gastroenteritis. Moreover, a band to total neutrophil ratio further increased the diagnosis specificity. The differential leukocyte count can contribute to early diagnosis of shigellosis in adult patients.
In a prospective study, Cryptosporidium oocysts were detected in seven (3.25%) immunocompetent ch... more In a prospective study, Cryptosporidium oocysts were detected in seven (3.25%) immunocompetent children with diarrhoea. The predominant clinical features were watery diarrhoea and vomiting. The patients&amp;amp;amp;amp;amp;amp;#39; mean age was 19 years and infection was more common in late summer-autumn than in the rest of the year. This first survey on cryptosporidiosis in Israeli children has shown a prevalence similar to that observed in other developed countries.
Although norfloxacin is the first fluoroquinolone antimicrobial agent released for clinical use, ... more Although norfloxacin is the first fluoroquinolone antimicrobial agent released for clinical use, information on its distribution into different tissues is somewhat limited [1]. Because of its broad spectn~m of activity against gram-negative bacilli, norfloxacin may be a valuable agent for prophylaxis and treatment of surgical wound infections. No data is available regarding the concentration of norfloxacin in the muscle tissue. Eight adult patients (six females and two males) scheduled for elective laparotomy were studied. The mean patient age was 62 years (range 40 to 79 years) and mean body weight was 72 kg (range 46 to 110 kg). Serum creatinine concentrations were < 12 mg~ in all instances. None of the patients had received antacids or antimicrobial agents in the preceeding 72 h. Each patient received norfloxacin as a single oral dose of 400 mg 3 to 6 h before Surgery. At the time of surgery a muscle tissue sample was obtained from the abdominal wall and blood was drawn concomitantly. Tissue and serum specimens were immediately frozen and stored at 7 0 ° C until the time of assay. Tissue samples were homogenized in a microhomogenizer with antibiotic free pooled human serum. All specimens were analyzed by a standard bioassay using a clinical isolate of Enterobacter cloacae known to be sensitive to norfloxacin (MICs 0.015 to 0.030 rag/l). 'The assay was sensitive to a minimal concentration of 0.1 mg/l. Standards for serum and tissue assay were prepared in pooled human serum. The study protocol was approved by the Institutional Review Board of the E. Wolfson Hospital and informed consent was obtained from all patients. The results are displayed in Table 1. Concentrations of norfloxacin in the abdominal wall muscle tissue ranged from < 0.1 to 2.3 mg/kg (mean 0.87 + 0.27 mg/kg). Mean concomitant serum level was L09 + 0.15 mg/1 (range 0.35 to 1.76 mg/1). The mean ratio of muscle tissue/serum concentration was 0.8. At present, the only known indication for prophylactic use of norfloxacin is prevention of gram-negative bacterial infections in patients with acute leukemia and granulocytopenia [2]. The efficacious suppression of gastrointestinal tract colonization by aerobic bacteria achieved with oral administration of norfloxacin [2] and the adequate concentration of this agent in the abdominal wall muscle tissue (as reflected in our results) should prompt its evaluation for prophylaxis in abdominal surgery. Norfloxacin is active against most gram-negative bacilli associated with postoperative wound infections, with reported MICs for members of the family Enterobacteriaceae in the range of 0.06 to 0.25 mg/l [3]. The mean concentration of norfloxacin in abdomTable 1: Muscle tissue and serum concentrations of norfloxacin following a single oral administration of 400 mg.
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