835 excretion of durand alanine aminopeptidase N-acetyl-p-D-glucosaminidase ing cefotaxime (HR 756) treatment and found no evidence for direct tubular toxicity of this drug. We have some preliminary pharmacokmetic results showing that there is no deterioration of the renal function under cefotaxime treatment. We have treated 15 patients infected with multiresistant strains-namely, Escherichia coli (4), Klebsiella pneumoniae (3), Proteus mirabilis (3), Providencia stuartii (3), and Enterobacter cloacce (2). All these microorganisms were resistant to ampicillin and cephalothin, and 8 were also resistant to gentamicin. 12 patients had an urinary-tract infection (u.T.i.) and 3 had a septicocmia. 6 patients with renal failure (serum-creatinine > 1.2 mg/dl) received cefotaxime in a dose varying from 500 mg to 1500 mg per 24 h. In 3 cases we have measured the serum concentrations of cefotaxime (see table). In all 6 patients renal function remained stable during treatment, as did renal function in the 9 patients without renal failure. In 14 patients the clinical response was excellent: 1 patient with an U.T.i. developed a superinfection with Pseudomonas ceruginosa after two days of Dr Ninane
Hour of onset of classical and El Tor cholera and -diarrhoea 1964-65 and 1975-77.
Research (former Cholera Research Laboratory) during 1964 and 1965. To compare the pattern with that seen a decade
later, I also analysed 1413 El Tor cholera and 801 diarrhoea
cases
admitted
to
and treated in the
same
acute
ward dur-
ing 1975-77. During both time periods most cholera and diarrhoea cases began during the night. As shown in the figure, almost a quarter of all cholera cases and over a fifth of all acute diarrhoea cases began between 3 and 6 A.M. The hour of onset has considerable epidemiological significance in that an infected man can travel a long distance during day to be attacked with cholera during the late hours of night. It remains to be seen whether gut physiology or some other process in the host affects the host-parasite relationship and influences the time of onset of cholera and acute diarrhaeal illness. I wonder if gut physiologists might find this problem a worthwhile challenge.
(Feb. 10,
p.
322) monitored the
treatment.
These promising preliminary results suggest that cefotaxime safe antimicrobial agent. However, in patients in renal failure, monitoring of blood concentrations will be needed until more is known about the pharmacology of this drug. is
a
We thank Dr Vander Elst
(Hoechst, Belgium)
Departments of Internal Medicine and Microbiology, St Pierre Hospital, B. 1000 Brussels, Belgium
for the cefotaxime.
N. CLUMECK R. VANHOOF Y. VANLAETHEM J. P. BUTZLER
CASEATING TUBERCULOSIS PRESENTING AS OCCULT CAUSE OF SCIATICA
SIR,-Osteosclerotic lesions of the lower lumbar vertebrae usually due to metastasis from cancer of the prostate or to
are
International Centre for Diarrhœal Disease Research,
Paget’s MOSLEMUDDIN KHAN
Dacca-12, Bangladesh.
CEFOTAXIME AND NEPHROTOXICITY
SIR,-Deterioration of renal function is a well-recognised complication of therapy with some cephalosporins. Potential nephrotoxicity has to be borne in mind whenever cephalosporins are evaluated or compared, especially since the introduction of the newer agents, compounds with a high stability to the -lactamases of gram-negative organisms and a high degree of in-vitro activity. These compounds are likely to have widespread clinical use. SERUM CONCENTRATIONS
(rJ.g/ml) OF CEFOTAXIME IN PATIENTS
nosis
logical changes. A 76-year-old man was admitted to hospital in May, 1978, complaining of back pain and sciatica. Lower lumbar back pain, dull and aching in character, had developed 6 months earlier, gradually progressing into his left buttock and, at the time of his admission to hospital, pain extended along the whole length of the back of his left leg and the sole of his foot as
to
tested. *Mean (and
range).
far as the hallux. He was unable to walk and was confined bed. He had been a coal miner for 50 years and smoked 20
cigarettes a day. When seen in hospital he was in severe pain. The cardiovascular and respiratory systems were clinically normal. A chest X-ray showed evidence of pneumoconiosis. Cranial nerves and upper limbs were normal. The left buttock, hamstrings, and WITH A MODERATE RENAL FAILURE
NORMAL RENAL FUNCTION
u =not
disease. We have seen a case where the eventual diagtuberculosis, there being no typical destructive radio-
was
(6 DETERMINATIONS)
(3 DETERMINATIONS) OR
Hour of onset of classical and El Tor cholera and -diarrhoea 1964-65 and 1975-77.
Research (former Cholera Research Laboratory) during 1964 and 1965. To compare the pattern with that seen a decade
later, I also analysed 1413 El Tor cholera and 801 diarrhoea
cases
admitted
to
and treated in the
same
acute
ward dur-
ing 1975-77. During both time periods most cholera and diarrhoea cases began during the night. As shown in the figure, almost a quarter of all cholera cases and over a fifth of all acute diarrhoea cases began between 3 and 6 A.M. The hour of onset has considerable epidemiological significance in that an infected man can travel a long distance during day to be attacked with cholera during the late hours of night. It remains to be seen whether gut physiology or some other process in the host affects the host-parasite relationship and influences the time of onset of cholera and acute diarrhaeal illness. I wonder if gut physiologists might find this problem a worthwhile challenge.
(Feb. 10,
p.
322) monitored the
treatment.
These promising preliminary results suggest that cefotaxime safe antimicrobial agent. However, in patients in renal failure, monitoring of blood concentrations will be needed until more is known about the pharmacology of this drug. is
a
We thank Dr Vander Elst
(Hoechst, Belgium)
Departments of Internal Medicine and Microbiology, St Pierre Hospital, B. 1000 Brussels, Belgium
for the cefotaxime.
N. CLUMECK R. VANHOOF Y. VANLAETHEM J. P. BUTZLER
CASEATING TUBERCULOSIS PRESENTING AS OCCULT CAUSE OF SCIATICA
SIR,-Osteosclerotic lesions of the lower lumbar vertebrae usually due to metastasis from cancer of the prostate or to
are
International Centre for Diarrhœal Disease Research,
Paget’s MOSLEMUDDIN KHAN
Dacca-12, Bangladesh.
CEFOTAXIME AND NEPHROTOXICITY
SIR,-Deterioration of renal function is a well-recognised complication of therapy with some cephalosporins. Potential nephrotoxicity has to be borne in mind whenever cephalosporins are evaluated or compared, especially since the introduction of the newer agents, compounds with a high stability to the -lactamases of gram-negative organisms and a high degree of in-vitro activity. These compounds are likely to have widespread clinical use. SERUM CONCENTRATIONS
(rJ.g/ml) OF CEFOTAXIME IN PATIENTS
nosis
logical changes. A 76-year-old man was admitted to hospital in May, 1978, complaining of back pain and sciatica. Lower lumbar back pain, dull and aching in character, had developed 6 months earlier, gradually progressing into his left buttock and, at the time of his admission to hospital, pain extended along the whole length of the back of his left leg and the sole of his foot as
to
tested. *Mean (and
range).
far as the hallux. He was unable to walk and was confined bed. He had been a coal miner for 50 years and smoked 20
cigarettes a day. When seen in hospital he was in severe pain. The cardiovascular and respiratory systems were clinically normal. A chest X-ray showed evidence of pneumoconiosis. Cranial nerves and upper limbs were normal. The left buttock, hamstrings, and WITH A MODERATE RENAL FAILURE
NORMAL RENAL FUNCTION
u =not
disease. We have seen a case where the eventual diagtuberculosis, there being no typical destructive radio-
was
(6 DETERMINATIONS)
(3 DETERMINATIONS) OR
