Developments in Antibiotic Treatment of Respiratory Infections : Proceedings of the Round Table Conference on Developments in Antibiotic Treatment of Respiratory Infections in the Hospital and General Practice, Held in the Kurhaus, Scheveningen, The Nethe

I was intrigued by your Coefficient of Resistance (CR) which eliminates a lot of variability in sensitivity testing. But the way you present it, you seem to introduce another kind of variability in comparing different drugs. For instance, how is the sensitive strain defined? Is it so defined that, for different kinds of antibiotics, is has the same meaning? Is that a very sensitive organism, or is it a marginally sensitive organism? I would guess it is very sensitive, because, up to a CR of 10, you can treat patients satisfactorily with antibiotics: that would imply that you would really need 10 times more of the antibiotic in the patient with the marginally sensitive micro-organism, with a coefficient of resistance of 10, than in the very sensitive organism. So, if at first sight it lookes very attractive, I begin to wonder what the implications are. Especially in comparing different antibiotics and concluding that the degree of resistance is higher for one antibiotic than in the other. Dr. Gould: Perhaps I did not make it entirely clear. I would normally expect, the control organism to be of the same species. One would take what one regarded as the standard sensitive strain, an organism which has the mean of the more sensitive group. If you have a bi-modal distribution, obviously you would take the more sensitive group. Originally, when this work was done with Staphylococcus and Streptococcus viridans, the Staphylococcus taken was the standard Oxford Staphylococcus which had an MIC of 0.03 units per ml. Similarly, with the Mycobacterium tuberculosis, it is a standard strain of human mycobacterium that has been used. Dr Mouton: I would like to comment on this subject, too, because I have the feeling that we are making things needlessly complicated. You say that you do not prefer the CR above MIC, but you used MIC for establishing a certain degree of sensitivity in your control strain. I feel that when you standardized your tests and used your control strain regularly to find out whether your media are alright, the MIC value is much easier to handle than a CR value, which has to be (cor)related for every bacterium separately. So, if your test method is standardized and you use control strains now and then to find out if there is no deviation from the normal values, we would not need this CR value. We would just use MIC as a value which can be compared-for whatever it is worth-with the concentrations that may be achieved in vivo. forms. Do you have any data on the significance of the L-forms. Do they really exist in relapses of chronic bronchitis? Dr Kayser: I do not believe that L-forms are real pathogens. Chairman: But they can revert. Dr Kayser: Ten years ago, there was a lot of talk about L-forms of bacteria, but now no paper has appeared on this subject. Dr Mouton: I can only say that it is a very difficult question to evaluate, because everybody is convinced that the L-form in itself is not pathogenic, but it can revert and the moment it reverts you are dealing with bacteria which are pathogenic of course. So, what you have to do is to find out the relationship between the isolation ofL-forms in patients during remission and the number of exacerbations that occur afterwards. Front Matter....Pages I-VIII Introduction. The Role of Host Defence in Respiratory Infections....Pages 1-6 Front Matter....Pages 7-7 The Current Antibiotic Sensitivity of Haemophilus Influenzae....Pages 9-21 Current Pattern of Antibiotic Sensitivity of Pneumococci....Pages 22-32 Antibiotic Sensitivity of Staphylococcus Aureus. Past and Present....Pages 33-52 The Colonization Resistance of the Digestive Tract with Special Emphasis on the Oropharynx....Pages 53-67 Front Matter....Pages 69-69 General Review on Pharmacokinetics of Antimicrobial Drugs in Relation to Respiratory Infections....Pages 71-78 Penetration of Macrolides into the Respiratory Tract....Pages 79-85 Penetration of Various Antibiotics into Sputum....Pages 86-97 Penetration of Various Antibiotics into the Middle Ear....Pages 98-115 Penetration of Various Antibiotics into Sinus Cavities....Pages 116-128 Front Matter....Pages 129-129 Antibiotic Treatment of Sinusitis and Otitis....Pages 131-145 Antibiotic Treatment of Chronic Bronchitis....Pages 146-162 Treatment of Respiratory Infections in Children....Pages 163-174 Antibiotic Treatment of Mycoplasma Pneumoniae Infections....Pages 175-187 Developments in Antibiotic Treatment of Respiratory Infections in General Practice towards Better Prescribing....Pages 188-195 Antibiotic Treatment during Influenza Virus Infections....Pages 196-207 Antimicrobial Treatment of Legionella Pneumonia....Pages 208-225 Pulmonary Infections in Myelosuppressed or Immunosuppressed Patients....Pages 226-237 Prevention of Respiratory Infections by Vaccination....Pages 238-247 Back Matter....Pages 249-251 If the organizers of the excellent symposium, on which this book is based, had wanted to devise an appropriate dramatic opening they could not have done better than to have the first speaker fail to appear because he was incarcerated in his high security isolation unit caring for a patient suffering from green monkey disease. In his consequently undelivered paper, now published in this book, he understandably dwells a little on the place (both philosophical and physical) of the laboratory in the investigation of highly transmissible infections and this subject characterizes the two themes that run through the chapters of this book: the relative roles of microbiologist and clinician in the investigation and management of infected patients, and the techniques, management and diseases most recently to come under scrutiny. In addition to some airing of the question (which some of us regard as pressing)as to what degree the microbiologist should be clinical and the clinician microbiological, there is welcome attention by the clinical haematologist and immunologist to humoral and cellular factors in infection that are acknowledged to be crucial but relative­ ly understudied. New looks at old diseases - urinary infections, urethritis and enteritis -and at an old drug, metronidazole, for new indications are all provided by authors who are at the advancing fronts of those sUbjects. The proceedings, completely updated and revised for this publication, seem to me to have been entirely successful in capturing the stimulation and enjoyment of the excellent and instructive symposium. This book records the papers and discussions at a Work- shop which took place in London on the 5th and 6th of April 1979, as part of the programme of the Commission of the European Communities on Medical and Public Health Research. Proceedings of the Round Table Conference on Developments in Antibiotic Treatment of Respiratory Infections in the Hospital and General Practice, held in the Kurhaus, Scheveningen, The Netherlands, June 15-16, 1980 Proceedings of the International Workshop on Combined Antimicrobial Therapy, held in Rome, 21-22 April, 1978