Indomethacin: A New Non-steroid Anti-inflammatory Agent

Abstract

Reports have been published of the successful treatment with ampicillin of a carrier of Salm.typhi, but of failure in six carriers of Salm.typhimurium (Stewart et al., 1961; Trafford et al., 1962).Ampicillin has failed in three carriers of salmonellae, but a fourth patient remained negative one month after cholecystectomy and ampicillin therapy (Tynes and Utz, 1962).The five relapses in the present series of 10 patients may have been due to the use of an inadequate dose, as they all occurred after treatment with less than 1 g.six-hourly.The administration of a larger dose in two of them resulted in a clinical and bac- teriological cure.It has been suggested that ampicillin may not reach the lower ileum in a concentration inhibi- tory to pathogenic bacteria, owing to rapid absorption from the upper part of the small intestine, and possibly to local destruction by penicillinase (Stewart and Harrison, 1961).This may contribute to failure of the drug in acute salmonelloses.Chronic salmonella infections are notoriously difficult to treat (Main, 1961).In acute salmonelloses chlorainphenicol is unsatisfactory in preventing the development of the carrier state (Douglas, 1950; Good and Mackenzie, 1950; Woodward et al., 1950).This is due to the bacteriostatic action of chloramphenicol and the low concentrations achieved in bile.Ampicillin, being bactericidal and highly concentrated in bile, may be a useful drug in carrier states when given in an adequate dose of at least 1 g.six-hourly for 21 days.It probably represents no advance in the treatment of acute salmonelloses, although more extensive trials are necessary (Brit.med.J., 1961).At the time of writing there was a large epidemic of paratyphoid infection in the Edinburgh area and ampicillin treatment was being compared with chloramphenicol for both the acute infec- tion and the carrier state in over 130 patients.It is hoped to publish the results of this trial after adequate long-term follow-up studies have been completed.Side-effects similar to those seen with other penicillins occurred in seven (19%) of the patients but were readily reversible.It seems likely that cross-sensitization exists among all penicillins, and it is important that patients should be questioned about previous penicillin allergy before ampicillin or any other penicillin is given.Summary Forty-eight patients were treated with ampicillin, 37 suffering from infections of the urinary tract, 10 from salmonelloses, and one from KI. pneumoniae septicaemia.The ampicillin sensitivity of the causative organisms has been studied, and concentrations of ampicillin in blood and urine have been estimated.In the treatment of infec- tions of the urinary tract ampicillin should be reserved for infections due to Proteus spp.It is not the drug of first choice for E. coli infections, being less effective and more costly than cycloserine.The majority of strains of Klebsiella are resistant.A follow-up study showed a 38% long-term failure rate, the possible causes of which are discussed.