[Diagnosis and therapy of urinary tract infections].

Urinary tract infections (UTI) are one of the most frequent indications for antibacterial chemotherapy. We must be differentiate between complicated and uncomplicated as well as between upper and lower UTI. Regarding the definition of significant bacteriuria (> or = 10(5) CFU/ml), some relativations are necessary.

[Current status and change in infectiology].

Clinical infectiology had passed through a marked transformation in the past, it is changing in the present time and will do so in the future. The most important factors for these changes are: the change of the living standard of the people, the increased number of persons with dispositions for infections, a better knowledge about the microbial etiology of infections and new possibilities of diagnostics and therapy of infectious diseases. The importance of these changes are in Germany inadequately reflected not only in the clinical practice but also in medical teaching and research.

[Treatment with antibacterial chemotherapy].

The importance of a true indication of antimicrobiological chemotherapy is discussed on beginning of the paper. A correct choice of antibiotics and proper strategy of therapy will be demonstrated. Additionally essential antibiotics are presented.

[Effective microbiologic spectrum of gyrase inhibitors--indications and contraindications].

Ciprofloxacin is an essential enrichment of the antibacterial therapy. The activity spectrum comprises enterobacteria, haemophiliacs and Neisseriae, furthermore Legionellae and species of Pseudomonas (except Ps. maltophila).

[Antimicrobial chemotherapy of cholecystitis and cholangitis].

Antibacterial chemotherapy of cholecystitis and cholangitis is of limited value, i.e. as a supportive measure.

[Microbiologic diagnosis of diseases of the lung, bronchi and pleura].

Microbiological examination of sputum specimens is of limited value and may give misleading results. On the other side, knowledge of aetiologic agents and corresponding antibiograms may be life-saving in nosocomial pneumonias, for instance. Bronchoalveolar lavages and invasive diagnostic procedures are necessary to obtain microbiological materials without contamination by oral germs.

[Principles of modern antibiotic therapy in the general practice and clinic. Discussion of the contribution by Walter Siegenthaler and Gertrude Siegenthaler-Zuber published in Z. gesamte inn. Med. 42 (1987) 614-618].

W. Siegenthaler's and G. Siegenthaler-Zuber's opinion, according to which in the majority of infections in practice an etiological (microbiological) diagnosis may be renounced and the guiding slogan "before therapy the gods have placed the diagnosis" should be relativized for the situation in the practice in contrast to the situation in the clinic, is opposed.

[Microbiologic and clinical significance of cefotiam].

Modern cephalosporins are of considerable importance for the therapy of severe infections by multiresistant organisms. According to in-vitro-findings on ampicillin-resistant E. coli as well as Klebsiella spp.

[Bacampicillin in urinary tract infections tolerance in patients with impaired kidney and liver function].

The evaluation of a 10-day 3 x 800 mg dosage regimen was equivalent for bacampicillin to oral ampicillin therapy (using 3 or 4 g respectively per day) in patients with primary UTI (n = 50) in clinical and bacteriological respect. The cure rate amounted to 69 and 68,4% respectively 2 days after therapy. No differences could be assessed after a 2-, 4- and 6-week period.

[Damage caused by antibiotics and chemotherapeutic agents].

Side effects of antibiotics are based on direct toxic effects, depending on dose and excretion function, on allergico-immunological reactions and on interactions with other pharmaca. Furthermore the falsification of laboratory parameters and the disturbance of the microecology are significant. World-wide clinical observations lasting for decades are the basis of the knowledge about frequent and infrequent side effects.

[The value of fosfomycin].

After description of the most important properties of fosfomycin including pharmacokinetics, antibacterial activity and hitherto got clinical experiences the determinations of the resistance on frequent clinical pathogenic agents are reported. They were performed in the diffusion test in a platelet content of 20 micrograms with admixture of glucose-6-phosphate. High sensitivity rates showed E.

[Experiences with the Antibody-coated Bacteria Test in the diagnosis of urinary tract infections].

We examined 67 cases with significant bacteriuria for the presence of antibody-loaded bacteria which shall refer to an infection of the upper urinary tract. With the help of this method we could diagnose 43 of the 45 cases with acute and chronic pyelonephritis. Three of the 22 cases with a bacteriuria of other genesis proved as falsely positive.

[The present significance of infection medicine and the problem of clinical microbiology].

Despite the reduction of the number of contagious infectious diseases the bacterial infection still play a considerable role. Here endogenic infections by the normal flora of the own body stand in the foreground. As hospital or nosocomial infections they endanger the patient who is disturbed in his defense by the basic disease and/or iatrogenically, in which case opportunistic germs and polyresistant problem germs participate.

[Therapy of bacterial endocarditis].

The successful treatment of bacterial endocarditis requires a close cooperation to a clinical microbiological laboratory. This performs blood cultures, estimation of sensitivity to the different antibiotics, if anyhow possible also quantitatively, and supervision of therapy by serum bactericidal tests. Synergistic combinations by adding one of the aminoglycosides bring the best chances for therapeutic success.