578
diphtheria morbidity.3 The rise in morbidity and mortality in the USSR persuaded the Ministry of Health to reintroduce obligatory testing for diphtheria in all patients with exudative tonsillitis, peritonsillitis, and croup, firstly, in 1983 in the Russian Federation4 and, secondly, in 1986 in the USSR.5 Gabrichevsky Institute for Epidemiology and Microbiology, Moscow, USSR
M. P. KORZENKOVA
Children’s Hospital No 7, Moscow
V. A. IVANOV
infected and topical nystatin or 5% povidone iodine cream were initially used for an average of 12 days (range 7-16) in eight children before the topical application of 2% mupirocin. The affected areas were treated twice daily with 2% mupirocin in a polyethylene glycol base for 5 days. These were examined by microscopy and culture, and sensitivity testing was done, before and after 48 hours and 5 days of mupirocin. All patients showed in-vitro sensitivity of the candida isolates
against mupirocin, 5-fluorocytosine, amphotericin B, econazole, and ketoconazole; isolates were sensitive to miconazole in five with intermediate sensitivity in the remaining five. The minimum inhibitory concentration for mupirocin was measured by standard bacteriological methods and was 256 ug/ml in seven patients and 512 in three. Eradication of all candida organisms was achieved within 2-5 days, with rapid healing of the exudative excoriated wounds. Candida spp showed universal sensitivity to 2% mupirocin with a low order of antifungal activity. The antifungal efficacy of mupirocin should be further assessed as a topical antifungal agent.
patients,
Gabrichevsky Institute for Epidemiology and Microbiology Children’s Hospital No 7
T. V. PLATONOVA M. A. DOLJIKOVA
APR, Ridway GL, Gruneberg RN, et al. Routine screening for Corynebacterium diphtheriae. Lancet 1990; 336: 1199. 2. Favorova AA, Astafeva HB, Korzenkova MP, et al, eds. Diphtheria. Moscow, 1988. 3. Order no 580 of the USSR Ministry of Health. Moscow, 1974. 1. Wilson
4. Order no 275 of the RSFSR Ministry of Health. Moscow, 1983. 5. Order no 450 of the USSR Ministry of Health. Moscow, 1986.
H. RODE P. M. DE WET
Department Paediatric Surgery, University of Cape Town,
Mupirocin resistance SIR,-We have been monitoring the use of and resistance to the mupirocin, a topical agent active against Staphylococcus aureus. Mupirocin resistance was noted soon after its introduction.1 We have studied a large district general hospital (DGH) and a small skin hospital (SH), over the same six months since November, 1990. Resistance
to
mupirocin is defined
concentration above 8
mgjl.
Resistance
as
a
rates
mean
and
inhibitory
amounts
of
mupirocin prescribed were:
Institute of Child Health, Red Cross Children’s Hospital, 7700 Rondebosch, South Africa
A. J. W. MILLAR S. CYWES
1. Rode H, de Wet PM, Cywes S. The antimicrobial effect of Allium sativum L (garlic). S Afr J Sci 1989; 85: 462-64. 2. Rode H, de Wet PM, Millar AJW, et al. Bacterial efficacy of mupirocin in multi-antibiotic resistant Staphylococcus aureus bum wound infection. J Antimicrob Chemother 1988; 21: 589-95. 3. White AR, Beale AS, Boon RJ, et al. Antibacterial activity of mupirocin. In: Dobson RL, Leyden JJ, Noble WC, Price JD, eds. Bactroban (mupirocin). Proceedings of an International Symposium, Nassau, 1984. Amsterdam: Excerpta Medica, 1985: 19-36.
Psoriasis in The resistance rate in the skin hospital is of concern, being much greater than the 0-3% found by us earlier for both hospital and general practice strains.2 Cross-infection may be occurring, but the difference between the two centres is probably due more to the high use of mupirocin in the skin hospital. A valuable agent should be prescribed with care lest its useful life be curtailed. Department of Medical Microbiology, Dudley Road Hospital, Birmingham B18 7QH, UK
1. Rahman M, Noble WC, Cookson B. Lancet 1987; ii: 377.
RICHARD WISE
JANE JOHNSON Mupirocin-resistant Staphylococcus
aureus.
Lacey RW, Noble WC, Reeves DS, Wise R, Redhead RJ. Mupirocin-resistant Staphyloccus aureus. Lancet 1990; 335: 1095.
2. Cookson BD,
Efficacy of mupirocin in cutaneous candidiasis SiR,—Three main categories of topical antifungal agents are used-polyenes, azoles, and disinfectants. Nonetheless, therapeutic failure is common, and new antifungal agents are being looked for.1 In December, 1987, while testing sensitivities of a Candida albicans cultured from the bile of a paediatric liver transplant patient against various antifungal agents, very effective inhibition by mupirocin was noted. Subsequently the fungicidal activity of mupirocin in wounds contaminated with C albicans and Staphylococcus aureus was investigated during topical therapy with 2% mupirocin for multiantibiotic-resistant staphylococcal bum wound infections and in vitro.2 Zonal inhibition of C albicans that was comparable to six other commonly used topical antifungal agents was seen with 2% mupirocin on sensitivity agar. Mupirocin, a novel topical antibiotic, has very good in-vitro and in-vivo sensitivity at concentrations of 0-25-128 Ilg/ml against representative strains of aerobic and anaerobic gram-positive and gram-negative bacterial On the basis of these observations, perineal candida skin infections were treated in a prospective trial with topical 2% mupirocin ointment. Ten children (mean age 17 months, range 3 months to 5 years) were investigated. The perianal and groin sites were predominantly
practice
SiR,—The diversity of current therapies for psoriasis reflects the fact that many existing treatments are lacking in efficacy, convenience of use, or freedom from major adverse effects. Unfortunately, Dr Menter and Dr Barker (July 27, p 231) placed topical steroids at the head of their list of therapeutic options for psoriasis. The adverse effects of excessive use, together with the risk of serious flares after steroid withdrawal, make steroids a poor first-line choice and most UK dermatologists reserve them for special circumstances. We agree that cyclosporin is a welcome addition as a systemic agent for patients with severe psoriasis but adverse effects limit its wider application.’ The potential efficacy of topical cyclosporin remains unclear. Calcipotriol ointment is a convenient once-daily treatment that seems to be free from serious side-effects.2 Although mildly irritant in some patients, calcipotriol does not cause skin staining, which is almost invariable with dithranol. Calcipotriol has been shown to be superior to betamethasone valerate2and, in our view, it should now be ranked high among the treatment options for patients with noninflammatory chronic plaque psoriasis. Rupert Hallam Department of Dermatology, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
J. G. MCDONAGH CHRISTINE I. HARRINGTON
A.
1. Lowe NJ. Systemic treatment of severe psoriasis. N Engl J Med 1991; 324: 333-34. 2. Kragballe K, Gjertsen BT, de Hoope D, et al. Double-blind, right/left comparison of
calcipotriol and betamethasone valerate in
treatment
of psonasis
vulgaris. Lancet
1991; 337: 193-96. 3. Cunliffe
WJ, Claudy A, Fairiss G, et al. A multicentre comparative study of calcipotriol (MC903) ointment in patients with psoriasis vulgaris BrJ Dermatol 1991; 125 (suppl 38): 27.
Pregnancy after transcervical endometrial resection SiR,—Transcervical endometrial resection (TCER) is a hysteroscopic technique that has been used for the management of intractable uterine bleeding since 1983.1 Although its immediate complications are well recognised,2 the long-term effects are not
diphtheria morbidity.3 The rise in morbidity and mortality in the USSR persuaded the Ministry of Health to reintroduce obligatory testing for diphtheria in all patients with exudative tonsillitis, peritonsillitis, and croup, firstly, in 1983 in the Russian Federation4 and, secondly, in 1986 in the USSR.5 Gabrichevsky Institute for Epidemiology and Microbiology, Moscow, USSR
M. P. KORZENKOVA
Children’s Hospital No 7, Moscow
V. A. IVANOV
infected and topical nystatin or 5% povidone iodine cream were initially used for an average of 12 days (range 7-16) in eight children before the topical application of 2% mupirocin. The affected areas were treated twice daily with 2% mupirocin in a polyethylene glycol base for 5 days. These were examined by microscopy and culture, and sensitivity testing was done, before and after 48 hours and 5 days of mupirocin. All patients showed in-vitro sensitivity of the candida isolates
against mupirocin, 5-fluorocytosine, amphotericin B, econazole, and ketoconazole; isolates were sensitive to miconazole in five with intermediate sensitivity in the remaining five. The minimum inhibitory concentration for mupirocin was measured by standard bacteriological methods and was 256 ug/ml in seven patients and 512 in three. Eradication of all candida organisms was achieved within 2-5 days, with rapid healing of the exudative excoriated wounds. Candida spp showed universal sensitivity to 2% mupirocin with a low order of antifungal activity. The antifungal efficacy of mupirocin should be further assessed as a topical antifungal agent.
patients,
Gabrichevsky Institute for Epidemiology and Microbiology Children’s Hospital No 7
T. V. PLATONOVA M. A. DOLJIKOVA
APR, Ridway GL, Gruneberg RN, et al. Routine screening for Corynebacterium diphtheriae. Lancet 1990; 336: 1199. 2. Favorova AA, Astafeva HB, Korzenkova MP, et al, eds. Diphtheria. Moscow, 1988. 3. Order no 580 of the USSR Ministry of Health. Moscow, 1974. 1. Wilson
4. Order no 275 of the RSFSR Ministry of Health. Moscow, 1983. 5. Order no 450 of the USSR Ministry of Health. Moscow, 1986.
H. RODE P. M. DE WET
Department Paediatric Surgery, University of Cape Town,
Mupirocin resistance SIR,-We have been monitoring the use of and resistance to the mupirocin, a topical agent active against Staphylococcus aureus. Mupirocin resistance was noted soon after its introduction.1 We have studied a large district general hospital (DGH) and a small skin hospital (SH), over the same six months since November, 1990. Resistance
to
mupirocin is defined
concentration above 8
mgjl.
Resistance
as
a
rates
mean
and
inhibitory
amounts
of
mupirocin prescribed were:
Institute of Child Health, Red Cross Children’s Hospital, 7700 Rondebosch, South Africa
A. J. W. MILLAR S. CYWES
1. Rode H, de Wet PM, Cywes S. The antimicrobial effect of Allium sativum L (garlic). S Afr J Sci 1989; 85: 462-64. 2. Rode H, de Wet PM, Millar AJW, et al. Bacterial efficacy of mupirocin in multi-antibiotic resistant Staphylococcus aureus bum wound infection. J Antimicrob Chemother 1988; 21: 589-95. 3. White AR, Beale AS, Boon RJ, et al. Antibacterial activity of mupirocin. In: Dobson RL, Leyden JJ, Noble WC, Price JD, eds. Bactroban (mupirocin). Proceedings of an International Symposium, Nassau, 1984. Amsterdam: Excerpta Medica, 1985: 19-36.
Psoriasis in The resistance rate in the skin hospital is of concern, being much greater than the 0-3% found by us earlier for both hospital and general practice strains.2 Cross-infection may be occurring, but the difference between the two centres is probably due more to the high use of mupirocin in the skin hospital. A valuable agent should be prescribed with care lest its useful life be curtailed. Department of Medical Microbiology, Dudley Road Hospital, Birmingham B18 7QH, UK
1. Rahman M, Noble WC, Cookson B. Lancet 1987; ii: 377.
RICHARD WISE
JANE JOHNSON Mupirocin-resistant Staphylococcus
aureus.
Lacey RW, Noble WC, Reeves DS, Wise R, Redhead RJ. Mupirocin-resistant Staphyloccus aureus. Lancet 1990; 335: 1095.
2. Cookson BD,
Efficacy of mupirocin in cutaneous candidiasis SiR,—Three main categories of topical antifungal agents are used-polyenes, azoles, and disinfectants. Nonetheless, therapeutic failure is common, and new antifungal agents are being looked for.1 In December, 1987, while testing sensitivities of a Candida albicans cultured from the bile of a paediatric liver transplant patient against various antifungal agents, very effective inhibition by mupirocin was noted. Subsequently the fungicidal activity of mupirocin in wounds contaminated with C albicans and Staphylococcus aureus was investigated during topical therapy with 2% mupirocin for multiantibiotic-resistant staphylococcal bum wound infections and in vitro.2 Zonal inhibition of C albicans that was comparable to six other commonly used topical antifungal agents was seen with 2% mupirocin on sensitivity agar. Mupirocin, a novel topical antibiotic, has very good in-vitro and in-vivo sensitivity at concentrations of 0-25-128 Ilg/ml against representative strains of aerobic and anaerobic gram-positive and gram-negative bacterial On the basis of these observations, perineal candida skin infections were treated in a prospective trial with topical 2% mupirocin ointment. Ten children (mean age 17 months, range 3 months to 5 years) were investigated. The perianal and groin sites were predominantly
practice
SiR,—The diversity of current therapies for psoriasis reflects the fact that many existing treatments are lacking in efficacy, convenience of use, or freedom from major adverse effects. Unfortunately, Dr Menter and Dr Barker (July 27, p 231) placed topical steroids at the head of their list of therapeutic options for psoriasis. The adverse effects of excessive use, together with the risk of serious flares after steroid withdrawal, make steroids a poor first-line choice and most UK dermatologists reserve them for special circumstances. We agree that cyclosporin is a welcome addition as a systemic agent for patients with severe psoriasis but adverse effects limit its wider application.’ The potential efficacy of topical cyclosporin remains unclear. Calcipotriol ointment is a convenient once-daily treatment that seems to be free from serious side-effects.2 Although mildly irritant in some patients, calcipotriol does not cause skin staining, which is almost invariable with dithranol. Calcipotriol has been shown to be superior to betamethasone valerate2and, in our view, it should now be ranked high among the treatment options for patients with noninflammatory chronic plaque psoriasis. Rupert Hallam Department of Dermatology, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
J. G. MCDONAGH CHRISTINE I. HARRINGTON
A.
1. Lowe NJ. Systemic treatment of severe psoriasis. N Engl J Med 1991; 324: 333-34. 2. Kragballe K, Gjertsen BT, de Hoope D, et al. Double-blind, right/left comparison of
calcipotriol and betamethasone valerate in
treatment
of psonasis
vulgaris. Lancet
1991; 337: 193-96. 3. Cunliffe
WJ, Claudy A, Fairiss G, et al. A multicentre comparative study of calcipotriol (MC903) ointment in patients with psoriasis vulgaris BrJ Dermatol 1991; 125 (suppl 38): 27.
Pregnancy after transcervical endometrial resection SiR,—Transcervical endometrial resection (TCER) is a hysteroscopic technique that has been used for the management of intractable uterine bleeding since 1983.1 Although its immediate complications are well recognised,2 the long-term effects are not
