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A 24-year-old heterosexual male, HIV-infected intravenous drug addict, with necrotizing pneumonitis and empyema due to Streptococcus cremoris is presented. The patient had fever, severe dyspnea and chest pain. Chest roentgenogram demonstrated pleural effusion on the left side. A thoracocentesis revealed purulent exudate and S. cremoris was isolated. Fever and pleural effusion disappeared with penicillin and clindamycin therapy. The most likely source of the infection was ingestion of unpasteurized milk and cheese.

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The effects of five macrolide antibiotics: erythromycin, josamycin, miokamycin, roxithromycin and rokitamycin, on human polymorphonuclear leukocyte (PMN) chemotaxis was studied in vitro and ex vivo. At therapeutic concentrations none of the antibiotics tested affected in vitro PMN chemotaxis. In vitro, erythromycin, josamycin, miokamycin, roxithromycin and rokitamycin decreased PMN chemotaxis significantly only at the concentration of 10 mg/l, which is not usually reached in vivo. Ex vivo studies after the ingestion of therapeutic doses of erythromycin, josamycin, miokamycin and roxithromycin by five volunteers showed a significant effect on PMN chemotaxis. However, further studies are needed to confirm and better evaluate the clinical significance of recent and novel macrolides on PMN chemotaxis.

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