Fluoxetine is a new antidepressant agent which is a selective inhibitor of neuronal serotonin uptake; it has minimal affinity for muscarinic, dopaminergic, histaminic, serotonergic, or noradrenergic receptors (Stark et al, 1985). This specificity of activity suggests that fluoxetine may have a side-effect profile which is different from previously available antidepressants.The safety of fluoxetine has been extensively studied: several hundred patients have received the drug continuously for more than one year - some have had therapy for 5 years or more. Previous reviews of the safety of fluoxetine (Wernicke, 1985; Zerbe, 1986) have described a smaller population of patients than is now available.This review is drawn from data pooled from comparative clinical trials, which included 4336 patients: fluoxetine - 2938, tricyclic antidepressants (TCAs) - 599, and placebo - 799 patients. The TCAs studied were amitriptyline, imipramine, and doxepin. Most patients were adults with major depressive disorder, and the most common study design was a 6-week comparative double-blind phase, followed by unblinded long-term treatment. While the core of this study is a data base of 2938 fluoxetine-treated patients, all serious adverse events reported in over 7500 fluoxetine-treated patients worldwide, as of mid-1987, have been included.

We conducted a study to determine the usefulness of the Gram stain in the detection of intravascular catheter-associated infection. A total of 330 intravascular catheters were prospectively collected from adults and children suspected of having such an infection. Semiquantitative solid-agar cultures of the distal catheter tip were correlated with blood cultures. Catheter-associated bacteremia occurred in 34 per cent of cases in which catheter tips were colonized (greater than or equal to 15 colonies per agar plate). There were no cases of catheter-associated bacteremia in patients with uncolonized catheters. Immediately after culture, whole catheter segments were stained by the Gram technique. Gram-negative and gram-positive bacteria and yeast were easily identifiable under oil immersion (X 1000), located predominantly on external catheter surfaces. Any catheter with at least one organism per 20 oil-immersion fields was designated as positive by Gram stain, but the majority of the 41 positive catheters had much larger numbers of organisms. The Gram stain of the catheter tip was 100 per cent sensitive and 96.9 per cent specific for the detection of catheter-tip colonization, with positive and negative predictive values of 83.9 and 100 per cent, respectively. We conclude that a Gram stain of the distal catheter tip is a simple, inexpensive, and accurate test for the rapid diagnosis of intravascular catheter-associated infection.

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