Excretion of an antibiotic in bile may result in high intra-intestinal concentrations and thus alteration in the faecal flora. We investigated the effects of cefoperazone (75% biliary excretion), ceftriaxone (45%) and cefotaxime (5%) on the aerobic faecal flora. Cefoperazone reduced numbers of normal Gram-negative bacilli and selected resistant Pseudomonas, Serratia and Klebsiella-Enterobacter. Ceftriaxone was similar. However, cefotaxime had little effect on the normal Gram-negative flora, and did not promote the emergence of resistant organisms.

Adherence of microorganisms to the intestinal mucosa is an important and initial step in the pathogenesis of gastrointestinal infections and mediated by carbohydrate structures on the cell surface. Adherence can be blocked by carbohydrate receptor analogues. Aqueous extracts from carrots (carrot soup) contain acidic oligosaccharides, which are able to block adherence of various enteropathogenic microorganisms to HEp-2 cells and human intestinal mucosa in vitro. Dependent on the grade of polymerisation the most potent blocking ability was seen for trigalacturonic acid. Clinical studies revealed, that aqueous carrot extracts are significantly superior to the basic glucose-electrolyt-solution for oral rehydration in acute gastrointestional infections of children.

Antibiotic concentrations observed in vivo were simulated in an in vitro two compartment model with a dialyser interconnection. Kill kinetics and regrowth pattern of bacteria were investigated under these fluctuating antibiotic concentrations. There were large differences in the rate of reduction of viable organisms by various antibiotics not reflected in small differences in initial MIC values. Data suggested that the area under the concentration curve might be of importance in determining the antimicrobial activity of substances rather than the initial concentration. The inclusion of pharmacokinetic parameters in antimicrobial susceptibility testing might add a new dimension to the appreciation of the activity of antimicrobial substances.

For people in the 21st century, it is hard to imagine the world before antibiotics. At the beginning of the 20th century, as many as nine women out of every 1,000 who gave birth died, 40 percent from sepsis. In some cities as many as 30 percent of children died before their first birthday. One of every nine people who developed a serious skin infection died, even from something as simple as a scrape or an insect bite. Pneumonia killed 30 percent of those who contracted it; bacterial meningitis was almost universally fatal. Ear infections caused deafness; sore throats were not infrequently followed by rheumatic fever and heart failure. Surgical procedures were associated with high morbidity and mortality due to infection. This picture changed dramatically with three major developments: improvements in public health, vaccines, and antibiotics. Over the course of the 20 th century, deaths from infectious diseases declined markedly and contributed to a substantial increase in life expectancy. Antibiotics, in particular, have saved millions of lives. But the world is now at dire risk of losing this progress. Bacteria and other microbes evolve in response to their environment and inevitably develop mechanisms to resist being killed by antibiotics but also disinfectants [1,2]. For many decades, the problem was manageable as the growth of resistance was slow and the pharmaceutical industry continued to create new antibiotics. Over the past decade, however, this brewing problem has become a crisis. The evolution of antibiotic resistance is now occurring at an alarming rate and is outpacing the development of new countermeasures capable of thwarting infections in humans [3]. This situation threatens patient care, economic growth, public health, agriculture, economic security, and national security. The UN Interagency Coordination Group on Antimicrobial Resistance demands therefore immediate, coordinate and ambitious measures to combat this problem [4].

Acute pancreatitis and pancreas pseudocysts are rare events in children. We report an infant aged six months with the cardinal symptoms of abdominal pain, vomiting and fever. After the exclusion of an acute abdominal emergency conservative therapy was started. Due to the persistence of the symptoms an explorative laparatomy had to be done on day four of the illness. A postoperative seen fistula of the pancreas was successfully closed by a sandostatin therapy.