No abstract

Ampicillin plus Cloxacillin (2 gm of each daily) or a placebo were given at random and on a double blind basis to 52 and 50 patients undergoing oral, laryngeal or pharyngeal surgery for neoplastic lesions. The frequency of postoperative wound and respiratory infections was significantly higher (p <0.05) among the placebo‐treated patients. Most infections in both groups were caused by gram‐negative rods. No untoward effects were related to the use of ampicillin plus cloxacillin and this form of therapy did not increase the rate of pharyngeal or wound asymptomatic colonization by bacteria.

The paper reports a re-evaluation--based on the Kiel classification for non-Hodgkin lymphomas--of a group of cases initially diagnosed as undifferentiated small cell carcinomas or primary lymphomas of the thyroid. Twelve such cases were found among the 155 cases of primary malignant tumours of the thyroid recorded at the Institut Jules Bordet between 1955 and 1975. The review of the clinical charts and the histology showed that all the cases were in fact malignant lymphomas fitting easily into one of the groups described in the Kiel classification. These findings support the growing opinion that undifferentiated small cell carcinoma of the thyroid does not exist as a distinctive clinicopathological entity. Furthermore, the Kiel classification proved to be an excellent prognostic indicator, since all the cases classified as highly malignant were indeed fatal, whereas the surviving cases--three of which had shown tumoral extension beyond the thyroid capsule--fell into the group of low malignancy. Lastly, this study acknowledges the frequently observed association of malignant lymphoma of the thyroid with stigmata of Hashimoto's disease, and thus supports the concept that the continuous antigenic stimulation observed in the latter could trigger the development of a malignant lymphoma.

A total of 99 patients with head and neck cancer who were to undergo surgery were randomized in a prospective comparative study of sulbactam-ampicillin (1:2 ratio; four doses of 3 g of ampicillin and 1.5 g of sulbactam intravenously [i.v.] Wound infections occurred in 14 (33%) sulbactamampicillin-treated patients and 9 (21%) clindamycin-amikacin-treated patients (P = 0.19; not significant). The rates of bacteremia were 2 and 4%, respectively. The rates of bronchopneumonia were 14.3 and 23.2%, respectively (P was not significant). Most infections were polymicrobial, but strict anaerobes were recovered only from patients who received sulbactam-ampicillin. Antimicrobial treatment was required within 20 days after surgery for 42% of the sulbactam-ampicillin-treated patients and 44% of the clindamycin-amikacintreated patients. By comparison with previous studies, we observed a decreased efficacy of antimicrobial prophylaxis in patients with head and neck cancer undergoing surgery because of the increased proportion of patients who were at very high risk for infection (extensive excision and plastic reconstruction in patients with recurrent stage III and IV cancers) and because of the longer durations of surgery.It has been proven and widely accepted that patients with head and neck cancer undergoing surgery (clean contaminated procedures) benefit from preoperative antibiotic prophylaxis once the skin and oropharyngeal cavities are opened (5,17,18,27,30). Simple laryngectomy has been associated with a very low risk of infection (<4%) (5, 20). Placebo-controlled studies are considered unethical in patients undergoing surgery for head and neck cancer (excluding simple laryngectomy), and any new regimen should be compared with an effective regimen, which has been clindamycin plus an aminoglycoside (netilmicin or amikacin), as determined from studies previously performed in our center (11,27). The combination of a P-lactam antibiotic with a 1-lactamase inhibitor has a spectrum of activity very similar to that of the clindamycin-amikacin combination, including strict anaerobes. However, in recent studies, we have documented that a significant number of failures were due to methicillin-resistant staphylococci (11,27). The in vitro activity of the combination ampicillin-sulbactam against methicillin-resistant staphylococci is high (21,23,34), and the combination of amoxicillin-clavulanic acid was found to be effective in a rat model of endocarditis (7). On the other hand, the combination of clindamycin-amikacin is consid-* Corresponding author. t Present address: European Organization for Research and Treatment of Cancer Central Office, 1200 Brussels, Belgium. ered to be ineffective against those bacteria, since methicillin-resistant staphylococci are frequently resistant to clindamycin and should probably be considered to be resistant to amikacin as well.As far as the choice of the ,-lactamase inhibitor is concerned, sulbactam has two advantages over clavulanic acid; it is more potent (up to 100-fold) in inhibiting the cl...