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SUMMARY Cervical smears from 30 women were examined. Fifteen of these had actinomycetes visible by direct smear examination and the organisms were isolated in 13. Of the remainder, all had negative smears and culture was similarly negative in 12, whilst in 3, the cultures were either positive (1) or suspicious (2).During the last ten years actinomycetes have increasingly been recognised in cervical smears of women using intrauterine contraceptive devices (IUCD). The identification of these actinomycetes has mainly been based on morphological findings.1-3 However, Bhagavan and Gupta4 isolated four strains of actinomycetes from 11 cases (36-3 %) taken from a series of 36 women diagnosed by Papanicolaou stain. Two of these isolates were identified as Actinomyces israeli using fluorescein-labelled antisera; the other two isolates were not ascribed to a species.It is well documented that actinomycetes are difficult to obtain from a mixed culture5-7 and that there are at least six different strains of actinomycetes which can produce actinomycotic infections.8 Therefore a cultural method which improves the isolation rate would be of benefit in diagnosis and an aid towards precise identification which in turn would assist the investigation of cervical infection.In a previous retrospective study we showed that actinomycetes were present in 42 of 293 (14 %) IUCD users and that most of these women were using all-plastic devices.9 In a continuing study, women found to have organisms suggestive of actinomycetes in routine cervical smears are being recalled to a special clinic. As part of this study attempts are made to culture the organisms from cervical swabs and from removed devices. Patients and methodsThirty women in two groups (A and B) were examined at a special clinic. In group A cases, referral was because actinomyces-like-organisms (ALOs) had been seen or suspected in cervical smears stained by Papanicolaou's method at a previous examination, Accepted for publication 14 January 1981 whilst group B women were randomly selected from those attending a family planning clinic. Two of group B were shown on first examination to have cervical smears positive for ALOs and these were transferred thereafter to group A. In group A cases, the second examination was within a 2-5 month period of the first and all women still had an IUCD in situ. Cervical smears and swabs were taken from the external os in these women and in six cases, the IUCD was removed, and studied bacteriologically.The cervical smears were Gram-stained and examined for leucocytes, ALOs and microcolonies of actinomycetes. Within two hours of sampling, bacteriological examination was made on the swabs and selected beads of pus from the device. CULTURE METHODA primary inoculum was made by soaking the swabs or emulsifying selected beads of pus from the device in 5 ml thioglycollate broth (BBL). From this primary inoculum a series of tenfold dilutions was made in thioglycollate broth (10-1 to 10-4). 0*1 ml of each dilution was inoculated in duplicate on two 10 %...

Since the advent of the plastic IUCD, an increasing number of patients with clinical pelvic actinomycosis have been reported in the literature and in a very much larger number of women, actinomycetes have been identified in cervical smears, either by Papanicolaou stain or specific immunofluorescence. After a 3-year study, we have concluded that actinomycetes can readily be cultured wherl the growth of more rapidly growing anaerobes is inhibited by metronidazole and anaerobic culture is continued for up to 14 days. We consider that actinomycetes form part of a polymicrobial anaerobic infestation developing in the presence of a foreign body. The organisms are found almost exclusively in women who have used all-plastic IUCDs for a long term and, from a continuing study. it is apparent that most disappear rapidly when the plastic device is removed or replaced by a copper device. Significant symptomatic evidence of infection is found in a small proportion of patients who are actinomycete-positive.

The in vitro activity of ciprofloxacin against a wide range of bacterial isolates was assessed in comparison with norfloxa~in, enoxacin, co-trimoxazole and penicillin (or anapicillin) where appropriate. Minimal inhibitory concentrations (MICs) indicated that ciprofloxacin was highly active against gram-negative bacilli of the Enterobacteriaceae and Pseudomonas groups, notably against strains resistant to gentamicin. Similarly, Staphylococcus aureus (including methiciUin-resistant strains) and Haemophilus influenzae were susceptible, regardless of penicillinase production. Norfloxacin and enoxacin were less active than ciprofloxacin against the majority of species tested, although enoxacin blood levels were generally higher. Most co-trimoxazole-resistant strains were susceptible to the quinoline group of drugs.The quinoline carboxylic acids, derivatives ofnalidixic acid, represent a new development in this class of synthetic antimicrobials. Because of their wider spectrum and enhanced activity, ciprofloxacin, norfloxacin and enoxacin may now be regarded as serious candidates for the treatment of systemic disease, in addition to the role established by their precursors in urinary tract infections. The results of a number of studies (1-5) suggest that the quinolines are possible alternatives to the more conventional beta-lactams and aminoglycosides for the control of significant infections caused by a wide range of bacterial species. Their lack of cross-resistance with the latter antibiotics and high bactericidal activity against gram-negative bacilli, including Pseudomonas spp., should be advantageous in the hospital setting, especially in the immunocompromised patient with granulocytopenia. This report describes a series of comparative determinations of the minimal inhibitory concentration (MIC) of these antimicrobial substances and a few alternatives, using a selection of clinical isolates from hospitals in the Johannesburg region of South Africa. Materials and Methods Antimicrobials and Determination of MICs.A microtitre broth dilution technique was employed for the Enterobacteriaceae, Pseudomonas spp., Staphylococcus aureus and Streptococcus faecalis. Microtitre trays were filled with 0.1 ml samples of antimicrobial dilutions with the use of a Dynatech MIC-2000 dispenser. The antimicrobials had previously been dissolved in Mueller-Hinton broth (Oxoid) at concentrations ranging from 64 to 0.03 rag/1 in a doubling dilution series. Co-trimoxazole was made up in a ratio of 1 : 19 of trimethoprim to sulfamethoxazole, covering a range of 8/152 to 0.004/0.08 mg]l. Trays were prepared and kept at -20 ~ for a maximum of 6 weeks prior to use. A suspension of 5 • 107 colony forming units (CFU) per ml was inoculated into the trays using the Dynatech multipin inoculator, to give a final concentration of approximately 5 X 105 CFU/ml. A supplement of magnesium and calcium cations was used for Pseudomonas aeruginosa. An agar plate dilution method was adopted for Haemophilus spp., Neisseria spp., Streptococcus pneumoniae and S...