Giardia lamblia is among the commonest intestinal protozoa world-wide and may cause significant morbidity, especially in children. Although 5-nitroimidazole compounds have formed the mainstay of giardiasis treatment for several years, the increasing number of reports of refractory cases given these and other antigiardial agents has raised concern and led to a search for other compounds. The aim of the present study was to compare the efficacy and safety, in the treatment of children infected with G. lamblia, of nitazoxanide, given at a dose of 7.5 mg/kg twice a day for 3 days, with those of tinidazole, given as a single dose of 50 mg/kg. Overall, 166 children, each proven to be infected with G. lamblia by the microscopical examination of a faecal sample, were included in the open and randomized trial, each being allocated to receive nitazoxanide or tinidazole. The parents of each treated child were asked to collect two faecal samples from the child between 5 and 10 days after the completion of treatment, for the parasitological follow-up. Only if no G. lamblia were found in both post-treatment samples from a child was that child considered cured. Among the 137 children who completed the study (74 given nitazoxanide and 63 given tinidazole), the frequency of parasitological cure following a single dose of tinidazole was significantly higher than that following six doses of nitazoxanide (90.5% v. 78.4%; P<0.05). Both treatment schedules were well accepted and well tolerated, with only mild, transient and self-limited side-effects reported. The commonest symptom on enrolment, diarrhoea, generally cleared 2-6 days after the initiation of treatment. Although apparently less efficacious than tinidazole, nitazoxanide remains a good candidate for the treatment of children with G. lamblia infection.

The effectiveness of various antibiotics was tested in the eradication of a strain of methicillin-susceptible Staphylococcus aureus (MSSA) of cardiac vegetations, in an experimental model of endocarditis in rabbits. Twelve animals comprised the control group and 48 the treated ones. After inducing the experimental endocarditis, the animals were treated for three days; then mortality, blood cultures at 48 and 72 hours and the title of the colony forming units per gram of vegetation (CFU/g) were evaluated. Imipenem and the cloxacillin-gentamicin association were found to be as effective as cloxacillin in eradicating the microorganisms of the vegetation. Clindamycin in high doses was shown to be a valid alternative. Vancomycin, teicoplanin, rifampin and ciprofloxacin were less effective than cloxacillin. The experimental model seems to be an effective method for evaluating antimicrobial treatments in staphylococcal endocarditis.

A patient developed bacteremia with CDC group M-6, a Moraxella-like bacterium, after a complicated heart catheterization. He was treated with tobramycin and ampicillin. The aortic valve was later replaced and did not show any signs of infection. The slow growth of M-6 can delay diagnosis and give misleading antibiotic susceptibility results. Penicillin is not always active against this organism. A patient developed bacteremia with CDC group M-6 (a Moraxella-like bacterium) following heart catheterization. These organisms have been recovered from wounds, urine, sputum, and blood (1). They grow slowly in liquid media. This characteristic property can lead to erroneous results in antibiotic susceptibility tests. These bacteria can be detected within 24 h by the BACTEC automated blood culture system (Johnston Laboratories, Inc., Towson, Md.). However, their growth in subculture media is much slower. Not all of the strains are susceptible to penicillin. There is a previous report of endocarditis with M-6 (4). Case report. A 57-year-old man developed palpitations and orthostatic dizziness lasting 24 h on 1 February 1982. He had rheumatic fever as a child, and a murmur of his heart was first noted in 1946. He received a 6-week treatment with intravenous penicillin for streptococcal endocarditis in 1969. Aortic insufficiency with a 30 mm Hg gradient was diagnosed in 1972. The patient remained well until presenting symptoms on 1 February 1982. On 1 March 1982, the patient had a difficult cardiac catheterization showing a dilated left ventricle and a calcified tricuspid aortic valve with 3 + insufficiency. By 4 March 1982 he had developed generalized weakness and fever. He was hospitalized on 5 March 1982 with a temperature of 38.8°C, aortic valve murmurs (3/6 systolic and 1/6 diastolic), and bilateral femoral hematomas. His leukocyte count was 6,200, with 77% neutrophils, 3% bands, and 15% lymphocytes; his hematocrit was 44.4%, and hemoglobin was 14.7 g/dl. Mild cardiomegaly was noted by chest X ray, and his electrocardiogram showed left ventricular hypertrophy and left atrial enlargement. Eleven sets of blood cultures were obtained over a period of 23 h between 5 and 6 March 1982. All cultures became positive within 24 h in the BACTEC system containing tryptic soy broth. Identification was made by the method of King (5), as later revised by her successors (6). The API 20E was ineffective because of slow metabolic activity and poor growth of the organism. It took 10 days from the time of detection of the organism by BACTEC to the time of its identification. Muller-Hinton agar, oxidation-fermentation broth media, and blood agar were supplied by Calscott Laboratories, Carson, Calif. The results were corroborated by the State of California Microbial Diseases Laboratory at Berkeley (Table 1). The organism was nonmotile, gram negative, and coccobacillary and completely reduced nitrates and nitrites without gas production. It was resistant to penicillin but susceptible to

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