Lincomycin Hydrochloride Monohydrate Research Articles

Sensitivity of Group A Streptococci to Antibiotics

More than 60% of all strains of group A streptococci isolated during the period from 1974 to 1975 from children with streptococcal infections in Hokkaido district, Japan, were highly resistant to erythromycin. These strains were found to be multiply resistant to lincomycin hydrochloride monohydrate, chloramphenicol, and tetracycline, and were exclusively type 12 by T-protein typing. The clinical symptoms produced by these organisms were rather mild, responded to penicillin well, and were rarely complicated with glomerulonephritis. The high prevalence of resistant group A streptococci was nationwide, which may have been related to recent excessive use of erythromycin and other macrolide antibiotics. Erythromycin can no longer be considered the drug of choice in the management of streptococcal infections in Japan. This suggests that a periodic surveillance of antibiotic sensitivity of streptococcal isolates may be necessary in other countries in which macrolide antibiotics are frequently prescribed.

Pseudomembranous colitis. A fatal case following prophylactic cephaloridine therapy

DIARRHEA and pseudomembranous colitis are recognized complications of antibiotic use. Clindamycin hydrochloride 1 has been implicated in most of the cases, but chloramphenicol sodium succinate, 2 ampicillin sodium, 3 lincomycin hydrochloride monohydrate, 4,5 and tetracycline hydrochloride 6,7 may also cause the disease. Combinations of antibiotics that have included a cephalosporin drug have been implicated in several reports of this disorder. 8 However, we are aware of only two case reports of colitis following the use of cephalosporin alone. 9,10 This report describes a fatal case of cephaloridine-associated colitis. Report of a Case A 67-year-old woman underwent vaginal hysterectomy for uterine prolapse on Oct 5, 1978. On the same day, preoperatively, she received 1.0 g of cephaloridine intramuscularly prophylactically and then 0.5 g intravenously every six hours postoperatively. There was no history of gastrointestinal disorders, and she had been receiving no medications prior to hospital admission. On the first postoperative day,

Pseudomembranous Colitis

DIARRHEA and pseudomembranous colitis are recognized complications of antibiotic use. Clindamycin hydrochloride 1 has been implicated in most of the cases, but chloramphenicol sodium succinate, 2 ampicillin sodium, 3 lincomycin hydrochloride monohydrate, 4,5 and tetracycline hydrochloride 6,7 may also cause the disease. Combinations of antibiotics that have included a cephalosporin drug have been implicated in several reports of this disorder. 8 However, we are aware of only two case reports of colitis following the use of cephalosporin alone. 9,10 This report describes a fatal case of cephaloridine-associated colitis. Report of a Case A 67-year-old woman underwent vaginal hysterectomy for uterine prolapse on Oct 5, 1978. On the same day, preoperatively, she received 1.0 g of cephaloridine intramuscularly prophylactically and then 0.5 g intravenously every six hours postoperatively. There was no history of gastrointestinal disorders, and she had been receiving no medications prior to hospital admission. On the first postoperative day,

Topically Applied Lincomycin for Acne

To the Editor.— In a large clinical practice, our experience with topical use of erythromycin in acne has been discouraging. Similar discouraging reports regarding topical application of tetracycline in acne turned our attention to two of the few remaining effective antibiotics, lincomycin hydrochloride monohydrate (Lincocin) and clindamycin (Cleocin). In topical form, clindamycin is becoming very popular among clinical dermatologists. For topical use, clindamycin in sterile solution for injection is diluted in appropriate vehicle and applied two to three times daily. Injectable clindamycin is in the phosphate form. Biological studies on clindamycin phosphate supplied by the manufacturer reveal that the phosphate form of this drug is inactive in vitro. Cleavage of the phosphate radical by phosphatases in the liver results in the active form of the drug. This argues against the effectiveness of injectable clindamycin phosphate used topically in the treatment of acne. Clindamycin hydrochloride hydrate (Cleocin Hydrochloride) solution, which

Vaccination of Chickens Against Marek’s Disease with the Turkey Herpesvirus Vaccine Using a Pneumatic Vaccinator

A pneumatic vaccinator has been successfully used to administer cell-associated turkey herpesvirus (HVT) vaccine without a loss in titer due to the pressure required to administer the vaccine. Laboratory studies have also shown that chickens vaccinated with graded doses of the HVT vaccine using doses as low as 41 PFU offered protection against Marek’s disease (MD) when compared to the unvaccinated controls.The pneumatic vaccinator has also been successful in administering a combination of HVT vaccine and tissue culture fowl pox vaccine. Vaccinated birds were protected against challenge with virulent MD virus as well as fowl pox virus. Antibiotics such as spectinomycin pentahydrate or lincomycin hydrochloride monohydrate and spectinomycin sulfate tetrahydrate were used in combination with the HVT and fowl pox vaccine and none of the antibiotics appear to have an adverse effect on the efficacy of either vaccine.

Unfavorable effect of atropine-diphenoxylate (Lomotil) therapy in lincomycin-caused diarrhea

In this double-blind, randomized study, 200 normal subjects received a three-day course of one of five treatment regimens: lincomycin hydrochloride monohydrate injection (sterile solution, 300 mg/ml) with two tablets of either placebo, a mixture of atropine sulfate and diphenoxylate hydrochloride (Lomotil), an aspirin-phenacetin-caffeine (APC) combination or the latter with codeine, or an injection of saline with two placebo tablets. Gastrointestinal irritation was most prominent in subjects receiving lincomycin with atropine-diphenoxylate and lincomycin with APC plus codeine (<i>P</i>&lt;.05). Decreased intestinal motility from atropine-diphenoxylate or codeine may increase the contact time between the lincomycin (or its metabolites) or some developing toxic substances and the mucosal epithelium. The use of atropine-diphenoxylate or codeine in treating lincomycin-induced diarrhea may be questionable. (<i>JAMA</i>235:1451-1454, 1976)

Unfavorable Effect of Atropine-Diphenoxylate (Lomotil) Therapy in Lincomycin-Caused Diarrhea

In this double-blind, randomized study, 200 normal subjects received a three-day course of one of five treatment regimens: lincomycin hydrochloride monohydrate injection (sterile solution, 300 mg/ml) with two tablets of either placebo, a mixture of atropine sulfate and diphenoxylate hydrochloride (Lomotil), an aspirin-phenacetin-caffeine (APC) combination or the latter with codeine, or an injection of saline with two placebo tablets. Gastrointestinal irritation was most prominent in subjects receiving lincomycin with atropine-diphenoxylate and lincomycin with APC plus codeine (P less than .05). Decreased intestinal motility from atropine-diphenoxylate or codeine may increase the contact time between the lincomycin (or its metabolites) or some developing toxic substances and the mucosal epithelium. The use of atropine-diphenoxylate or codeine in treating lincomycin-induced diarrhea may be questionable.

Subtotal Colectomy for Refractory Pseudomembranous Enterocolitis

Pseudomembranous enterocolitis resulting from therapy with antibiotics such as clindamycin and lincomycin hydrochloride monohydrate does not always respond to drug and vigorous medical support. We describe two seriously ill patients who recovered after subtotal colectomy with ileostomy.

Efficacy of Turkey Herpesvirus Vaccine When Administered Simultaneously with Fowl Pox Vaccine

The efficacy of the turkey herpesvirus (HVT) vaccine in protecting chickens challenged with virulent Marek’s disease (MD) virus was unaffected by the presence of either the chick embryo fowl pox vaccine or fowl pox vaccine derived from cell culture. Conversely the HVT vaccine did not affect the efficacy of the fowl pox vaccine in chickens challenged with pathogenic fowl pox virus. A combination of spectinomycin dihydrochloride pentahydrate and lincomycin hydrochloride monohydrate as well as spectinomycin sulfate tetrahydrate were found to be compatible with the HVT and fowl pox vaccines as demonstrated by resistance after challenge with virulent MD virus or fowl pox virus.

Drug-induced colitis mimicking an acute surgical condition of the abdomen.

Pseudomembranous colitis secondary to antibiotic therapy has received increasing recognition. During a one-year period, eight of 42 patients with this entity had findings closely resembling an acute surgical condition of the abdomen manifested by fever, leukocytosis, and severe abdominal pain and tenderness. All eight patients received clindamycin and two were also given lincomycin hydrochloride monohydrate. Differentiation from an acute surgical condition of the abdomen was difficult until the characteristic findings of pseudomembranous colitis were noted on proctoscopic examination. Unnecessary celiotomy was averted in all patients. Seven of eight patients responded to discontinuation of the antibiotic and supportive measures; one required a diverting ileostomy. Drug-induced colitis must be an important consideration in any patient recently receiving antibiotics who develops fever, abdominal pain, and diarrhea.

Pseudomembranous Colitis

Two patients with diarrhea and pseudomembranous colitis associated with lincomycin hydrochloride monohydrate and clindamycin phosphate therapy were treated with cholestyramine resin, with prompt remission of symptoms. (<i>JAMA</i>231:1157-1158, 1975)

Pseudomembranous colitis. Association with antibiotics and therapy with cholestyramine.

Two patients with diarrhea and pseudomembranous colitis associated with lincomycin hydrochloride monohydrate and clindamycin phosphate therapy were treated with cholestyramine resin, with prompt remission of symptoms.

Stevens-Johnson Syndrome From Clindamycin

A case of Stevens-Johnson syndrome (erythema multiforme exudativum major) from clindamycin occurred. To our knowledge, Stevens-Johnson syndrome from clindamycin or from its parent compound, lincomycin hydrochloride monohydrate, has not previously been reported.

Actinomycosis Treated With Lincomycin

Actinomycosis in four patients allergic to penicillin has been treated successfully with lincomycin hydrochloride monohydrate. The rapid good response suggests that lincomycin offers a satisfactory substitute for penicillin in allergic individuals.

Lincomycin Therapy and Urinary Glucose Tests

To the Editor:— To answer the question, Does antibiotic therapy, specifically lincomycin hydrochloride monohydrate, and the metabolic products resultant from this therapy present in the urine have any effect on the validity of urine glucose evaluation, the following experiment was done. An aliquot of urine was obtained from normal subjects (six per group) who had received either placebo, 300, 600, 900, 1,200, or 1,500 mg of lincomycin hydrochloride monohydrate given intravenously within a one-hour period. (Urine was collected over a 24-hour period from the start of the infusion.) Glucose was added to this urine in the following concentrations: 0.25, 0.50, 0.75, 1.0, and 2.0 grams per 100 ml, which corresponds to the values (Clini-Test), respectively, of: trace, 1+, 2+, 3+, and 4+. The urine was tested prespiking and postspiking (Clini-Test, Tes-Tape, and Lab Sticks). (The latter two tests give only a positive or negative result.) All prespiking tests were negative.

β-Hemolytic Streptococcal Infection

THIS study was designed to determine whether lincomycin hydrochloride monohydrate is superior to penicillin G potassium in treating recurrent streptococcal illnesses or the streptococcal carrier state or both. In our first study on the comparative effectiveness of lincomycin and penicillin against β-hemolytic streptococci, we showed that the treatment of these infections with lincomycin resulted in fewer bacteriologic recurrences than was the case when penicillin was used. To our surprise no of β-hemolytic streptococci occurred among 100 children treated with lincomycin whereas 12 occurred among 102 children treated with penicillin. 1 The experience of Martin F. Randolph, MD, and Raymond M. L. De Haan, MD (unpublished data) with lincomycin was similar to ours in that carriers were only infrequently found after lincomycin treatment of the initial streptococcal illness. This suggested that lincomycin might therefore be more effective than penicillin in one of the most common therapeutic problems faced by the

Lincomycin in Larger Doses

To the Editor:— We have been using large doses of lincomycin hyd o-chloride monohydrate (Lincocin) for the treatment of endocarditis (Arch Intern Med120:361, 1967) and severe staphylococcal infections and wish to bring to the immediate attention of fellow practitioners the fact that large doses of lincomycin, given rapidly, seem to be associated with cardiopulmonary arrest. We have observed four cases in which this has occurred. On the other hand, the same dosages given slowly have been tolerated by hundreds of patients. I therefore suggest that when more than 4 gm of lincomycin hydrochloride monohydrate are given intravenously that they should be diluted in at least 500 ml of fluid. This infusion should be run in at a maximum rate of 100 ml/hr.

Pancreatic, hepatic, and renal excretion of antibiotics in dogs. Observations on erythromycin, lincomycin, kanamycin, and colistimethate excretion.

FEW EXOGENOUS substances are known to be excreted by the pancreas, in contrast to excretion by the kidney and liver. Only zinc 1,2 and manganese 3 had been shown to be actively secreted by the pancreas until Dainko and associates 4,5 reported in 1963 the apparent active secretion of erythromycin, kanamycin sulfate, and colistimethate sodium by the dog's pancreas. If these findings are consistently reproducible, new fields of clinical investigation of pancreatic function may well be realized. In an attempt to confirm this unique observation we undertook a study in dogs by means of simultaneous collections of pancreatic juice, bile, urine, and serum after intravenous administration of erythromycin, kanamycin, lincomycin hydrochloride monohydrate, and colistimethate. Erythromycin excretion has been studied extensively in animals, 6-10 including man. 11-18 Urinary excretion has varied from 12.0% to 16.6% of the given parenteral dose and bile excretion from 4.3% to 33.6%. The 4.3% figure was derived

PENICILLIN AND THE STREPTOCOCCUS

To the Editor:Recognizing the fact that medical progress is in part measured by new therapies I am nevertheless disturbed by the article Beta Hemolytic Streptococcal Illness (Amer J Dis Child112: 21-27, 1966). Evaluating the effectiveness of ampicillin (Penbritin, Polycillin, Omnipen) and lincomycin hydrochloride monohydrate (Lincocin) in the treatment of streptococcal disease in children implies, by matter of association with penicillin G, their acceptibility as modes of therapy in streptococcal disease. The point should be made that despite the fact these drugs work, they are certainly not acceptable substitutes for penicillin in cases of pure streptococcal illness. It should be stressed that they have very definite properties and advantages which should suggest their use at specified times only. The problem of emergence of drug resistant organisms is a most serious one. Fortunately, β-hemolytic streptococci have remained sensitive to penicillin despite its continued widespread use. Let's not exhaust our armamentarium.