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Regression of the Forbes-Albright syndrome after pituitary apoplexy.

Infections caused by Bacteroides should be treated early in order to diminish the incidence of morbidity and mortality (Bodner et al., 1970; Ellner and Wasilauskas, 1971). Therefore bacteriological investigations should be carried out as soon as possible, and swabs should be cultured within three hours of being taken in order to prevent strict anaerobes from dying out. It was not possible to do this for all the specimens in this series. Specimens taken at operations out of laboratory hours are now being dealt with on an "on call" basis to avoid delay before culture. This has led to an increase in positive results and early reporting of sensitivity tests. The strains of Bacteroides reported here were resistant to penicillin and ampicillin, therefore other antibiotics should be used to treat the infections. Our results confirm that clindamycin is the drug of choice as suggested by the in-vitro studies of Ingham et al. (1968), Kislak (1972), and the report of Tracy et al. (1972). Other antibiotics may be useful, however, especially erythromycin and lincomycin, which may be given parenterally as well as by mouth. Our in-vitro sensitivity patterns suggest that many of the infections might have responded to co-trimoxazole, but the use of the drug in this infection needs clinical evaluation. It is difficult to assess the importance of Bacteroides as a cause of death in the patients who had concomitant serious disease. Among the septicaemic patients, however, it is perhaps worth noting that of the five treated with clindamycin all survived, whereas of four not so treated only one survived. Septiceemia may affect any age group from the very young with appendicitis to the elderly with carcinoma. It is necessary to secure early blood cultures from patients-particularly those where the source of infection is either the bowel or vagina. In this group it is probably worth while adding clindamycin or lincomycin to the antibiotics to be given empirically, as already suggested in Lancet (1973). In this series there was no evidence of bleeding disorder said to be due to a heparinase produced by Bacteroides species (Gesner and Jenkins, 1961; Tracy et al., 1972).