No studies testing the safety of changing intravenous systems containing in-line burettes at 72 hours in an intensive care setting have been performed. Patients entering a medical or surgical intensive care unit were alternatively assigned to have any line with an in-line burette changed at either 48 hour (105 patients) or 72 hour (65 patients) intervals. Daily quantitative cultures with a 2 ml aliquot of burette fluid were obtained. Contaminated burette fluid was detected in 60 of 1181 (5.0%, 95% confidence interval, 3.7% to 6.3%) samples from the burettes changed at 48 hour intervals, and in 40 of 901 (4.4%, 95% confidence interval, 3.0% to 5.8%) samples from 72 hour interval burettes. Significant bacterial contamination of burette fluid, defined as ten or more colonies per milliliter, occurred in only seven (0.6%) cultures from patients in the 48 hour interval group compared with only three (0.3%) cultures in the 72 hour group. None of the contaminated burette fluids was associated with a primary bacteremia. Change of inline burettes in patients in intensive care at 72-hour intervals is safe and should result in substantial cost savings to hospitals.

Improvements in antimicrobial activity and pharmacokinetics have moved the 4-quinolones into the forefront of antibiotic research. The 4-quinolones are analogues of nalidixic acid, and there are presently at least six agents in this group under investigation in the United States. It is difficult to generalize their clinical usefulness, since these agents exhibit different pharmacokinetic profiles, antimicrobial activity (with varied minimum inhibitory concentrations among similar organisms), and dosage regimens.

The 4-quinolones are potential therapeutic alternatives for infections caused by a variety of organisms. They include: Neisseria gonorrhoeae; Pseudomonas aeruginosa; Haemophilus influenzae; Staphylococcus aureus; common enteric pathogens (salmonella, shigella, Campylobacter, etc); and intracellular bacteria (legionella, chlamydia, mycobacteria, etc).

Clinical efficacy has been demonstrated in urinary tract infections, respiratory tract infections, and sexually transmitted diseases. Future studies will undoubtedly demonstrate effectiveness in numerous additional infectious processes.

The purpose of this article is to compare the 4-quinolones in regards to pharmacokinetics and spectrum of activity and review the clinical studies involving these agents.

Sweden is divided into 23 counties, each governed by a county council. Among many other things the county council is by law responsible for health, medical, and dental care for the inhabitants of the county, which means that virtually all hospitals are owned and run by the counties. There are very few private hospitals. The counties also run primary care outpatient centers. There are private practitioners in the larger cities, but only some 5% of physicians work full-time in private practice. However, more than 50% of dentists are in private practice.