By R. Van Furth (auth.), Ralph Van Furth (eds.)
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The reorganization of common perform and the NHS suggest that GPs now face many new and specified moral dilemmas of their perform. With strain on assets and an expanding situation to guage the results of health and wellbeing care, GPs have extra duties that can clash with the first target of taking care of the person sufferer.
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Only prolonged incubation, preferably using large inocula in the tube-dilution technique will make this resistance of the cephalosporins apparent (Table 5) . This cross-resistance has been shown to be important for the treatment of patients . R. Staphylococcus aureus and treated with cephaloridin, improved for a few days, but then relapsed. At that time a Staphylococcus aureus strain was isolated of which the cephaloridin resistance was much more marked. It is important for microbiologists and clinicians to know that resistances to methicillin and other penicillinase resistant penicillins and to the cephalosporins, run parallel.
If you use a high dose, you will kill the first- or second-step mutants, but if low doses are used, then the first- or second-step mutants can survive and then a third or fourth mutation can occur and they become progressively more resistant. Dr Vanderpitte: I agree. There are probably two mechanisms: one bacterial, the step-wise increase of the MICs, and the second to have receptive hosts for them. It is probably not an accident that the second major focus of such pneumococci is in New Guinea, also in people who are very poor and probably in a chronic state of malnutrition.
Sa bath LD, Barrett FF, Wilcox C, Gerstein DA, Finland M: Methicillin resistance ofStaphylococcus aureus and Staphylococcus epidermidis. Antimicr Ag Chemother 1968:302, 1969. 41. Siebert WT, Moreland N, Williams TW: Methicillin-resistant Staphylococcus epidermidis. South Med 171 (11): 1353, 1978. 42. Laverdiere M, Peterson P, Verhoef J, Williams DN, Sabath LD: In vitro activity of cephalosporins against methicillin-resistant, coagulase-negative staphylococci. J Infect Dis 137 (3):245, 1978. 43.