The purpose of this study was to determine the efficacy and toxicity of amonafide in unresectable or recurrent head and neck cancer and to determine if the degree of toxicity with amonafide correlated with the acetylator phenotype of the patient. Thirty patients were registered on the study and received amonafide, 300 mg/m2, over two hours each day for five consecutive days every 21 days. There was one partial response (3%) which lasted four months. The dose-limiting toxicity was myelosuppression. Acetylator phenotype was determined prior to treatment using HPLC to quantitate caffeine metabolites in urine samples after administration of caffeine. This pharmacokinetic evaluation was performed in 21 patients and revealed that (17/21) 81% of the patients were slow acetylators and 19% of the patients were rapid acetylators. No association was found between acetylator phenotype and toxicity in our patient population. Based on this study, it appears that amonafide given at 300 mg/m2 for 5 consecutive days every 21 days is not active in squamous cell carcinoma of the head and neck, and that acetylator status does not correlate with toxicity.

A Dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in Otorhinolaryngology, Johannesburg, 2018 / This study is a seven year (01/07/08 - 30/06/15) retrospective review of the microbiology of deep neck infections in 52 adult patients at Chris Hani Baragwanath academic hospital. Micro-organisms isolated from patients with deep neck infections were analysed, including their antibiotic susceptibility patterns. The effectiveness of empiric usage of amoxicillin – clavulanic acid against commonly identified microbes and recommended alternative antibiotic usage were reviewed.The register records of 70 microscopy, culture, and antibiotic sensitivity results of specimens taken intraoperatively, in patients with deep neck infections who underwent surgical intervention, were analysed. Aerobic identified gram negative bacilli and streptococcus species; and anaerobic Prevotella, were the most frequently isolated microorganisms. Microbial sensitivity and resistance to amoxicillin – clavulanic acid was reported in 15% (n = 8) of patients with deep neck infections. Hence, the effectiveness of empiric usage of amoxicillin – clavulanic acid, against microbes commonly involved in deep neck infections in adults at Chris Hani Baragwanath academic hospital; cannot be proved nor disproved and is thus recommended as an option; alternative empiric antibiotic usage likewise cannot be recommended. Further periodic surveillance of microbial profiles and associated antimicrobial susceptibility results, in larger population samples of patients with deep neck infections; utilizing standardized protocols, is suggested. / XL2018

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