ISSN:0891-3668    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Objective.To compare the safety and efficacy, in treating acute otitis media (AOM) in children, of a new formulation of amoxicillin/clavulanate potassium (Augmentin®) oral suspension providing 45/6.4 mg/kg/day and administered twice daily (bid) for 5 and 10 days, respectively, with the safety and efficacy of the original formulation providing 40/10 mg/kg/day and administered three times daily (tid) for 10 days.Study design.Eight hundred sixty-eight children ages 2 months to 12 years with AOM were randomly assigned to one of the three treatment groups. Stringent criteria were used for the diagnosis of AOM and for determinations of "cure" and "improvement." Subjects were reexamined on Days 12 to 14 and 32 to 38.Results.Among subjects whose treatment and follow-up conformed fully to protocol, the proportion of treatment successes (clinically cured or improved) on Days 12 to 14 was 78.8% (149 of 189) in the tid 10-day group, 86.5% (154 of 178) in the bid 10-day group and 71.1% (140 of 197) in the bid 5-day group. Corresponding values on Days 32 to 38 were 64.2% (95 of 148) in the tid 10-day group, 63.1% (94 of 149) in the bid 10-day group and 57.8% (93 of 161) in the bid 5-day group. None of the differences between the tid 10-day regimen and either of the 2 bid regimens were statistically significant, but the bid 10-day regimen was significantly more effective than the bid 5-day regimen in younger subjects. In the study population as a whole, results were similar to those in per protocol subjects. Overall the incidence of protocol-defined diarrhea was 26.7% (74 of 277) in the tid 10-day group, compared with 9.6% (27 of 280) in the bid 10-day group (P< 0.0001) and 8.7% (25 of 286) in the bid 5-day group (P< 0.0001).Conclusions.In comparison with the original formulation of Augmentin® administered tid for 10 days in the treatment of AOM in children, the new formulation administered bid for 10 days provides at least equivalent efficacy and causes substantially less diarrhea. Administration for 5 days appears not to provide equivalent efficacy, but the difference appears limited to younger children and the margin of difference is small.

ISSN:0891-3668    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Objective.We identified the pathogens causing persistent and recurrent acute otitis media (AOM) and the clinical efficacy of cefprozil as treatment.Study design.This was a noncomparative, open label multicenter trial. Children ages 6 months to 12 years with signs and symptoms of AOM and evidence of middle ear effusion, as confirmed by pneumatic otoscopy or tympanometry, underwent tympanocentesis and subsequent treatment with cefprozil (15 mg/kg given twice daily) for 10 days. Patients with recurrent otitis media or failure of previous antibiotic therapy or prophylaxis were particularly sought for the study.Results.Two hundred sixty-two (99%) of 265 enrolled children were considered evaluable. The median age of the study group was 1 year. Ninety-eight (37%) of the children had a history (within 30 days) of prior antibiotic use. Ninety-seven (37%) met our definition of recurrent AOM, 48 (18%) met our definition of persistent AOM and 132 (50%) children had 3 or more previous episodes of acute otitis media within 12 months before study. Eighty-two (31%) of the enrollment tympanocentesis had no growth, 150 (57%) had a single bacterial pathogen and 29 (11%) had multiple bacterial pathogens. Of the 93Streptococcus pneumoniaepretreatment isolates, 50 (54%) were penicillin-susceptible, 12 (13%) were penicillin-intermediate resistant and 31 (33%) were penicillin-resistant. Of the 75Haemophilus influenzaepretreatment isolates, 42 (56%) produced beta-lactamase as did 4 (27%) of the 15Moraxella catarrhalisstrains. A satisfactory clinical response by pathogen was found in 75% (70 of 93) withS. pneumoniae, 75% (56 of 75) withH. influenzaeand 93% (13 of 14) withM. catarrhalis;the response with single pathogen infections was higher than those with multiple pathogens (118 of 150 (78%) and 17 of 29 (59%), respectively;P= 0.03). The response for patients with isolates ofS. pneumoniaethat were penicillin-susceptible, -intermediate or -resistant were 39 of 50 (78%), 11 of 12 (92%) and 21 of 31 (68%), respectively. Older children had a satisfactory clinical outcome more frequently than younger children (P< 0.001), and the response to therapy varied for persistent, recurrent and recently untreated AOM (P< 0.01).Conclusion.Persistent and recurrent AOM involves the same pathogens as recently untreated AOM but bacteria with reduced antibiotic susceptibility may be more frequently present. This noncomparative study suggests that cefprozil 30 mg/kg/day given in two divided doses for 10 days may be effective in the treatment of children with persistent and recurrent AOM.

ISSN:0891-3668    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background.Among the lower respiratory tract infections during infancy requiring hospitalization, respiratory syncytial virus (RSV) bronchiolitis is the most frequent disease entity. Nevertheless treatment remains controversial.Methods.A poll among the European Society for Paediatric Infectious Diseases (ESPID) members was conducted to determine the respective local and national treatment policies of RSV bronchiolitis.Results.The questionnaire was returned by 88 centers represented in ESPID (response rate 64%). Ribavirin was used occasionally for high risk patients in 34 centers although 16 hospitals follow the guidelines of the Red Book Committee of the American Academy of Pediatrics. There were no centers using ribavirin for all patients. Bronchodilator treatment was used universally in various combinations for all patients in 54 centers and for all high risk patients in 15. Corticosteroids were used by >80% of ESPID colleagues in various combinations of administration routes.Conclusion.The lack of effective treatment for RSV bronchiolitis and the controversy in the literature concerning antiviral, bronchodilator and antiinflammatory therapy leads to inconsistent treatment strategies.

ISSN:0891-3668    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background.An increase in the number of patients presenting with extraintestinal salmonellosis has occurred at our institution. The purpose of this study was to review the extraintestinal salmonellosis cases in our institution and to investigate the possible reasons for this increase.Methods.A retrospective review of patients from 1985 through 1996 was carried out to identify patients with extraintestinal infections withSalmonella.Demographic data were gathered and statistical evaluations comparing differences among groups (1985 to 1989, 1989 to 1992, 1993 to 1996) was done using theGstatistic, adjusted (maximum likelihood) chi square or the Fisher's exact test.Results.Thirty-nine patients were identified with extraintestinal salmonellosis and although the number of cases had increased from 8 in 1985 to 1988 to 18 in 1989 to 1992 and 13 from 1993 to 1996, the percentage of cases that were extraintestinal were similar (3.3%, 6%, 4.9%;P> 0.1). Seventy-two percent of patients had underlying risk factors with the most common being age <3 months (44%), sickle cell anemia (13%) and gastrointestinal surgery (10%). Fever and diarrhea were more common presenting symptoms in patients <3 months of age than in older patients (P< 0.05).Salmonella typhimuriumandSalmonella heidelbergwere the most common serotypes isolated and an increasing trend of ampicillin resistance was noted from 0% in 1985 to 1988 to 39% from 1989 to 1992 and 23% from 1993 to 1996.Conclusions.The reasons for an increasing trend in extraintestinal cases of human salmonellosis at our institution were not identified. This illness continues to occur in infants and children with well-recognized risk factors.

ISSN:0891-3668    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Objective.To describe the epidemiology of vancomycin usage at a children's hospital.Methods.A cohort study of patients at Egleston Children's Hospital who were charged for the receipt of vancomycin from October, 1992, through October, 1995, was performed. Data were obtained from pharmacy charge records in the hospital's medical records information system.Results.During the study period there were 3589 patient hospitalizations in which vancomycin was used. Patients receiving vancomycin were predominantly male (56.6%) and white (62.4%), ranged in age from 0 to 31 (median, 3.8) years and had an average length of stay of 6.0 days. The total number of vancomycin doses was 105 704; the median number of vancomycin doses during each patient hospitalization was 11.0 (range, 1 to 1215). The total charge for vancomycin used was $2 009 746; the median charge for vancomycin per patient was $297.50 (range, $11 to 19 864). The majority (75.7%) of vancomycin doses were given on the hematology (27.6%), neurosurgery (17.9%), cardiothoracic surgery (13.4%), neonatology (9.7%) or general pediatrics (7.1%) services. Overall surgery service patients were significantly more likely to receive vancomycin than were medicine service patients (1267 doses/6221 admissionsvs.1954/19 446; relative risk, 2.03;P< 0.001). During the study period the number of vancomycin doses decreased significantly (P< 0.001).Conclusions.This study shows the value of evaluating antimicrobial use through a pharmacy database. Although vancomycin use decreased during the study period, large amounts of vancomycin are still being prescribed primarily on subspecialty service patients. Interventions to reduce vancomycin use should focus on these groups.

ISSN:0891-3668    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Objectives.To determine the reliability of respiratory rate and subcostal retractions in diagnosing acute lower respiratory infection (ALRI) in undernourished children.Methods.Three hundred twelve children with ALRI and 446 with upper respiratory infection were classified according to weight and height as normal, stunted, wasted or stunted and wasted and also as normal, underweight or marasmus. The sensitivity and specificity of tachypnea, subcostal retractions and the presence of either sign in identifying children with a clinical diagnosis of ALRI or radiologic pneumonia in each of the nutritional categories were determined and compared.Results.Among children with ALRI the mean respiratory rate in those with normal nutrition (61.5 ± 16.1,n= 160) was not significantly different from those who were stunted (57.5 ± 16.5,n= 59), wasted (61.3 ± 14,n= 66) or stunted and wasted (55.4 ± 12.8,n= 27) (P> 0.05) or from those classified as underweight (60 ± 15.9,n= 150) or marasmus (62.5 ± 14.5,n= 27) (P> 0.4). The sensitivity and specificity of tachypnea, subcostal retraction or the presence of either sign in detecting ALRI was also not statistically significantly different among the children in the different nutritional categories (P> 0.05). The sensitivity of tachypnea or subcostal retraction in identifying children with radiologic pneumonia was also not significantly different among children in the different nutritional categories; the sensitivity of either sign was higher in under-weight children than in children with normal nutrition (P= 0.028).Conclusions.The data suggest that the current WHO algorithm is suitable for diagnosis of ALRI in undernourished children.

ISSN:0891-3668    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Objective.To adapt, implement and evaluate a model of scabies control in an Australian Aboriginal community.Methods.After initially examining the population, we offered all residents treatment with 5% permethrin cream. Visits were made during the ensuing 25 months to rescreen and to treat newcases of scabies and contacts.Results.The prevalence of scabies was reduced from 28.8% before the program to <10% during the entire period (from 32.3% to <10% in children) (P< 0.01 for each visit). The initial prevalence of pyoderma in children was 69.4%, which was reduced and maintained at approximately one-half that rate during the last 16 months (P< 0.004 for the last 4 visits). Residual pyoderma in children was significantly less severe and no longer scabies-related.Conclusions.This simplified model of scabies control had a substantial effect on scabies prevalence and on pyoderma prevalence and severity which was sustained for >2 years. It could prove useful for other communities with high rates of scabies and pyoderma.

ISSN:0891-3668    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Objective.To assess the level of increased risk, if any, of hospitalizations for aseptic meningitis after Jeryl-Lynn mumps strain measles-mumps-rubella (MMR) vaccine in the Vaccine Safety Datalink population.Study design.A possible increased risk of aseptic meningitis 8 to 14 days after receipt of MMR was observed in a preliminary screening analysis of automated data from the Vaccine Safety Datalink (VSD) project Year 2 analysis. To further evaluate this association a retrospective 10-year matched case-control study was undertaken in the four health maintenance organizations (HMOs) in the VSD project. Cases ascertained from a broad scan of the automated data were validated against a standard case definition. Two controls matched on age, sex, HMO and HMO membership were assigned per case.Results.The VSD project involves the cooperative collection of automated vaccination and medical outcome data from four large HMOs that currently have 500 000 children younger than 7 years of age under surveillance. Review of automated screening results from the first 2 years of data revealed a possible increased risk of aseptic meningitis 0 to 14 days after MMR with a relative risk of 3.61 (95% confidence interval, 1.0 to 13.1) although the total number of cases was small. Although the automated data had suggested a possible association of aseptic meningitis with MMR containing the Jeryl-Lynn strain of mumps, review of validated hospitalized cases during the observation period did not reveal evidence of an increased risk of aseptic meningitis after MMR containing the Jeryl-Lynn strain of mumps (odds ratio <1.0 for all analyses).Conclusion.Although it is recognized that hospitalized cases represent a minority of the total cases of aseptic meningitis, it is reassuring that in this evaluation no increased risk of aseptic meningitis after MMR vaccine was found.

ISSN:0891-3668    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Objective.To study the etiologic role of toroviruses as a cause of gastroenteritis in humans.Methods.The design was a case-control study. We compared the rate of torovirus detection in fecal specimens from a selection of children with acute or persistent diarrhea and controls without diarrhea from a study of childhood diarrhea in an urban Brazilian slum. Stool samples were coded and tested in a blinded fashion for the presence of torovirus antigen by enzyme-linked immunosorbent assay, other enteropathogens, toxins and fecal leukocytes.Results.Thirty-three children with acute diarrhea, 41 children with persistent diarrhea and 17 controls were enlisted in the study. Torovirus antigen was detected in 9 (27%) samples from children with acute diarrhea, 11 (27%) samples from children with persistent diarrhea and none of the samples from controls (P< 0.05). In addition the presence of enteroaggregativeE. coliwas associated with persistent diarrhea and the presence ofCryptosporidiumoocysts was common although not significant (P= 0.08); torovirus andCryptosporidiumoccurred in different subsets of samples, whereas torovirus and enteroaggregativeEscherichia coliwere commonly found in combination.Conclusions.These data indicate that toroviruses, alone or in combination with enteroaggregativeE. coli,may play a pathogenic role in acute and possibly persistent diarrhea. Further studies are warranted to determine the etiologic role of toroviruses in gastroenteritis.

ISSN:0891-3668    

出版商:OVID    

年代:1997

数据来源: OVID