ISSN:0891-3668    

出版商:OVID    

年代:1988

数据来源: OVID

ISSN:0891-3668    

出版商:OVID    

年代:1988

数据来源: OVID

ISSN:0891-3668    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The presence of rectal or genital infection withChlamydia trachomatisin children is frequently considered an indicator of sexual abuse. The diagnosis of chlamydial infection in these children has been complicated by the use of antigen detection methods instead of culture. We report five cases in which the use of chlamydial antigen detection tests in the evaluation of suspected child abuse gave false positive results. An enzyme immunoassay was used in two cases (Chlamydiazyme; Abbott Diagnostics) and a direct florescent antibody test was used in the remaining three cases (Microtrak; Syva). The sites examined were the urethra, vagina and rectum. In all cases chlamydial cultures obtained several days later with no interim antibiotic therapy were negative. Four of the five children examined were probably victims of sexual abuse. The enzyme immunoassay and direct fluorescent antibody tests have been evaluated primarily for urethral and cervical cultures from adults; neither test has been approved or evaluated for rectal or genital sites in children. At these sites use of both tests may be associated with a large proportion of false positives caused by contamination with fecal flora which can cross-react with the antibodies used in the test. These tests also have limited utility in populations where the prevalence of chlamydial infection is low (<10%), as has been reported for sexually abused children. Becuase of the medicolegal implications only “gold standard‘’ methods (i.e. culture) performed by a competent laboratory should be used in evaluating chlamydial infection in sexually abused children.

ISSN:0891-3668    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

In a double blind study 175 patients with acute otitis media were randomized into 2 treatment groups: 10 days of therapy with cefaclor or 5 days of therapy followed by 5 days of placebo. The dosage of cefaclor was 40 mg/kg/day administered orally in equally divided doses at 12-hour intervals. Tympanocentesis before treatment yielded specimens that containedStreptococcus pneumoniaeorHaemophilus influenzaeor both in 55% of specimens.Branhamella catarrhaliswas isolated from 21% of specimens.

ISSN:0891-3668    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

If the initial use of amoxicillin fails to cure otitis media, a family will be burdened with medical costs for a second medication, additional office visit fees and time lost from employment. For some families the initial choice of a more expensive but more effective antibiotic may be more cost effective. Using a decision analysis approach we compared the cost effectiveness of amoxicillin and cefaclor. As the amoxicillin efficacy rate decreases or as parental salaries are increased, the cost-effective advantage moves towards cefaclor. With the decision analysis method described, a practitioner can use costs and efficacy rates relevant to his or her practice to determine the most cost-effetive initial antibiotic for a child with otitis media.

ISSN:0891-3668    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Nonhematogenous osteomyelitis (NHO) occurred in 24 pediatric patients (ages 8 months to 18 years; median, 14 years; 23 male) admitted from 1980 to 1985. Predisposing factors included compound fracture (12), deep decubiti (4) and foot puncture (3). Infection involved tibia (7), foot bones (6), proximal femur (3) and ulna (2). Patients presented with drainage (64%), pain or tenderness (44%) and fever (32%) lasting for 1 to 180 days (median, 10 days). In 24% both white blood cell count and erythrocyte sedimentation rate were normal. Initial radiographs were nondiagnostic in 42% after compound fractures. Bone cultures were positive in 15 of 18 (83%) patients for:Staphylococcus aureus(9),Staphylococcus epidermidis(2),Pseudomonas aeruginosa(4),Escherichia coli(2),Enterobacter sp.(2),Streptococcus faecalis, Serratia sp., Klebsiella pneumoniae, Achromobacter xylosoxidans, Aeromonas hydrophilaandPseudomonas fluorescens(1 each). Wound cultures failed to predict bone culture results in 12 of 16 patients (75%). NHO recurred in 8 of 19 patients (42%) despite intravenously administered antibiotics for >28 days and debridement in 7 of 8 patients. The indolent nature of NHO complicates diagnosis, especially in patients with recent compound fractures. Only prompt bone culture can confirm the presence of NHO and reliably guide antimicrobial therapy.

ISSN:0891-3668    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Infection is the leading cause of death in children with cancer. A retrospective review of 100 episodes of sepsis in 80 children with cancer for a 21-month period showed that 74% of isolates were Gram-positive bacteria. Coagulase-negative staphylococci were the most common pathogens, accounting for 35% of all isolates. Initial empiric antibiotic therapy of fever in neutrogenic cancer patients was piperacillin and tobramycin. All but 12% of the Gram-negative isolates were susceptible to one or both of the antibiotics. However, 31% of the Gram-positive isolates were resistant to both antibiotics and 38% of the coagulase-negative staphylococci were methicillin-resistant. All of the latter were susceptible to vancomycin. The increasing incidence of coagulase-negative staphylococci as causes of sepsis in cancer patients suggests that the choice of antibiotics for initial empiric therapy may need to include vancomycin or an antistaphylococcal penicillin depending on the local incidence of methicillin resistance.

ISSN:0891-3668    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Ketoconazole and griseofulvin were compared in a double blind fashion in 47 children with dermatophytosis and positive fungal culture. After 6 weeks of therapy there was clinical and mycologic cure or improvement of the lesions in 92% of patients treated with ketoconazole (Group A) and in 76% of those given griseofulvin (Group B). A patient in Group A showed clinical deterioration of the lesions after 4 weeks of treatment, although modification of antifungal therapy was not necessary to achieve final healing. One ketoconazole-treated patient relapsed within 7 days after cessation of therapy. In Group B the antifungal agent was changed in five cases due to worsening or slow resolution of the lesions and persistence of positive cultures after 6 weeks of treatment. Both ketoconazole and griseofulvin were useful drugs for treatment of dermatophytoses in children.

ISSN:0891-3668    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The mortality related to coccidiodal meningitis (CM) has been reduced since the introduction of amphotericin B therapy, but children with CM continue to suffer significant morbidity. Some of this is related to the toxicity of the drug.We report nine children with CM treated with orally administered ketoconazole and intraventricularly administered miconazole. Four of them had been treated initially with amphotericin B with resultant failure in one and severe toxicity in all four. The other five children were treated only with imidazoles. All nine children had evidence of ventriculitis at the time of diagnosis and had ventriculoperitoneal shunts inserted for control of increased intracranial presure.There was no relapse or recrudescence of CM in a follow-up period of 32 to 90 months on imidazole therapy. The coccidioidal complement-fixation antibody titers in the cerebrospinal fluid of the lateral ventricle became negative in all children 3 to 51 months after diagnosis (mean, 17 months). The serum antibody titers demonstrated a 16− to 256-fold decrease from their maximal levels. Four children are still receiving intraventricular miconazole whereas the others have not received miconazole for an average of 51 months.Therapy with the imidazoles was well-tolerated. The main morbidity was related to the shunts required for control of increased intracranial pressure. There was no evidence of hepatic toxicity and no clinical evidence of adrenal insufficiency although transient adrenal suppression was demonstrated at 4 but not at 24 hours after ketoconazole administration.

ISSN:0891-3668    

出版商:OVID    

年代:1988

数据来源: OVID