Long-acting Penicillin Research Articles

Multicenter case-control study of risk factors associated with development of vaccine-associated sarcomas in cats.

To determine whether particular vaccine brands, other injectable medications, customary vaccination practices, or various host factors were associated with the formation of vaccine-associated sarcomas in cats. Prospective multicenter case-control study. Cats in the United States and Canada with soft tissue sarcomas or basal cell tumors. Veterinarians submitting biopsy specimens from cats with a confirmed diagnosis of soft tissue sarcoma or basal cell tumor were contacted for patient medical history. Time window statistical analyses were used in conjunction with various assumptions about case definitions. No single vaccine brand or manufacturer within antigen class was found to be associated with sarcoma formation. Factors related to vaccine administration were also not associated with sarcoma development, with the possible exception of vaccine temperature prior to injection. Two injectable medications (long-acting penicillin and methyl prednisolone acetate) were administered to case cats more frequently than to control cats. Findings do not support the hypotheses that specific brands or types of vaccine within antigen class, vaccine practices such as reuse of syringes, concomitant viral infection, history of trauma, or residence either increase or decrease the risk of vaccine-associated sarcoma formation in cats. There was evidence to suggest that certain long-acting injectable medications may also be associated with sarcoma formation.

Rabbit syphilis diagnosed clinically in household rabbits.

This paper deals with 16 cases presented from April to December 2001 and diagnosed clinically as rabbit syphilis, because they showed distinct lesions around the nose and/or mouth, responded to chemotherapy, and the "Rapid Plasma Reagin" test was positive. Twelve cases exhibited initial symptoms and four were relapses. Lesions around the genitalia and/or anus as well as the nose and/or mouth were seen in 8 cases, and 6 cases indicated sneezing. Fifteen cases were successfully treated with oral administration of chloramphenicol, and one was treated with long-acting penicillin by intramuscular injection. The mean age of onset was 8.8 months. As none of these cases had any mating history, the disease was likely to be maternally transmitted.

Sydenham's chorea: risk factors and the role of prophylactic benzathine penicillin G in preventing recurrence

To determine the effect of prophylactic long-acting penicillin G in preventing recurrence of Sydenham's chorea and to discover the risk factors associated with occurrence of symptoms, 18 children with symptoms over a 5-year period were prospectively identified. Of these, ten were boys and eight were girls. The majority occurred between the ages of 8 and 10 years [mean (SD) 9.10 (2.62) years]. Sydenham's chorea was generalized in 14 children and one-sided in four. There was no difference in the incidence of right- and left-sided hemichorea. Among the risk factors examined, only a history of chorea in relatives had a significant association with the occurrence of Sydenham's chorea (OR = 6.39; 95% CI 1.30-31.3). A comparison of recurrence between those given prophylactic long-acting penicillin G and those who had none showed a statistically significant difference in the recurrence experience between the two groups (p < 0.02).

The Role of Splenectomy in Patients with Sickle Cell Disease

The Role of Splenectomy in Patients with Sickle Cell Disease

A Clinicoepidemiologic Study of Heart Disease in Schoolchildren of Menoufia, Egypt

This study was conducted to determine the prevalence of rheumatic heart disease (RHD) and congenital heart disease (CHD) in primary schoolchildren of Menoufia, Egypt and to study the relationship between these two problems and socioeconomic conditions. A total of 8000 children were screened for cardiac disease in their schools. Children with confirmed RHD and CHD in addition to 200 healthy children (controls) were visited at their homes to assess their social environment and other factors according to a designed questionnaire. We found prevalence rates of 3.4/1000 and 2.6/1000 for the RHD and CHD respectively. The most common cardiac defects were double mitral and pulmonary stenosis in the RHD and CHD groups respectively. Nineteen (39.6%) of the patients were diagnosed for the first time during the study. Penicillin prophylaxis was received by only four (14.8%) of the RHD children and none of the CHD children. The number of other affected siblings, increased multiparity, repeated abortion, and intake of contraceptives by mothers were significantly higher in families of the children with CHD. The proportion of illiterate, unskilled, and heavy smoking fathers was higher in the two patient groups. Family income was lowest in the RHD group, while increased crowding index and low whole social environment were significantly related to both RHD and CHD. Effective programs at the community and health service levels are needed in Menoufia to solve the problem of heart disease in schoolchildren in the immediate future.

Effect of long-acting penicillin and Levamisole® on gain and health of stressed calves (1992)

Two studies were conducted to determine the effect of long-acting penicillin and/or levamisole injected at arrival or levamisole injected on day 1 and/or day 7 on the health and gain of newly received, highly stressed, light weight calves. Levamisole injected at arrival reduced (P<.05) sickness of newly arrived calves during the first 5 days. However, it did not reduce overall sickness during the receiving period. Long-acting penicillin injected at arrival did not reduce sickness, but did improve (P<.05) gain of calves during the growing period. The combination of levamisole and long-acting penicillin or the combination of levamisole on day 1 and day 7 did not reduce morbidity in these highly stressed calves.

Effect of Oral Administration of Bacterial Extracts on the Bactericidal Capacity of Polymorphonuclear Leucocytes in Children with Recurrent Respiratory Infections

The effect of orally administered bacterial extracts given intermittently over 16 weeks on the bactericidal capacity of polymorphonuclear leucocytes (PMNs) in children with recurrent respiratory infections was investigated using a luminol-amplified chemiluminescence assay. Chemiluminescence of PMNs stimulated with zymosan or N-formyl-methionyl-leucyl-phenylalanine (fMLP) before and after treatment with bacterial extracts or intramuscular benzanthine penicillin was evaluated. Chemiluminescence induced by opsonized zymosan increased significantly (P less than 0.05) after treatment with bacterial extracts, whereas no significant changes were observed in the fMLP-stimulated PMNs. Long-acting penicillin treatment did not significantly affect zymosan- or fMLP-stimulated chemiluminescence. The data suggest that orally administered bacterial extracts can increase the opsonic capacity of serum and thus the bactericidal capacity of PMNs in subjects with recurrent respiratory infections.

Prophylaxis against Neisseria meningitidis Infections and Antibody Responses in Patients with Deficiency of the Sixth Component of Complement

Forty South African patients with homozygous deficiency of the sixth component of complement (C6) have been identified in an area where group B meningococcal meningitis is endemic; 22 of the 24 proband cases presented with recurrent meningococcal meningitis. In a 2- to 4-year prospective study, patients with recurrent infections who received monthly prophylactic long-acting penicillin were significantly protected from subsequent neisserial infection compared with those who did not receive penicillin (P = .02, Fisher's exact test). Heterogeneous susceptibility to neisserial infection was confirmed by following C6-deficient patients who presented with one or no Neisseria meningitidis infections. These patients, on no prophylaxis, had significantly fewer infections (P = .004) than did patients who presented with recurrent disease. Functional C6 activity was restored by transfusion of fresh frozen plasma in a C6-deficient patient resistant to conventional antibiotic treatment. Antibody levels to the serotype 2 outer membrane proteins were significantly elevated in C6-deficient patients compared with control groups (P = .001).

Hoigne's Syndrome-Reply

In Reply .—The fact that this child developed hallucinations immediately after receiving an intramuscular injection of penicillin, that she attempted to run away, and that the episode was short lived is highly suggestive of Hoigne's syndrome. However, this syndrome has never been described in association to the injection of G benzathine. Yet, we think Dr Press was right in her retrospective identification. How can this apparent contradiction be solved? About eight to ten years ago, there was a vogue of utilizing mixed penicillins for the treatment of streptococcal pharyngotonsillitis. The typical combination was that of long-acting G benzathine and intermediateacting G procaine. To add to the confusion, the brand name often only identified the G benzathine, while the procaine content was only represented by initials. We propose that this 12-year-old girl received such a hidden procaine penicillin in association to the long-acting penicillin, and this resulted

The control of endemic treponematoses.

In the 1950s and 1960s, following a decision by the Second World Health Assembly in 1949, mass treatment campaigns against the endemic treponematoses were undertaken with the support of the World Health Organization and the United Nations Children's Fund. The control policy was based on recognition of the importance of screening at least 90% of the target population; of conducting periodic resurveys and treating missed, new, and imported cases; of treating the entire treponemal reservoir (including latent cases and contacts); and of using adequate dosages of long-acting penicillin (minimal dosages were recommended). Later, policies on the extent of contact treatment at different levels of endemicity were established. During these mass campaigns, approximately 50 million clinical and latent cases and contacts were treated; prevalence of endemic treponematoses was reduced dramatically. The major reasons for resurgence of yaws and endemic syphilis in some areas are discussed. One important factor has been the failure of many countries to integrate active control measures into local health services after the mass campaigns. Yaws and pinta are continuing to decline to very low levels in the Americas. In West Africa, especially, incidence of yaws and endemic syphilis have returned to high levels. Few significant endemic areas remain in Asia except in Indonesia and Papua New Guinea.

Tissue Damage Caused by the Intramuscular Injection of Long-Acting Penicillin

In order to elucidate whether tissue damage produced on occasion by intramuscular injection of long-acting penicillin is due to accidental intra-arterial injection or vasospasm, two types of experiments were carried out in rabbits. In the first set of experiments, six New Zealand White rabbits were given intra-arterial injections of 0.4 mL of a mixture containing 300,000 U of penicillin G benzathine and 300,000 units of penicillin procaine per milliliter (Bicillin C-R) into the left femoral artery and 0.4 mL of normal saline into the right femoral artery as autocontrol. In a second set of experiments, 0.4 mL of the same penicillin preparation was injected in the space surrounding the left femoral artery in five New Zealand rabbits, and 0.4 mL of normal saline was injected in a similar fashion around the right femoral artery as control. The legs of the rabbits that received the intra-arterial injection of penicillin invariably developed ischemic manifestations. None of the legs of rabbits given intra-arterial injections of normal saline had pathologic manifestations. None of the rabbits that received the periarterial penicillin preparation or normal saline developed abnormalities. These results strongly suggest that the tissue damage produced by penicillin is secondary to the intra-arterial administration of the drug.

Group G streptococcal epizootic in a closed cat colony.

An epizootic of beta-hemolytic Lancefield group G streptococcal infections occurred in a specific-pathogen-free colony of laboratory cats. A total of 19 out of 68 animals in a single building were affected over a 10-day period. Clinical signs included fever, depression, lymphadenopathy, pharyngitis, and submandibular edema. The organism was recovered from the pharynx in two of five clinically normal cats from the affected building. Cultures from 12 animals in the same colony but housed in unaffected buildings were negative. Two doses of long-acting penicillin G 72 h apart stopped the outbreak and resulted in negative cultures for previously affected animals. Three months later, two new cases occurred in the same building. The disease was finally eradicated from the colony by depopulating the affected building.

Single injection treatment of meningococcal meningitis I. Long-acting penicillin: MacFarlane, J. T., Anjorin, F. I., Cleland, P. G., Hassan-King, M. Tor-Agbidye, S., Wali, S. S., Weir, W. R. C., Whittle, H. C., Yahaya, H. N. and Greenwood, B. M. (1979). Transactions of the Royal Society of Tropical Medicine and Hygiene, 73, 693

Single injection treatment of meningococcal meningitis I. Long-acting penicillin: MacFarlane, J. T., Anjorin, F. I., Cleland, P. G., Hassan-King, M. Tor-Agbidye, S., Wali, S. S., Weir, W. R. C., Whittle, H. C., Yahaya, H. N. and Greenwood, B. M. (1979). Transactions of the Royal Society of Tropical Medicine and Hygiene, 73, 693

Single injection treatment of meningococcal meningitis 1. Long-acting penicillin

A single injection of a long-acting preparation of penicillin (Triplopen) was compared with a five-day course of crystalline and procaine penicillin in the treatment of meningococcal meningitis. The clinical response of patients treated with Triplopen was very similar to that of patients treated with crystalline penicillin and much more convenient to administer. However, four patients treated with Triplopen had a positive CSF culture 48 or 72 hours after their injection. One injection of Triplopen cannot, therefore, be recommended as an entirely safe form of treatment for meningococcal meningitis unless patients can be carefully followed.

Sexually transmitted diseases on a tropical island.

The epidemiology control and treatment of sexually transmitted diseases (STD) in Singapore are outlined. The incidence of gonorrhea and syphilis increased from 136 and 14 cases/1000 respectively in 1970 to 149 and 21.4 cases/1000 in 1975. The number of cases of syphilis fell from 428 in 1975 to 201 in 1976 and a further 40% decline was recorded for the 1st half of 1977. Gonorrhea rates increased overall in 1976 but the number of cases among men declined and the identification rate among women (who outnumber men by 3:1 among gonorrhea cases) markedly improved. Singapore has exceptionally high rates of chancroid any lymphogranuloma venereum. 30% of STD cases are ages 20-24 and 21% are ages 25-29. 18.5% of male cases are ages 15-19 in contrast to only 5.6% of female cases. Health education programs are aimed at the general public secondary school children and boys in military service. A national health campaign against 6 infectious diseases including STD was launched in 1976 and followed in 1977 by a booster campaign on STD alone. A significant increase in knowledge was measured among students and military personnel. Since prostitutes comprise an important source of infection a medical scheme to periodically check and treat prostitutes was initiated in 1976. The decline in syphilis and in gonorrhea among men observed in 1977 is attributed to this scheme. Contact tracing has a 30% success rate. All contacts are investigated but not routinely treated. If epidemiologic investigation suggests infection the contact is treated after tests are performed. STD patients may seek treatment from a general practitioner or from a free public clinic operated by the Hospital Division of the Ministry of Health. Syphilis is treated with the long-acting benzathine penicillin and gonorrhea with either 3 megaunits of injection procaine penicillin or 2 gm of ampicillin with probenecid. Although there is no full-time department of dermato-venereology in the university medical students are taught the entire spectrum of STD. It has been government policy to share Singapores advanced laboratory facilities and expertise with neighboring countries.

Prevention of heart disease in infants and children

Summary In this monograph, measures are discussed that should be undertaken during childhood to prevent heart disease. Known causes of congenital heart disease include maternal rubella, ingestion of thalidomide during pregnancy, chromosomal anomalies and somatic syndrome complexes. Appropriate preventive measures are immunization with live-attenuated rubella vaccine and avoidance of unnecessary medications during pregnancy. Analysis of chromosomes and genetic counseling in families with an infant with Down's syndrome may be a preventive measure. Prenatal diagnosis of hereditary defects associated with CHD seems to be a promising area of prevention. The outlined etiologic factors account for less than 6% of CHD. Multifactorial inheritance (genetic-environmental interaction) may be responsible for the majority of the CHD. Appropriate genetic counseling and quoting the risk of recurrence is all that one usually can do. Acute rheumatic fever (ARF) is causally related to streptococcal throat infection. Prevention of first attacks of ARF by prompt identification and adequate treatment of streptococcal pharyngitis and prevention of recurrences of ARF with monthly doses of long-acting penicillin seem appropriate. Orodental or other surgical procedures produce transitory bacteremia and these bacteria may lodge on the diseased or deformed heart valves or endocardium and cause endocarditis. Antibiotics are recommended for preventing endocarditis in any patient with a congenital or acquired heart defect 1–2 hours prior to and for 2 days following any potentially bacteremia-producing procedure. The etiology of atherosclerosis is not clearly established. In longitudinal epidemiologic studies, the concept of “risk factors” was developed, which indicates any personal characteristic(s) that is associated with a higher than average incidence of atherosclerosis. Risk factor modification for the adult population to reduce the incidence of atherosclerosis appears to be generally accepted. Despite lack of concrete evidence for effectiveness of risk factor modification in the pediatric age group, many groups of workers recommend such a modification. These include a lowfat and low-cholesterol diet for all children (beyond infancy), screening for hyperlipidemia and prompt treatment if detected, routine blood pressure recording in the pediatrician's office, lowering of dietary salt intake, discouraging cigarette smoking, prevention (or early treatment) of obesity, encouraging moderate exercise and monitoring carbohydrate tolerance of progeny of diabetic patients. Identification of children at risk by a family history of premature onset of an atherosclerotic event may be more practical because of a higher yield. These and the progeny of persons with hypertension, diabetes mellitus and hyperlipidemia should be screened for hyperlipidemia, hypertension (and treated appropriately if present) and counseled as to proper nutrition, exercise and avoidance of smoking. Health education of children and the population at large with regard to current knowledge of risk factors of coronary heart disease and possible methods of prevention is necessary if programs for prevention of atherosclerosis are to be effective. When dealing with children with functional (innocent) heart murmurs and mild organic heart disease, the pediatrician and the pediatric cardiologist should ensure by appropriate counseling that “cardiac nondisease” is not produced. Finally, the miscellaneous group includes prevention of irreversible damage to cardiovascular structures or complications in patients with congenital or acquired heart disease by timely and appropriate medical and/or surgical intervention.

An outbreak of dermatophilosis in sable &lt;I&gt;Hippotragus niger&lt;/I&gt; and roan &lt;I&gt;Hippotragus equinus&lt;/I&gt; in the Kruger National Park

A severe skin disease diagnosed as dermatophilosis took on alarming proportions in roan antelope Hippotragus equinus and sable antelope Hippotragus niger herds, which were kept in a 256 ha enclosure in the Kruger National Park, Republic of South Africa. Only calves were effected. Numerous Dermatophilus organisms were identified in skin biopsies taken from affected areas and examined histologically. Complete recovery followed a single treatment of intramuscular injections of a combination of a long-acting penicillin and streptomycin and the topical application of a preparation which included copper sulphate and benzene hexachloride. Factors which probably contributed to the outbreak included prolonged wetness, flies, a high density of susceptible animals and playful butting behaviour of the calves. This is the first report of the occurrence of dermatophilosis as a disease entity in wildlife species in southern Africa.

Streptococcal pyoderma of the penis following fellatio.

Gonococcal pharyngitis has been correlated with fellatio in both heterosexual females and homosexual males. This report describes another complication of fellatio, group A beta-eaemolytic streptococcal pyroderma on the penis after exposure to a male who probably had pharyngitis. the erythematous, purulent lesions should be cultured. After the organism has been identified, adequate treatment with either a long-acting parenteral penicillin or a 10-day course of oral penicillin is important in order to prevent the possible life-threatening complication of post-streptococcal glomerulonephritis.

ELIMINATION AND REAPPEARANCE OF STREPTOCOCCI IN SKIN LESIONS AND ON NORMAL SKIN FOLLOWING PENICILLIN TREATMENT

The rapidity of disappearance of group A streptococci from impetiginous lesions and normal skin was examined in 49 children treated with 10 days of oral penicillin (34) or long-acting benzathine penicillin (15). Before treatment (Rx) 92% of children had streptococci recovered from normal skin. One week later 20 of 23 children (87%) on oral penicillin were free of streptococcal skin lesions; 6 (26%) had streptococci present on normal skin, 2 of whom had positive lesions. Following benzathine penicillin none of 12 children had lesions 1 week later; 2 had positive normal skin sites. In further studies, 13 children were examined and cultured on presentation and 1, 2, 3, 6 and 7 days after Rx was begun. In 7 children on oral penicillin the mean interval for streptococcal eradication from lesions was 3 days (range 2-4) and from normal skin 2 days; streptococci reappeared on normal skin in 5 children by 4 days. In 6 children, following benzathine penicillin, lesions and normal skin yielded no streptococci by a mean period of 2.5 days (range 2-4); in 1 child organisms reappeared on the normal skin. Persistence of streptococci in skin lesions for a few days after either oral or parenteral Rx has practical and theoretical implications. Streptococcal recovery from normal skin in these circumstances may reflect survival or new acquisition, and further study is needed to clarify this point.

Latent Syphilis— Nomenclature of Its Stages

To the Editor.— Asymptomatic syphilis until two (or four) years after infection is usually termed early latent, and after that, late latent. However, the major practical differences in latent infections are before and after the first year. Secondary symptoms are more apt to recur in the first year; untreated cases are considered communicable in the first year; the probability of some successful contact follow-up exists in the first year—after that, attempts at it are wasted. In the first year, adequate treatment requires 2.4 million units of long-acting penicillin, where possible, repeated once. After that, it is advisable to add a third dose. The serology of syphilis that is treated within the first year is likely to revert to negative within another year. For these reasons, some health departments have drawn the border line between early latent and late latent at the end of the first year. Yet it seems difficult