Prophylactic Penicillin Research Articles

Candida Albicans Endocarditis

TO OUR knowledge only 37 cases ofCandida albicansendocarditis have so far been reported,1with only four survivals among them. The first diagnosis ofCandidaendocarditis before death was made in 1940.2 In the patient to be described in the present report,C albicanswas cultured from the blood during life, and she was still well eight months after treatment had been concluded. Report of a Case An 8-year-old Bantu girl was admitted to the Pretoria General Hospital on Oct 12, 1964, with a history of epistaxis for three days, and dyspnea on effort for a few months. About ten months earlier, she had been treated in the same hospital for Sydenham's chorea, and mitral stenosis and insufficiency had then been noted. After a ten-week period of hospitalization she was discharged, but failed to attend the outpatient department thereafter for observation and continuation of prophylactic penicillin therapy.

Disruption of a Mitral-Valve Prosthesis

EXTERNAL CARDIAC MASSAGE has wide application in the treatment of cardiac arrest. Though complications have been reported to accompany this maneuver, 1-4 it is unquestionably a valuable resuscitative measure. Nevertheless, the case reported below suggests there are certain situations where closed-chest cardiac massage might well be hazardous. Report of a Case A 22-year-old mentally retarded woman was first admitted to North Carolina Memorial Hospital in 1955 with the diagnosis of rheumatic heart disease, mitral-valve insufficiency, and subacute bacterial endocarditis secondary to infection with α-hemolytic streptococci. At that time, her electrocardiogram showed frequent premature ventricular contractions with runs of bigeminal rhythm. She responded well to therapy and was discharged on a regimen of prophylactic penicillin and digitalis. Her second admission was in 1961 for sterilization by abdominal hysterectomy. Her preoperative and postoperative course was complicated by ventricular arrhythmia, necessitating a prolonged hospitalization. In April 1962, prior to her third admission, she

CONTROLLED TRIAL OF PROPHYLACTIC PENICILLIN IN THORACIC SURGERY.

CONTROLLED TRIAL OF PROPHYLACTIC PENICILLIN IN THORACIC SURGERY.

Case 20-1963

Presentation of Case First admission. A fifty-year-old salesman was referred to the hospital because of dyspnea. Nineteen years previously he was rejected for military service because of a heart murmur. There was no history of cardiac disease, rheumatic fever, scarlet fever, previous dyspnea, chest pain or palpitation, and physical activity had never been limited. Seven months before entry to this hospital several teeth were extracted, and he was given prophylactic penicillin for the first time. Four weeks later he was admitted to another hospital because of night sweats, weakness, aching of the extremities and diarrhea. Physical examination revealed a . . .

PROPHYLACTIC PENICILLIN AND POSTOPERATIVE CHEST INFECTIONS

PROPHYLACTIC PENICILLIN AND POSTOPERATIVE CHEST INFECTIONS

Experimental penicillin prophylaxis of staphylococcal infection in rabbits.

SummaryExperimental wound infections with small inocula of staphylococci were regularly produced in rabbits. Prophylactic penicillin was effective in preventing such experimental wound infections due to “penicillin-resistant” staphylococci when size of inoculum was small and when the infecting organisms were derived from environment containing no penicillin. Under similar conditions penicillin was not effective in preventing wound infection due to small inocula of “penicillin-resistant” staphylococci which were derived from an environment containing penicillin.The authors acknowledge technical assistance of Charmion Carnes.

Intra-osseous venography with special reference to its complications.

After a survey of the technique of intra-osseous venography and the literature on its complications a series of 14 venographies performed on 13 patients with injection of 40–60 ml. of 35 per cent Umbradil into the medial malleolus is presented. The complications, which occurred with a higher frequency than might have been expected on the basis of the literature, are reviewed. Pain at the site of injection developed in all the patients; in about half of the cases the pain was intense, and in two instances it persisted for more than a month. In spite of prophylactic penicillin treatment fever developed in four patients. The venographic examination was followed by thrombophlebitis in two cases; one of these was of short duration, whereas the second persisted for several months and resulted in post-traumatic reflex dystrophy of two months' duration. Follow-up radiographs revealed slight periosteal thickening at the site of injection in three patients.

Prophylactic penicillin administration in the prevention of perinatal deaths

Prophylactic penicillin administration in the prevention of perinatal deaths

Subcutaneous emphysema in fracture of facial bones

In three patients with fresh fractures of the facial bones involving the nasal sinuses, subcutaneous periorbital emphysema occurred immediately after they had blown their noses. In all cases, the emphysema subsided spontaneously within a week. The patients were treated with prophylactic penicillin and were told not to blow their noses for three weeks.

Prophylactic subconjunctival penicillin and streptomycin after cataract extraction.

As a result of Sorsby's reports * suggesting that subconjunctival injections of penicillin could prevent experimental production of endophthalmitis by susceptible organisms, it became the practice of several services at the Illinois Eye and Ear Infirmary during 1949 to administer penicillin subconjunctivally as a prophylactic measure at the completion of cataract extractions. During 1952 streptomycin was added to the subconjunctival preparation to increase its bacterial range. This modification was made because of the unfortunate occurrence during one afternoon of three consecutive cases of postoperative endophthalmitis due to Aerobacter aerogenes, which proved to be penicillin-resistant. A total of 1202 cases had prophylactic penicillin injections, and in 3226 cases the injection contained both penicillin and streptomycin. During the immediately preceding period and the early part of the same period some services at the Infirmary did not use any prophylactic injection, and these cases, totaling 1773, form the control series. TECHNIQUE The penicillin-streptomycin solution

Prophylactic penicillin in anterior ocular transplantation technic in mice.

SummaryOf 192 mice with anterior chamber implants of newborn mouse lung. 97 were treated with systemic penicillin. An additional 193 mice were prepared with corneoscleral incisions into the anterior ocular chamber and 95 of this group received systemic penicillin. Beginning on the day of operation. penicillin was given in 5.000 unit doses over a 3-day period. The eyes were enucleated after an interval of 8 days. and studied microscopically. Seventy percent of mice receiving penicillin exhibited inflammation and/or infection in the transplanted eye, while 65% of the untreated mice with transplants had inflammatory and or an infectious response in the transplanted eye, the difference not being statistically significant. We may conclude that prophylactic penicillin at the therapeutic levels utilized is of no value in reducing the inflammatory response in the experimental anterior chamber technic of lung transplantation in the mouse eye.The author wishes to acknowledge the valuable assistance of Drs. B. L. Se...

Small caliber missile blast wounds of the hand: Mechanism and early management

1. 1. Wounds of the hand incurred from the blast effect of high velocity, small caliber missiles are described. These appeared to be characteristic enough and followed such an identical course as to constitute a pattern of trauma. 2. 2. The literature on the subject of blast effect in wound has been reviewed and the pathologic condition discussed. No reports have been found pertaining to the specialized problem which is produced when this type of wounding is found in the hand. 3. 3. The mechanism of blast effect of these wounds is described thus permitting a better understanding of the pathologic condition produced in the wound and the clinical course of the patient. 4. 4. An outline of treatment is given which was found to be satisfactory for the early care of these wounds. This was aimed at the prevention of infection, the preservation of anatomy and function and the combatting of edema. 5. 5. Initial treatment may be summarized as follows: careful and thorough cleansing, minimal debridement, single layer of vaseline gauze to cover wound, compression dressing, Kramer wire splinting, elevation of hand and; arm and prophylactic tetanus toxoid and penicillin. 6. 6. Early secondary treatment is recommended as follows: delayed primary closure of wound of exit at approximately eight days, reapplication of pressure dressing with elevation of hand and arm and early movement of the fingers and thumb thereafter.

Use of prophylactic penicillin in obstetrics

Use of prophylactic penicillin in obstetrics

Prophylactic penicillin during labor in infection-prone patients

Although penicillin given during labor should theoretically give protection against infection, there are as yet only a few reports which present reliable data indicating actual results. In the present experiment 100 obstetrical patients with premature rupture of the membranes for at least 20 hours, labor for 20 hours or more, or both were given prophylactic penicillin at regular intervals before delivery; whereas a like number of controls were untreated. Taking into account the differences in the two groups (as shown by comparisons of the length of labor, lapse of time after premature rupture of the membranes, incidence of antepartum fever, inflammation of the placenta, etc.) there was demonstrated a considerable protection against puerperal infection in such patients from the use of penicillin during labor. However, welcome as is this protection, the prevention was so far from complete in these infection-prone patients as to suggest only a very cautious extension of the indications for delivery by cesarean section in such difficult cases. In agreement with Keettel, Scott, and Plass, there was some reason to believe that the use of larger prophylactic doses of penicillin should be expected further to reduce the occurrence of puerperal infection.On theoretical grounds it has been suggested that the fetus should receive some protection against antenatal infection from the penicillin given to the mother before delivery, though factual evidence regarding this seems to be largely lacking. In the present series the gross results, as well as an analysis of the figures, failed to indicate any advantage to the child from prophylactic antepartum treatment of the mother.

Cesarean section after prolonged labor. Influence of prophylactic sulfonamide and penicillin therapy on operative procedure and end results

1.1. From June 2, 1940, to Dec. 31, 1949, there were 500 cesarean sections performed on the obstetrical service at Bellevue Hospital; seventy (14 per cent) of these operations were done after labors of 30 hours or more.2.2. The seventy patients with prolonged labors in all but one instance were delivered by low flap cesarean section.3.3. Fifty-nine cases (all treated by the lower segment transperitoneal type of operation) in which sulfonamides and/or penicillin were used prophylactically intra and/or post partum are analyzed in some detail. All but three had ruptured membranes for an average duration of about 39½hours.4.4. Cephalopelvic disproportion was the most frequent primary indication for operative intervention; the most frequent secondary indication was uterine inertia.5.5. The over-all morbidity calculated on the scale described was 54.4 per cent. Local infection of the uterus, herein described as endometritis, was the most frequent cause for morbidity, occurring in 88.9 per cent of all morbid patients.6.6. Eight cases in which grossly purulent amniotic fluid was discovered at operation are analyzed in detail.7.7. In the latter half of the series, along with a higher incidence of hemorrhages, there was a more marked increase in the administration of blood transfusions; 79.3 per cent of all patients received transfusions at operation or immediately postoperatively.8.8. There were three fetal or neonatal deaths, an incidence of 5.5 per cent. In two cases double anesthesias were administered, the first because of a complication of labor, the second for the operation.9.9. During the period June 2, 1940, to Dec. 31, 1949, there were no deaths following low flap cesarean section after labors of 30 hours or longer from hemorrhage or infection.

PENICILLIN RESISTANCE OF NONHEMOLYTIC STREPTOCOCCI FROM RHEUMATIC CHILDREN RECEIVING PROPHYLACTIC PENICILLIN

The nonhemolytic streptococci in the throats of children receiving prophylactic oral penicillin tend to be more resistant than those isolated from children who are not receiving penicillin. Children who are not receiving penicillin carry some strains which are as resistant as those carried by the children on penicillin prophylaxis. The higher resistance of the nonhemolytic streptococci isolated from children on penicillin prophylaxis appears, in most instances, to be due to the selection of resistant and the elimination of more sensitive strains. Although the penicillin-resistance of nonhemolytic streptococci isolated from the throats of children receiving prophylactic penicillin is increased, the resistance is not as great as that reported for some strains of nonhemolytic streptococci isolated from patients whose subacute bacterial endocarditis was successfully treated.

An evaluation of prophylactic penicillin administration to parturient women

T HE effectiveness of penicillin in combating postpartum infections has suggested its use prophylactically during labor. The drug has already been used by Ode11 andPlassl in the control of intrapartum infections with considerable benefit to both mother and child. On the basis of these casual observations, it, seemed advisable to learn more accurately if penicillin administration during labor and the early puerperium would produce a significant reduction in the number of puerperal fevers. This study was directed at ascertaining this information by means of controlled experimental use of the drug. The patients were delivered in the Department of Obstetrics and Gynecology of the State University of Iowa.Hospitals between Feb. 3,1947, and Feb. 1,1948. So far as was practicable, alternate patients as determined by the delivery room nurse received prophylactic penicillin” according to a predetermined schedule. The only patients excluded were those delivered by the abdominal route and those receiving penicillin therapeutically prior to the onset of labor. All patients were delivered under similar delivery room technique by medical students, residents, or the senior staff. Postpartum temperatures were taken by mouth every four hours (excluding 2:00 A.M.) during labor and the postpartum stay, which averaged from six to nine days.

Intraperitoneal sulfonamide prophylactic treatment and penicillin therapy in potentially infected cesarean sections: Perez, Manuel Luis, and Echevarria, Ramon: Rev. obst. y ginec. 7: 166–197, 1947

Intraperitoneal sulfonamide prophylactic treatment and penicillin therapy in potentially infected cesarean sections: Perez, Manuel Luis, and Echevarria, Ramon: Rev. obst. y ginec. 7: 166–197, 1947

The prophylactic use of penicillin in obstetrics

1.1. Four hundred forty-six patients received prophylactic penicillin intramuscularly every three hours for ten doses beginning immediately post partum, with a morbidity rate due to genital tract infection of 2.2 per cent using the “standard morbidity” and 37.6 per cent using the low standard selected (99.2° F. for more than twelve hours).2.2. In the control group of four hundred fifty-seven cases, the morbidity rate was 7.4 per cent using the “standard morbidity” and 54.9 per cent using the low standard.3.3. The effect of prophylactic penicillin associated with both early and late risers was compared with the nonprophylactic-penicillin group, using both the “standard morbidity” and the low standard of 99.2° F. An appreciable improvement in percentage morbidity was noted during use of prophylactic penicillin on both early and late risers.4.4. The seasonal variation of morbidity for both groups using both standards of morbidity was noted. In general, it shows no regular variation. The monthly improvement of morbidity under prophylactic penicillin is noted.5.5. The relation of operative procedures to morbidity was noted and the effect of prophylactic penicillin in reducing this morbidity studied. The percentage morbidity during operative procedures was definitely less with the use of prophylactic penicillin.6.6. A study of the incidence and percentage of the causes of morbidity was made and the effect of prophylactic penicillin in reducing the incidence of these various diseases. The improvement was noted chiefly in those cases associated with genital tract infection. Fewer patients developing a temperature of 99.2° F. went on to higher temperatures.7.7. Average hospital days per patient of both groups were compared.

Effect of penicillin on the bacteremia following dental extraction

The administration of large doses of penicillin for twenty-four hours prior to dental extraction caused a significant decrease in incidence of bacteremia following extraction but failed to prevent it in a large number of cases. The agent was particularly effective in decreasing bacteremia after extraction of teeth from infected gums. The possible modus operandi of prophylactic penicillin in preventing subacute bacterial endocarditis is suggested and the recommendation made that this agent be given to all patients with rheumatic and congenital heart disease before and after dental extraction.