Use Of Parenteral Antibiotics Research Articles

A bacteriological study in hospitalized children with pneumonia.

A total of 110 consecutive hospitalized children with severe lower respirator tract infection were studied with the aim of determining the main bacterial pathogens responsible. Of these, 57 were classified as severe pneumonia and 53 as very severe pneumonia. Streptococcus pneumoniae was the most common organism identified in 24.6% and 32.1% of cases of severe and very severe pneumonia, respectively, followed by Haemophilus influenzae type b, which was seen in 17.5% and 20.8%, respectively. The highest diagnostic yield was with the latex particle agglutination test on serum and urine. Blood culture was positive in only ten of the 110 children. No difference was found between the aetiological agents identified in severe and very severe cases of pneumonia. Therefore, the use of different parenteral antibiotics for two clinically defined groups of pneumonia, as recommended by WHO in their standard case management guidelines for the ARI control programme, does not seem necessary.

MANAGEMENT OF FEBRILE CHILDREN WITH URINARY TRACT INFECTIONS

Abstract This study of the management of children with fever and urinary tract infection (UTI) was conducted to identify factors associated with initial admission, outpatient treatment, and outpatient treatment failure. A retrospective chart review identified children 3 months to 16 years of age with an emergency department (ED) diagnosis of cystitis, pyelonephritis, or UTI, a positive urine culture, and an ED temperature of >38°C. Sixty-nine patients (90% female) were studied; 19% were admitted initially. Age younger than 2 years was associated with admission ( P v 39.2°C, P = .03, Mann-Whitney U ) but was unrelated to age, initial white blood cell count, or use of parenteral antibiotics. These results indicate that most children with fever and UTI do not require hospital admission; those with temperatures of ≥40°C are at increased risk for outpatient failure.

Risk of infection, infecting flora and treatment considerations in penetrating abdominal trauma

Infectious complications postoperatively for penetrating abdominal trauma are a major cause of morbidity, which contributes significantly to increased length of hospitalization stay and the cost of patient care. The results of recent studies have suggested that the probability of a major infection after traumatic intestinal perforation of the individual patient can be predicted from risk factors noted at the time of the operation. The factor most closely associated with the development of infection is peritoneal contamination by intestinal contents. Other significant risk factors (p < 0.05) are the number of organs injured, number of units of blood administered, ostomy formation for left colonic injury and patient age. The risk of patients being infected can be predicted and thereby used to guide postoperative treatment decisions. Adjusting trauma care choices in antibiotics, duration of antibiotic administration and incisional wound management could result in significant savings. Standard operative procedures, the use of parenteral antibiotics (the duration of which has been one to two days in most recent studies) effective against endogenous aerobic and anaerobic organisms and leaving the surgical incision open decrease the incidence of postoperative wound infection. Despite such preventive measures, major infection remains a problem.

The costs of burn care: an analysis with an emphasis on the use of parenteral antimicrobials.

Because infection is a common cause of morbidity and mortality in patients with burns and intensive antibiotic therapy is often required, the focus of this study was to describe the patterns of use and costs of parenteral antibiotics in a burn unit. The study also evaluated the overall economics of burn care in our population. Forty-one percent of the study group received parenteral antimicrobial agents; the specific agents, indications, and costs are described. The costs of parenteral antibiotics made up a negligible 1.2% of hospital costs and only 12.4% of pharmacy costs. This study revealed the continued hospital losses related to the reimbursement system used by diagnosis-related groups for patients with Medicare. If all patients studied (n = 61) were reimbursed under diagnosis-related groups the unit would have experienced an annual loss of approximately 1.2 million dollars. If specialized burn care facilities are to remain, it may be necessary to reevaluate the appropriateness of the diagnosis-related group reimbursement system for burn-related injury. This is especially important if all third-party reimbursement sources consider conversion to this system of compensation.

Comparison of the Clinical Efficacy and Tolerance of Gentamicin PMMA Beads on Surgical Wire Versus Combined and Systemic Therapy for Osteomyelitis

These data do not prove a statistical superiority of conventional antibiotics or Septopal in the treatment of chronic osteomyelitis. This result, however, is complicated by the biased data set represented by the combined treatment. The data do suggest that cost of treatment is considerably less in patients who are treated with local antibiotics (i.e., Septopal) alone. The rate of adverse experiences was directly related to the use of parenteral antibiotics, with higher rates of adverse experiences in the conventional and combined treatment groups. Furthermore, the Cierny-Mader Physiologic Class had the best correlation with outcome, suggesting that host factors are probably of critical importance in inducing remission of chronic osteomyelitis. This protocol was not designed to test the role of debridement in the treatment of osteomyelitis: it was assumed that debridement would be the same in both groups. It is the investigators' strong opinion, however, that adequacy of debridement was an important determinant in quiescence or recurrence in the study patients. Similarly, there was no strict control for adequacy of soft-tissue coverage provided by local or distant tissue transfer. Again, the investigators believe that adequacy, including viability and durability, of soft-tissue covering was an important determinant for the end result in these patients. Other covariants such as smoking, history, nutritional status, and other measures of general health will be added to this model when data are available. This analysis will allow definition of the appropriate clinical situations in which use of Septopal alone or combined with parenteral antibiotic is indicated.

Septicaemia and adrenal haemorrhage in congenital asplenia.

Five patients developed overwhelming infection as a result of congenital asplenia, which was previously unsuspected in all cases. Each illness followed a fulminant course resulting in death within 24 hours. They illustrate the respective roles of Haemophilus influenzae infection (n = 4) and adrenal haemorrhage (n = 4) in this condition. We suggest a management protocol for screening infants with abnormalities of the atria or viscera with splenic ultrasound and examination of a blood film for Howell-Jolly bodies. Vaccination and prophylactic antibiotics should be considered for those at risk. Vigorous use of parenteral antibiotics and steroids in suspected infection is recommended.

Antibiotic Overprescribing-- Quantity or Quality?

<h3>To the Editor.—</h3> A letter in the December 23/30, 1988, issue of<i>JAMA</i>entitled "Imipenem Overprescribing" invited clinicians to contribute additional information regarding antibiotic use. The<i>term overprescribing</i>attracted our attention, since it is frequently bandied about in discussion of recently marketed antibiotics. We felt that it would be of interest to physicians and pharmacists to look at prescribing patterns of antibiotics, marketed within the last 7 years, from a national sample of hospitalized patients. <h3>Study. —</h3> We retrospectively reviewed data on parenteral antibiotic use from Pharmaceutical Data Services, Inc, of Scottsdale, Ariz. This computerized database compiles all patient discharge data (disease, procedures, and drug use) contributed from 50 geographically stratified hospitals in the United States. Presently, the database captures a 2% sample of national discharges. The hospitals' characteristics are as follows: teaching, 54%; nonteaching, 46%; nonprofit, 62%; church operated, 22%; for profit, 8%; government, 8%; 400 or more

Role of Parenteral Antibiotics in the Management of Extensive Burns

SummaryA total of 458 burn patients admitted in the Plastic surgery department of the Postgraduate Institute of Medial Education and Research, Chandigarh during 1982-1985 have been analysed. The situations have been identified where the use of parenteral antibiotics is indicated. Emphasis is laid upon the judicious and rational use of systemic antibiotics during the course of extensive burns especially in cases of established invasive sepsis.

Evaluation of single-dose cefazolin prophylaxis for toxic shock syndrome.

Otolaryngologists have increased their use of parenteral prophylactic antibiotics to prevent toxic shock syndrome following nasal surgery. This rare but potentially serious postoperative complication presumably requires nasal carriage of a toxigenic strain of Staphylococcus aureus by a susceptible patient. We investigated the effect of a single preoperative dose of intravenous cefazolin on nasal carriage of S aureus. Thirty patients were studied; 15 were S aureus carriers initially and 12 (80%) remained culture positive after prophylaxis and at the time surgery was completed. We conclude that this particular regimen is unlikely to have a major effect on the incidence of toxic shock syndrome following nasal surgery.

The effect of citric acid on the healing of periodontal ligament-free, healthy roots, horizontally implanted against bone and gingival connective tissue.

Edentulous sites were created in four adult baboons by prior extraction of all premolars. Amputated healthy molar roots were implanted horizontally into shallow grooves cut into the alveolar bone at these sites so that one side of the root faced gingival connective tissue and the other bone. Prior to implantation the roots were planed to remove all periodontal investing tissue and were demarcated by a circumferential groove into two portions. One portion was treated with citric acid (pH 1) for 3 minutes, thus creating side‐by‐side experimental and control sites facing both bone and soft tissue. The experimental sites were randomly distributed between apical and coronal root ends and observation periods of 4, 8, and 12 weeks were obtained. Efforts were made to reduce infection at the implantation site by the use of topical and parenteral antibiotics. After sacrifice the tissues were processed for routine light microscopy. Histometric analysis revealed that citric acid, in this situation remote from the influence of periodontal ligament and junctional epithelium, did not enhance new fibrous attachment and new cementum formation nor did it reduce artifactual tissue separation, root resorption, or ankylosis. Ankylosis and root resorption were the predominent features of the healing root surfaces facing bone and gingival tissue, respectively. However, the amount of root resorption on the gingival side was apparently less pronounced than that reported for similar studies probably because of the use of antibiotics to control infection.

Clinical experiences in the use of chemotherapy for bovine dermatophilosis in Nigeria

The importance of bovine dermatophilosis in Nigerian Livestock economy has compelled concerted efforts to combat the disease in order to increase the output of animal protein to the increasing human population. Some of the efforts include tick control to prevent the disease, the application of local and proprietary topical preparations and the use of parenteral antibiotics once the disease occurs. The most common and most successful treatment approach has been the use of parenteral antibiotics. Several antibiotics either singly or in combination have been used with varying degrees of success. A single high dose of penicillin plus streptomycin was found effective but relapses were common; the same combination given on three consecutive days was found effective and resulted in fewer relapses. Recently, a single dose of a new preparation, the long-acting oxytetracycline (Terramycin/LA) was found to be highly effective, resulting in approximately 90% cure rate in different grades of infection. Tribrissen (trimethoprim plus sulphadiazine) was apparently ineffective. Some of the limitations to the use of antibiotics on a wide scale in the field has been discussed.

Double-blind randomized study of prophylactic trimethoprim/sulfamethoxazole in granulocytopenic patients with hematologic malignancies

In a double blind study, oral prophylactic trimethoprim/sulfamethoxazole was evaluated for its utility in preventing serious infections in patients with hematologic malignancy. Of 58 evaluated granulocytopenic episodes in 47 patients, acute leukemia was the underlying malignancy in 46 episodes. Trimethoprim/sulfamethoxazole prophylaxis resulted in fewer microbiologically documented infections (seven versus 15; p = 0.029). This was primarily the result of a reduction in episodes of bacteremia in the trimethoprim/sulfamethoxazole-treated group as compared with the placebo-treated group (three versus nine episodes; p = 0.05). The combined frequency of disseminated candidiasis, candidemia, and esophagitis of presumed fungal etiology was greater in the trimethoprim/sulfamethoxazole-treated group (six) than in the placebo-treated group (two) but not significantly so (p = 0.13). Similarly, there were no significant differences between groups in the overall incidence of infectious complications, number of febrile days, use of parenteral antibiotics, or number of days following randomization to first infectious episode. Throat and rectal surveillance cultures more frequently revealed trimethoprim/sulfamethoxazole-resistant gramnegative bacilli and yeasts in the trimethoprim/sulfamethoxazole-treated group. More frequent emergence of yeast isolates from previously culture-negative patients was documented (p = 0.033). Thus, in this study, trimethoprim/sulfamethoxazole prophylaxis during granulocytopenia reduced the incidence of microbiologically documented infections. However, the emergence of resistant bacteria and of fungi may limit the potential usefulness of this approach.

Total Hip Revision Arthroplasty

The results of revision total hip arthroplasty, with or without sepsis, are compared in a review of the recent literature. In 661 total hip revisions without sepsis, there is an overall 54% excellent/good/satisfactory rate and a 12% infection rate. Of 1063 total hip revisions in the presence of or after sepsis, there is an overall success rate of 73% and a 17% reinfection rate. Comparison of the two groups is difficult due to the different criteria used to diagnose infection, the variable use of parenteral antibiotics and cement impregnated with antibiotics, the frequently short follow-up periods, and the definition of success by different rating s stems. Aside from infection, before advising revision surgery or excision arthroplasty, consideration should be given to the individual patient, the hip to be revised, and the technical skills available. Follow-up should be monitored yearly by an independent examination of the patient, not by chart review or telephone questionnaire. Standardized rating methods should be used, together with strict criteria for the diagnosis of infection. Only in this way will results from different centers be comparable.

The curative treatment of carcinoma of the sigmoid, rectosigmoid, and rectum.

This retrospective series comprises 902 patients who underwent curative resection of the sigmoid colon, rectosigmoid, and upper rectum at the Mayo Clinic during the years 1959 to 1969. Lesions were divided according to the location from the dentate line, with 346 patients having had a lesion located more than 20 cm from the dentate line; in the remaining 556 patients, the lesion was between 6 and 20 cm distant. A thorough analysis was undertaken comparing these two groups of patients on the basis of operative mortality and morbidity, including anastomotic complications, 5- and 10-year survival, and incidence of local recurrence. Overall operative mortality was 1.9%, with an 8.1% incidence of anastomotic complications. The overall 5-year survival rate was 72% and the 10-year survival rate was 55%. The incidence of anastomotic recurrence for anastomosis performed with the use of extraperitoneal rectum was 5.8%; recurrence at the suture line developed in 2.9% of patients who underwent anastomosis to serosa-covered bowel. In addition to the above data, information will be presented which demonstrates the effect of the patient's height and weight on the surgeon's ability to perform a low-anterior anastomosis. Finally, the incidence of anastomotic complications and of local recurrence were analyzed according to the intestinal preparation employed, the use of parenteral antibiotics , and the method of drainage used near the anastomosis.

Antibiotics in colonic surgery

Two hundred consecutive patients undergoing elective resection of the colon for carcinoma were studied. These patients all received mechanical preparation of the colon as well as oral nonabsorbable antibacterial agents. In addition, 76.5 per cent received postoperative parenteral antibiotics. In twenty-seven (13.5 per cent) of these patients an infectious complication developed. However, only two patients developed a complication secondary to Staph aureus, coagulase-positive. The remaining cultures grew out bacteria which were highly sensitive to the usual antibacterial agents. This study indicates that the use of nonabsorbable antibacterial agents in preparation of the colon for surgery is not harmful. Moreover, the combined use of postoperative parenteral antibiotics does not appear to increase infectious morbidity. Until this problem is finally resolved, an open mind to the use of these agents and continued critical observation are urged.