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Biomedical subjects

A Mulhall

Publications and source records attributed to A Mulhall.

At least 55 records · Page 3Linked to original sources
PubMed1983

Efficacy, pharmacology, and safety of amdinocillin in treatment of neonates.

One hundred and nine neonates with complications conducive to lethal infections were investigated to determine the efficacy, pharmacokinetics, and safety of amdinocillin. Of these 109 neonates, 70 were participants in the clinical study and 39 in the pharmacokinetic study. Amdinocillin (40 mg/kg per day) and penicillin (60,000 units/kg per day) were administered separately in divided doses by intramuscular injection at six-hourly intervals for five days. Amdinocillin/penicillin proved to be a safe and effective alternative to gentamicin/penicillin; no adverse reactions were noted nor did the regimen adversely affect renal or hepatic function. Throughout the treatment period, amdinocillin maintained high therapeutic serum levels. Resistance to amdinocillin did not develop during treatment.

Amdinocillin↗
PubMed1983

Efficacy of chloramphenicol in the treatment of neonatal and infantile meningitis: a study of 70 cases.

The efficacy of chloramphenicol in the treatment of 21 neonates and 9 infants with proven meningitis and 37 neonates and 3 infants with suspected meningitis was evaluated from mortality and morbidity data, and by assay of the drug in serum and cerebrospinal fluid. Minimum inhibitory concentrations (MICs) were established for ten isolates. 25% of neonates and 50% of infants had subtherapeutic concentrations of chloramphenicol in serum or cerebrospinal fluid. Dosage was less than that currently recommended in over half of these subjects. Mild toxicity (reversible thrombocytopenia) was observed in only 1 of 20 babies being treated at the recommended dose. Toxic reactions, including the grey-baby syndrome, occurred in 10 babies receiving higher doses. In 4 cases, doses up to ten times that prescribed had been given, and death of 1 baby was attributable in part to chloramphenicol toxicity. 5 of 21 neonates and 1 of 9 infants with bacteriologically proven meningitis died, an overall mortality of 20%. Those infected with gram-negative bacteria had a higher mortality than those infected with gram-positive bacteria (p less than 0 . 05). 21% of the survivors had neurological sequelae. Therapeutic concentrations of chloramphenicol will be achieved in serum and cerebrospinal fluid with daily doses of 25 mg/kg in preterm and term infants during the first week of life and 37 . 5-50 mg/kg for older term babies. The drug should be assayed at 48-hour intervals, to maintain concentrations in the therapeutic, non-toxic range. Dosage should be increased when the peak serum concentration falls below 20 mg/l and decreased when the trough serum concentration exceeds 15 mg/l or the peak concentration exceeds 30 mg/l.

Administration, Oral↗
PubMed1983

The pharmacokinetics of chloramphenicol in the neonate and young infant.

The peak and trough serum concentrations and total body clearance of chloramphenicol were determined by microbiological assay in a multicentre investigation of 90 babies. Chloramphenicol was administered by the intravenous, intramuscular or oral route and dosage ranged between 12 and 210 mg/kg/day. A wide variation in both serum levels and clearance amongst babies receiving the same dose was observed. Neonates (64) had significantly higher serum concentrations (P less than 0.001) and slower clearance (P less than 0.0001) than infants (26). Oral administration in neonates resulted in lower steady state serum levels (P less than 0.02) than those following intravenous administration. Term neonates cleared chloramphenicol more rapidly than their preterm contemporaries (P less than 0.005). Forty-one per cent of subjects had potentially toxic serum levels; subtherapeutic peak serum levels (less than 15 mg/l) were recorded in 39/90 babies. Concomitant penicillin therapy resulted in higher serum concentrations (P less than 0.05); phenobarbitone was not associated with increased clearance or lower steady state serum levels of chloramphenicol. Postnatal age and gestational age accounted for some of the variability in pharmacokinetic response to chloramphenicol. Although many babies receiving the recommended dose had serum levels within the accepted range (15-25 mg/l), others did not. Routine monitoring of chloramphenicol in every baby receiving this antibiotic is essential: the regimens of 18% babies in the present study were altered after assay.

Administration, Oral↗
PubMed1983

Incidence of potentially toxic concentrations of gentamicin in the neonate.

The incidence of putatively toxic serum concentrations and the factors influencing their occurrence were investigated in a study of 91 neonates receiving parenteral gentamicin twice daily at a dose of mean (SD) 5.5 (0.1) mg/kg/day. Most neonates were preterm and of low birthweight. Serum concentrations, area under the curve (AUC), and clearance were calculated. Potentially toxic trough concentrations (greater than 2 mg/l) were recorded in 57 of 91 (63%) neonates; 24 of these had trough concentrations greater than 3 mg/l. These babies were of a significantly lower gestational age and were younger than the remainder of the population. Toxic trough concentrations were not accompanied by raised peak serum values. A wide variation in all pharmacokinetic variables was observed. Peak serum concentration was most highly correlated with dose, while trough concentration, AUC, and clearance were more dependent on postnatal age. Clearance of gentamicin decreased significantly with increasing serum urea and creatinine concentrations. Preterm neonates in the first week of life are likely to develop potentially toxic serum concentrations when receiving the currently recommended dose of gentamicin (5-6 mg/kg/day). To prevent accumulation the dosage interval may need to be increased to 18 hours in these babies.

Female↗
PubMed1982

The safety and pharmacokinetics of cefotaxime in the treatment of neonates.

Seventeen neonates with clinical signs of infection who would otherwise have received gentamicin with penicillin were treated with cefotaxime (50 mg/kg bd) for a period of 5 days. One hundred eleven bacteriological cultures were collected and those from 6/17 neonates yielded pathogenic or potentially pathogenic bacteria. Biochemical investigations undertaken before, during, and after the treatment revealed no adverse effects on renal or hepatic function associated with cefotaxime therapy. In addition to manual methods, a computer program was used to determine six pharmacokinetic variables. The mean peak serum level was 87.4 +/- 36.2 mg/liter, the mean trough level 8.0 +/- 6.9 mg/liter and the serum half life 3.1 +/- 0.8 hours. All the neonates showed clinical improvement following cefotaxime treatment with no adverse clinical signs and were discharged well from hospital. It is concluded that cefotaxime may be safely used in neonates and is a suitable alternative to gentamicin and penicillin for primary treatment in units that do not have a persistent and serious problem with infections due to Pseudomonas aeruginosa.

Bacterial Infections↗
PubMed1982

Cefuroxime in the treatment of neonates.

The new broad spectrum cephalosporin, cefuroxime, was used to treat 28 neonates with suspected or proved infection. All of them had had complications at birth or in early neonatal life which were known to predispose to infection. The treatment regimen consisted of intramuscular or intravenous cefuroxime (50 mg/kg twice a day) for 5 days. Previously, such infants would have received gentamicin with penicillin or ampicillin. Pathogenic or potentially pathogenic bacteria were isolated from 7 (25%) of them. All of these organisms were sensitive to cefuroxime. None of the babies had meningitis, but blood cultures from 2 gave positive results. There was significant clinical improvement in 27 of them after 5 days of treatment and each was well on discharge from hospital. Serum urea, total protein, albumin, and alanine transaminase levels were estimated before, during, and after cefuroxime treatment. There were no changes attributable to cefuroxime nor were any changes in haemoglobin, packed cell volume, or total differential white cell counts observed. There were no adverse clinical side effects. One hundred and ninety-four samples of serum were assayed for cefuroxime. The mean peak level after intramuscular injection (42.7 mg/l) was reached in 0.8 hours, and the mean trough level was 10.5 mg/l. The mean half-life of cefuroxime in infants aged less than 4 days was 5.8 hours. In 4 infants older than 8 days, it ranged from 1.6-3.8 hours. Half-life was not associated with birthweight. Cefuroxime is a safe, well-tolerated, and rapidly absorbed drug for the treatment of neonates with suspected or proved infections; it is a useful alternative to gentamicin, if the use of an aminoglycoside is not clearly indicated.

Bacterial Infections↗
PubMed1980

Comparison of methods available for assay of chloramphenicol in clinical specimens.

Eight methods for the assay of chloramphenicol in clinical samples were compared with our own modification of a plate diffusion technique using Sarcina lutea and yeast extract agar. Six of the eight methods were less sensitive than originally reported, and five of them were considered unsuitable for use in clinical microbiology practice. The remaining three methods together with the S. lutea/yeast extract modification were used to assay chloramphenicol in 20 samples of serum. Twenty samples of cerebrospinal fluid were also assayed by the S. lutea/yeast extract method. Our results indicate that only the Bacillus subtilis (sensitivity 6x0 mg/l) and the S. lutea (sensitivity 2x5 mg/l) diffusion methods are suitable for use with clinical samples in routine practice. The problems of chloramphenicol toxicity, appropriate dosage regimens, and the need for assay of the drugs are considered.

Bacillus subtilis↗
PubMed1979

Biochemical identification of clinically important yeasts.

Four commercially available kits for the speciation of yeasts were tested against 50 clinical isolates that had been identified by conventional methods. On biochemical grounds alone, the four systems varied from 71% to 100% in their efficiency in identifying Candida albicans. Yeasts other than C. albicans were identified with an efficiency varying from 24% to 83%. Conclusions are drawn on the value of these systems to the routine laboratory.

Candida albicans↗
PubMedDate not supplied

Development of an in vitro bladder model.

The first of the three articles in this series (1) expounded the case for a broader approach to research design in nursing. In particular, the experimental approach and the use of laboratory studies were highlighted as areas that nurses have tended to neglect. This second article explores the development of an in vitro bladder model for use in experiments examining infections in catheterised patients.

Education, Nursing↗
PubMedDate not supplied

The bladder model: clinical implications.

The first two articles in this series (1, 2) discussed the importance of the experimental approach within nursing research, and described the development of a bladder model which could be used to investigate errors in practice. The final article will document the use of this model in examining the design features of four urinary drainage bags and in investigating the effect of a potential error in practice.

Clinical Nursing Research↗
PubMedDate not supplied

Transcultural nursing. Anthropology: a model for nursing.

The links between anthropology and nursing are not as tenuous as they may at first appear. Social anthropology provides a relevant framework for understanding transcultural nursing and can help to explain some of the drawbacks of using transcultural ideas to care for patients from different cultures.

Anthropology, Cultural↗
PubMedDate not supplied

The cultural context of death: what nurses need to know.

This paper introduces some of the historical work of sociologists and anthropologists on death and dying and discusses its relevance to nursing practice. Contemporary issues are highlighted as well as the importance of examining these contributions critically.

Anthropology, Cultural↗