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Biomedical subjects

B Hovelius

Publications and source records attributed to B Hovelius.

At least 19 recordsLinked to original sources
PubMed1992

Production of betalactamase by respiratory tract bacteria in children: relationship to antibiotic use.

Sales of antibiotics have increased in Sweden during the past decade. This has been paralleled by an increase in the frequency of beta-lactamase-producing respiratory tract bacteria. To investigate the effects of regional differences in use of antibiotics on beta-lactamase production in respiratory tract bacteria, we collected nasopharyngeal specimens and information about antibiotic use from 1133 children attending day-care centres in four rural municipalities with low use, and one urban municipality with high use of antibiotics, use being assessed from pharmacy sales. The frequency of beta-lactamase production among isolates of Branhamella catarrhalis and Moraxella nonliquefaciens was significantly higher in the urban municipality. This appeared to be a long-term ecological effect of differences in the level of use of antibiotics between the urban and rural populations, rather than an effect of recent antibiotic treatment of individual patients.

Anti-Bacterial Agents↗
PubMed1991

Erythromycin and phenoxymethylpenicillin (penicillin V) in the treatment of respiratory tract infections as related to microbiological findings and serum C-reactive protein.

Respiratory tract pathogens (beta-haemolytic streptococci groups A, C and G, Haemophilus influenzae, Branhamella catarrhalis or pneumococci), were isolated from nasopharyngeal and/or throat swabs in 73/138 (53%) patients greater than 10 years of age with a clinical diagnosis of acute sinusitis, acute tonsillitis, purulent nasopharyngitis or acute bronchitis. Serological evidence of a viral infection (influenza A and B, parainfluenza 1, 2 and 3, respiratory syncytial virus, adenovirus) or Mycoplasma pneumoniae infection was found in 10% of the patients. The serum content of C-reactive protein (S-CRP) was increased (greater than 12 mg/l) in 26/33 (79%) patients with streptococci and in 22/59 (37%) patients without respiratory tract bacteria. In patients with a serological evidence of a virus tonsillitis, the S-CRP was also high (32-64 mg/l). At follow-up 10-12 days after the first visit, the clinical effect of erythromycin and penicillin V was judged to be similar (90% clinical effect). Relapse or re-infection with group A streptococci were seen in 7 patients (4 on erythromycin, 3 on penicillin). In another 6 patients (3 on erythromycin, 3 on penicillin), antibiotic treatment was switched owing to persisting symptoms, probably due to H. Influenzae infection in 3 cases. The patients' own estimates of their symptoms suggested treatment with erythromycin to have a more rapid effect than treatment with penicillin.

Acute Disease↗
PubMed1990

Prescription of antibiotics to out-patients in hospital clinics, community health centres and private practice.

Prescription of antibiotics in Sweden varies between countries within a range of 13-20 DDD/1000 inhabitants/day. In Malmöhus county, which accounts for the highest prescription rate, the amounts and proportions of erythromycin and tetracyclin prescribed are particularly large. All prescriptions for antibiotics dispensed in half of the pharmacies in the county during a one-week period were examined with respect to type of antibiotic and category of physician responsible for the prescription. Among 5,165 antibiotic prescriptions examined, broad spectrum antibiotics were more frequent in urban than in rural areas, and were more often prescribed by hospital physicians and private practitioners than by district physicians. Erythromycin was particularly often prescribed by paediatricians, the frequency being comparable to that of phenoxymethylpenicillin. Retrospective analysis of consultations at the ENT and paediatric clinics for respiratory tract infections showed that phenoxymethylpenicillin was not always the drug of choice by hospital physicians, despite a recommendation to that effect by the Board of Health and Welfare. The findings suggest that the choice of antibiotics is determined not only by medically relevant factors and Board recommendations but also by the habits of the consulting physicians.

Anti-Bacterial Agents↗
PubMed1990

Decreased absence due to infectious diseases in children at two day care centres over an eight-year interval.

Causes of absence were recorded at two day care centres during a seven-month period in 1979/80 and a corresponding period in 1987/88, for 82 and 87 children, respectively. During the eight-year interval absence due to disease decreased from 8.2% to 5.7% of total day-care days. A decrease in epidemic diseases during the eight years was evident. There were no cases of morbilli, parotitis or rubella in 1987/88, following an immunisation programme for these diseases initiated in 1982. An out-break of varicellae occurred in 1979/80, as compared with only few cases in 1987/88. Respiratory tract infection was the most common type of illness both in 1979/80 and in 1987/88. The mean number of illness episodes of respiratory tract infections per child, aged 5-6, was significantly higher in the earlier than in the later period, whereas no corresponding difference was evident for the younger age groups. Although, in the meantime parent benefits for home care of sick children had become more generous, attendance at the two day care centres rose from 62% in 1979/80 to 79% in 1987/88 of total day-care days, suggesting a truly decreased morbidity. The carriage rates of pneumococci, Haemophilus influenzae and Branhamella catarrhalis decreased with increasing age of the children, and that of beta-haemolytic streptococci increased; however, the carriage rates during the two periods did not differ significantly. The overall isolation frequencies of these bacteria were 72%, 43% and 38%, respectively, for children aged 1-2, 3-4, and 5-6 years, and 5.9% for the staff.

Absenteeism↗
PubMed1990

Quantification of nasopharyngeal bacteria for diagnosis of respiratory tract infection in children.

Agreement between clinical signs of bacterial respiratory tract infections and quantities of respiratory tract pathogens in nasopharynx was studied in 77 children, aged 6-13 years. Specimens were obtained from 27 clinically bacterial and 51 clinically non-bacterial respiratory tract infections, and in 124 instances from healthy children. Viable counts of Streptococcus pneumoniae, Haemophilus influenzae, Branhamella catarrhalis, and beta-haemolytic streptococci were made from swab specimens suspended in saline before being plated on agar media. The frequency of these species in children with clinically bacterial, non-bacterial and no signs of respiratory tract infections were 85%, 47% and 26%, respectively. Bacterial counts greater than 10(4) colony-forming units (CFU)/ml of the pathogens occurred in 59% of clinically bacterial infections, as compared with 18% in clinically non-bacterial infections (p less than 0.001), the corresponding figures for counts greater than 10(3) CFU/ml being 85% and 41% (p less than 0.01), respectively. At neither level of bacterial count (i.e. greater than 10(4) or greater than 10(3], was there a significant difference between the healthy and those with a clinically non-bacterial infection. The quantification of bacteria in nasopharyngeal samples may thus be of clinical diagnostic value.

Bacteria↗
PubMed1990

The diagnosis of bacteriuria during pregnancy.

Three diagnostic tests, Nitur, Urobact, and Uricult, were evaluated in the detection of bacteriuria in 865 pregnant women. As reference method agar culture was performed. Heavy growth (greater than 10(5) CFU/ml) of urinary tract bacteria was considered a true positive result and demonstrated in 58 (6.7%) of the women, 14 of whom had gram-negative rods. The sensitivity of the nitrite test was extremely low (0.13). The test gave negative results in eight of 17 specimens yielding heavy growth of Escherichia coli or Proteus mirabilis. Although the Urobact test was highly sensitive as regards gram-negative infection, it had an unacceptably low (0.27) predictive value in positive tests. The sensitivity of the Uricult test was low (0.35) in this study. The predictive value (0.50) of a positive test result may be acceptable, since just over half of the false positive results were explainable by moderate growth of urinary tract pathogens (10(4)-10(5) CFU/ml). It is argued that semi-quantitative urine culture may be preferable to the rapid diagnostic methods studied for the screening of bacteriuria in pregnant women.

Agar↗
PubMed1990

Decentralized laboratory testing: attitudes of physicians and medical students.

Attitudes regarding the use of decentralized laboratory testing were examined in two groups of district physicians (DP; n = 15), a group of physicians undergoing postgraduate training as specialists in general medicine (PP; n = 17), and a group of medical students who had completed five years of basic studies (MS; n = 15). A sorting test was employed involving 56 cards with names of laboratory tests presently or soon available for use within primary health care. The DPs showed a relatively high consensus concerning which analyses were needed most for near-to-patient testing. MSs (who had a basically hospital-oriented education) differed from DPs and PPs in emphasizing the need for a greater number of directly available tests in primary health care. The differences probably reflect differences in clinical experience. The importance of practically oriented education is stressed.

Attitude of Health Personnel↗
PubMed1989

Reduction in antibiotic usage following an educational programme.

The past decade has seen a steady increase in the consumption of antibiotics in Sweden, most of which are prescribed for respiratory tract infections. Trends in the prescribing of antibiotics for respiratory tract infections at the community health centre in Höör, southern Sweden, analysed before and after an educational programme, showed a significant reduction in the use of antibiotics, 67.6% of patients (n = 216) having been prescribed antibiotics before the programme in contrast to 43.9% (n = 212) afterwards. The reduction was particularly marked with regard to erythromycin and broad-spectrum antibiotics, and in cases of rhinitis/rhinopharyngitis, pharyngitis and bronchitis. On an annual basis, the reduction was equivalent to 2.5 defined daily doses per 1000 inhabitants per day. The study has shown that a reduction in antibiotic usage for respiratory tract infections can be achieved without changing the indications for antibiotic treatment.

Anti-Bacterial Agents↗
PubMed1989

Cefadroxil as an alternative to metronidazole in the treatment of bacterial vaginosis.

A randomized single-blind study was performed to compare the efficacy of cefadroxil to that of metronidazole in the treatment of bacterial vaginosis. 22 women completed the study with follow-ups after 1 and 4 weeks. After completion of treatment 2/11 women receiving metronidazole still had bacterial vaginosis compared with 1/11 women receiving cefadroxil. At follow-up after 4 weeks 3/10 women treated with cefadroxil had recurrent bacterial vaginosis while the corresponding figures for metronidazole were 2/9.

Adult↗
PubMed1988

Beta-lactamase production in the upper respiratory tract flora in relation to antibiotic consumption: a study in children attending day nurseries.

The occurrence of beta-lactamase production in Haemophilus influenzae, Branhamella catarrhalis and Moraxella nonliquefaciens was compared in 191 healthy children attending day nurseries in 2 municipalities differing with regard to the prescription rate of beta-lactam antibiotics. A significantly higher frequency of beta-lactamase production was recorded in M. nonliquefaciens isolated in the municipality with the higher prescription rate. A corresponding difference was not recorded for H. influenzae or B. catarrhalis. Approximately 75% of the nasopharyngeal pathogens H. influenzae, B. catarrhalis and Streptococcus pneumoniae, as well as the commensal M. nonliquefaciens, were eliminated and often replaced by other strains of either species over a period of one month. Although none of the children were on antibiotics a substantial proportion of the acquired strains produced beta-lactamase. This suggested that the carrier rate of beta-lactamase producing strains of the respiratory tract is not only related to the effect of recent antibiotic treatment but also to the prevalence of such strains in the population.

Anti-Bacterial Agents↗
PubMed1987

Bacterial vaginosis: microbiological and clinical findings.

A prospective study was performed involving 101 women who consecutively attended a primary health care unit for complaints of genital malodour and/or abnormal vaginal discharge. Bacterial vaginosis was diagnosed in 34 women on the basis of four diagnostic criteria: vaginal pH greater than 4.7, homogeneous vaginal discharge, a positive amine test and clue cells. The sensitivity of these criteria was greater than 90% except for homogeneous discharge (82%). Their specificity was greater than 90% except for vaginal pH greater than 4.7 (46%); a specificity of 87% could have been achieved by using the criterion for vaginal pH greater than or equal to 5.0. There was a strong association between diagnosis of bacterial vaginosis and the concomitant occurrence of Gardnerella vaginalis, Mobiluncus spp. and Bacteroides spp. There was no difference between women with or without bacterial vaginosis as regards contraception methods (except for use of an intrauterine device), age at first intercourse, or earlier episodes of vaginal discharge. Sexual transmission of the predominant bacteria was not supported by data collected from the male consorts.

Adolescent↗
PubMed1987

Causes of frequency and dysuria in women.

Bacteria in excess of 10(4) colony-forming units per ml (CFU/ml), were isolated from voided urine specimens from 127 (79%) of 160 women, 15-45 years of age, consulting in general practice due to frequency and dysuria. Escherichia coli was the species most frequently isolated, followed by Staphylococcus saprophyticus. Chlamydia trachomatis was isolated from 8 (5%) patients, in 6 of whom greater than 10(4) CFU/ml urine were isolated. A 2-fold titre increase in micro-immunofluorescence antibodies to C. trachomatis was demonstrated in 8 cases, the organism itself being isolated in 1 case only. No viruses were isolated in any of 18 women with negative urine cultures. Proteinuria and/or haematuria was found more frequently in patients with S. saprophyticus than in patients with gram-negative rods. Tests for nitrite indicated bacteriuria in only 58% of the patients with greater than 10(4) CFU/ml urine, which can be partly explained by the fact that S. saprophyticus only occasionally reduces nitrate. Cocci were noted in urine sediment in 75% of patients in whom S. saprophyticus was isolated.

Adolescent↗
PubMed1986

Chlamydial infections in children: a seroepidemiological study.

A seroepidemiological study was conducted in 329 Swedish children aged 3-12 years, some of whom had upper respiratory tract infections, in order to determine the prevalence of serum IgG and IgM antibodies to Chlamydia trachomatis in this age group. Serum antibodies were detected by microimmunofluorescence assay. IgG antibodies were found in 28 (8.5%) of the children; titers were greater than or equal to 1:16 in 15 children (4.6%). Their prevalence in boys (9.4%) and girls (7.6%) was not significantly different. IgM antibodies were found in only six children. Their peak prevalence occurred in boys at the age of 8, and in girls at the age of 12. The serological findings are discussed in the light of current knowledge about chlamydial infections in children and the specificity of chlamydial antibody tests.

Age Factors↗
PubMed1985

Antibody-coating and haemagglutination by Staphylococcus saprophyticus.

Cocci coated with IgG, IgA and IgM occurred in 21, 20 and 9 of 28 urine specimens, respectively, containing Staphylococcus saprophyticus. There was no correlation between the occurrence of antibody-coated cocci and symptoms from the upper or lower urinary tract. Nor was antibody-coating correlated to the occurrence of proteinuria or haematuria. Antibody-coated cocci occurred more often, however, in patients with symptoms for 7 days or more than in patients with symptoms for a shorter duration. Direct haemagglutination of sheep erythrocytes was demonstrated in 30 of 61 washed urine sediments containing S. saprophyticus. There was a significant correlation between non-haemagglutinating specimens and the occurrence of antibody-coated bacteria in these specimens.

Antibodies, Bacterial↗