Flavobacterium meningosepticum meningitis in a newborn infant. Treatment with intraventricular erythromycin.
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Cerebral Ventricles↗
Biomedical subjects
E G Maderazo
Publications and source records attributed to E G Maderazo.
Chloramphenicol: A review of its use in clinical practice.
Chloramphenicol has certain notable characteristics: it penetrates reliably into the central nervous system; it is usually bacteriostatic, but is bactericidal for Hemophilus influenzae, Streptococcus pneumoniae, and Neisseria meningitidis; it is metabolized in the liver, and levels of drug in serum need to be monitored in patients with liver disease and in neonates. Potential toxicity limits the use of this drug. It has been estimated that death from aplastic anemia occurs in oe of 24,500-40,800 courses of treatment. The incidence of aplastic anemia after parenteral therapy is unknown; however, only a few cases have been reported. The gray baby syndrome occurred in premature and newborn infants receiving high or unmodified doses of chloramphenicol. This condition can be avoided by reduction of dosage and by monitoring levels of drug in the serum of these infants. The most common toxicity is a reversible, dose-related bone marrow suppression, which is identified by serial monitoring of reticulocyte and complete blood cell counts. Many of the indications for use of this drug are still controversial because studies comparing the toxicity and efficacy of chloramphenicol and of alternative antibiotics have not been done.
Anemia, Aplastic↗
Effects of intravenous fat infusion on neonatal neutrophil and platelet function.
Intravenous fat (Intralipid) is used extensively as a major component of parenteral nutrition for patients in the neonatal intensive care unit. Abnormalities of polymorphonuclear leukocyte (PMN) and platelet number or function related to Intralipid infusion have been reported although conflicting results exist. In order to examine potential adverse hematologic effects of Intralipid, 10 ill neonates were studied before and after a 16-hr infusion of 1 g/kilo of Intralipid. PMN count, chemokinesis, chemotaxis, and aggregation were unchanged pre- and post intralipid infusion. Platelet count, bleeding time, and platelet aggregation were also unchanged. Similar results were obtained in vitro when neonatal and adult PMNs and platelets were incubated in Intralipid and their function analyzed. These findings suggest that short-term, low-dose Intralipid has no measurable impact on neonatal PMN or platelet activity and support its use in neonates even in the presence of infection or thrombocytopenia.
Blood Platelets↗
Institution-specific patterns of infection and Gram's stain as guides for empiric treatment of patients hospitalized with typical community-acquired pneumonia.
STUDY OBJECTIVE: To determine the appropriateness of cefazolin as empiric treatment of typical, as opposed to atypical, bacterial community-acquired pneumonia at our institution. DESIGN: Combination of retrospective chart review and prospective determination of microbial susceptibilities and cefazolin-associated cost savings. SETTING: General acute-care referral hospital. PATIENTS: We evaluated the charts of patients discharged with a diagnosis of community-acquired pneumonia over a 10-year period. Gram's stains and culture results of sputum samples processed over 2 months were analyzed to determine the ability of the stains to predict positive Haemophilus influenzae cultures. The susceptibility and beta-lactamase status of clinical isolates of H. influenzae were determined. Cost savings of cefazolin as empiric treatment for community-acquired pneumonia were evaluated. MEASUREMENTS AND MAIN RESULTS: The frequency of H. influenzae pneumonia at our institution was 15% of the three major bacterial community-acquired pneumonias. Gram's stain was highly accurate in predicting the presence or absence of Haemophilus sp in sputum. Five patients had positive outcomes with cefazolin treatment despite being diagnosed with H. influenzae pneumonia. The organism isolates demonstrated intermediate sensitivity to cefazolin and 85% were beta-lactamase negative. Our program that encourages empiric use of cefazolin over cefuroxime for typical bacterial community-acquired pneumonia has allowed a modest projected annual cost savings of $24,000. CONCLUSIONS: We concluded that when Gram's stain of sputum does not show Haemophilus sp in patients with typical bacterial community-acquired pneumonia, empiric treatment with cefazolin is appropriate and results in cost savings.
Adult↗