Search PubMed⌕ Search

Biomedical subjects

F Sereni

Publications and source records attributed to F Sereni.

At least 37 records · Page 2Linked to original sources

Control of antibiotic therapy in paediatric patients. II. Appropriateness of antibiotic choice in selected diseases.

The adequacy of antibiotic choice and the importance of the physician's knowledge of antibiotic use in causing errors in prescribing were investigated. A prospective three-month study was conducted in nine Italian pediatric hospital wards, involving every patient admitted to hospital for otitis, pneumonia or pharyngotonsillitis. The suspected aetiology and the antibiotic prescribed were recorded on a special form by the physician in charge. Each choice of antimicrobial agent was judged as adequate, justifiable or not justified. Out of 314 prescriptions 56.1% were assessed as adequate, 4.1% as justifiable and 39.8% as not justified. Analysis of the suspected bacteria, and of the correlation between the presumed aetiological agent and the prescribed antibiotic, demonstrates that inadequate knowledge of the physician plays a major role in producing a high percentage of unjustified prescriptions.

Anti-Bacterial Agents↗

Control of antibiotic therapy in pediatric patients. I. A computer system to collect and analyze antibiotic prescriptions in hospitals.

A computer system to record and analyze antibiotic prescriptions in hospitalized children is described. This system is especially organized in order to obtain simultaneously a quantitative evaluation of antibiotic use and a qualitative analysis of the process by which the physician makes his decision for therapy. The practical employment of this program has been demonstrated by analyzing 765 prescriptions given in nine different pediatric hospital wards. Many errors of prescription have been demonstrated: antibiotic therapy was based on the clinical impression alone in 31.5% of the prescriptions, antibiotic choice was rational in 20.1% and the posology prescribed complied with the usually applied schemes in 22.4%. Finally, the physician's attitude regarding laboratory monitoring of side effects was adequate in 52.8% before treatment and 33.4% during antibiotic treatment.

Aging↗

Multiexponential elimination of gentamicin. A kinetic study during development.

The long-term disposition of gentamicin (up to 100-240 h) was studied in 13 premature newborns (33 weeks mean gestational age) and in 7 infants and children (1 month to 8 years). The data fitted bi- or triexponential curves with terminal half-lives averaging 51 and 37 h. Newborns showed lower values of body clearance, central compartment and steady state volumes of distribution than infants and children (respectively, 12.8 vs. 50.4 ml/min/1.73 m2, 9.03 vs. 17.5 liters/1.73 m2, and 15.7 vs. 35.5 liters/1.73 m2). The ratio between the amount of gentamicin predicted at steady state in the tissue compartment and in the total body was also significantly lower in newborns than in the older group (0.4 vs. 0.52). These data provide pharmacokinetic demonstration of an age dependence in gentamicin tissue distribution and excretion during the early stages of human development.

Adult↗

Kinetics and efficacy of theophylline in the treatment of apnea in the premature newborn.

Aminophylline (theophylline-ethylenediamine) was administered to 27 premature newborns to prevent apneic spells. Of the 22 patients monitored for theophylline concentration, a therapeutic blood level was reached in 19 in 1--2 days, and 3 stayed below it. "Toxic" blood levels (less than or equal to 20 microgram/ml) were reached in 3 cases, one of whom showed signs of toxicity. Theophylline treatment was not efficient in the prevention of apnea when a serious underlying disease was present. Theophylline blood half-life (mean:27.0 h) and clearance (mean 12.9 ml/h/kg) confirmed the slow elimination pattern of the drug in the premature infant.

Apnea↗

Value of monitoring plasma salicylate levels in treating juvenile rheumatoid arthritis. Observations in 42 cases.

Plasma salicylate concentration was monitored in 42 children on long-term salicylate therapy for rheumatoid arthritis. A given dose of salicylate per kg resulted in large variations in plasma levels, both between individuals and for a single individual at different times. The factors responsible for such variations were studied; in 6 cases urinary metabolites of salicylate were analysed. The relation between salicylate dosage and plasma half-life accounts for the fact that small changes in dosage can result in large changes in plasma concentration. The addition of corticosteroid or ACTH therapy results in lower plasma levels of salicylate, and necessitates higher dosage of salicylate. After the introduction of routine monitoring of plasma salicylate, the incidence of toxic symptoms fell sharply.

Adolescent↗

Gentamicin dosage in preterm and term neonates.

Pre-dose and peak serum levels of gentamicin were measured in 82 neonates (25-42 weeks' gestational age), and for comparison in 10 infants and 9 children. Dosage was 2-2.5 mg/kg twice daily for the neonates, and three times daily for infants and children. Neonates were subdivided according to gestational age and weight. Serum levels of gentamicin were very variable in all groups. Preterm neonates of low gestational age (25-30 weeks) showed a 66% incidence of pre-dose levels exceeding 1 microgram/ml, indicating possible accumulation. In the less premature neonates this incidence was still 20-29%. The level of 4 microgram/ml, the minimum concentration required to inhibit most of the bacteria sensitive to gentamicin, was reached in increasing numbers of neonates as their gestational age rose (from 30% in the 31- to 35-week gestational age group, to 60% at term); those small-for-gestational age had consistently lower levels. It is concluded that term neonates require dosage to be individualized and serum levels of the drug to be monitored.

Body Weight↗

Placental transfer to diazepam and its disposition in the newborn.

Diazepam (DZ) placental transfer in pregnant women at term, following single or repeated drug administration by various routes, was evaluated. DZ and its metabolite N-demethyldiazepam (NDZ) were constantly present in umbilical cord plasma at concentrations comparable to the mother's shortly after drug administration. N-methyloxazepam (MOX) was detected in cord plasma only in a limited number of cases following chronic DZ treatment. Postmortem analysis of fetal tissue concentrations showed accumulation of NDZ in heart and lungs. Differences in NDZ concentrations between venous cord (VC) and arterial cord (AC) plasms suggest metabolic degradation of DZ in the fetus. The DZ apparent plasma half-life in the newborn was found to be longer (31 plus or minus 2 hr) than previously observed in infants and children. The low drug clearance appears to be linked to reduced urinary excretion of hydroxylated metabolites, suggesting limited capability to dispose of DZ in the newborn.

Administration, Oral↗