Biomedical subjects
Publications and source records attributed to N Aswapokee.
A 20-year-old woman receiving corticosteroid treatment for systemic lupus erythematosus developed pulmonary nocardiosis with hydrophneumothorax. The organism identified as Nocardia asteroides resisted to sulfonamide and cotrimoxazole but sensitive to chloramphenicaol and streptomycin in vitro. She seemed to respond to chloramphenicol but subsequently had peritonitis and succumbed later.
A 24-year-old Thai woman receiving corticosteroid treatment for systemic lupus erythematosus, developed pulmonary nocardiosis after pulmonary collapse. The correct diagnosis was reached when dissemination had occurred which was characterized by two subcutaneous abscesses and acute uveitis of the right eye. Gram stain of sputum and pus revealed delicate, branching, Gram-positive filamentous mycelia which were identified as Nocardia asteroides on culture. Subcutaneous abscesses and exophthalmos disappeared after one week of therapy and she made an uneventful recovery.
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Inappropriate use of antimicrobial agents has been found to be common in various parts of the world, but there have been few studies in developing countries. In Siriraj Hospital, Mahidol University, the largest university Hospital in Thailand, a study was performed to estimate the appropriateness of the use of antimicrobial drugs. Each of the nine medical wards was sampled in random order, and daily surveillance of all patients over two 2-week periods identified 307 of the total 690 patients to have been prescribed an antibiotic. In only 27 of the 307 patients was the use of antibiotics entirely appropriate. The main problem was the use without evidence of infection (in 110 of the 307 patients), which we estimate would result in the loss for the hospital of approximately $40,000 (U.S.) each year on the medical wards alone. The choice of antimicrobial agents and pharmacokinetic considerations were also inappropriate. Use of expensive drugs where cheaper ones were available, however, was not frequent (71 of the 655 prescriptions). Attempts to rectify antimicrobial misutilization, based on the results of this study, can be focused specifically at improving clinical recognition of infectious disease by education. The pattern of antimicrobial use in a university teaching hospital in Bangkok, Thailand, reflects a high proportion of misuse. The need for rationalization of antimicrobial use is urgent.