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Biomedical subjects

R F Jacobs

Publications and source records attributed to R F Jacobs.

143 records · Page 8Linked to original sources
PubMedDate not supplied

Nosocomial pneumonia in children.

Nosocomial pneumonia continues to be a leading cause of fatal nosocomial infection in the United States. Although there are differences in pathogens by age, the importance of nosocomial pneumonia is apparent in the adult population as well as in the pediatric patient groups. The ability to diagnose these infections utilizing clinical suspicion and microbiologic/rapid diagnostic tests will allow the clinician to effectively treat nosocomial pneumonia in the critically ill patient. Unfortunately, these treatment modalities and preventive measures have not kept pace with our understanding of the pathogenesis of this infection. The pediatric patient population presents several unique and specific infection control, diagnostic and treatment problems for the practicing clinician. The appropriate infection control and isolation policies for specific viral and multiple antibiotic resistant bacterial isolates remains a cornerstone in the prevention of nosocomial pneumonia. The judicious use of empiric antibacterial chemotherapy remains important in the treatment of patients with nosocomial pneumonia. However, in the pediatric patient population the recognition that viral and fungal etiologies are important causes of nosocomial pneumonia challenge the clinician to apply the appropriate diagnostic and effective treatment regimens in pediatric nosocomial pneumonias. The epidemiologic data for the clinician's own institution in regards to etiologic causes of nosocomial pneumonia, drug susceptibility patterns as well as the seasonal and patient distribution of these infections are critical. Nosocomial pneumonia will continue to remain a significant cause of morbidity, mortality, and hospital cost in the United States in the upcoming decades. The advent of new rapid diagnostic testing and improved treatment modalities for effective therapy and prevention will be aided by the advent of immunologic therapy for these disease states.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMedDate not supplied

Cefotaxime pharmacokinetics and treatment of meningitis in neonates.

Pharmacokinetic studies on cefotaxime/desacetylcefotaxime were carried out in very low birth weight newborns (n = 18; 500-1500 g; 28.4 +/- 2.4 weeks gestational age) during the first week of life. We have previously reported that the elimination t 1/2 of cefotaxime (3.4-6.4 h) and desacetylcefotaxime (9.4 h) was longer than previously described in term infants and children. In very low birth weight neonates, a single 50 mg/kg daily dose of cefotaxime may produce accumulation of the metabolite desacetylcefotaxime in serum. In a non-comparative prospective clinical trail, 22 infants (one week - three months) were treated for gram-negative enteric bacillary meningitis with cefotaxime at a dosage of 50 mg/kg/day. The predominant pathogen was Escherichia coli in 14 cases and Enterobacter cloacae in four cases. Cultures of the cerebrospinal fluid obtained 24-48 h after the initiation of treatment were sterile in all subjects. Survival and complication rates of 95% and 19%, respectively, were observed. This compared favorably to previously published experiences with alternative treatment regimens for neonatal gram-negative enteric meningitis. In both the pharmacokinetic and meningitis studies, the safety profile for cefotaxime was excellent with no adverse reactions.

Cefotaxime↗
PubMedDate not supplied

Ceftazidime versus ceftazidime plus tobramycin in febrile neutropenic children.

Although the effectiveness of antibiotic monotherapy in febrile neutropenic patients remains unproven, ceftazidime has been shown previously to be effective monotherapy for the empiric treatment of selective patients. The efficacy and safety of ceftazidime versus ceftazidime plus tobramycin was evaluated in the treatment of febrile children (range 8 months to 18 years) with neutropenia secondary to cancer chemotherapeutic agents. Of the evaluable 89 patients, 45 received ceftazidime and 44 received ceftazidime plus tobramycin for 5 to 10 days. At the end of therapy, 30 (67%) of the 45 ceftazidime-treated patients were clinically cured compared with 38 (86%) of 44 combination-treated patients. Thirteen (29%) of the patients treated with ceftazidime failed to respond clinically to treatment, versus four (9%) of the patients treated with ceftazidime/tobramycin (p = 0.046). This study suggests that ceftazidime as monotherapy in febrile neutropenic children may be inferior to combination therapy for optimal clinical response in these patients.

Adolescent↗
PubMedDate not supplied

Group C beta-hemolytic streptococcal endocarditis: report of a pediatric case.

A 9-year-old boy with a ventricular septal defect and a bicuspid aortic valve developed bacterial endocarditis due to group C streptococci. He responded to an initial antibiotic regimen of nafcillin plus gentamicin and was cured by the use of penicillin G following the isolation of the organism. The unusual nature of this case is discussed and physicians are cautioned to recognize this organism as a potential cause of infectious endocarditis in the pediatric population.

Aortic Valve↗
PubMedDate not supplied

Cefotaxime and desacetylcefotaxime in neonates and children: a review of microbiologic, pharmacokinetic, and clinical experience.

Over the past 5 yr, we have conducted two clinical and two pharmacokinetic investigations of cefotaxime (CTX) and desacetylcefotaxime (dCTX) in neonates, infants, and children. A total of 50 children with culture-proven bacterial meningitis were randomized to receive either 200 mg/kg/day of CTX (n = 23, mean age 24.4 mo) or standard doses of ampicillin (AMP) and chloramphenicol succinate (CAPS; n = 27, mean age 16.6 mo). Results were similar between the CTX and Amp/CAPS groups for clinical/microbiological cures (100% versus 96%, respectively) and for survival without sequelae (78% vs. 77%, respectively). All bacterial isolates were sensitive to CTX, and the comparison of the MIC/MBC values for CTX to the CSF bactericidal titers suggested antimicrobial activity for dCTX. In a second clinical trial, 20 infants (1 wk-3 mo) were treated with 200 mg/kg/day of CTX for Gram-negative enteric bacillary meningitis. Cultures of CSF obtained 24 hr after the initiation of treatment were sterile in all subjects. Survival and complication rates of 95% and 21%, respectively, were observed. This compared favorably to previously published experiences with alternate treatment regimens for Gram-negative meningitis in the newborn. In both meningitis studies, the safety profile for CTX was excellent.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Recurrent meningococcal meningitis caused by poly groups X-W135: importance of chemoprophylaxis.

Presented is a case report and literature review of the causes of recurrent meningococcal meningitis. After all factors were analyzed, the cause of reinfection in this child was postulated to be ineffective chemoprophylaxis of close contacts following the initial episode. The efficacy of chemoprophylaxis in household members and close contacts in meningococcal disease, although not demonstrated in controlled trials, has been recommended since 1974 by the Meningococcal Disease Surveillance Group. Considering known carriage rates, reports of secondary infections in close contacts, reinfection in the same person, and a high case fatality ratio, chemoprophylaxis in such cases seems justified.

Adult↗
PubMedDate not supplied

Frozen deglycerolyzed blood prevents transfusion-acquired cytomegalovirus infections in neonates.

Frozen deglycerolyzed blood (FDB) was used for routine transfusions to 63 low birth weight newborns (less than or equal to 1500 g) over a 12-month period in an effort to decrease transfusion-acquired cytomegalovirus (CMV) infections. Nine of the 63 infants also received nonfrozen blood products (platelets, liquid blood). Seventy-two percent of the donor blood units were CMV-seropositive. Urine cultures and serum titers for anti-CMV antibody (immunoglobulins G and M) were obtained prior to the initial transfusion and sequentially throughout the study. No infant (0 of 54) who received only FDB acquired CMV, whereas 3 of 9 infants (33%) who received non-frozen blood and FDB acquired CMV, as evidenced by CMV viruria and/or a 4-fold rise in immunoglobulin G anti-CMV antibody titers. These results suggest that transfusions with frozen deglycerolyzed blood decrease the risk in low birth weight infants of acquiring CMV, regardless of the CMV serologic status of the donor.

Antibodies, Viral↗
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Group A streptococcal postvaricella osteomyelitis.

Osteomyelitis as a complication of varicella has been rarely reported. We report two individual cases of postvaricella osteomyelitis in which group A beta-hemolytic Streptococcus was implicated. In the first case group A beta-hemolytic Streptococcus was isolated from blood cultures and bone aspirate cultures from the femoral metaphysis. The second case of postvaricella osteomyelitis involved the distal fibula and was diagnosed by characteristic radiographic changes in the distal fibula, a positive bone scan, purulent varicella lesions that contained group A beta-hemolytic Streptococcus, and a prompt response to penicillin therapy. These cases have implications for the choice of appropriate antimicrobial therapy in the treatment of osteomyelitis complicating varicella.

Chickenpox↗
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Endotracheal tobramycin in gram-negative pneumonitis.

This report describes the treatment of resistant gram-negative pneumonitis in a compromised host by the combined use of intravenous and endotracheal tobramycin. The endotracheal administration appeared to have an effect on the serum concentration and elimination rate, necessitating a reduction in the amount of drug given intravenously. The only apparent clinical complication of endotracheal drug administration was transient coughing. The addition of endotracheal aminoglycosides to intravenous antibiotics may be useful in pediatric patients with unresponsive (or other difficult-to-treat) pneumonitis caused by resistant microorganisms. The potential contribution of endotracheal aminoglycosides to the serum level and/or disposition profile must be recognized, and therapeutic drug monitoring guided accordingly when this route of administration is used.

Adolescent↗
PubMedDate not supplied

Treatment of tuberculous infection and disease in children: the North American perspective.

The standard preventive therapy for paediatric patients with tuberculous infection centres on isoniazid therapy. The chosen regimen of isoniazid therapy is based on individual patient factors. In the case of known or suspected resistance, combination therapy [e.g. isoniazid and rifampicin (rifampin)] or alternative therapies (e.g. pyrazinamide, a fluoroquinolone and/or ethambutol) should be employed. The goal of treatment of tuberculous disease is to achieve sterilisation in the shortest possible time. More intensive multiple drug combination regimens (e.g. isoniazid, rifampicin and pyrazinamide) have resulted in successful 6- and 9-month treatment regimens in children. If drug resistance is suspected then a fourth drug is added to the initial treatment regimen and the length of therapy may be extended to 18 months. The paediatric information available on the commonly used antituberculous agents (e.g. isoniazid, rifampicin, pyrazinamide and ethambutol) is reviewed in this article. Agents are described with an emphasis on their formulation availability, mechanism of action, pharmacokinetic properties (e.g. absorption, distribution, metabolism and elimination), adverse effects, and interactions (e.g. drug-drug, drug-food and drug-disease).

Antitubercular Agents↗
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CT and ultrasound imaging of retropharyngeal abscesses in children.

PURPOSE: To show the role of ultrasound (US) in distinguishing retropharyngeal abscess from adenitis in children. METHODS: Eleven infants and children had clinical symptoms suggestive of retropharyngeal infection. Radiographic evaluation included, lateral neck radiography (11/11), contrast-enhanced neck CT (10/11), contrast-enhanced neck MR (1/11), and real time US (11/11) patients. US was used to characterize masses as solid (adenitis) or complex (abscess) and for guiding intraoperative aspiration and drainage. RESULTS: Contrast CT and MR showed findings suspicious for abscess in all 11 cases. Only three children had surgically drainable abscesses. CT numbers within inflammatory masses did not distinguish adenitis from abscess. US was able to correctly diagnose abscess or adenitis in each case. CONCLUSION: Lateral neck radiography and contrast CT identify and localize retropharyngeal inflammatory masses in children. US, but not CT, distinguishes between adenitis and abscess and aids in intraoperative aspiration and drainage.

Abscess↗