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Biomedical subjects

U B Schaad

Publications and source records attributed to U B Schaad.

155 records · Page 9Linked to original sources
PubMedDate not supplied

Nalidixic acid in children: retrospective matched controlled study for cartilage toxicity.

The new fluoroquinolones allow effective oral therapy of infections due to Pseudomonas aeruginosa. Studies on efficacy and safety of these promising agents are not recommended in childhood because of cartilage toxicity which has been observed in growing animals. However, the first quinolone antimicrobial, nalidixic acid, showed identical arthropathic effects in young animals and is licensed for paediatric use. A review of the hospital charts revealed 11 patients who had received nalidixic acid over nine to 600 days and were available for control examination three to 12 years later. For each nalidixic acid case a carefully selected matched pair, who had never received nalidixic acid, was identically analyzed. Three patients from the nalidixic acid and three from the control group reported arthralgia, which was judged to have no relation to drug therapy. Growth curve and both functional and radiological joint findings were completely normal in all cases. These results suggest that quinolone-associated arthropathy does not occur in children, even after long-term therapy.

Cartilage Diseases↗
PubMedDate not supplied

Arthritis in disease due to Neisseria meningitidis.

Three clinical types of arthritis in meningococcal disease are presented; their classification is based on a review of the literature from 1887 and on experience with pediatric patients treated in Dallas, Texas. The most common type is arthritis complicating acute meningococcal disease; it occurred in 1,180 of the patients reviewed or approximately 5% of children and 11% of adults with meningococcal disease. Septic or allergic pathogenesis was documented in fewer than 5% of these, 1,180 patients. However, the search for an immunologic basis, conducted in a small number of patients, produced results suggesting that immune complexes are involved in many patients with sterile effusions. Large joints, especially the knee, were involved in 95% of the cases, and almost half the patients had polyarthritis. Chronic meningococcemia, an infrequently reported clinical entity, was accompanied more often by arthralgia than arthritis. Primary meningococcal arthritis, which is a rare form of acute septic arthritis, affected large joints almost exclusively and was polyarthritic in about one-third of cases. The management was the same for all types of meningococcal arthritis and consisted primarily of specific antimeningococcal chemotherapy. Evacuation of pus is recommended, since this treatment may be expected to shorten the relatively long symptomatic course. The prognosis for patients with meningococcal arthritis is excellent, and joint residua are rare.

Adult↗
PubMedDate not supplied

Single-dose pharmacokinetics of intravenous sulbactam in pediatric patients.

The pharmacokinetics of intravenously administered sulbactam were studied in 17 pediatric patients two to 14 years of age. Single doses of 12.5 or 25 mg/kg were infused over 3 min, and in previously healthy children, mean peak plasma concentrations 5 min after dosing were 71 and 163 micrograms/ml, respectively. Noncompartmental and compartmental calculations resulted in similar pharmacokinetic parameters. Linear pharmacokinetics were found in the concentration range studied. The mean terminal-phase half-life was 1.75 hr, the mean total plasma clearance was 180 ml/min per 1.73 m2, and the mean apparent volume of distribution was 340 ml/kg. Approximately 70%-80% of an intravenous dose was excreted unchanged in the urine. In children with cystic fibrosis, both total plasma clearance and apparent volume of distribution were significantly increased. The data support the intravenous administration of 12.5-25 mg of sulbactam/kg every 6 to 8 hr for assessing the adequacy of this drug as an adjunct to beta-lactam therapy for various bacterial infections in children.

Adolescent↗
PubMedDate not supplied

Reactive arthritis associated with Campylobacter enteritis.

Campylobacter jejuni has recently become recognized as a leading cause of diarrhea. To date reactive arthritis has rarely been diagnosed in association with Campylobacter enteritis. Clinical manifestations, diagnostic studies and management of 21 patients with Campylobacter-reactive arthritis are reviewed. The symptom-free interval between diarrhea and arthritis lasts from a few days to several weeks. In two-thirds of the patients sterile joint involvement is multiple, is migratory and includes large joints. Fever and leukocytosis are usually absent, whereas the erythrocyte sedimentation rate is elevated. Positive association with HLA-B27 is found in approximately 60% of cases. Arthritic course is self-limiting and ranges from one week to several months, and prognosis is excellent. These features of Campylobacter-reactive arthritis are consistent with those of reactive arthritis associated with Salmonella, Shigella or Yersinia intestinal infection.

Adolescent↗
PubMedDate not supplied

An extended experience with cefuroxime therapy of childhood bacterial meningitis.

Eighty-four pediatric patients with bacterial meningitis were prospectively evaluated while receiving cefuroxime (200 mg/kg/day in four equal intravenous doses) as single-drug therapy for 9 to 13 days. Six cases were admitted in extremis and died within a few hours because of irreversible central nervous system damage or shock. The remaining 78 patients were cured, and prompt bacteriological and clinical responses were noted. The pathogens were Haemophilus influenzae b (43 cases), Neisseria meningitidis (20 cases), Streptococcus pneumoniae (10 cases) and unknown (five cases). All pathogens were susceptible in vitro to cefuroxime including two strains of beta-lactamase producing H. influenzae. Time to defervescence, incidence and cause of both prolonged and secondary fever, as well as type and frequency of complications and sequelae compared favorably to other series. It is concluded that cefuroxime is effective and safe single-drug therapy for childhood bacterial meningitis beyond the neonatal age group.

Cefuroxime↗
PubMedDate not supplied

Acute streptococcal tonsillopharyngitis: a review of clinical efficacy and bacteriological eradication.

This review evaluates studies published between January 1997 and August 2003 comparing clinical outcome and bacteriological eradication rates for patients with acute streptococcal tonsillopharyngitis treated with penicillin or other antimicrobial agents. Studies were identified using MEDLINE, and clinical outcome and bacteriological eradication at end of treatment and 2 weeks after end of treatment were ascertained. Any longer-term follow-up was also noted, along with treatment-related adverse events and compliance. Clinical efficacy rates between penicillin and comparator antibiotics were generally high and similar. Bacterial eradication rates were more variable and, 2 weeks after treatment, ranged from 64% to 93% for penicillin and 31% to 98% for comparators. Simpler dosing schedules and shorter therapy durations produced higher compliance rates. This review highlights the similarities and differences between treatment with penicillin and a wide range of comparator antibiotics. Therapy for acute group A streptococcal pharyngitis should combine excellent clinical efficacy, high bacteriological eradication rates, good tolerance and a simple, convenient dosing regimen.

Acute Disease↗
PubMedDate not supplied

Pharmacology and efficacy of vancomycin for staphylococcal infections in children.

Vancomycin is effective against most multiply resistant staphylococci, organisms that are becoming increasingly important in clinical medicine. Reported experience with vancomycin therapy in pediatric patients is limited. In this study vancomycin was administered intravenously to 33 patients whose ages ranged from one week to 16 years and who had suspected or proved infections caused by either Staphylococcus aureus or Staphylococcus epidermidis. The spectrum of staphylococcal infections included skin and soft-tissue infections and abscesses, osteomyelitis, pneumonia, shunt infections, endocarditis, and septicemia. All 29 patients with bacteriologically proved staphylococcal infections responded to vancomycin therapy. Peak and trough concentrations of vancomycin in serum produced satisfactory bacteriostatic and bactericidal titers against the infecting pathogens. In an anephric patient hemodialysis removed only negligible amounts of vancomycin. The amount of vancomycin that penetrated into ventricular fluid of 10 patients with shunt infections ranged from 7% to 37% (mean, 18%) of serum concentrations. One case of phlebitis and one case of transient elevation of serum levels of aspartate amino transferase were observed. No renal or otologic damage was detected in any patient. Adequate dilution of the drug, intravenous administration during 1 hr, and monitoring of the concentration in serum of patients undergoing long-term treatment and/or with impaired renal function minimize the likelihood of side effects. Vancomycin is an effective and safe agent for treatment of staphylococcal infections in pediatric patients.

Adolescent↗
PubMedDate not supplied

Use of the new quinolones in pediatrics.

For many years quinolone-induced cartilage toxicity observed in experiments with some skeletally immature animals represented indisputable contraindication for the use of these promising antimicrobials in prepubertal patients. Our clinical, magnetic resonance imaging and histopathological monitoring of ciprofloxacin use, together with the published experiences of other groups, suggest that the quinolone antibiotics do not cause arthropathy in humans. Conditions that potentially qualify for quinolone use (especially ciprofloxacin) in children include oral antipseudomonal (or antistaphylococcal) therapy for pulmonary exacerbation in cystic fibrosis, and for complicated urinary tract, skeletal, aural and shunt infections. In addition to these rare indications, there is an urgent need in developing countries for availability of the new quinolones for treating children with endemic and epidemic shigellosis and invasive salmonellosis. At present these compounds are not approved for pediatric patients; therefore each such treatment must be part of a controlled study or respect the compassionate use regularities.

Adolescent↗