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Biomedical subjects

W E Feldman

Publications and source records attributed to W E Feldman.

29 records · Page 2Linked to original sources
PubMed1978

Effect of prior antibiotic therapy on concentrations of bacteria in CSF.

A prospective study was done to determine the effect of prior antibiotic therapy on concentrations of bacteria in CSF at the time of diagnosis. Concentrations of Haemophilus influenzae type b in CSF of partially treated patients were significantly smaller than in CSF of untreated patients. This was also true of patients with meningococcal meningitis, but no difference was observed between patients with pneumococcal meningitis. The identification of H influenzae by Gram stain of CSF was significantly decreased by prior antibiotic therapy. Measurable levels of antibiotic (penicillins, aminoglycosides) were present in CSF of ten of 23 patients. Two partially treated patients were diagnosed by detection of meningococcal antigen in CSF by counterimmunoelectrophoresis although cultures of CSF were sterile. Both of these patients had measurable levels of penicillin in CSF. These data indicate that prior antibiotic therapy significantly decreases the concentration of H influenzae type b and meningococcus in CSF and therefore decreases the usefulness of CSF Gram stain. Partial therapy may sterilize the CSF of some patients.

Bacteria↗
PubMed1978

Clinical and pharmacokinetic evaluation of nafcillin in infants and children.

Nafcillin (150 mg/kg/day, divided every six hours) was administered intravenously to 46 patients ranging from 5 to 163 months of age with suspected or proved bacterial infections. Thirteen of 15 patients with bacteriologically proved infection responded to nafcillin. Two patients with cellulitis due to Escherichia coli or to Hemophilus influenzae type b did not improve with nafcillin therapy. A mean serum nafcillin concentration of 48 microgram/ml was observed 30 minutes after a dose of 37.5 mg/kg. The mean serum half-life was 0.76 hours. There was no significant relation between age and serum half-life, volume of distribution, or plasma clearance rate. Two patients developed neutropenia and six other patients developed an eosinophilia greater than 400/mm3 while receiving nafcillin. No significant toxic effect of nafcillin on liver or renal function was observed. One patient had phlebitis. There was a significant correlation between nfacillin concentrations and serum inhibitory and bactericidal titers (P less than 0.001). Results from this study indicate that nafcillin is a safe and effective antibiotic for the treatment of infections due to susceptible bacteria in the dosage tested.

Adolescent↗
PubMed1978

Effect of ampicillin and chloramphenicol against Haemophilus influenzae.

Synergy, determined by isobolograms constructed from the minimal inhibitory concentrations of combinations of ampicillin and chloramphenicol, was observed against six of 13 ampicillin-susceptible Haemophilus influenzae type b isolates and against five of eight ampicillin-resistant strains by using a small inoculum of 10(4) colony forming units (CFU) per milliliter. Synergy occurred against nine of 13 ampicillin-susceptible and against two of eight ampicillin-resistant strains using a large inoculum of 10(7) CFU/ml. When synergy was not observed, additive effects occurred against the remainder of isolates. Additive effects were also observed against single strains of chloramphenicol-resistant, nontypeable H. influenzae and H. parainfluenzae. No antagonism was observed. These data indicate that ampicillin and chloramphenicol may be synergistic against a significant number of H. influenzae strains depending on inoculum size, but the effect is unpredictable for a given isolate. These data support the recommendation that ampicillin and chloramphenicol both be used as initial therapy for patients with suspected bacterial meningitis.

Ampicillin↗
PubMed1976

Bacteroides fragilis ventriculitis and meningitis. Report of two cases.

Two patients with Bacteroides fragilis meningitis and ventriculitis were treated. In one infant infection developed at 2 1/2 months of age as a result of an infected ventriculoatrial shunt inserted to treat hydrocephalus. In the second patient ventriculitis and meningitis developed at 20 days of age, while he was convalescing from surgery for gastric perforation that had occurred at 5 days of age. Both patients were treated with ampicillin, chloramphenicol, and clindamycin, which sterilized the blood and lumbar cerebrospinal fluid but not the ventricular cerebrospinal fluid. The first patient received no further antibiotic therapy and died at 5 months of age. Metronidazole therapy sterilized the ventricular fluid of the second patient, who survived the infection. Ventriculitis should be suspected in patients with B fragilis meningitis. A brain scan should be done to detect signs of ventriculitis or brain abscess. Metronidazole may be the drug of choice in patients with B fragilis ventriculitis or meningitis who do not respond to chloramphenicol.

Ampicillin↗
PubMed1976

Concentrations of bacteria in cerebrospinal fluid of patients with bacterial meningitis.

Concentrations of bacteria in cerebrospinal fluid ranged from 4.5 X 10(3) to 3 X 10(8) colony-forming units/ml in 27 patients with bacterial meningitis before antibiotic therapy and from 4 X 10(1) to 1.4 X 10(6) CFU/ml in four patients after one to two days of antibiotic therapy. All patients with persistent positive cultures had pretreatment concentrations of 10(7) CFU/ml or greater. A significant association was observed between cerebrospinal fluid lactic acid dehydrogenase activity and concentrations of bacteria (p less than 0.01). Large inocula of Hemophilus influenzae type b (10(7)) increased the minimal inhibitory concentration for penicillin and ampicillin but not for chloramphenicol. The minimal inhibitory concentration of each of the three antibiotics increased when group B streptococci were assayed. These data indicate that persistence of a positive culture may be related to large initial concentrations of bacteria. The relative "resistance" in vitro of large inocula possibly contributes to this persistence. These observations are also consistent with the hypothesis that lactic acid dehydrogenase activity in cerebrospinal fluid is derived from bacteria.

Ampicillin↗
PubMed1976

Relapse of Hemophilus influenzae type b meningitis after combined antibiotic therapy: report of a case.

Antibiotic therapy of bacterial meningitis is being reevaluated due to reports of ampicillin-resistant strains of Hemophilus influenzae type b. The infant reported had a relapse of H. influenzae type b meningitis after an excellent clinical and bacteriologic response to an initial course of combined antibiotic therapy including chloramphenicol. This relapse is postulated to be due to localized cerebral vasculitis which was not treated for a sufficient period of time during the initial course of therapy. The patient responded well to a second course of penicillin and chloramphenicol. Since the use of pencillin and chloramphenicol will be increasing, the clinician should be aware that bacteriologic relapse of H. influenzae type b meningitis may occur with chloramphenicol therapy.

Ampicillin↗
PubMed1975

Cerebrospinal fluid lactic acid dehydrogenase activity. Levels in untreated and partially antibiotic-treated meningitis.

High levels of cerebrospinal fluid (CSF) lactic acid dehydrogenase (LDH) activity were found in 23 cases of bacterial meningitis, but significantly lower levels of CSF LDH activity were observed in 11 patients with viral meningitis and in 13 patients with no central nervous system infection. No correlation was found between levels of CSF LDH activity and specific agents or the amounts of CSF white blood cell, protein, and glucose. The number of meningitis cases of unknown cause that could be classified as probably bacterial or viral was increased by determination of the level of CSF LDH activity. The level of CSH LDH activity is useful in differentiating bacterial from viral meningitis and, along with determination of the CSF blood cell counts and protein and glucose levels, aids in classification of meningitis before culture results are available.

Adolescent↗
PubMedDate not supplied

Etiology and treatment of facial cellulitis in pediatric patients.

By a retrospective chart review patients with buccal cellulitis were divided into groups with and without a probable portal of entry of infection at the time of diagnosis. Tooth abscesses or breaks in the skin were the usual portals of entry. Patients with a portal of entry were significantly older (P less than 0.001), had lower white blood cell counts on admission (P less than 0.01) and recovered more rapidly (P = 0.001). Haemophilus influenzae type b was recovered only from those with no portal of entry. Staphylococcus aureus and Streptococcus pyogenes caused infection in both groups but were more frequent in those with a portal of entry. Bacteremia was proved only in the group with no portal, and H. influenzae b grew from 14 to 15 positive blood cultures. All cultures of cerebrospinal fluid yielded no growth. We suggest that patients with no portal of entry on presentation receive initial parenteral therapy for H. influenzae b and Gram-positive cocci. Our current regimen is a combination of a semisynthetic penicillinase-resistant penicillin such as oxacillin and chloramphenicol. Oxacillin alone is indicated for those with a break in the skin leading to infection, whereas penicillin is appropriate for patients with dental infection. This initial therapy should be altered depending upon culture results when available.

Abscess↗