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Biomedical subjects

W J Rodriguez

Publications and source records attributed to W J Rodriguez.

116 records · Page 7Linked to original sources
PubMedDate not supplied

Erythromycin-sulfisoxazole for persistent acute otitis media due to ampicillin-resistant Haemophilus influenzae.

In patients with acute otitis media who had failed to improve with ampicillin therapy, 35% of Haemophilus strains isolated from the middle ear were ampicillin-resistant. Twenty-nine children (24 of whom had failed to respond to ampicillin) were treated with 40 mg erythromycin ethylsuccinate per kg per day and 100 to 150 mg sulfisoxazole per kg per day. Middle ear exudate was cultured on chocolate and 5% sheep blood agar. Twenty-three of 29 Haemophilus isolates were nontypable, 10% (3 children) were type b, 2 were Haemophilus parainfluenzae and one was not typed. All strains were resistant to ampicillin by disc susceptibility testing, and 28 of 29 strains produced beta-lactamase. The minimal inhibitory concentration of ampicillin for 15 strains ranged from 3.12 to 100 micrograms/ml (median, 6.25 micrograms/ml). The erythromycin ethylsuccinate and acetyl sulfisoxazole combination was effective in treatment of acute otitis media secondary to ampicillin-resistant Haemophilus influenzae. After 10 days of erythromycin ethylsuccinate-sulfisoxazole therapy, 18 patients had normal tympanic membranes. Of 11 with middle ear effusion, 7 cleared, 3 had recurrent otitis media within 1 month and 1 had persistent otitis media with effusion. Our experience suggests the efficacy of this combination in otitis media caused by ampicillin-resistant H. influenzae.

Acute Disease↗
PubMedDate not supplied

Experience with the microbiologic diagnosis of Campylobacter enteritis in an office laboratory.

Campylobacter jejuni has been recognized as a frequent cause of bacterial diarrhea in infants and children. C. jejuni is a fastidious, Gram-negative, comma-shaped or sea gull-shaped, curved rod which is capable, particularly during the summer months, of causing slimy mucoid, blood diarrhea, abdominal pain and fever. In our pediatric office laboratory we found over a 12-month period that 14 (10%) of 126 stool specimens contained this pathogen. All but two children were diagnosed during the late spring and summer. There was no common source for Campylobacter infections in the patients. In 8 (66%) of 12 patients, C. jejuni infection was immediately detected by examining a 1% aqueous basic fuchsin-stained stool smear. Uncontrolled observations from this study suggest that erythromycin therapy, if started within 2 to 3 days of the onset of illness, is clinically effective.

Adolescent↗
PubMedDate not supplied

Duration of middle ear effusion after acute otitis media.

In approximately 50% of young children persistent otitis media with effusion (POME) is found by otoscopic examination or by tympanometry 10 to 14 days after the physician institutes antimicrobial treatment for acute otitis media. Over a 180-day period the course of persistent otitis media with effusion was studied in predominantly middle class, otherwise healthy white children under 3 years of age. One month after POME was first diagnosed, 22 (29%) of the children still had POME. By the second month 11 (14%) of these children still had POME. Only 5 (6%) of the study population had POME which persisted for more than 90 days. The mean duration of POME was 40 days; (median 14 days). These data suggest that in most cases POME is a self-limiting condition when found in young, otherwise healthy, middle class white children.

Child, Preschool↗
PubMedDate not supplied

Ceftazidime vs. standard therapy for pediatric meningitis: therapeutic, pharmacologic and epidemiologic observations.

One hundred patients ages 1 month to 15 years received either ceftazidime (CZ) at a dose of 150 mg/kg/day divided every 8 hours or conventional treatment with chloramphenicol and ampicillin (CA). Seventy-eight had isolates recovered from the cerebrospinal fluid: 40 (51%) were Haemophilus influenzae (all ampicillin-susceptible); 16 (21%) were Streptococcus pneumoniae; 14 (18%) were Neisseria meningitidis; 3 (4%) were salmonellae; 1 (2%) was Pseudomonas; and 1 (2%) was Group B Streptococcus. Six patients with negative cerebrospinal fluid culture had positive latex agglutination (two H. influenzae, three N. meningitidis, one S. pneumoniae). Sixty-one patients had positive blood cultures. CZ inhibited 100% of H. influenzae at 0.78 micrograms/ml, S. pneumoniae at 0.39, N. meningitidis at 0.04 and salmonellae at 0.39 micrograms/ml. The mean peak serum concentration of CZ was 36.4 micrograms/ml with a mean cerebrospinal fluid level of 7.4 micrograms/ml. If one eliminates from the statistics those patients who died less than or equal to 24 hours after admission, five (10%) of 49 patients treated with CZ died, one (2%) improved and 43 (88%) were cured. Overall 29 patients died, 12 receiving CZ (20%) and 8 receiving CA (21%). There were no significant CZ-related toxicities. Gross neurologic sequelae were noted in 5% of 38 CZ patients and 4% of 28 CA patients. CZ compared favorably to CA for treatment of meningitis.

Adolescent↗
PubMedDate not supplied

Trimethoprim-sulfamethoxazole in the treatment of otitis media secondary to ampicillin-resistant strains of Haemophilus influenzae.

Between August 1977 and January 1979, 16 children (7 males and 9 females) ranging in age from 5 to 38 months (mean age 18 months) were treated with trimethoprim-sulfamethoxazole (TMP-SMX) (40 mg/kg SMX per 24 hours) for otitis media caused by beta-lactamase strains of ampicillin-resistant Haemophilus influenzae. Fourteen patients had failed after antecedent ten-day courses of ampicillin (9 patients) or amoxicillin (5 patients) therapy. The remaining two patients received only five days of ampicillin before changing to TMP-SMX. Six of the isolates were nontypable, 3 were type B, 5 isolates were Haemophilus parainfluenzae, and 2 strains were unavailable for typing. Of 13 strains tested, 10 had a minimal inhibitory concentration (MIC) in excess of 3.12 microgram/ml of ampicillin; the remaining 3 had an MIC of < 3.12 microgram/ml. All 13 isolates were susceptible to 0.19 microgram/ml TMP-SMX. Five of 16 children were symptomatic (irritable; fever of > 38.2 C); within three days of starting TMP-SMX treatment, they became asymptomatic. Fifteen of 16 patients (93%) responded favorably after ten days of TMP-SMX. Only one patient had H influenzae resistant to ampicillin (12.5 microgram/ml) and sensitive to TMP-SMX (0.19 microgram/ml) isolated from the middle ear at the end of ten days of TMP-SMX. At the end of TMP-SMX therapy, middle ear effusions were noted in ten patients; the fluid was sterile in the four patients who had a second tympanocentesis. There were two recurrences within one month of TMP-SMX therapy. No adverse clinical reactions were noted.

Ampicillin↗
PubMedDate not supplied

Cefuroxime: mechanisms of action, antimicrobial activity, pharmacokinetics, clinical applications, adverse reactions and therapeutic indications.

Cefuroxime is a second generation cephalosporin with a broad antimicrobial activity against both Gram-positive and Gram-negative organisms. It has excellent in vitro activity against staphylococcal strains, streptococcal strains (other than enterococci), N. gonorrhoeae, H. influenzae and N. meningitidis. It also has excellent in vitro activity against members of the Enterobacteriaceae with the exception of Serratia and indole-positive Proteus. Ps. aeruginosa and B. fragilis are resistant. Cefuroxime is relatively free of serious side effects. It is metabolically stable, and most of it is excreted unchanged in the urine. Three fourths of it are distributed in the extravascular compartment. Blood levels exceed the in vitro minimum inhibitory concentrations for many important gram negative pathogens. Clinical studies have shown cefuroxime to be effective therapy for infections of soft tissue, respiratory tract, urinary tract, genital tract (caused by N. gonorrhoeae) and the central nervous system. Superinfections with Ps. aeruginosa and enterococcal strains may present a problem. In spite of excellent diffusion into bone and joint tissues, the available clinical data are too limited to make a recommendation for its use in bone and joint infections.

Adolescent↗