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[Study of cefroxadine in pediatrics regarding clinical efficacy and serum levels (author's transl)].

Basic and clinical evaluations of cefroxadine were carried out in children, and the following results were obtained. 1. Cefroxadine 20 mg/kg was administered to 9 children with heart disease for the prophylaxis against infections before undergoing cardiocatheterization and cardioangiography, and serum levels were determined. Peak levels reached after 30 minutes in 4 of the 9 cases, with a mean peak level of 22.5 mcg/ml and after 1 hour in 5 cases, with a mean peak level of 16.2 mcg/ml. Half life was 3.1 hours in the former group in a 6-hour blood sampling (1.04 hours in a 2-hour sampling) while in the latter group it was 1.37 hours. 2. Clinical responses were evaluated in 56 children comprising 23 cases of pharyngitis, 8 of tonsillitis, 13 of scarlet fever, 10 of urinary tract infections and 2 of impetigo. Fifty of these cases had excellent and good responses showing a efficacy rate of 89.3%. 3. From 42 of the cases, 43 strains were isolated as causative organisms. Major organisms included 27 strains of S. pyogenes, 9 of E. coli and 3 of S. aureus. As for bacteriological responses, all strains were eradicated. 4. No severe side effects were observed except for diarrhea of 1 cases and eosinophilia of 2 cases. Furthermore, no children refused to take cefroxadine dry syrup.

Cephalosporins↗

[Laboratory and clinical studies of cefroxadine (author's transl)].

The authors have carried out the laboratory and clinical studies of cefroxadine (CXD), and obtained the following results. The antibacterial activities of CXD were measured by plate dilution method on 26 clinical isolates of S. aureus, E. coli and K. pneumoniae. CXD inhibited the growth of all strains of S. aureus at concentrations less than 6.25 microgram/ml, the peak of activity distribution was obtained at 3.13 microgram/ml with an inoculum size of 10(6) cells/ml. And the p eak sensitivity distribution of E. coli was obtained at 6.25 microgram/ml. The growth of all strains of K. pneumoniae was inhibited at concentrations of less than 25 microgram/ml. Phagocytosis was determined by QUIE'S method. In the presence of CXD, phagocytosis of human PMNs was not enhanced to E. coli and K. pneumoniae. For pharmacokinetic study, CXD was given orally at a single dose of 10 mg/kg to 3 children before and after meals. The serum levels of CXD on fasting were 14.2 microgram/ml, 11.0 microgram/ml, 4.0 microgram/ml and 0.57 microgram/ml at 0.5, 1, 2. 4 hours after administration respectively, and the level at 6 hours was not detectable. Half-life was 0.65 hours. The serum levels of CXD after meals were 3.9 microgram/ml, 5.3 microgram/ml, 5.3 microgram/ml, 2.4 microgram/ml and 0.42 microgram/ml at 0.5, 1, 2, 4, 6 hours after administration respectively, but at 8 hours it was not detectable. Half-life was 0.95 hours. The 8-hour urinary excretion rates on fasting and non fasting were 89.4%, 89.0% respectively. CXD was given to 31 cases with tonsillitis, 4 with bronchitis, 1 with impetigo, 3 with cervical lymphadenitis, 7 with U.T.I, totalling 46. A daily dose of CXD 400 approximately 1,500 mg was given for 4 approximately 14 days. Clinical results obtained were good and excellent responses in 43/46 (93.5%) cases. No side effects were observed except for 1 case with elevation of GOT, 2 cases with elevation of GOT and GPT and 1 case with eosinophilia.

Adolescent↗

[Clinical evaluation of cefroxadine dry syrup in children (author's transl)].

Clinical efficacy of cefroxadine dry syrup, a new oral cephalosporin antibiotic, was evaluated in children, and the following results were obtained. 1. Three children were given a single oral dose of about 10 mg/kg of the drug when fasting, and its blood concentrations were determined. Blood concentrations were maximum at 30 approximately 60 minutes, i.e., 16.9 approximately 18.2 microgram/ml, and markedly low at 4 hours. 2. Thirty-six patients with the following diseases were tested with 23.1 approximately 44.4 mg/kg/day of the drug in 3 to 4 divided doses; 21 patients with lacunar tonsillitis, 2 with tonsillitis, 1 with scarlet fever, 4 with bronchitis and tonsillitis, 2 with cystitis, 4 with pyelonephritis, 1 with impetigo and 1 with probable Mycoplasma pneumonia. An overall efficacy rate in 35 patients excluding the last mentioned case was 91.4%, i.e., excellent in 20, good in 12 and poor in 3, and an eradication rate of the causative organisms was 88.9%. 3. Adverse reactions noted were diarrhea in 1 patient, eruption and diarrhea in 1 transient neutropenia in 1, eosinophilia in 3 and an elevation of GOT and GPT in 1. None were significant. 4. Taste and flavor of the drug was considered to be well palatable to children. 5. Taking into consideration of the results of fundamental evaluation of the drug, cefroxadine dry syrup is considered to be a potent new antibiotic in children, and the recommended dose will be 10 mg/kg 3 to 4 times a day.

Bacterial Infections↗

[Skin and genital diseases of the mother as indications for induced abortion].

Therapeutic progress in medicine has diminished the number of diseases representing indications for interruption. This is true for impetigo herpetiformis and for herpes gestationis. In scleroderma, acute lupus erythematosus and dermatomyositis, the question has to be decided individually. Particularly in lupus erythematosus, contraception is to be advised because of the teratogenic side effects of therapeutic drugs. Metastases can arise in the fetus from a malignant melanoma of the mother. Whether pregnancy can promote the development or the progression of malignant melanoma, is still under discussion. Nevertheless, melanomalignoma must be regarded as an absolute indication for interruption.

Abortion, Eugenic↗

Tissue and fluid concentrations of cefadroxil monohydrate.

In summary, there are several tissues and fluids in which the penetration of cefadroxil appears to be superior to that of other antibiotics, including other cephalosporins. A possible explanation for this relates to the characteristic solubility of cefadroxil in both aqueous and lipid solvents. A study comparing IV, IM and PO administration of cefadroxil appears to support this thesis. Clinically, based on work which shows that patients who had higher concentrations of antibiotic in sputum made a faster recovery, cefadroxil may have an advantage since sputum is one of the fluids in which the drug appears to have superior and earlier penetration. In addition, in comparison with cephalexin, penetration of skin-blister fluid by cefadroxil was superior, suggesting an advantage in treating disorders of the skin and skin structures, such as impetigo. The possibility of different dosage requirements for male and female patients, based on the difference in the availability of lipid deposit sites, cannot be considered clinically significant at this time.

Blister↗

[Pediculosis capitis: a questionnaire survey in 4 schools of the Bordeaux Academy 1990-1991].

A questionnaire survey of head lice treatment was conducted in four schools--each including a nursery and an elementary school--in the Bordeaux area. Two schools were situated in the centre of the city, one in a suburban area and one in a rural area (50 km from the city). Four-page questionnaires were filled in anonymously by the parents in April 1991; 840 answers were obtained (80 p. 100 response rate). Between January 1990 and March 1991, 48.7 p. 100 of children had at least one episode of head lice infestation (infestation rates varied from 38.8 to 62.6 p. 100 depending on the schools); 30.5 p. 100 of children were contaminated for the first time during that period. Lice were detected by the parents in 95 p. 100 of the cases. The prevalence of lice was higher in females (60 p. 100) than in males (40 p. 100). The highest prevalence was noted in the suburban school where 17 p. 100 of the parents were unemployed at the time of the survey. The peak age for head lice was 7, but 19.4 p. 100 of nursery school children aged 2-4 years had been contaminated at least once. Impetigo was rare (1.2 p. 100), and pruritus was noted in only 14.2 p. 100 of the cases. Most children had been contaminated at school. Curative treatment was counselled by a chemist in 87 p. 100 of the cases. Pyrethrins were used in 81 p. 100, and the shampoo (Hegor) plus spray (Paraspecial Poux) association was the most frequent, totalling two-thirds of prescriptions.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗

Treatment of bacterial, fungal, and parasitic infections in the HIV-infected host.

In the human immunodeficiency virus (HIV) infected patient, skin infections caused by S aureus are extremely common. Impetigo, ecthyma, and folliculitis are all seen. Recurrences are common due to a nasal carriage rate of 50%. Dermatophytosis usually manifests as tinea pedis or unguium and is caused by Trichophyton rubrum. Oral candidiasis may be the initial evidence of HIV infection, and is predictive of more rapid progression to acquired immune deficiency syndrome (AIDS). Topical agents are usually effective for oral lesions, but involvement of the esophagus requires oral imidazole therapy. Systemic fungal infections are most commonly caused by cryptococcosis or histoplasmosis. The finding of either of these infectious agents in the skin is pathognomonic of disseminated infection. Cryptococcus presents as umbilicated papules resembling molluscum or as large ulcerations. Histoplasmosis has no specific cutaneous morphology. Scabies is very common in HIV-infected persons, and once the helper T-cell count is less than 200, it may present atypically. Permethrin is the recommended treatment in this setting.

Anti-Infective Agents↗

[Bacteriological, pharmacokinetic and clinical studies of SY5555 dry syrup in the pediatric field].

Bacteriological, pharmacokinetic and clinical studies on SY5555 dry syrup (powder which is dissolved before use), a new penem antibiotic for oral use, were performed. The following results were obtained. 1. Antibacterial activities. MICs of SY5555, clavulanic acid/amoxicillin (CVA/AMPC), cefotiam (CTM), cefpodoxime (CPDX), cefaclor (CCL) and cefdinir (CFDN) were determined against clinically isolated Staphylococcus aureus, coagulase negative staphylococci, Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenzae, Moraxella catarrhalis, Escherichia coli and Enterobacter cloacae at a dose of 10(6) CFU/ml. MICs of SY5555 against S. aureus, CNS, S. pneumoniae, S. pyogenes, H. influenzae, M. catarrhalis, E. coli and E. cloacae were 0.2, 0.2, 0.2, < or = 0.025, 0.78, 0.2, 0.78 and 3.13 micrograms/ml, respectively, showing excellent antibacterial effects on these pathogens. Although the effects of SY 5555 against H. influenzae and E. coli were slightly inferior to those of CPDX and CFDN, the drug showed the most excellent antibacterial effect on other strains as compared with the control drugs. 2. Absorption and excretion In this study, plasma concentrations and urinary recovery rates were examined after administration of SY5555 at doses of 5 and 10 mg/kg (potency) after meals. With both 5 and 10 mg/kg doses, peak plasma concentrations were reached 1 hour after administration, at 0.25-2.61 micrograms/ml (mean 1.47 micrograms/ml) and 1.08-2.17 micrograms/ml (mean 1.74 micrograms/ml), respectively. The plasma levels rapidly decreased to 0.06-0.19 micrograms/ml (0.12 micrograms/ml) and 0.0503-0.0637 micrograms/ml) after 6 hours. The half-lives 1.12 hours in the 5 mg/kg group and 1.0 hour in the 10 mg/kg group. The urinary recovery rates were determined in the first 8 hours after administration in the 5 mg/kg and 6 hours in the 10 mg/kg group, and the values were as low as 1.05-12.3% and 1.6-4.33%, respectively. 3. Clinical results The clinical responses were examined in a total of 73 cases including 4 acute pneumonia, 13 acute bronchitis, 11 tonsillitis, 3 pharyngitis, 12 scarlet fever, 2 pertussis, 6 urinary tract infection, 6 otitis media, 7 lymphadenitis, 2 staphylococcal scalded skin syndrome, 2 phlegmon, 4 impetigo and 1 purulent parotitis. The treatment was effective or better in 66 of 70 cases with an efficacy rate of 94.3% (3 undeterminable cases were excluded). Bacteriological effects were examined during the clinical course for detected or suspected pathogens found before administration of SY5555. The effects were determined in 50 cases including 7 cases of polymicrobacterial infections, 57 strains in total. Eight strains, however, persisted, hence the overall eradication rate was 86.0%.(ABSTRACT TRUNCATED AT 400 WORDS)

Absorption↗

[Bacteriological and clinical studies of SY5555 in pediatric field].

Clinical studies were carried out on SY5555, a new oral penem, in the field of pediatrics. The results obtained are summarized below. The clinical efficacies were examined in a total 31 patients consisting of 4 patients with pharyngitis, 10 with purulent tonsillitis, 4 with scarlet fever, 7 with impetigo, one with balanitis, one with cellulitis and 4 with UTI. The clinical efficacy rate was 96.8% (30/31). Bacteriological efficacies of SY5555 were examined on identified pathogens including 7 strains of Staphylococcus aureus, 6 of Streptococcus pyogenes, 3 of Enterococcus faecalis, 3 of Haemophilus influenzae, one of Escherichia coli and one of Citrobacter freundii. The bacteriological eradication rate was 81.0%. As for side effects, loose stool in one patient was noted. Abnormal laboratory findings test results included eosinophilia in 2 patients, eosinophilia and elevation of serum transaminase in one patient, and thrombocytosis in another.

Administration, Oral↗

[Clinical evaluation of a new oral penem, SY5555, in infants and children].

A clinical study was performed on SY5555, a newly developed penem antibiotic, in children. SY5555 was given orally to 14 patients at 19-29 mg/kg/day in 3 doses for 4 to 12 days. Clinical evaluations were made on the 14 patients including 4 with pharyngitis, 7 with tonsillitis, one with urinary tract infection, and 2 with impetigo. Overall clinical effects were excellent in 2, good in 12, with an efficacy rate of 100%. Causative organisms (Staphylococcus aureus and Streptococcus pyogenes) were all eradicated. As to adverse reactions, mild diarrhea was observed in 4 patients. These data suggest that SY5555 is a useful oral antibiotic for the treatment of bacterial infections in children.

Administration, Oral↗

[Clinical study of SY5555 dry syrup in the pediatric field].

SY5555 dry syrup (powder to be dissolved before use) was clinically used in pediatric patients. The following results were obtained: 1. The subjects were 6 pediatric patients including 1 case each with pharyngitis, tonsillitis, lacunar tonsillitis and impetigo contagiosa and 2 cases with scarlet fever. The drug was administered at a daily dose of 14.5-29.0 mg/kg divided into 3 dosages. The clinical results were excellent in 5 cases and good in 1 case with an efficacy rate of 100%. 2. Identified bacteria included 3 strains of Haemophilus influenzae, 2 strains of Streptococcus pyogenes and 1 strain of Staphylococcus aureus. Five strains were eradicated but 1 strain still remained with an bacteriological eradication rate of 83.3%. 3. No side effects were observed throughout the study period. In laboratory test results, elevated eosinophil count was observed in only 1 case. 4. Patients' compliance was good in general. 5. Based on the results mentioned above, the drug was considered to be a useful new oral antibiotic in the pediatric field.

Administration, Oral↗

[A clinical evaluation of SY5555 in the treatment of pediatric infections].

1. SY5555 dry syrup (powder which is dissolved before use) was administered to 25 patients with bacterial infections (6 cases of bronchitis, 2 cases of bronchopneumonia, 1 case of pertussis, 3 cases of scarlet fever, 5 cases of tonsillitis, 3 cases of urinary tract infections, 2 cases of staphylococcal scalded skin syndrome, 1 case of impetigo, 2 cases of purulent lymphadenitis). 2. Clinical efficacies were excellent in 11 patients and good in 13, poor in 1 with an efficacy rate of 96.0%. As pathogenic organisms, 15 strains were identified and 14 of them were eradicated with eradication rate of 93.3%. 3. No side effects were observed. As for abnormal laboratory test results increase in eosinophiles in 2 cases, decrease in filamented neutrophiles in 1 case, elevation of GOT and GTP in 1 case and elevation of GPT and gamma-GTP were observed. 4. There was no rejection incidence of the drug during the therapy. From the above results, we consider SY5555 in dry syrup form to be a useful and safe drug in the treatment of various bacterial infections in pediatric patients.

Administration, Oral↗

[Clinical and laboratory studies on SY5555 in pediatric infectious diseases].

Clinical effects of SY5555 dry syrup, a new oral penem antibiotic, were analysed in 20 children with various bacterial infections. Ages of the patients varied from 8 months to 14 years. Doses of SY5555 were varied from 12.8 mg/kg/day to 30.5 mg/kg/day, and it was administered in 3 divided dosages. Clinical efficacy rates were as follows; 6/7 in acute bronchitis, 5/5 in pharyngotonsillitis, 3/3 in acute otitis media and 2/2 in cystitis and 3/3 in impetigo contagiosa. The overall rate was 95.0% (19/20). Bacteriologically, eradications were obtained with 1/2 strains of Streptococcus pyogenes, 3/3 of Staphylococcus aureus, 1/1 of Haemophilus influenzae, and each of Staphylococcus epidermidis, Haemophilus parainfluenzae, coagulase-negative staphylococci and Serratia marcescens. Diarrhea was observed in 1 patient. And elevated eosinophiles or GPT was observed in one patient each. In vivo pharmacokinetics of SY5555 was examined in 2 cases. Peak plasma levels were observed at 1 hour after dosage in one patient and at 2 hours in another upon oral administration of 8.3 mg/kg of SY5555, and peak levels were 2.44 and 1.38 micrograms/ml respectively. Half-lives of SY5555 were 1.39 and 0.59 hr. Concentrations of SY5555 in urine after administration were 70.2 (2-4 hrs.) to 91.0 (0-5 hrs.) micrograms/ml, respectively. SY5555 dry syrup is considered as an useful and safe antibiotic in treating the infectious diseases in children.

Administration, Oral↗

[Clinical studies on cefozopran in pediatrics].

Cefozopran (CZOP, SCE-2787) was given intravenously to 12 children with acute bacterial infections including 9 with acute pneumonia, 1 each with acute pyothorax, impetigo and staphylococcal scalded skin syndrome. Good or excellent clinical responses were obtained in all of the 12 patients and bacterial eradications were achieved for all 10 strains identified in these cases. No side effects were noted. Eosinophilia was observed in one case, however. From the above clinical results, it appears that CZOP is a useful antibiotic for treatment of pediatric patients with various bacterial infections.

Bacteria↗

Skin lesions in association with beta-hemolytic Streptococcus group B.

A full-term male infant delivered by caesarean section following a prolonged rupture of the amniotic membranes of 30 hours' duration manifested peculiar skin lesions at the time of birth consistent with the healing phase of bullous impetigo. He was colonized with beta-hemolytic Streptococcus group B that was also cultured from the mother's cervix. It is possible this infant became infected in utero since the healing stage of the lesions suggest that they were present sometime before birth.

Humans↗

Common infections of the skin. Characteristics, causes, and cures.

If the skin's protective mechanisms are disrupted, cutaneous infection may result. Diagnosis is based on recognition of clinical signs. Accurate assessment of these signs and prompt initiation of appropriate treatment can help patients avoid serious complications, such as glomerulonephritis occurring with impetigo contagiosa or gangrene and sepsis occurring with cellulitis. Recurrence of skin infections is difficult to prevent, but patients should be encouraged to practice good hygiene and to avoid irritants and predisposing factors nonetheless.

Cellulitis↗

Streptococcal infections--updated.

Streptococci are amont the most common bacterial pathogens physicians encounter in practice. Infections with streptococci continue to occur with significant frequency despite the general sensitivity of these organisms to a variety of widely used antibiotics. In newborn infants and other special patient groups, streptococci may produce fulminant and fatal sepsis (Table 1). In normal children and adults, infections usually are short term and often mild or unrecognized but with the possibility of resulting, unpredictably, in nonsuppurative complications some weeks or months later. Although scarlet fever has become an unusual and clinically attenuated disease, its rashless analog, streptococcal pharyngitis, presents thorny problems in the differential diagnosis of symptomatic patients and in the detection of subclinical infections. Erysipelas now is a rare disease, but recent studies have confirmed that streptococci often are the primary etiologic agent in impetigo, another type of skin infection--with peculiar bacteriologic and epidemiologic features. Infections with group D streptococci have always been a special case because of their frequent resistance to penicillin, and group B streptococci (also somewhat resistant) present special problems in the perinatal period. Streptococci may appear in unexpected places or guises (see Table 1). Thus, the modern physician has little reason to relax in his vigilance for and knowledge of streptococcal infections.

Acute Disease↗

[Clinical evaluation of a new cephem S-1108 in infants and children].

A clinical study in children has been performed on S-1108, a newly developed cephem antibiotic. S-1108 was given orally to 30 patients, at doses between 8 and 12 mg/kg/day in 3 divided doses for 2 to 10 days. Clinical evaluations were made on 26 patients consisting of 12 patients of pharyngitis, 5 of tonsillitis and of impetigo, one each of bronchitis, cystitis, lymphadenitis and cellulitis. Overall clinical effects were excellent in 10, good in 15, fair in 1 with an efficacy rate of 96%. As to adverse reactions, mild diarrhea (2 patients) and transients elevation of transaminases (one patient) were observed. These data suggest that S-1108 is a useful oral antibiotic for the treatment of bacterial infections in children.

Administration, Oral↗