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PubMed1993

[A clinical evaluation of S-1108 in the treatment of pediatric infections].

1. S-1108 granules were administered to 22 children with bacterial infections (8 cases of bronchitis, 1 case of pneumonia, 3 cases of scarlet fever, 2 cases each of tonsillitis, pharyngitis, pertussis, purulent lymphadenitis and impetigo). 2. Clinical efficacies were excellent in 12 patients and good in 7, fair in 1, poor in 1 and unevaluable in 1 with an efficacy rate of 90.5%. 3. Neither side effects nor abnormal laboratory test values were observed. 4. There was no rejection of the drug during the therapy. From the above results, we consider S-1108 in granular form to be a useful and safe drug in the treatment of various bacterial infection in pediatric patients.

Administration, Oral↗
PubMed1993

Common facial skin lesions in children.

A variety of facial skin problems are encountered in a busy pediatric dental practice. The dentist should recognize and be able to identify the more common important skin lesions. The etiology, presentation, and prognosis of acne vulgaris, impetigo, warts, molluscum contagiosum, ringworm, tinea versicolor, spider nevus, atopic dermatitis, seborrhea, herpes simplex, and lesions of child abuse are discussed. Several of these conditions require prompt referral to a pediatrician or dermatologist.

Child↗
PubMed1993

Prevention and control of nosocomial infection caused by methicillin-resistant Staphylococcus aureus in a premature infant ward--preventive effect of a povidone-iodine wipe of neonatal skin.

In early 1983 we experienced a small scale epidemic of Staphylococcus aureus coagulase type IV in the premature infants unit. Children had bacteraemia or impetigo. The microorganism was resistant to methicillin, erythromycin and lincomycin and was susceptible to tetracycline, chloramphenicol and cefmetazole. The results of coagulase typing and antimicrobial sensitivities indicated that these cases represented nosocomial infection with MRSA. The source and route of the infection were investigated, and measures were taken to prevent bacterial spread from carriers and to keep instruments and environments clean. As the source of infection was not identified, we tried wiping the body surface of the premature infants with a diluted IsodineR solution (10% povidone-iodine; 1:100 dilution) in order to prevent colonization of the microorganism on the body surface. As a result, no additional MRSA infection occurred in the premature infant unit. During the subsequent 6 years of frequent surveys of carriers and wiping the appropriate body surface with diluted IsodineR solution we have had no recurrence of MRSA. None of the premature infants wiped with IsodineR solution showed any objective abnormalities, although laboratory testing disclosed an elevated blood iodine level and a transient mild reduction of T4 in some infants.

Administration, Topical↗
PubMed1993

[Clinical study on S-1108 in treatment of pediatric infections].

To evaluate the efficacy, the safety and the usefulness of a novel and esterified cephem antibiotic for oral use, S-1108, in pediatric infections, a clinical trial was performed. The study subjects were 15 patients including 9 with acute pharyngitis, 1 with acute tonsillitis, 2 with acute bronchitis, 1 with chronic pyelonephritis, 1 with acute abscess of the skin and 1 with impetigo contagiosa. S-1108 was administered orally at a dose of 3.7 mg/kg to 12.5 mg/kg t.i.d. for 4 to 9 days. Clinical effects were excellent in 7 cases, good in 6, fair in 1 and poor in 1. The Overall efficacy rate was 86.7%. Bacteriologically, causative organisms were all eradicated in evaluable 4 cases. As to side effects, diarrhea was observed in 2 cases. No abnormal laboratory test values were obtained.

Adolescent↗
PubMed1993

[Clinical evaluation of S-1108 in pediatric field].

Nine pediatric patients with bacterial infections (5 cases of tonsillitis, 3 cases of impetigo and 1 case of UTI) were treated with S-1108, and the efficacy and the safety were evaluated. The clinical responses to S-1108 treatment were excellent in 7 cases and good in 2. The efficacy rate was 100%. Bacteriologically, the causative organisms (Streptococcus pyogenes, Staphylococcus aureus, Haemophilus parainfluenzae and Escherichia coli) were eradicated. No clinical side effects were observed. Elevation of CK in 2 cases and eosinophilia in 1 case were noted.

Bacteria↗
PubMed1994

Skin disorders of pregnancy.

Skin disorders of pregnancy fall into three major groups: disorders due to physiologic changes, specific skin disorders of pregnancy, and skin tumors. Elevated levels of estrogen and progesterone stimulate melanogenesis, which causes hyperpigmentation, including melasma; high levels of circulating hormones also cause vascular changes and alter hair growth cycles. Specific skin disorders of pregnancy range from pruritic urticarial papules and plaques of pregnancy and pruritus gravidarum, which are fairly common, to pemphigus gestationis and impetigo herpetiformis, which are rare. Common skin tumors in pregnant women include pyogenic granuloma, which occurs primarily in the gingiva, and molluscum fibrosum gravidarum, or skin tags. While the effect of pregnancy on malignant melanoma continues to be disputed, recent studies indicate that long-term survival is close to that in the general population, although the disease-free interval is reduced.

Female↗
PubMedDate not supplied

[Epidemiology of skin diseases in 10,000 patients of pediatric age].

Ten thousand new patients were seen between January 1971 and January 1975 at the Department of Pediatric Dermatology, "Hospital del Niño IMAN" in Mexico City. The patients were between 0 and 18 years old. They represented 10.4% of the entire pediatric population attending the general out-patient clinic of the hospital. The results of our study showed no significant difference among the sexes of patients. The highest proportion of patients in the sample were under one year of age. The most frequently observed groups of dermatoses were: parasitic, cutaneous reactions, viral and bacterial. The ten diseases most frequently observed were: papular urticaria (16.3%); atopic dermatitis (12.9%); scabies (10.4%); viral warts (8.4%); impetigo (6.8%); pitiriasis alba (6.6%); vitiligo (2.6%); acne (2.5%); dermatophytosis (2.4%) and numular eczema (2.3%). The 20 skin diseases most frequently recorded accounted for 85.8% of the sample. The ten most frequent skin diseases in each group of age were also recorded. The monthly and annual frequency for the more frequent dermatoses was studied. The present study provides epidemiological information for a rational development of programs on care, education and investigation in pediatric dermatology in Mexico.

Adolescent↗
PubMed1993

[Bacteriological, pharmacokinetic and clinical studies of cefditoren pivoxil in the pediatric field].

Bacteriological, pharmacokinetic and clinical studies on cefditoren pivoxil (CDTR-PI, ME 1207) in granules, a new oral cephalosporin, were performed in the field of pediatrics. The results are summarized below. 1. Antibacterial activities: Antibacterial activities of CDTR were studied against Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenzae, Haemophilus parainfluenzae and Branhamella catarrhalis in comparison with those of cefteram (CFTM), cefixime (CFIX), cefaclor (CCL), cefpodoxime (CPDX) and cefotiam (CTM). MIC80's of CDTR against S. aureus, S. pneumoniae, S. pyogenes, H. influenzae, H. parainfluenzae and B. catarrhalis were 1.56, 0.39, < or = 0.025, < or = 0.025, 0.05 and 0.20 micrograms/ml, respectively. These results showed that CDTR has high antibacterial activities against these organisms. 2. Absorption and excretion: Serum concentrations and urinary recovery rates of CDTR-PI (administered in granules) were determined. Upon single oral doses of 3 mg/kg and 6 mg/kg, the peak serum concentrations were 0.5-2.45 micrograms/ml at 2 to 4 hours and 1.79-4.05 micrograms/ml at 1 to 4 hours, respectively, and T 1/2 was 1.07-9.67 hours and 0.99-3.00 hours, respectively. At 8 hours after dosing, serum concentrations were 0-0.87 micrograms/ml with a dose of 3 mg/kg and 0.27-0.73 micrograms/ml with 6 mg/kg. These values indicated that the drug has a dose-dependent pharmacokinetic behavior. Urinary recovery rates in the first 8 hours were 12.9-34.2% with a dose of 3 mg/kg and 11.8-26.9% with 6 mg/kg. 3. Clinical study: Clinical efficacies were examined in a total of 81 cases consisting of 20 cases of acute bronchitis, 13 of acute pneumonia, 21 of tonsillitis, 5 of pharyngitis, 7 of scarlet fever, 2 each of impetigo, otitis media and purulent cervical lymphadenitis, 1 of pertussis and 8 of UTI. The clinical efficacy rate was 97.5% (79/81), and bacteriological eradication rate was 100% (76/76). As for side effects, 2 cases of watery stools and 1 case of minor elevation of GPT were observed.

Administration, Oral↗
PubMed1993

Comparative efficacy and safety of oral fleroxacin and amoxicillin/clavulanate potassium in skin and soft tissue infections.

The objective of this open-label, randomized, multicenter study was to compare the efficacy and safety of fleroxacin, 400 mg administered orally once daily, and amoxicillin/clavulanate potassium (AMX/CP), 500 mg/125 mg administered orally three times daily, for 4-21 days to patients with skin and soft tissue infections (SSTIs). The specific diagnoses in both groups were primarily skin abscess, impetigo, and skin ulcer, as well as wound infection erysipelas, folliculitis, cellulitis, and lymphangitis. A total of 285 patients were randomized to treatment in a 2:1 ratio, 190 in the fleroxacin group and 95 in the AMX/CP group. Adult male or female inpatients or outpatients were included in the trial and were followed up after 3-5 days of therapy and 3-9 days after completion of therapy for assessment of bacteriologic, clinical, and safety parameters. The most frequently isolated pathogen in both treatment groups was Staphylococcus aureus. Bacteriologic cures were observed in 87 (76%) of 115 evaluable patients in the fleroxacin group and in 41 (72%) of 57 evaluable patients in the AMX/CP group. Clinical cure was seen in 86 (75%) of 114 patients in the fleroxacin group and 45 (79%) of 57 patients in the AMX/CP group. Clinical adverse events related to the trial medication were reported by 40 (21%) of 189 patients in the fleroxacin group and by 16 (17%) of 95 patients in the AMX/CP group. In both groups, most adverse events were mild or moderate in severity and involved the digestive system (primarily diarrhea, nausea, and vomiting). In the fleroxacin group, adverse events affecting the central nervous system (mainly dizziness, insomnia, somnolence) also were reported. In this study, both fleroxacin and amoxicillin/clavulanate potassium were effective and well tolerated in the treatment of skin and soft tissue infections.

Administration, Oral↗
PubMed1993

Soft tissue infections.

Several infectious processes ranging in severity from mild to overwhelming that affect the soft tissues are reviewed. Superficial infections such as impetigo, erysipelas, cellulitis, and subcutaneous bursitis are common and, for the most part, can be easily treated. Because suppurative tenosynovitis has the potential to destroy tendons, consultation with a hand surgeon should be obtained immediately. Mycobacterial and fungal tenosynovitis is usually chronic and patients present with a mass which, when excised and examined with appropriate stain and culture, reveals the unexpected diagnosis. Tropical myositis (muscle abscesses) is seen in temperate climates, primarily as a complication of AIDS. Necrotizing fasciitis and gas gangrene represent the hyperacute end of the spectrum of soft tissue restrictions. Although in most cases a history of trauma is present, spontaneous gas gangrene may arise from occult and colonic cancer. Patients do poorly unless immediate and extensive surgery is performed and appropriate antibiotics are given.

Bacterial Infections↗
PubMed1995

Insertional inactivation of virR in Streptococcus pyogenes M49 demonstrates that VirR functions as a positive regulator of streptococcal C5a peptidase and M protein in OF+ strains.

Mutational analysis confirms the presence of a positively controlled virulence regulon in the OF+ lineage of S. pyogenes. Although there are differences in the organization of the virR regulon in OF+ and OF- strains, expression of these surface proteins is dependent on a VirR protein. In addition, it appears that production of OF is dependent on virR. The contribution of OF to the pathogenesis of S. pyogenes is unknown. The greater association of OF+ strains with impetigo compared to the greater association of OF- strains with pharyngitis [2] may indicate that production of apoproteinase is a contributing factor to skin infections.

Adhesins, Bacterial↗
PubMed1995

Identifying high risk patients for Staphylococcus aureus infections: skin and soft tissue infections.

Staphylococcus aureus is the causative organism for many skin and soft tissue (SST) infections. Some SST infections have severe systemic complications, such as bacteraemia and sepsis. S. aureus is the cause of 75% of primary pyodermas. Pre-existing conditions, like tissue injury (ulcers, wounds) or tissue inflammation (exudative dermatitis), and also underlying disorders (such as poorly controlled insulin-dependent diabetes mellitus or cancer) are some of the risk factors for secondary infection with S. aureus. In S. aureus-infected primary skin disorders (impetigo, recurrent eczema), 2% mupirocin ointment has proved effective in several clinical trials. S. aureus is responsible for 25% of all burn-wound infections, and burn units could be the point of entry and source of spread of methicillin-resistant S. aureus infection outbreaks. Mupirocin (2% ointment) has also proven effective for topical treatment of these infections. Pressure sores develop in 6% of all patients admitted to acute and chronic health care institutions. An average of three aerobic species (including S. aureus) plus one anaerobic species are isolated when infected. Infectious complications are responsible for 60-80% of all intravenous drug user (IVDU) hospital admissions, 5-20% being due to S. aureus infective endocarditis (IE). The origin of IE in IVDUs is probably the skin. Data from a Collaborative Spanish Study of IVDU infectious complications (including more than 10,000 episodes) are discussed.

Burns↗
PubMed1996

Side-effects and complications of flashlamp-pumped pulsed dye laser therapy of port-wine stains. A prospective study.

The flashlamp-pumped pulsed dye laser (FPDL) was the first laser system specifically developed for the treatment of cutaneous vascular lesions such as port-wine stains (PWS), telangiectases and haemangiomas. Its theoretical advantages have been verified by numerous excellent clinical results. As there are few systematic studies on the adverse effects of this laser system, we investigated 100 consecutive patients who received FPDL therapy of PWS. Pain during and after laser therapy was a common complaint. Post-treatment erythema occurred in 29%, oedema in 73%, formation of bullae in 1%, and serous crusting in 46-83% of patients (based on our observations and the patients histories, respectively), all of which lasted for a maximum of 7 days. Furthermore, complications such as impetigo-like crusting occurred in 25%, bleeding in 12%, a pyogenic granuloma in 1%, hyperpigmentation in 27%, hypopigmentation in 1%, atrophic scarring in 3%, and an hypertrophic scar in 1%. Although most of these changes were only focal, and were predominantly transient, our results indicate that the incidence of side-effects and complications produced by the FPDL (wavelength 585 nm, pulsewidth 450 microseconds) may be higher than previously documented in the literature.

Adolescent↗
PubMed1996

[A clinical evaluation of azithromycin in the treatment of pediatric infection].

Fine granule preparation of azithromycin (AZM), a new macrolide antibiotic, was given to treat various infections in pediatric patients. Efficacies of AZM in a total of 21 patients (tonsillitis in six, bronchitis in five, pneumonia in five, impetigo contagiosa in three, staphylococcal scalded skin syndrome in one and bacterial enterogastritis in one) were rated "excellent" in 11 patients and "good" in eight. The remaining two cases were not included in the evaluation. AZM eradicated all strains of infection-causative bacteria identified in the 21 patients: Staphylococcus aureus in two, Streptococcus pneumoniae in four, Moraxella (Branhamella) catarrhalis in four, Haemophilus influenzae in six, Haemophilus parainfluenzae in three and Mycoplasma pneumoniae in one. One patient complained of mild diarrhea, while two patients showed increases in eosinophils as abnormal laboratory changes.

Anti-Bacterial Agents↗
PubMedDate not supplied

[Infections in pediatrics].

PROBABILITY-BASED ANTIBIOTIC THERAPY: In children, the risk of an unfavorable course of bacterial infections requires careful selection of the initial antibiotic prescription based on the disease state, bacterial epidemiology and the child's age. ACUTE COMMUNITY ACQUIRED PNEUMONIA: Before the age of 5 years, antibiotics active against Haemophilus influenzae such as amoxicillin or clavulanic acid can be given orally. In children over 5, amoxicillin or a macrolide are effective. SEVERE EAR, NOSE AND THROAT INFECTIONS: For sore throats, clinical and bacterial results of a 4-day antibiotic regimen using a second generation cephalosporin are equivalent (with better compliance) to a 10-day regimen of penicillin V. For acute middle ear infections, a combination of amoxicillin-clavulanic acid is usually prescribed as initial treatment. COMMUNITY ACQUIRED BACTERIAL MENINGITIS: The most recent consensus established the indication for cefotaxime or ceftriaxone. The increasing number of peni-R pneumococci and the major drop in the frequency of Haemophilus infections have led to new therapeutic propositions currently under investigation. ACUTE SKIN INFECTIONS: For impetigo, general antibiotics-oxacillin or a derivative-are required due to the risk of contagion. BONE AND JOINT INFECTIONS: For these urgent situations, in vitro sensitivity and antibiotic penetration into the infected tissue are the determining factors. BACTERIAL DIARRHEA: Antibiotics are not required in case of acute diaarhea with little or no fever. Antibiotics could be discussed for cholera-like diarrhea and are required in case of invasive bacterial diarrhea, shigelosis, cholera, and Clostridium difficile as well as diarrhea with fever and blood loss in infants or salmonella-induced diarrhea with signs of extradigestive complications. URINARY TRACT INFECTIONS: The choice of the antibiotic and the duration of treatment depend on the clinical presentation: lower tract infection, acute pyeloephritis, or prophylaxis. The causal germ must be identified for adapted antibiotic treatment.

Acute Disease↗
PubMed1977

[Study of S-6437 (sustained release cephalexin) in pediatrics (author's transl)].

In order to clinically evaluate S-6437, the following study was carried out in pediatric patients. This clinical study was performed in 30 patients ranging from 2 years and one month to 10 years and one month of age. Seven patients had scarlet fever, 3 acute pharyngitis, 4 acute suppurative tonsillitis, 6 acute bronchitis, 2 acute pneumonia, 3 acute pyelonephritis, 1 chronic pyelonephritis, 2 vaginitis, 1 acute gastro-enteritis, and 1 impetigo. The degree of these diseases were all mild or moderate. These patients were orally administered 35 approximately 50 mg/kg/day in two divided doses for 3 approximately 10 days. As a result, effectiveness of this preparation in these patients was 80% and no side effects were observed.

Acute Disease↗
PubMedDate not supplied

[Diagnosis in 1348 patients which consulted for a probable spider bite or insect sting].

Accumulate experience, from 1955 to 1995, in an outpatient university parasitology clinic in Santiago, with 1,384 patients referred from diverse public and private medical institutions because of a probable spider bite or insect stings, is presented. It is noteworthy that only 618 (44.7%) of consultations corresponded to clinical conditions originated by arthropods, whereas from the remaining 766, 612 (44.2%) were due to a bacterial, viral or parasitic etiology and 154 (11.1%) were caused by physical or chemical agents. Frequency of diagnosis was: loxoscelism 16.6%, spider bites (excluded Loxosceles laeta) 1.3%, scorpion sting 0.9%, tick stings 2.2%, insect bites 23.7%, impetigo 6.6%, folliculitis 11.3%, boil 22.7%, erysipelas 0.1%, pustula maligna 0.3%, herpes simplex 2.5, palpebral herpes zoster 0.3%, acute Chagas' disease 0.4%, angioneurotic edema 0.1%, ecchymosis 3.0, contact dermitis 7.8% and chemical dermitis 0.2%. These frequencies do not indicate the real occurrence of the diagnosed nosologies, but what happened in a specialized outpatient clinic dealing cheaply with parasitic diseases and arthropod envenomations. Description of relevant clinical features and epidemiological considerations of pathology observed, conjointly with differential diagnosis are presented.

Angioedema↗
PubMed1997

Outbreak of invasive group A Streptococcus associated with varicella in a childcare center -- Boston, Massachusetts, 1997.

Group A Streptococcus (GAS) causes common childhood diseases such as streptococcal pharyngitis and impetigo and can cause severe, life-threatening invasive disease including streptococcal toxic-shock syndrome and necrotizing fasciitis. Invasive GAS disease occurs when GAS infects a normally sterile site. Clusters of invasive GAS infection previously had not been reported among children in school or childcare centers (CCCs). However, on February 13, 1997, the Boston Public Health Commission received reports of cases of concurrent invasive GAS and varicella infection among two of 14 children in the same CCC classroom. Because of the potential for further spread of invasive disease, the Boston Public Health Commission initiated an investigation of these cases. This report describes the findings of the investigation, including risk factors for infection, and recommended prevention measures. The findings indicate the potential for widespread GAS infection and carriage in CCCs and suggest that, in this outbreak, antecedent use of varicella vaccine would have prevented cases of invasive GAS.

Boston↗