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  • 1
    Electronic Resource
    Electronic Resource
    INTRAPARTUM AND POSTPARTUM PYREXIA AND INFECTION AFTER INDUCTION WITH EXTRA-AMNIOTIC PROSTAGLANDIN E2 IN TYLOSE (1980)
    Oxford, UK : Blackwell Publishing Ltd
    BJOG 87 (1980), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: One hundred and twenty-four women, bearing 127 children, in whom labour was induced with extra-amniotic prostaglandin E2 in tylose were studied. High vaginal swabs taken from 111 patients immediately before insertion of prostaglandin E2were examined, specific identification of microbes being restricted to those present in the amniotic fluid, to haemolytic streptococci, and to other specific microbes. Lancefield group B streptococci were isolated from nine patients, and in eight of these the microbes were isolated from the amniotic fluid. Amniotic fluid was examined from 86 patients and was shown to be contaminated with microbes potentially pathogenic for mother or baby in 11 out of 86 (13 per cent) of the patients examined; in eight patients, the contaminating pathogen was the group B streptococcus. All 127 blood cultures taken during or just after delivery were negative. Six out of nine patients with a group B streptococcus in the vagina developed fever and proven streptococcal endometritis; one child developed fever and another streptococcal septicaemia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-0528.1980.tb04588.x
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  • 2
    Electronic Resource
    Electronic Resource
    Chloramphenicol in paediatrics: current prescribing practice and the need to monitor (1988)
    Springer
    European journal of pediatrics 147 (1988), S. 574-578 
    Details
    ISSN: 1432-1076
    Keywords: Chloramphenicol ; Neonates ; Pediatrics ; Toxicity ; Monitoring
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Two hundred and fifty-five neonates, infants and children, from 45 hospitals, who were receiving chloramphenicol therapy for serious infections were the subject of this study. Samples of serum and cerebrospinal fluid (CSF) were assayed for chloramphenicol and the patient's treatment regimens analysed. Less than 50% of neonates and 25% of infants received the “recommended” dose of chloramphenicol. In older children the recommended dose was used. Only 34% babies under 1 year of age and 50% older children had serum concentrations within the therapeutic range (15–25 mg/l). Thirty-one percent of neonates and infants had potentially toxic serum concentrations. Forty-three percent of neonates receiving chloramphenicol every 6h had subtherapeutic peak serum levels compared to 20% of those receiving the antibiotic every 12h. Concomitant administration of phenobarbitone or phenytoin had no effect on mean serum chloramphenicol levels. Serum concentrations of chloramphenicol were significantly higher in patients also receiving penicillin. CSF levels in 77 samples (39 patients) ranged from 1–60 mg/l. CSF from 44% patients contained less than 4 mg/l. Twelve neonates and infants (5.5%) suffered toxic side effects, four died. A further eight babies received an accidental 2- to 10-fold overdose and in three others an overdose was assumed following assay. No overdoses or toxic effects were reported in children over 1 year of age. Eight patients with impaired renal function had elevated serum levels and three showed toxic effects. In 22% patients dosage regimens were altered following assay. Even when the recommended dosage regimen for chloramphenicol is followed serum from all babies under 1 year of age should be assayed every 48–72 h if safe and effective levels are to be maintained.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00442465
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  • 3
    Electronic Resource
    Electronic Resource
    Routine lumbar punctures in the newborn — are they justified? (1990)
    Springer
    European journal of pediatrics 149 (1990), S. 797-799 
    Details
    ISSN: 1432-1076
    Keywords: Lumbar puncture ; Meningitis ; Newborn ; Sepsis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The records of 62,107 neonates cared for at three neonatal referral units between 1979 and 1985 were analysed with regard to the number of lumbar punctures (LP) performed and the results obtained. The mean perinatal mortality rate was 9.3/1000 live births and the neonatal mortality rate was 5.9/1000. The units were comparible in this respect. Two hundred and sixty three (0.4%) babies weighed less than 1.0 kg at birth and 510 (0.8%) babies weighed 1.0–1.5 kg. A total of 1554 LPs were performed on 1084 babies, 1.7% of the whole population. Seventeen babies were diagnosed as having meningitis following CSF examination; 5 weighed less than 1.5 kg (VLBW) (incidence of meningitis 6.5/100 births) and 12 weighed more than 1.5 kg (incidence 0.2/1000 live births). An LP was performed on 44% of VLBW babies and 1.2% of babies weighing more than 1.5 kg. In both groups approximately 1.5% of CSF samples were positive. Eight of the 17 positive results were obtained during the first 3 postnatal days. Only one VLBW baby had meningitis on the 1st day of life (1.3/1000). In view of the low incidence of meningitis and the risk factors associated with an LP it is questionable whether this procedure should be a routine investigation in the VLBW newborn.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01957285
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  • 4
    Electronic Resource
    Electronic Resource
    A comparison of ceftazidime and aminoglycoside based regimens as empirical treatment in 1316 cases of suspected sepsis in the newborn (1992)
    Springer
    European journal of pediatrics 151 (1992), S. 876-884 
    Details
    ISSN: 1432-1076
    Keywords: Infectious diseases ; Neonatal infections ; Cephalosporins ; Ceftazidime ; Aminoglycosides
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We report a prospective, non-blind, randomised, multicentre, parallel group, multinational investigation to compare ceftazidime to aminoglycoside based regimens as empirical treatment in 1316 cases of suspected sepsis in the newborn. In each of the 15 study centres either ceftazidime alone (CAZ) or ceftazidime + ampicillin (CAZ+AMP) was compared to an aminoglyocoside/ampicillin combination (AG+AMP). In all cases treatment was based on “an intention to treat”. Bacteria considered to be pathogenic were isolated from 176/1316 (13.4%) patients. The incidence of proven infection varied from 39% in a Yugoslav centre to 6% in a British centre; a further 489/1316 (37.1%) patients fulfilled the criteria for clinically suspected sepsis. A total of 210 bacterial isolates from 197 infection sites in 176 patients were considered to be clinically significant. The cure rate for evaluable patients with proven infection who were treated with CAZ+AMP (97%, 30/31) was significantly higher than that for the corresponding patients treated with AG+AMP (66%, 26/39), (P〈0.002). The difference in cure rate between CAZ monotherapy (79%, 34/43) and AG+AMP (86%, 32/37) was not significant. Treatment failed in 28/150 (18.7%) evaluable patients. There were significantly fewer failures (P〈0.001) with CAZ+AMP than with AG+AMP therapy. There were 55 staphylococcal infections. Treatment was successful in 16/19 evaluable patients treated with CAZ or CAZ+AMP and in 16/29 evaluable patients treated with AG+AMP. None of the study centres encountered problems with ceftazidime resistant bacteria. The cure rate for patients with only clinical and radiological evidence of sepsis was greater than 94% in all treatment groups. Of the study population 65 (4.9%) died, 15 deaths were attributed to infection, pathogenic bacteria were only isolated from 10. The mortality rate for infected babies was 5.7% compared to 4.8% for those without confirmed infection. All the deaths associated with infection were due to Gram-positive bacteria. This study suggests that the practice of continuing antibiotic therapy once pretreatment cultures are known to be negative should be seriously reconsidered. It is concluded that CAZ+AMP is superior to either AG+AMP or ceftazidime monotherapy for the treatment of infection in the newborn. Further studies are required to confirm these observations in neonates with proven infection.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01954122
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  • 5
    Electronic Resource
    Electronic Resource
    Pharmacokinetics and safety of ceftriaxone in the neonate (1985)
    Springer
    European journal of pediatrics 144 (1985), S. 379-382 
    Details
    ISSN: 1432-1076
    Keywords: Ceftriaxone ; Neonate ; Pharmacokinetics ; Safety
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The pharmacokinetics and safety of ceftriaxone were examined in 39 neonates who required antibiotics for clinically suspected sepsis. The drug was administered as a once daily dose of 50 mg/kg by the intravenous (IV) or intramuscular (IM) route. Ceftriaxone was assayed in 49 series of blood samples, 3 samples of cerebrospinal fluid (CSF) and 15 samples of urine by a microbiological technique. Blood was collected before, during and after treatment for biochemical analysis. Routine haematological investigations were also monitored. There was no significant differences between the maximum plasma concentrations following IV (153±39 mg/l) or IM (141±19 mg/l) administration (first dose). The mean elimination half-life, total body clearance, and volume of distribution following the first dose were 15.4±5.4 h, 0.28±0.12 ml/min per kg and 325±59 ml/kg respectively. Clearance increased with increasing postnatal age and body temperature (P〈0.0002) and decreasing plasma creatinine concentration (P〈0.005). Increasing plasma protein concentration was associated with a decrease in volume of distribution (P〈0.001). There were no drug-associated changes in any of the biochemical or haematological parameters examined. Ceftriaxone is a safe and well tolerated antibiotic for use in the treatment of newborn sepsis and possibly meningitis. A once daily administration of 50 mg/kg by the IV and IM routes provides satisfactory plasma concentrations throughout the dosage interval whilst avoiding accumulation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00441782
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  • 6
    Electronic Resource
    Electronic Resource
    Erfahrungen mit Ceftazidim in der Therapie von Neugeboreneninfektionen (1987)
    Springer
    Infection 15 (1987), S. S209 
    Details
    ISSN: 1439-0973
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Our experience of ceftazidime during the last three years has in almost every respect been favourable. As monotherapy it has resulted in clinical responses at least as good as those from gentamicin and ampicillin. The pharmacokinetics and activity of ceftazidime are far superior to those of gentamicin. We have not been able to demonstrate any significant haematological or biochemical side effects of ceftazidime therapy nor does it adversely affect neonatal blood clotting mechanisms. The incidence of superficial candidosis has not changed during the last three years. Use of third generation cephalosporins has resulted in an increase in neonatal colonisation with faecal streptococci but this has not resulted in any clinical problems. We have not observed any increase in the number of isolates ofEnterobacter spp. nor has there been an increase in the number of ceftazidime resistant microorganisms includingClostridium difficile, since ceftazidime was introduced. Drug accumulation does not occur in neonates receiving 25 mg/kg 12 hourly and throughout the dosage interval the serum therapeutic ratio for ceftazidime against common neonatal pathogens is superior to that of gentamicin with penicillin or ampicillin.
    Notes: Zusammenfassung Unsere Erfahrungen mit Ceftazidim in den vergangenen drei Jahren waren in nahezu jeder Hinsicht günstig. Die klinischen Ergebnisse mit Ceftazidim in Monotherapie waren mindestens ebenso gut wie mit Gentamicin plus Ampicillin. In seinen pharmakokinetischen Eigenschaften und seiner Aktivität ist Ceftazidim dem Gentamicin weit überlegen. Unter Ceftazidim-Therapie waren keine hämatologischen Nebenwirkungen nachzuweisen, die Blutgerinnung wurde beim Neugeborenen nicht beeinträchtigt. Während der vergangenen drei Jahre hat sich die Inzidenz oberflächlicher Kandidosen in unserem Patientengut nicht geändert. Während der Anwendung von Cephalosporinen der dritten Generation nahm die Kolonisation Neugeborener mit Darm-Streptokokken zu; klinische Probleme traten dabei jedoch nicht auf. Seit Einführung von Ceftazidim war keine Zunahme der Isolate vonEnterobacter spp. oder Ceftazidim-resistenter Mikroorganismen einschließlichClostridium difficile zu verzeichnen. Bei einer Dosierung von 25 mg/kg KG alle zwölf Stunden kumuliert Ceftazidim beim Neugeborenen nicht, und seine Aktivität im Serum gegen die üblichen Erreger von Neugeboreneninfektionen ist höher als die von Gentamicin in Kombination mit Penicillin oder Ampicillin.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01645873
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