Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 53
Filtrar
Mais filtros

Base de dados
Tipo de documento
Intervalo de ano de publicação
1.
Am J Med ; 82(4A): 142-5, 1987 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-3555028

RESUMO

Twenty-nine adult patients with cystic fibrosis received 750 or 1,000 mg of ciprofloxacin orally every 12 hours for two weeks. Pharmacokinetic data were collected on Days 1, 7, and 14. Pharmacokinetic analyses revealed minor differences between the dosage regimens, and results were similar on the first, seventh, and last day of therapy. Means for peak serum concentration (3.1 to 5.0 micrograms/ml), elimination half-life (4.8 to 5.3 hours), area under the time-concentration curve, and serum clearance (36.8 to 44.5 liter/hour) were similar to previously reported results for patients without cystic fibrosis. Sputum concentrations approximated serum values.


Assuntos
Ciprofloxacina/metabolismo , Fibrose Cística/metabolismo , Adulto , Ciprofloxacina/administração & dosagem , Ciprofloxacina/uso terapêutico , Ensaios Clínicos como Assunto , Fibrose Cística/complicações , Fibrose Cística/tratamento farmacológico , Feminino , Humanos , Cinética , Masculino , Infecções Respiratórias/complicações , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/metabolismo , Escarro/metabolismo
2.
Am J Med ; 82(4A): 189-95, 1987 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-3555035

RESUMO

Twenty-nine adult patients with cystic fibrosis who had chronic bronchopulmonary infection were randomly assigned to receive 750 or 1,000 mg of oral ciprofloxacin every 12 hours for two weeks. Assessments for efficacy and safety were made on treatment Days 7 and 14 and one week following completion of therapy, and pharmacokinetic data were collected on Days 1, 7, and 14. Fifteen of 28 evaluable patients showed clinical improvement, and none had clinical deterioration. The higher dosage of ciprofloxacin did not enhance the clinical response. Statistically significant, stepwise changes in clinical scores, pulmonary function, and sputum concentrations of Pseudomonas aeruginosa and Staphylococcus aureus were noted, but regression toward initial values occurred by one week after treatment. Although all P. aeruginosa isolates were initially inhibited by 2 mg/liter of ciprofloxacin or less, 45 and 35 percent of isolates were resistant after 14 days of therapy and one week later, respectively. Outpatient oral ciprofloxacin therapy was commonly associated with clinical improvement in adult patients with cystic fibrosis who have chronic bronchopulmonary infection, regardless of the emergence of resistant P. aeruginosa, and adverse reactions were infrequent. Further studies must delineate the long-term consequences of the frequent emergence of bacterial resistance.


Assuntos
Broncopneumonia/tratamento farmacológico , Ciprofloxacina/administração & dosagem , Fibrose Cística/tratamento farmacológico , Adolescente , Adulto , Broncopneumonia/complicações , Ensaios Clínicos como Assunto , Fibrose Cística/complicações , Feminino , Infecções por Haemophilus/complicações , Infecções por Haemophilus/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Pseudomonas/complicações , Infecções por Pseudomonas/tratamento farmacológico , Distribuição Aleatória , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/tratamento farmacológico
3.
Pediatrics ; 92(6): 833-7, 1993 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-8233746

RESUMO

OBJECTIVE: To prospectively characterize varicella occurring in children previously immunized with a live attenuated varicella vaccine (breakthrough varicella) through daily observation by medical personnel and to compare it with natural varicella followed in the same manner. DESIGN: A blinded clinical survey. SETTING: Four pediatric practices (two private; two hospital-based). PARTICIPANTS: Healthy 12-month-old through 17-year-old children with chickenpox were studied; 92 had natural varicella and 58 had breakthrough varicella. SELECTION PROCEDURES AND INTERVENTIONS: Study personnel, unaware of vaccination status, documented the clinical characteristics of each patient in the office or at the patient's home each day from enrollment until the day after the total number of lesions increased less than 10%. A standard form documenting number and description of lesions, temperature, duration of illness, and associated clinical complaints was completed each day by the same study personnel. Acute and convalescent sera were obtained on breakthrough cases. MEASUREMENTS AND RESULTS: Antibody to varicella-zoster virus was measured by the glycoprotein-based enzyme-linked immunosorbent assay. Of those with sera available, 85% were serologically confirmed. Eighty-seven percent of enrollees had a known exposure to chickenpox, with at least two thirds of each group having a greater than 4-hour or a household exposure. The numbers of total and vesicular lesions were significantly higher in the natural varicella group, regardless of exposure status (P = .021 to < .001). The group with breakthrough varicella had a significantly lower incidence of fever (P < .001) and a significantly shorter duration of illness (P < .001). Other associated constitutional complaints and complications were not significantly different between groups. CONCLUSION: Varicella in vaccine recipients is clinically modified and significantly less severe than natural disease.


Assuntos
Varicela/fisiopatologia , Herpesvirus Humano 3/imunologia , Vacinas Virais/imunologia , Adolescente , Varicela/imunologia , Varicela/patologia , Vacina contra Varicela , Criança , Pré-Escolar , Humanos , Imunização , Lactente , Estudos Prospectivos , Vacinas Atenuadas/imunologia
4.
Pediatr Infect Dis J ; 8(9 Suppl): S120-3; discussion S128-32, 1989 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-2682511

RESUMO

Aztreonam is the first monocyclic beta-lactam antibiotic released for clinical use. Extensive toxicity and safety data for aztreonam in animals, healthy volunteers and adult patients have been accumulated previously; recently these studies have been extended to children. Overall the incidence of adverse clinical reactions caused by aztreonam is similar to or lower than that caused by comparison drugs. There is no evidence that aztreonam causes significant ototoxicity or nephrotoxicity; biochemical and hematologic abnormalities are rarely significant. Compared with the broad spectrum cephalosporins, aztreonam causes less disruption of normal gastrointestinal flora and consequently a lower incidence of diarrhea. Aztreonam does not displace bilirubin from albumin and penetrates readily into cerebrospinal fluid. Because of negligible immunologic cross-reactivity with other beta-lactams, aztreonam has been safely administered to patients with IgE-mediated penicillin hypersensitivity. These data suggest that aztreonam should be safe and well-tolerated in infants and children with infections caused by susceptible Gram-negative bacteria.


Assuntos
Aztreonam/efeitos adversos , Animais , Aztreonam/toxicidade , Coagulação Sanguínea/efeitos dos fármacos , Humanos , Intestinos/efeitos dos fármacos , Intestinos/microbiologia , Rim/efeitos dos fármacos
5.
Pediatr Infect Dis J ; 12(1): 62-9, 1993 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-8417428

RESUMO

In this randomized, investigator-blinded multicenter study, tympanocentesis for acute otitis media with effusion in 137 ears from 108 children, 6 months to 12 years of age, revealed 84 definite pathogens and 32 potential pathogens. Twenty-nine aspirates from 23 subjects were sterile. Of the 116 isolates 42 (36%) were Streptococcus pneumoniae, 24 (21%) were Haemophilus influenzae, 9 (8%) were Moraxella catarrhalis, 9 (8%) were Streptococcus pyogenes and 1 (1%) was Staphylococcus aureus. Twenty-two (19%) definite pathogens produced beta-lactamase. Patients were randomized to cefixime (8 mg/kg/day daily) or cefaclor (40 mg/kg/day divided into two doses). Efficacy was determined by pneumatic otoscopy and tympanometry at the end of therapy visit on Days 11 to 14 and up to 4 weeks of follow-up. At end of therapy subjects with definite pathogens exhibited a satisfactory clinical outcome in 26 of 36 (72%) ears for cefaclor and 40 of 48 (83%) ears for cefixime recipients (P = 0.12). For ears with beta-lactamase-producing isolates there were no (0 to 12) cefixime failures but 4 of 10 cefaclor failures (P = 0.03). Diarrhea/loose stools were more frequent in cefixime (16 of 58) than cefaclor (4 of 50) recipients. One cefixime subject required discontinuation of drug. Overall efficacy for treatment of acute otitis media with effusion was not different; however, cefixime appeared more effective for infections caused by beta-lactamase-producing organisms.


Assuntos
Anti-Infecciosos/uso terapêutico , Cefaclor/uso terapêutico , Cefotaxima/análogos & derivados , Otite Média com Derrame/tratamento farmacológico , Doença Aguda , Anti-Infecciosos/administração & dosagem , Cefaclor/administração & dosagem , Cefixima , Cefotaxima/administração & dosagem , Cefotaxima/uso terapêutico , Criança , Pré-Escolar , Método Duplo-Cego , Esquema de Medicação , Resistência Microbiana a Medicamentos , Feminino , Humanos , Lactente , Masculino , Otite Média com Derrame/microbiologia
6.
Pediatr Infect Dis J ; 14(10): 879-84, 1995 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-8584316

RESUMO

We obtained nasopharyngeal cultures for Streptococcus pneumoniae from 54 children ages 2 to 24 months attending an Omaha child-care center (CCC) in April 1994. Thirty-two (59%) of the 54 children were colonized with S. pneumoniae belonging to serotypes 23, 19, 6 and 11. Seventeen (53%) of the pneumococcal isolates were highly resistant to penicillin (minimal inhibitory concentration > or = 2.0 micrograms/ml; HR-SP) and 7 (22%) were intermediately resistant to penicillin (0.12 < or = minimal inhibitory concentration < or = 1.0 microgram/ml; IR-SP). Within each pneumococcal capsular serotype, there were 1 to 3 DNA subtypes based on pulsed field gel electrophoresis analysis. A single pulsed field gel electrophoresis strain predominated in most CCC rooms, suggesting horizontal transmission among cohorted children. Nasopharyngeal cultures obtained 4 months later revealed similar S. pneumoniae colonization rates (28 of 52, 54%); however, only 2 (7%) of 28 isolates were HR-SP and 11 (39%) were IR-SP. Colonization with resistant pneumococci persisted after 4 months in 4 (12%) of 34 children cultured on both occasions. Antibiotic use by attendees had decreased notably between the two sampling periods, suggesting that selective pressure within the CCC might contribute to seasonal variation in colonization rates with HR-SP and IR-SP. We conclude that multiple genetic clones of penicillin-resistant pneumococci can occur simultaneously in a single CCC, especially during periods of heavy antibiotic selection pressure. However, individual clones of penicillin-resistant S. pneumoniae may be spread from child to child, suggesting that colonization with penicillin-resistant S. pneumoniae should now be considered a CCC-associated phenomenon.


Assuntos
Nasofaringe/microbiologia , Resistência às Penicilinas , Streptococcus pneumoniae/isolamento & purificação , Antibacterianos/farmacologia , Creches , Pré-Escolar , Eletroforese em Gel de Campo Pulsado , Humanos , Lactente , Testes de Sensibilidade Microbiana , Sorotipagem , Streptococcus pneumoniae/classificação , Streptococcus pneumoniae/genética
7.
Pediatr Infect Dis J ; 15(8): 667-72, 1996 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-8858669

RESUMO

OBJECTIVES: To determine the prevalence of penicillin-nonsusceptible Streptococcus pneumoniae (NS-SP) at 12 child-care centers (CCC) in urban and rural Nebraska and to evaluate the genetic diversity of pneumococcal strains present in the CCC environment. METHODS: Nasopharyngeal cultures for S. pneumoniae were obtained from children 2 to 24 months old. Capsular serotyping, pulsed field gel electrophoresis (PFGE) and microbroth dilution MICs were performed for all S. pneumoniae. Antibiotic exposure was also evaluated as a potential risk factor for colonization with NS-SP. RESULTS: Nasopharyngeal colonization with S. pneumoniae was present in 121 (56%) of 215 children. The MICs of penicillin were 0.12 to 1.0 microgram/ml for 57 (47%) and > 1.0 microgram/ml for 10 (8%) isolates. Clindamycin MICs of > 0.5 microgram/ml were found in 6 isolates (5%). MICs of ceftriaxone were 0.5 microgram/ml in 28% of S. pneumoniae and 1.0 microgram/ml in 7%. PFGE and capsular serotyping demonstrated multiple strains that were penicillin-nonsusceptible in both the urban and rural CCC. PFGE and capsular serotype defined shared strains within each CCC, but some PFGE "types" could be found in multiple serotypes. Antibiotic exposure during the 2 months before nasopharyngeal culture was not a statistically significant risk factor for nasopharyngeal colonization with NS-SP. CONCLUSIONS: NS-SP are highly prevalent in urban and rural Nebraska. PFGE similarities between serotypes may reflect "serotype switching" but may also reflect genetic similarity between S. pneumoniae strains.


Assuntos
Portador Sadio/microbiologia , Resistência às Penicilinas , Infecções Pneumocócicas/microbiologia , Streptococcus pneumoniae , Portador Sadio/epidemiologia , Creches , Humanos , Lactente , Testes de Sensibilidade Microbiana , Epidemiologia Molecular , Nasofaringe/microbiologia , Nebraska/epidemiologia , Infecções Pneumocócicas/epidemiologia , Prevalência , População Rural , Sorotipagem , Streptococcus pneumoniae/efeitos dos fármacos , Streptococcus pneumoniae/isolamento & purificação , População Urbana
8.
Pediatr Infect Dis J ; 14(9): 751-9, 1995 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-8559623

RESUMO

From January, 1992, to January, 1994, penicillin-resistant (minimal inhibition concentration (MIC) > 0.06 microgram/ml) Streptococcus pneumoniae (PRSP) isolates accounted for 48 (17%) of 283 isolates from acute otitis media (AOM) or recurrent AOM in 246 ambulatory patients in rural Kentucky. By broth microdilution, relatively penicillin-resistant (MIC > 0.06 to 1.0 microgram/ml) and highly penicillin-resistant (MIC > or = 2.0 micrograms/ml) strains were detected in 25 (16%) and 23 (15%), respectively, of 157 pneumococcal middle ear isolates. Using 1994 National Committee for Clinical Laboratory Standards breakpoints for pneumococci (unavailable for oral cephalosporins except cefuroxime), highly PRSP strains were almost uniformly susceptible to clindamycin and vancomycin. In contrast highly PRSP strains were resistant to most oral antimicrobials customarily used for AOM with one-third of strains highly resistant (MIC > or = 2.0 micrograms/ml) to ceftriaxone. Serotypes 6B, 19F and 23F accounted for 95% of highly PRSP strains and serotype 9V for 48% of relatively PRSP strains. By multivariate analysis, otitis-prone condition (P = 0.0008) and number of antibiotic courses before day of culture (P < 0.0001) were independently predictive of PRSP. Highly PRSP isolates were more commonly isolated from patients recently treated within 3 days (30%) vs. those who completed therapy more than 3 days earlier (2%) (P < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)


Assuntos
Otite Média/tratamento farmacológico , Resistência às Penicilinas , Infecções Pneumocócicas/tratamento farmacológico , Streptococcus pneumoniae/efeitos dos fármacos , Doença Aguda , Adolescente , Análise de Variância , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Resistência Microbiana a Medicamentos , Feminino , Humanos , Incidência , Lactente , Kentucky/epidemiologia , Masculino , Testes de Sensibilidade Microbiana , Otite Média/epidemiologia , Otite Média/microbiologia , Infecções Pneumocócicas/epidemiologia , Estudos Prospectivos , Fatores de Risco , Sorotipagem , Streptococcus pneumoniae/isolamento & purificação
9.
Diagn Microbiol Infect Dis ; 39(3): 195-7, 2001 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-11337189

RESUMO

An in vitro study of the activity of 10 oral agents against 153 pediatric isolates of Streptococcus pneumoniae identified moxifloxacin and levofloxacin as the most active agents regardless of penicillin or macrolide susceptibility. Moxifloxacin inhibited all strains at 0.25 microg/ml and was 8- to 16-fold more potent than levofloxacin.


Assuntos
Anti-Infecciosos/farmacologia , Compostos Aza , Fluoroquinolonas , Levofloxacino , Ofloxacino/farmacologia , Infecções Pneumocócicas/microbiologia , Quinolinas , Streptococcus pneumoniae/efeitos dos fármacos , Administração Oral , Antibacterianos/farmacologia , Criança , Pré-Escolar , Resistência Microbiana a Medicamentos , Resistência a Múltiplos Medicamentos , Humanos , Lactamas , Macrolídeos , Testes de Sensibilidade Microbiana , Moxifloxacina , Infecções Pneumocócicas/tratamento farmacológico , Streptococcus pneumoniae/isolamento & purificação
10.
Diagn Microbiol Infect Dis ; 41(1-2): 89-92, 2001.
Artigo em Inglês | MEDLINE | ID: mdl-11687320

RESUMO

An in vitro study of the activity of 9 agents against 181 US pediatric isolates of Streptococcus pneumoniae identified imipenem and faropenem as the most active agents. Overall, faropenem was the most potent oral agent inhibiting 98% of isolates at 1 microg/mL.


Assuntos
Antibacterianos/farmacologia , Lactamas , Streptococcus pneumoniae/efeitos dos fármacos , Farmacorresistência Bacteriana Múltipla , Testes de Sensibilidade Microbiana , beta-Lactamas
11.
Inflammation ; 11(1): 111-5, 1987 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-3032792

RESUMO

Evidence suggests that part of the pathophysiologic response seen in group B streptococcal (GBS) sepsis may be due to polymorphonuclear leukocyte (PMN) activation. Indomethacin (INDO), which inhibits eicosanoid metabolism, attenuates the pathophysiologic response stimulated by GBS, possibly due to inhibition of PMN aggregation. We examined the capability of two eicosanoid metabolism inhibitors, INDO and nordihydroguaiaretic acid (NDGA), to inhibit PMN aggregation induced by heat-inactivated opsonized GBS and GBS-activated plasma. Opsonized GBS-induced PMN aggregation was inhibited by INDO (50-500 microM) and NDGA (1-100 microM). Over similar concentration ranges, INDO and NDGA had no significant effect on PMN aggregation induced by GBS-activated plasma. PMNs in plasma aggregate in response to unopsonized GBS. The stimuli for aggregation are opsonized GBS and GBS-activated plasma. INDO (50-500 microM) was unable to inhibit aggregation under this condition. Over the same concentration range in which INDO inhibited opsonized GBS-induced PMN aggregation, INDO was unable to inhibit opsonized GBS-induced superoxide production in PMNs. NDGA was examined but was found to interfere with the assay. The above evidence suggests PMN aggregation via eicosanoid metabolism may play a role in GBS-induced sepsis, which may be attenuated by agents such as INDO and NDGA.


Assuntos
Vacinas Bacterianas/farmacologia , Neutrófilos/citologia , Streptococcus agalactiae/imunologia , Agregação Celular , Temperatura Alta , Humanos , Indometacina/farmacologia , Masoprocol/farmacologia , Superóxidos/metabolismo , Vacinas Atenuadas/farmacologia
12.
Inflammation ; 11(1): 87-93, 1987 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-3552979

RESUMO

We studied the aggregatory characteristics of human polymorphonuclear leukocytes (PMNs) in response to heat-inactivated group B streptococcus. PMNs suspended in physiologic salt solution do not aggregate to heat-inactivated group B streptococcus (GBS) unless the GBS is previously opsonized in autologous plasma. The aggregating activity of both opsonized GBS and activated plasma are reduced if the plasma is decomplemented before incubation with GBS. Pretreatment of PMNs with pronase inhibited opsonized GBS-induced aggregation, suggesting aggregation via cell membrane receptors for opsonic fragments of C3. Pronase pretreatment had no significant effect on aggregation induced by activated plasma or arachidonic acid. Unlike PMNs in physiologic salt solution, PMNs suspended in plasma aggregate when stimulated by unopsonized GBS. GBS aggregates PMNs via complement cascade activation, opsonization, and interaction with cell membrane receptors to stimulate cellular mechanisms resulting in PMN aggregation.


Assuntos
Vacinas Bacterianas/farmacologia , Neutrófilos/citologia , Streptococcus agalactiae/imunologia , Agregação Celular , Temperatura Alta , Humanos , Neutrófilos/efeitos dos fármacos , Proteínas Opsonizantes/metabolismo , Pronase/farmacologia , Vacinas Atenuadas/farmacologia
13.
Pediatr Clin North Am ; 47(2): 373-94, 2000 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-10761509

RESUMO

Varicella vaccine is safe, effective, and cost-effective in healthy children, adolescents, and adults. Breakthrough cases of MVLS are significantly milder than wild-type varicella infection. No severe adverse events have been reported following vaccination, and the incidence of herpes zoster is less in vaccinees than in individuals who have had natural varicella infections. To date, there is no evidence waning immunity following vaccination. "New and improved" varicella vaccines that may be more effective than the current vaccine and can be stored at refrigerator temperatures may soon become available in the United States.


Assuntos
Vacina contra Varicela , Adolescente , Adulto , Animais , Povo Asiático , Varicela/complicações , Varicela/imunologia , Vacina contra Varicela/efeitos adversos , Vacina contra Varicela/classificação , Vacina contra Varicela/imunologia , Criança , Herpesvirus Humano 3/imunologia , Herpesvirus Humano 3/patogenicidade , Humanos , Memória Imunológica , Japão
14.
J Perinatol ; 21(8): 559-64, 2001 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-11774021

RESUMO

We present a case of fatal herpes simplex type 2 (HSV-2) in a premature infant born to a mother diagnosed with recurrent HSV-2, based on history and HSV serology results. It was clinically evident at delivery, and subsequently confirmed by laboratory studies that the infant was infected before delivery. There was histopathologic evidence of placentitis and chorioamnionitis upon examination of the placenta and fetal membranes. This case illustrates a relatively uncommon complication of recurrent genital herpes at delivery--intrauterine transmission to the fetus from a primary episode during pregnancy.


Assuntos
Herpes Genital , Herpes Simples/transmissão , Transmissão Vertical de Doenças Infecciosas , Doenças Placentárias/microbiologia , Complicações Infecciosas na Gravidez , Evolução Fatal , Feminino , Herpes Simples/patologia , Humanos , Recém-Nascido , Masculino , Necrose , Gravidez , Recidiva
15.
J Reprod Med ; 37(4): 372-4, 1992 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-1593564

RESUMO

A case of localized neonatal herpes simplex virus (HSV) infection involved a prior fetal scalp electrode site. Rupture of the fetal membranes, placement of the fetal scalp electrode and delivery occurred within 30 minutes. The mother had no previous history of genital lesions, and no herpetic lesions were noted at delivery.


Assuntos
Eletrodos , Monitorização Fetal/efeitos adversos , Herpes Simples/etiologia , Dermatoses do Couro Cabeludo/etiologia , Aciclovir/administração & dosagem , Aciclovir/uso terapêutico , Feminino , Herpes Simples/diagnóstico , Herpes Simples/microbiologia , Humanos , Recém-Nascido , Trabalho de Parto Induzido , Dermatoses do Couro Cabeludo/tratamento farmacológico , Dermatoses do Couro Cabeludo/microbiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA