Oral ciprofloxacin vs. intravenous ceftazidime plus tobramycin in pediatric cystic fibrosis patients: comparison of antipseudomonas efficacy and assessment of safety with ultrasonography and magnetic resonance imaging. Cystic Fibrosis Study Group.

BACKGROUND: More data on the efficacy and safety of ciprofloxacin in pediatric cystic fibrosis patients are needed. METHODS: One hundred eight pediatric cystic fibrosis patients (ages 5 to 17 years) with acute bronchopulmonary exacerbations entered a randomized multicenter trial designed to compare the safety and efficacy of antipseudomonas therapy with oral ciprofloxacin (15 mg/kg twice daily; maximum dosage 750 mg twice daily) or intravenous ceftazidime plus tobramycin (CAZ/TM) for 14 days. RESULTS: Clinical improvement was observed in 93% of patients treated with oral ciprofloxacin and in 96% of those receiving parenteral therapy. Transient suppression of Pseudomonas aeruginosa was achieved in 63% of patients at the end of the course of iv CAZ/TM therapy and in 24% receiving ciprofloxacin. Ultrasound examination and nuclear magnetic resonance imaging scans showed no evidence of cartilage toxicity in any of the ciprofloxacin-treated patients. Musculoskeletal adverse events were reported with similar frequency in the two groups of patients (7% in the group receiving ciprofloxacin therapy and 11% in the IV CAZ/TM group). The only sustained musculoskeletal symptom was a case of synovitis in a patient receiving parenteral CAZ/TM. CONCLUSION: Ciprofloxacin thus appears to be safe and effective for use in young patients with bronchopulmonary exacerbation of cystic fibrosis.

Passive smoke exposure in infants and children with respiratory tract diseases.

1. The adverse effect of passive smoke exposure on the respiratory tract, particularly in infants and children, is not an issue of dispute. It was the objective of this study to analyse the extent and the intensity of passive smoke exposure in infants and children with respiratory tract diseases, and compare the information obtained with parents' subjective assessment. At the time of admission to the hospital, the parents of 295 infants and children (aged 1 month to 11 years) were questioned by the physician as to the smoking habits in the families' homes. An HPLC method was employed to determine simultaneously nicotine, cotinine and trans-3'-hydroxycotinine in the children's urine. 2. The sum of the nicotine metabolites turned out to be a sensitive marker in determining passive smoke exposure. Measurements revealed passive smoke exposure in 66% of the children, the frequency in younger children being significantly (P < 0.001) higher than in children over 5 years (84% vs 52%). The average concentration of nicotine metabolites in younger passive smokers was significantly (P < 0.001) higher when compared to the older ones (193 nmol/l vs 86 nmol/l). Forty-nine per cent of the parents assessed that their children had experienced passive smoke exposure, and another 10% emphasised that they only smoked in the absence of their child. In children with cystic fibrosis and bronchial asthma, the number of passive smokers as assessed by their parents were lower by 65% and 29% respectively when compared to the findings obtained from measurements. In children without respiratory diseases, the difference was as little as 18%. 3. Parents when questioned in conjunction with an illness of their children, tended to understate, or even withhold the truth about, passive smoke exposure. Therefore, reliable information on passive smoke exposure of patients can only be obtained through objective measurements.

[Compliance of children with bronchial asthma in long-term therapy with theophylline retard preparations]. / Untersuchungen zur Compliance von Kindern mit Asthma bronchiale bei einer Dauertherapie mit Theophyllin-Retardpräparaten.

427 samples of the saliva of 235 children were taken on an outpatient basis to follow up long-term theophylline treatment. 37 samples from 34 children did not reveal the presence of any theophylline. The absolute non-compliance found in this manner is 21% in the 9 to 12 years age bracket and significantly higher than with the children below 9 years and above 14 years of age (8 and 10%, respectively). Better differentiation of compliance and separation from underdosing was achieved in 38 children by comparing the outpatient-controlled theophylline levels with the values obtained on an inpatient basis. For 10 patients this method definitely revealed non-compliance, whereas compliance was doubtful with 12 children and 15 children had strictly adhered to the prescribed dosage regimen. To improve the intake discipline the theophylline levels should be regularly followed up under outpatient conditions and evaluated in cooperation with the patients.

[Treatment strategy in childhood bronchial asthma]. / Behandlungsstrategie des kindlichen Asthma bronchiale.

Although bronchial asthma is the most frequent chronic disease in childhood, not all of the affected children are readily recognised as asthmatics well in time for appropriate treatment. Since most of the children can get rid of the symptoms if all the available treatment methods are made use of systematically, early diagnosis and correct estimation of the disease pattern are essential for good long-term prognosis. New pathogenetic knowledge on the importance of inflammatory processes affecting the bronchial mucosa has definitely shifted the points of emphasis in asthma treatment as is evident from the international consensus recommendations. Focus of drug therapy is on prophylactic antiphlogistic treatment. Only in cases of severe asthma continual bronchodilatory medication is also recommended. The inhalative route is beneficial and feasible for all age groups. Long-term treatment, wherever necessary, also includes continual medical supervision in consultation with a paediatric pneumologist.

[Pulmonary alveolar microlithiasis]. / Microlithiasis alveolaris pulmonum.

Case report from a 12-years old russian girl with pulmonary alveolar microlithiasis. The diagnosis was confirmed by histologic examination from biopsy specimen of the lung. The differential diagnosis and the histomorphology are discussed.

[The significance of the flow-volume curve in pediatric lung diseases]. / Zur Bedeutung der Flussvolumenkurve in der pädiatrischen Pulmologie.

Even slight obstructions in small airways are detectable by means of the flow-volume curve. Therefore this method is to recommend for early diagnosis and especially in infancy. Advantages were demonstrable at the examination of different groups of asthmatics and in children with cystic fibrosis. The great sensitivity of the flow values was also shown at the bronchospasmolytic test and for provocation tests particularly. The flow-volume curve is an important routine method in pediatric pulmonology to determine the dimension and location of ventilation disorders and for follow-up studies and therapy supervision.

[Results of specific hyposensitization in children with pollinosis]. / Ergebnisse der spezifischen Hyposensibilisierung bei Kindern mit Pollinose.

Hyposensitization was carried out in 120 children aged 5 to 15 years with proven sensitivity to various pollen for 3 to 5 years before the start of the season. By reason of the results of intracutaneous tests 90 patients were treated with mixed pollen allergen and 30 patients with grass pollen allergen. A retrospective study was undertaken on the base of a questionnaire. Every year after the season duration and severity of symptoms as well as consumption of medicine were registered. The total success of hyposensitization amounted to 70.8% and this result varied on the one hand in dependence of the duration of disease on the other hand in dependence of the duration of treatment. A more inconvenient result was seen in those children who suffered from asthmatic symptoms exclusively compared to patients with hay fever. Local side effects resulted sporadically in 71.5% and systemic side effects in 15.7% by subcutaneous injection of depot-pollen allergen. Despite of extensive and not indifferent mode of treatment, hyposensitization should be performed in a correct way as soon as possible after exact indication.

[Value of computer tomography in bronchopulmonary diseases in childhood]. / Stellenwert der Computertomografie bei bronchopulmonalen Erkrankungen im Kindesalter).

In 20 children with bronchopulmonary symptoms and striking x-ray-thorax-findings computer-tomography examinations were carried out in addition to the usual diagnosis. Mediastinal demand for room and screening for tumor are recognized as essential indications in infancy for the application of CT-diagnosis in the chest. Computerized tomography is also indicated if an anomaly of blood vessels is suspected. In all other pulmonal diseases CT gives valuable information but in no case it replaces a bronchologic examination.

[Peculiarities of theophylline therapy in childhood]. / Besonderheiten der Theophyllintherapie im Kindesalter.

Profound knowledge of the pharmacokinetics of theophylline is a prerequisite to successful therapy. In children the clearance of theophylline is considerably greater than in adults. The required higher dosage in relation to body weight results in more pronounced oscillations of drug levels in serum. Investigations in 280 children in the age of 1 to 18 years with bronchial asthma, treated with theophylline compounds, confirm the necessity of individual dosage and surveillance of the drug level in serum. Instead of the determination of the drug level in serum, its measurement in saliva is sufficiently reliable and less molesting. Checks of drug level are also a valuable educational measure to improve patients' compliance with drug intake. The effectivity of asthma therapy in children could be decisively improved by an adequate formulation of a slow release preparation of theophylline.

[Initial experiences with "Oranienburg" slow-release theophylline in asthma therapy of children and adolescents]. / Erste Erfahrungen mit Theophyllin retard "Oranienburg" in der Asthmatherapie bei Kindern und Jugendlichen.

Experiences in 50 patients show that Theophyllin retard Oranienburg (280 mg theophylline) could be used as an effective bronchospasmolytic drug on conditions of mono- and combination-therapy. Advantages of this preparation are improvement of the compliance and an undisturbed night-sleep in patients. However an optimum dosage is hardly maintained in children by the present dose of a single tablet of 280 theophylline content. The effectiveness in therapy of childhood asthma could be improved by stronger sustained release effect and different doses of tablets.

[Findings of combined ventilation/perfusion scintigraphy in children with abnormalities of the bronchi, the lung and lung blood vessels]. / Befunde der kombinierten Ventilations-/Perfusionsszintigraphie bei Kindern mit Fehlbildungen der Bronchien, der Lungen und Lungengefässe.

Combined ventilation/perfusion scintigraphy with 133Xe/99mTc-HAM was performed within the framework of bronchological diagnostics in 38 children suffering from malformations of the bronchi, lungs and pulmonary vessels, and in 9 children after surgery of hernia of the diaphragm. The findings in stenoses, cysts in the bronchial system and in children with pulmonary vessel malformations, in one child with pulmonary agenesia and in a few other malformations, are presented. The significance of these findings in bronchological diagnosis in case of pulmonary malformations or clinical follow-up is discussed. Combined ventilation/perfusion scintigraphy is a valuable contribution to preliminary diagnosis and in follow-up of children with pulmonary malformations.

[Some new treatment strategies for lung involvement in patients with mucoviscidosis]. / Einige neue Behandlungsstrategien der Lungenmanifestation bei Mukoviszidosepatienten.

Autogenic drainage, PEP mask breathing as well as physical exercise are now well established in the treatment of pulmonary disease in cystic fibrosis, but there are different opinions about oxygen therapy over a long period as well as corticosteroid treatment. First reports on amiloride inhalations seem to be hopeful, but there is no experience with cystic fibrosis children till now, therefore clinical use can not be recommended. Heart lung transplants are not to consider as an alternative treatment for all cystic fibrosis patients, in special cases it may be successful.

[Oral ciprofloxacin therapy in juvenile patients with cystic fibrosis--results of a prospective pilot study]. / Orale Ciprofloxacin-Therapie bei juvenilen Patienten mit zystischer Fibrose--Ergebnisse einer prospektiven Pilotstudie.

Efficacy and safety of oral ciprofloxacin were studied in a prospective study at three cystic fibrosis centres, covering 24 in-patients suffering from cystic fibrosis and acute bronchopulmonary exacerbation. The patients were between 10 and 17 years of age. Pseudomonas infection was present in 75% of these patients. Despite frequent persistence of the pathogens, clinical improvement was noted in 75% of the treated children. A definite increase of the average MIC was not seen in 20 cases of persisting strains. No serious side effects occurred during the 14-day oral treatment course. Ciprofloxacin is a useful alternative to conventional parenteral treatment with antibiotics in patients suffering from cystic fibrosis and infections of the airways.