RESUMEN
UNLABELLED: Orally administered anti-CD3 antibodies are biologically active in the gut through induction of regulatory T cells, exert an immune-modulatory effect, and alleviate insulin resistance and liver damage in patients with NASH. AIMS: To determine the safety of oral anti-CD3 monoclonal antibody (MAb) immunotherapy in chronic HCV patients with associated immune dysfunction. METHODS: Four groups (n = 9) of chronic HCV patients who were nonresponders to interferon plus ribavirin therapy received oral placebo (group A) or anti-CD3 MAb at one of three dosage levels for 30 days. Patients were followed for safety parameters and serum levels of liver enzymes, virus, cytokines and regulatory T cells. RESULTS: Oral anti-CD3 immunotherapy was safe and well tolerated; no treatment-related adverse events were noted. The following improvements were noted relative to pretreatment levels: HCV viral load and AST and ALT levels decreased in the low- and high-dose groups following 30 days of therapy. In two of the treated groups, an increase in regulatory T cells (CD4(+) CD25(+) ) was noted. The positive effects were somewhat more apparent in subjects with initially elevated liver enzyme levels. CONCLUSIONS: Oral anti-CD3 MAb immunotherapy for nonresponder HCV patients was safe and well tolerated. Trends and statistically significant improvements were observed as reductions in viral load and liver enzyme levels, along with an increase in regulatory T-cell levels. These data support a role for the immune system in the pathogenesis of HCV infection and suggest that this immunotherapy is worthy of evaluation in combination with HCV antiviral drugs.
Asunto(s)
Complejo CD3/inmunología , Hepatitis C Crónica/terapia , Factores Inmunológicos/administración & dosificación , Hígado/enzimología , Linfocitos T Reguladores/inmunología , Carga Viral , Administración Oral , Adolescente , Adulto , Anciano , Alanina Transaminasa/sangre , Anticuerpos Monoclonales/administración & dosificación , Anticuerpos Monoclonales/efectos adversos , Aspartato Aminotransferasas/sangre , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Femenino , Humanos , Factores Inmunológicos/efectos adversos , Masculino , Persona de Mediana Edad , Placebos/administración & dosificación , Resultado del Tratamiento , Adulto JovenRESUMEN
The emergence of fluconazole-resistant Candida (FRC) is worrisome, but little is known about susceptibility patterns in different nosocomial settings. We prospectively analysed Candida bloodstream isolates in 18 medical centres in Israel (six tertiary-care and 12 community hospitals). The study included 444 episodes of candidaemia (450 patient-specific isolates, 8.5% fluconazole-resistant). Institutional FRC bloodstream infection rates correlated with annual inpatient days, and were strongly associated with the presence and activity of haematology/oncology services. Infection with Candida krusei and fluconazole-resistant Candida glabrata occurred exclusively in hospitals with >600 beds. These findings suggest that empirical antifungal strategies should be tailored to the nosocomial setting.
Asunto(s)
Antifúngicos/farmacología , Candida/efectos de los fármacos , Candidemia/epidemiología , Infección Hospitalaria/epidemiología , Farmacorresistencia Fúngica , Fluconazol/farmacología , Adulto , Anciano , Candida/aislamiento & purificación , Candida glabrata , Femenino , Hospitales , Humanos , Israel/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Estudios ProspectivosRESUMEN
Zygomycetes infection is associated with a high mortality in transplant populations. We describe a child with liver allograft Rhizopus oryzae infection who was salvaged by liver re-transplantation. A 10-year-old child presented with anastomotic bile leak that was repaired. A combined antibiotics and voriconazole regimen was introduced for Escherichia coli and Candida krusei growth in the peritoneal fluid. Despite broad antibiotic and antifungal coverage, the patient continued to have an ongoing infection. A follow-up computed tomography scan 8 weeks later showed 2 liver abscesses infiltrating the stomach and the diaphragm, with splenic infarcts and pericardial effusion. Aspirated samples from the liver abscess and the pericardial fluid revealed R. oryzae. Immunosuppression was discontinued and an antifungal regimen combining amphotericin B, posaconazole, and caspofungin was introduced. After 3 weeks of treatment with control of the systemic signs of infection, a positron emission tomography showed the fluorescence stain limited to the liver. With infection confined to the liver, the child underwent liver re-transplantation, splenectomy, and partial gastrectomy. Immunosuppression was reintroduced with recovery of the immune response observed by the CD4 cells adenosine triphophate release (Cylex(™) ImmuKnow(®) assay) and posaconazole was continued for another year. At 3-year follow-up, the child maintained normal graft function. We conclude that discontinuation of immunosuppression combined with a modern antifungal regimen may allow salvage re-transplantation in patients with liver mucormycosis.
Asunto(s)
Trasplante de Hígado/efectos adversos , Mucormicosis/diagnóstico , Rhizopus/aislamiento & purificación , Antifúngicos/uso terapéutico , Niño , Humanos , Terapia de Inmunosupresión , Inmunosupresores/administración & dosificación , Hígado/microbiología , Hepatopatías/tratamiento farmacológico , Hepatopatías/inmunología , Hepatopatías/microbiología , Mucormicosis/inmunología , Mucormicosis/microbiología , Rhizopus/clasificación , Rhizopus/efectos de los fármacos , Trasplante Homólogo/efectos adversosRESUMEN
The purpose of this study was to assess the long-term effectiveness of the antibiotic lock technique (ALT) in conjunction with systemic antibiotics for the salvage of long-term central venous catheter (CVC)-associated coagulase-negative Staphylococcus (CONS) bloodstream infections (BSIs) in children. A retrospective study of children with CVC-associated CONS BSIs treated with systemic vancomycin and ALT with vancomycin was carried out. The primary outcome was the immediate and 3-month success rate of salvage of the CVC. During the study period, 23 patients had persistent CONS bacteremia and were treated with ALT and systemic vancomycin. Of the 23 vancomycin lock treatments, eight catheters were removed during the acute event because of persistent bacteremia, six had relapse of CONS bacteremia within 30 days, and two had relapse within 90 days. Only seven CVCs (30%) were salvaged. Long-term transcutaneous CVCs (Hickman CVCs) were significantly associated with higher salvage rates than implantable ports (75% vs. 18%, P = 0.05). ALT with vancomycin for CVC-associated bacteremia has a limited long-term effectiveness, especially with implantable ports. Larger prospective studies are needed for the long-term evaluation of this technique.
Asunto(s)
Antibacterianos/uso terapéutico , Bacteriemia/tratamiento farmacológico , Infecciones Relacionadas con Catéteres/tratamiento farmacológico , Catéteres de Permanencia/efectos adversos , Desinfección/métodos , Infecciones Estafilocócicas/tratamiento farmacológico , Staphylococcus/aislamiento & purificación , Adolescente , Adulto , Niño , Preescolar , Coagulasa/análisis , Femenino , Humanos , Lactante , Masculino , Recurrencia , Estudios Retrospectivos , Staphylococcus/enzimología , Resultado del Tratamiento , Vancomicina/uso terapéutico , Privación de Tratamiento , Adulto JovenRESUMEN
SUMMARY: Complex and prolonged cardiovascular operations are increasingly performed on young infants and children. The aims of this study were to define the incidence, causative bacterial pathogens and risk factors for sternal wound infections (SWIs) in infants and children undergoing cardiac surgery. The study group included all children who underwent cardiac surgery by median sternotomy at a tertiary paediatric centre from 1999 to 2003 and who were diagnosed with a postoperative SWI. Charts were reviewed for pre-, intra- and postoperative variables. The findings were compared with control patients operated on immediately before and after the cases and analysed by a stepwise logistic regression model. Of the 1821 children who underwent cardiac surgery, 49 (2.69%) had SWI; full data were available for 47. Twenty-nine (61.7%) had superficial wound infection and 18 (38.3%) deep wound infection. The main bacterial pathogens were Staphylococcus aureus in 14 patients (39%) and Pseudomonas aeruginosa in 12 (33%). Three variables emerged as significant independent risk factors for SWI: young age (odds ratio: 0.63; 95% confidence interval: 0.47-0.85; P<0.001 for each additional year), cyanotic heart disease (4.93; 1.98-12.3; P<0.001), and central venous catheter (CVC) dwell time (1.15; 1.06-1.24; P<0.001 for each additional day). Gram-negative infections were significantly associated with preoperative oxygen treatment (P=0.007) and prolonged urinary catheter dwell time (P=0.004). This study confirms younger age as risk factor for SWI and adds cyanotic heart disease and duration of CVC as new independent risk factors. Specific risks for Gram-negative infections are identified and should help to introduce new preventive strategies to decrease the incidence and severity of SWI.
Asunto(s)
Infecciones por Pseudomonas/epidemiología , Pseudomonas aeruginosa , Infecciones Estafilocócicas/epidemiología , Staphylococcus aureus , Esternón/cirugía , Infección de la Herida Quirúrgica/epidemiología , Cirugía Torácica , Adolescente , Estudios de Casos y Controles , Niño , Preescolar , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Israel/epidemiología , Masculino , Pediatría , Infecciones por Pseudomonas/microbiología , Pseudomonas aeruginosa/aislamiento & purificación , Factores de Riesgo , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/aislamiento & purificación , Infección de la Herida Quirúrgica/microbiologíaRESUMEN
Etoposide (VP-16) is a topoisomerase II (topo II) inhibitor chemotherapeutic agent. Studies indicate that VP-16 enhances proinflammatory cytokines secretion from tumour cells, including IL-8, a chemokine associated with proangiogenic effects. Fluoroquinolones inhibit topo II activity in eukaryotic cells by a mechanism different from that of VP-16. The fluoroquinolone moxifloxacin (MXF) has pronounced anti-inflammatory effects in vitro and in vivo. We studied the effects of MXF and VP-16 on purified human topo II activity and further analysed their combined activity on proliferation, apoptosis and caspase-3 activity in THP-1 and Jurkat cells. Moxifloxacin alone slightly inhibited the activity of human topo II; however, in combination with VP-16 it led to a 73% reduction in enzyme activity. VP-16 inhibited cell proliferation in a time and dose-dependent manner. The addition of moxifloxacin for 72 h to low-dose VP-16 doubled its cytotoxic effect in THP-1 and Jurkat cells (1.8- and 2.6-fold decrease in cell proliferation, respectively) (P<0.004). Moxifloxacin given alone did not induce apoptosis but enhanced VP-16-induced apoptosis in THP-1 and Jurkat cells (1.8- and two-fold increase in annexin V positive cells and caspase-3 activity, respectively) (P<0.04). VP-16 induced the release of IL-8 in a time and dose-dependent manner from THP-1 cells. Moxifloxacin completely blocked the enhanced release of IL-8 induced by 0.5 and 1 microg ml(-1) VP-16, and decreased IL-8 release from cells incubated for 72 h with 3 microg ml(-1) VP-16 (P<0.001). VP-16 enhanced the release of IL-1beta and TNF-alpha from THP-1 cells, whereas the addition of MXF prevented the enhanced cytokine secretion (P<0.001). We conclude that MXF significantly enhances VP-16 cytotoxicity in tumour-derived cells while preventing VP-16-induced proinflammatory cytokine release. This unique combination may have clinical benefits and cytotoxic drug 'sparing effect' and should be further studied in vivo.
Asunto(s)
Apoptosis/efectos de los fármacos , Compuestos Aza/farmacología , Proliferación Celular/efectos de los fármacos , Etopósido/farmacología , Quinolinas/farmacología , Antiinfecciosos/farmacología , Antineoplásicos Fitogénicos/farmacología , Caspasa 3/metabolismo , Línea Celular Tumoral , ADN-Topoisomerasas de Tipo II/metabolismo , ADN Superhelicoidal/metabolismo , Relación Dosis-Respuesta a Droga , Sinergismo Farmacológico , Activación Enzimática/efectos de los fármacos , Fluoroquinolonas , Humanos , Interleucina-1beta/metabolismo , Interleucina-8/metabolismo , Células Jurkat , Moxifloxacino , Plásmidos/efectos de los fármacos , Plásmidos/metabolismo , Factores de Tiempo , Factor de Necrosis Tumoral alfa/metabolismoRESUMEN
Nontuberculous mycobacterial (NTM) infection, particularly due to Mycobacterium abscessus, is an emerging disease that can be relentlessly progressive, particularly in cystic fibrosis (CF) patients. The risk factors that were associated with this increasingly symptomatic infection in a group of CF patients were investigated. A total of 139 CF patients aged 2-52 yrs were reviewed. Sputum was cultured for NTM annually or whenever clinical deterioration was unexplained. In total, 12 patients (8.6%) had positive cultures and six (4.3%) met the criteria for NTM pulmonary disease (five with M. abscessus). Five had allergic bronchopulmonary aspergillosis (ABPA) compared with one out of 133 patients without NTM disease. Five had received systemic steroids (four as a treatment for ABPA) compared with only one out of 133 without NTM lung disease. All six NTM patients deteriorated markedly following mycobacterial infection, and forced expiratory volume in one second dropped 18-46%. Despite prolonged triple antibiotic therapy, M. abscessus was not eradicated, and four out of six did not return to baseline clinically. In conclusion, severe nontuberculous mycobacterial lung disease, particularly with Mycobacterium abscessus, is becoming a perplexing challenge in cystic fibrosis patients. Allergic bronchopulmonary aspergillosis and systemic steroids appear to be risk factors, although small patient numbers limit this to a descriptive observation. When pulmonary condition deteriorates, increased surveillance for mycobacteria would enable prompt diagnosis and treatment.
Asunto(s)
Aspergilosis Broncopulmonar Alérgica/complicaciones , Fibrosis Quística/complicaciones , Fibrosis Quística/tratamiento farmacológico , Infecciones por Mycobacterium no Tuberculosas/complicaciones , Micobacterias no Tuberculosas/aislamiento & purificación , Esteroides/uso terapéutico , Adolescente , Adulto , Aspergilosis Broncopulmonar Alérgica/epidemiología , Niño , Fibrosis Quística/epidemiología , Fibrosis Quística/microbiología , Femenino , Humanos , Israel/epidemiología , Masculino , Infecciones por Mycobacterium no Tuberculosas/epidemiología , Factores de Riesgo , Esteroides/efectos adversosRESUMEN
A 15-year-old patient with acute lymphoblastic leukemia and Fusarium infection was treated with voriconazole. She developed asymptomatic bradycardia, QT interval prolongation, and nonsustained, polymorphic ventricular tachycardia, which recurred upon rechallenge with the drug. Voriconazole levels and metabolism were within expected normal values. This non-concentration-dependent, voriconazole-associated ventricular tachycardia mandates cardiac rhythm monitoring during voriconazole treatment.
Asunto(s)
Antifúngicos/efectos adversos , Bradicardia/inducido químicamente , Pirimidinas/efectos adversos , Taquicardia Ventricular/inducido químicamente , Triazoles/efectos adversos , Adolescente , Femenino , Fusarium , Humanos , Micosis/tratamiento farmacológico , Infecciones Oportunistas/tratamiento farmacológico , Torsades de Pointes/inducido químicamente , VoriconazolRESUMEN
The incidence of candidaemia is steadily increasing in neonatal intensive care units (NICUs). Several neonatal risk factors for candidaemia have been identified, however, the number of cases in controlled studies is small and knowledge concerning maternal and perinatal risk factors is limited. The present study attempted to identify modifiable, independent maternal, perinatal and neonatal risk factors for candidaemia using a retrospective case-control study in the NICU of a tertiary-care paediatric medical centre. The study group consisted of 56 neonates admitted to the NICU between 1996 and 2000 who acquired candidaemia. The control group comprised the first infant admitted immediately after each study infant matched for gestational age (+/-10 days) and birthweight (+/-200 g). Potential maternal, perinatal and neonatal risk factors were compared between the groups using statistical methods and analysed by univariate and multivariate stepwise logistic regression models. The independent risk factors found to be significantly associated with increased risk of candidaemia were duration of ventilation and presence of bacteraemia before candidaemia. Maternal steroids had a significant protective effect. The positive predictive value using these three parameters was 78.38%. Maximizing in-utero steroid treatment in high-risk pregnancies, minimizing the days of mechanical ventilation and investment of efforts in prevention of bacteraemia may help to reduce the incidence of candidaemia in the NICU.
Asunto(s)
Candidiasis/etiología , Infección Hospitalaria/etiología , Fungemia/etiología , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Análisis de Varianza , Antibacterianos/efectos adversos , Antibacterianos/uso terapéutico , Antiinflamatorios/uso terapéutico , Antifúngicos/uso terapéutico , Bacteriemia/complicaciones , Peso al Nacer , Candidiasis/epidemiología , Candidiasis/prevención & control , Estudios de Casos y Controles , Distribución de Chi-Cuadrado , Infección Hospitalaria/epidemiología , Infección Hospitalaria/prevención & control , Utilización de Medicamentos , Fungemia/epidemiología , Fungemia/prevención & control , Edad Gestacional , Hospitales Pediátricos , Humanos , Incidencia , Recién Nacido , Control de Infecciones/métodos , Control de Infecciones/normas , Israel/epidemiología , Modelos Logísticos , Valor Predictivo de las Pruebas , Respiración Artificial/efectos adversos , Factores de Riesgo , Factores de TiempoRESUMEN
AIM: The finding that 10% povidone-iodine skin disinfectant may compromise thyroid function in premature infants prompted its replacement with 0.5% chlorhexidine gluconate solution in 70% isopropanol. The objective of this study was to compare the incidence rates of true infection and contamination associated with the use of these two disinfectants in the neonatal intensive care unit. METHODS: The study population comprised two cohorts of infants admitted to our neonatal intensive care unit: 1) in 1992-1993 when only 10% povidone-iodine was used as a skin disinfectant, and 2) in 1995-1996 when only 0.5% chlorhexidine gluconate solution in 70% isopropanol was used. A retrospective chart review was conducted to determine whether all documented positive blood, CSF and suprapubic aspirate cultures indicated true infection or contamination. True infection was defined as clinical symptoms and/or laboratory abnormalities suggestive of sepsis, with positive blood, CSF or suprapubic aspirate cultures. RESULTS: 1146 infants were admitted during the study periods, 507 during the first period and 639 during the second. In the early group, 17.6% of infants had major malformations, 72.0% were premature and 25.2% had weights of < 1500 g. Corresponding percentages for the latter group were 16.0%, 80.6% and 32.9%, respectively. No statistically significant differences were found between the two research periods in rate of infants with positive blood cultures, true infections, or contamination. CONCLUSION: The use of 0.5% chlorhexidine gluconate solution in 70% isopropanol as a skin disinfectant is justified in neonatal intensive care units because it is not associated with an increased incidence of infections as opposed to 10% povidone-iodine and is devoid of detrimental effects.
Asunto(s)
Antiinfecciosos Locales/administración & dosificación , Infecciones Bacterianas/prevención & control , Clorhexidina/análogos & derivados , Clorhexidina/administración & dosificación , Unidades de Cuidado Intensivo Neonatal , Povidona Yodada/administración & dosificación , Estudios de Cohortes , Humanos , Recién Nacido , Recien Nacido Prematuro , Estudios Retrospectivos , Encuestas y CuestionariosRESUMEN
We analyzed the effect of the two quinolones moxifloxacin and ciprofloxacin on the repopulation of hematopoietic organs and on the production of cytokines by various organs of cyclophosphamide (CP)-induced leukopenic mice. The effect was compared to that of G-CSF. Cyclophosphamide injection induced a severe leukopenia, with nadir at day 4 post-injection. All the quinolone and G-CSF-treated animals showed WBC>500/microL at the nadir, compared to 50% of saline-treated mice. Cyclophosphamide induced a marked decrease in the number of myeloid progenitors (CFU-C) in bone marrow (BM) and spleen. Quinolone or G-CSF treatment resulted in a 1.4-4.3-fold increase in CFU-C numbers in the BM; no enhancement was observed in the spleen. Treatment with CP resulted in enhanced colony-stimulating activity (CSA) in bone shaft and spleen and decreased activity in bladder and lung. Treatment of CP-injected mice with quinolones significantly enhanced CSA in the bone shaft, spleen, lung and bladder on different days. In normal mice the highest levels of GM-CSF and IL-6 were observed in lung-conditioned medium (compared to bone shaft, spleen and bladder). Injection of CP resulted in a 22.5- and 93-fold decrease in GM-CSF and IL-6 levels, respectively, in lung-conditioned medium, while treatment with quinolones resulted in 2-4-fold increase in GM-CSF with no effect on IL-6 production. G-CSF treatment had no enhancing effect on GM-CSF nor on IL-6 production. We conclude that moxifloxacin and ciprofloxacin administered to CP-injected mice revert some of the immune suppressive effects of cyclophosphamide.
Asunto(s)
Antiinfecciosos/farmacología , Compuestos Aza , Ciprofloxacina/farmacología , Ciclofosfamida , Fluoroquinolonas , Factor Estimulante de Colonias de Granulocitos/farmacología , Inmunidad/efectos de los fármacos , Leucopenia/inducido químicamente , Quinolinas , Animales , Células de la Médula Ósea , Huesos/metabolismo , Recuento de Células , Medios de Cultivo Condicionados , Técnicas de Cultivo , Citocinas/biosíntesis , Modelos Animales de Enfermedad , Factor Estimulante de Colonias de Granulocitos y Macrófagos/biosíntesis , Granulocitos , Hematopoyesis/efectos de los fármacos , Células Madre Hematopoyéticas , Humanos , Interleucina-6/biosíntesis , Recuento de Leucocitos , Pulmón/metabolismo , Masculino , Ratones , Ratones Endogámicos BALB C , Moxifloxacino , Quinolonas/farmacología , Bazo/citología , Bazo/metabolismo , Vejiga Urinaria/metabolismoRESUMEN
BACKGROUND: Bronchiolitis caused by respiratory syncytial virus is one of the major causes of hospitalization in young children, especially during the winter. Recent evidence has shown that pharmacological treatment, especially nebulized epinephrine, in addition to the traditional supportive treatment, can alleviate symptoms and shorten hospitalization, but this approach is not yet widespread. OBJECTIVES: To determine whether the management of bronchiolitis in Israel is moving toward a stronger emphasis on pharmacological care. METHODS: A questionnaire on the diagnosis and management of bronchiolitis was completed by 27 heads of pediatric departments throughout Israel. The questionnaire dealt with the frequency of usage of diagnostic and selected therapeutic procedures. RESULTS: Chest X-ray and arterial blood gases are commonly used as a diagnostic aid in more than 75% of the departments, and antibiotics are prescribed routinely in 24%. Corticosteroids are still in use: 48% use systemic steroids, and 19% nebulized steroids. Nebulized epinephrine is used in 22% of the departments, while nebulized beta-agonists are used frequently in two-thirds of the departments. CONCLUSIONS: Despite convincing data that beta-agonists and steroids have no positive effect on the outcome of bronchiolitis on the one hand, and that nebulized epinephrine has advantages in children on the other, we found significant use of the former two agents and sparse use of the latter. Greater awareness is needed among pediatricians, and measures should be introduced to incorporate the new recommendations, with further study of the effect of the old and new drugs on bronchiolitis.
Asunto(s)
Bronquiolitis Viral/tratamiento farmacológico , Broncodilatadores/uso terapéutico , Epinefrina/uso terapéutico , Infecciones por Virus Sincitial Respiratorio/tratamiento farmacológico , Administración por Inhalación , Agonistas Adrenérgicos beta/uso terapéutico , Antibacterianos/uso terapéutico , Bronquiolitis Viral/diagnóstico , Bronquiolitis Viral/terapia , Niño , Recolección de Datos , Medicina Basada en la Evidencia , Glucocorticoides/uso terapéutico , Humanos , Lactante , Israel , Nebulizadores y Vaporizadores , Terapia por Inhalación de Oxígeno , Infecciones por Virus Sincitial Respiratorio/diagnóstico , Infecciones por Virus Sincitial Respiratorio/terapiaRESUMEN
Pediatric care in the community is gradually replacing traditional care in hospitals. Despite that, research activity in the community setting is minimal due to objective difficulties. These are mainly constraints of time, office work and lack of research-supporting logistics. In the past decade, throughout the world, primary physicians interested in research have grouped together and formed research networks. The aim of such networks is to support and promote research in the community. An Israel Pediatric Research in Office-Setting network (IPROS) was established 2 years ago by the Israel Ambulatory Pediatric Association (IAPA). Today, there are over 140 pediatricians listed in IPROS, representing the heterogeneous composition of pediatricians in Israel. The network's policy is defined by a joint steering committee. The committee is composed of IAPA representatives, senior network members and Schneider Hospital senior investigators. The research subjects are diverse, and represent common practical issues. Effective intra-net communication is vital to the existence of the network, and is accomplished by 3 modalities: 1) semiannual updates by mail, 2) e-mail, using an electronic mailing list to facilitate connection between members, 3) semi-annual meetings. Research budgets are derived from public sources like the Ministry of Health and IAPA, and private sources such as pharmaceutical companies. The administration of the network is supported by Schneider Children's Medical Center, and financed by IAPA.
Asunto(s)
Pediatría/organización & administración , Investigación/organización & administración , Atención Ambulatoria , Niño , Humanos , Israel , Proyectos de Investigación , Sociedades MédicasRESUMEN
We compared the effect of 6 quinolones on growth of murine bone marrow (BM) progenitor cells in vitro, and their in vivo effect on repopulation of BM and on survival of sublethally irradiated mice. The addition of clinically attainable concentrations of ciprofloxacin, sparfloxacin or clinafloxacin, in concert with pokeweed mitogen (PWM) to murine spleen cells, resulted in a significant enhancement in colony stimulating activity. A 1.5-1.8 fold increase in the number of myeloid progenitors (CFU-C) was observed in the presence of quinolone-PWM spleen conditioned medium (SCM) (prepared with the above-mentioned quinolones) compared with control cultures exposed to PWM-SCM only. Three other quinolones showed either no stimulatory-effect (fleroxacin, norfloxacin) or had an inhibitory effect (ofloxacin) on CFU-C growth. The stimulatory quinolones share in common a cyclopropyl moiety at position N1 of the quinolone ring. This moiety is lacking in the other 3 quinolones. The secretion of interleukin-3 (IL-3) and granulocyte-macrophage colony-stimulating factor (GM-CSF) by murine spleen cells exposed to quinolone-PWM-SCM was significantly enhanced with all 6 quinolones. However, this effect was associated with a parallel increase in CFU-C only with ciprofloxacin (10 micrograms/mL), sparfloxacin (1 microgram/mL) and clinafloxacin (0.05 microgram/mL). The in vivo activity was assessed in sublethally irradiated mice (650 rad) treated with quinolones for 5 d. The number of CFU-C in BM and the number of peripheral white blood cells (WBC) 8 d post-irradiation was significantly enhanced in mice treated with ciprofloxacin (45 mg/kg/d), sparfloxacin (22.5 mg/kg/d) and clinafloxacin (11.25 mg/kg/d) compared to saline treated animals (p < or = 0.05). Clinafloxacin at higher dosage (45 mg/kg/d) resulted in a decrease in myeloid progenitors in BM. A similar increase in progenitors and WBC was observed in animals treated with high doses, above clinical relevance, of ofloxacin, and norfloxacin (90 mg/kg/d), and with fleroxacin (45 and 90 mg/kg/d). Quinolone-treated animals, at the above-cited doses, showed enhanced survival on d18 compared to saline treated animals. The only exception was the higher mortality of clinafloxacin-treated mice. The above observations imply that certain quinolones, sharing specific molecular structure, are potential immunomodulators at clinically relevant concentrations. These compounds should be further studied in neutropenic patients and BM or peripheral blood progenitor cell recipients.
Asunto(s)
Antiinfecciosos/farmacología , Fluoroquinolonas , Hematopoyesis/efectos de los fármacos , Hematopoyesis/efectos de la radiación , Células Madre Hematopoyéticas/efectos de los fármacos , Animales , Médula Ósea/efectos de la radiación , Células Cultivadas , Ciprofloxacina/farmacología , Radioisótopos de Cobalto , Ensayo de Unidades Formadoras de Colonias , Medios de Cultivo Condicionados , Fleroxacino/farmacología , Factor Estimulante de Colonias de Granulocitos y Macrófagos/biosíntesis , Células Madre Hematopoyéticas/citología , Células Madre Hematopoyéticas/efectos de la radiación , Hemoglobinas/metabolismo , Interleucina-3/biosíntesis , Recuento de Leucocitos/efectos de los fármacos , Recuento de Leucocitos/efectos de la radiación , Linfocitos/citología , Linfocitos/inmunología , Masculino , Ratones , Ratones Endogámicos BALB C , Norfloxacino/farmacología , Ofloxacino/farmacología , Quinolonas/farmacología , Irradiación Corporal TotalRESUMEN
The worldwide epidemiology and population-based incidence of Q fever endocarditis (QFE) have been less well studied than those for uncomplicated Q fever. An exhaustive literature review revealed 408 patients with QFE reported between 1949 and 1994, mostly from 3 large geographic areas. Underlying valvular heart disease was almost invariably present, and 38% had prosthetic valves. The most common clinical manifestations were fever and congestive heart failure. The mortality rate dropped over the years from 65% to 25%, but a meta-analysis of published data showed the death rate to be significantly lower among patients receiving combination therapy (12/65, 18%), as compared to patients treated with tetracycline alone (18/41, 44%, p = 0.005). A 10-year (1983-1992) retrospective nationwide survey of QFE in Israel revealed 35 patients with QFE, representing an annual incidence of 0.75 cases per 1 million population. Underlying heart disease, clinical manifestations and outcome in the Israeli group were not substantially different from those described in the world literature. The current state-of-the-art clinical approach includes early diagnosis, prompt initiation of combination therapy for at least 3 years, and long-term clinical and serologic follow-up. Adherence to these rules might have contributed to the improved prognosis in recent years.
Asunto(s)
Endocarditis Bacteriana/epidemiología , Fiebre Q/epidemiología , Adulto , Anciano , Antibacterianos , Anticuerpos Antibacterianos/sangre , Coxiella burnetii/aislamiento & purificación , Quimioterapia Combinada/uso terapéutico , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/microbiología , Femenino , Enfermedades de las Válvulas Cardíacas/complicaciones , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Israel/epidemiología , Masculino , Persona de Mediana Edad , Fiebre Q/complicaciones , Fiebre Q/diagnóstico , Fiebre Q/tratamiento farmacológicoRESUMEN
Acute bacterial peritonitis is a common surgical disease treated with fluid resuscitation, surgery and antibiotics. The choice and use of antibiotics is an important supplement of therapy. Cephalosporins are among the most frequently used drugs for this condition. Although there is evidence that these agents reach the peritoneal cavity under normal conditions, no data are available regarding their delivery and concentration during acute secondary bacterial peritonitis. In order to determine the effectiveness of these agents in such cases, we studied the diffusion of three generations of cephalosporins--cefazolin, cefonicid and cefotaxime--into the peritoneal cavity during controlled bacterial peritonitis in rats. Our results show that all three drugs reached therapeutic concentrations in the peritoneal fluid; the highest concentration was obtained by the third-generation cefotaxime.
Asunto(s)
Infecciones Bacterianas/tratamiento farmacológico , Cefazolina/farmacocinética , Cefonicid/farmacocinética , Cefotaxima/farmacocinética , Cefalosporinas/farmacocinética , Peritonitis/tratamiento farmacológico , Enfermedad Aguda , Animales , Evaluación Preclínica de Medicamentos , Monitoreo de Drogas , Cavidad Peritoneal , Distribución Aleatoria , Ratas , Ratas Wistar , Distribución TisularRESUMEN
Children with partially treated (PT) meningitis present diagnostic and therapeutic dilemmas. Since the approach to these children is not uniform, both in the literature and in daily practice, we conducted a survey among leading Israeli pediatricians from various hospitals to learn about their opinions and practices relating to this problem. Twenty-eight of 30 senior pediatricians responded to a questionnaire encompassing the various aspects of PT meningitis. The results of the survey highlighted the confusion and lack of clear policy regarding the definition, diagnostic approach and treatment of these children. Fifty percent of the pediatricians stated that even one dose of an antimicrobial agent, regardless of the type of drug, is sufficient for the definition of PT meningitis; 43% of the responders did not require any threshold parameter in CSF findings for the definition of probable bacterial meningitis among PT children and 52% did not think that a second lumbar puncture was useful as a diagnostic aid in PT meningitis. Epidemiological circumstances played a role in the diagnostic and therapeutic approach of infectious disease specialists mainly, but less so in the other groups of pediatricians. Finally, more than half the responders did not use throat cultures to identify potential carriers among PT meningitis patients and did not consider the use of prophylactic treatment in close contacts. These data clearly indicate the need for guidelines regarding the various aspects of PT meningitis.