Subject(s)
Gastroenteritis/drug therapy , Sulfamethoxazole/therapeutic use , Trimethoprim/therapeutic use , Yersinia Infections/drug therapy , Adolescent , Child , Child, Preschool , Clinical Trials as Topic , Double-Blind Method , Drug Combinations/therapeutic use , Feces/microbiology , Female , Humans , Infant , Male , Trimethoprim, Sulfamethoxazole Drug Combination , Yersinia enterocolitica/drug effectsABSTRACT
We conducted a prospective, randomized evaluation of oral chloramphenicol administration for completion of therapy of Haemophilus influenza type b meningitis in 44 children: 21 received drug by this route after the second day of therapy, the remainder continued to receive the drug intravenously. Resolution of clinical manifestations and cerebrospinal fluid indicators of meningitis was equivalent with both routes in 43 patients. One infant failed to achieve efficacious serum concentrations by either route of administration. Paired analysis of the area under the serum concentration versus time curve in 13 patients after oral and intravenous administration indicated equivalent bioavailability. Neutropenia was the only observed drug-related toxicity and correlated with the highest observed serum concentration. We conclude that: (1) chloramphenicol can be used by the oral route to complete treatment of H. influenzae type b meningitis; (2) a dose of 75 mg/kg/day is effective and less likely than higher doses to cause neutropenia; and (3) the measurement of serum chloramphenicol concentrations is important, regardless of route of administration.
Subject(s)
Chloramphenicol/administration & dosage , Meningitis, Haemophilus/drug therapy , Administration, Oral , Child , Child, Preschool , Chloramphenicol/pharmacology , Chloramphenicol/therapeutic use , Drug Evaluation , Haemophilus influenzae/drug effects , Humans , Infant , Infusions, Parenteral , Kinetics , Nervous System Diseases/chemically induced , Prospective Studies , Random Allocation , Time FactorsABSTRACT
The early diagnosis of congenital infection frequently depends on the ability to distinguish between infant IgM and maternal IgG antibodies. Staphylococcal protein A, which specifically binds IgG, removed maternal IgG from the serum of newborn infants. Residual IgM antibodies to CMV, rubella, toxoplasmosis, and syphilis were then identified by routine serologic techniques. Persistence of greater than or equal to 25% of the original antibody titer following SPA adsorption distinguished the sera of infants with congenital infection from those of healthy infants. No false negative results were encountered. Specificity of the serologic results of SPA-treated infant sera correlated with IgM-specific identification of the causative agent. Potentially false positive titers were identified by concurrent elevation of IgA or rheumatoid factor. Adsorption of cord or neonatal serum with SPA facilitates accurate serologic diagnosis of congenital infection.