Medical management of orbital cellulitis.

To determine the appropriate early management of orbital cellulitis and the current bacterial etiology and to evaluate the clinical usefulness of orbital computed tomographic imaging for this infection, a prospective study of orbital cellulitis was conducted during a 2-year period, 1999 to 2000, after the introduction of a conservative medical management plan designed by our pediatric infectious diseases, ophthalmology and otolaryngology services. Basically patients did not have surgical intervention unless progressive involvement of the optic nerve occurred after 24 to 36 h of intravenous antimicrobial therapy. Nine patients had orbital cellulitis and subperiosteal abscesses; only one required surgical drainage because of progressive disease, this case being culture-negative. One had a blood culture positive for Streptococcus pneumoniae; conjunctival cultures showed moderate to heavy growth for S. pneumoniae from this and two other patients, but otherwise bacterial etiology could not be defined. Haemophilus influenzae was not recovered from any of their blood or conjunctival cultures. This experience, during the computed tomography scan and Haemophilus vaccine era, supports an initial medical management approach for most patients with subperiosteal or retrobulbar abscesses resulting in orbital cellulitis.

A program description of health care interventions for homeless teenagers.

This prospective review was designed to determine the effectiveness of a broad-spectrum health intervention program for homeless and runaway youth. Diagnosis, treatment, and counseling for drug use, sexually transmitted diseases (STDs), and other health issues were provided all new admissions to a residential care facility during a 2-month enrollment. Education was continued during a 9-month follow-up period based on the program entitled Bright Futures, previously developed and published by the National Center for Education in Maternal and Child Health. Sixty percent of the 106 study residents had STDs on admission and 7% developed new STDs after completing therapy and undergoing counseling. Drug dependence was reduced from 41% to 3%, and 42% achieved full-time or part-time employment. Fifty-nine percent completed hepatitis B immunization with the 3-dose series. This experience suggests that an organized program of interventions in a residential care facility for homeless teenagers can significantly reduce drug dependence and STDs.

Compliance issues related to the selection of antibiotic suspensions for children.

OBJECTIVE: To evaluate the palatability, cost and other compliance issues as variables in the selection of antibiotic suspensions for children. METHODS: Eighty-six physicians and health care personnel randomly sampled amoxicillin (used as a standard for comparison) and 11 other antibiotics, evaluating them in categories of appearance, smell, texture, taste and aftertaste. Overall scoring was then adjusted for cost, duration of therapy and dosing intervals. RESULTS: Overall taste (palatability) ranking of antibiotics, highest to lowest, was as follows: loracarbef, cefdinir, cefixime, azithromycin, ciprofloxacin, trimethoprim-sulfamethoxazole, clarithromycin, trimethoprim, amoxicillin/clavulanate, cefpodoxime and cefuroxime. Overall rating of antibiotics was greatly influenced by other compliance variables, in order of their impact: cost; duration of therapy (5 vs. 10 days); and dosing intervals. Cost was not judged to be a major factor by most participants unless antibiotic expense was >$50.00 for treatment of otitis media in our hypothetical 2-year-old, 13-kg child. Taking all variables into consideration, final ranking from highest to lowest was azithromycin, cefdinir, loracarbef, cefixime, amoxicillin, trimethoprim-sulfamethoxazole, cefpodoxime, trimethoprim, clarithromycin, ciprofloxacin, cefuroxime and amoxicillin/clavulanate. CONCLUSIONS: Variables related to compliance for families filling antibiotic prescriptions and children taking these products are important in the selection of antimicrobial therapy. Because final assessment is likely to vary considerably among health care personnel, decisions must be made on an individual basis.

Prevention and management of sexually transmitted diseases in adolescents.

This review focuses on the diagnosis and treatment of common sexually transmitted diseases (STDs) encountered among adolescents in the U.S. and other developed countries. Included are new recommendations for the treatment of primary and recurrent genital herpes, management of pelvic inflammatory disease, and a revised approach to the care of adolescent victims of sexual assault. Diagnosis begins with a classification based on major clinical findings: genital ulcers with lymphadenitis, urethritis, vaginal discharge, pelvic inflammatory disease, and male STD syndromes. Appropriate laboratory evaluation for each of these clinical presentations is detailed and treatment options are summarized. Preventive interventions along with suggestions for an approach to the preadolescent well care visit, generally scheduled at age 11ñ12 years, are offered. Routine preventive therapy after a sexual assault takes into account difficulty in follow-up and the need to reassure adolescents and their families that all prophylaxis for possible infection has been provided.

Plasmodium falciparum malaria.

A 13-year-old adolescent daughter of a missionary presented with fever and jaundice 1 week after returning from Africa. Examination of peripheral blood film revealed the diagnosis of Plasmodium falciparum infection. Therapy with oral quinine and doxycycline was curative. Diagnosis requires a travel history and a high index of suspicion. Because of the frequency of international travel, United States physicians need to be familiar with the presentation and management of imported P falciparum. Preparation for such travel must include careful counseling and optimal use of chemoprophylaxis.

HIV seronegativity in an infant with the acquired immunodeficiency syndrome.

We report the case of an infant with progressive human immunodeficiency virus (HIV) infection and persistent seronegativity. The child had Pneumocystis carinii pneumonia at 4 months of age and was documented to be HIV-infected by HIV-1 deoxyribonucleic acid (DNA) polymerase chain reaction (PCR), but enzyme-linked immunosorbent assay (ELISA) and Western blot tests for HIV-1 and HIV-2 specific antibodies remained negative until the infant was 10 months old. This case should increase awareness about the possibility of seronegative HIV infection in infants and stress the fact that in questionable cases, even if the screening serology is negative, additional methods of diagnosis (ie, PCR, viral culture, and p24 antigen) should be considered.