The spread of multiply resistant Streptococcus pneumoniae at a day care center in Ohio.

Streptococcus pneumoniae, type 23F, resistant to penicillin (MIC, 2 micrograms/mL) and multiple other antimicrobic agents, was isolated from middle ear fluid of a child with otitis media attending a day care center in Ohio. To determine the extent of spread of this strain, nasopharyngeal culture surveys were done, and 52 carriers were identified among 250 children attending the index day care center. No carriers were found among 121 children at two other day care centers in the same urban area. Use of prophylactic doses of antibiotics (P < .001) and frequent use of antibiotics (P < 0.001) were risk factors for nasopharyngeal carriage. Carriers were more likely to have had frequent otitis media episodes (P < .02) and otitis media not responsive to antimicrobial therapy (P < .001). Strategies to limit the spread of highly resistant pneumococcal strains should include encouraging judicious use of antimicrobic agents and reevaluating indications for prophylactic use of antimicrobic agents.

Clinical evaluation of cefamandole in childhood infections.

Cefamandole was evaluated for the initial management of bacterial infections in 60 infants and children. Infections included cellulitis (22), pneumonia (21), cervical lymphadenitis (8), arthritis or osteomyelitis (6), otitis media (2), and epiglottitis 91). Appropriate bacterial cultures and laboratory tests were performed for all patients. Cefamandole, 100 to 150 mg/kg/day divided into four doses given every six hours, was administered by the intravenous route. All bacterial isolates were sensitive to cefamandole, and all patients had good clinical and bacteriological responses. Duration of cefamandole therapy ranged between three and 30 days. Some of the patients' treatments were changed to specific narrow-spectrum antimicrobials after availability of the bacterial sensitivities. Cefamandole was tolerated well by most patients. Mild leukopenia and neutropenia developed in one patient and slight eosinophilia in four patients. These hematological abnormalities resolved spontaneously. These data suggest that cefamandole is an effective agent for the initial treatment of nonmeningitic infections in children.

Individualized CME learning opportunities. A critical role for the community hospital.

This paper has attempted to define the critical role that community hospitals can play in continuing medical education, a type of education that historically has been oriented toward large group instruction, often at the expense of individualized learing. Professional societies and organizations, major medical faculties, and educational programs sponsored by various groups may well be the basic structures for providing high-quality new information. However, rarely do presentations by these groups involve reclarification, synthesis, and examination of present knowledge and behavior, nor do they typically allow physicians to share their experiences or learn by doing--all of which have great importance to the learning habits of practicing physicians. The local medical community, through use of an instructional format like the one outlined, may be able to fill this crucial gap.