Allan D. Friedman

Impetigo contagiosa. III: Comparative efficacy of oral erythromycin and topical mupirocin

Abstract: Ninety‐seven patients with impetigo were prospectlvely enrolled in a study to determine the comparative efficacy of systemic and topical antibiotic therapy. After obtaining a bacterial culture from a representative losion, the children were randomized to receive seven days of either oral erythromycin or topical mupirocin administered three times daiiy. Staphylococcus aureus aione was Isoiated from 51% and in association with group A β‐hemoiytic streptococci (GABS) from 29%; GABS aione was isoiated from 4% of patients. Of 48 children who received erythromycln, 43 (90%) were citnicaily improved or cured, and 11 of 17 were bacteriologicaliy cured. Of 49 children who received mupirocin, 47 (96%) were clinicaily improved or cured, and 10 of 14 were bacterioiogicaiiy cured. At three week foliow‐up, clinical cure rates and number of secondary househoid cases of impetigo were equivaient In both treatment groups. Mupirocin appears to be a weil‐toierated, aibeit expensive, aiternative to erythromycin for the treatment of impetigo.

Superficial fungal infections of the skin : diagnosis and current treatment recommendations

SummarySuperficial fungal infections are common. Most diagnoses of fungal infections of the skin can be made by physical examination, assisted by the use of a Wood’s lamp, skin scrapings for microscopic examination, and fungal cultures.Dermatophyte infections are common at all ages, in both sexes, and they have a worldwide distribution. These infections include tinea capitis, tinea cruris, tinea pedis, tinea corporis, tinea manuum and tinea barbae. Tinea versicolor, caused by Malassezia furfur, and candidal infections are also common.Treatment modalities include oral and topical agents. Good personal hygiene is an important adjunct to antifungal therapy. Decisions regarding the appropriateness of therapy in a given patient must take into account the extent and location of the infection, the benefits and risks of each of the treatments, and cost.Oral therapies include griseofulvin, ketoconazole, and itraconazole. There are a large variety of topical treatments, including nystatin, selenium sulfide, tolnaftate, haloprogin, miconazole, clotrimazole, and sodium thiosulfate. Important to successful treatment is compliance with what is sometimes a long course of treatment, and good personal hygiene.

Efficacy of sponging vs acetaminophen for reduction of fever

Seventy-three children with acute febrile illnesses were enrolled in a study to compare the efficacy of sponging, sponging plus acetaminophen, and acetaminophen alone as methods of lowering body temperature. The greatest temperature reduction was seen in the combined acetaminophen plus sponging group. The smallest temperature reduction was noted in children who received sponging alone. We urge reconsideration of routine sponging of febrile young patients.

Impetigo Contagiosa: A Comparison of Erythromycin and Dicloxacillin Therapy

Abstract: One hundrud patients with impetigo were prospectively enrolled in a study to determine the current ctiology and comparative therapeutic efficacy of two oral antimicrobial agents active against both group A β‐hemolylic streptocitcci (GABS) and Staphilococcus aureus. After obtainini; a bacterial culture from a representatne impeliginous lesion, rhe children uere randomi/cd to roeeive in days of eithcr erythromycin (40 mg/kg/day) or dictoxacillin (25 mg/ kg/day). S. aureus alone uas isolated from 46 children, and in associaiion with GABS from 25 children. GABS alone wa‐v isolated from nine patients, Of the 59 evahluable children with S. areus isolates. 28 of 29 treated with erythromycin and 29 of 30 treated with dicioxaeillin were cured or improved on follow‐up examination. Thus, ue conclude Uiat erythromycin is the drug of choice for impetigo in our miiKvesiern loeale because of its high efficiency and relatively low cost.

Shock in children with gram-negative bacillary sepsis and Haemophilus influenzae type b sepsis.

To study the incidence of shock in children in association with gram-negative bacillary (GNB) sepsis and Haemophilus influenzae type b sepsis, we reviewed all episodes of septicemia with those organisms in a 10-month period. GNB were isolated from 10.95% and H. influenzae b from 13.8% of the patients whose blood cultures yielded bacteria. Shock occurred in 12.5% of patients with sepsis caused by GNB and in 10.3% of those with H. influenzae b sepsis. Shock occurred more frequently in patients with H. influenzae b sepsis with meningitis (20.6%) and more commonly in those who had GNB sepsis without meningeal involvement (11.4%). GNB sepsis was associated with severe shock and caused death of three of the four patients. Only one of the five patients with shock caused by H. influenzae b had severe shock and died. The good outcome of patients with sepsis and shock caused by H. influenzae may be related to the health status before illness and prompt appropriate antibiotic therapy.

Value of Rapid Diagnosis of Respiratory Syncytial Virus Infection on Management of Small Infants

Respiratory syncytial virus (RSV) is a common cause of infection in infancy and early childhood. A presumptive diagnosis of RSV infection can frequently be made on clinical grounds. Confirmation can be made by viral culture, which may take 3 to 7 days. Immunofluorescent assay (IFA) is a specific and sensitive test that can provide laboratory confirmation of RSV infection the same day. Rapid diagnosis of RSV infection may have implications regarding prevention of nosocomial spread of RSV, early initiation of anti-viral therapy, use of antibiotics, and duration of hospital stay. Data are presented regarding the use of RSV-IFA and its effect on patient management.