Charles M. Ginsburg

Stevens-Johnson syndrome in children.

During a 22-year period 51 cases of Stevens-Johnson syndrome (SJS) occurred in infants and children who ranged in age from 3 months to 14 years. Fifty-six percent of patients had an antecedent upper respiratory tract infection or non-specific viral infection, and 67% had received a prescription medication in the 3 weeks before onset of SJS. Nineteen patients (37%) were treated with adrenocorticosteroid medication during their hospitalization. Age, sex, duration of illness, body temperature on admission and history of antecedent medication were similar for the steroid- and non-steroid-treated patients. Rates of infection and overall complications were significantly greater in steroid-treated patients than in those treated symptomatically. These observations suggest that steroid drugs should not be used for treatment of SJS in infants and children.

Absorption of lindane (gamma benzene hexachloride) in infants and children

Concentrations of lindane (gamma benzene hexachloride) were measured in blood from children who had received treatment with 1% lindane lotion. Lindane was present in the blood of all patients from two of 48 hours following application. Concentrations were inversely related to weight, surface area, and were independent of the quantity of lindane applied.

Relation of concentrations of Haemophilus influenzae type b in cerebrospinal fluid to late sequelae of patients with meningitis

Forty-four patients with Haemophilus influenzae type b meningitis had follow-up evaluations approximately one year after hospital discharge. Patients with greater than or equal to 10(7) colony-forming units of H. influenzae type b per milliliters CSF had significantly greater frequencies of speech impairment (P less than 0.001), hearing loss (P = 0.04), and moderate or severe neurologic sequelae (P less than 0.01). Patients with greater than or equal to 1 microgram H. influenzae b antigen/ml CSF had a greater incidence of hearing loss (P = 0.03) but not of speech abnormalities (P = 0.06) or other neurologic sequelae (P = 0.64). Glucose concentrations less than 10 mg/dl correlated with the incidence of hearing loss (P = 0.02) and speech impairment (P = 0.02). Partial antibiotic therapy, CSF protein concentrations, and number of CSF polymorphonuclear leukocytes did not correlate well with sequelae. These data indicate that pretreatment concentrations of H. influenzae b and glucose concentrations in CSF were the best predictors of late sequelae of patients with H. influenzae b meningitis.

Acute Mastoiditis in Infants and Children

During a 25-year period, 57 cases of acute mastoiditis occurred in infants and young children who ranged in age from 2 months to 12 years of age. All patients had abnormalities of the tympanic membrane and most had fever and localized edema and redness of the overlying skin. Fifty per cent of the infants who were less than one year of age had swelling primarily above the involved ear pushing the pinna out and down. By contrast, older children had swelling of the skin overlying the mastoid process which produced the classical finding of an elevated earlobe. Mastoid roentgenograms were a useful adjunct to diagnosis, revealing concurrent osteomyelitis in 9 patients. A diagnosis of specific bac terial etiology was made in 80 per cent of the patients in whom cultures were performed. Streptococcus pneumoniae, Staphylococcus aureus and Streptococcus pyogenes were the bacteria most frequently isolated. Unusual manifestations or serious complications occurred in 53 per cent of the patients, including one death (due to meningitis). These data indicate that the frequency of serious complications from acute mastoiditis has not declined over the past 3 decades.

Criteria for hospitalizing children who have ingested products containing hydrocarbons

The clinical records of 950 children who ingested products containing hydrocarbons were reviewed. Eight hundred children were asymptomatic at the time of the initial evaluation and remained so during a six-to eight-hour period of observation. All had normal chest films, and all were treated as outpatients. One hundred fifty other children were admitted to the hospital; 79 were symptomatic at the time of initial medical evaluation and had abnormal chest roentgenograms. Seventy-one other children were asymptomatic but had roentgenographic evidence of pulmonary involvement (36) or had had pulmonary symptoms before arriving at the medical facility (35). Complications (seven) occurred only in symptomatic children who had roentgenographic evidence of pneumonia. These data suggest that the majority of children who are brought for medical evaluation after ingesting hydrocarbon-containing substances do not experience pulmonary complications and therefore do not require hospitalization. Only children who are symptomatic at the time of initial medical evaluation or who became symptomatic during a six- to eight-hour observation period require hospitalization.

Haemophilus influenzae type b disease. Incidence in a day-care center.

Haemophilus influenzae type b (HIB) disease was observed during a 14-month period in seven of 48 infants attending a day-care center. Surveillance studies showed that 28 (58%) infants had positive nasopharyngeal cultures for HIB; four infants were colonized with HIB for nine to 12 months. Ampicillin trihydrate prophylaxis failed to reduce the HIB carrier rate. Haemophilus influenzae type b polysaccharide vaccine was administered to 34 of the children. Sera obtained prior to immunization showed detectable antibody in all infants. Only nine (26%) infants had twofold or greater rises in serum HIB antibody titers after vaccination. Antibody response was independent of age, preimmunization antibody concentration, and HIB carrier status. In one infant, HIB meningitis developed four months after she received polysaccharide vaccine. This outbreak emphasizes that HIB is highly contagious in closed populations of young, susceptible infants.

Erythromycin: A review of its uses in pediatric practice

Erythromycin continues to be a valuable and useful antimicrobial agent in children. Its low index of toxicity, freedom from sensitization, and reliable absorption and when administered orally contribute to make it an attractive agent in the treatment of a variety of minor respiratory and skin infections, especially in those situations where real or potential allergy to penicillin exists. Additional major uses are in the eradication of the carrier state in whooping cough and in diphtheria, especially in those instances when oral therapy can be tolerated. Dispite use over more than two decades, resistance developing in formerly susceptible organisms has not been a problem and thus seems unlikely to become so in the future.

Concentrations of antimicrobial agents in middle ear fluid, saliva and tears.

Antibiotics concentrations in middle ear fluid (MEF), saliva and tears were measured in children with persistent middle ear effusions undergoing tympanostomy tube placement. In 31 children given cefaclor, specimens of serum, saliva and MEF were collected at 0.5, 1, 2, 3 or 5 h after a dose. Another group of 37 children were randomized to receive a single dose of penicillin V, amoxicillin, ampicillin, erythromycin estolate, erythromycin ethylsuccinate, trimethoprim-sulfamethoxazole or cefaclor. Concentrations of antibiotics in saliva and tears bore no consistent relationship to those in MEF. Mean concentrations of all drugs in MEF were several-fold greater than the usual minimal inhibitory concentrations (MIC) of pneumococci, but only with trimethoprim and cefaclor were they greater than in usual MICs for Haemophilus influenzae. Concentrations of antibiotics in MEF in persistent effusions were comparable to those previously reported in acute purulent effusions.

Clinical Pharmacology of Cefadroxil in Infants and Children

The pharmacokinetics of cefadroxil suspension were studied in 30 children, 13 months to 12 years of age (mean age, 5.7 years). Average peak concentrations in serum of 11 to 14 μg/ml and of 7 to 10 μg/ml after 15- and 10-mg/kg doses, respectively, were not substantially affected by the feeding status. The serum half-life values were 1.3 to 1.5 h. Cefadroxil was detected in saliva of all children 2 h after 15-mg/kg doses: the levels ranged from 0.17 to 2.6 μg/ml (mean, 0.46 μg/ml). The average concentrations in urine were 1,700 and 2,620 μg/ml at 0 to 2 and 2 to 4 h, respectively, after 15-mg/kg doses. In a randomized controlled study of 50 children with impetigo, cefadroxil was as effective as penicillin G in curing existing lesions and in preventing development of new lesions. Cefadroxil may be useful for therapy of mucocutaneous and urinary tract infections in infants and children.

Concentrations of erythromycin in serum and tonsil: comparison of the estolate and ethyl succinate suspensions

Concentrations of erythromycin were measured in serum and tonsil from children who had received either the estolate or ethyl succinate suspension before surgery. The in vitro assay measured total erythromycin activity against a group A beta hemolytic streptococcus. Levels of erythromycin in serum and tonsil after single and multiple doses of the estolate were significantly higher than those after administration of the ethyl succinate. The therapeutic implications of these findings are unknown.