Cheryl Schmitt

Vancomycin during pregnancy: Does it cause hearing loss or nephrotoxicity in the infant?

Vancomycin was administered intravenously to 10 pregnant women for the treatment of methicillin-resistant Staphylococcus aureus infections. Auditory brainstem response testing and renal function studies were performed on the 10 babies in the experimental group and 10 babies in each of two control groups to determine the safety of vancomycin use during pregnancy. Auditory brainstem responses were not normal at birth in six infants from the three different groups studied (N = 30) but were normal at 3 months in five. The sixth infant had conductive hearing loss unrelated to vancomycin use that spontaneously disappeared at 12 months of age. Renal function was normal in all infants. Vancomycin was detected in cord blood in two patients and in breast milk in one. Adequate serum levels were achieved with routine doses in eight mothers tested; no adverse reactions occurred. It appears that vancomycin use during the second and third trimesters of pregnancy does not produce sensorineural hearing loss or nephrotoxicity in the infant.

Vulvovaginal candidiasis complicating recurrent bacterial vaginosis.

&NA; In this study the authors reveal a high incidence of asymptomatic and symptomatic vulvovaginal yeast infection in patients with recurrent bacterial vaginosis. Symptomatic yeast vaginitis in these patients presents frequently as a mixed infection with symptoms and signs of both clinical entities being present simultaneously. The authors diagnosed vulvovaginal candidiasis in 10 (29%) out of 35 patients with a history of recurrent bacterial vaginosis; vulvovaginal candidiasis and bacterial vaginosis together were detected in 12 (34%) out of 35 women. Optimal therapeutic results usually require concomitant treatment of both candidal vaginitis and bacterial vaginosis. The lack of specificity of signs and symptoms of vaginitis mandates that women with recurrent bacterial vaginosis, for each symptomatic recurrence, be examined and evaluated by the use of simple laboratory tests to determine a specific diagnosis. Failure to appreciate the frequency of candida superinfection leads to empirical and inappropriate therapy for bacterial vaginosis.

Clinical, microbiological, and biochemical factors in recurrent bacterial vaginosis

Because so little is known about the pathogenesis of recurrent bacterial vaginosis (BV), a longitudinal microbiological study was conducted on 13 women with recurrent BV treated sequentially with conventional metronidazole therapy. A rapid clinical response characterized by disappearance of mal odor and an improvement in vaginal discharge occurred in 92% of 31 clinical episodes of BV, with patients no longer satisfying the composite clinical criteria for the diagnosis of BV. However, prospective evaluation of these asymptomatic women revealed profound residual biochemical and microbial abnormalities which were best evident on Gram stain and wet mount examination of vaginal secretions. Other common residual abnormalities included mild persistent elevation of vaginal pH and polyamine and fatty acid levels and the presence of clue cells in small numbers. Residual abnormalities could be quantified to create an overall symptom code which predicted recurrence, and it was found that the severity of residual abnormalities was inversely related to the time required until the next recurrence occurred. The severity and prevalence of residual abnormalities following clinically successful therapy support the concept that BV recurrence, especially when it is early, represents a relapse rather than a reinfection. This concept may have important therapeutic implications.