Hugh E. Evans

Prevention of bronchopulmonary dysplasia by administration of bovine superoxide dismutase in preterm infants with respiratory distress syndrome

The effectiveness of bovine superoxide dismutase (SOD) in the prevention of bronchopulmonary dysplasia was evaluated in a prospective double-blind controlled study in 45 neonates (mean gestational age 28.7 weeks, mean weight 1154 gm) with severe respiratory distress syndrome. All were ventilator dependent with FiO2 greater than or equal to 0.7 at 24 hours of age. Either bovine SOD (0.25 mg/kg) or saline solution was administered subcutaneously every 12 hours according to random selection until patients could be maintained in room air without ventilatory or continuous positive airway pressure (CPAP) support. SOD levels were detected in all patients given treatment. Mean peak values at 4 hours after dose ranged from 0.15 micrograms/ml (dose 1) to 0.45 micrograms/ml (dose 10). The drug was well tolerated, and no side effects were detected. Among the 31 survivors (SOD 14, placebo 17) radiologic evidence of BPD was significantly less in patients given SOD (3/14 vs 12/17, P = 0.008). Clinical signs of bronchopulmonary dysplasia (wheezing, pneumonia) were less in patients given SOD (3/14 vs 11/17, P = 0.019). Patients given SOD required fewer days of CPAP (P less than 0.003). There were no differences in days of O2 therapy, intermittent positive pressure breathing, or incidence and severity of patent ductus arteriosus or intraventricular hemorrhage. This preliminary study suggests that SOD may be helpful in reducing the severity of bronchopulmonary dysplasia in infants with respiratory distress syndrome.

Three-day antimicrobial therapy of urinary tract infection†

l. Bailey RR, and Abbott GD: Treatment of urinary-tract infection with a single dose of amoxycillin, Nephron 18:316, 1977. 2. Ronald AR, Boutros P, and Mourtada H: Bacteriuria localization and response to single-dose therapy in women, JAMA 235:1854, 1976. 3. Rubin RH, Fang LST, Jones SR, etal: Single-dose amoxicillin therapy for urinary tract infection, JAMA 244:561, 1980. 4. Anderson JD, Aird MY, Johnson AM, etal: The use of a single 1 g dose of amoxicillin for the treatment of acute urinary tract infections, J Antimicrob Chemother 5:481, 1979. 5. Stamey TA, Fair WR, Timothy MM, Millar MA, Mihara G, and Lowery YC: Serum versus urinary antimicrobial concentrations in cure of urinary-tract infections, N Engl J Med 291:1159, 1974. 6. Kallenius G, and Winberg J: Urinary tract infections treated with single dose of short-acting sulphonamide, Br Med J 1:1175, 1979. 7. McCracken GH Jr, Ginsburg CM, Namasonthi V, and Petruska M: Evaluation of short-term antibiotic therapy in children with uncomplicated urinary tract infections, Pedi. atrics 67:796, I981. 8. Ingelfinger JR, Avner ED, Tolkoff-Rubin NE, et al: Single dose amoxicillin treatment of uncomplicated urinary tract infections as effective as conventional therapy, Pediatr Res 15:694, 1981 (abstr). 9. Ellner PD, and Papachristos T: Detection of bacteriuria by dip-slide: Routine use in a large general hospital, Am J Clin Pathol 63:516, 1975. 10. Bauer AW, Kirby WMM, Sherris JC, e t a l : Antibiotic susceptibility testing by a standardized disk method, Am J Clin Pathol 45:493, 1966. 11. Siegel S: Nonparametric statistics for the behavioral sciences, New York, 1956, McGraw-Hill Book Company, lnc., p. 96. 12. Kunin CM: Detection, prevention and management of urinary tract infections, Philadelphia, 1972, Lea & Febiger, Publishers. 13. Helm EB, Shah PM, and Stille W: Kinetics of bacterial elimination in urine during antimicrobial treatment, J Antimicrob Chemother (Suppl) 5:191, 1979.

Tonsillectomy and Adenoidectomy Review of Published Evidence For and Against the T and A

There is no compelling evidence of any long term benefit from a T and A. Thus, the most conservative approach still seems appropriate. Consistent with the doctrine of primum non nocere (above all do no harm), the burden of proof of the efficacy for surgery should be on those who urge operation..

Single-dose gentamicin therapy of recurrent urinary tract infection in patients with normal urinary tracts

Results of single-dose therapy of urinary tract infections in pediatric patients have been contradictory mainly because of selection criteria. We evaluated the efficacy of a single dose of gentamicin in patients with normal urinary tracts and in whom urinary tract infections were recurrent. Twenty-one patients were included in the study, and a similar number in a conventional group given treatment for 10 days. Cure rate was 100% in both groups. The recurrence rates of 67% in the study and 52% in the conventional group were comparable. Single-dose therapy seems to have a role in the treatment of urinary tract infection in the absence of urinary tract malformation.

Cardiac response to oral and aerosol administration of beta agonists

tration of gammaglobulin was followed by dramatic correction of thrombocytopenia without side effects. Neonatal passive immune thrombocytopenia is by definition transient, so the effect of intravenously administered intact gammaglobulin, although of limited duration, may be sufficient to improve the thrombocytopenia until spontaneous correction occurs. This approach to treatment appears to be both safe and effective, but platelet transfusion should probably be performed when the thrombocytopenia is more severe and bleeding is life threatening. Whether intravenously administered gammaglobulin may also be effective in the treatment of active isoimmune neonatal thrombocytopenia resulting from a platelet incompatibility between the infant and mother remains to be established.

Lack of Cardiac Effect from Repeated Doses of Albuterol Aerosol A Margin of Safety

To simulate the pattern of use by some patients at home, we studied the effect of frequently repeated inhalation of albuterol aerosol on cardiac rhythm. Fifteen stable outpatient asthmatic children, ages 9-14 years were treated with two puffs of albuterol aerosol (180 mcg) followed either by hourly placebo or hourly albuterol aerosol for 5 hours (10 puffs = 900 mcg) in a randomized, double-blind crossover study. Cardiac rhythm was Holter monitored and pulmonary function was tested hourly for 5 hours. Heart rate (HR) was analyzed at hourly intervals. Pretreatment heart rate of 95.4 bpm ±1.9 SEM declined by 0.4-3 (bpm) after single dose and declined by 2.2-5.6 (bpm) from 99.2 (bpm) ± 2.3 SEM during multiple doses. No one developed arrhythmia, and side effects were infrequent on either day. Forced expiratory volume in 1 second (FEV1) increased similarly on both regimens. It remained stably elevated on the multiple doses, but it started to decline at 120 minutes after the single dose. Our study shows a substantial margin of safety in administration of albuterol aerosol to asthmatic children.

Reversible acute renal failure in lead poisoning

8. Bond JA, Harley DM, Lades HM: Plasma concentration of benzodiazepines. Br J Clin Pharmacol 4:51, 1977. 9. Lassius R, Dietrichson P, Lunde PKM: Effects of diazepam and desmethyldiazepam in spasticity and rigidity: A quantitative study of reflexes and plasma concentration. Acta Neurol Scand 61:378, 1980. 10. Morselli PL, Principi N, Tognoni G, Reali E, Belvedere G, Stranden SM, Sereni F: Diazepam elimination in premature and full term infants and children. J Perinat Med 1:133, 1973. 11. Langslet A, Meberg A, Bredesen JE, Lunde PKM: Plasma concentrations of diazepam and N-desmethyldiazepam in newborn infants after intravenous, intramuscular, rectal and oral administration. Acta Paediatr Scand 67:699, 1978.

High titer multiple dose therapy with HBIG in newborn infants of HBsAg positive mothers

These data are consistent with the hypothesis that most children with seizures can be safely and effectively treated with once daily doses of phenobarbital. Although therapeutic efficiency was only indirectly assessed, in no case did the change in dosing frequency significantly alter steady-state serum or saliva phenobarbital concentrations. This result is predictable in view of the studies on phenobarbital kinetics in children.:! .~ It also appears that although a wide range of doses is necessary to achieve therapeutic levels, most children achieve therapeutic levels on less than 5 mg/kg/day. The data also suggest that salivary levels can be used to determine an approximate value for simultaneous serum levels, Salivary levels can be used to predict simultaneous serum levels more reliably in a given patient if saliva to serum ratios are measured previously, since the intraindividual variation was much smaller than the intersubject

Evaluation of Cefotaxime in Bacterial Infections

Cefotaxime, a third generation cephalosporin antibiotic, was evaluated in 26 infants and children for the treatment of documented or suspected bacterial infections, including pneumonia (10 cases), soft tissue skin infection (13 cases), and urinary tract infection (3 cases). An average daily dose of 60 mg/kg in 3 to 4 divided doses was administered parenterally for an average of 7 days. In 14 of the cases, primary pathogens, including Haemophilus influenzae b (resistant to ampicillin), Staphylococcus aureus, Staphylococcus pyogenes, Streptococcus pneumoniae and Escherichia coli, were eradicated. Clinical recovery occurred in each case. Blood levels at different time intervals and biological half-life were similar to those reported for adults. Mild and transient side effects observed were elevation of SGOT in two cases, alkaline phosphatase in one, and eosinophilia in one case.

Clinical and Pharmacokinetic Evaluation of Moxalactam in Infants and Children

Moxalactam, a new beta-lactam antibiotic was evaluated in the treatment of 21 pediatric patients including 16 with clinical and radiological evidence of pneumonia and 5 with urinary tract infection (UTI). Clinical and radiological resolution of pneumonia occurred in all. Bacteriological efficacy in pneumonia, however, was assessed in only 1 patient whose blood culture grew H. influenzae type b. In patients with UTI, the therapy was successful, bacteriologically as well as clinically. The only side effects observed were mild transient elevation of SGOT and alkaline phosphatase in 6 cases. The peak and trough levels of the drug were manyfold higher than the known minimum inhibitory concentrations of common pathogens. The mean t1/2 projected of 95 and 124 min with intravenous and intramuscular route, respectively, were similar to those reported in adults.