Robert H. High

Comparison of serum levels following the administration of oral and parenteral preparations of penicillin to infants and children of various age groups

Summary 1. Penicillin levels in the serum of infants and children of various age groups were obtained following the administration of two oral and two parenteral preparations of penicillin. The various preparations were given in single doses of 10,000 units per pound of body weight. 2. Distinctly higher and more sustained blood levels were observed in the full-term newborn and premature infants than in older infants and children after the administration of comparable doses of all four preparations. The possible explanations for these differences have been discussed. 3. Minor differences have been observed in the levels following the administration of orally administered potassium penicillin-G and orally administered procaine penicillin. 4. Orally administered penicillin in doses of 10,000 units per pound of body weight produced levels of at least 0.03 unit per millititer for a minimum of six hours in full-term newborn and premature infants, for a minimum of four hours in infants up to 2 years of age, and for at least two hours in children over 2 years. 5. In all age groups intramuscularly administered potassium penicillin-G in doses of 10,000 units per pound of body weight resulted in very high initial levels. The levels declined rapidly, however, so that the 6-hour levels were comparable to those observed after the oral administration of penicillin in all age groups except the youngest newborn infants. 6. Intramuscularly administered procaine penicillin in doses of 10,000 units per pound of body weight produced high, sustained levels for six hours; detectable levels were often demonstrable at the end of twentyfour hours. 7. Suggestions have been made for dosage regimens for orally administered penicillin.

KANAMYCIN IN THE TREATMENT OF INFECTIONS IN INFANTS AND CHILDREN

Kanamycin sulfate, originally isolated and studied by Umezawa and his associates at the Japanese National Institute of Health and at Tokyo University, has wide antimicrobial Preliminary studies in the United States have confirmed this finding as reported in February 1958.6 The present study was undertaken to obtain preliminary information on the use of this drug in infants and children. Certain bacteriological studies were made on freshly isolated bacterial species. Serum concentrations of the drug were analyzed following a variety of intramuscular doses of kanamycin sulfate. Finally, a group of infants and children was treated with this new antimicrobial drug The results of these studies are reported below.

Effectiveness of penicillin administered orally at intervals of twelve hours.

Summary A series of 308 cases of common infections in infants and children was studied to evaluate the effectiveness of penicillin administered orally at intervals of four and twelve hours. Patients who received 300,000 unitsof penicillin at intervals of twelve hours responded as satisfactorily as did those who received 200,000 units as the initial dose followed by 100,000 units at intervals of four hours. The effectiveness of procaine penicillin was comparable to that of potassium penicillin-G, when each was administered in equivalent amounts at intervals of twelve hours.

Further observations of epidemic diarrhea of the newborn

Summary In an outbreak of epidemic diarrhea of the newborn involving sixty-three infants, there were fifteen deaths. The incidence of the disease and the death rate were higher among the premature infants. In eleven instances a biphasic clinical course was encountered, in which after clinical and biochemical improvement there suddenly developed ominous symptoms with a state of collapse and death for eight of the infants. Control of the outbreak was not obtained until the entire department was closed to admissions and thoroughly cleaned before it was reoccupied. An etiologic bacterial agent was not discovered, and virologic studies could not be performed. Therapeutic measures included maintenance of hydration, correction ofacidosis, modification of feeding, and administration of amino acid solution, plasma, and whole blood. Neither sulfonamide nor penicillin therapy seemed to influence the clinical course of epidemic diarrhea of the newborn, and in a limited series the intramuscular administration of gamma globulin had no apparent prophylactic or therapeutic effect.

Ineffectiveness of aureomycin in preventing theprimary vaccinia reaction

Summary The evolution of the primary vacciniareaction is not affected by the concurrent administration of aureomycin in doses of approximately 50 mg. per kilogram per day for a period of five days.