Terry Yamauchi

A prospective randomized comparison of cefotaxime vs ampicillin and chloramphenicol for bacterial meningitis in children

Fifty children with bacterial meningitis were prospectively randomized to receive cefotaxime (50 mg/kg/dose every 6 hours) or ampicillin and chloramphenicol in standard doses. Twenty-three patients received cefotaxime and 27 received standard therapy. Bacterial isolates included: Haemophilus influenzae (29), Streptococcus pneumoniae (eight), Neisseria meningitidis (eight), group B streptococci (three), and Salmonella enteritidis (two). Ten (34%) of the H. influenzae isolates were resistant to ampicillin, nine on the basis of beta-lactamase production. All strains were susceptible to cefotaxime. Clinical cure rates for the cefotaxime (100%) and standard therapy (96%) groups were similar; survival without detectable sequelae was similar, at 78% and 77%, respectively. The duration of therapy, 11.1 +/- 2.4 days (range 10 to 21 days) vs 11.9 +/- 3.9 days (range 10 to 21 days), and days to defervescence, 4.7 +/- 2.6 days (range 1 to 14 days) vs 5.6 +/- 2.9 days (range 2 to 17 days), were similar in the cefotaxime and standard therapy groups, respectively. No adverse drug reactions or side effects were noted in either group. Cefotaxime was found to be as safe and effective as standard therapy for the treatment of bacterial meningitis in children.

Airborne pathogen isolation capability in emergency departments of US children's hospitals

The requirement for negative pressure isolation procedures has been an accepted component of pediatric care to protect patients and staff from highly infectious respiratory agents. Surveys regarding airborne isolation were distributed to 43 pediatric emergency departments at US childrens hospitals with 26 responses. There was a median of 5 airborne isolation rooms, a median of 4 of those with negative pressure, and 61% without an ante-room. Capacity to manage pediatric patients infected with a highly pathogenic airborne-transmitted organism during an epidemic is limited.

Consultation with the Specialist: Enterococcal Infections

Introduction The enterococci, normal inhabitants of the human and animal bowel flora, were considered for years to be nonvirulent microorganisms. Over the past decade, however, the role of enterococci in human disease has taken on new importance. Serious diseases, such as bacteremia, which is associated with significant mortality, and endocarditis, are prime examples of human enterococcal infections. More recently, the wide-spread use of antimicrobial agents has led to the emergence of multiresistant microorganisms, previously considered to be nonpathogenic, as significant agents in human diseases. Morphologically, enterococci are gram-positive cocci that grow in chains and resemble streptococci. Previously, enterococci were placed in the Lancefield Group D streptococci genus; currently, they are in a new bacterial genus classification Enterococcus (Table). Clinical Diseases Enterococci may cause serious infections in the hospitalized patient and have been reported as the third leading cause of nosocomial infections in the United States. The recovery of enterococci from the urinary tract, surgical wounds, and the blood documents the importance of these bacteria in hospital-acquired infections. [See table in the PDF file] The urinary tract is the most common site infected by enterococci. Surgical instrumentation, intervention, and catheterization are invasive procedures that place the patient at risk for enterococcal infection.

Recurrent Meningococcal Meningitis Caused by Poly Groups X-W135: Importance of Chemoprophylaxis

Presented is a case report and literature review of the causes of recurrent meningococcal meningitis. After all factors were analyzed, the cause of reinfection in this child was postulated to be ineffective chemoprophylaxis of close contacts following the initial episode. The efficacy of chemoprophylaxis in household members and close contacts in meningococcal disease, although not demonstrated in controlled trials, has been recommended since 1974 by the Meningococcal Disease Surveillance Group. Considering known carriage rates, reports of secondary infections in close contacts, reinfection in the same person, and a high case fatality ratio, chemoprophylaxis in such cases seems justified.