Victor L. Yu

Hepatitis B and hepatitis B vaccine requirements in schools of nursing in the United States: a national survey.

To ascertain use of the hepatitis B vaccine and occurrence of hepatitis B infection in nursing students, 1152 U.S. nursing schools were surveyed; 54.3% responded. The vaccine was required by 4.2% and recommended by 7.7%. Baccalaureate programs tended to require the vaccine more than the associate degree or diploma programs (p = 0.062). The occurrence of exposure of nursing students to blood and body fluids in the past 5 years was reported by 89.7%. Students in the diploma program had significantly more exposures (98.6%) than those in the associate degree (92.8%) and baccalaureate programs (82.7%; p less than 0.0005). At least one case of hepatitis B in the past 5 years was reported by 6.8%. Development of positive serologic markers in students after exposure to blood was reported by 7.1%. Seropositivity tended to occur in the Southeast and West (p = 0.035) and in cities with a relatively higher incidence of acquired immunodeficiency syndrome (p = 0.075). Diploma programs were significantly more likely to institute appropriate follow-up for students after exposure to blood of patients who were known or unknown carriers of hepatitis B virus (p less than 0.0001). For students exposed to blood of patients whose hepatitis B status was unknown and patients who were known hepatitis B carriers, 19.2% and 8.9%, respectively, reported they performed no follow-up whatsoever. U.S. nursing students are inadequately protected against hepatitis B. Nursing school administrators and faculty should be educated on the risks of hepatitis B infection and the indications and use of the hepatitis B vaccine.

Steady‐state moxalactam kinetics: Comparisons with other cephalosporins

Moxalactam is a new beta‐lactam antimicrobial with an extended spectrum. Serum concentrations were determined in 14 patients at steady state using bioassay and high‐pressure liquid chromatography methods. Mean peak and trough serum concentrations were 195 and 29.5 μg/ml for the 2‐gm dose and 214 and 28.8 μg/mlfor the 3‐gm dose. Peak and trough levels exceeded the minimum inhibitory concentration of the infecting bacteria in 100% and 67% of the patients. The 3‐gm dose is recommended for infections caused by Pseudomonas aeruginosa and other organisms with higher minimum inhibitory concentrations. Half‐lifes ranged from 1.7 to 5.7 hr and reflected the varying renal functions of the patients. A relationship (r = 0.878, p < 0.001) between creatinine clearance and elimination rate constant was established by bivariant linear regression analysis.