RESUMO
Forty-four patients with Haemophilus influenzae type b meningitis had follow-up evaluations approximately one year after hospital discharge. Patients with greater than or equal to 10(7) colony-forming units of H. influenzae type b per milliliters CSF had significantly greater frequencies of speech impairment (P less than 0.001), hearing loss (P = 0.04), and moderate or severe neurologic sequelae (P less than 0.01). Patients with greater than or equal to 1 microgram H. influenzae b antigen/ml CSF had a greater incidence of hearing loss (P = 0.03) but not of speech abnormalities (P = 0.06) or other neurologic sequelae (P = 0.64). Glucose concentrations less than 10 mg/dl correlated with the incidence of hearing loss (P = 0.02) and speech impairment (P = 0.02). "Partial" antibiotic therapy, CSF protein concentrations, and number of CSF polymorphonuclear leukocytes did not correlate well with sequelae. These data indicate that pretreatment concentrations of H. influenzae b and glucose concentrations in CSF were the best predictors of late sequelae of patients with H. influenzae b meningitis.
Assuntos
Infecções por Haemophilus/líquido cefalorraquidiano , Perda Auditiva Funcional/etiologia , Perda Auditiva/etiologia , Meningite por Haemophilus/líquido cefalorraquidiano , Distúrbios da Fala/etiologia , Adolescente , Adulto , Idoso , Antibacterianos/uso terapêutico , Proteínas do Líquido Cefalorraquidiano/análise , Criança , Pré-Escolar , Ensaio de Unidades Formadoras de Colônias , Glucose/líquido cefalorraquidiano , Infecções por Haemophilus/complicações , Infecções por Haemophilus/tratamento farmacológico , Humanos , Lactente , Leucócitos/análise , Masculino , Meningite por Haemophilus/complicações , Meningite por Haemophilus/tratamento farmacológico , Pessoa de Meia-Idade , Exame Neurológico , Estudos ProspectivosRESUMO
Nafcillin (150 mg/kg/day, divided every six hours) was administered intravenously to 46 patients ranging from 5 to 163 months of age with suspected or proved bacterial infections. Thirteen of 15 patients with bacteriologically proved infection responded to nafcillin. Two patients with cellulitis due to Escherichia coli or to Hemophilus influenzae type b did not improve with nafcillin therapy. A mean serum nafcillin concentration of 48 microgram/ml was observed 30 minutes after a dose of 37.5 mg/kg. The mean serum half-life was 0.76 hours. There was no significant relation between age and serum half-life, volume of distribution, or plasma clearance rate. Two patients developed neutropenia and six other patients developed an eosinophilia greater than 400/mm3 while receiving nafcillin. No significant toxic effect of nafcillin on liver or renal function was observed. One patient had phlebitis. There was a significant correlation between nfacillin concentrations and serum inhibitory and bactericidal titers (P less than 0.001). Results from this study indicate that nafcillin is a safe and effective antibiotic for the treatment of infections due to susceptible bacteria in the dosage tested.
Assuntos
Infecções Bacterianas/tratamento farmacológico , Nafcilina/uso terapêutico , Adolescente , Criança , Pré-Escolar , Avaliação de Medicamentos , Humanos , Lactente , Testes de Sensibilidade Microbiana , Nafcilina/metabolismo , Nafcilina/farmacologia , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus , Infecções Estreptocócicas/tratamento farmacológicoAssuntos
Doenças do Recém-Nascido/tratamento farmacológico , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus agalactiae/efeitos dos fármacos , Ampicilina/uso terapêutico , Líquido Cefalorraquidiano/microbiologia , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Gentamicinas/uso terapêutico , Humanos , Recém-Nascido , Testes de Sensibilidade Microbiana , Penicilina G/uso terapêuticoRESUMO
Concentrations of bacteria in cerebrospinal fluid ranged from 4.5 X 10(3) to 3 X 10(8) colony-forming units/ml in 27 patients with bacterial meningitis before antibiotic therapy and from 4 X 10(1) to 1.4 X 10(6) CFU/ml in four patients after one to two days of antibiotic therapy. All patients with persistent positive cultures had pretreatment concentrations of 10(7) CFU/ml or greater. A significant association was observed between cerebrospinal fluid lactic acid dehydrogenase activity and concentrations of bacteria (p less than 0.01). Large inocula of Hemophilus influenzae type b (10(7)) increased the minimal inhibitory concentration for penicillin and ampicillin but not for chloramphenicol. The minimal inhibitory concentration of each of the three antibiotics increased when group B streptococci were assayed. These data indicate that persistence of a positive culture may be related to large initial concentrations of bacteria. The relative "resistance" in vitro of large inocula possibly contributes to this persistence. These observations are also consistent with the hypothesis that lactic acid dehydrogenase activity in cerebrospinal fluid is derived from bacteria.