Upper respiratory tract infections are a frequent cause of illness. In children, acute otitis media (AOM) is the most common illness for which children receive medical attention. In adults, 20 million cases of bacterial sinusitis are reported yearly and the disease represents the fifth most common diagnosis for which an antibiotic is prescribed [1].
“…the present and future major challenge for all the specialists involved in the epidemiology and treatment of acute otitis media will be the identification of those children who will benefit most from the antibiotic treatment.”
Background. One dose of intramuscular ceftriaxone has been recently licensed in the United States for the treatment of acute otitis media. However, data regarding the bacteriologic and clinical efficacy of this regimen in the treatment of nonresponsive acute otitis media are incomplete. Objectives. To determine the bacteriologic and clinical efficacy of a 1-day 50-mg/kg vs. a 3-day 50-mg/kg/day intramuscular ceftriaxone regimen in the treatment of nonresponsive acute otitis media in children. Patients and methods. In an open, prospective study 109 patients ages 3 to 36 months with culture-proved, nonresponsive acute otitis media were randomized to receive 1 (n = 49) or 3 (n = 60) 50-mg/kg/day intramuscular ceftriaxone doses, respectively. Middle ear fluid was aspirated for culture by tympanocentesis on the day of enrollment (Day 1); a second tympanocentesis with middle ear fluid culture was performed on Days 4 to 5. Additional middle ear fluid cultures were obtained if clinical relapse occurred after completion of therapy. Bacteriologic failure was defined by positive cultures on Days 4 to 5. Patients were followed until Day 28 after completion of therapy. Susceptibility of the middle ear pathogens was measured by E-test. Results. Organisms recovered (n = 133) were Streptococcus pneumoniae (30 and 35 isolates for the 1-day and 3-day treatment group, respectively), Haemophilus influenzae (26 and 38, respectively) and Moraxella catarrhalis (n = 4). Of the 30 S. pneumoniae isolated from the 1-day group, 27 (90%) and 6 (20%) were nonsusceptible to penicillin and ceftriaxone, respectively; 9 of 27 (33%) were fully resistant to penicillin. Thirty-four (97%) and 6 (17%) of the 35 S. pneumoniae isolated from the 3-day group were nonsusceptible to penicillin and ceftriaxone, respectively; 16 of 34 (47%) were fully resistant to penicillin. Bacterial eradication of all H. influenzae and penicillin-susceptible S. pneumoniae was achieved in both treatment groups. Bacterial eradication of 14 of 27 (52%) and 33 of 34 (97%) penicillin-nonsusceptible S. pneumoniae was achieved in the 1-day and 3-day group, respectively. Seven (50%) of the 14 patients from the 2 groups who did not achieve bacterial eradication did not improve clinically on Days 4 to 5 and required additional ceftriaxone treatment. Conclusion. The 3-day intramuscular ceftriaxone regimen was significantly superior to the 1-day intramuscular ceftriaxone regimen in the treatment of nonresponsive acute otitis media caused by penicillin-resistant S. pneumoniae.
Neutropenia is a less commonly encountered feature of Rh hemolytic disease of the newborn, and its management may be problematic. Two newborn infants with neutropenia complicating Rh incompatibility—induced hydrops fetalis were treated with intravenous recombinant human granulocyte colony-stimulating factor (rhG-CSF), 5 μg/kg/day for 5 days. Both patients responded to therapy with a rapid and persistent increase of their neutrophil counts to normal values. The treatment was well tolerated and no adverse clinical events were observed. rhG-CSF induces a significant increase in peripheral absolute neutrophil counts of neutropenic neonates with Rh hydrops fetalis and was well tolerated. The contribution of rhG-CSF to clinical recovery warrants further investigation.
Among diseases requiring frequent visits to community physicians, pulmonary diseases specialists and pediatric emergency departments (PED) and leading also to high rates of hospitalizations, asthma is a leading chronic illness among children in the United States [5,6].Asthma affects individuals of all ages, races, ethnicities and incomes, but the rates of black and poor children suffering from this condition are disproportionately
