Use of adult isolation facilities in a UK infectious diseases unit.
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Biomedical subjects
Publications and source records attributed to A Pallett.
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The clinical efficacy and toxicity of once-daily compared with multiple-daily gentamicin dosing, in combination with azlocillin, were studied retrospectively in febrile neutropenic episodes following intensive chemotherapy. Fifty-two episodes were studied in 28 patients with acute myeloid leukaemia. Reasons for initiation of antibiotic therapy, dose, duration of treatment, organism isolation rates, response, cost comparison and toxicity were studied in the two treatment groups. The main indication for initiation of antibiotic therapy was neutropenic fever without a documented infection (80.8% of episodes). The response rate to once-daily gentamicin dosing and azlocillin was three times higher than to multiple-daily gentamicin dosing and azlocillin (P = 0.0112). The incidence of toxicity was low overall and was slightly but not significantly higher in the once-daily group. In this clinical context once-daily gentamicin at a dose of 7 mg/kg/day is more effective than a multiple-daily dosing regimen but may be more toxic.
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OBJECTIVE: To examine the range of disease caused by invasive Candida infection in neonates and infants and to discuss the available treatment options, particularly surgery and drug therapy. PATIENTS AND METHODS: Five consecutive infants with invasive urinary tract Candida infection presenting over an 18-month period were reviewed. Treatment protocols included a combination of surgery and treatment with amphotericin, flucytosine and fluconazole. RESULTS: The range of disease severity from simple Candida urinary tract infection to overwhelming multi-organ sepsis was demonstrated. Urinary tract obstruction was identified as a predisposing factor in three of the five cases. In all cases, infection was cleared by the treatment protocol. Two cases with bilateral renal pelvic fungal balls showed resolution with no surgery in three kidneys and showed no advantage of pyelotomy and perfusion. CONCLUSION: The results question the role of surgery, which may be limited to the relief of primary urological obstruction. We advocate the use of oral fluconazole to prevent or treat early systemic infection and, for severe systemic infections, a prolonged course of fluconazole in combination with flucytosine should be considered as an alternative to amphotericin, which is toxic and can only be given intravenously.
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