Guidelines for improving the use of antimicrobial agents in hospitals: a statement by the Infectious Diseases Society of America.
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Biomedical subjects
Publications and source records attributed to H L Moffet.
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Two children, aged 3 months and 4 years, respectively, were treated with ten weeks of amphotericin B for culture proved pulmonary blastomycosis. Organisms were easily demonstrated in nasopharyngeal or sputum specimens on admission. Although organisms were present until the 12th and 19th days of therapy, respectively, they were viable through only the seventh and 12th days of therapy. Both patients had thrombophlebitis, anemia, neutropenia, hypokalemia, fever, and vomiting develop during therapy. The less toxic drug hydroxystilbamidine isethionate, given for only 17 to 30 days, has been used successfully in at least six previously reported cases. Long courses of amphotericin B therapy may not be necessary for the treatment of pulmonary blastomycosis in selected children.
Most illnesses in ambulatory patients are infections; most of these are upper, middle, or pararespiratory infections. Although these diseases are rarely serious, they result in immense amounts of time lost from work and incalculable expense for over-the-counter medications. Guidelines for antibiotic and other drug therapy for these diseases need a better scientific foundation.
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A prospective study was made of 1,000 consecutive duplicate blood cultures obtained from sick children to evaluate the usefulness of sodium polyanethol sulfonate (SPS). With the small volumes of blood (1 to 5 ml) usually obtained for blood cultures in children, SPS did not increase the frequency of recovery of organisms judged to be associated with clinical infections, with the possible exception of Diplococcus pneumoniae. However, the use of SPS was associated with an increased frequency of recovery of organisms judged to be contaminants, such as Staphylococcus epidermidis and propionibacteria, possibly because SPS enhanced the recovery of a very small inoculum of skin bacteria.
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