Gentamicin, nephrotoxic risk and treatment of neonatal infection.
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Biomedical subjects
Publications and source records attributed to N Lambert-Zechovsky.
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The effect of an amoxycillin-clavulanic acid combination on the intestinal bacterial ecosystem was studied by differential quantitative analysis of the fecal flora in 11 hospitalized pediatric patients aged 8 months to 4 years. The antibiotic combination was given orally to 7 patients and intravenously to 4. The modifications in the intestinal flora are more important with oral route than intravenous route. After treatment, an increase in ampicillin-resistant E. coli with overgrowth of Klebsiella were found. Our previous studies have shown that this microbial overgrowth carries a risk of secondary septicemia. A strain of amoxycillin-resistant Serratia marcescens emerged but did not pullulate . The other aerobic or anaerobic bacteria were not significantly modified. Most strains which emerged after therapy remained susceptible to the combination. Yeasts emerged in two patients. Thus, the amoxycillin-clavulanic acid combination results in intestinal Klebsiella overgrowth, requiring monitoring of the intestinal bacterial ecosystem.
A differential quantitative study was used to evaluate the effects of parenteral cefoperazone upon children's fecal flora. Fecal specimens were obtained from 16 patients, before, during and after therapy. Cefoperazone therapy was associated with major changes in fecal flora. There was marked reduction or suppression to undetectable levels of Enterobacteria, Staphylococci and Streptococci in 13 patients. During therapy, yeasts were selected or acquired in 7 cases. 5 to 10 days after cefoperazone was discontinued, the fecal flora was virtually the same as before treatment. Thus, cefoperazone should prove very useful in the treatment of septicemia due to intestinal overgrowth.
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We evaluate a new and quick micromethod which detect strains of Salmonella, Shigella and Yersinia from suspected colonies isolated of stool specimens. In our study, from 2 384 non pathogen bacteria or as Salmonella. And we determined 297 strains of Salmonella, two hours after isolation on selective medium. This method is very easy and permits to have a rapid diagnostic of strains of Salmonella.
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Quantitative cultures were made of jejunostomy fluid from 22 children with extrahepatic biliary atresia following hepatoportoenterostomy. Bacterial flora characteristics did not differ in patients with or without cholangitis. With the exception of Streptococcus group D, the most frequently encountered bacterial species with the highest mean concentrations in the jejunostomy fluid, were those mostly responsible for cholangitis (Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa). In 19 of 22 acute episodes, the organism causing cholangitis identified in blood and/or liver was also isolated from jejunostomy fluid. However, quantitative determinations in this fluid did not permit reliable identification of this organism. When the same bacterium caused early relapse, it often persisted in the jejunostomy fluid.
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The authors use a biologic micromethod to identify five hundred species and biotypes of Haemophilus strains isolated from clinical specimens. The relation between biotypes and infection is studied. A rapid and highly accurate test to search for beta-lactamase production is done to determined the actual ampicillin resistance in Haemophilus for different biotypes. 6.9 p. cent of Haemophilus influenzae and 17.5 p. cent of Haemophilus para-influenzae were found resistant to ampicillin.
We have used an enzyme immunoassay method to measure serum levels of gentamicin in neonates according to gestational age, birth weight, dosage and intervals of intramuscular injections. Peak, predose serum levels and half-life decrease when gestational age increase. For the same gestational age, peak serum levels decrease in small weight neonates. Toxic postdose serum levels were obtained in preterm neonates with a daily regimen exceeding 5 mg/kg. Serum concentration monitoring of gentamicin is recommended to ensure adequate dosage and interval of injections.
A retrospective study was conducted of 587 bacteriological samples collected from 387 children with acute otitis media treated as outpatients over a period of 30 months, to determine relative frequency of the causative germs and their resistance to antibiotics. The most frequently involved bacteria were staphylococci (16 p.cent) of which 70 p.cent were Staph. Epidermidis, and Haemophilus (17 p.cent), résistance to ampicillin being present in 19 p.cent. These results, which differ from those in the published literature, suggest that paracentesis with systematic bacteriological typing is the treatment of choice in acute otitis media.
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