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Biomedical subjects

R D Feigin

Publications and source records attributed to R D Feigin.

At least 55 records · Page 3Linked to original sources
PubMed1982

Clindamycin versus nafcillin or methicillin in the treatment of Staphylococcus aureus osteomyelitis in children.

The treatment of osteomyelitis due to Staphylococcus aureus was evaluated by randomized trial in 12 children who received clindamycin and 13 children who received nafcillin or methicillin. In the nafcillin/methicillin group, the mean duration of intravenous (IV) therapy was 27 days (range 14 to 38 days) plus 3.7 weeks (range 0 to 8 weeks) of oral therapy with dicloxacillin. In the clindamycin group, the mean duration of IV therapy was 5.8 days (range three to ten days) plus 4.7 weeks (range three to nine weeks) of oral therapy with clindamycin. The geometric means (GMs) of peak serum bactericidal titers for IV therapy were 45 (range 16 to 256) and seven (2 to 256) for nafcillin/methicillin and clindamycin respectively. The GMs of peak serum inhibitory and bactericidal titers for oral therapy with clindamycin were 99 (range 16 to 512) and four (range 1 to 128) and were generally within one dilution of the IV titer. The outcome of therapy was excellent for ten children in the nafcillin/methicillin group and for 11 children in the clindamycin group. In the clindamycin group, the outcome did not correlate with achieving a peak bactericidal titer of greater than 1:8. Clindamycin administered IV until the patient is afebrile for three consecutive days and then orally for approximately four weeks is an alternative to nafcillin/methicillin in the therapy of S aureus osteomyelitis in children.

Administration, Oral↗
PubMed1982

Adherence of Haemophilus influenzae to buccal epithelial cells.

The role of adherence of Haemophilus influenzae to epithelial surfaces in the pathogenesis of infection is unknown. Fluorescent-antibody and radiolabeled adherence methods were adapted to study H. influenzae adherence to human buccal epithelial cells. By the fluorescent-antibody method, 19 of 21 (90%) nontypable H. influenzae strains were found to be adherent compared with 2 of 42 (5%) type b strains (P less than 0.0001). Using a radiolabeled adherence method, we found that 9 of 12 (75%) nontypable H. influenzae strains were adherent to buccal epithelial cells whereas only 3 of 32 (9%) type b strains were adherent (P = 0.001). Results of H. influenzae adherence examined by both methods correlated significantly (P = 0.01). H. influenzae adherence to adult pharyngeal, nasal, and buccal epithelial cells was comparable. Type b H. influenzae did not adhere to the buccal epithelial cells of well children, children with H. influenzae type b disease, or children with upper respiratory infections. In contrast, nontypable H. influenzae did adhere to the buccal epithelial cells of well children and children with upper respiratory infections. These observed in vitro differences in adherence between nontypable and type b H. influenzae strains may explain differences in colonization, pathogenesis, and types of infection due to nontypable and type b H. influenzae.

Adhesiveness↗
PubMed1982

Serotype and ampicillin susceptibility of Haemophilus influenzae causing systemic infections in children: 3 years of experience.

Over a 3-year period, 96% of systemic infections in children caused by Haemophilus influenzae were of serotype b. Of 346 invasive infections, 15 (4%) were caused by non-type b H. influenzae. The monthly prevalence of ampicillin resistance in all isolates was highly variable (0 to 63%). Ampicillin resistance in H. influenzae causing invasive disease occurred in 13% of non-type b and 21.8% of type b isolates. There was no significant difference (x2 - 0.21; p greater than 0.10) in the rate of ampicillin resistance between type b and non-type b H. influenzae causing systemic illness in children over a 3-year period.

Adolescent↗
PubMed1981

Pharmacokinetics and cerebrospinal fluid penetration of moxalactam in children with bacterial meningitis.

The serum pharmacokinetics and CSF penetration of moxalactam were determined in 39 children with bacterial meningitis. The mean serum concentrations 30 minutes after a 37.5 or 50 mg/kg dose were 66.7 and 113 micrograms/ml, respectively. The t 1/2 beta was between 1.8 and 2.0 hours. The mean +/- 1 SD CSF/serum percentage was 18.5 +/- 16.0% (range 2.0 to 61%) for all children on any day of therapy or hour, after the last of three 50 mg/kg doses. Cerebrospinal fluid bactericidal titers were greater than or equal to 1:32 in 13 of 14 CSF specimens. Moxalactam adequately penetrates into the CSF of children with bacterial meningitis after repetitive 50 mg/kg doses.

Blood-Brain Barrier↗
PubMed1981

Assessment of Haemophilus influenzae type b opsonins by neutrophil chemiluminescence.

A luminol-enhancement chemiluminescence assay and a radiolabeled uptake assay were developed to assess opsonins for Haemophilus influenzae type b. Opsonins in acute and convalescent sera from 17 children with H. influenzae type b meningitis, along with pooled normal human sera, were evaluated and compared with anti-polyribosephosphate antibody concentrations. Five children had a rise in the chemiluminescence-area under the curve for convalescent compared with acute sera. Patient chemiluminescence--area-under-the-curve values were significantly (P less than 0.05) more likely to exceed 50% of normal human serum values if sera contained greater than or equal to 0.1 microgram of anti-polyribosephosphate antibody per ml. Magnesium ethylene glycol tetraacetic acid chelation and heat inactivation of patient and normal human sera significantly (P less than 0.05) reduced chemiluminescence--area-under-the-curve activity. Thus, complement appears to contribute significantly to the opsonization of H. influenzae type b in sera of children. Two of nine children had increases in opsonins as assayed by 3H-labeled H. influenzae type b uptake. After natural systemic H. influenzae type b infection, young children are unable to respond acutely with an increase in anti-polyribosephosphate antibody or serum opsonic activity.

Antibodies, Bacterial↗
PubMed1981

Ataxia and deafness in children due to bacterial meningitis.

Eight children with postmeningitis ataxia had detailed neurologic, audiologic, and neurovestibular evaluations. Prolonged fever, prolonged hyponatremia, or septic arthritis occurred in six during hospitalization. Severe to profound sensorineural hearing losses were present in seven of the children. Electronystagmography was abnormal in three of seven children. In seven children, the ataxia has persisted, but steady improvement has been observed during the course of repeated examinations. Hearing should be evaluated routinely in any child who develops meningitis.

Ataxia↗
PubMed1980

Rapid identification of the invading microorganism.

There has been great progress in recent years in the development of sensitive techniques for the rapid identification of microorganisms in material obtained from patients with a wide variety of infections. While some of these methods employ chemical and microscopic analysis, most investigative interest has centered on the detection of specific antigens by exquisitely sensitive immunologic tests. Properly used, these techniques can yield specific diagnoses within a matter of a few hours, thus facilitating management of both patient and others who are at risk for contracting the infection. Because these techniques detect antigens rather than viable organisms, specific diagnosis is also possible when antibiotic therapy administered prior to testing has rendered cultures sterile. In some instances assay of the concentration of antigen present in biologic fluids can be used in prognosis.

Agglutination Tests↗
PubMed1980

In vitro susceptibility of 104 clinical isolates of Haemophilus influenzae to moxalactam (LY127935), ampicillin, chloramphenicol, and ticarcillin.

A total of 104 strains of Haemophilus influenzae isolated from pediatric patients over a 1-year period were tested for susceptibility to moxalactam (LY127935), ampicillin, chloramphenicol, and ticarcillin. Of these strains, 30 produced beta-lactamase. LY127935 inhibited 99% of the strains at a concentration of 0.125 microgram/ml; the remaining strain was inhibited by this antibiotic at 0.25 microgram/ml. beta-Lactamase-producing strains were inhibited by ampicillin at greater than or equal to 2 microgram/ml. beta-Lactamase-negative strains were all inhibited by ampicillin at less than or equal to 1 microgram/ml, except for one nontypable strain which required 2 microgram of ampicillin per ml for inhibition. All strains were susceptible to chloramphenicol at less than or equal to 4 microgram/ml. beta-Lactamase-producing strains were less susceptible (geometric mean = 4.702 microgram/ml) to ticarcillin than were strains which did not produce beta-lactamase (geometric mean = 0.331 microgram/ml). LY127935 susceptibility was not influenced by increasing inoculum size, as ws ampicillin susceptibility. Combinations of LY127935 and chloramphenicol or ampicillin were not antagonistic in vitro.

Ampicillin↗
PubMed1979

Changes in the incidence of necrotizing enterocolitis associated with variation of the gastrointestinal microflora in neonates.

The incidence of necrotizing enterocolitis was noted to vary in association with significant variation in the gastrointestinal microflora cultured from infants in the neonatal intensive care unit. Increased colonization with E. coli and K. pneumoniae was associated with an increased incidence of necrotizing enterocolitis, which suggests that these organisms are related to the pathogenesis of necrotizing enterocolitis.

Digestive System↗
PubMed1979

Epidemiologic and bacteriologic evaluation of neonatal necrotizing enterocolitis.

The incidence of necrotizing enterocolitis (NEC) in our neonatal unit has varied from 4.7% to zero to 4.4% during three time periods. Simultaneously, significant changes have occurred in the spectrum of bacterial species in the gastrointestinal tract of unaffected infants in the same unit. During the first period of increased attack rate, 82% of gastric and 88% of fecal Enterobacteriaceae were E. coli and K. pneumoniae. When the attack rate decreased the frequencies were 11% (gastric) and 47% (fecal), and P. mirabilis was retrieved with increased frequency. The return of E. coli and K. pneumoniae as the dominant organisms was associated with an increase in NEC. Infants with NEC, compared with controls, had a statistically significant increased frequency of retrieval of E. coli and K. pneumoniae from gastric and fecal samplings. The data suggest an active role for certain enteric bacteria in the pathogenesis of NEC.

Enterocolitis, Pseudomembranous↗
PubMed1979

Alterations in gastrointestinal microflora during antimicrobial therapy for necrotizing enterocolitis.

Changes in the gastrointestinal microflora were noted in 22 infants during combined topical and parenteral antimicrobial therapy for necrotizing enterocolitis (NEC). Gastric and fecal cultures obtained during therapy showed significantly decreased Gram-negative aerobic organisms, most of which were Enterobacteriaceae, when compared with pretreatment cultures. Members of this bacterial family have been implicated in the pathogenesis of NEC in many reports. The data presented here show that the number of organisms retrieved can be reduced with this method of antimicrobial therapy.

Clindamycin↗