INTRODUCTION: Otitis externa (OE) is an infection of the external auditory canal affecting children and adults and is associated with symptoms of local pain and tenderness. Twice-daily topical treatment with ofloxacin otic solution (0.3% [Floxin otic solution]) for 10 days has been reported to be as effective and well tolerated as neomycin sulfate/polymyxin B sulfate/hydrocortisone otic suspension (Cortisporin otic suspension) administered four times daily for 10 days. OBJECTIVE: This study compared the efficacy, safety, and ear-pain resolution of once-daily ofloxacin otic solution (0.3%) versus neomycin sulfate/polymyxin B sulfate/hydrocortisone otic suspension administered four times daily, in children with OE. RESEARCH DESIGN, PATIENTS, AND METHODS: This multicenter, randomized, parallel-group, evaluator-blinded study was conducted at 34 centers in 278 pediatric OE patients aged 6 months to 12 years. Patients received five drops of ofloxacin otic solution (0.3%) in the affected ears once daily or three drops of neomycin sulfate/polymyxin B sulfate/hydrocortisone otic suspension four times daily, for 7-10 days. Patient evaluations were performed at pretherapy (day 1), end of therapy (days 7-9), and test of cure (7-10 days post-treatment) visits. Data for 208 patients were clinically evaluable and those for 90 patients were microbiologically evaluable. Scores were obtained for patient assessments of pain severity. MAIN OUTCOME MEASURES: The overall clinical response was cure in the clinically evaluable patients, demonstrated by resolution of OE signs and symptoms at the test of cure visit. The overall clinical-microbiological response was cure in the microbiologically evaluable patients demonstrated by both clinical cure and microbiological eradication. RESULTS: For the clinically evaluable patients, equivalent cure rates were obtained between the once-daily ofloxacin-treated and four-times-daily neomycin sulfate/polymyxin B sulfate/hydrocortisone-treated patients (93.8% and 94.7%, respectively). For the clinically and microbiologically evaluable patients, the overall cure rates were 96.4% versus 97.1% for the ofloxacin-treated and neomycin sulfate/polymyxin B sulfate/hydrocortisone-treated patients, respectively. The eradication rates for the prevalent pathogen, Pseudomonas aeruginosa, were 98% versus 100% for ofloxacin-treated and neomycin sulfate/polymyxin B sulfate/hydrocortisone-treated patients, respectively. Decreases in pain severity were similar in both treatment groups. Statistical analyses were limited by the small numbers of patients in each treatment group. CONCLUSION: In the treatment of OE in children, once-daily ofloxacin otic solution was as effective and safe as neomycin sulfate/polymyxin B sulfate/hydrocortisone otic suspension given four times daily. The two treatments provide rapid and comparable pain relief; however, ofloxacin otic solution does not have the risk of ototoxicity associated with neomycin and provides effective pain relief without adjunctive steroids.

Administration, Topical↗

PubMed2005

A randomized, multicenter, double blind, double dummy trial of single dose azithromycin versus high dose amoxicillin for treatment of uncomplicated acute otitis media.

BACKGROUND: High dose amoxicillin is recommended for the initial treatment of children with acute otitis media (AOM), particularly patients at risk for having drug-resistant Streptococcus pneumoniae. Single dose azithromycin (30 mg/kg) is considered an alternative agent for the treatment of AOM. OBJECTIVE: To compare the clinical efficacy and safety of single dose azithromycin with that of high dose amoxicillin among children with uncomplicated AOM. METHODS: This was a double blind, double dummy, multinational, clinical trial in which children (6-30 months of age) with AOM were randomized to treatment with single dose azithromycin (30 mg/kg) or high dose amoxicillin (90 mg/kg/d, in 2 divided doses) for 10 days. Tympanocentesis was performed at baseline and clinical responses were assessed at days 12-14 (end of therapy) and at days 25-28 (end of study). RESULTS: The study enrolled 313 patients, and 83% of the patients were < or =2 years of age. A total of 158 patients in the azithromycin group and 154 in the amoxicillin group were considered clinical modified intent-to-treat patients. A middle ear pathogen was detected for 212 patients (68%). Haemophilus influenzae was the most common pathogen (isolated for 96 patients), followed by S. pneumoniae (92 patients), Moraxella catarrhalis (23 patients) and Streptococcus pyogenes (23 patients). beta-Lactamase production was observed for 17% of H. influenzae isolates and 100% of M. catarrhalis isolates. Thirty-five (38%) S. pneumoniae isolates were penicillin-nonsusceptible and 24 (26%) isolates were macrolide-resistant. At the end of therapy, clinical success rates for azithromycin and amoxicillin were comparable for all patients (84 and 84%, respectively) and for children < or =2 years of age (82 and 82%, respectively). At the end of therapy and end of study, clinical efficacies among all microbiologic modified intent-to-treat evaluable subjects were comparable for patients treated with azithromycin (80%) and patients treated with amoxicillin (83%). The rates of treatment-related adverse events for azithromycin and amoxicillin were 20% and 29%, respectively (P = 0.064). Diarrhea was more common in the amoxicillin group than in the azithromycin group (17.5 and 8.2%, respectively) (P = 0.017). Compliance, defined as completion of > or =80% of the study medication, was higher in the azithromycin group (100%) than in the amoxicillin group (90%) (P = 0.001). CONCLUSIONS: In this study, single dose azithromycin was as effective as high dose amoxicillin for the treatment of children with AOM, whereas rates of adverse events were lower and compliance improved with the simplified single dose regimen.

Amoxicillin↗

PubMed2005

Adolescent abuse of dextromethorphan.

Dextromethorphan hydrobromide (DXM), a constituent of more than 125 patent cough/cold remedies, is the most popular antitussive medication in the United States. Cough syrups or capsules also contain additional ingredients such as acetaminophen, chlorpheniramine maleate, guaifenesin, and/or pseudoephedrine, and toxicity with overdosage is additive to that of dextromethorphan alone. An unknown number of adolescents in the United States and Europe intoxicate themselves with acute megadoses of dextromethorphan. A megadose of DXM is defined as 5 to 10 times the dose recommended for control of annoying nonproductive coughs. Although a moderate overdose of pure DXM hydrobromide is free of serious adverse effects, approximately 5% of persons of European ethnicity lack the ability to metabolize the drug normally, leading to rapid acute toxic levels. Variable quantities of pure dextromethorphan powder in multiples of 1 gram are easily available from the worldwide web, including e-Bay. Recipe-like extraction procedures are quickly available on the Internet for seemingly simple and inexpensive home manufacture of concentrated dextromethorphan powder from Coricidin HBP Cough & Cold tablets (street name triple C). Adolescents intoxicate themselves at parties and even before or after school since the drug is legal, relatively inexpensive, and easily purchased or shoplifted at drug or convenient stores. Acute megadoses of the drug have profound psychological and physiological effects similar to those of phencyclidine (PCP). Megadoses of dextromethorphan used to self-intoxicate, can produce a false-positive screening test for phencyclidine in a urine specimen.

Acetaminophen↗

PubMed2004

Stuttering priapism associated with withdrawal from sustained-release methylphenidate.

Stuttering priapism is intermittent, prolonged, painful, pathologic erections with intervening periods of detumescence. An adolescent had stuttering priapism associated with withdrawal from sustained-release methylphenidate. To our knowledge, this is the first such report of stuttering priapism associated with stimulant drugs for treatment of attention deficit hyperactivity disorder.

Adolescent↗

PubMed2004

Pseudomonas aeruginosa septic shock secondary to "gripe water" ingestion.

We report the case of a 9-month-old girl who presented in septic shock after ingestion of a contaminated herbal supplement commonly used to treat colic. Herbal supplements are widely used by well-meaning parents for many common conditions. Pediatricians should be aware that the variable manufacturing and packaging conditions of herbal supplements can lead to contamination with infectious agents.

Anti-Bacterial Agents↗

PubMed2004

Intranasal mucocele of the nasolacrimal duct: an important cause of neonatal nasal obstruction.

Anterior nasal obstruction secondary to cystic or solid masses is believed to be uncommon. Previous single or series case reports of intranasal mucoceles of the nasolacrimal duct have been published in otolaryngology, ophthalmology, or radiology journals but were not found in general pediatric journals. A 5-year retrospective chart review from our children's hospital found 10 previously unreported cases of intranasal mucocele of the lacrimal duct causing neonatal nasal obstruction. The purpose of this report is to familiarize pediatricians with this entity, which was the most common cause of anatomic anterior nasal obstruction at our hospital.

Female↗

PubMed2003

Urine testing for drugs of abuse: a survey of suburban parent-adolescent dyads.

BACKGROUND: The American Academy of Pediatrics is opposed to involuntary diagnostic testing for drugs of abuse. OBJECTIVE: To gather data about attitudes of parents and their teenagers about involuntary drug testing on parental request. DESIGN: Adolescents and their accompanying parents separately answered a printed survey in the offices of their private pediatrician. The survey posed 2 hypothetical questions about urine testing: (1) Do parents have the right to ask a teenager's physician to order a urine test for drugs of abuse without the teenager's knowledge-if the teenager has falling school grades, an uncooperative attitude, and major untruthfulness? (2) In such a case, should the teenager's physician obtain a urine test for drugs on parental request only, without the teenager's consent? RESULTS: A total of 393 paired evaluable surveys were collected: 77.6% from Virginia and 22.4% from Ohio. There were no significant differences in answers between the 2 study sites. Of the students, 85.8% had either an A or a B grade point average. Current marijuana use was unusually low in our teenaged respondents. Of the parents surveyed, 81.7% would want a physician to be able to perform a urine test for drugs of abuse for a problematic teenager without the young person's consent. The answers to the 2 questions about urine drug tests had poor kappa coefficients of agreement between teenagers and parents (0.04 and 0.09, respectively). Reanalysis, using the variables of age, grade point average, and frequency of marijuana smoking, showed little difference in agreement scores. CONCLUSIONS: In the 2 suburban pediatric practices surveyed, parental opinions and expectations were at variance with the American Academy of Pediatrics policy statement on nonconsensual urine drug testing in the presence of clinical problems. Pediatricians need to be conscious of this clinical-ethical dilemma, become familiar with the American Academy of Pediatrics policy on drug testing, and develop their own position and expertise in this area. The dyad method (parent-teenager survey) is novel and improved the methodology of our study. We surveyed middle-class suburban adolescents while previous studies of adolescents surveyed inner-city populations.

Adolescent↗

PubMed2003

Judicious antibiotic use for purulent rhinorrhea: do pediatric infectious disease specialists practice what they preach?

Explore the source record for details and available documents.

Anti-Bacterial Agents↗

PubMed2002

Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis. Infectious Diseases Society of America.

Explore the source record for details and available documents.

Acute Disease↗

PubMed2002

Antibiotic use for upper respiratory tract infections: how well do pediatric residents do?

BACKGROUND: Antibiotics are often used inappropriately for the treatment of upper respiratory tract infections in children, and the emergence of resistant bacteria is a growing public health concern. OBJECTIVE: To assess awareness and compliance with the Centers for Disease Control and Prevention (Atlanta, Ga) and American Academy of Pediatrics (Elk Grove Village, Ill) principles for judicious antibiotic use for upper respiratory tract infections among residents from a sample of pediatric residency programs in the mid-Atlantic region of the United States. PARTICIPANTS AND METHODS: Residents at the participating programs were requested to complete a survey questionnaire. RESULTS: Of the 524 pediatric residents surveyed, 74% (388 participants) completed the questionnaire. Familiarity with the principles increased with a year of training; 16%, 36%, and 50% of first-year (PL1), second-year (PL2), and third- or fourth-year (PL3/PL4) residents, respectively, had heard or read about the principles (chi(2)(trend); P<.001). In response to a direct question about the use of antibiotics for an otherwise well, afebrile 18-month-old child with purulent rhinorrhea, 29%, 25%, and 15% of PL1, PL2, and PL3/PL4 residents, respectively, would prescribe antibiotics within 10 days of onset of illness (chi(2)(trend); P =.008). A significant difference was found between PL1 vs PL3/PL4 participants (difference = 20%; 95% CI = 3%-26%). If the same infant had a temperature of 38.8 degrees C, then 63%, 45%, and 47% of PL1, PL2, and PL3/PL4 residents, respectively, would prescribe antibiotics (chi(2)(trend); P =.008). CONCLUSIONS: Awareness among pediatric residents about the judicious use of antibiotics for upper respiratory tract infections is often lacking, and inappropriate use of antibiotics for this condition continues to be prevalent. This was especially noted among PL1 residents, with an improving trend noted with increasing years of training.

Data Collection↗

PubMed2002

Evaluation of diagnostic tests for influenza in a pediatric practice.

INTRODUCTION: Recent advances in the diagnosis and treatment of influenza virus infections include: (1) rapid bedside diagnosis methods with simple commercially available tests; and (2) Food and Drug Administration approval of treatment for children 1 year of age and older with neuraminidase inhibitor drugs. For proven benefit antivirals should be used within 2 days of onset of symptoms. OBJECTIVES: We conducted a performance improvement exercise comparing the sensitivity and specificity of four rapid tests for influenza viruses: (1) Flu OIA (Biostar); (2) Quickvue Influenza Test (Quidel); (3) Z Stat Flu (ZymeTx); and (4) Directigen Flu A (Becton Dickinson). METHODS: During the 1999 to 2000 epidemic, symptomatic patients seen at the private practice of one of the authors provided specimens collected and processed according to the manufacturer's directions. Throat swabs only were used to collect the specimens for the Z Stat Flu Kit. Directigen was performed immediately, and the others were run in parallel within 12 to 24 h. Specimens were frozen first at -20 degrees C for up to 3 days and shipped in transport medium to the Virology Research Laboratory of the Virginia State Health Department for culture where they were stored at -60 degrees C until cultured. Some of the samples were processed by a commercial laboratory. RESULTS: Specimens from 116 patients were available for influenza culture; for 88 of these culture was performed at the State Health Department Laboratory, and for 28 culture was performed at a local commercial medical laboratory. Influenza virus (A) was detected in 58 of 116 (50%) specimens, 10 (17%) of these only by direct fluorescent antigen samples. Viral culture-direct fluorescent antigen results were used as the standard. Of the 4 tests Biostar and Z Stat Flu required more technician time (by an average of 2-fold). The 4 tests had sensitivities ranging from 72 to 95%. Z Stat differed significantly in sensitivity from the other three (P = 0.001). The specificities of Directigen, Quickvue, Flu OIA and Z Stat Flu were similar (76 to 86%). The positive predictive value of Directigen, Quickvue and FluOIA and Z Stat ranged from 80 to 86%. The negative predictive value of all 4 tests ranged from 75 to 94%. Z Stat Flu had a lower negative predictive value than the other 3 tests (75%; P = 0.001. CONCLUSION: In this first head-to-head comparison of four rapid diagnostic tests for influenza, Directigen Flu A, Quickvue and Flu OIA appear equivalent in sensitivity, specificity, positive predictive value and negative predictive value. Z Stat Flu was not as sensitive or as efficient as the other three tests.

Adolescent↗

PubMed2002

Marijuana: a decade and a half later, still a crude drug with underappreciated toxicity.

In 1984, I published in this journal a review entitled "Marijuana: A Crude Drug With a Spectrum of Underappreciated Toxicity." In the introduction to that article, I disclosed that our son Keith, who was 15 years old at the time, was in a long-term, modified outpatient adolescent drug and alcohol rehabilitation program because he had become dependent on marijuana with its associated behavioral, interpersonal, scholastic, and antisocial problems. Keith and most of his friends had experimented several times with LSD, beer, and several other drugs but never used injection drugs. Marijuana was clearly Keith's drug of choice and the only drug he used with regularity. Approximately 1 year later, Keith graduated from the treatment program. He completed the early aftercare component, relapsed several times, and completed a 4-month refresher drug rehabilitation program in another state. Nine years after admission to the first rehabilitation program, Keith finally attained some adult goals. Now 34 years old, he has been drug-free for 10 years. He is the president and owner of a successful discount cellular phone business that he started. More important, a decade ago, he reestablished an excellent and close relationship with his parents. As far as I can tell, Keith remains drug-free except for an occasional beer.

Adolescent↗

PubMed2002

Are pediatricians adhering to principles of judicious antibiotic use for upper respiratory tract infections?

BACKGROUND: In 1997, the Centers for Disease Control and Prevention (CDC), in collaboration with other professional organizations, released principles for judicious use of antibiotics in pediatric upper respiratory illnesses (URI). This study compared use of antibiotics for URI in children before (1995) and after (1998) publication of the principles and compared survey responses with practice habits. METHODS: A questionnaire was mailed to a sample of pediatricians in northern Virginia. Office records of a randomly selected subset of pediatricians were reviewed. RESULTS: Seventy-five percent of pediatricians completed the questionnaire; 51/149 (34%) chose to prescribe antibiotics for purulent rhinorrhea of less than 10 days' duration. This was significantly lower than that reported in the 1995 survey. However, review of office records of a random sample of these pediatricians revealed no significant difference in antibiotic use in children with uncomplicated URI in the 2 years studied. CONCLUSIONS: Injudicious antibiotic use for URI is prevalent among pediatricians in northern Virginia. Actual practice habits are at variance with response to case vignettes.

Anti-Bacterial Agents↗

PubMed1995

Animal research.

Explore the source record for details and available documents.

Animal Experimentation↗