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Biomedical subjects

U B Schaad

Publications and source records attributed to U B Schaad.

At least 109 records · Page 6Linked to original sources
PubMed1987

[Vaccine failure].

The different causes of vaccine failure are presented on the basis of epidemiological definitions and facts. The relevant factors necessary for successful active immunization are potential presence of passively transmitted antibodies, possible interaction with combined vaccine administration, technical requirements, individual immune response, and duration of immunity. Knowledge of these factors often provides the individual explanation for vaccine failure, or serves to prevent it as well as to predict susceptibility to natural infection.

Antibody Formation↗
PubMed1987

[Infectious diarrhea in children. Results of a prospective study concerning various epidemiological and clinical aspects of infectious diarrhea in children].

Over a 3-year period (from October 1981 to September 1984) 352 pediatric patients were treated for infectious diarrhea at the Division for Pediatric Infectious Diseases, Department of Pediatrics, University of Berne, Switzerland. Routine diagnostic tests on stool samples included cultures for Salmonella, Shigella, Campylobacter and Yersinia, and enzyme-linked immunosorbent assay (Rotazyme) for rotaviruses. In selected cases special tests for parasitic pathogens were also performed. The patients were divided into three etiologic groups to compare epidemiological, clinical and laboratory characteristics; group 1 = rotavirus, group 2 = no detectable pathogen, and group 3 = bacterial agents. Specific etiology of diarrhea was established in 210 of the 352 patients (59.5%). Rotaviral gastroenteritis represented the most common diagnosis (42.5%), whereas Salmonella was isolated from fecal cultures in 9% and Campylobacter jejuni in 3%. A parasitic etiology was documented in only 1%. In 5 patients two pathogens were recovered from stools: rotavirus and Salmonella in 4 cases and Salmonella and Campylobacter in 1 case. Relevant features of rotavirus, Salmonella and Campylobacter gastroenteritis in childhood are described in detail.

Adolescent↗
PubMed1987

[Pericarditis as a complication of rubella].

Report on a five-year-old boy with clinically suspect and serologically proven rubella infection who developed serous pericarditis. Two-dimensional echocardiography documented a moderate pericardial effusion which resolved within one week. A review of the literature revealed that both peri- and myocarditis represent rare complications of rubella.

Cardiomegaly↗
PubMed1987

Efficacy of inhaled amikacin as adjunct to intravenous combination therapy (ceftazidime and amikacin) in cystic fibrosis.

Eighty-seven patients with cystic fibrosis were admitted to hospital with an acute exacerbation of pulmonary symptoms associated with isolation of Pseudomonas aeruginosa from sputum. The patients were randomly allocated to receive intravenously administered ceftazidime (250 mg/kg/day) and amikacin (33 mg/kg/day) alone or with inhaled amikacin (100 mg twice a day). Other aspects of the 2-week treatment were constant. The two therapy groups were comparable in all aspects. At the completion of therapy, the addition of aerosolized amikacin produced temporary eradication of P. aeruginosa in 70% of the patients, compared with 41% in the intravenous therapy only group (P less than 0.02). Suppression of P. aeruginosa in sputum cultures was correlated with the amikacin sputum concentrations. However, both regimens resulted in similar improvements in clinical, radiologic, laboratory, and pulmonary function measurements, and within 4 to 6 weeks most patients were recolonized with P. aeruginosa. There was no serious toxicity or adverse effect. In patients with cystic fibrosis, the addition of aerosol aminoglycoside to systemic antipseudomonal combination therapy is not clinically beneficial.

Acute Disease↗
PubMed1987

Sequential intravenous-oral amoxycillin/clavulanate (Augmentin) therapy in paediatric hospital practice.

The efficacy and safety of intravenous and sequential intravenous-oral clavulanate-potentiated amoxycillin therapy was evaluated in 71 hospitalized paediatric patients, one month to 16 years of age. The infections treated included peritonsillar abscess (2 patients), purulent tracheitis (1), acute epiglottitis (24), pneumonia (31), pansinusitis (4), mastoiditis (1), cellulitis (4), lymphadenitis (2) and pyelonephritis (2). The severity of disease was rated as moderate in 31 patients (44%), and as severe in 40 (56%). Bacterial pathogens could be cultured in 26 cases (37%). The response to therapy was prompt and followed by clinical cure in each patient. Adverse drug effects included phlebitis (in 6%), mild gastrointestinal complaints (6%), rash (4%) and transient neutropenia and elevation of transaminases (one case each). It is concluded that amoxycillin/clavulanate is effective and safe treatment for bacterial infections of the respiratory tract, urinary tract, skin or soft tissues in children.

Administration, Oral↗
PubMed1987

Preliminary experience with ceftazidime monotherapy in perinatal infection.

Ceftazidime, a new cephalosporin antibiotic, was used as monotherapy to treat 75 term neonates with suspected perinatal bacterial infection. Septicemia was documented in ten patients (13%). Ceftazidime was administered as 25 mg/kg doses intravenously every 12 h. Peak serum concentrations at 0.5 h after dose ranged from 57 to 115 micrograms/ml and trough serum concentrations prior to next dose from 2 to 15 micrograms/ml. The overall clinical, bacteriological and laboratory response to ceftazidime was satisfactory and the drug was well tolerated. However, reservations with regard to study design, limited gram-positive drug activity and potential emergence of drug resistance require further well-controlled clinical evaluations of ceftazidime in neonatal intensive care units, before definite recommendations for the use of this antibiotic in perinatal infection can be formulated.

Age Factors↗
PubMed1986

[Disease (Lyme disease) in pediatric patients in Switzerland caused by spirochetes (Borrelia burgdorferi) of Ixodes ricinus].

Lyme disease in children is studied in the light of questionnaires sent out twice to departments and divisions of pediatrics in Switzerland. Thirty-six serologically proven cases were collected. The 48 clinical signs attributed to Lyme disease involved the skin in 40%, the nervous system in 40%, and the joints in 20%. They were erythema chronicum migrans (13), lymphocytoma (4), acrodermatitis chronica atrophicans (2), peripheral facial palsy (14), sensomotor radiculoneuritis (2), meningoencephalitis (3) and arthritis (10, 7 of which were monoarthritic). Only half the patients had a history of tick-bite. Antibiotic therapy, usually with penicillin, reduced both the duration of symptoms and frequency of secondary disease. Cardiac involvement and chronic stages with residua were not observed in this series.

Adolescent↗
PubMed1986

[Prospective evaluation of coagglutination and latex agglutination in the diagnosis of bacterial meningitis in childhood].

UNLABELLED: Two simple and low-priced kits to detect bacterial antigens in cerebrospinal fluid (CSF) specimens from patients with suspected meningitis have recently become available. Methods employed by these kits are staphylococcal coagglutination (COA) and latex agglutination (LA). The COA "Phadebact CSF-kit" (Pharmacia) detects Haemophilus influenzae type b (HIb), Neisseria meningitidis (NM) groups A, B, C, Y and W 135 and Streptococcus pneumoniae (SP), whereas the LA "Slidex Méningite-kit" (BioMérieux) includes HIb, NM A, NM C and SP. These two diagnostic tests were compared with the standard methods for analyzing CSF specimens from children with suspected meningitis. A total of 336 CSF specimens were tested. Forty-three were from children with bacterial meningitis due to HIb, NM or SP obtained before antimicrobial therapy. Thirty-four of them (79%) were correctly detected by COA, 23 (54%) by LA, and 42 (97%) by microscopic analysis of stained smears. There were 65 CSF samples of such meningitis cases obtained after initiation of antimicrobial therapy: COA detected 26 (40%), LA 17 (26%) and staining 26 (40%). With culture-positive CSF specimens from patients before therapy, the best sensitivities were obtained with LA for SP (100%) and COA for HIb (87%), whereas the results for NM antigen detection were only 43% with COA and 0% with LA (no reagent against NM B). Cross-reactions with other bacterial antigens were frequent with COA (26%) and rare with LA (2%), resulting in false-positive findings in 6 of the 66 positive tests with COA (9%) but in none of the 40 positive tests with LA (0%). One of the 48 specimens from aseptic meningitis cases was false-positive for HIb by COA, whereas all 172 normal specimens were negative with both methods. With 5 culture-negative CSF specimens from patients with unequivocal purulent meningitis COA detected bacterial antigen in 5 and LA in 2. CONCLUSIONS: The two kits evaluated cannot replace standard methods for analyzing CSF specimens, in view of insufficient sensitivity (mainly LA) or frequent cross-reactions and false-positive values (COA). However, due to their simplicity, rapidity, and possible identification of bacterial pathogens after initiation of antimicrobial therapy, these kits are recommended as an useful addition to standard methods.

Adolescent↗
PubMed1986

Treatment of bacterial meningitis.

Bacterial meningitis remains a life-threatening infection at any age, and prompt, adequate treatment is of great prognostic importance. Due to the special features of the meninges as a site of infection, many problems are associated with antimicrobial therapy. Approximately 80% of the patients with bacterial meningitis belong to the pediatric age group, and the three principal pathogens are Haemophilus influenzae type b, Neisseria meningitidis and Streptococcus pneumoniae. The diagnostic requirements essential for satisfactory management are defined and the antibiotic therapy of meningitis is discussed in detail. Data obtained from both experimental and clinical meningitis are indicative that a minimum bactericidal titre of 1:10 should be achieved in the cerebrospinal fluid for optimal therapeutic results. Recommendations are given for specific antimicrobial treatment according to patient's age and causative organism, as well as guidelines for further lumbar punctures, duration of therapy and prophylaxis, with emphasis on the important role of the newer cephalosporin compounds in treatment of meningitis.

Humans↗
PubMed1986

Levels of free granulocyte elastase in bronchial secretions from patients with cystic fibrosis: effect of antimicrobial treatment against Pseudomonas aeruginosa.

Large amounts of free granulocyte elastase (GE), an enzyme capable of mediating airway damage, have been found in bronchial secretions of patients with cystic fibrosis who are infected with Pseudomonas aeruginosa. This finding indicates an imbalance between GE and its antiproteases, alpha 1-proteinase inhibitor (alpha 1-PI) and bronchial mucosal inhibitor (BMI), in the airways of these individuals. The effect of intravenous antimicrobial treatment against P. aeruginosa on activity and concentration of GE, BMI, and alpha 1-PI was evaluated in 30 treatment courses of 20 patients with cystic fibrosis. Although sputum volume and level of immunoreactive GE decreased and concentrations of alpha 1-PI and BMI increased significantly (P less than .05), a high level of free GE persisted. No active alpha 1-PI and BMI were detectable after treatment. High levels of GE correlated with a poor pulmonary condition (rs = .98, P less than .001). In vitro, elastolytic activity of bronchial secretions from patients with cystic fibrosis was significantly inhibited by eglin C and an oxidation-resistant variant of alpha 1-PI, both compounds currently produced by recombinant DNA technology.

Anti-Bacterial Agents↗
PubMed1986

Pharmacokinetics of a syrup formulation of amoxycillin-potassium clavulanate in children.

The pharmacokinetics of a syrup formulation consisting of four parts of amoxycillin and one part of potassium clavulanate (Augmentin) were studied in 11 paediatric patients, 3 to 14 years of age. Single oral doses of 25 mg of Augmentin per kg body weight (20 mg of amoxycillin per kg plus 5 mg of potassium clavulanate per kg, i.e. 1 mg of the syrup per kg) were administered on an empty stomach, and were well accepted and tolerated. Mean peak plasma concentrations 60-90 min after dosing were 7.2 mg/l for amoxycillin and 2.0 mg/l for clavulanic acid. Mean terminal phase plasma half-lives were 1.4 and 1.0 h, respectively. It is concluded that 25-mg/kg doses of this syrup formulation of Augmentin administered three times daily should be adequate therapy for various childhood bacterial infections.

Adolescent↗
PubMed1986

Antimicrobial therapy of Pseudomonas pulmonary exacerbations in cystic fibrosis. A prospective evaluation of netilmicin plus azlocillin versus netilmicin plus ticarcillin.

High-dose anti-Pseudomonas chemotherapy is mandatory in the treatment of acute pulmonary exacerbations in patients with advanced cystic fibrosis and Pseudomonas aeruginosa isolated from their sputum. However, neither the regimen itself nor its objective evaluation have been optimized yet. In a prospective controlled evaluation 42 such exacerbations were treated for two weeks with netilmicin combined by randomisation with either azlocillin or ticarcillin. Other aspects of therapy were constant. The two therapy groups were comparable in all aspects. Both regimens produced similar improvements in clinical, radiological, laboratory, bacteriological and pulmonary function measurements. Concentrations of sputum bacteria were significantly reduced; transient eradication was documented in 29% and correlated with antibiotic susceptibility of the initially isolated Pseudomonas strains. The highly dosed antibiotics were well tolerated and emergence of resistance was rarely observed. It is concluded that both antibiotic combinations are beneficial and safe in cystic fibrosis. Monitoring of such intensive hospital treatment must include multiple parameters.

Adolescent↗
PubMed1986

[Prospective placebo-controlled double-blind study using a bacterial lysate in infections of the respiratory tract and ENT region in children].

94 children suffering from frequent infections of the respiratory tract and of the ear, nose and throat were treated under double-blind conditions with either a bacterial lysate (n = 45) or a placebo (n = 49). During the 6 months of the trial both treatments brought about a significant decrease in the incidence and duration of these infections as well as in the duration of concomitant antibiotherapy in comparison to the corresponding prior 6-month reference period. As these positive results recorded under the bacterial lysate and the placebo could not be differentiated statistically, the influence of meteorological and epidemiological factors as well as of the age of the children is discussed.

Adjuvants, Immunologic↗
PubMed1985

[Special infections of the respiratory tract in children].

Inspiratory or exspiratory stridor associated with dyspnea represents a common pediatric symptomatology compatible with various diseases which usually are of infectious etiology. The causative obstruction of the infantile airways may lead to life-threatening respiratory failure. A review is conducted of the most important emergencies characterized by stridor and dyspnea in early childhood: croup syndromes (acute viral laryngotracheitis, spasmodic croup, bacterial tracheitis), epiglottitis and bronchiolitis.

Bacterial Infections↗
PubMed1985

High performance liquid chromatographic determination of moxalactam in human plasma and cerebrospinal fluid.

A sensitive and reproducible method for the measurement of moxalactam in plasma and cerebrospinal fluid is described. Plasma proteins were removed by precipitation with ice-cold methanol at pH 5.6 and centrifugation. The supernatant was analysed by HPLC on a mu-Bondapack/phenyl column, with a mobile phase of acetonitrile/water/PIC Reagent A (20/80/1), and detection at 280 nm. The calibration curve was linear for plasma concentrations from 10 micrograms/ml to 60 micrograms/ml. Reproducibility was 4.7% (coefficient of variation) for within-day analysis and 13.8% for day-to-day analysis. Plasma concentrations in 9 moxalactam-treated patients with severe infections ranged from 0.9 micrograms/ml to 409 micrograms/ml. Individual pharmacokinetic parameters were calculated using a personal computer. In selected cases moxalactam concentrations were also determined in cerebrospinal fluid and tracheal aspirates.

Child↗
PubMed1985

Single-dose ceftriaxone kinetics in the newborn.

Ceftriaxone kinetics were characterized after a single, 2-minute, intravenous infusion of 50 mg/kg to 20 sick infants 1 to 8 days old who weighed 1.78 to 4.36 kg. Plasma binding parameters could be determined by equilibrium dialysis in 16 of the infants, in whom kinetic parameters for free ceftriaxone in plasma were also determined. Compared with corresponding values in adults, the elimination t1/2 was longer in infants (19 and 8.4 hours) because of reduced total systemic clearance (4.48 and 8.51 ml/min/m2). The apparent steady-state volume of distribution was of the same order in infants and adults (5,130 and 5,350 ml/m2). Both renal and nonrenal clearance of free ceftriaxone were reduced in infants, but these decreases were partially offset by an increased free fraction; plasma binding affinity and capacity constants for infants were about half the adult values. The mean fraction of dose excreted unchanged in urine was estimated at 70% in the neonates and 46% in adults. There were no clinically significant correlations between the kinetic parameters and either age since birth or age since conception. The fraction of free ceftriaxone in plasma inversely correlated with age since conception and was lower in female infants, which decreased the systemic clearance and volume of distribution of total drug in the female infants compared with the male infants. Values for the volume of distribution and clearance parameters were not related to body size (weight or body surface area). From our results, a ceftriaxone dosage of 50 to 100 mg/day is recommended during the first week of life for newborn infants who weigh between 1.8 and 4.4 kg. Impaired renal function may require a reduction in dosage.

Adult↗