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Biomedical subjects

W E Feldman

Publications and source records attributed to W E Feldman.

At least 19 recordsLinked to original sources
PubMed1997

The economic impact of high-risk pregnancies.

To compare the costs of prenatal care, labor and delivery, and postnatal care of 775 high-risk (HR) pregnancies with costs of 2,825 low-risk pregnancies, data were collected from retrospective chart review and computerized financial records of infants and mothers. Claims paid to providers, hospitals, and ancillary services were the direct medical costs of care for Sentara Health Plan. The total prenatal, labor and delivery, and postnatal costs were more than 6 million dollars and 3.5 million dollars for premature and term babies, respectively. Postnatal and total costs were related inversely to gestational ages and birth weights and directly related to length of stay. The data indicate the substantially increased cost of identified HR pregnancies. The gestational age and birth weight correlate with postnatal and total costs.

Adolescent↗
PubMed1993

Pharyngitis in children.

Although the group A beta-hemolytic streptococcus is the most important treatable cause of pharyngitis, other organisms, including viruses and groups C and G streptococci, should always be considered in the diagnosis of pharyngeal symptoms. Clinical findings and a rapid strep test aid in making the diagnosis of group A streptococcal pharyngitis. In nonallergic patients with the latter, penicillin V potassium is the antibiotic of choice; for those allergic to penicillin, erythromycin is my preferred alternative.

Adolescent↗
PubMed1991

Current status of pediatric vaccines.

Pediatric immunization schedules have become more complex, especially with the approval of two new vaccines for Haemophilus influenzae type b and changes in recommendations for measles vaccine. In addition, vaccines for other infections (eg, rotavirus, varicella, and respiratory syncytial virus) are in development and likely will become available in the future. These recent advances raise hope that the list of diseases eradicated through vaccination will be expanded.

Adolescent↗
PubMed1984

Moxalactam therapy for neonatal meningitis due to gram-negative enteric bacilli. A prospective controlled evaluation.

Moxalactam and ampicillin sodium therapy were compared with amikacin sulfate and ampicillin therapy for meningitis due to gram-negative enteric bacilli in 63 infants enrolled in the Third Neonatal Meningitis Cooperative Study. The population characteristics and causative organisms were comparable for the two treatment groups. Cultures of CSF were positive for approximately three days in both study groups. Case-fatality rates were 23% and 15% for moxalactam-treated infants and ampicillin- and amikacin-treated infants, respectively. Developmental or neurological abnormalities were found in about 40% of survivors, and the rates were comparable for both treatment groups. Computed tomograms in 44 infants were interpreted as normal in 13 (30%); hydrocephalus, abscesses, and low-density areas were the most frequent abnormalities. We conclude that moxalactam is a suitable alternative for treatment of meningitis due to gram-negative enteric bacilli.

Amikacin↗
PubMed1984

M-mode echocardiographic abnormalities in Rocky Mountain spotted fever.

Rocky Mountain spotted fever is a serious acute systemic illness frequently complicated by cardiac involvement. To evaluate the spectrum of myocardial dysfunction, we obtained M-mode echocardiograms on nine consecutive patients with Rocky Mountain spotted fever within 72 hours of admission. Seven of the nine patients had echocardiographic evidence of impaired left ventricular function; two of the seven had no other evidence of cardiac involvement. The extent of impairment of left ventricular function reflected the clinical severity of the illness. Left ventricular myocardial dysfunction is a frequent complication of Rocky Mountain spotted fever. Echocardiography may provide the only clinical evidence of cardiac involvement in these patients.

Child↗
PubMed1983

Effect of growth phase on the bactericidal action of chloramphenicol against Haemophilus influenzae type b and Escherichia coli K-1.

The bactericidal action of chloramphenicol against six Haemophilus influenzae type b isolates and six Escherichia coli K-1 isolates was compared. Cells were grown in antibiotic-free medium into the late-stationary and mid-exponential phases of growth, and inocula of 10(5) to 10(6) cells per ml were added to fresh media containing 1 or 10 micrograms of chloramphenicol per ml for H. influenzae isolates, 80 micrograms of chloramphenicol per ml for E. coli isolates, or no chloramphenicol (antibiotic free). Quantitative kinetic studies indicated that each chloramphenicol concentration killed H. influenzae cells in the stationary phase of growth significantly more rapidly than it did those in the exponential phase of growth (P less than 0.001; analysis of variance). E. coli in either the stationary or the exponential phase were killed at the same rate by 80 micrograms of chloramphenicol per ml (P greater than 0.05). These results suggest that chloramphenicol may kill these organisms by different mechanisms.

Chloramphenicol↗
PubMed1983

Haemophilus influenzae type b brain abscess complicating meningitis: case report.

A 7-month-old child developed beta-lactamase negative Haemophilus influenzae type b meningitis which was treated with parenteral ampicillin and chloramphenicol for two days and ampicillin for eight additional days. She was readmitted two days after discharge on the 14th day after the initial hospitalization because of a suspected relapse of meningitis. Cultures of CSF and blood yielded no growth, and therapy with ampicillin and chloramphenicol was discontinued after three days. After discharge, her fontanel became full and a large, right, frontoparietal brain abscess was found on her third admission on day 25. Pus from the abscess yielded beta-lactamase negative H influenzae type b but CSF and blood yielded no growth. The abscess resolved after needle aspiration of pus and 4 weeks of therapy with ampicillin and chloramphenicol. It is speculated that this rare complication of H influenzae meningitis arose from a focal infection in an area of brain necrosis that resulted from the initial meningitis.

Anti-Bacterial Agents↗
PubMed1982

Relation of concentrations of Haemophilus influenzae type b in cerebrospinal fluid to late sequelae of patients with meningitis.

Forty-four patients with Haemophilus influenzae type b meningitis had follow-up evaluations approximately one year after hospital discharge. Patients with greater than or equal to 10(7) colony-forming units of H. influenzae type b per milliliters CSF had significantly greater frequencies of speech impairment (P less than 0.001), hearing loss (P = 0.04), and moderate or severe neurologic sequelae (P less than 0.01). Patients with greater than or equal to 1 microgram H. influenzae b antigen/ml CSF had a greater incidence of hearing loss (P = 0.03) but not of speech abnormalities (P = 0.06) or other neurologic sequelae (P = 0.64). Glucose concentrations less than 10 mg/dl correlated with the incidence of hearing loss (P = 0.02) and speech impairment (P = 0.02). "Partial" antibiotic therapy, CSF protein concentrations, and number of CSF polymorphonuclear leukocytes did not correlate well with sequelae. These data indicate that pretreatment concentrations of H. influenzae b and glucose concentrations in CSF were the best predictors of late sequelae of patients with H. influenzae b meningitis.

Adolescent↗
PubMed1982

Penetration of cefoxitin into cerebrospinal fluid of infants and children with bacterial meningitis.

Three consecutive doses of 75 mg of cefoxitin per kg were given intravenously every 6 h (225 mg/kg), in addition to penicillin or ampicillin, to 24 patients on days 4 and 5 and 9 and 10 of therapy for meningitis. Haemophilus influenzae b was isolated from cerebrospinal fluid (CSF) of 21 patients, Streptococcus pneumoniae from 2 patients, and Neisseria meningitidis from 1 patient. The median minimal inhibitory and bactericidal concentrations of cefoxitin for 16 isolates of H. influenzae b were 0.312 and 0.625 micrograms/ml, respectively. Sixteen of 18 isolates of H. influenzae b and S. pneumoniae were killed by 2.5 micrograms of cefoxitin per ml. Mean levels in CSF peaked at 1 h at 6 and 4.9 micrograms/ml on days 5 and 10, respectively. CSF levels on days 5 and 10 were greater than or equal to twice the median minimal inhibitory and bactericidal concentration in 20 and 18 patients, respectively. However, bacterial levels in CSF were greater than or equal to 2.5 micrograms/ml in only 11 of 23 patients on days 5 and 10. No significant adverse effects were found. These data indicate that at this dosage, cefoxitin may not reach levels in the CSF required for killing all susceptible strains of H. influenzae b and S. pneumoniae.

Cefoxitin↗
PubMed1982

Clinical and pharmacokinetic evaluation of parenteral moxalactam in infants and children.

Thirty-four infants and children ranging in age from 2.5 to 180 months (mean, 40 months) were treated with parenteral moxalactam (150 mg/kg per day) for suspected or proved bacterial infections outside the central nervous system. Six patients infected with Haemophilus influenzae b, nine infected with Staphylococcus aureus, three infected with Streptococcus pneumoniae, one infected with Streptococcus pyogenes, one infected with Enterobacter aerogenes, one infected with Fusobacterium nucleotum, and one infected with Staphylococcus epidermidis, microaerophilic streptococcus, and Propionibacterium sp. were clinically and bacteriologically cured. One patient with polymicrobial pansinusitis did not respond to moxalactam. No patients developed meningitis. All of the isolates tested were inhibited by less than or equal to 5 micrograms of moxalactam per ml, except for one Staphylococcus epidermidis isolate which was resistant to greater than 20 micrograms/ml. Five patients had transient neutropenia which resolved after the drug was discontinued. The mean peak serum level was 106 micrograms/ml at 15 min after a 50-mg/kg dose. The mean elimination half-life was 91.2 min. These data indicate that this dosage of moxalactam is a safe and effective treatment for bacterial infections outside the central nervous system.

Adolescent↗
PubMed1982

Clinical studies of a new latex particle agglutination test for detection of Haemophilus influenzae type b polyribose phosphate antigen in serum, cerebrospinal fluid, and urine.

A new latex particle agglutination test for direct detection of Haemophilus influenzae type b polyribose phosphate antigen in serum, cerebrospinal fluid, or urine was evaluated from studies at four clinical centers. Although use of a serum buffer significantly reduced inconclusive agglutination of the latex particles, the retesting of serum samples, after heat inactivation and dilution, resolved all serum samples, with one exception, as reactive or nonreactive for the presence of the polyribose phosphate antigen. A clinical accuracy of 100% was obtained for the latex particle agglutination method in respect to its capability for detection of polyribose phosphate antigen in all patients with confirmed infection by H. influenzae type b.

Haemophilus Infections↗
PubMed1980

Clinical and pharmacokinetic evaluation of parental cefoxitin in infants and children.

Thirty-two infants and children ranging in age from 3 to 151 months (mean, 26 months) were treated with parenteral cefoxitin (150 mg/kg per day). Ten patients with isolates of Haemophilus influenzae (six with cellulitis, two with arthritis, and two with mastoiditis), four with Staphylococcus aureus (one with lymphadenitis, one with septicemia, and two with abscess), and three patients with Streptococcus pneumoniae (one each with cellulitis, abscess, and arthritis), were clinically and bacteriologically cured by therapy. Two additional patients with septic arthritis and facial cellulitis developed meningitis with H. influenzae type b and S. pneumoniae, respectively. Minimal inhibitory and bactericidal concentrations were </=5 mug/ml for 15 isolates. Minimal bactericidal concentrations were >20 mug/ml for one strain of S. aureus and one of H. influenzae type b. The mean peak serum levels were 81.9 and 68.5 mug/ml 15 min after intravenous or intramuscular doses, respectively. The mean elimination half-lives were 42.4 and 40.1 min after intravenous or intramuscular doses, respectively. The mean volumes of distribution were 5,540 and 4,760 ml after intravenous and intramuscular doses, respectively. Mean plasma clearance was 242 and 257 ml/min per m(2) after intravenous and intramuscular doses, respectively. Therapy was discontinued in one patient because of neutropenia, which resolved after cefoxitin was stopped. Eosinophilia and transiently elevated liver function tests occurred in eight and six patients, respectively. These data indicate that cefoxitin may be an effective treatment for infections due to susceptible bacteria in the dosage tested, but its use may be limited because of the occurrence of meningitis during therapy in some patients.

Adolescent↗
PubMed1980

Skin abscess caused by Candida albicans: unusual presentation of C. albicans disease.

A 9-month-old patient developed a Candida albicans skin abscess at the repair site of a lumbar myelomeningocele. There was no evidence of C. albicans infection elsewhere in the body. The infection may have been acquired at the time of the original myelomeningocele repair at 2 days of age. The abscess was cured by surgical drainage and amphotericin B therapy. This case indicates that laboratories should be aware of C. albicans as an unusual cause of abscess.

Abscess↗
PubMed1979

Effect of ampicillin and chloramphenicol against Streptococcus pneumoniae and Neisseria meningitidis.

Antagonism, determined by isobolograms constructed from data from combinations of ampicillin and chloramphenicol at or below the minimal inhibitory or bactericidal concentrations, was observed against 13 clinical isolates of meningococcus and against one isolate of pneumococcus. Synergy occurred against six strains of pneumococcus and three of meningococcus. Additive effects were noted against 14 isolates of pneumococcus and 5 of meningococcus. There was no relationship between the minimal inhibitory or bactericidal concentrations for the isolates and the occurrence of antagonistic, additive, or synergistic effects. These data indicate that ampicillin and chloramphenicol may be antagonistic in vitro against some strains of pneumococcus or meningococcus.

Ampicillin↗
PubMed1979

Clinicopharmacological evaluation of amoxicillin and probenecid against bacterial meningitis.

Forty-three infants and children with bacterial meningitis were treated intravenously with 200 mg of amoxicillin sodium per kg per day for 10 days. (Patients were initially treated with ampicillin and chloramphenicol until the bacterial etiology was defined.) Patients were randomly treated with amoxicillin only or with amoxicillin and four doses of probenecid (10 mg/kg per dose) orally every 6 h for 24 h before the lumbar puncture at day 10. Serum and cerebrospinal fluid (CSF) were obtained on days 1, 5, and 10 of therapy for antibiotic assay. The mean peak serum concentration of amoxicillin of 49.2 micrograms/ml was increased to 61.4 micrograms/ml in patients who received probenecid. The half-life in serum (1.5 h) and area under the curve with probenecid (112.5 micrograms/ml-h) were increased compared with those of amoxicillin alone (1.3 h and 82.2 micrograms/ml-h). The mean peak CSF concentrations on days 1 and 5 were similar, but day 1 concentrations remained between 2.0 micrograms/ml and 5.0 micrograms/ml throughout the 4 h after a dose, whereas the day 5 values decreased at the same decay rate as that in serum. All CSF concentrations were lower on day 10, but patients receiving probenecid had peak values occurring at 1 hr rather than at 0.5 h, and levels were significantly greater at 1 and 2 h after a dose. There were no deaths and patients responded well to treatment.

Amoxicillin↗