The Journal of antimicrobial chemotherapy
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J. Antimicrob. Chemother. · Dec 1997
Randomized Controlled Trial Comparative Study Clinical TrialFluconazole versus nystatin in the prevention of candida infections in children and adolescents undergoing remission induction or consolidation chemotherapy for cancer.
An open, prospective, randomized pilot study was performed to assess the efficacy and safety of oral fluconazole 3 mg/kg once daily compared with oral nystatin 50,000 units/kg/day in four divided doses in preventing candida infections in 50 children undergoing remission induction or consolidation therapy for cancer. In 21 of 25 fluconazole-treated and 20 of 25 nystatin-treated patients the overall outcome of prophylaxis was clearly successful. Mild and transient oropharyngeal candidosis was observed in two and three patients in the fluconazole and nystatin groups respectively. ⋯ Transient elevations of hepatic transaminases were more common in the fluconazole group, although not statistically significant (28% vs 12%, P = 0.15). Reversible grade I gastrointestinal and skin symptoms were observed in four patients randomized to fluconazole (16 vs 0%, P < 0.05). Fluconazole was as safe and effective as nystatin in controlling yeast colonization and in preventing superficial and invasive candida infections and the empirical use of amphotericin B in children and adolescents undergoing intensive chemotherapy for cancer.
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J. Antimicrob. Chemother. · Nov 1996
Antimicrobial susceptibility of Haemophilus influenzae, Neisseria meningitidis and Streptococcus pneumoniae isolates causing meningitis in The Netherlands, 1993-1994.
The increasing antimicrobial resistance among pathogens frequently isolated from patients with bacterial meningitis formed the rationale to perform a surveillance study to determine the prevalence of resistance in The Netherlands. Haemophilus influenzae strains (n = 316) isolated from cerebrospinal fluid (CSF), 1125 meningococcal strains isolated from blood or CSF and 398 pneumococcal strains isolated from CSF in 1993 and 1994 were tested by the Etest for susceptibility to commonly prescribed antibiotics for the treatment of community-acquired meningitis. In H. influenzae strains ampicillin-resistance occurred in 7.0%, resistance to chloramphenicol in 2.2%, and resistance to both antibiotics in 0.9%. ⋯ Based on these results, we conclude that empirical therapy of childhood community-acquired bacterial meningitis with amoxycillin and chloramphenicol is no longer justified in children who have not been vaccinated against H. influenzae type b. In vaccinated or older children and adults, amoxycillin is a rational choice for empirical treatment of meningitis. The prophylactic use of rifampicin in contacts of patients with meningococcal disease is still applicable.
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J. Antimicrob. Chemother. · Nov 1996
Antimicrobial practice. Development of guidelines for gentamicin dosing.
The performance of dosage guidelines for starting gentamicin therapy was evaluated prospectively in 50 patients with suspected or proven Gram-negative septicaemia and the results were compared with results from similar group of 50 patients for whom the guidelines were not followed. Peak concentrations were significantly higher when the guidelines were followed (7.2 (+/- 1.9) mg/L vs 5.7 (+/- 1.8) mg/L) but there was no difference in trough concentrations. ⋯ However, use of the guidelines achieved peaks of > 7 mg/L in only 56% of patients. A revised protocol with higher doses given less frequently was therefore developed and a prospective assessment of its performance indicated that satisfactory concentrations were obtained in 96% of patients.