Minerva pediatrica
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Review Comparative Study
Antibiotic treatment for urinary tract infections in pediatric patients.
This review focuses on antibiotic treatment of acute urinary tract infections (UTIs) in children who are neurologically and anatomically intact. Neonates younger than 28 days with a febrile UTI should be hospitalized, given supportive care and treated with parenteral amoxicillin and cefotaxime. Following a good response to 3 to 4 days of parenteral antibacterial therapy, outpatient treatment with an oral antibiotic should be given to complete 14 days of therapy. ⋯ Children with cystitis who are moderately to severely symptomatic should receive an oral antibiotic and supportive care immediately. If the therapy is effective, children with cystitis should show a good clinical response in 2 to 3 days. If the response is satisfactory and the culture shows an organism susceptible to the antibiotic used, complete 5 to 7 days of treatment with the oral antibiotic.
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Review
Colonization with antibiotic-resistant Gram-negative bacilli in the neonatal intensive care unit.
Infections with Gram-negative bacilli have affected critically ill newborns throughout the era of modern neonatal intensive care. Selected topics regarding the acquisition of Gram-negative bacteria, particularly those expressing antibiotic resistance, in the neonatal intensive care unit (NICU) are reviewed. Some data suggest that the recent introduction of intrapartum antibiotic prophylaxis programs, through which selected women are administered penicillin or ampicillin during labor to prevent vertically transmitted Group B streptococcal disease, has increased the incidence and resistance of early onset Gram-negative bacillary infection in the newborn over the past 5 years. ⋯ Althou-gh some clinically-undetected cross-transmission of resistant bacilli occurs during non-outbreak periods, most colonizing antibiotic-resistant bacilli are unique to each infant. The role of antibiotic exposure on the acquisition of antibiotic resistant bacilli in the intensive care nursery is difficult to calculate given the covariance of such exposure to other markers of severe disease. Experience has demonstrated, however, that use of the aminoglycosides is infrequently associated with emergence of resistance in the newborn, whereas the use of higher-generation cephalosporins may be associated with the rapid appearance of bacilli resistant to betha-lactams.