Pediatric infectious disease
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A number of well-designed comparison studies have shown the superiority of oral or injectable antibiotics over typical treatment in the treatment of impetigo contagiosa. Erythromycin, phenoxymethyl penicillin, intramuscular benzathine penicillin G as well as clindamycin, cefaclor and amoxicillin with clavulanic acid have been shown to be extremely effective. Because of significant differences in study design, it is difficult to compare drugs investigated in different studies. ⋯ If oral antibiotics are prescribed they should be given for 10 days. Systemic as opposed to topical antibiotics should be considered more strongly in situations where the incidence of impetigo is high, since these drugs are clearly superior in sterilizing the lesions quickly to prevent transmission. Other situations that favor the use of systemic as opposed to topical antibiotics include the presence of nephritogenic strains in the population, whether endemic or epidemic, more severe or spreading lesions and a population with poor hygiene.
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In 1982 Costa Rica had an infant mortality of 18 per 1000 live births and a life expectancy at birth of 76 years for women and 72 years for men. In the evolution of infant health in Costa Rica two paradigms were identified. One developed in the decades before 1970 and the other during the 1970s. ⋯ The "infectious disease paradigm" recognized infectious diseases as the main determinants of morbidity, mortality and malnutrition in childhood. The strategies derived from such a revolutionary paradigm aimed at the control and eradication of infectious diseases, and they resulted in a rapid improvement of child nutrition and health. However, the infectious disease paradigm does not seem to reduce infant mortality below the present level.(ABSTRACT TRUNCATED AT 250 WORDS)