C-reactive protein as a marker for guiding the duration of antibiotic therapy in suspected neonatal bacterial infection

The need to assign an effective and safe strategy to manage neonates with different forms of bacterial infections was an important objective among neonatologists at different centers. The classic approach is to provide the appropriate antibiotic regimen for cases with proved bacterial infection for a definite minimum duration and to discontinue the treatment after clinical and culture evidence of cure. This strategy, although reliable and effective, was found to pose a burden of longer duration of hospital stay and antibiotic therapy with undesired medical and economic consequences. This study was prospectively done to evaluate the use of C-reactive protein [CRP] as a reliable and safe guide to stop antibiotic therapy in those patients. It included 306 term neonates with suspected bacterial infection. C-reactive protein was highly sensitive in confirming bacterial infection in all the 72 cases [23.5%] who had positive cultures and was extremely specific in excluding bacterial infection in all the 234 [76.5%] neonates with negative cultures. Follow up of neonates with culture proved bacterial infection showed that, CRP value < 10 mg/dl could be used as a quite effective marker to terminate antibiotic therapy in neonates with various forms of bacterial infections, including the serious forms; septicemia and/or meningitis. The duration of antibiotic treatment in the group of neonates with CRP guided protocol was significantly less than the duration of treatment in the group guided by culture evidence of cure. At the same time, there was no significant difference in the rate of relapse among both groups. The results obtained in this study might provide a highly needed guide to limit the unnecessary use of antibiotics, in an economic, easy, safe and reliable manner, a situation that would be of great value in countries with rather limited economic resources

Study of the value of supplemental dietary fiber on the glycemic control in insulin-dependent diabetic patients [IDDM]

Diabetes mellitus is the most common chronic metabolic disorder encountered during childhood and adolescence. Dietary fiber is defined as "remnants of plant resistant to hydrolysis by the alimentary enzymes of man, the group of substances that remain in the ileum but are partly hydrolyzed by bacteria in the colon". This study aimed at assessing the short- and long-term effects of supplemental fiber intake on the glycemic control in children with IDDM. After adjustment of their insulin dose and planning of their diet, they came for the short-term study on which they were given a liquid glucose load according to their body weight [1.75 g/kg], FBG and 2 hour PPBG were estimated. On the second visit, they were given the same liquid glucose load to which 2 g of guar gum powder was added; also FBG and 2 hour PPBG were estimated. For the long-term study, the patients were given supplemental fiber to be taken at home for 8 weeks [2 g guar gum 3 times daily with the 3 main meals]. Glycosylated hemoglobin and fructosamine serum levels were measured both on the start and at the end of the study period and compared. The results of this study showed that supplemental fiber improved glycemic control both in the short- and long-term situations. This study concluded that: the addition of supplemental fiber to the diet resulted in a significant reduction in postprandial rise in blood glucose. Prolonged addition of supplemental fiber to the daily meals of children with IDDM resulted in a significant reduction in the levels of glycosylated hemoglobin and fructosamine. Prolonged addition of supplemental fiber to the daily meals of children with IDDM resulted in a significant reduction in the daily insulin requirement. We recommend the addition of supplemental fiber to the diet of diabetic children. Further studies need to be carried out on children with IDDM using naturally occurring foods with high fiber content for longer periods of time. IDDM: Insulin dependent diabetes mellitus; NIDDM: Non insulin dependent diabetes mellitus FBG: Fasting blood glucose; PPBG: Postprandial blood glucose; BMI: Body mass index