Cefaclor versus ampicillin for outpatient treatment of urinary tract infections.

An unblinded, randomized, prospective clinical trial of cefaclor, 250 mg twice daily, versus ampicillin, 500 mg four times daily, for a total of ten days of therapy, was conducted with 100 patients presenting to an emergency department with signs, symptoms, and urinalysis results suggestive of urinary tract infection (UTI). Eighty patients had a UTI proven by pre-therapy urine culture. Significantly more of the bacteria isolated were sensitive to cefaclor (96.3%) than to ampicillin (78.0%), P less than 0.01. Seventy-one patients returned for all follow-up visits and urine cultures. The overall success rate in the cefaclor group was 75.7% and in the ampicillin group 79.4%. There was a 10% failure rate in treating clinical cystitis with both regimens, and the satisfactory outcome rate for pyelonephritis and cystitis was similar in both treatment groups.

Efficacy of cervical spine immobilization methods.

Cervical spine immobilization devices are widely used to stabilize the cervical spine and prevent neurologic deficits associated with unstable fractures. In order to quantitate their efficacy we measured controlled cervical spine motion in three axes, using six different immobilization methods in 25 volunteers instructed to actively move their necks as much as possible in the directions of flexion, extension, rotation, and lateral bending while lying supine. Control measurements were made with no device and measurements were repeated following immobilization with: soft collar (SC), hard collar (HC), extrication collar (EC), Philadelphia collar (PC), bilateral sandbags joined with 3-inch cloth tape across the forehead (ST), and the combination of sandbags, tape, and the Philadelphia collar (ST/PC). Neck movements were reported in degrees recorded on a hand-held goniometer. There were no significant differences between control and SC measurements except in rotary movement. PC was not significantly better than the other two types of hard collars, except in limiting extension. ST immobilization was significantly better than any of the other four methods used alone, for all four movements. The addition of PC to ST was significantly more effective in reducing extension only.

Possible temporal association between diphtheria-tetanus toxoid-pertussis vaccination and sudden infant death syndrome.

Because diphtheria and tetanus toxoids pertussis (DTP) vaccine is routinely given during the period of highest incidence of sudden infant death syndrome (SIDS), this study was undertaken to determine if there is a temporal association between DTP immunization and SIDS. Parents of 145 SIDS victims who died in Los Angeles County between January 1, 1979, and August 23, 1980, were contacted and interviewed regarding their child's recent immunization history. Fifty-three had received a DTP immunization. Of these 53, 27 had received a DTP immunization within 28 days of death. Six SIDS deaths occurred within 24 hours and 17 occurred within 1 week of DTP immunization. These SIDS deaths were significantly more than expected were there no association between DTP immunization and SIDS. An additional 46 infants had a physician/clinic visit without DTP immunization prior to death. Forty of these infants died within 28 days of this visit, seven on the third day and 22 within the first week following the visit. These deaths were also significantly more than expected. These data suggest a temporal association between DTP immunization, physician visits without DTP immunization and SIDS.