Efficacy and safety of cefotaxime in combination with metronidazole for empirical treatment of brain abscess in clinical practice: a retrospective study of 66 consecutive cases.

Sixty-six consecutive patients with brain abscesses referred to a department of neurosurgery during a 10-year period and treated with cefotaxime were studied retrospectively by means of a prospectively designed protocol whose main areas of emphasis were duration of antibiotic treatment, sterilization rate, clinical outcome in relation to prognostic factors, and side effects. Sixty-two of these patients were treated additionally with metronidazole, and surgery was performed in 53 patients. Mental status was altered in 33 patients, 11 of whom were comatose. Rupture of the abscess into the ventricles occurred in eight patients. Death was attributable to brain abscess formation in three patients (4.5%). Forty-six percent of the surviving patients recovered without any neurological deficits. Reversible adverse reactions, which occurred in 38 patients, were the most common reason for withdrawal of cefotaxime. In 76% of these cases, there was a significant improvement before the onset of the adverse reaction. The median duration of parenteral antibiotic treatment was 36, 41, 22, and 46 days in patients treated with excision, aspiration, evacuation of subdural empyema, and antibiotics alone, respectively. Taking prognostic factors into consideration, mortality attributable to brain abscess was lower than previously reported. This finding, along with the abscess sterilization results, indicates that cefotaxime in combination with metronidazole is a highly effective treatment but is associated with a high frequency of reversible side effects. The results indicate that a shorter duration of treatment should be investigated.

The district nurse and the district physician in health care teams. An analysis of the content of primary health care.

An assessment of community nursing in relation to physician care has been made in a Swedish primary care district. The staff was organized in health care teams. A totally integrated, comprehensive care service for everyone in the geographically defined district was made possible, as all members of the team used the same medical records. Visits in district care (district nurse, practical nurse) amounted to more than 50% of the visits to the teams. The visiting pattern in district care was dominated by the young and the old, the ages below 5 years of age making 3.7 visits per year, and the ages above 75 years making 10.0 visits. Health care was an important task among the children, while chronic ulcer of skin, senile dementia and diabetes were the most common diagnoses among the elderly. Every third visit in district care was a home visit. In almost 50% of the visits no appointment had been made in advance, which demonstrates a high accessibility to the district nurse. The distribution of diagnoses presented several social problems. Diagnoses like neuroses, alcoholism, and senile dementia produced many visits by few patients. Compared to physician visits, the district nurse made more home visits, had more visits among the young and the old, and had a different distribution of diagnoses. Regardless of, or despite, their different ways of working, the district nurse and the district physician complemented each other in the team co-operation. Besides her role as a health professional concerned about health care and medical treatment, the district nurse is an important social contact for many individuals living in her district.