RESUMO
We describe a case of a 25-year-old female with an acute left otomastoiditis, accompanied by a left temporal extradural abscess with moderate perifocal edema and meningitis. Intravenous meropenem (2 g 8-hourly) and intravenous methylprednisolone (40 mg once daily) were commenced empirically. Teicoplanin (400 mg once daily intravenously) was added after 5 days when culture results were available. Teicoplanin was discontinued on day 25 but meropenem and methylprednisolone were continued for a further 15 days, after which the abscess completely resolved without sequelae. No treatment-induced adverse effects or seizures were observed. Thus, in selected patients, antibacterials (in conjunction with a corticosteroid) may be successfully used without surgery to treat brain abscesses and in such circumstances meropenem is a useful option for empiric therapy.
Assuntos
Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Abscesso Encefálico/tratamento farmacológico , Quimioterapia Combinada/uso terapêutico , Mastoidite/complicações , Meningite/tratamento farmacológico , Tienamicinas/uso terapêutico , Adulto , Antibacterianos/administração & dosagem , Anti-Inflamatórios/administração & dosagem , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/etiologia , Edema Encefálico/diagnóstico por imagem , Edema Encefálico/tratamento farmacológico , Edema Encefálico/etiologia , Quimioterapia Combinada/administração & dosagem , Feminino , Humanos , Injeções Intravenosas , Meningite/diagnóstico por imagem , Meningite/etiologia , Meropeném , Metilprednisolona/administração & dosagem , Metilprednisolona/uso terapêutico , Teicoplanina/administração & dosagem , Teicoplanina/uso terapêutico , Tienamicinas/administração & dosagem , Tomografia Computadorizada por Raios XRESUMO
The authors valued the incidence and clinical therapeutic aspects of Haemophilus influenzae type b (Hib) meningitis in children. They report a retrospective study, in children, with diagnosis of acute purulent meningitis, from January 1982 to December 1994, aged between 1 month and 14 years. Particular attention was direct to Haemophilus influenzae type b meningitis (20 cases). The incidence rate of Hib meningitis in the overall cases (89) was 22.47% (20), while among children younger than 5 years Hib was the most frequently pathogen isolated (20/58-34.47%). In 1/4 of cases, particularly in children younger than 1 years, exordium was aspecific and unclear. At admission culture and examination of Cerebrospinal Fluid (CFS) have been done. CFS was cultured on blood agar and chocolate plates. A latex agglutination test was used for rapid detection of the bacterial antigens. In some cases we looked for bacterial antigens in urine. 20% of children had complications and 10% had sequelae (1 years of follow-up). We didn't have any dead. Antibiotic treatment was principally with Ampicillin, Cephalosporin and Chloramphenicol. The results of this study confirm the Hib gravity and suggest that the administration of conjugate vaccine against Hib to all living in Italy is justified.
Assuntos
Haemophilus influenzae , Meningite por Haemophilus/microbiologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Meningite por Haemophilus/patologia , Meningite por Haemophilus/fisiopatologia , Estudos RetrospectivosRESUMO
The authors report their experience on the use of oral suspension of Clarithromycin in respiratory infections in the pediatric age. Thirty-three patients affected by various infectious pathologies of the respiratory tract, treated with oral Clarithromycin at the dosage of 15 mg/kg/day, were studied. The therapeutic outcome was very encouraging, the drug well tolerated and without side effects.
