Search

There do not seem to be any available and effective treatments for infections caused by the respiratory syncytial virus (RSV), particularly for high-risk infants. Researchers have evaluated the use of ribavirin, steroids, and most recently an RSV specific antibody treatment called RSV immune globulin (RSVIG). None of the studies have shown significant improvements with any of the therapies. Combination therapies have had some preliminary success but need further study. Potential complications with routine RSVIG preventive therapy include transmitting the infection to others, cost, and efforts required for lengthy monthly treatments., ABBREVIATIONS. RSV, respiratory syncytial virus; RSVIG, respiratory syncytial virus immune globulin; IVIG, intravenous immune globulin; BPD, bronchopulmonary dysplasia. The most savage controversies are those about matters as to which there [...]

A cesarean section should be performed on pregnant women who are having a first episode of genital herpes lesions at the time of delivery but not on those having a recurrent episode. Herpes simplex virus (HSV), the microorganism that causes genital herpes lesions, can be transmitted to the newborn during passage through the birth canal. A study reviewed articles published in the medical literature that examined the use of cesarean section in women with a first episode of lesions and in those with a recurrent episode at the time of delivery. The use of cesarean section in women with recurrent lesions was costly and had a high risk of complications or death for the mother. It was more cost-effective and had fewer risks to the mother if the woman had no prior history of lesions.

Pregnant women whose husbands do not have symptoms of infection with herpes simplex virus type 2 (HSV-2) may still be at risk for contracting HSV-2. HSV-2 is a virus that causes genital herpes, and it can harm newborns who are exposed to it during passage through the birth canal. Of 190 pregnant women and their spouses, both members of 139 couples (73%) had the same HSV-2 infection status. Fifty-seven percent of these couples were negative for antibodies against HSV-2 and 16% were positive. In the remaining 51 couples (27%), one member was positive for antibodies against HSV-2, and the other was negative. Members of these couples had been sexually intimate for an average of 6.1 years. Eighteen women who were HSV-2 negative had husbands that were HSV-2 positive, and 10 of these husbands (56%) had never experienced symptoms of genital herpes. Five percent of the 190 pregnant women had an unsuspected risk of contracting HSV-2.

Respiratory syncytial virus is an important cause of respiratory infection in infants and children. The drug ribavirin was shown to be effective against this virus, and was approved in December 1986 for the treatment of respiratory syncytial virus infection. However, approval of ribavirin was based on studies testing its effectiveness in infants who were breathing normally, or without the aid of respiratory equipment. The studies consisted of three clinical trials, or human studies, including two with normal infants and one with infants who had underlying disease. These studies were criticized for problems in design and inability to show the effects of ribavirin on mortality, duration of hospitalization or treatment, and need for respiratory assistance. Because ribavirin may precipitate, or accumulate, in respiratory equipment, it is not approved for use in infants who require mechanical assistance. The effects of ribavirin were assessed in infants with respiratory syncytial virus infection who required assisted breathing. A system was designed to deliver ribavirin to infants without the accumulation of ribavirin in the respiratory equipment. The study involved 28 infants, including 7 infants with underlying diseases and 21 infants who were previously healthy. The duration of assisted breathing was 4.9 days in ribavirin-treated infants and 9.9 days in infants who were given an inactive placebo. The average duration of oxygen therapy was 8.7 days in ribavirin-treated patients and 13.5 days in placebo-treated patients. The duration of hospitalization was 13.3 days in ribavirin-treated patients and 15 days in the placebo group. Among the 21 normal infants, the period of hospitalization was 9 days those given ribavirin, compared with 15.3 days for those who received the placebo. These findings show that ribavirin reduces the duration of assisted breathing, oxygen treatment, and hospitalization. (Consumer Summary produced by Reliance Medical Information, Inc.)

It appears that dexamethasone should be used in addition to antibiotics in the treatment of children with bacterial meningitis caused by Haemophilus influenzae. Dexamethasone is a corticosteroid that works as an anti-inflammatory. A number of studies since 1988 have showed trends toward a minimization of complications in children with bacterial meningitis who receive both antibiotics and dexamethasone. However, the evidence remains equivocal. Dexamethasone does not appear to be necessary for treating bacterial meningitis caused by Streptococcus (S.) pneumoniae or Neisseriae meningitidis. Additionally, in areas where drug resistance to S. pneumoniae exists and vancomycin therapy is used, corticosteroids may be harmful. Possible side effects of dexamethasone treatment include gastrointestinal bleeding and the potential for corticosteroid treatment to reduce the ability of antibiotics to penetrate the cerebrospinal fluid.

Technical Report: Precautions Regarding the Use of Aerosolized Antibiotics. Charles G. Prober, MD; Philip D. Walson, MD; Jim Jones, PharmD; and the Committee on Infectious Diseases and Committee on Drugs. In 1998, the Food and Drug Administration (FDA) approved the licensure of tobramycin solution for inhalation (TOBI). Although a number of additional antibiotics, including other aminoglycosides, [Beta]-lactams, antibiotics in the polymyxin class, and vancomycin, have been administered as aerosols for many years, none are approved by the FDA for administration by inhalation. TOBI was approved by the FDA for the maintenance therapy of patients 6 years or older with cystic fibrosis (CF) who have between 25% and 75% of predicted forced expiratory volume in 1 second ([FEV.sub.1]), are colonized with Pseudomonas aeruginosa, and are able to comply with the prescribed medical regimen. TOBI was not approved for the therapy of acute pulmonary exacerbations in patients with CF nor was it approved for use in patients without CF. Currently, no other antibiotics are approved for administration by inhalation to patients with or without CF. The purpose of this statement is to briefly summarize the data that supported approval for licensure of TOBI and to provide recommendations for its safe use. The pharmacokinetics of inhaled aminoglycosides and problems associated with aerosolized antibiotic treatment, including environmental contamination, selection of resistant microbes, and airway exposure to excipients in intravenous formulations, will be discussed. Pediatrics 2000;106(6). URL: http://www.pediatrics.org/cgi/content/ full/106/6/e89; aerosolized antibiotics, tobramycin solution for inhalation; cystic fibrosis; Pseudomonas aeruginosa.