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Keywords: Adverse drug reactions; hospitalized children; infectious diseases; causality; frequency; Iran A major problem of drug therapy, one that confronts primary care physicians on a daily basis, is the risk [...]

Vancomycin is a a glycopeptide antibiotic with bacetiocidal effects on gram positive bacteria by interfering with cell wall synthesis. The necessity for monitoring of serum vancomycin concentrations(SVCs) has been recently noticed at many institutions because of concerns for its nephrotoxicity. We aimed to describe the SVCs monitoring in pediatric patients, in an effort to determine subtherapeutic or toxic levels. The medical records were reviewed for all patients older than 60 days of age admitted to the general or subspecialty services who received intravenous vancomycin at Children's Medical Hospital in Tehran, Iran between July 2003 and December 2005. Because pharmacokinetic parameters for children with cancer maybe different, this group was evaluated separately. During the study, 167 infants and children without cancer and 42 patients with cancer; aged between 3 months to 17.5 years were treated with vancomycin for various infections. In children without cancer, peak SVCs were in an adequate therapeutic range for 93% of patients(8-55 μg/ml). For children with cancer, peak SVCs was lower than 10 μg/ml (10%), and trough values were lower than 5 μg/ml (21%). In conclusion, according to the results of this research, due to different pharmacokinetics of vancomycin in cancerous patients, the monitoring of vancomycin plasma concentrations is necessary for the best therapeutic antibacterial activities with a fewer occurrence of serious adverse effects. [ABSTRACT FROM AUTHOR]

Background: Chronic granulomatous disease (CGD) is a rare primary immunodeficiency (approximately 1 case in 200.000-250.000 newborns) caused by defect in one of the components of nicotinamide adenine dinucleotide phosphate (NADPH)-oxidase enzyme (membrane-bound glycoproteins gp91, and cytosolic subunits p47-phox, p67-phox, p40-phox and p22-phox). This leads to defective intracellular killing by phagocyte cells. One of the components of NADPH-oxidase is p22-phox which is encoded by CYBA gene. In this study were identified new genetic changes of CYBA in 22 Iranian patients with autosomal recessive-CGD (AR-CGD). Methods: Twenty two CGD patients based on defect in NADPH oxidase activity (by NBT slide test and DHR-123 assay) and their demographic data and clinical histories were entered this study. They were referred to Immunology, Asthma and Allergy Research Institute (IAARI) for diagnosis and treatment. All patients had p22-phox deficiency based on western blotting. Genomic DNA was extracted from peripheral blood mononuclear cells (PBMCs) and PCR followed by direct sequencing to find p22-phox mutations. Results: Mutation analysis of CYBA revealed 12 different mutations, including three novel mutations: one deletion in exon 1, and two transitions in exon 3 [c.136G>A (p.Gly46Ser)], and exon 6 [c.388C>T (p.Gln130X)]. Conclusions: Three new mutations of CYBA gene in 4 of 22 Iranian patients with AR-CGD were found. These 3 novel mutations can partly complete the data base of Human Gene Mutation Database (HGMD). It can also be helpful for further prenatal diagnosis of next children in the affected families. Also it will be useful for timely decision making in bone marrow transplantation as treatment for CGD patients. [ABSTRACT FROM AUTHOR]

Obtaining uncontaminated urine samples are important to diagnosis urinary tract infection in neonates. The present study was designed to compare urine contamination rates in two common methods of urine collection: urine bag versus suprapubic aspiration. In a cross-sectional study, 119 consecutive infants (aged 3 to 28 days) with fever who were referred to Children's Hospital Medical Center in Tehran between September 2004 and March 2005 were included. Urine was collected simultaneously by bag and suprapubic aspiration. The urine samples were analyzed and bacterial cultures performed using standard bacteriologic techniques. The rate of culture contamination differed markedly according to the method of urine culture. Suprapubic aspiration specimens were sterile in 92.4%. Pathogenic bacteria were isolated in 7.6%. No bacterial isolates were deemed to be contaminants. Only 8.5% of bag specimens were sterile. Of non-sterile cultures, 36.9% of bacterial isolates were deemed to be pathogenic and 54.6% contaminants (P < 0.001 vs. suprapubic aspiration). Pyuria (P = 0.002) and bacteriuria (P < 0.001) were more frequent in specimens obtained by bag than urine from suprapubic aspiration. The existence of a urinary tract anomaly was the main predictor for a positive culture in urine obtained by suprapubic aspiration. Contamination rates and rates of pyuria and bacteriuria are remarkably higher for urine obtained by bag specimens than for urine obtained by suprapubic aspiration. [ABSTRACT FROM AUTHOR]

Background and Purpose: Shunt infection represents a particularly morbid condition, which can also result in mortality. In order to decrease the high morbidity and mortality rates, prevention is an essential step. The purpose of this study was to compare the prophylactic use of ceftriaxone and trimethoprim-sulfamethoxazole (SXT) for the prevention of ventriculoperitoneal (VP) shunt infection., Methods: In this prospective, single-institution, randomized clinical trial, 107 children with hydrocephalus and an indication for shunting were randomly assigned to prophylaxis with ceftriaxone (n = 50) or SXT (55), each administered as a single dose during anesthesia and two divided doses postoperatively. Patients were followed up for at least one year., Results: The mean age of patients was 15 months, and 85% were aged 6 months or younger. During the first postoperative year, meningitis occurred in 13.5% of patients receiving ceftriaxone and 14.5% of the SXT group, with no statistically significant difference between the groups. Younger age, presence of cerebrospinal fluid leakage and aqueductal stenosis as a cause of hydrocephalus showed significant correlation with meningitis occurrence on univariate analysis. However, only the latter 2 factors were associated with meningitis on multivariate analysis. The risk of shunt infection did not correlate with the gender of the patient, time of VP shunt surgery, or duration of hospitalization for shunting., Conclusion: Ceftriaxone and SXT showed similar efficacy in preventing shunt infection. Cerebrospinal fluid leakage before or after VP shunt placement and aqueductal stenosis were independent risk factors for meningitis after VP shunt.

Background and Purpose: The aim of this study was to determine the frequency of adverse reactions to antibiotics by organ system in hospitalized children in the infectious ward of a pediatric diseases referral center in Iran., Methods: All patients treated with antibiotics were evaluated daily for the presence of ADRs during a 5-month period. For each suspected ADR, a specialized questionnaire was completed in order to obtain the information necessary for analysis of ADRs., Results: Among 300 patients, 65 ADRs were seen in 36 patients (12%) during their hospitalization. Pneumonia was the most common reason for administering antibiotics; ceftriaxone and rifampin were the most frequently implicated antibiotics in ADRs. There was a significant relationship between the number of drugs used and the rate of ADRs (p=0.0001). The most commonly affected organ systems were skin and appendages, and the gastrointestinal system. Maculopapular rashes were the most frequent skin ADRs., Conclusions: As antibiotics are the most frequently used drugs in children, and also because of significant relationship between the number of drugs used and ADRs, limited use and careful selection of type and dose of antibiotics as well as close clinical observation are very important in minimizing ADRs.

Bacille Calmette-Guérin (BCG) osteomyelitis is a very rare complication of BCG vaccination. We report a 14-month-old boy who received BCG vaccination at birth. He developed pain and swelling in his left calf at 11 months of age. BCG osteomyelitis was diagnosed in right femur and left tibia. He had no evidence of immunodeficiency. After antituberculous therapy and surgical treatment, the bone lesions disappeared and he was discharged from hospital without any sequela during 11 months of follow-up.