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Single dose amoxicillin treatment of urinary tract infections
Abstracts
in treatment died and only 13% of patients with greater than one debridement survived. Prompt recognition and aggressive debridement and antibiotics are essential for survival, especially in patients with underlying chronic diseases. [LAS] Editor’s Note: For the emergency physician who must cover critical care units, it is important to be aware of this activity, and be willing to examine a post operative wound, and obtain aggressive surgical support. It is also important to be aware of sepsis in the diabetic or cardiac patient whose other problems may capture the attention of the emergency department. Foulsmelling serosanguinous drainage always suggests a serious mixed aerobic-anaerobic infection.
0 SINGLE DOSE AMOXICILLIN TREATMENT OF URINARY TRACT INFECTIONS. Shapiro ED, Wald ER. J Peds 1981; 99:989992. Single dose antimicrobial treatment of lower urinary tract infections has been shown to be safe and effective in adults. 35 patients (2 to 18 years of age) diagnosed as having an uncomplicated urinary tract infection were given amoxicillin either as a single dose of 50 mg/kg or as a lo-day course of 40 mg/kg/day in three divided doses. Repeat urine cultures were then performed at two and 12 days and one and three months following initiation of treatment. 18 children received single dose treatment and 17 children conventional 10 day treatment. Recurrences of infection during the 3 months followup period occurred in 3 children in the single dose treatment group and 2 children in the 10 day treatment group. There was found to be no significant difference in the cure rates of the two groups. There does not appear to be an increased frequency of recurrent infection following single dose treatment. The two cases of amoxicillin “resistant” infection were not cured by single dose therapy. A longer course of the drug may be effective and was in one case. Although single dose treatment of urinary tract infections in children may be effective the authors feel that additional studies are needed before it can be recommended as standard initial therapy in children. [Tony Tercier, MD] Editor’s Note: This is very encouraging! Patient compliance is always a difficult proposition, especially in the pediatric age group.
105
Therefore, anything that reduces the number of medication doses is certainly to be sought.
0 DIPSLIDE URINE CULTURES AND COST CONTAINMENT. Kennon WC, Soderdahl DW. Surg GynecolObstetr 1982; 155:807808. The validity of dipslide urine cultures was tested by comparing results of conventional culture plating techniques against dipslide cultures on the urine of 1000 consecutive urine samples from an outpatient urology clinic. Cultures were positive in 83 of loo0 and 77 of 1000 samples by conventional techniques and dipslide cultures, respectively. All positive dipslide cultures correlated completely with conventional cultures for a sensitivity rate of 93 percent. There were no false-positive cultures, for a specificity rate of 100 percent. All false negative cultures yielded borderline or 10,000 bacteria per milliliter results and it was speculated that the disparity may have been due to false-positive conventional cultures, secondary to a delay in plating. Use of the dipslide cultures could result in health care cost reductions by eliminating many follow up clinic visits. Patients can culture their urine and interpret the results at home. The authors calculated a savings of $0.413 per culture by using the dipslide method. [W. Peter Vellman, MD] Editor’s Note: This suggests a means of improving patient compliance, i.e., asking the patient to continue taking therapy so long as dipslide culture remains positive.
0 PERMANENT ATRIAL STANDSTILL: THE CLINICAL SPECTRUM. Woolliscroft J, Tuna, N. Amer JCardiol1982; 49:2037-2041. The authors present a case of permanent atrial standstill in a 34-year-old man with limbgirdle muscular dystrophy. Permanent atria1 standstill is seen in three well defined groups of patients: (1) those with long standing cardiac disease, (2) those with neuromuscular disorders, and (3) in apparently healthy persons that present with syncope, vertigo or stroke. In those patients with long standing cardiac disease pathologic studies invariably show severe and widespread atria1 fibrosis and degeneration. In the neuromuscular group, permanent atria1 standstill is associated with Charcot-Marie mus-
in treatment died and only 13% of patients with greater than one debridement survived. Prompt recognition and aggressive debridement and antibiotics are essential for survival, especially in patients with underlying chronic diseases. [LAS] Editor’s Note: For the emergency physician who must cover critical care units, it is important to be aware of this activity, and be willing to examine a post operative wound, and obtain aggressive surgical support. It is also important to be aware of sepsis in the diabetic or cardiac patient whose other problems may capture the attention of the emergency department. Foulsmelling serosanguinous drainage always suggests a serious mixed aerobic-anaerobic infection.
0 SINGLE DOSE AMOXICILLIN TREATMENT OF URINARY TRACT INFECTIONS. Shapiro ED, Wald ER. J Peds 1981; 99:989992. Single dose antimicrobial treatment of lower urinary tract infections has been shown to be safe and effective in adults. 35 patients (2 to 18 years of age) diagnosed as having an uncomplicated urinary tract infection were given amoxicillin either as a single dose of 50 mg/kg or as a lo-day course of 40 mg/kg/day in three divided doses. Repeat urine cultures were then performed at two and 12 days and one and three months following initiation of treatment. 18 children received single dose treatment and 17 children conventional 10 day treatment. Recurrences of infection during the 3 months followup period occurred in 3 children in the single dose treatment group and 2 children in the 10 day treatment group. There was found to be no significant difference in the cure rates of the two groups. There does not appear to be an increased frequency of recurrent infection following single dose treatment. The two cases of amoxicillin “resistant” infection were not cured by single dose therapy. A longer course of the drug may be effective and was in one case. Although single dose treatment of urinary tract infections in children may be effective the authors feel that additional studies are needed before it can be recommended as standard initial therapy in children. [Tony Tercier, MD] Editor’s Note: This is very encouraging! Patient compliance is always a difficult proposition, especially in the pediatric age group.
105
Therefore, anything that reduces the number of medication doses is certainly to be sought.
0 DIPSLIDE URINE CULTURES AND COST CONTAINMENT. Kennon WC, Soderdahl DW. Surg GynecolObstetr 1982; 155:807808. The validity of dipslide urine cultures was tested by comparing results of conventional culture plating techniques against dipslide cultures on the urine of 1000 consecutive urine samples from an outpatient urology clinic. Cultures were positive in 83 of loo0 and 77 of 1000 samples by conventional techniques and dipslide cultures, respectively. All positive dipslide cultures correlated completely with conventional cultures for a sensitivity rate of 93 percent. There were no false-positive cultures, for a specificity rate of 100 percent. All false negative cultures yielded borderline or 10,000 bacteria per milliliter results and it was speculated that the disparity may have been due to false-positive conventional cultures, secondary to a delay in plating. Use of the dipslide cultures could result in health care cost reductions by eliminating many follow up clinic visits. Patients can culture their urine and interpret the results at home. The authors calculated a savings of $0.413 per culture by using the dipslide method. [W. Peter Vellman, MD] Editor’s Note: This suggests a means of improving patient compliance, i.e., asking the patient to continue taking therapy so long as dipslide culture remains positive.
0 PERMANENT ATRIAL STANDSTILL: THE CLINICAL SPECTRUM. Woolliscroft J, Tuna, N. Amer JCardiol1982; 49:2037-2041. The authors present a case of permanent atrial standstill in a 34-year-old man with limbgirdle muscular dystrophy. Permanent atria1 standstill is seen in three well defined groups of patients: (1) those with long standing cardiac disease, (2) those with neuromuscular disorders, and (3) in apparently healthy persons that present with syncope, vertigo or stroke. In those patients with long standing cardiac disease pathologic studies invariably show severe and widespread atria1 fibrosis and degeneration. In the neuromuscular group, permanent atria1 standstill is associated with Charcot-Marie mus-