Impact of treatment guidelines on use of ribavirin

Article Abstract:

Infection with respiratory syncytial virus (RSV) frequently causes illness of the lower respiratory tract in infants and young adults. RSV infection occurs in epidemic proportions each year, and affects all children by their third year. Although this infection tends to resolve spontaneously, it can cause extensive disease and death due to its widespread nature and potential to cause severe disease in some patients. Immunity or natural defense against RSV is only short-term, and a vaccine against RSV has not been developed. The aerosolized or spray form of the antiviral agent ribavirin was approved for treating RSV infection in 1985. Guidelines for the use of ribavirin in infants were published by the American Academy of Pediatrics in 1987. Ribavirin was recommended for infants with a high risk of disease due to chronic lung conditions, congenital heart disease, or weakened immune systems; certain premature infants; normal but severely ill patients; and infants less than six weeks old. The adherence of physicians to these guidelines was assessed in a review of 100 patients who received 177 courses of ribavirin treatment between 1977 and 1988. Ninety-four percent of the patients fulfilled the requirements for ribavirin treatment of RSV, including 38 percent with heart, lung, and immune disorders; 35 percent of infants under six weeks of age; and 21 percent with severe illness. RSV infection was confirmed in 71 percent of the patients with underlying disease; 71 percent of patients aged six weeks or less; and 81 percent of patients with severe illness. Among 80 patients with illness compatible with RSV infection, 56 percent were treated with ribavirin. Thus, half of the patients with suspected RSV infection were treated with ribavirin, and included mainly patients with underlying conditions or very young age. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drug therapy, Diseases, Respiratory tract infections, Dosage and administration, Ribavirin

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Immunization response varies with intensity of acute lymphoblastic leukemia therapy

Article Abstract:

Vaccines are given to boost immunity against a specific disease. For example, the measles vaccine causes the production of a type of antibody, or immune protein, directed against the measles virus; these measles antibodies will protect the immunized child from developing the disease. Some studies show that children with cancer who are being treated with chemotherapy have lower antibody levels and diminished responses to immunization. It is not known whether the intensity or duration of chemotherapy affects the production of antibodies or responses to immunization in children with cancer. The levels of antibodies directed against three types of bacteria were assessed in children with acute lymphoblastic leukemia (ALL): Clostridium tetani, which causes tetanus; Corynebacterium diphtheriae, which causes diphtheria; and Haemophilus influenzae B, which causes influenza. ALL is a blood cancer that is characterized by the overgrowth of lymphoblasts, which give rise to lymphocytes, a type of immune cell. The children were being treated with different regimens of chemotherapy, which varied in intensity. A combined tetanus-diphtheria vaccine was given to 24 children receiving maintenance chemotherapy. An influenza vaccine was then given to 19 of the 24 children one month later. All patients had protective antibody levels against tetanus; 94 percent had protective levels against diphtheria; and 84 percent had protective antibody against influenza. The levels of antibodies before and after vaccination and the responses to immunization varied with the intensity of chemotherapy, but were not influenced by the duration of chemotherapy or the numbers of blood cells. It is thus recommended that the influenza vaccine be given to children who are receiving chemotherapy for acute lymphoblastic leukemia. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Physiological aspects, Chemotherapy, Immunization of children, Immunization, Antibodies, Lymphoblastic leukemia in children, Acute lymphocytic leukemia, Childhood leukemia

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Prolonged bacteremia with catheter-related central venous thrombosis

Article Abstract:

In severe illness, catheters are frequently placed deep within the venous system. When catheters are used on a long-term basis, a possible complication is bacterial infection, which may itself be associated with the development of a thrombus, or clot, forming at tip of the catheter. This occurs in part because the catheter passes through the skin (breaking the cutaneous barrier) and can seed bacteria into the tract of the catheter. The catheter itself, a foreign body within the body, may also trigger the development of biochemical mechanisms that can produce a clot, which can also become infected. Seven children were studied who had systemic infections that were associated with central venous catheters. When treated with antibiotics appropriate to the specific bacteria involved, they failed to improve. Ultrasonography, a simple noninvasive imaging method which uses sound energy to visualize soft tissues of the body, was able to detect in each case an associated thrombus of the great veins. In all cases the catheter had to be removed before the antibiotics could successfully fight the children's infection, and for the thrombus to be dissolved. The deaths of two of the children were not directly related to the catheter. Physicians must be aware of the possibility of central venus thrombus in children who have long-term central venous catheters. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Diagnosis, Causes of, Thromboembolism, Intravenous catheterization, Thromboembolism in children

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