No abstract

Penetration into the middle ear of four antibiotics commonly used in treatment of otitis media was studied by administering a single oral dose of amoxicillin, cefaclor, erythromycin-sulfisoxazole, or trimethoprim-sulfamethoxazole to 83 children with chronic serous otitis media. The antibiotic was given 15-240 min before the removal of middle ear fluid (MEF) by ventilation tubes inserted through the tympanic membrane. At the time MEF was obtained, a sample of blood was drawn from the patient, and concentrations of antibiotic in both specimens were assayed either microbiologically by a disk diffusion method or by high-pressure liquid chromatography. Amoxicillin had the highest ratio of mean peak concentration in MEF to minimal inhibitory concentration (MIC) for the three most common pathogens of otitis media (Streptococcus pneumoniae, ampicillin-sensitive Haemophilus influenzae, and Streptococcus pyogenes), whereas trimethoprim-sulfamethoxazole had the highest ratio of mean peak concentration in MEF to MIC for ampicillin-resistant Haemophilus influenzae.

Summary Over a 30-day period, Acinetobacter calcoaceticus var. antiratus was the responsible pathogen for hospital-acquired pneumonia in 10 patients, and resulted in the colonization of the upper respiratory tract in an additional 9 patients. Wright respirometers contaminated by this organism were shown to be the common source for the outbreak as indicated by the recovery of a single serotype (8J), the inability to recover Acinetobacter from any other environmental source, and the demonstration that moisturized Wright respirometers are capable of "aerosolizing" fluids containing Acinetobacter.

To study the effect of age on ultimate outcome of febrile illness, the authors prospectively studied 1,202 adult patients who came to an emergency room/walk-in clinic setting with temperatures of 101.0 degrees F (38.3 degrees C) or more. The patients were divided into four age categories: 17 to 40 years, 40 to 59 years, 60 to 79 years, and 80 years old or older. Advancing age was significantly (P less than 0.0005) associated with more serious disease, a higher rate of bacterial pathogen isolation, and a higher rate of life-threatening or deadly consequences. Of patients 17-39 years old, 58.2 per cent had viral syndromes, otitis media, or pharyngitis as the causes of fever. Of patients aged 40-59 years, only 20.7 per cent had one of these diseases. However, of patients 60 years old or older, only 4.1 per cent (15 of 370) had viral syndromes, otitis media, or pharyngitis, and the overall rate of hospitalization for this group was 92.5 per cent. The authors conclude that febrile patients 60 years old or older seen in emergency room/ambulatory care settings are extremely likely to have serious diseases. Caution should be exercised before concluding that their fevers are of benign origin.