Effect on pain intensity of injection sites and speed of injection associated with intramuscular penicillin

The aim of this one‐group, quasi‐experimental study was to examine the effect of choice of injection site and injection duration on the intensity of pain associated with intramuscular penicillin injection. Injections containing the same dose of drug were administered 12 hours apart for each patient over 5 s/mL and 10 s/mL durations in the dorsogluteal and ventrogluteal sites. Sixty patients who had a medical order for intramuscular penicillin at least twice in a day and for two successive days at the same dose were included in the study. No difference in pain was perceived by participants between the two injection durations at either the dorsogluteal or the ventrogluteal site. This study showed that intramuscular penicillin can be administered to either site over 5 s/mL or 10 s/mL durations. There is a need for further research with a randomized controlled design in different settings and in a larger sample on the impact of choice of injection site and injection duration on pain intensity.     

Recent increase in non-tuberculous mycobacterial infection in patients with connective tissue diseases in Japan

BackgroundNon-tuberculous mycobacterial (NTM) infection is currently a growing health concern due to the increasing incidence and the need for prolonged therapy. In patients with connective tissue diseases, use of immunosuppressants may lead to an increased risk of NTM infection. However, few studies have examined the recent incidence of NTM infection among connective tissue diseases patients. This study investigated recent trends in NTM infection among connective tissue diseases patients.MethodsWe included adult patients from whose cultures NTM were isolated between January 2009 and October 2017 in our hospital. By reviewing their medical records, connective tissue diseases patients were identified. Types of connective tissue disease, NTM species, and treatment of NTM infection were extracted.ResultsNTM was isolated from 657 patients during the period. Among these, 24 patients had connective tissue diseases. The number and rate of NTM isolates from connective tissue diseases patients increased during the period, with 4 patients 2009 to 2012 (1.9%), and 20 patients from 2013 to 2017 (3.3%; P = 0.04). The proportion of Mycobacterium avium complex (MAC) to total NTM tended to be lower among connective tissue diseases patients (58.3%) than among non-connective tissue disease-patients (72.8%), but the difference was not significant (P = 0.20). Mycobacterium xenopi was significantly more frequent in connective tissue disease patients than in non-connective tissue diseases patients (P < 0.01).ConclusionThe recent increase in the incidence of NTM infections in connective tissue diseases patients was larger than that in the total population. NTM species other than MAC were isolated from connective tissue diseases patients.     

Treatment of posttraumatic osteitis with intravenous ofloxacin

The subjects were 25 patients with osteomyelitis (n = 17) or other bone or joint infections, scheduled for surgical procedures, including debridement, sequestrectomy, and bone resection and reconstruction. Staphylococcus aureus was isolated in 22 patients, Staphylococcus epidermidis in one, Streptococcus haemolyticus in one, Pseudomonas aeruginosa in one, and a Pasteurella species in one. During surgery and for a mean of four days after surgery, each patient received 200 mg of ofloxacin intravenously twice daily (one patient received 300 mg and another received 400 mg twice daily). The patients were then given 200 mg of ofloxacin orally twice daily until the wound was healed (after a mean of 18 days). The wound was healed in all patients and no cases of reinfection occurred. It is concluded that intravenous ofloxacin given perioperatively may be more effective than oral ofloxacin in the management of osteomyelitis.     

Treatment of refractory epilepsy with intravenous immunoglobulins

Summary Sixty-one refractory epileptic patients (46 with partial epilepsy) were treated with intravenous immunoglobulins in a controlled double-blind/dose finding clinical trial; 18 (7 females, mean age 18.5 years) received placebo, while 14 (3 females, mean age 26.2 years, 2 excluded), 14 (4 females, mean age 24.6 years, 1 excluded) and 15 (5 females, mean age 24.4 years) patients received 100, 250 and 400 mg/kg per infusion of intravenous immunoglobulins, respectively. Seven perfusions were scheduled, four the 1st week, and thereafter one during the 2nd, 3rd and 6th week. The patients were followed for 6 months. An optional infusion was given at the end of the study. A comparison of the mean number of seizures per day was made between the baseline (4 weeks before the first infusion) and the 6th month after the first infusion. Patients were considered responders if they had a decrease of at least 50% in daily seizure frequency at the end of the study compared with the baseline. We did not find severe adverse events. One patient had to stop infusions for possible related side effects (vomiting). When all patients were analyzed together, we found a positive trend in favor of intravenous immunoglobulin treatment, but this was not significant (P=0.095). There was no relationship between dose and efficacy (P=0.31). When the largest group with partial epilepsy was analyzed separately, we noted 19 responders in the test group, compared with 2 in the placebo. These results were significant (P=0.041) and remained significant in the subgroup of partial epilepsy with secondarily generalized seizures (30 patients,P=0.049). The results were not significant after the 3rd month. There was an insignificant correlation between a better therapeutic response and a lower IgA serum level (P=0.07) or a more severe daily seizure frequency (P=0.06). The mechanisms of action of intravenous immunoglobulins in epilepsy still remain hypothetical.