Short-term (48 hours) versus long-term (7 days) antibiotic prophylaxis for permanent pacemaker implantation

BACKGROUND: Infection following permanent pacemaker implantation is a dreaded complication. Antibiotic prophylaxis for 1-10 days at the time of implant has been used in the past but there is no consensus regarding its duration. We carried out a prospective, randomized study of two durations of antibiotic prophylaxis to determine which one was more effective. METHODS AND RESULTS: One hundred and seventy-eight patients undergoing permanent pacemaker implantation for the first time were randomized to receive short duration (group A, n = 8 8) or longer duration (group B, n = 90) antibiotic prophylaxis for 2 days and 7 days, respectively. Patients in both groups received cloxacillin 2 g 2 hours prior to the procedure followed by ampicillin and cloxacillin (50 mg/kg/day in 4 divided doses) and gentamicin (3 mg/kg/day in 2 divided doses) for the respective duration. Patients were followed up for 1-17.3 months (9.3 +/- 1.8 months) in group A and 1-16.5 months (8.9 +/- 2 months) in group B. One patient in group B had an infection at the pacemaker site and two patients in each group had to undergo reimplantation due to pus in the pocket. There was no significant difference in the primary end-point in both groups. CONCLUSIONS: A short course (48 hours) of antibiotic prophylaxis following permanent pacemaker implantation is as effective as a longer course (7 days).     

基底动脉尖卒中

儿童卒中常见［１］,在过去２０年里,抗磷脂抗体（ＡＰＬＡ）一直被认为是缺血性卒中的一个重要原因。在所有缺血性卒中中,以大脑中动脉分布区最为常见,而后循环则最为罕见［２］．本文报告１例ＡＰＬＡ引起的儿童基底动脉尖卒中。ｌ 病例报告 患儿,男,８岁,因发热４天突发失明１２小时人院．无癫■、神志改变、头痛或呕吐史．无眼痛或幻视,入院时发热。全身周围血管搏动正常,血压正常．其他检查未见明显异常。患儿间歇出现嗜睡,双侧眼睑下垂伴完全失明。上视麻痹伴左视时水平震颤加重。瞳孔３ｍｍ,对光反射正常。眼底正常．躯干…     

Empyema in infancy and childhood

A study of 108 cases of empyema during 18 months period showed the incidence of empyema to be 2.17%. Staph. aureus (17.6%) was the common causative organism. Response to a combination of cloxacillin and gentamicin was better than that of crystalline penicillin and gentamicin. Only 30.3% cases needed intercostal drainage for more than 2 weeks. Almost 43% cases could be discharged by 3-4 weeks after hospitalisation and 38.1% by 30-57 days. The mortality rate was 12.1%. Among the survivors, excluding 8 children who left against medical advice, all had complete recovery excepting one child in whom AFB was isolated and who developed bronchiectasis and recurrent hemoptysis, inspite of antituberculous treatment. Age of the child, antibiotic combination given and nutritional status appear to be the main factors influencing the recovery and prognosis.