1998 Journals

Vol.2 No.1 July-Dec 1998
RATIONAL USE OF IMMUNOMODULARS IN PEDIATRICS
Prof. Lulu C. Bravo, MD *
Keywords: immunomodulators,immunoglobulins,corticosteriods,immunonutritionals,isoprinosine,IVIG,IG

Immunomodulators are agents that regulate the immune response. In the past years there have been tremendous researches and studies on various biologic agents used to manipulate immune regulation for the prevention and management of infectious disease infants and children. Our task is to review and evaluate some of the immunomodulators that are commonly encountered and to determine their usefulness in the management of childhood illness.
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ANTIBODY RESPONSES OF THREE HAEMOPHILUS INFLUENZAE TYPE B (HIB) CONJUGATE VACCINES AFTER A PRIMARY VACCINATION SERIES IN FILIPINO INFANTS
Maria Rosario Z. Capeding, MD,* Hanna Nohynek,* Luz G. Pascual,* Helena Kayhty,* Lydia T. Sombrero,* Juhani Eskola,* and Petri Ruutu*
Hib vaccine, antibody response, reactogenicity

Serum antibody responses to three Haemophilus influenza type b (Hib) capsular polysaccharide-protein conjugate vaccines (PRP-OMP, PRP-T, and HbOC) were evaluated in 174 Philippine infants after primary vaccination series (Hib groups) or into a control group. A vaccination was carried out at 6, 10, and 14 weeks of age based in the local Expanded Program of Immunization schedule. Sera were collected at six weeks of age for the Hib groups and one month after the third dose for all subjects. Anti-Hib concentrations were determined by the Farr-type radioimmunoassay. There were no significant differences in the GMC after the primary series of three doses were significant; GMC was highest for PRP-T (6.62 Ug/ml), followed by HbOC (1.9 Ug/ml), and the lowest for the control group (0.11 Ug/ml). Hib conjugate vaccines are generally well tolerated. Both local and systemic reactions observed in the infants resolved within 24 hours from onset. We conclude that all three Hib conjugate vaccines (PRP-T, HbOC, and PRP-OMP) were immunogenic after primary doses among Filipino infants. *Research Institute for Tropical Medicine, Manila, Philippines *National Public Health Institute, Helsinki, Finland
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THE USE OF PIPERACILLIN/ TAZOBACTAM AMONG NEONATES, INFANTS AND CHILDREN**
C.N. Maramba-Untalan,MD*, Lulu C. Bravo, MD*
Piperacillin/Tazobactam, gram negative bacilli, adverse events of Piperacillin/Tazobactam

Beginning mid-1996, an increase in the incidence of gram negative bacteria resistant to third generation cephalosporins was observed in all pediatric wards (including the NICU and PICU) in the Philippine General Hospital. Several broad spectrum antibiotics, including Piperacillin/ Tazobactam (PIP/TAZO) were used empirically in patients suspected to have these infections. Charts of 124 patients admitted to the pediatric wards who were treated with 129 courses PIP/TAZO for at least four days from the period of August to November 1996 were reviewed to determine clinical efficacy and adverse effects of this drug. All patients were given an aminoglycoside. Ages ranged from 0 months to 16 years, and 84% were neonates. All patients were categorized as follows: Category 1 (n=75) – patients with positive isolates (blood, urine, ETA, peritoneal fluid, CSF) sensitive to PIP/TAZO, Category 2 (n=75) – patients with poor response to third generation cephalosporins with cultures; Category 3 (n=15) – received PIP/TAZO but isolates were later found to be resistant. Only Categories 1 and 2 patients were evaluated for clinical efficacy while patients in all Categories were evaluated with adverse effects. Majority of the isolates were gram negative organisms including Enterobacter, Klebsiella, H.alvei, Pseudomonas and Acinetobacter. Indications for treatment included early onset neonatal sepsis, nosocomial pneumonia, febrile neutropenia, peritonitis and nosocomial UTI. The following clinical responses were observed: Category 1,66% cured, 12% improved, 22% failed; Category 2 2,70% cured, 7% improved, and 23% failed. Thus, clinically evaluable patients showed a favorable response of 78%. Three (3) patients died while receiving PIP/TAZO. All the deaths were due to underlying infections. Twenty-nine patients experienced 35 adverse events: vomiting or residuals (4%), rashes (1.6%), gastrointestinal bleeding (1.6%), thrombocytopenia (8.5%), and candidal infections (9.3%).
Conclusions: Piperacillin/Tazobactam may be used as definitive or empiric therapy in pediatric patients with known resistance or poor response to standard antimicrobial therapy.
*Philippine General Hospital-University of the Philippines, College of Medicine **Presented at the Poster presentation of the 8th International Congress of Infectious Disease, Boston, USA, May 1998
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THE 1997 ANTIMICROBIAL RESISTANCE SURVEILLANCE DATA
Celia C. Carlos, MD*
Keywords: antimicobial resistance enteric pathogens, respiratory tract pathogens, gram positive cocci, gram negative bacilli, N.gonorrhea

For 1997, the antimicrobial resistance surveillance program (ARSP)of the Department of Health collected data from evelen hospitals -9 in Metro Manila, 1 in the Visayas (the Celestino Gallares anMemorial Hospital – CGMH) and 1 in Mindanao (Zamboanga Medical Center – ZMC ), Resistance data for 27,559 isolates were reported and analyzed, CGMH reported 1,251 isolates whereas ZMC had 1,209 isolates which were increases of 12 and 31% repectively from the number reported in 1996.
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COMPARATIVE STUDY OF ROUTINE HANDWASHING VERSUS USE OF 70% ISOPROPYL ALCOHOL IN REDUCING RESIDENT BACTERIAL FLORA IN THE HANDS OF NURSERY PERSONNEL
Volanda G. Cotillon, MD *, Lulu C. Bravo, MD *
isopropyl alcohol, hand washing, neonatal intensive care unit
Objective: To compare the efficacy of soap and water versus 70% isopropyl alcohol as a handwashing agent in the neonatal intensive care unit.
Design: Prospective randomized trial.
Setting: UP-PGH Neonatal Intensive Care Unit.
Subjects: Forty six 46 subjects comprised of 9 doctors, 30 nurses, and 7 nursing aides assigned at Neonatal intensive care unit from June 1, 1997 to June 30, 1997.
Methodology: The subjects were randomly assigned to either Group A or Group B each having twenty three (23) subjects. Group A performed hand washing with Perla soap as an agent. A culture of the dominant hand by imprint method using blood agar plate was done on each subject before and after the application of hand washing agents. The inoculated blood agar plates were incubated for 48 to 72 hours at 37 degrees C. The identification and colony count of the organism isolated were done. The mean change in the number of colony count on cultures before and after hand washing was used in the primary measure of the efficacy of hand washing agent.
Results: The use of soap and water increased the mean colony count from 125 to 146 after hand washing, while 70% isopropyl alcohol reduced the mean colony count of resident bacteria flora from 116 to 7 after hand washing. Testing for significance using the T test revealed that the mean change in the number of colony count of resident bacteria flora using soap and water was -21 while using isopropyl alcohol was 109 with a value of <0.0001 hence 70% isopropyl alcohol is more effective in reducing the number of colony count of resident bacteria flora in the hands of nursery personnel.
Conclusion: This study concludes that 70% isopropyl alcohol is more effective than soap and water in reducing the number of colony count of resident bacteria flora specifically coagulase-negative Staphylococcus organisms and can be used as an alternative hand washing agent in the Neonatal Intensive Care Unit especially during busy work and when rapid disinfection is necessary.*Philippine General Hospital *3rd Prize Winner PSMHD Junior Research Contest

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CEFPROZIL IN THE TREATMENT OF ACUTE UPPER AND LOWER RESPIRATORY TRACT INFECTIONS IN FILIPINO SUBJECTS
Vivina Chiu,MD, FPPS, FPSN* Josefina Carlos,MD, FPPS, FPIDSP, FPSMID* Bella Siasoco,MD, FPCCP* Cynthia Aguirre,MD, FPPS, FPIDSP* Victor Quimpo,MD, FPSMID*
Keywords: cefrozil, streptococcus pneumoniae, neisseria spp, moraxella catarrhalis, hemophilis influenzae
Abstract:
Cefprozil is a new orally semisynthetic cephalosporin with broad spectrum antibacterial activity recently introduced in the Philippines. It is highly active against Streptococcus pneumonia, Neisseria sp, Moraxella cattarhalis and Haemophilus influenza. In an open-label, multicenter study, Cefprozil was evaluated to assess its efficacy and safety in 136 Filipino patients with acute upper (n=50) and lower respiratory tract infections (n=86). The overall clinical response rate was 98.5% (134/136). Cefprozil was effective, well-tolerated and safe treatment of respiratory tract infections.
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