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pneumonia

Treating penicillin-resistant pneumococci with penicillin

7 Jul, 09 | by Bob Phillips

Now if you ask me, the idea of treating a penicillin-resistant organism with penicillin seems faintly ridiculous…  like an iron with drawing pins on the sole plate. Either the bug is resistant (which to me means it resists dying when I use the drug) or it isn’t (so it will die) but it seems that this may not be as straightforward as it seems.

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Azithromycin for chest infections in severe CP?

22 Oct, 07 | by BMJ

Is the frequency of recurrent chest infections, in children with chronic neurological problems, reduced by prophylactic Azithromycin?
You see Jonny, an 8 yr old boy with severe dystonic CP as a result of his premature birth at 26 wks gestation with another chest infection. He is mainly gastrostomy fed and had a Nissen’s fundoplication 5 yrs ago at the same time his gastrostomy was inserted. He has copious secretions and a poor cough reflex; these are made worse by Nitrazepam he requires for his dystonia. Evidence from previous barium studies and swallow assessments show that he chronically aspirates his secretions. He has no symptoms of upper airway obstruction. He has had increasingly frequent lower respiratory tract infections over the last year, requiring admission and intra-venous antibiotics (a total of four times in 2006). His weight and height have fallen from the 10th to the 3rd percentile. A chest x-ray shows chronic changes suggestive of underlying bronchiectasis. Immune function and Sweat test are normal. He awaits a CT scan. He has daily physiotherapy and regular suction and usually produces copious muco-purulent secretions. He is on maximal anti-reflux medication already. Would prophylactic Azithromycin reduce his risk of further LRTI? Or might it increase growth of multi resistant organisms within his sputum?

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Is the use of Chest Physiotherapy Beneficial in Children with Community Acquired Pneumonia?

11 Jul, 07 | by BMJ

A 7 year old boy is admitted to the General Paediatric ward with a community acquired Pneumonia Radiograph pneumonia affecting the right lower lobe. It is suggested on the ward round that we arrange chest physiotherapy to try and reduce the length of his hospital stay. We wonder if there is evidence to support the use of physiotherapy in this case.

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