The efficacy and safety of 0.5% Levofloxacin versus fortified Cefazolin and Amikacin ophthalmic solution for the treatment of suspected and culture-proven cases of infectious bacterial keratitis: a comparative study

Abstract Background: Bacterial keratitis is a major devastating ocular condition that quickly deteriorates the patient’s vision. Vigorous and prompt treatment of bacterial keratitis with broad-spectrum antibiotic eye-drops is preferred. Objective: Evaluate the efficacy and safety of 0.5% Levofloxacin for the treatment of suspected and cultureproven cases of infectious bacterial keratitis in comparison to fortified Cefazolin and Amikacin ophthalmic solution. Materials and methods: Seventy-one eyes from 69 patients suspected of having infectious bacterial keratitis were enrolled in the study. The patients were randomized into two arms, 0.5% Levofloxacin eye drops (34 eyes) or fortified Cefazolin and Amikacin (37 eyes). Sixty-eight eyes were included in the efficacy analysis. During treatment, on days 2, 7, 14, and 21, the patient’s symptoms and signs were scored from grade 0-3 (absent to severe). Results: At the end of the treatment, 61 out of 71 eyes completely healed. The resolution of the keratitis was not significantly different between both groups. There were no significant differences in the mean time-duration for the ulcer to heal or for the symptoms and clinical signs to disappear between the two groups. No serious adverse events or side effects from the disease were found. The patients compliance was 80% based on the self-reported diaries. Conclusion: The efficacy and safety of 0.5% topical Levofloxacin was comparable to fortified Cefazolin and Amikacin for the treatment of mild-to-moderate bacterial keratitis. Topical Levofloxacin is far superior because of its availability and patient compliance when used as monotherapy for the treatment of infectious bacterial keratitis.

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Lenalidomide Administration In Patients With POEMS Syndrome

Blood ◽

10.1182/blood.v122.21.3235.3235 ◽

2013 ◽

Vol 122 (21) ◽

pp. 3235-3235 ◽

Cited By ~ 1

Author(s):

Flora Zagouri ◽

Efstathios Kastritis ◽

Maria Gavriatopoulou ◽

Theodora Psaltopoulou ◽

Theodoros N. Sergentanis ◽

...

Keyword(s):

Partial Response ◽

Sample Size ◽

Conflicts Of Interest ◽

Small Sample ◽

Poems Syndrome ◽

High Dose ◽

Time Interval ◽

Efficacy And Safety ◽

The Mean ◽

Mean Time

Abstract The most effective treatment for patients with POEMS is high dose therapy with autologous stem cell support (ASCT); however, several patients are not be eligible for this procedure while others may relapse after ASCT. Hence, there is a clear need for the development of new therapies for the management of POEMS. Lenalidomide is an immunomodulatory drug that has proven efficacy in patients with multiple myeloma and seems to represent an attractive option for use in POEMS. The purpose of this study was to synthesize all available data emerging from case reports/case series and our experience so as to evaluate the efficacy and safety of lenalidomide in patients with POEMS. This systematic review was performed in accordance with the PRISMA guidelines. Eligible articles were identified by a search in MEDLINE and ClinicalTrials.gov databases for the period up to April 8, 2013. The search strategy included the following keywords: (POEMS AND (lenalidomide OR revlimid). In addition, we checked all the references of eligible articles, so as to identify potentially eligible papers. Articles in Chinese and Japanese were excluded; two investigators, working independently, searched the literature and extracted data from eligible studies. All studies that examined the efficacy and safety of lenalidomide administration in patients with POEMS diagnosis, regardless of sample size, were considered eligible. Moreover, eligible cases of patients diagnosed with POEMS syndrome and who were treated with lenalidomide in our Department were additionally included in this pooled analysis. POEMS diagnosis was established according to criteria by Dispenzieri et al (Am J Hematol 2012). Hematological, radiological and neurological response was assessed according to the statements of the authors in the individual eligible manuscripts; in case these were not clearly stated, we applied the D'Souza criteria. An overall of 11 articles, which included 51 patients, were analyzed. The mean age of patients at lenalidomide administration was 55.2 years (SD: 10.8; median: 54.5 years; range: 32-79 years). The mean time from POEMS diagnosis to lenalidomide administration was 30.1 months (SD: 37.4; median: 18 months; range: 0- 164 months). In most patients lenalidomide was administered at a dose of 25 mg (days 1-21) in combination with dexamethasone (40 mg weekly in cycles of 28 days), until disease progression or unacceptable toxicity. Lenalidomide was given as first, second, third and fourth line treatment in 19.1%, 50%, 19.1% and 11.9% of patients, respectively. The mean time from last treatment till lenalidomide administration was 17.2 months (SD: 27.0; median: 5 months; range: 0-111 months). There were 43 patients evaluated for hematological response; the latter included complete response in 18.6%, very good partial response in 39.5%, partial response in 37.2% and stabilization of the disease in 4.7% of cases. Of note, VEGF reduction occurred in all reported cases; neuropathy improved in 92.0% of cases and stabilized in 8%. Organomegaly was improved in 87% of cases, skin changes in 73.7% and edema in 95%. In 8 patients, ASCT was performed after lenalidomide treatment and no particular toxicity or harvest issues were observed. Lenalidomide was well tolerated; two cases with respiratory infection grade 3 and one case neutropenia grade 4 were recorded. Data to assess progression were available in 44 patients; among them 6 progressed. Of note, among the 6 patients who progressed during the observation period, only two relapsed within the first year. The Kaplan-Meier PFS estimate at 12 months was equal to 93.9%. No deaths were reported during the follow-up period. Given the small sample size as well as the small number of events, no significant associations emerged. Nevertheless, some trends of marginal significance seem worth observing, i.e. longer time interval between diagnosis and lenalidomide administration was associated with less frequent neuropathy response (OR: 0.98, 95% CI: 0.96-1.00, p=0.053). We conclude that the use of lenalidomide in patients with POEMS seems to be a highly effective and safe therapy, even in patients previously exposed to one or more lines of therapy. The PFS achieved by lenalidomide was rather prolonged (PFS at 12 months 93.9%); furthermore, marked clinical, neurological, hematological and VEGF levels improvement in patients treated with this agent was observed. Disclosures: No relevant conflicts of interest to declare.

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Diamond Burr for the Treatment of an Indolent Corneal Ulcer in a Foal

Acta Scientiae Veterinariae ◽

10.22456/1679-9216.85679 ◽

2017 ◽

Vol 45 ◽

pp. 4

Author(s):

João Antônio Tadeu Pigatto ◽

Luciane De Albuquerque ◽

Ângela Beatriz de Oliveira Bacchin ◽

Géssica Maria Ribeiro Da Silva ◽

Michelle Becker Petersen ◽

...

Keyword(s):

Corneal Epithelium ◽

Corneal Ulcer ◽

Clinical Signs ◽

Ophthalmic Solution ◽

Eye Drops ◽

Current Case ◽

Fluorescein Staining ◽

Ophthalmic Examination ◽

Corneal Ulcers ◽

Diamond Burr

Background: Indolent corneal ulcers have been described as superficial ulcers with an associated rim of loose peripheral epithelium Treatment for indolent ulcers include debridement, grid keratotomy, multiple punctate keratotomy, third eyelid flaps, application of cyanoacrylate tissue adhesives, superficial keratectomy, and a debridement with a diamond burr.Case: A 2-month-old female American Quarter Horse was referred to the Ophthalmology Veterinary Section of the Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil, presenting epiphora and blepharospasm. A local veterinarian doctor had prescribed broad spectrum topical antibiotic and anti-inflammatory drops, although there was no positive response to the treatment for the past two weeks. Ophthalmic examination reveals and moderate discomfort in the left eye, epiphora, and mild corneal edema in the area of the defect. Slit lamp biomicroscopy revealed a superficial corneal ulcer with about 6 mm. Corneal epithelium did not adhere to underlying corneal stroma. The remainder of the ophthalmic examination of the left eye was unremarkable. The diagnosis of a corneal ulcer was made based on these clinical signs and fluorescein staining of the cornea where the stain dissects under the unattached epithelial lip. A handheld battery-operated motorized diamond burr, with a 3.5 mm medium grit tip, was utilized to remove the epithelium. The medical treatment included tobramycin eye drops, and flurbiprofen sodium ophthalmic solution, being applied six times daily, after the procedure, during two weeks, and atropine sulphate 1% was applied once a day, during three days. The foal was hospitalized until healing the corneal ulcer. For two weeks, the foal was assessed daily, and, after that, follow-up visits were scheduled weekly for four months. Healing was defined as the point at which the cornea no longer retained fluorescein.Discussion: Ulcers localized to the corneal epithelium, do not heal within the expected time frame, and have been characterized by epithelial border poorly adherent corneal and being commonly referred as indolent corneal ulcers. In this case, corneal ulcers are chronic and have not responded to an appropriate therapy for 14 days. The corneal ulcer was diagnosed based on history, clinical signs and fluorescein staining of the cornea. Usually, medical treatments provide disappointing results. Surgical treatment aims to remove the loosened epithelium in order to facilitate the growth of new epithelial cells, with stronger adhesion complexes. The utilization of a diamond burr, for the treatment of an indolent corneal ulcer, has been previously reported in humans, and dogs. In the present case, the debridement with a diamond burr was chosen on account of excellent results obtained in previous studies in humans and dogs, when treating indolent corneal ulcers. In the current case, the corneal ulcer healed in ten days, while in a study comparing the outcome in 23 horses treated by debridement, grid keratotomy, or superficial keratectomy, the mean times until complete healing were 15, 16 and 23 days, respectively. In the present case, debridement with diamond burr was effective in the treatment of a recurrent corneal ulcer in a foal.

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Treatment of Noninfectious Corneal Disorders With Plasma Rich in Growth Factors and ReGenerating Agent Matrix

10.21203/rs.3.rs-49518/v1 ◽

2020 ◽

Author(s):

Ronald Mauricio Sanchez-Avila ◽

Edmar Uribe-Badillo ◽

Carlos Fernandez-Vega Gonzalez ◽

Francisco Muruzabal ◽

Borja De la Sen Corcuera ◽

...

Keyword(s):

Growth Factors ◽

Adverse Events ◽

Corneal Ulcer ◽

Eye Drops ◽

Ocular Surface Disease Index ◽

Corneal Ulcers ◽

Corrected Visual Acuity ◽

The Mean ◽

Mean Time

Abstract Background: To provide the efficacy and safety of Plasma Rich in Growth Factors (PRGF) associated with tissue ReGeneraTing Agent (RGTA) drops for the treatment of noninfectious corneal ulcers.Methods: This retrospective study included patients from Fernandez-Vega University Institute between 2010 and 2019, with noninfectious corneal ulcers and no response to standard treatments. RGTA treatment was firstly applied (1 drop every two days), but if ulcer closure was not achieved, PRGF eye drops treatment was added (4 times/day). The time to reach the ulcer closure; the Best Corrected Visual Acuity (BCVA), intraocular pressure (IOP), Visual Analog Scale (VAS, in frequency and severity of symptoms), and Ocular Surface Disease Index (OSDI) were evaluated. The presence of adverse events along the follow-up period was also reported. Results: Seventy-four patients (79 eyes) were included in the study, forty-six eyes (62.2%) were women, and the mean age was 56.8 ± 17.3 years. The neurotrophic corneal ulcer was the most frequent disorder found in the patients of the study (n = 27, 34.2%), mainly due to the herpes virus (n = 15, 19.0%). The mean time of PRGF eye drops treatment associated with RGTA matrix was 4.2 ± 2.2 (1.5 -9.0) months, and the follow-up period was 44.9 ± 31.5 months. The ulcer closure was achieved in 76 eyes (96.2%). BCVA, VAS and OSDI improved significantly from the baseline (p<0.001), while IOP remained unchanged (p=0.665). No adverse events were recorded. Conclusions: The use of RGTA and PRGF in noninfectious ulcers was effective and safe, and it could be a therapeutic alternative for this type of corneal diseases.

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Iatrogenic hyperadrenocorticism in 28 dogs

Journal of the American Animal Hospital Association ◽

10.5326/15473317-35-3-200 ◽

1999 ◽

Vol 35 (3) ◽

pp. 200-207 ◽

Cited By ~ 26

Author(s):

HP Huang ◽

HL Yang ◽

SL Liang ◽

YH Lien ◽

KY Chen

Keyword(s):

Reference Range ◽

Clinical Signs ◽

Acth Stimulation ◽

Cutaneous Lesions ◽

Elevated Alkaline Phosphatase ◽

Baseline Cortisol ◽

Initial Improvement ◽

The Mean ◽

Mean Time ◽

Aspartate Transferase

Twenty-eight dogs with iatrogenic hyperadrenocorticism were studied. The most common clinical signs were cutaneous lesions (27/28), polydipsia (21/28), polyuria (19/28), and lethargy (16/28). The most predominant findings on biochemical profile were elevated alkaline phosphatase (ALP, 15/28) and alanine transferase (ALT, 14/28); hypercholesterolemia (14/28); elevated aspartate transferase (AST, 12/28); and elevated triglycerides (12/18). Baseline cortisol levels of all 28 dogs were at the lower end of the reference range and exhibited suppressed or no response to adrenocorticotropic hormone (ACTH) stimulation. The mean time for each dog to show initial improvement of clinical signs after corticosteroid withdrawal was six weeks, with another mean time of 12 weeks to demonstrate complete remission.

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Prospective study comparing Xalatan® eye drops and two similar generics as to the efficacy and safety profile

European Journal of Ophthalmology ◽

10.1177/1120672117747030 ◽

2018 ◽

Vol 28 (4) ◽

pp. 378-384 ◽

Cited By ~ 2

Author(s):

Andreas Diagourtas ◽

Kostantinos Kagelaris ◽

Kostantinos Oikonomakis ◽

Andreas Droulias ◽

Nikolaos Kokolakis ◽

...

Keyword(s):

Intraocular Pressure ◽

Safety Profile ◽

Ocular Surface ◽

Disease Index ◽

Ocular Surface Disease ◽

Eye Drops ◽

Efficacy And Safety ◽

Ocular Surface Disease Index ◽

Significant Difference ◽

The Mean

Purpose: To evaluate the efficacy and safety between two generic prostaglandins Lataz–Xalaprost (Greece) and the corresponding original drops (Xalatan®). Material and methods: In this prospective randomized study, 60 patients diagnosed with open-angle glaucoma or ocular hypertension were enrolled, who had never received antiglaucoma treatment. Subjects were divided randomly into three groups (Xalatan, Lataz, and Xalaprost groups) and they were studied over 16 weeks. At each visit, the mean applanation tonometry values and tear break-up time were measured. The Ocular Surface Disease Index questionnaire was used to evaluate patient’s symptoms. Results: There was a statistically significant difference (p < 0.001) in the mean values of the intraocular pressure between the baseline and the last visit (Xalatan group: from 23.11 ± 1.61 mmHg to 15.81 ± 1.22 mmHg, Lataz group: from 23.26 ± 1.33 mmHg to 15.80 ± 1.47 mmHg, and Xalaprost group: from 23.08 ± 1.45 mmHg to 16.08 ± 1.38 mmHg). Both generic eye drops showed mean percentage intraocular pressure reduction comparable to the standards of prostaglandin analogues (Xalatan: 31.57%, Lataz: 32.06%, and Xalaprost: 30.34%). Xalatan reduced the tear break-up time less, followed by Lataz and then by Xalaprost (Xalatan: from 8.5 to 8 s, Lataz: from 8.2 to 7.4 s, and Xalaprost: from 8.7 to 7.7 s). Xalatan presented the best safety profile, followed by Lataz and least was Xalaprost, according to Ocular Surface Disease Index questionnaire’s results. Conclusion: No significant difference was recorded in the effectiveness of each generic prostaglandin compared to the original. Furthermore, no patient had to change medication. The differences that arose in the safety profile of the three eye drops suggest a prompt closer initial monitoring of patients who are administered generic eye drops.

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Clinical signs and duration of cyanide toxicosis delivered by the M-44 ejector in wild dogs

Wildlife Research ◽

10.1071/wr05020 ◽

2006 ◽

Vol 33 (3) ◽

pp. 181 ◽

Cited By ~ 4

Author(s):

Amber L. Hooke ◽

Lee Allen ◽

Luke K.-P. Leung

Keyword(s):

Initial Phase ◽

Clinical Signs ◽

Sodium Cyanide ◽

Cerebral Hypoxia ◽

Ocular Reflex ◽

Righting Reflex ◽

The Mean ◽

The Difference ◽

Wild Dogs ◽

Mean Time

Sodium cyanide poison is potentially a more humane method to control wild dogs than sodium fluoroacetate (1080) poison. This study quantified the clinical signs and duration of cyanide toxicosis delivered by the M-44 ejector. The device delivered a nominal 0.88 g of sodium cyanide, which caused the animal to loose the menace reflex in a mean of 43 s, and the animal was assumed to have undergone cerebral hypoxia after the last visible breath. The mean time to cerebral hypoxia was 156 s for a vertical pull and 434 s for a side pull. The difference was possibly because some cyanide may be lost in a side pull. There were three distinct phases of cyanide toxicosis: the initial phase was characterised by head shaking, panting and salivation; the immobilisation phase by incontinence, ataxia and loss of the righting reflex; and the cerebral hypoxia phase by a tetanic seizure. Clinical signs that were exhibited in more than one phase of cyanide toxicosis included retching, agonal breathing, vocalisation, vomiting, altered levels of ocular reflex, leg paddling, tonic muscular spasms, respiratory distress and muscle fasciculations of the muzzle.

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Comparative evaluation of efficacy and safety of bepotastine besilate 1.5% ophthalmic solution versus olopatadine hydrochloride 0.1% ophthalmic solution in patients with vernal keratoconjunctivitis

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20211652 ◽

2021 ◽

Vol 10 (5) ◽

pp. 552

Author(s):

Priya Gupta ◽

Seema Baishnab ◽

Parveen Rewri

Keyword(s):

Clinical Symptoms ◽

Ophthalmic Solution ◽

Histamine Receptor ◽

Vernal Keratoconjunctivitis ◽

Eye Drops ◽

Efficacy And Safety ◽

Open Label ◽

Male Predominance ◽

Significant Difference ◽

Symptoms And Signs

Background: Vernal keratoconjunctivitis (VKC) is a chronic, seasonally exacerbated, allergic ocular inflammation. It affect children and young adults and has male predominance. The first line of treatment often used is dual acting drugs like olopatadine and bepotastine. It combine the immediate histamine receptor antagonism, coupled with mast cell stabilization with other anti-inflammatory properties. The present study was conducted to compare the efficacy and safety of olopatadine 0.1% and bepotastine 1.5% eye drops in VKC patients.Methods: This was a prospective, open label, randomized and comparative clinical study conducted for 21 days. 65 patients of VKC of 5-15 years of either sex were randomized in two study arm. Arm A, given bepotastine 1.5% and arm B, given olopatadine 0.1% twice daily for 21 days. Symptoms and signs scoring of VKC along with safety assessment were recorded on baseline and at time of follow up on 7th day and 21st day.Results: After 3 weeks of drug therapy, patients in both arms showed improvement in the symptoms and signs scoring of VKC. There was no statistically significant difference between the two treatment arms. However, improvement in clinical parameters particularly ocular itching, which is the main complaint of patients with VKC was more in bepotastine arm as compared to olopatadine treated arm. Both the drugs were well tolerated without any serious adverse effect.Conclusions: Both olopatadine and bepotastine were found to be effective in alleviating the clinical symptoms and signs of VKC. However, bepotastine performed better in reducing ocular itch than olopatadine.

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To explore the impact of following the pre-operative fasting guidelines by ASA (American society of anesthesiologists), in improving patient outcome.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.07.4783 ◽

2021 ◽

Vol 28 (7) ◽

pp. 1018-1021

Author(s):

Maqsood Ahmed Siddiqui ◽

◽

Ashok Perchani ◽

Hamid Raza ◽

Ahmeduddin Soomro ◽

...

Keyword(s):

Tertiary Care ◽

Cross Sectional Study ◽

Care Hospital ◽

Start Time ◽

Time Duration ◽

Cross Sectional ◽

Emergency Procedures ◽

The Mean ◽

The Impact ◽

Mean Time

Objective: To analyze the occurrence and consequences of a prolonged preoperative-fasting. Study Design: Cross-sectional study. Setting: Large tertiary care hospital in Pakistan. Period: October 2018 to October 2019. Material & Methods: We collected data for all the procedures that occurred during the study period and divided the cases into emergency procedures, add-on procedures and elective cases. We excluded the first cases of the day and excluded the emergency and add-on cases. We studied the patients NPO duration and their scheduled start time of the procedure and compared with their actual start time of the procedure. Results: The study population was n= 434 cases. Of these 434 cases n= 164 cases were performed on time and n= 270 cases were delayed by 60 minutes or more from their scheduled time. The most frequent reason was a previous cases running longer than expected in 59.25% of the cases, the second most common reason was a change in sequence and order of the procedures which was the case for delay in 14.44% of the cases. The overall mean time of NPO for the patients was found to be 770.1 +/- 130.6 minutes, for the delayed cases the mean time duration of NPO was 812.3 +/- 105.3 minutes. The mean time of case delay was 155.2 +/- 102.7 minutes for overall cases and for the significantly delayed case the mean time period of delay was 190.2 +/- 92.1 cases. Conclusion: Our results showed that 60% of the cases have a prolonged NPO status due to delays in start of their surgical procedure as compared to the scheduled times.

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Clinical Evaluation of Corridor Disease in Bos indicus (Boran) Cattle Naturally Infected With Buffalo-Derived Theileria parva

Frontiers in Veterinary Science ◽

10.3389/fvets.2021.731238 ◽

2021 ◽

Vol 8 ◽

Author(s):

Elizabeth A. J. Cook ◽

Tatjana Sitt ◽

E. Jane Poole ◽

Gideon Ndambuki ◽

Stephen Mwaura ◽

...

Keyword(s):

Rapid Development ◽

Clinical Signs ◽

Nasal Discharge ◽

Theileria Parva ◽

Related Condition ◽

Pathology Laboratory ◽

Laboratory Findings ◽

Post Exposure ◽

The Mean ◽

Mean Time

Corridor disease (CD) is a fatal condition of cattle caused by buffalo-derived Theileria parva. Unlike the related condition, East Coast fever, which results from infection with cattle-derived T. parva, CD has not been extensively studied. We describe in detail the clinical and laboratory findings in cattle naturally infected with buffalo-derived T. parva. Forty-six cattle were exposed to buffalo-derived T. parva under field conditions at the Ol Pejeta Conservancy, Kenya, between 2013 and 2018. The first signs of disease observed in all animals were nasal discharge (mean day of onset was 9 days post-exposure), enlarged lymph nodes (10 days post-exposure), and pyrexia (13.7 days post-exposure). Coughing and labored breathing were observed in more than 50% of animals (14 days post-exposure). Less commonly observed signs, corneal edema (22%) and diarrhea (11%), were observed later in the disease progression (19 days post-exposure). All infections were considered clinically severe, and 42 animals succumbed to infection. The mean time to death across all studies was 18.4 days. The mean time from onset of clinical signs to death was 9 days and from pyrexia to death was 4.8 days, indicating a relatively short duration of clinical illness. There were significant relationships between days to death and the days to first temperature (chi2 = 4.00, p = 0.046), and days to peak temperature (chi2 = 25.81, p = 0.001), animals with earlier onset pyrexia died sooner. These clinical indicators may be useful for assessing the severity of disease in the future. All infections were confirmed by the presence of macroschizonts in lymph node biopsies (mean time to parasitosis was 11 days). Piroplasms were detected in the blood of two animals (4%) and 20 (43%) animals seroconverted. In this study, we demonstrate the successful approach to an experimental field study for CD in cattle. We also describe the clinical progression of CD in naturally infected cattle, including the onset and severity of clinical signs and pathology. Laboratory diagnoses based on examination of blood samples are unreliable, and alternatives may not be available to cattle keepers. The rapid development of CD requires recognition of the clinical signs, which may be useful for early diagnosis of the disease and effective intervention for affected animals.

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Clinical Impact of Malaria Rapid Diagnostic Testing at a US Children’s Hospital

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piz022 ◽

2019 ◽

Vol 9 (3) ◽

pp. 298-304

Author(s):

Leslie A Enane ◽

Kaede V Sullivan ◽

Evangelos Spyridakis ◽

Kristen A Feemster

Keyword(s):

Diagnostic Testing ◽

Clinical Signs ◽

Length Of Hospital Stay ◽

Clinical Impact ◽

Rapid Diagnostic Testing ◽

Children's Hospital ◽

Antimalarial Therapy ◽

Children’S Hospital ◽

The Mean ◽

Mean Time

Abstract Background Children who develop malaria after returning to a setting in which the disease is not endemic are at high risk for critical delays in diagnosis and initiation of antimalarial therapy. We assessed the clinical impact of the implementation of malaria rapid diagnostic testing (RDT) on the management of children with malaria at an urban US children’s hospital that serves a large immigrant population. Methods This was a retrospective cohort study of all children diagnosed with laboratory-confirmed malaria at the Children’s Hospital of Philadelphia (CHOP) between 2000 and 2014. RDT using a US Food and Drug Administration–approved immunochromatographic assay was introduced at CHOP on August 1, 2007. We compared clinical management and outcomes of patients with malaria diagnosed before and after RDT introduction. Results We analyzed 82 pediatric malaria cases (32 before and 50 after RDT implementation). The majority of these patients had traveled to West Africa (91.5%) and were infected with Plasmodium falciparum (80.5%). The mean time to a positive result decreased from 10.4 to 0.9 hours (P < .001) after the introduction of RDT for patients with P falciparum. The mean time to antimalarial therapy decreased from 13.1 to 6.9 hours (P =; .023) in hospitalized patients. We found no significant reduction in the mean number of clinical signs of severe malaria between 0 and 48 hours of hospitalization and no difference in the need for exchange transfusion, time to resolution of parasitemia, or length of hospital stay. Conclusions Implementation of RDT for malaria was associated with shorter times to malaria diagnosis and initiation of antimalarial therapy. The results of this study support RDT in the optimal management of patients with malaria who present in settings in which the disease is not endemic.

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