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Gordon SF, Lam J, Vasquez JT, Cercone R, Tenneti N, Hart J, Chisholm M, Heland M, Hoq M, Kaufman J, Danchin M. A tailored COVID-19 vaccination pathway for children 5-11 years in Victoria, Australia. Vaccine 2023; 41:3436-3445. [PMID: 37120401 PMCID: PMC10106821 DOI: 10.1016/j.vaccine.2023.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 03/09/2023] [Accepted: 04/11/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Procedural anxiety was anticipated in children 5-11 years during the COVID-19 vaccine rollout in Victoria, Australia, as children in this age group receive few routine vaccines. Therefore, the Victorian state government designed a tailored, child-friendly vaccine program. This study aimed to assess parental satisfaction with elements of the bespoke vaccination pathway. METHODS The Victorian government and state-run vaccination hubs in Victoria facilitated an online immunisation plan to help parents identify their child's support needs, and utilised experienced paediatric staff and additional supports for children with severe needle distress and/or disability. All parents/guardians of children 5-11 years who received a COVID-19 vaccine in a vaccination hub were sent a 16-item feedback survey via text message. RESULTS Between 9 February and 31 May 2022 there were 9203 responses; 865 children (9.4%) had a first language other than English, 499 (5.4%) had a disability or special needs, and 142 (1.5%) were Aboriginal or Torres Strait Islander. Most parents (94.4%; 8687/9203) rated their satisfaction with the program as very good or excellent. The immunisation plan was used by 13.5% (1244/9203) of respondents, with usage more common for Aboriginal or Torres Strait Islander children (26.1%; 23/88) or families with a first language other than English (23.5%; 42/179). The child-friendly staff (88.5%, 255/288) and themed environment (66.3%, 191/288) were the most valued measures for vaccination. Additional support measures were required by 1.6% (150/9203) of children in the general population and 7.9%, (17/261) of children with a disability and/or special needs. CONCLUSION A tailored COVID-19 vaccination program for children 5-11 years, with additional support for children with severe needle distress and/or disability, had high parental satisfaction. This model could be utilised for COVID-19 vaccination in pre-school children and for routine childhood vaccination programs to provide optimal support to children and their families.
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Affiliation(s)
- S F Gordon
- COVID-19 Vaccination Program, Department of Health, 50 Lonsdale Street, Melbourne, Victoria 3000, Australia; Vaccine Uptake Group, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Melbourne, Victoria 3052, Australia.
| | - J Lam
- COVID-19 Vaccination Program, Department of Health, 50 Lonsdale Street, Melbourne, Victoria 3000, Australia
| | - J T Vasquez
- COVID-19 Vaccination Program, Department of Health, 50 Lonsdale Street, Melbourne, Victoria 3000, Australia
| | - R Cercone
- COVID-19 Vaccination Program, Department of Health, 50 Lonsdale Street, Melbourne, Victoria 3000, Australia
| | - N Tenneti
- COVID-19 Vaccination Program, Department of Health, 50 Lonsdale Street, Melbourne, Victoria 3000, Australia
| | - J Hart
- COVID-19 Vaccination Program, Department of Health, 50 Lonsdale Street, Melbourne, Victoria 3000, Australia
| | - M Chisholm
- COVID-19 Vaccination Program, Department of Health, 50 Lonsdale Street, Melbourne, Victoria 3000, Australia
| | - M Heland
- COVID-19 Vaccination Program, Department of Health, 50 Lonsdale Street, Melbourne, Victoria 3000, Australia
| | - M Hoq
- Vaccine Uptake Group, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Melbourne, Victoria 3052, Australia; Department of Paediatrics, The University of Melbourne, Grattan Street, Parkville, Melbourne, Victoria 3010, Australia
| | - J Kaufman
- Vaccine Uptake Group, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Melbourne, Victoria 3052, Australia; Department of Paediatrics, The University of Melbourne, Grattan Street, Parkville, Melbourne, Victoria 3010, Australia
| | - M Danchin
- COVID-19 Vaccination Program, Department of Health, 50 Lonsdale Street, Melbourne, Victoria 3000, Australia; Vaccine Uptake Group, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Melbourne, Victoria 3052, Australia; Department of Paediatrics, The University of Melbourne, Grattan Street, Parkville, Melbourne, Victoria 3010, Australia; Department of General Medicine, Royal Children's Hospital, 50 Flemington Road, Parkville, Melbourne, Victoria 3052, Australia
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Gordon SF, Virah Sawmy E, Duckworth E, Wolthuizen M, Clothier HJ, Chea M, Tenneti N, Blow N, Buttery JP, de Luca J, Korman TM, Barnes S, Slade C, Maggs C, Giles ML, Teh BW, Aboltins C, Langan KM, Van Diemen A, Crawford NW. Victorian Specialist Immunisation Services (VicSIS) - bolstering adult clinics for COVID-19 vaccines. Hum Vaccin Immunother 2022; 18:2052701. [PMID: 35471988 PMCID: PMC9225531 DOI: 10.1080/21645515.2022.2052701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The Victorian Specialist Immunization Services (VicSIS) was established in Victoria, Australia, in February 2021, aiming to enhance vaccine safety services for Coronavirus disease (COVID-19) vaccines. VicSIS supports practitioners and patients with complex vaccine safety questions, including those who experience adverse events following immunization (AEFI) after COVID-19 vaccines. VicSIS provides individual vaccination recommendations, allergy testing, vaccine challenges, and vaccination under supervision. VicSIS initially comprised of eight adult COVID-19 specialist vaccination clinics, subsequently, expanding to better support pediatric patients as the Australian vaccine roll-out extended to adolescents and children. Since their establishment to September 2021, the inaugural VicSIS clinics received a total of 26,401 referrals and reviewed 6,079 patients. Consults were initially predominantly for pre-vaccination reviews, later predominantly becoming post-vaccination AEFI reviews as the program progressed. Regardless of the type of consult, the most common consult outcome was a recommendation for routine vaccination (73% and 55% of consult outcomes respectively). VicSIS is an integral component of the COVID-19 vaccination program and supports confidence in COVID-19 vaccine safety by providing consistent advice across the state. VicSIS aims to strengthen the health system through the pandemic, bolstering specialist immunization services beyond COVID-19 vaccines, including training the next generation of vaccinology experts.
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Affiliation(s)
- Sally F Gordon
- Vaccine Safety and Evaluation, COVID-19 Vaccination Program, Victorian Department of Health, Melbourne, Australia
| | - Elise Virah Sawmy
- Vaccine Safety and Evaluation, COVID-19 Vaccination Program, Victorian Department of Health, Melbourne, Australia
| | - Eleanor Duckworth
- Vaccine Safety and Evaluation, COVID-19 Vaccination Program, Victorian Department of Health, Melbourne, Australia
| | - Michelle Wolthuizen
- Vaccine Safety and Evaluation, COVID-19 Vaccination Program, Victorian Department of Health, Melbourne, Australia
| | - Hazel J Clothier
- Vaccine Safety and Evaluation, COVID-19 Vaccination Program, Victorian Department of Health, Melbourne, Australia.,SAEFVIC, Murdoch Childrens Research Institute (MCRI), Melbourne, Australia.,Centre for Health Analytics, Melbourne Children's Campus, Melbourne, Australia
| | - Malinda Chea
- Vaccine Safety and Evaluation, COVID-19 Vaccination Program, Victorian Department of Health, Melbourne, Australia
| | - Naveen Tenneti
- Vaccine Safety and Evaluation, COVID-19 Vaccination Program, Victorian Department of Health, Melbourne, Australia
| | - Ngaree Blow
- Vaccine Safety and Evaluation, COVID-19 Vaccination Program, Victorian Department of Health, Melbourne, Australia
| | - Jim P Buttery
- Vaccine Safety and Evaluation, COVID-19 Vaccination Program, Victorian Department of Health, Melbourne, Australia.,SAEFVIC, Murdoch Childrens Research Institute (MCRI), Melbourne, Australia.,Centre for Health Analytics, Melbourne Children's Campus, Melbourne, Australia
| | - Joseph de Luca
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Melbourne, Australia
| | - Tony M Korman
- Department of Medicine, Monash University, Melbourne, Australia.,Monash Infectious Diseases, Monash Health, Melbourne, Australia
| | - Sara Barnes
- Department of Monash Lung, Sleep, Allergy and Immunology, Monash Health, Melbourne, Australia.,Department of Medicine, Monash University, Melbourne, Australia
| | - Charlotte Slade
- Department of Allergy and Clinical Immunology, Melbourne Health, Melbourne, Australia
| | - Callum Maggs
- Department of Infectious Diseases, Barwon Health, Geelong, Australia
| | | | - Benjamin W Teh
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Craig Aboltins
- Department of Infectious Diseases, Northern Health, Epping, Victoria, Australia.,Northern Health Clinical School, the University of Melbourne, Victoria, Australia
| | - Katherine M Langan
- Department of Infectious Diseases, Sunshine Hospital, Western Health, Melbourne, Australia
| | - Annaliese Van Diemen
- Vaccine Safety and Evaluation, COVID-19 Vaccination Program, Victorian Department of Health, Melbourne, Australia
| | - Nigel W Crawford
- Vaccine Safety and Evaluation, COVID-19 Vaccination Program, Victorian Department of Health, Melbourne, Australia.,SAEFVIC, Murdoch Childrens Research Institute (MCRI), Melbourne, Australia
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De Luca JF, Awad A, Vogrin S, Douglas AP, Lutjen A, Gordon SF, Crawford NW, Barnes S, Trubiano JA. Safety of COVID-19 vaccine challenge in patients with immediate adverse reactions to prior doses: A multi-centre cohort study. Allergy 2022; 78:293-296. [PMID: 35924675 PMCID: PMC9539178 DOI: 10.1111/all.15467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/23/2022] [Accepted: 08/02/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Joseph F. De Luca
- Centre for Antibiotic Allergy and Research, Department of Infectious DiseasesAustin HealthHeidelbergVic.Australia,Department of MedicineUniversity of MelbourneMelbourneVic.Australia
| | - Andrew Awad
- Centre for Antibiotic Allergy and Research, Department of Infectious DiseasesAustin HealthHeidelbergVic.Australia
| | - Sara Vogrin
- Department of MedicineSt Vincent's Hospital, University of MelbourneFitzroyVic.Australia
| | - Abby P. Douglas
- Centre for Antibiotic Allergy and Research, Department of Infectious DiseasesAustin HealthHeidelbergVic.Australia
| | - Antje Lutjen
- Department of AllergyMonash HealthClaytonVic.Australia
| | - Sally F. Gordon
- Vaccine Safety and Evaluation, COVID‐19 Vaccination ProgramVictorian Department of HealthMelbourneVic.Australia
| | - Nigel W. Crawford
- SAEFVIC, Victorian Vaccine Safety ServiceMCRIParkvilleVic.Australia,Department of PaediatricsUniversity of MelbourneMelbourneVic.Australia
| | - Sara Barnes
- Department of AllergyMonash HealthClaytonVic.Australia
| | - Jason A. Trubiano
- Centre for Antibiotic Allergy and Research, Department of Infectious DiseasesAustin HealthHeidelbergVic.Australia,Department of MedicineUniversity of MelbourneMelbourneVic.Australia
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Gordon PJ, Gordon SF. We want to gain the public's trust, but are we listening to them? BMJ 2017; 358:j4203. [PMID: 28931511 DOI: 10.1136/bmj.j4203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gordon PJ, Gordon SF. Self regulation is an oxymoron. Assoc Med J 2016. [DOI: 10.1136/bmj.i4049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Gordon SF. Separating zebras from horses. J Am Board Fam Pract 2001; 14:162. [PMID: 11314927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Abstract
Drug allergies are a major problem in the clinic and during drug development. At the present time, it is not possible to predict the potential of a new chemical entity to produce an allergic reaction (hypersensitivity) in patients in preclinical development. Such adverse reactions, because of their idiosyncratic nature, only become apparent once the drug has been licensed. Our present chemical understanding of drug hypersensitivity is based on the hapten hypothesis, in which covalent binding of the drug (metabolite) plays a central role in drug immunogenicity and antigenicity. If this theory is correct, then it should be possible to develop in vitro systems to assess the potential of drugs to bind to critical proteins, either directly or indirectly after metabolic activation to protein-reactive metabolites (bioactivation) and initiate hypersensitivity. The purpose of this review is to assess critically the evidence to support the hapten mechanism, and also to consider alternative mechanisms by which drugs cause idiosyncratic toxicity.
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Affiliation(s)
- B K Park
- Department of Pharmacology and Therapeutics, University of Liverpool, PO Box 147, L69 3GE, Liverpool,
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Naisbitt DJ, Gordon SF, Pirmohamed M, Park BK. Immunological principles of adverse drug reactions: the initiation and propagation of immune responses elicited by drug treatment. Drug Saf 2000; 23:483-507. [PMID: 11144658 DOI: 10.2165/00002018-200023060-00002] [Citation(s) in RCA: 114] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Adverse drug reactions account for between 2 to 5% of all hospital admissions and can prevent the administration of an otherwise effective therapeutic agent. Hypersensitivity or immune-mediated reactions, although less common, tend to be proportionately more serious. There is convincing evidence to implicate the immune system in the pathogenesis of hypersensitivity reactions. Our understanding of the way in which the immune system recognises drugs is based on the hapten hypothesis; the onset of hypersensitivity involves drug bioactivation, covalent binding to proteins, followed by uptake, antigen processing and T cell proliferation. Central to this hypothesis is the critical role of drug metabolism, with the balance between metabolic bioactivation and detoxification being one important component of individual susceptibility. The purpose of this review is to classify drug hypersensitivity reactions in terms of their clinical presentation, and also to consider recent advances in our understanding of the chemical, biochemical and, in particular, cellular immunological mechanisms of hypersensitivity. The following topics are reviewed: (i) drug disposition and cellular metabolism; (ii) mechanisms of antigen processing and presentation; (iii) the role of cytokines and co-stimulatory molecules in the induction and maintenance of a polarised immune response; and (iv) the application of the hapten hypothesis, danger hypothesis and serial triggering model to drug hypersensitivity. A greater understanding of the mechanism(s) of hypersensitivity may identify novel therapeutic strategies and help to combat one of the more severe forms of adverse reactions to drugs.
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Affiliation(s)
- D J Naisbitt
- Department of Pharmacology and Therapeutics, University of Liverpool, Merseyside, England.
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Abstract
OBJECTIVE To describe the efficacy, safety, and wearability of estrogen replacement therapy of a 7-day estradiol transdermal system (Climara), developed using new drug-in-adhesive technology. STUDY DESIGN The pharmacokinetics of the 7-day system were investigated in single- and multiple-dose studies, a relative bioavailability study of the two patch sizes, and comparative studies with the twice-weekly transdermal system (Estraderm). Safety and efficacy in the treatment of vasomotor symptoms compared with conjugated equine estrogens (Premarin) and placebo were evaluated in two 11-week, randomized, double-blind, multicenter trials in 603 women; the data are combined in this report. Irritation and adhesion were also evaluated in comparative studies with Estraderm, Micropore (an inert once-weekly tape), and placebo controls. RESULTS Blood levels were sustained for the full 7 days of patch wear, there was no drug accumulation, and a physiologic estrone to estradiol ratio was maintained. Pharmacokinetics studies showed dose proportionality of the 0.05 and 0.1 mg/day patches. Both patch sizes significantly decreased the frequency of hot flushes compared with placebo and were comparable with conjugated equine estrogens. There was a statistically significant difference between the two patch sizes. The mean overall decline in the hot flush rate was 74.6% for the 0.1 mg patch versus 64.5% for the 0.05 mg patch (p < or = 0.05). The combined data also showed that the onset of efficacy is within 1 to 2 weeks after the start of therapy and that efficacy is fully sustained during the 7-day patch wear period with some diminution of effect during the treatment-free week of each cycle. Treatment was well tolerated. Adverse events led to withdrawal from the studies in 8.9% of subjects. In most of these (6.8% of subjects), the cause was adverse skin reactions. Skin irritation was similar to Estraderm in comparative studies, whereas adhesion was significantly better with Climara. CONCLUSION The Climara patch delivers estradiol for a full 7 days. Clinical efficacy of both patch sizes is comparable with currently accepted therapy and is sustained for the entire week of patch wear. A significant difference in response between the two doses supports dose titration. The patch is well tolerated and has excellent adhesion.
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Affiliation(s)
- S F Gordon
- Future HealthCare Research Centers, Atlanta, GA 30340, USA
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10
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Gordon SF, Thompson KA, Ruoff GE, Imig JR, Lane PJ, Schwenker CE. Efficacy and safety of a seven-day, transdermal estradiol drug-delivery system: comparison with conjugated estrogens and placebo. The Transdermal Estradiol Patch Study Group. Int J Fertil Menopausal Stud 1995; 40:126-34. [PMID: 7663539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of a new, seven-day, transdermal estradiol system in healthy postmenopausal women with hot flushes. METHODS Two studies are described. In the first study, subjects were randomized to treatment with a 0.05 mg/day estradiol patch, a 0.1 mg/day estradiol patch, or a placebo patch; and in the second study, to treatment with either of the two estradiol patches or oral conjugated estrogens (as Premarin) 0.625 mg/day. Efficacy was evaluated on the basis of diary entries recording hot-flush frequency and severity. Subjects' and investigators' global assessments of treatment efficacy were recorded at follow-up visits. RESULTS In Study 1, both the 0.05-mg and 0.1-mg estradiol patches were significantly more effective than placebo in reducing hot flushes and were associated with higher global assessments. In Study 2, all three active treatments produced a significant reduction in the number of hot flushes compared with base-line. There were no statistically significant between-group differences, although the response to the 0.1-mg estradiol patch was greater, and to the 0.05-mg estradiol patch less, than the response to conjugated estrogens. The patches were generally well tolerated. Skin irritation from the patch was the most common adverse experience in both studies. CONCLUSIONS The new, seven-day, transdermal system effectively and safely treats post-menopausal vasomotor symptoms.
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Affiliation(s)
- S F Gordon
- Future HealthCare Research Centers, Atlanta, Georgia, USA
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Gordon SF. Laparoscopic uterine suspension. J Reprod Med 1992; 37:615-6. [PMID: 1387909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Laparoscopic uterine suspension is an effective method of correcting symptomatic uterine retroversion. Eighty patients with deep dyspareunia reproduced by palpation of their retroverted uterus underwent a modified Gilliam uterine suspension under laparoscopic visualization. There were no intraoperative or postoperative complications requiring laparotomy, and symptoms were relieved in 74 patients.
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Affiliation(s)
- S F Gordon
- Northside Gynecological and Obstetric Professional Association, Atlanta, Georgia
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Cox CE, Serfer HS, Mena HR, Briefer C, Childs SJ, Gordon SF, Zoller JS. Ofloxacin versus trimethoprim/sulfamethoxazole in the treatment of uncomplicated urinary tract infection. Clin Ther 1992; 14:446-57. [PMID: 1638586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A multicenter randomized study was conducted to compare the efficacy and safety of ofloxacin with that of trimethoprim/sulfamethoxazole (TMP/SMX) in the treatment of uncomplicated urinary tract infection in adults. Patients were randomized to receive either oral ofloxacin 200 mg daily for three days (102 patients), or oral TMP/SMX 160 mg/800 mg twice daily for seven days (100 patients). The pathogen was eradicated in 73 (97.3%) of the 75 evaluable patients receiving ofloxacin and in 66 (97.1%) of the 68 evaluable patients receiving TMP/SMX. The most frequently isolated pathogens were Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis. More urinary pathogens were susceptible to ofloxacin than to TMP/SMX, although this difference was not statistically significant. The clinical cure rate for patients receiving ofloxacin was 93.3%, with 4% improved and 2.7% failed. For patients receiving TMP/SMX, the clinical cure rate was 86.4%, with 12.1% improved and 1.5% failed. Side effects were reported by 29.7% of the patients receiving ofloxacin and by 40.4% of the patients receiving TMP/SMX. Drug-related adverse experiences, as determined by the investigators, occurred in 5% of the ofloxacin patients and in 15.2% of the TMP/SMX patients, a statistically significant difference. No patients receiving ofloxacin, compared with three patients receiving TMP/SMX, discontinued therapy because of an adverse reaction. These results indicate that short-course ofloxacin is as effective as TMP/SMX in the treatment of uncomplicated urinary tract infection. Ofloxacin therapy is also better tolerated than TMP/SMX.
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Affiliation(s)
- C E Cox
- Department of Urology, University of Tennessee College of Medicine, Memphis
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Gordon SF. Alcoholism and semi-truck drivers. Iowa Med 1990; 80:487. [PMID: 2262305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Eron LJ, Gordon SF, Harvey LK, Sites JG. A trial using early preoperative administration of cefonicid for antimicrobial prophylaxis with hysterectomies. DICP 1989; 23:655-8. [PMID: 2678768 DOI: 10.1177/106002808902300904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A single dose of cefonicid given 3.5-5.0 hours or 0.5-1.0 hour preoperatively was compared with cefoxitin given as five doses beginning 0.5-1.0 hour preoperatively for prophylaxis of infection in 202 patients undergoing vaginal or abdominal hysterectomy. The administration of cefonicid 3.5-5.0 hours preoperatively was intended to simulate situations where surgery may be delayed or prolonged. The trial was double-blind, and patients were randomized to one of the three regimens. Operative site infections were noted in 6.2 percent of patients (7/113) who received cefonicid 3.5-5.0 hours preoperatively, in 7.0 percent of patients (3/43) who received cefonicid 0.5-1.0 hour preoperatively, and in 4.3 percent of patients (2/46) who received cefoxitin (p greater than 0.05). Enterococci were isolated most frequently from operative-site infections. When administered 3.5-5.0 hours preoperatively, cefonicid was as effective as more traditional regimens.
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Affiliation(s)
- L J Eron
- Georgetown School of Medicine, Washington, DC
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McGregor JA, Gordon SF, Krotec J, Poindexter AN. Results of a randomized, multicenter, comparative trial of a single dose of cefotetan versus multiple doses of cefoxitin as prophylaxis in cesarean section. Am J Obstet Gynecol 1988; 158:701-6. [PMID: 3281461 DOI: 10.1016/s0002-9378(16)44530-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
In a multicenter, open, randomized, comparative trial, 308 women undergoing cesarean section were given a single 1 gm dose of cefotetan or three 2 gm doses of cefoxitin after cord clamping to reduce the incidence of postoperative infectious morbidity. Of the 286 evaluable patients, 195 received cefotetan and 91 received cefoxitin. Most patients were in active labor and one third had ruptured membranes. Microorganisms cultured from the endocervix or intraoperatively from the endometrium or abdominal wall operative sites were comparable for the two groups. In this multicenter study, the difference between the percentage of patients receiving cefotetan who did not develop clinical signs and symptoms of infection (93%) and the percentage of patients receiving cefoxitin (85%) considered clinical successes was statistically significant (p = 0.02, chi 2). The bacteriologic response rate for patients taking cefotetan was also significantly higher than that for patients taking cefoxitin (93% versus 85%, p = 0.03). Isolates recovered from the endocervix, endometrium, or operative site were comparable for the two groups. Both drugs were well tolerated. In this evaluation, cefotetan administered in a single dose of 1 gm was more effective as a prophylactic agent than multiple 2 gm doses of cefoxitin in the reduction of infectious morbidity in this large series of patients undergoing cesarean section.
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Affiliation(s)
- J A McGregor
- Department of Obstetrics and Gynecology, University of Colorado Health Sciences Center, Denver 80262
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Abstract
In a single-center clinical trial, a single 1 gm dose of cefotetan was as effective as a prophylactic agent as multiple 2 gm doses of cefoxitin in the prevention of postoperative infectious morbidity in women undergoing abdominal or vaginal hysterectomy. Among the 39 clinically evaluable women in the cefotetan group and 19 clinically evaluable women in the cefoxitin group, the successful clinical response rates were 97% and 95%, respectively. None of the women in either group who had vaginal hysterectomies developed postoperative complications. One woman in each group developed a major wound infection at the abdominal hysterectomy site. Although the satisfactory bacteriologic response rate was higher among the 36 bacteriologically evaluable women in the cefotetan group than among the 12 bacteriologically evaluable women in the cefoxitin group (83% versus 80%), the difference was not statistically significant. No drug-related adverse reactions were reported for any patient.
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Berkeley AS, Freedman KS, Ledger WJ, Orr JW, Benigno BB, Gordon SF, McGregor JA, Galask RP, Sevin BU. Comparison of cefotetan and cefoxitin prophylaxis for abdominal and vaginal hysterectomy. Am J Obstet Gynecol 1988; 158:706-9. [PMID: 3128112 DOI: 10.1016/s0002-9378(16)44531-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The safety and efficacy of parenteral prophylaxis with either cefotetan or cefoxitin were evaluated in a prospective, randomized study of 355 subjects undergoing abdominal or vaginal hysterectomy. Each subject received either a single 1 gm dose of cefotetan intravenously 30 to 60 minutes before operation or three 2 gm doses of cefoxitin, the first 30 to 60 minutes before operation and subsequent doses 6 and 12 hours later. Prophylaxis was successful in 69 of 70 (98.6%) receiving cefotetan and 32 of 33 (97.0%) receiving cefoxitin who underwent vaginal hysterectomy. Prophylaxis was successful in 160 of 169 (94.7%) receiving cefotetan and in 79 of 83 (95.2%) receiving cefoxitin who underwent abdominal hysterectomy. Both drugs were well tolerated and without serious side effects or complications. On the basis of these findings, we conclude that a single 1 gm dose of cefotetan given before operation is as safe and effective as a multiple-dosing regimen of cefoxitin in subjects undergoing vaginal hysterectomy and in those undergoing abdominal hysterectomy at institutions where prophylaxis is indicated.
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Affiliation(s)
- A S Berkeley
- Department of Obstetrics and Gynecology, New York Hospital/Cornell Medical Center, NY 10021
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Grizzard WS, Blackshear WM, Rush JA, Gordon SF. Noninvasive carotid evaluation using pulsed Doppler imaging for patients with ophthalmic disorders. Ophthalmology 1982; 89:1235-40. [PMID: 7155533 DOI: 10.1016/s0161-6420(82)34646-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Pulsed Doppler imaging provides an accurate, noninvasive technique for evaluation of the carotid bifurcation. We have found it useful in evaluating patients with amaurosis fugax and ocular emboli. It can also be used to evaluate blood flow within ocular and orbital tumors. The continuous wave Doppler is useful for detection of abnormal orbital blood flow in patients with dural-cavernous fistulae.
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Gordon SF, Russell J. A randomized controlled study comparing ceftizoxime, cefamandole, and cefoxitin in obstetric and gynaecological surgery: a preliminary report. J Antimicrob Chemother 1982; 10 Suppl C:289-92. [PMID: 6296022 DOI: 10.1093/jac/10.suppl_c.289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Zeigerman JH, Gordon SF. Cancer of the female urethra. A curable disease. Obstet Gynecol 1970; 36:785-9. [PMID: 5536176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
MESH Headings
- Adenocarcinoma/diagnosis
- Adenocarcinoma/radiotherapy
- Adenocarcinoma/surgery
- Adolescent
- Adult
- Aged
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/radiotherapy
- Carcinoma, Squamous Cell/surgery
- Carcinoma, Squamous Cell/therapy
- Carcinoma, Transitional Cell/diagnosis
- Carcinoma, Transitional Cell/radiotherapy
- Carcinoma, Transitional Cell/surgery
- Female
- Humans
- Lymphoma, Non-Hodgkin/diagnosis
- Lymphoma, Non-Hodgkin/radiotherapy
- Lymphoma, Non-Hodgkin/surgery
- Melanoma/diagnosis
- Melanoma/radiotherapy
- Melanoma/surgery
- Middle Aged
- Neoplasm Metastasis
- Sarcoma/diagnosis
- Sarcoma/radiotherapy
- Sarcoma/surgery
- Urethral Neoplasms/diagnosis
- Urethral Neoplasms/mortality
- Urethral Neoplasms/radiotherapy
- Urethral Neoplasms/surgery
- Urethral Neoplasms/therapy
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