At the control care center, 45/118 (38%) of people were cultured from the oropharynx. Seven (16%) were colonized. The pulsed-field gel electrophoresis was the same for the control care facility, but varied from the electrophoresis pattern at the study facility.
In conclusion, the authors summarized the findings of K. kingae osteomyelitis/septic arthritis in a daycare facility. There were no identifiable risk factors for invasive disease or for asymptomatic carrier state. It is important to remember that up to 50% of culture negative cases of septic arthritis in patients less than two years of age may be attributed to K. kingae. Thus, the clinician must maintain a high index of suspicion and relay this information to the laboratory so that appropriate measures are taken to ensure the optimal growth environment for the bacteria.
Although the study size was small, the investigators provide initial documentation regarding outbreaks of invasive K. kingae infections. Further studies will be useful to clarify the exact mode of transmission and appropriate duration of antimicrobial therapy.
Systematic Review of Therapy for Pediatric Migraine
Damen L, Bruijn JKJ, Verhagen AP, et al. Symptomatic treatment of migraine in children: a systematic review of medication trials. Pediatrics. 2005;116(2):295-302.
Migraines affect 3%-5% of prepubescent children. The symptoms frequently include unilateral throbbing headache associated with nausea and vomiting. If poorly controlled, the headaches can cause students to miss school and have a decreased quality of life. Symptomatic pharmacologic interventions involve analgesics, triptans, and antiemetics. Nonpharmacologic interventions include dietary changes, biofeedback, and exercise. Treatment is tailored to the patient; however, there are limited studies providing evidence describing the most efficacious pharmacologic treatment for managing symptomatic migraines.
The authors conducted a retrospective literature review to evaluate the evidence from randomized controlled trials (RCT) and clinical controlled trials (CCT) regarding the treatment of symptomatic migraine in children younger than 18. The primary outcome measure was headache clinical improvement defined as a headache decline by >50%. Secondary measures included headache intensity, frequency, duration, and headache index. The authors searched Medline, Embase, PsychInfo, Web of Science, and Cinahl from the start of the databases to June 2004. They used appropriate search terms including “headache,” “migraine,” “child” and variations thereof. Further, they searched reference lists of the articles and the included studies. Two authors independently reviewed the titles and abstracts to determine acceptability in the study. They also used the Delphi list to assess the methodologic quality of the included trials.
Of 3,492 relevant studies, 10 met the inclusion criteria specified by the authors. There were a total of 1,575 patients with a mean age of 11.7 +/- 2.2 years included in the study. A mean of 19.8% of subjects did not complete participation in their respective studies. Overall, the percentage of male and female participants was equal. Six studies were considered to be of high quality by the authors. They found moderate evidence that ibuprofen and acetaminophen were more effective in decreasing headache symptoms one and two hours after ingestion in comparison with a placebo. Further, the nasal spray sumatriptan was more efficacious in diminishing headache than placebo; however, it was associated with more side effects. Intravenous prochlorperazine was more effective than intravenous ketorolac in diminishing symptoms one hour after intake.
While accomplishing a sound systematic review of the available controlled trials, the authors conclude that there are insufficient trials of adequate quality to fully elucidate the most efficacious symptomatic pharmacologic therapy for pediatric patients suffering from migraine headaches. A large randomized prospective trial comparing analgesics, triptans, and antiemetics against placebo is needed. TH