Treatment Of Pediatric Infections Research Articles

Improving Short Course Treatment of Pediatric Infections: A Randomized Quality Improvement Trial.

Short courses of antibiotic treatment are effective for pediatric community-acquired pneumonia (CAP) and skin and soft tissue infections (SSTI). We compared the effectiveness of education with performance feedback, clinical decision support (CDS), and the combination in encouraging appropriately short treatment courses by primary care clinicians. We designed a site-randomized, quality improvement trial within a large pediatric primary care network. Each practice was randomly assigned to 1 of 4 groups: education and feedback; CDS; both interventions ("combined group"); and control. We performed difference-in-differences analysis to compare the proportion of cases with short course treatment before and after intervention among the 4 groups. For all cases of CAP and SSTI, the proportion in the control group treated with the recommended duration did not change from the baseline period (26.1% [679 of 2603]) to the intervention period (25.8% [196 of 761]; P = .9). For the education and feedback group, the proportion rose from 22.3% (428 of 1925) to 45.0% (239 of 532; P < .001); for the CDS group, from 26.6% (485 of 1824) to 52.3% (228 of 436; P < .001); and for the combined group, from 26.2% (491 of 1875) to 67.8% (314 of 463; P < .001). A difference-in-differences analysis showed that all 3 intervention groups improved performance compared with the control group (P < .001); the combined group had greater improvement than the education and feedback group or the CDS group (P < .001). In this quality improvement project to encourage shorter duration treatment of CAP and SSTI, both education with performance feedback and CDS were effective in modifying clinician behavior; however, the combination of the two was substantially more effective than either strategy alone.

#12 Comparing Treatment of Pediatric Bronchiolitis and Upper Respiratory Infections in Primary, Tertiary, and Urgent Care Settings

Abstract Background Pediatric bronchiolitis and upper respiratory infections (URI) are almost always of viral origin and thus managed without antibiotics. Inappropriate antibiotic use for such diagnoses can contribute to antimicrobial resistance. We assessed the appropriateness of pediatric bronchiolitis and URI treatment in primary, tertiary, and urgent care settings within a large private health system in Upstate New York and compared treatment appropriateness between the three settings. Method We conducted a retrospective, observational chart review of patient visits in pediatric primary, pediatric tertiary, and urgent care settings where there was a presumptive diagnosis of bronchiolitis or URI between January 1 and December 31, 2019 using ICD-10 diagnostic codes. We assessed patient treatment for each visit as “appropriate,” “possibly appropriate,” or “inappropriate” based on extracted chart data. We performed simple proportion calculations for each treatment category in each care setting, and then compared proportions for each treatment category between settings using chi-square and logistic regression models. Results Of the 450 patient visits reviewed in each care setting, 354 primary care, 375 tertiary care, and 442 urgent care visits met the inclusion criteria. Table 1 shows the proportion of appropriate, possibly appropriate, and inappropriate visits in the primary, tertiary, and urgent care settings. The tertiary care and urgent care settings had a statistically significant proportion of possibly appropriate or inappropriate encounters at 2.4% and 4.8% respectively. In comparing odds ratios for possibly appropriate or inappropriate treatment of pediatric bronchiolitis and URIs between care settings, urgent care setting treatments were 5.77 times more likely to be inappropriate or possibly appropriate than in pediatric primary care settings (95% CI [1.71, 19.5]). Differences in treatment between primary and tertiary care settings and tertiary and urgent care settings were not statistically significant. Conclusion In 2019, nearly all reviewed encounters in the pediatric primary, pediatric tertiary, and urgent care settings within a large private health system in Upstate New York adhered to clinical guidelines for bronchiolitis and URI treatment. However, the urgent care setting had a significantly greater odds of possibly appropriate or inappropriate treatment of these pediatric infections, highlighting an opportunity for further education and intervention to improve guideline adherence for bronchiolitis and URI management in that setting.

Role of Faropenem in Treatment of Pediatric Infections: The Current State of Knowledge.

Carbapenems play an important role in the management of bacterial infections. Meropenem, imipenem, ertapenem, and faropenem are carbapenems with the broadest antibacterial spectrum and strong antibacterial activity. Faropenem is a novel oral carbapenem with an advantage over other parenteral carbapenems in the series. Like other β-lactam antibiotics, faropenem inhibits cell wall synthesis by inhibiting penicillin-binding proteins (PBPs). Faropenem is stable against β-lactamase and has a low propensity for bacterial resistance. Faropenem has demonstrated excellent in-vitro and clinical activity in adult infections with a broad spectrum of activity. Faropenem also has a favorable safety profile. These activities of the faropenem created the interest of researchers in exploring its use in the treatment of pediatric infections. After promising outcomes in-vitro and clinical evaluation in children, faropenem is now approved in some parts of the world for the treatment of pediatric infections. Faropenem oral dry syrup is available for the treatment of a wide range of pediatric infections, including upper respiratory tract infections, urinary tract infections, dermatological infections, and bacterial periodontal infections in children. The current recommended clinical dose in pediatric patients is 15 mg/kg/ day, divided into three doses. The availability of faropenem dry syrup has expanded the current therapeutic options for treating pediatric infections.In this review, we have put light on the in-vitro and clinical studies of faropenem dry syrup in pediatric patients, along with its molecular and pharmacological basics.

1157. Determining the Clinical Utility of 16S rRNA in the Management of Pediatric Infections

BackgroundConventional culture remains the gold standard to facilitate a targeted antimicrobial regimen in the treatment of bacterial infections. However, certain pediatric infections are caused by fastidious organisms and treatment with antibiotics prior to specimen collection may hamper growth of pathogens in routine culture. The use of 16S rRNA in culture negative infections has improved identification of bacterial pathogens in select scenarios. However, the specific impact of 16S rRNA on clinical decision making, especially in pediatric infections, is not well-defined. This study aims to elucidate the utility of 16S rRNA on clinical management of pediatric infections.MethodsA retrospective analysis was done on different clinical specimens which had 16S rRNA performed from August 2016 – March 2020 in our institution. Detailed chart review was performed to determine how the 16S rRNA result impacted clinical decision making. Clinical utility was defined as change in patient’s overall antimicrobial regimen, pathogen confirmation, and treatment duration.ResultsSeventy-four samples from 71 pediatric patients were included in the analysis: 32 (43%) were fluid specimens and 42 (57%) were tissue specimens. Significant clinical utility was identified in 30 (40.5%) of 74 clinical samples (p < 0.0001). Of all specimens, pulmonary samples yielded the most clinical utility (n=9, 30%) followed equally by joint fluid (n=6, 20%) and bone (n=6, 20%). There was no significant difference in clinical utility between fluid and tissue specimens (p= 0.346). In 64 patients whose antimicrobial spectrum coverage was analyzed, patients with broad spectrum coverage was decreased from 48 to 21 and narrow spectrum coverage increased from 16 to 43 using 16S rRNA result, though not significant (p= 0.4111). Of all patients included in the analysis, the median number of antibiotics used before 16S rRNA result, 2, was significantly decreased to 1 (p < 0.0001).Conclusion16S rRNA has a significant impact in terms of decreasing number of antibiotics used in treatment of pediatric infections. Pulmonary specimens have the highest clinical utility among all samples. Additional cost benefit analysis needs to be completed to further determine clinical benefit.Disclosures All Authors: No reported disclosures

Aminoglycosides-alive and well in treatment of pediatric infections: A case of benefit versus risk.

Aminoglycosides-alive and well in treatment of pediatric infections: A case of benefit versus risk.

小児感染症と筋注用Pyrrolidinomethyl tetracycline (Hostacycline) の臨床

小児感染症と筋注用Pyrrolidinomethyl tetracycline (Hostacycline) の臨床

Bacteriological, pharmacokinetic and clinical studies of sulbactam/ampicillin in the pediatric field

The usefulness of sulbactam/ampicillin (SBT/ABPC) in the treatment of pediatric infections was evaluated. 1. Twenty pediatric patients with infection were treated with SBT/ABPC and an intravenous dosage of 27.8-47.4 mg/kg, 3 to 4 times a day. Clinical efficacies in 18 patients excluding 2 patients of Mycoplasma pneumonia (9 cases of pneumonia, 6 urinary tract infection, 1 tonsillitis, 1 maxillary sinusitis and 1 osteomyelitis) were judged to be excellent in 13 patients and good in 5. There was no case of failure. 2. Bacteriological efficacies against 16 strains (1 Staphylococcus aureus, 3 Enterococcus faecalis, 4 Haemophilus influenzae, 2 Haemophilus parainfluenzae, 5 Escherichia coli and 1 Serratia sp.) isolated from 13 of the 18 patients were rated as "eradicated" for 13 strains, "decreased" for 1 and "unchanged" for 2 with an eradication rate of 81.3%. Of 13 strains eradicated, 3 were those with high beta-lactamase productivity. 3. Rash as a side effect developed in 1 patient and eosinophilia and elevated GOT and GPT were observed in 7 patients but none of them were serious. 4. Blood levels of the drug following an intravenous dose of 30 mg/kg were determined in 2 pediatric patients. Blood levels of SBT and ABPC at 30 minutes after intravenous administration were 19.0 and 29.2 micrograms/ml in one patient and 21.0 and 31.6 micrograms/ml in another, respectively, and those at 4 hours were 0.48 and 0.62 microgram/ml in one patient and 0.59 and 0.89 microgram/ml in another, respectively. The half-lives of SBT were 0.67 and 0.70 hour and those of ABPC were 0.64 and 0.69 hour in the 2 patients, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Azithromycin in children: A critical review of the evidence

Background: Azithromycin is a macrolide antibiotic that can be dosed once daily. In the last decade, the body of literature concerning the clinical applications of azithromycin has grown rapidly, leading to improved understanding as well as new questions about the role of this drug in the treatment of adult and pediatric infections. Objective: This review explores the use of azithromycin in the treatment of pediatric infections. Methods: We conducted a MEDLINE literature search to identify pertinent English-language studies of azithromycin published between 1987 and 2001. Results: The use of azithromycin in the treatment of acute Streptococcus pyogenes pharyngotonsillitis, acute otitis media, community-acquired pneumonia, pertussis, skin and soft tissue infections, Mycobacterium avium complex (MAC), trachoma, typhoid fever, cat-scratch disease, cryptosporidiosis, and legionnaires' disease has been studied in clinical trials. Conclusions: Azithromycin is indicated as a first-line treatment for respiratory tract infections caused by Legionella species, Mycoplasma pneumoniae, and Chlamydia pneumoniae, and as empiric therapy for community-acquired pneumonia in older children and adolescents who are deemed appropriate for outpatient oral therapy. Azithromycin in a single dose is an excellent treatment for chlamydia cervicitis/urethritis and for trachoma and has demonstrated efficacy in prophylaxis and treatment of disseminated MAC infections in children who have AIDS. Azithromycin may be considered as an alternative in the treatment of skin and soft tissue infections, although local patterns of resistance of pathogens must be considered in its selection.

New Role of Quinolones in Respiratory Tract Infections

Because of limited activity of the standard quinolones such as ciprofloxacin and ofloxacin against some clinically important organisms including Streptococcus pneumoniae and methicillin‐resistant Staphylococcus aureus, new quinolones have been developed. In addition to their improved activity against S pneumoniae, some also demonstrate excellent anaerobic activity. None of the quinolones have a role to play in the treatment of paediatric infections. Quinolones (both older and newer agents) have demonstrated equivalent efficacy to standard antimicrobials in the treatment of acute sinusitis. Several groups have suggested that quinolones are excellent agents in the treatment of high risk patients with acute exacerbations of chronic bronchitis. These patients include the elderly, and those with frequent exacerbations, significant comorbid conditions. long duration of chronic bronchitis and major impairment of lung function. There is no evidence to suggest that the newer quinolones will differ from the currently available agents for th is disease. The major advantage of the newer quinolones appears to be in the treatment of patients with community‐acquired pneumonia where pneumococcal infection is a real concern. A new parenteral quinolone with pneumococcal activity may replace the standard macrolide/cephalosporin combination that is commonly prescribed. For patients with nosocomial pneumonia, the newer agents are alternative choices, especially among patients with early onset pneumonia (less than five days of hospitalization), but are unlikely to replace ciprofloxacin in the intensive care unit setting because of poor Pseudomonas aeruginosa coverage.

Bacteriological and clinical studies on meropenem in the pediatric field

Bacteriological and clinical studies have been performed on meropenem (MEPM, SM-7338), a newly developed carbapenem antibiotic, in the pediatric field. 1. Antibacterial activities of MEPM against 24 clinical isolates were determined. MEPM showed excellent activity against Gram-positive bacteria including Staphylococcus aureus and Gram-negative bacteria, especially Escherichia coli and Branhamella catarrhalis. Against Haemophilus influenzae, MEPM had a higher activity than imipenem and flomoxef, but had a lower activity than piperacillin and cefoperazone. 2. Clinical efficacies of MEPM were evaluated in 32 cases with bacterial infections. A poor efficacy was observed in 1 patient with phlegmon but excellent or good efficacies were obtained in other 31 patients with tonsillitis (1), pneumonia (17), UTI (12), or SSSS (1). The overall efficacy rate was 96.9%. All strains except 1 of S. aureus were eradicated by the administration of MEPM, and a high eradication rate of 95.8% (23 out of 24 strains) was obtained. 3. No side effects were observed in 35 evaluated cases. As abnormal laboratory test results, elevated GOT, elevated GPT, eosinophilia and neutropenia were noted in 4, 4, 4 and 2 patients, respectively. 4. Influences on blood coagulation parameters were studied. PIVKA II was elevated upon administration of MEPM in some cases, but no changes in ATT, TT, HPT or Fbg were observed during the treatment. Based on the above results, it has been concluded that MEPM is a safe and effective drug to use in the treatment of pediatric infections. The usual recommended dosage and administration should be 10 to 20 mg/kg of MEPM at a time, using intravenous drip infusion, 3 times a day.

A clinical study on cefdinir 10% granule in pediatrics

Clinical evaluations of cefdinir (CFDN) 10% granule were carried out. The obtained results are summarized as follows. 1. Clinical responses to CFDN of 23 patients with pediatric infections were excellent in 11 and good in 8. The overall efficacy rate was 82.6%. 2. Bacteriologically, the eradication rate for 23 strains of bacteria identified to be pathogens was evaluated and was 82.6%. 3. Side effects observed were diarrhea in 2 of 25 patients. The incidence was 8.0%. Abnormal laboratory test results observed included 2 cases with elevation of GOT and 1 case with elevation of GPT. These results suggest that CFDN 10% granule, as well as 5% granule, may be a very useful and safe drug for the treatment of pediatric infections.

Clinical studies on 10% cefdinir granules in pediatric infections

Ten% cefdinir (CFDN, FK482) granular preparation, a new oral cephalosporin preparation intended for children, was given to children with various infections. The results obtained are summarized as follows. 1. Ten% CFDN granules were administered to a total of 21 children with upper or lower respiratory tract infections, urinary tract infections or infectious impetigo at daily doses of 6.4-18 mg/kg divided into 3 portions. Clinical efficacies were "excellent" in 13 patients, "good" in 7 patients and "unknown" in 1 patient (viral infection), hence an efficacy of 100% was obtained. 2. Bacteria identified in various disease cases included 19 strains of 7 species, and the eradication rate was 100%. 3. No side effects were noted in any of the children. Laboratory test results showed an abnormality in 1 case with eosinophilia. These results suggest that 10% CFDN granules as well as 5% CFDN granules may be a very useful and safe drug for the treatment of pediatric infections.

Intravenous sulbactam/ampicillin in the treatment of pediatric infections

A total of 82 patients involving 83 episodes of proven or presumed bacterial infection were treated with sulbactam/ampicillin. These included 36 cases of soft tissue infection or abscess, four cases of joint or bone infection, 20 cases of respiratory tract infection (17 cases of pneumonia, two of otitis media, and one of tonsillitis), 15 urinary tract infections, three cases of enterocolitis, one case of infective endocarditis, two cases of septicemia, and two of peritonitis. The causative pathogen was isolated in 48 cases (49 infections). These pathogens included Staphylococcus aureus 13 cases, Staphylococcus epidermidis one, Streptococcus pyogenes two, Streptococcus pneumoniae two, Viridans group streptococcus two, peptostreptococcus one, Haemophilus influenzae one, Escherichia coli 12, Enterobacter cloacae three, Proteus mirabilis one, Acinetobacter calcoaceticus one, Salmonella spp. two, Shigella sonnei one, Bacteroides fragilis one, and polymicrobial infections of various combinations in five cases. No bacterial pathogens were isolated in 34 infections, 14 cases of pneumonia and 15 soft tissue infections. Sulbactam/ampicillin was given by intravenous bolus in a dosage range of 75–450 mg/kg/day in four divided doses for variable periods of time depending on the type and severity of the infection. Of a total of 83 episodes of infections, 80 (96.4%) cases were either cured or improved. Bacteriologic eradication also occurred in 46 (93.9%) of 49 infections. Side effects were diarrhea in two patients, acute hemolytic anemia in one patient, and transient elevations in SGOT and leukopenia in one patient. Side effects disappeared upon completion of treatment. Sulbactam/ampicillin is a safe and effective antibiotic for the treatment of common pediatric infections.

Sulbactam/ampicillin in the treatment of pediatric infections

Seventy eight pediatric patients (43 males, 35 females) aged 34 days to 17 years were treated with intravenous or intramuscular sulbactam/ampicillin 3 or 4 times daily for skeletal system infection (10 cases), systemic salmonellosis (2 cases), intrathoracic infection (12 cases), and soft tissue or miscellaneous infections (54 cases). The dose used to treat the majority of patients was 200 mg of ampicillin plus 100 mg of sulbactam per kg/day. The duration of treatment ranged from 8 to 23 days. Sulbactam/ampicillin alone was used in 68 patients. Ten patients were treated with an additional antibacterial agent. The overall cure rate was 98.7% for all 78 study patients. One patient with an abscess in the neck was shown to be infected with a strain of Escherichia coli resistant to sulbactam/ampicillin. Only one patient experienced a rash, but it did not necessitate discontinuation of therapy. This study shows that sulbactam/ampicillin is a safe and effective agent in the treatment of various pediatric infections.

A clinical study on cefteram pivoxil in pediatrics

Clinical evaluations of cefteram pivoxil (CFTM-PI, T-2588) were carried out. The obtained results are summarized as follows. 1. Clinical responses to CFTM-PI of 39 patients with pediatric infections were excellent in 16, good in 21, fair in 1 and poor in 1. The overall efficacy rate was 94.9%. 2. Bacteriologically, eradication rates for 39 isolates presumed to be pathogens were evaluated. The eradication rates obtained were 94.1% in 17 strains of Gram-positive cocci, 90.9% in 22 strains of Gram-negative rods. 3. Side effects observed were diarrhea in 2 patients, diarrhea and abdominal pain in 1, erythema and edema in 1. The incidence was 8.7%. An abnormal value found in clinical laboratory tests was eosinophilia in 1 patient. The results suggested that CFTM-PI might be a very useful and safe drug for the treatment of pediatric infections.

Studies on efficacy, safety and dosage of rokitamycin in the treatment of pediatric infections

The usefulness of a new macrolide antibiotic rokitamycin (RKM, TMS-19-Q) was evaluated in the field of pediatrics. 1. Twenty seven patients were enrolled in the study. One patient was excluded from the study because the illness was due to a viral infection. They included 14 boys and 13 girls with ages 7 months to 9 years 11 months. 2. The patients were treated with RKM at daily doses ranging 19.2-41.1 mg/kg, divided into 3 equal portions. The administration was done orally at fasting, lasting 2-15 days, with total doses of 22.2-500.0 mg/kg. 3. The patients were diagnostically classified into the following categories: 9 with acute pharyngitis, 15 with acute bronchitis, and one each with pneumonia, purulent lymphadenitis and Campylobacter enteritis. 4. The clinical response to the treatment was good or excellent in 22 of the patients with an overall efficacy rate of 81.5%. An efficacy rate of 88.9% was achieved for the patients with acute pharyngitis, 80.0% for those with acute bronchitis, and 100% for the patient with purulent lymphadenitis and the patient with Campylobacter enteritis. From the patient with pneumonia whose response was evaluated "fair" was Haemophilus influenzae isolated by culturing pharyngeal material. This organism was found resistant to RKM by the disk method. 5. Bacteriological responses were as follows; of 26 isolates presumed to be pathogens, 9 were eradicated, 5 decreased, 7 unchanged and 5 unknown, with an eradication rate of 42.9%. 6. Neither adverse reactions nor abnormal changes in laboratory findings were observed with the medication in any patients during and after the end of the treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Combination antibiotic therapy in pediatrics

Combinations of beta-lactam and aminoglycoside antibiotics are frequently used in the treatment of pediatric infections. At our institution, amikacin has been the sole aminoglycoside utilized for the past five years. Such regimens are used empirically in specific patient populations to treat the pathogens most likely to be responsible for a symptom complex, e.g., sepsis in the immunocompromised host, pneumonitis in patients with cystic fibrosis, neonatal infections such as sepsis or meningitis, and infections in patients with intestinal perforations. Beta-lactam and aminoglycoside combinations are employed as definitive therapy when synergistic interactions can be predicted, such as in systemic Pseudomonas infections, viridans streptococcal endocarditis, or enterococcal infections. In all of these circumstances, we have utilized amikacin extensively as the sole aminoglycoside, with highly satisfactory results. In vitro antibiotic synergy studies, including those employing aminoglycosides such as amikacin, may be used to predict in vivo antibiotic interactions. However, definitions of in vitro synergy vary with the laboratory method used to evaluate synergy. Furthermore, recent data from our laboratory suggest that the absence of demonstrated in vitro synergy between amikacin and imipenem may not correlate with improved survival of neutropenic rats with gram-negative sepsis that are treated with both agents. Thus, in vitro studies of synergy may underestimate the frequency of improved outcomes with combination antibiotics, especially with amikacin and imipenem. There are potential risks associated with the use of multiple, broad-spectrum antibiotics, including fungal or bacterial superinfection and increased drug toxicity. Although the former is common in pediatric patients, aminoglycoside (amikacin) toxicity has rarely been a problem. Combination antibiotic regimens that include an aminoglycoside such as amikacin continue to have an important role in pediatrics and should be used empirically or definitively for the specific indications discussed.

Clinical experience with intravenous Augmentin in the treatment of paediatric infections.

The clinical efficacy of intravenous Augmentin (a formulation containing amoxycillin plus clavulanic acid) was investigated in an open study in fifty-eight children with a mean age of 6 years (range 1-15 years). The normal dosage was in the range 100-200 mg/kg/day Augmentin, administered parenterally by short i.v. infusion in 3 or 4 divided doses. Most patients were hospitalised for lower respiratory tract infections. Complete clinical cure or distinct clinical improvement was achieved in all assessable cases. Bacteriological success was obtained in 92% of the assessable cases. In two patients, mild, transient exanthema was noted after i.v. Augmentin was replaced by oral Augmentin. No additional therapeutic measures were required.

Treatment of pediatric infections with amikacin as first-line aminoglycoside

Because of increased aminoglycoside resistance of hospital bacterial isolates, aminoglycoside sensitivity patterns of isolates in a large children's hospital were assessed before and during a 33-month period of almost exclusive amikacin use. There was no significant change in overall resistance rates of gram-negative enteric bacteria to gentamicin (4.8 percent and 4.6 percent), tobramycin (2.5 percent and 3.6 percent), and amikacin (1.2 percent and 1.8 percent) from the pre-amikacin period to the amikacin usage period, respectively. No significant differences were observed for isolates of Escherichia coli, Klebsiella, Serratia, Acinetobacter, and Pseudomonas species. In contrast, significant decreases in gentamicin and tobramycin resistance rates for Enterobacter, Citrobacter, and Pseudomonas aeruginosa and in gentamicin resistance of Proteus were found. Very little change in resistance of staphylococcal isolates was seen during a shorter evaluation period. Pediatric aminoglycoside usage includes therapy of neonatal infections, cystic fibrosis, febrile neutropenic episodes in patients with cancer, abdominal surgery, bacterial endocarditis, and gram-negative central nervous system infections. Amikacin has also been used successfully as single-dose therapy of urinary tract infections, and acceptable cerebrospinal fluid levels of amikacin have been documented in hydrocephalic patients with ventriculitis. In vitro studies of 22 bacterial isolates demonstrated synergy between amikacin and penicillin or newer cephalosporins in 13, an additive effect in seven and indifference in two. No antagonism was found. In addition, in vivo synergy between imipenem and amikacin was found in neutropenic infant rats with P. aeruginosa sepsis using a strain with which no synergy was demonstrable in vitro. Amikacin is effective in pediatric infections and is well tolerated by children. Because excessive or inadequate levels are frequent with usually recommended doses, particularly in neonates and patients with compromised renal function or cystic fibrosis, serum levels should be monitored to minimize risk and to ensure therapeutic levels.

Clinical evaluation of ceftazidime in the treatment of pediatric infections

Ceftazidime (CAZ) was evaluated for its safety and efficacy in 31 children. Of the 25 confirmed bacterial infections, 23 were cured by the CAZ therapy (efficacy rate, 92%). CAZ was assessed as effective in acute pharyngitis with vomiting (4), acute laryngitis (1), pneumonia (8), urinary tract infections (5), acute gastroenteritis (1), infection accompanying acute leukemia (septicemia suspected) (1), acute purulent meningitis (2) and abscess of the lateral cervical cyst (1). The main pathogens which responded to CAZ were H. influenzae, S. pyogenes, E. coli and P. aeruginosa. As adverse events, mild melena with prolonged prothrombin time (1) was found to be associated with the CAZ therapy. Half-life of the CAZ serum level was 0.97 +/- 0.10 hours, and urinary excretion was high. Penetration into the CSF in 2 cases of acute purulent meningitis was satisfactory. The data suggest that CAZ is a safe and effective injectable antibiotic when used in children with infections of CAZ-susceptible bacteria including P. aeruginosa.