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Objective. To investigate the associations between patient age, sociological factors, and the microbiology of pediatric neck infections. Methods. Retrospective chart review of children up to 5 years old who underwent surgical management of suppurative cervical lymphadenitis. Results. A total of 76 individuals met inclusion criteria; 93% of culture-positive infections were caused by Staphylococcus aureus in infants, compared with 59% in children between 13 months and 5 years of age ( P = .002). Of the S aureus isolates, 51% were methicillin-resistant S aureus (MRSA) and 49% were methicillin-sensitive S aureus. Methicillin resistance was associated with African American race ( P = .004); 67% of participants received empirical antibiotics prior to admission. Of these, 73% received antibiotics in the β-lactam class, and 25% received treatment with clindamycin. Conclusions. Incidence of MRSA is high in infants with cervical lymphadenitis who fail empirical antibiotic therapy and require surgical management. Empirical coverage for cervical lymphadenitis with β-lactam antibiotics may provide inadequate coverage for early infection in this population.

Dciscovered by Duggar 50 years ago following a systematic screening of soil samples for antimicrobial activity,1 the tetracyclines remain one of the most widely used antibiotic classes in the world.2 Since 1970, the use of tetracyclines in children was strongly discouraged in the United States following concerns over adverse effects, especially dental staining and delayed bone growth, and the availability of effective, safer alternatives, such as P-lactams.3 The appearance of new or emerging pathogens, the increase in tick-borne infections, and the global problem of antimicrobial resistance, especially that in gram-positive bacteria during the 1990s, has led to renewed interest in many of the older antimicrobial agents such as tetracyclines and chloramphenicol.4 This article addresses the role of tetracyclines in children in the 21st century, including their spectrum of antimicrobial activity, mechanisms of bacterial resistance, pharmacokinetics, types of adverse reactions, and potential

Childhood sarcoidosis is a rare multisystemic granulomatous disease of unknown etiology. The clinical presentation can vary greatly depending upon the organs involved. Two distinct forms of sarcoidosis exist in children. Older children usually present with a multisystem disease similar to the adult manifestation, with frequent hilar lymphadenopathy and pulmonary infiltration. Early-onset childhood sarcoidosis is a unique form of the disease characterized by the triad of rash, uveitis, and arthritis in patients presenting before age 4 years. The diagnosis of sarcoidosis is confirmed by demonstrating a typical noncaseating granuloma on a biopsy specimen. The current therapy of choice for childhood sarcoidosis with multisystem involvement is corticosteroids. Methotrexate given orally in low doses is effective and safe and has steroid-sparing properties.

Nephrotoxicity, as evidenced by renal insufficiency is a well-known consequence of gentamicin therapy. We report two patients with gentamicin-induced syndrome of hypokalemic metabolic alkalosis and hypomagnesemia. Both had complete recovery of renal tubular function after cessation of antibiotic therapy. These cases emphasize the need to routinely monitor patients receiving gentamicin therapy for electrolyte abnormalities to avoid potential morbidity.