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Data have been accumulated to determine the prevalence of yeast colonization of the skin and digestive tract of hospitalized and nonhospitalized infants and children. There was no difference in the prevalence between hospitalized patients at the time of admission and nonhospitalized children. However, there was a positive correlation of the duration of hospitalization and the prevalence of yeast colonization. There were no correlations of hospitalization with site of colonization, age of the patient, or type of yeast isolated.

The outstanding feature of this group of viruses is the wide spectrum of disease it produces in man. Type B viruses have been associated with gastroenteritis, pleurodynia, pharyngitis, meningoencephalitis, aseptic meningitis, pericarditis, myocarditis and respiratory infections. Type A viruses are associated with herpangina, hand, foot and mouth disease, conjunctivitis, meningoencephalitis and respiratory infections. The diagnostic virology laboratory is developing rapid methods of identification.

The combined use of amphotericin B and 5-fluorocytosine in the treatment of two children with Candida albicans meningitis is described. Therapy consisted of nine to 13 days of iv amphotericin B, combined with, or followed by six to nine weeks of oral 5-FC. Each organism was sensitive to 5-FC before starting therapy. Resistance did not develop during therapy. CSF administration was not necessary and toxic reactions were minimal and transient; neither patient has suffered a recurrence four years and 14 months, respectively, after discontinuance of therapy. The combination of short-term therapy with iv amphotericin B plus long-term oral 5-FC was successful in these two patients.

A suitable model of Haemophilus influenzae meningitis will facilitate better understanding of the pathophysiology, therapy, and prevention of the disease and its sequelae. Bacteremia and meningitis were induced in infant New Zealand white rabbits by intranasal inoculation of H. influenzae type b. Intranasal trypsin prior to challenge significantly increased (p = 0.002) the rate of bacteremia from 64% (7/11) to 100% (45/45). In the trypsin-treated group, H. influenzae b was isolated from the CSF of 89% (25/28) of 17- to 21-day-old rabbits and from 76% (13/17) of 23- to 30-day-old animals, p = 0.3; fatality rates were 88% and 31%, respectively, p = 0.001. Bacteremia developed within 24 hr of inoculation and meningitis within 96 hr. Death occurred 1 to 7 days after the development of meningitis. Histologic evidence of nasopharyngitis and meningitis was found at autopsy. The intranasal route of infection, the age-dependent outcome, the size of the animal, and its low cost and availability make the infant rabbit an appropriate model of H. influenzae b meningitis.

Minimum inhibitory concentrations of seven new beta-lactam derivatives were determined against 35 isolates of Yersinia enterocolitica. Ceftizoxime and ceftriaxone were the most active of the antimicrobial agents tested.

Administration of antibody to Escherichia coli strain J5 reduces mortality in patients with gram-negative septic shock. Limited evidence suggests that this antibody is present in the serum of healthy individuals and deficient in persons with malignancy; however, the age-related prevalence of serum antibody to strain J5 in normal subjects is unknown. We developed an ELISA method to measure IgG and IgM antibody to purified J5 lipopolysaccharide (LPS) in sera from 33 maternal-newborn cord pairs, 40 neonates, and 253 individuals aged from one day to twenty years. Reciprocal geometric mean titers for serum antibody to strain J5 LPS were as follows: maternal-IgG, 12.3; IgM, 174; one month old or less-IgG, 8.3; IgM, 5.6; one to 24 months old-IgG, 10.5; IgM, 44.7; greater than 24 months old -IgG, 16.2; IgM, 200. We conclude that human serum antibody to J5 LPS is predominantly IgM and that it is usually present by two years of age. The ELISA method should provide a valuable tool in studying the relation of core glycolipid antibody to immunity and therapy of gram-negative bacterial infections.

The prevention and treatment of peritonitis in patients undergoing peritoneal dialysis is often complicated by several factors, including nephrotoxicity, requirement for hospitalization, parenteral antibiotic therapy, and infection caused by resistant microorganisms. Ciprofloxacin, a new carboxyquinolone derivative, may offer the advantages of oral administration, a broad spectrum of antibacterial activity, and safety for the management of these patients. The pharmacokinetics of ciprofloxacin in serum and peritoneal fluid of eight adult patients undergoing chronic ambulatory peritoneal dialysis (CAPD) were investigated. Each patient ingested a single 750-mg dose of ciprofloxacin, and drug concentrations were measured by high-pressure liquid chromatography in serum and peritoneal fluid for 48 h after the dose. Serum concentrations reached a mean peak of 3.6 micrograms/ml 1 to 2 h after the oral dose. The mean terminal serum half-life was 16.8 h, and the mean peritoneal fluid/serum concentration ratio was 0.64. The mean peak ciprofloxacin concentration in peritoneal fluid was 1.3 micrograms/ml, and the bioactivity of the drug in peritoneal fluid was confirmed. These data indicated that therapeutic concentrations of ciprofloxacin against bacterial pathogens commonly associated with peritonitis in CAPD patients may be achievable in the peritoneal fluid after oral administration to patients undergoing CAPD. In addition, the pharmacokinetic data provide guidelines for further clinical studies of oral ciprofloxacin in CAPD patients.

A 16-year-old diabetic patient developed Rhizopus pneumonia and was initially treated with amphotericin B for 7 days. Because of clinical deterioration of the patient, rifampin was added empirically. The patient improved clinically, and lung tissue removed surgically 8 weeks later showed no fungal elements by histopathological studies or by culture. An in vitro study of amphotericin B alone and in combination with rifampin against the isolate from the patient and 11 additional isolates of Rhizopus spp. was designed. The activity of amphotericin B in the presence of rifampin (10 or 5 micrograms/ml) increased fourfold against 9 of 10 clinical and 1 of 2 environmental isolates. Amphotericin B activity in the presence of 2 micrograms of rifampin per ml increased fourfold against 6 of 10 clinical isolates and increased twofold against an additional 3 clinical isolates. Amphotericin B in the presence of 1 microgram of rifampin per ml inhibited 9 of 10 isolates at a concentration of one-half the MIC of amphotericin B alone. These findings were confirmed by dose-response curves calculated from fungal dry weight determinations of Rhizopus spp. incubated in serial dilutions of amphotericin B combined with rifampin. These observations demonstrate in vitro, and possibly in vivo, synergy between amphotericin B and rifampin against Rhizopus spp.

Susceptibilities of 82 clinical isolates of Streptococcus pneumoniae, including 25 from the middle-ear fluid, were evaluated against antibiotics commonly used in the treatment of acute otitis media. Potentially significant resistance occurred in 6% of the isolates to erythromycin and an erythromycin-sulfisoxazole combination. The combination of trimethoprim and sulfamethoxazole was synergistic for 95% of the isolates. Only 2.5% of all of the isolates were resistant to both erythromycin-sulfisoxazole and trimethoprim-sulfamethoxazole. The presently used drug regimens should be effective against the majority of S. pneumoniae isolates in otitis media.

We review the clinical and laboratory features of 79 children with 83 episodes of pneumococcal meningitis over a 26-year period. The onset of illness was often severe, with convulsions occurring in 31% of the patients. The mortality was 10.8% and all deaths occurred in patients younger than 1 year of age; the death rate has dropped from 19% in the 1948 to 1962 era to 3% from 1963 to 1973. The association of pneumonia with meningitis, the presence of hypoglycorrhachia, and an increased CSF protein concentration were associated with a poor prognosis; bacteremia and convulsions were also more common in the fetal cases. Neurologic sequelae including recurrent meningitis, deafness, hydrocephalus, convulsions, and retardation were present in 56% of the patients observed. Findings from EEGs did not correlate well with the clinical picture during the acute or convalescent stage of the illness. Despite accurate diagnosis, prompt therapy, and a decrease in the mortality in the past decade, pneumococcal meningitis in children is still often associated with a serious outcome.

Hospital nursery A has used chloramphenicol and nursery B has used the combination of penicillin G sodium and kanamycin sulfate routinely in the treatment of neonatal sepsis and other bacterial infections. A hypothesis was formulated that these different antibiotic pressures would select out a substantial number of populations of resistant bacteria in each of the two nurseries. This was tested by periodic sampling of the skin, mouth, and rectal flora of babies and the permanent personnel in these nurseries. These bacteria were studied for susceptibility to a number of antibiotics. The population of resistant strains selected out was correlated with the antibiotics used in each nursery. There is a need for continuing surveillance of hospital nursery strains of bacteria for in vitro susceptibilities to commonly prescribed antimicrobials.

Sulfamethoxazole-trimethoprim and three oral cephalosporins, cefaclor, cephalexin, and cephradine, were evaluated in vitro as possible alternatives to chloramphenicol in the treatment of non-central nervous system infections due to ampicillin-resistant Haemophilus influenzae. Sixty-four isolates of H. influenzae, including 31 beta-lactamase-positive strains, were tested by the agar dilution method. All strains were inhibited by 0.78/0.039 mug sulfamethoxazole-trimethoprim per ml and by 0.78 mug of chloramphenicol per ml. At 6.25 mug/ml, 100, 11, and 3% of all strains were inhibited by cefaclor, cephalexin, and cephradine, respectively. Thus, on the basis of drug concentrations presumably achievable in serum, 100% of strains were susceptible to sulfamethoxazole-trimethoprim, chloramphenicol, and cefaclor. However, a considerable inoculum effect was noted with both beta-lactamase-positive and -negative strains, when tested with sulfamethoxazole-trimethoprim; the minimal inhibitory concentrations of cefaclor were only slightly affected. Also, synergistic effects of sulfamethoxazole-trimethoprim, sulfamethoxazole-erythromycin, and sulfamethoxazole-cefaclor were seen when combinations were tested against both beta-lactamase-positive and -negative strains, as determined by minimal inhibitory concentrations measured by the broth dilution method and by killing curve analyses. These results support further evaluation of these combinations and of cefaclor alone for the treatment of non-central nervous system infections due to H. influenzae.

The in vitro activity of the aminoglycoside antibiotics tobramycin, sisomicin, amikacin, gentamicin, and netilmicin (SCH 20569) were compared against 26 gentamicin-resistant isolates of Pseudomonas aeruginosa cultured from hospitalized children. Tobramycin had the greatest activity on a weight basis, followed by sisomicin, gentamicin, amikacin, and netilmicin. All isolates were resistant to achievable concentrations of netilmicin and gentamicin, but 23% were inhibited by achievable concentrations of tobramycin, 8% by amikacin, and 4% by sisomicin. The combinations carbenicillin/tobramycin, carbenicillin/sisomicin, and carbenicillin/amikacin were synergistic for 92% of strains; antagonism was not encountered. These in vitro results suggest that tobramycin, sisomicin, or amikacin in combination with carbenicillin would be the safest initial regimen in the therapy of gentamicin-resistant Pseudomonas infections pending susceptibility studies.

Humoral antibody to Chlamydia trachomatis was determined in 820 infants and children. Of 120 newborns, 63 (52.5%) had indirect immunofluorescence titers of 1:8 or more to C trachomatis (L-2 strain) in the cord blood. Among the 700 infants and children, a progressive increase in seropositivity was observed: 5% for 1- to 2-years-olds, 25% for 3- to 6-year-olds, and 43% for 7- to 15-year-olds. Seropositivity rates were not related to sex or race; however, significantly higher titers were observed in female compared with male subjects and in blacks compared with whites. These data suggest that C trachomatis infection occurs commonly in children. The nature of the illness, if any, preceding seroconversion is unknown and needs to be elucidated.

Recent developments (including more accurate assays) that have led to revised recommendations for route of administration, dosage, and indications for chloramphenicol are reviewed. Chloramphenicol is most bioavailable by the oral route; doses of 75 mg/kg/day provide adequate therapeutic concentrations for most clinical indications. Serum concentrations of the drug should be monitored to ensure adequate therapeutic concentrations and to avoid toxicity. This is particularly important in newborns, in patients with liver dysfunction, and in those receiving concomitant drugs that may influence free chloramphenicol concentrations. The indications for chloramphenicol therapy evaluated are: Haemophilus influenzae infections, anaerobic infections, salmonellosis, Rocky Mountain spotted fever, and eye infections. Chloramphenicol is useful in the treatment of invasive Haemophilus influenzae infections resistant to ampicillin, in selected anaerobic and ocular infections, and for rickettsioses in patients under the age of eight years. Because the rare but life-threatening complication of chloramphenicol (aplastic anemia) persists, indications for the drug's clinical use are narrowing once again with the advent of third-generation cephalosporins highly active against gram-negative bacilli including ampicillin-resistant H. influenzae. Similarly, metronidazole or clindamycin may be preferred for some anaerobic infections.

Two cases of pertussis complicated by the syndrome of inappropriate antidiuretic hormone secretion (SIADH) are reported. Both patients experienced seizures associated with hyponatremia. Patients with severe pertussis are at risk for SIADH and should be monitored closely for its development.

A case of ringworm of the arm is described in a 6-year-old child, after swimming with a polyurethane cast. This report illustrates a potential problem when these casts are inadequately dried and worn for prolonged periods in warm climates. Accurate diagnosis depends on demonstration of fungus in the lesion by smear and culture. Topical antifungal therapy led to rapid resolution.

The antibacterial activity of tobramycin, gentamicin, erythromycin, cloxacillin, kanamycin, cephalexin, penicillin, carbenicillin and polymyxin were compared against 303 clinical bacterial isolates from a pediatric hospital patient population. Standard disk diffusion and agar-dilution methods were employed. Significant activity was demonstrated for tobramycin against pseudomonas, Klebsiella, Escherichia coli and both Staphylococcus aureus and albus; Tobramycin was significantly more active against Pseudomonas than gentamicin or the other antibiotics testedmcomparable activity to gentamicin was present for the other types of bacteria; Cross-resistance was not encountered between tobramycin and gentamicin. 30 isolates of E. coli were tested against the combination of tobramycin and ampicillin by the growth-curve method. Synergism was demonstrated in 4 isolates, antagonism in 1 and an additive effect in 25. A bactericidal effect was present at 24h against 17 isolates with tobramycin alone and against 25 isolates when combined with ampicillin. These results provide in vitro rationale for the consideration of tobramycin for clinical use in patients with Psuedomonas infections for the combination of ampicillin and tobramycin for the treatment of selected E.coli infections.

Efforts to prevent Haemophilus influenzae type b (HIB) infections in infancy have been hampered by the low immunogenicity of capsular polysaccharide vaccines in children younger than 18 mos. In searching for alternate immunogens, we have studied the protective potential of polysaccharide-poor, lipid-rich endotoxin (LPS) core in experimental HIB infections. Because all gram-negative bacteria have similar LPS core structures, we were able to use as vaccine the J5 mutant of Escherichia coli 0111, the LPS of which consists only of core components, and thus to avoid problems in interpretation arising from vaccine contamination with non-LPS HIB immunogens. Mice were given graded inocula of HIB and developed lethal infection analogous to human HIB disease when virulence was enhanced with mucin and hemoglobin. After active immunization with heat-killed E. coli J5, 40/50 (80%) of infected mice survived, compared with 14/50 (28%) of saline-immunized controls (P less than 0.005). Passive immunization with rabbit antiserum against E. coli J5 prevented lethal HIB infection when administered 24 or 72 h before or 3 h after infection. This protection was abolished by adsorption of antiserum with purified J5 LPS, with survival reduced from 14/24 to 0/24 (P less than 0.005). Furthermore, rabbit antiserum to purified J5 LPS gave just as potent protection against death as antiserum to whole J5 cells. These studies demonstrate that immunity to core LPS confers protection against experimental murine HIB infection and provide the framework for a new approach to prevention of human disease from HIB.

Fifty-nine children were enrolled in an open trial of aztreonam, a monocyclic beta-lactam, therapy for serious gram-negative infections. Thirty-six infections were microbiologically evaluable and received five or more days of therapy. Patients' ages ranged from 3 days to 12 years, and diagnoses included pyelonephritis or cystitis (20), deep soft tissue or joint infection (seven), septicemia (four), pneumonia (three), peritonitis, and epiglottitis. Causative bacteria included Escherichia coli and other Enterobacteriaceae, Pseudomonas aeruginosa, and Haemophilus influenzae. The standard regimen was 30 mg/kg every six or eight hours intravenously. All isolates were aztreonam-susceptible and were eradicated during therapy. Two patients had microbiologic relapses: a patient with Salmonella choleraesuis meningitis who was initially treated for only ten days and a patient with E coli pyelonephritis. Clinical cure was achieved in 31 of 36 children. Pharmacokinetic studies performed in six children demonstrated no difference in serum concentrations or pharmacokinetic variables between day 1 and day 7 of therapy. Although several patients had transient eosinophilia (eight), elevated levels of aminotransferase (seven), or thrombocytosis (ten), no clinically significant adverse effects were noted. In this initial, uncontrolled study, aztreonam was effective and safe in the treatment of a variety of serious gram-negative infections in children.

Isolates were obtained from 169 middle ear aspirates of 148 children with recently treated acute otitis media (RTOM) and from 123 aspirates of 84 children with previously untreated acute otitis media (UOM). In RTOM Streptococcus pneumoniae and Group A streptococcus (P less than 0.02) were recovered less frequently whereas Staphylococcus aureus (P less than 0.001) and Haemophilus influenzae (P less than 0.02) were recovered more frequently than in UOM. Patients with RTOM had more beta-lactamase-producing organisms and multiple isolates. Bilateral sterile aspirates were more common in RTOM although bilateral otitis media was more common in UOM. In RTOM most Branhamella catarrhalis isolates were co-pathogens whereas Staphylococcus epidermidis were always isolated in pure culture. Amoxicillin was the antimicrobial most frequently (83.9%) received for the recently treated episode of otitis media. In RTOM 62.4% of isolates were susceptible to previously prescribed antibiotics, suggesting that factors other than antimicrobial susceptibility are also important in the occurrence of RTOM.

Intraperitoneal antibiotics are used to treat Pseudomonas aeruginosa peritonitis, a serious complication of continuous ambulatory peritoneal dialysis. However, P. aeruginosa killing is often inefficient despite low MBCs. Broth dilution MIC/MBC and time kill curves of tobramycin, amikacin, netilmicin, azlocillin, piperacillin, ceftazidime, cefsulodin, and ciprofloxacin were determined in peritoneal dialysis fluid (PDF), buffered PDF, fluid recovered from patients on continuous ambulatory peritoneal dialysis (RPF), and cation-supplemented Mueller-Hinton broth. MBCs of all antibiotics were 8 to 16 times greater in PDF and RPF than in Mueller-Hinton broth or buffered PDF. Use of the time kill curve technique and Mueller-Hinton broth showed that aminoglycosides killed greater than or equal to 99.9% of P. aeruginosa at 1 h, ciprofloxacin killed greater than or equal to 99.9% at 2 h, and beta-lactams killed greater than or equal to 99.9% at 6 h. In contrast, killing was not demonstrated in PDF by any drug at 6 h and by aminoglycosides only at 24 h. Bactericidal activity was optimal in RPF for ciprofloxacin at 1 h and for aminoglycosides at 2 h; bactericidal activity was not demonstrated in RPF with any beta-lactam (no kill by penicillins; less than 99% kill by cephalosporins). Slow bacterial growth, increased protein binding, and glucose concentrations and other inhibitors may interfere with beta-lactam activity in RPF. These considerations and reported clinical failures and toxicity of aminoglycoside therapy warrant further study of quinolones and drug combinations in P. aeruginosa peritonitis.

The manifestations of leiomyoma of the large bowel in a 2-year-old boy included prolonged fever, anemia, and thrombocytosis. This parallels the previously reported case in an adult. Awareness of these features may suggest the diagnosis in future patients, and thereby offer opportunities to study the pathogenesis of these abnormalities before surgery.

We tested CI-919 (AT-2266), a nalidixic acid analog, against 555 gram-positive and gram-negative bacteria, using microbroth or agar dilution methods. The activity of CI-919 was compared with those of cephalosporins, tobramycin, ticarcillin, dicloxacillin, rifampin, chloramphenicol, ampicillin, and trimethoprimsulfamethoxazole. The minimal inhibitory concentrations of CI-919 for 90% of isolates were (in micrograms per milliliter): Pseudomonas spp. (including Pseudomonas aeruginosa), 4.0; Enterobacteriaceae, 0.5; Staphylococcus spp., 2.0; Haemophilus influenzae, 0.12; Campylobacter jejuni, 0.12; and enterococci, 16. The minimal inhibitory concentrations of CI-919 for 90% of 82 tobramycin-resistant, gram-negative strains was 4.0 micrograms/ml. CI-919 was bactericidal for most isolates, showing no cross-resistance with unrelated antimicrobial agents, and was stable for 11 weeks at temperatures ranging from 22 to -70 degrees C. Inoculum size and media pH had little effect on the antibacterial activity of CI-919 for nine strains tested. CI-919 may be useful as an oral antibiotic for the treatment of infections due to diverse bacteria, including P. aeruginosa.

A rapidly developing outbreak of pneumonia in young infants was documented in two isolated Artic populations in May 1972. These were studied virologically, serologically and clinically. In addition to the two stricken communities, one apparently unaffected with serious clinical illness and a fourth, in which are located the major hospital and airport in the eastern Arctic, were also studied. One hundred and twenty-four patients were studied serologically and 81 respiratory and other specimens were obtained for virus isolation from 40 of these patients. Clinical records were kept of the outbreak in each area and a detailed questionnaire was filled out for 140 children and their families. Respiratory syncytial irus (RSV) was cultured from eight ill children. Electron microscopy provided the first evidence of RSV infection. A seroconversion rate of approximately 50% was seen in both affected communities as well as in the clinically unaffected one. The epidemic in the first two communities was characterized by severe pneumonia and frequent hospitalization but no cases of bronchiolitis were seen. No evidence for other causes of this outbreak could be obtained by testing for antibodies to influenza A and B, parainfluenza 1, 2 and 3, adenovirus and herpes simplex viruses. Unusual features of this epidemic of RSV infection include the high attack rate, severe morbidity, illness manifest almost exclusively as pneumonia rather than bronchiolitis and the difference between the expression of disease in different communities. Historical data and clinical observations were inadequate to explain these unusual features.

Oral and intravenous (IV) antibiotic regimens were compared in 15 children with etiologically defined osteomyelitis and/or septic arthritis. On admission all children were started on standard IV therapy; seven were changed to oral antibiotics within 72 hours and the remaining eight continued on IV therapy for four weeks. Oral antibiotic doses were adjusted to achieve a peak serum bactericidal titer of greater than or equal to 1:8 against the patient's own pathogen. All patients were treated in hospital for four weeks; therapy continued for a minimum of six weeks or until the erythrocyte sedimentation rate (ESR) fell below 20 mm/hr. The clinical course and outcome were similar in both groups. There were no treatment failures nor any relapses during a 12-month follow-up period. This prospective study supports, with controlled data, the concept that acute skeletal infections can be safely and successfully treated with carefully monitored oral therapy.

A model of overwhelming E. coli K1 sepsis and early meningitis was developed in infant rabbits and used to compare clinical and bacteriologic efficacy of ampicillin, moxalactam, cephalothin and chloramphenicol. Intraperitoneal injection of 10(7) E. coli K1 into 1- or 2-wk-old rabbits produced a rapidly progressive infection which, if left untreated, produced bacteremia in 100% of animals, meningitis in 78%, and mortality in 100%. Therapy was initiated 4 h after ip infection at which time mean bacterial concentration (log10 CFU/ml) ranged from 4.4-4.8 in the blood and from 1.8-2.3 in the cerebral spinal fluid (CSF). Pre-treatment frequency of bacteremia (100%) and meningitis (17-23%) was similar for all experimental groups. Antibiotic concentrations in blood and CSF 2 h after a dose exceeded the E. coli minimum inhibitory concentration with the exception of CSF cephalothin, which was undetectable. Moxalactam, ampicillin, and chloramphenicol significantly reduced the incidence of bacteremia and meningitis relative to cephalothin or saline controls (P less than 0.02). Mortality rates among the former three groups were high (64-82%) but significantly less than in saline or cephalothin-treated rabbits (100%). In this neonatal model of fulminant sepsis with early meningitis, moxalactam provided no therapeutic advantage over ampicillin or chloramphenicol.

In vitro studies indicates that the constitutents of the drug combination co-trimoxazole are synergistic against Salmonella and effective against shigella isolated from children ill with gastroenteritis. The drug is well absorbed in children with gastroenteritis due to a variety of causes and is distributed, excreted and metabolized in a manner similar to that seen in normal adult volunteers. The drug is tolerated well by children with gastroenteritis even in very high dosages. Despite its in vitro and pharmacokinetic advantages, co-trimoxazole was not any more efficient than any other durg or no therapy in the treatment of salmonella gastroenteritis; it seems to have a role, however, in the treatment of typhoid fever and may be life-saving in patients infected with ampicillin- and chloramphenical-resistant strains. It is also effective in the treatment of shigella gastroenteritis and is recommended where ampicillin-resistant strains are encountered. Its potential usefulenss for the treatment of other bacterial causes of gastroenteritis in children must be evaluated by further controlled therapeutic trials.

Four hundred and fifty-eight clinical bacterial isolates from a children's hospital were examined for antibiotic susceptibility to amikacin (BB-KS) in comparison with a number of other antibiotics by the disk diffusion and agar dilution methods. The wide spectrum of activity of amikacin against Gram-negative bacteria was confirmed; it included E. coli, Proteus species, Enterobacter species, and Pseudomonas aeruginosa. Staphylococci were highly sensitive, but other Gram-positive bacteria tested were resistant. A disk zone diameter of 10 mm effectively separated resistant form sensitive bacteria in a standard disk diffusion test.

We examined 134 pediatric clinical isolates of Enterobacteriaceae, Pseudomonas aeruginosa, and gram-positive cocci for susceptibility to aztreonam alone and in combination with seven other antibiotics. All 98 gram-negative isolates were susceptible to aztreonam with similar inhibitory and bactericidal activity. Combinations of aztreonam with cefoxitin, ampicillin, or clindamycin were generally indifferent or additive. Synergism was occasionally seen against enteric organisms with aztreonam plus cefoxitin or clindamycin. Combinations of tobramycin and aztreonam were synergistic (62%) against P. aeruginosa; aztreonam plus piperacillin or ticarcillin was additive. Aztreonam did not affect the activity of nafcillin against Staphylococcus aureus, or of ampicillin against species of Streptococcus group B or D. Antagonism was seen only with aztreonam plus cefoxitin against Enterobacter species, but not at clinically significant concentrations. Several combinations of antibiotics with aztreonam should be appropriate for initial therapy of infections in children without major risks of antibacterial antagonism.

The antibacterial activity of BMY-28100, a new oral cephalosporin, was measured against 300 bacterial isolates from pediatric infections by standard agar dilution methodology. The effect of inoculum size on activity was also assessed. BMY-28100 was more active than cephalexin or cefaclor against all bacterial species tested.

A bacteriologic survey was performed to estimate the prevalence and duration of meningococcal carriage in children in Montreal, Canada. Infants and children with proven meningococcal infection, or with asymptomatic meningococcal nasopharyngeal (NP) carriage, and their household contacts, were also studied to define communicability. N. meningitidis was present in 30 (2.4%) of the NP cultures from 1238 asymptomatic infants and children in this civilian population during a non-epidemic period. Meningococcal carriage was not found in 278 subjects 1--60 days of age; there was no difference in carriage rates between the sexes and between hospitalized and non-hospitalized children in all age groups. Meningococci were initially isolated from 11 of 106 household contacts of 29 ill index cases and from 15 of 104 contacts of 29 asymptomatic carriers; 35% of all contacts (index cases and carriers) were colonized by the eighth week of surveillance. Duration of NP carriage was longer (mean 15.2 weeks) in disease-free families than in families of ill patients (mean 5.5 weeks). Serogroups B and C were most commonly isolated from both ill and asymptomatic subjects. Resistance to sulfadiazine (MIC greater than or equal to mg/100 ml) was present in 6.5% and 39.4% of group B and group C strains, respectively. Although chemoprophylaxis was not used, there were no secondary cases among the 29 families of index cases.