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In a retrospective nation-wide Swedish study of Haemophilus influenzae meningitis and epiglottitis, a total of 500 cases of culture-verified meningitis and 841 cases of epiglottitis fulfilling strict clinical criteria were found during a three-year period. Eight families with two cases of these infections occurring with an interval of less than 60 days were identified. Four of the secondary cases occurred in siblings and four in mothers of the index case. Two of the secondary cases were twins to the index case. This shows that the risk of developing invasive H. influenzae infections is considerably increased in both siblings and parents of patients with invasive infection. Rifampicin prophylaxis, which is recommended in the United States for family contacts, would, however, prevent less than 1 % of all invasive infections with H. influenzae.

Two methods for determining the sensitivity of Haemophilus ducreyi to antimicrobial agents were compared ; an agar dilution method and the Etest. The MICs of seven antimicrobial agents ; penicillin V, ampicillin, trimethoprim, tetracycline, chloramphenicol, erythromycin and ciprofloxacin were determined for 20 strains of H. ducreyi. The MICs determined with the Etest and with the agar dilution method, showed 86% agreement within one two-fold dilution. The Etest is a good alternative method to the agar dilution technique for antimicrobial susceptibility testing of H. ducreyi. Owing to its simplicity and good reproducibility, the test is well suited for routine use in clinical microbiology laboratories in developing countries.

We report a prospective, non-blind, randomised, multicentre, parallel group, multinational investigation to compare ceftazidime to aminoglycoside based regimens as empirical treatment in 1316 cases of suspected sepsis in the newborn. In each of the 15 study centres either ceftazidime alone (CAZ) or ceftazidime + ampicillin (CAZ+AMP) was compared to an aminoglyocoside/ampicillin combination (AG+AMP). In all cases treatment was based on “an intention to treat”. Bacteria considered to be pathogenic were isolated from 176/1316 (13.4%) patients. The incidence of proven infection varied from 39% in a Yugoslav centre to 6% in a British centre; a further 489/1316 (37.1%) patients fulfilled the criteria for clinically suspected sepsis. A total of 210 bacterial isolates from 197 infection sites in 176 patients were considered to be clinically significant. The cure rate for evaluable patients with proven infection who were treated with CAZ+AMP (97%, 30/31) was significantly higher than that for the corresponding patients treated with AG+AMP (66%, 26/39), (P < 0. 002). The difference in cure rate between CAZ monotherapy (79%, 34/43) and AG+AMP (86%, 32/37) was not significant. Treatment failed in 28/150 (18.7%) evaluable patients. There were significantly fewer failures (P < 0.001) with CAZ+AMP than with AG+AMP therapy. There were 55 staphylococcal infections. Treatment was successful in 16/19 evaluable patients treated with CAZ or CAZ+AMP and in 16/29 evaluable patients treated with AG+AMP. None of the study centres encountered problems with ceftazidime resistant bacteria. The cure rate for patients with only clinical and radiological evidence of sepsis was greater than 94% in all treatment groups. Of the study population 65 (4.9%) died, 15 deaths were attributed to infection, pathogenic bacteria were only isolated from 10. The mortality rate for infected babies was 5.7% compared to 4.8% for those without confirmed infection. All the deaths associated with infection were due to Gram-positive bacteria. This study suggests that the practice of continuing antibiotic therapy once pretreatment cultures are known to be negative should be seriously reconsidered. It is concluded that CAZ+AMP is superior to either AG+AMP or ceftazidime monotherapy for the treatment of infection in the newborn. Further studies are required to confirm these observations in neonates with proven infection.