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BACKGROUND: Hospital readmissions are receiving increasing attention as an indicator of health care quality and waste. Hospitalists provide a unique perspective on the underlying processes that result in acute care readmissions and the extent to which readmissions can be prevented.

The pharmacokinetics and cerebrospinal fluid (CSF) penetration of cefotaxime (Ctx) and desacetylcefotaxime (dCtx) were evaluated in 13 infants and children with meningitis after dose 6 of Ctx in a multiple-dose intermittent intravenous infusion regimen (50 mg/kg every 6 h). Model-dependent and noncompartmental pharmacokinetic parameters were determined and were found to be congruous.

Cerebrospinal flbid (CSF) penetration of imipenem-cilastatin was evaluated in 20 children (aged 4 months to 11 years) with central nervous system infections. A total of 10 children received a single 25-mg/kg intravenous dose, and 10 received three 25-mg/kg intravenous doses at 6-h intervals. Blood and CSF were obtained 1.5 to 2.5 h after the last dose during the early (days 1 to 3) and the late (days 7 to 10) stages of infection. Imipenem concentrations after single-dose infusion in serum and CSF during the early phase of treatment (8.59 ± 0.95 and 1.36 0.32 ,ig/ml, respectively) were similar to those during the late phase (9.96 ± 2.36 and 2.08 ± 1.14 ,ug/ml, respectively). Concentrations of imipenem in serum and CSF after multiple-dose infusion during the early phase (11.97 ± 2.03 and 1.87 ± 0.29 ,ug/ml, respectively) were similar to those during the late phase (9.571.76 and 1.22 ± 0.11 p.g/ml, respectively). There were no significant differences in the serum or CSF imipenem concentrations between the single-and multiple-dose groups during the early or late treatment stages. Cilastatin concentratiods in serum and CSF were similar in all groups with the exception of the multiple-dose, early-versus late-phase evaluationt of CSF cilastatin concentration. There was no correlation between age or absolute. CSF neutrophil count and the serum or CSF concentrations of imipenem or cilastatin.We found a mean CSF penetration of 15 to 27% for imipenem and 16 to 66% for cilastatin in children. These findings suggest that imipenem-cilastatin sufficiently penetrates into CSF in children to warrant further investigation of this compound in pediatric central nervous system infections.Primaxin (Merck Sharp & Do4me Laboratories, West Point, Pa.) is a 1:1 combination of a stable derivative of thienamycin, N-formimidoyl thienamycin (imipenem), and the renal dihydropeptidase inhibitor cilastatin (10). Imipenem has a broad antibacterial spectrum that includes aerobic and anaerobic gram-positive and gram-negative microorganisms. The compound has documented activity against Staphylococcus aureus, methicillin-resistant S. aureus, Staphylococcus epidermidis, Pseudomonas sp., and Listeria monocytogenes (8,11,13,18