Acetaminophen serum concentrations were studied in 21 infants and children with fever. The maximum serum concentrations ranged from 9.96 to 19.6 micrograms/ml after a single dose of 12-14 mg/kg and 13.9 to 40.1 micrograms/ml after a single dose of 22-27 mg/kg. Ten patients were restudied at steady-state after repeat doses had been given every 4 or 8 h for 1 to 3 days. Total area under the acetaminophen serum concentration-time curve normalized for dose averaged 0.181 (ml/min/kg)-1 after the first dose and 0.202 (ml/min/kg)-1 at steady-state (p less than 0.05). Five patients showed a 13 to 44% increase in the AUC; one had a 10% decrease in the AUC; and four had less than 6% change in the AUC. There was no evidence of hepatotoxicity. These data suggest that acetaminophen may accumulate after repeated therapeutic doses in children with fever.

The activity of four antifungal agents against 15 systemic (blood and vascular catheter) and 10 superficial (skin) Malassezia furfur isolates was evaluated. MIC ranges were similar for the two groups of organisms: amphotericin B, 0.3 to 2.5 ,g/ml; flucytosine, >100 ,g/ml; miconazole, 0.4 to 1.5 ,utg/ml; and ketoconazole, 0.025 to 0.4 ,g/mi.Malassezia furfur is a lipid-dependent yeast commnonly found on the skin of adolescents and adults and the causative agent of tinea versicolor, a chronic, superficial skin infection (9). The organism has recently been isolated from the skin of neonates in intensive care nurseries and also from deep-line vascular catheters and catheter blood cultures in patients with signs and symptoms of sepsis (1,4,7,8). Adnministration of parenteral fat emulsions for caloric supplementation via a deep-line catheter is highly associated with subsequent catheter colonization and probable sepsis (4,7,8). However, M. furfur has not been recovered directly from fat emulsi6n fluids, and we hypothesize that catheter colonization and associated sepsis occur subsequent to skin colonization, while the fat emulsions provide the necessary lipid growth requirement for the organism. The organism has also been recovered from peripheral blood and lung tissue at biopsy and autopsy, suggesting the systemic nature of this infection (8). Although most patients have been successfully managed by removal of the infected catheter, vascular access is often critical, and treatment of patients with antifungal therapy while the catheter remains in place is an alternative form of management. (5) grew >15 CFU (most grew >100 CFU) of M. furfur; (iii) tnost patients had multiple positive catheter blood cultures collected over several days; (iv) the patients appeared septic, and laboratory data supported this observation (fever, apnea, bradycardia, thrombocytopeniaj leukocytosis, elevated neutrophil band counts); (v) patients responded dramatically to catheter removal; and (vi) no other infectious agent was recovered from blood or catheter tip culture. We previously reported the clinical presentation of five of these patients (7). Skin isolates were obtained from scrapings of the back or chest of infants hospitalized in an intensive care unit. Organisms Were isolated on glucose-yeast extract-peptone agar (GYP-S) supplemented with glycerol monostearate (0.25%), Tween 80 (0.2%), and olive oil (2%) (6). Isolates were subcultured once or twice on GYP-S, harvested after 2 or 3 days of growth at 35°C, and stored frozen at -70°C in whole sheep blood.

Ibuprofen may be an alternative to acetaminophen to control fever in children but little is known about its pharmacokinetics in pediatric patients. We studied 17 patients (age 3-10 yr) with fever; the most prevalent diagnoses were streptococcal pharyngitis and otitis media. Ibuprofen liquid was given as a single dose, 5 mg/kg (9 patients) or 10 mg/kg (8 patients). Multiple blood samples were collected over 8 hours and analyzed by HPLC. The maximum observed serum concentrations of ibuprofen ranged from 17-42 micrograms.ml-1 at 5 mg.kg-1 and 25-53 micrograms.ml-1 at 10 mg.kg-1 doses. Pharmacokinetics did not appear to be affected by ibuprofen dose. Mean tmax, oral clearance and elimination half life were 1.1 h, 1.2 ml.min-1.kg-1, and 1.6 h, respectively in patients at 5 mg.kg-1 doses; the corresponding values were 1.2 h, 1.4 ml.min-1.kg-1, and 1.6 h in those receiving 10 mg.kg-1 doses. There was no relationship between age and ibuprofen kinetics. No adverse effects occurred in any patients. These data suggest that ibuprofen pharmacokinetics may not be affected by dose between 5 and 10 mg/kg or age between 3 and 10 years.

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