Intracranial tuberculomas can sometimes develop or increase in size despite administration of appropriate therapy. We report the case of a child whose intracranial tuberculomas paradoxically enlarged while therapy was being administered, and we review 23 other cases in which tuberculomas increased in size or number and 17 cases in which tuberculomas appeared during therapy. These phenomena generally occurred within 3 months of the start of therapy. All but four patients had neurological deterioration that prompted obtaining a repeated computed tomographic scan. One patient died, about one-fourth of patients had residual neurological symptoms, and less than one-third of the patients required surgical intervention. Most patients received a 12-18 month course of antituberculous therapy. Adjunctive therapy with steroids appears to diminish neurological symptoms and may improve outcome. Paradoxical enlargement or development of tuberculomas usually does not represent failure of antituberculous therapy; the most likely explanation for these phenomena is an interaction between the host's immune response and the direct effects of mycobacterial products.

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Caspofungin was generally well tolerated in pediatric patients aged 6 months through 17 years. Efficacy outcomes in patients with invasive aspergillosis or invasive candidiasis were consistent with previous adult studies in these indications.

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After the introduction of antibiotics in the mid-20th century, clinicians soon witnessed clinical failures secondary to bacterial resistance. Despite scientists' efforts to synthesize more potent antibiotics during the last five decades, bacterial resistance continues to evolve, in large part because of the overuse and misuse of antibiotics. The treatment of several pathogens, including methicillin-resistant Staphylococcus aureus, penicillin-resistant Streptococcus pneumoniae and vancomycin-resistant enterococci, is problematic. New solutions are needed to preserve the activity of our current antibiotic armamentarium, to lower the overall risk of bacterial resistance and to successfully treat patients with resistant bacterial infections. Options include: development of new antibiotics to treat resistant organisms; vaccination to prevent infections; and improved use of antibiotics. Because bacteria will eventually develop means to avoid being killed by antibiotics, judicious use of antibiotics by all clinicians is imperative. Appropriate antibiotic use involves selection of a "targeted spectrum" antibiotic, as well as an appropriate dose and duration.

HMPV was detected in 9% of high-risk children who were hospitalized with lower respiratory tract disease, representing the second most common virus in this population. Compared with all other subjects (including RSV-infected), subjects infected with HMPV were older but were born more prematurely.

The disposition of ABLC in neonates was similar to that observed in other age groups: weight was the only factor that influenced clearance. Based on these results and previously published safety and efficacy data, we recommend a daily dosage between 2.5 and 5.0 mg/kg for treatment of invasive Candida infections in neonates.Invasive Candida infections are important causes of infectious morbidity and mortality in premature neonates (10,34,36). The reported frequency in very-low-birth-weight infants, the neonatal population at highest risk, is as high as 20%, with a case fatality rate as high as 50% despite the best available treatment (33,41,43). Current therapeutic options with documented antifungal efficacy include amphotericin B deoxycholate (DAMB) alone or in combination with flucytosine, fluconazole, and the small liposomal formulation of amphotericin B (19,23,39). While treatment with DAMB is frequently limited by the compound's inherent nephrotoxicity (6), fluconazole, a generally well-tolerated, highly water-soluble, renally cleared drug, is not always active (40) and accurate dosing is difficult in very premature neonates that often display extreme variations in the extracellular fluid compartment and urinary output (42). Similarly, while liposomal amphotericin B appears to be well tolerated and effective (30,31), no pharmacokinetic data exist for neonates and dosing is therefore still determined by maximally tolerated dosages. For these reasons, there clearly is a need for improved, pharmacokinetically based antifungal therapies in neonates with invasive Candida infections.Amphotericin B lipid complex (ABLC) is a unique lipid formulation and is composed of dimiristoyl phosphatidylcholin/dimiristoyl phospatidylglycerol in a 1:1 molar ratio of lipid to amphotericin B and forms large ribbon-like structures. Following intravenous administration, ABLC is rapidly and efficiently taken up by cells of the mononuclear phagocytic system, mainly of the liver, spleen, and lungs, resulting in a larger volume of distribution (V) than that of conventional DAMB but a lower peak maximum concentration of the drug in the serum and lower values in the blood for the area under the concentration-time curve (25,27). Based on a series of large, open-label, noncomparative clinical trials (44, 46), ABLC was approved by the Food and Drug Administration for the treatment of adult and pediatric patients with invasive fungal infections who are intolerant of or refractory to DAMB therapy. In addition, a prospective, randomized multicenter trial in 231 patients Ն16 years of age with invasive Candida infections has demonstrated that a dosage of 5 mg/kg of ABLC was less nephrotoxic and as effecitve as DAMB at a dosage of 0.6 to 1.0 mg/kg of body weight (WT) (E. J.

MMRV was generally well tolerated and had comparable immunogenicity and overall safety profiles to MMR + V administered concomitantly. Long-term persistence of antibodies after receipt of MMRV is expected based on similar antibody titers against all 4 antigens 1 year postvaccination compared with recipients of MMR and V.