Ninety patients (41 males, 49 females) with a diagnosis of meningitis, urinary tract infection (UTI), gastroenteritis or other miscellaneous gram-negative infections were enrolled. Their ages ranged from 7 days to 10 years, with a mean age of 4 months. 58 (63%) patients had an etiology confirmed by either positive culture (52; 89%) or latex agglutination (6; 10%). 41 of these patients had meningitis diagnosed by positive CSF culture (38) or by positive CSF latex agglutination (3); 27/41 patients also had positive blood cultures. Aztreonam MIC100 for 27 isolates of Haemophilus influenzae, all ampicillin-sensitive, was 0.19 μg/ml; 4 Salmonella sp., 1 Neisseria meningitidis and 1 Serratia marcescens isolates were inhibited by 0.19 μg/ml, and the MIC100 for 2 Klebsiella pneumoniae, 1 Proteusvulgaris and 2 Pseudomonas aeruginosa isolates were 0.045 and 0.19, 0.022 and 12.5 ∣ig/ml, respectively. Bacteriologic cures were effected in 37/38 (97%) patients with meningitis, 8 (100%) with UTI and 6 (100%) with other gram-negative infections. Bacteriologic failure occurred in 1 patient with P. vulgaris (aztreonam MIC/MBC 0.006/0.011 μg/ml), who died. Bacteriologic relapse occurred in 3 patients: 1 with P. aeruginosa (aztreonam MIC/MBC 12.5/12.5 u, g/ml; corresponding aztreonam CSF level 5 μg/ml) was successfully treated with other antibiotics; 1 with H. influenzae (MIC/MBC aztreonam 0.022/0.045 μg/ml) relapsed after a course of aztreonam and a subsequent course of ampicillin and Chloromycetin, also experienced a relapse on ampicillin and chloramphenicol, had a negative CT head scan, mastoid, and long-bones film and was ultimately cured with another course of parenteral ampicillin; 1 with K. pneumoniae was malnourished (MIC/MBC aztreonam 0.19/0.19 μg/ml) and relapsed after a week off therapy despite initial CSF sterilization after 24 h of therapy. Additional clinical failures occurred in 2 patients with Salmonella sp. (aztreonam MIC 0.09 μg/ml) who died 3–5 days into treatment (they both were ill for more than 19 days prior to aztreonam treatment). Peak aztreonam serum levels ranged from 12.4–104 μg/ml (mean 44 μg/ml); CFS levels ranged from 3–52 μg/ml (mean 15.6 u.g/ ml). Overall, 52 (94%) patients were clinically cured, and of these, 48 (92%) were bacteri-ologic cures. There were no clinically significant adverse effects secondary to aztreonam use. Aztreonam appears safe and effective in the treatment of pediatric gram-negative infections.
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