Pharmacokinetics and pharmacodynamics of meropenem in children with severe infection.

This study aimed to describe the pharmacokinetic (PK) characteristics of meropenem in children with severe infections and to assess the pharmacokinetic/pharmacodynamic (PK/PD) profiles of various meropenem dosage regimens in these patients. Fourteen children with severe infections received intravenous (i.v.) bolus doses of meropenem (20 mg/kg/dose) every 8 h (q8h). Serum samples were obtained before and serially after the second dose of meropenem, and a population PK analysis was performed. The final model was used to simulate serum concentration-time profiles with various dosage regimens. The PK/PD target was to achieve a serum meropenem concentration higher than the minimum inhibitory concentration (MIC) of the causative organism (i.e. Pseudomonas aeruginosa and Enterobacteriaceae) for ≥40% of the dosing interval (40%T>MIC). The median age and weight of the children were 6.0 years and 20.0 kg, respectively. Meropenem serum concentration-time profiles were best described by a two-compartmental model with first-order elimination. The simulations showed that the probabilities of target attainment (PTAs) for organisms with an MIC of 1 mg/L were 0.678 and 1.000 following i.v. bolus and 3-h infusion of meropenem (20 mg/kg/dose), respectively. Using a 3-h infusion of a 20 mg/kg/dose, the PTA was 0.999 and 0.765 for organisms with MICs of 4 mg/L and 8 mg/L, respectively. Meropenem given as i.v. bolus doses of 20 mg/kg/dose q8h appeared to be inadequate for PK/PD target attainment for organisms with an MIC of 1 mg/L. The simulations showed that meropenem administration via a 3-h infusion using the same dose improved the PTA.

An 8-year-old boy with severe disseminated Staphylococcus aureus infection.

We report an 8-year-old boy who developed high fever and low-back pain. He was diagnosed as having a paravertebral abscess with severe disseminated Staphylococcus aureus infection. He received intravenous antibiotics and drainage of the abscess. Afterwards, he developed thrombosis, endocarditis and empyema thoracis. He received further intravenous antibiotics and proper drainages for his conditions. He eventually recovered well. This case highlights the need for rapid diagnosis and appropriate treatment of severe S aureus infection to prevent serious complications.

Unusual manifestations of Epstein-Barr virus infection in an 8-month-old male infant.

Severe acute hepatitis is a rare complication of Epstein-Barr virus (EBV) infection. The authors report a case of an 8-month-old male infant who presented with subacute fever and jaundice. The physical examination showed hepatosplenomegaly and ecchymoses on his abdomen, chest wall and extremities. He received vitamin K therapy and prednisolone, and he recovered well without further complications or sequelae. Although severe acute hepatitis is a rare complication of EBV infection, clinicians should recognise this condition in order to provide a prompt treatment.

Disseminated cryptococcosis in an HIV-positive boy.

Cryptococcosis is rare among children, only occurring in about 1% of children with HIV. We report the case of a 12-year-old boy with disseminated cryptococcosis. He had a history of recurrent pneumonia. He then developed meningeal symptoms and was found to have disseminated Cryptococcus neoformans by cerebrospinal fluid and bone marrow aspirate culture. He was treated with amphotericin B for 2 weeks (1 mg/kg/day), and then with fluconazole orally for 8 weeks (12 mg/kg/day). He also received a new diagnosis of HIV and was started on antiretroviral therapy 2 weeks after starting antifungal treatment. At follow-up 8 weeks later, he was doing well.

A 14-year-old girl with tuberculous otitis media and brain abscess.

Tuberculosis is a rare cause of chronic suppurative otitis media and mastoiditis. Intracranial complications are rare. The authors report a case of a 14-year-old girl with chronic otitis media of her right ear for 2 years. Her presentation was as follows: 10 days before admission she had a high fever, headache, alteration of consciousness and a generalised seizure. CT scanning of her brain showed right otomastoiditis with early brain abscess of the right cerebellum. She underwent right radical mastoidectomy and aspiration of the cerebellar abscess. The pus from the mastoid and cerebellar abscess was stained positive for acid-fast bacilli (AFB). The pus culture grew Mycobacterium tuberculosis (MTB). Her discharge diagnosis was tuberculous mastoiditis (TM) with cerebellar abscess. Long-term treatment plans included antituberculous drugs for 1 year.

A 12-day-old male newborn with extensive vesicles and fever.

Neonatal varicella infection is a rare condition since vaccine introduction. The authors report the case of a 12-day-old male who presented with a fever and generalised vesicular eruption. The patient's mother had varicella infection 1 day before delivery without treatment. The neonate initially did not receive prophylaxis or treatment. He subsequently was started on intravenous acyclovir and recovered without further complications or sequelae. Prompt diagnosis and treatment for maternal prenatal varicella infection is necessary to prevent infection in the newborn, and healthcare provider awareness to avoid nosocomial transmission.

A 3-year-old boy with kyphosis, back mass and weakness.

Spinal tuberculosis (TB) in children is uncommon. The authors report a case of a 3-year-old boy who was diagnosed with TB spondylitis. He presented to the hospital with a back mass, back pain and inability to walk. He failed to receive TB prophylaxis after having been in close contact to his mother who had pulmonary TB. He received incision and drainage and continued on anti-TB regimens without complications. At 4-month follow-up, he was able to stand and walk without assistance. It is important to carry out contact investigations and provide TB prophylaxis to children who have had a history of contacting TB index cases to prevent TB disease and serious complications of TB infection.

A 6-year-old boy with fever, rash and severe pneumonia.

The authors report a 6-year-old boy with fever, rash and cough. He was diagnosed with severe measles pneumonia and admitted to the paediatric intensive care unit with severe dyspnoea 8 days after symptom onset. He received intravenous antibiotics and high dose vitamin A. Three days later, he had recovered and was discharged home. He had not been vaccinated for measles, mumps and rubella according to the schedule. This case highlights the need for rapid diagnosis, appropriate treatment and determination of vaccination status of children with measles in order to prevent complications.