Aztreonam therapy of gram-negative infections predominantly of the urinary tract in children

Twenty-two patients aged 3 weeks to 9 years (mean, 18 months) were enrolled in a study of the efficacy and safety of aztreonam for the treatment of gram-negative infections in children. Efficacy was evaluable in sixteen patients. Infections treated included urinary tract infections (13 patients), central line related sepsis (one patient), intraabdominal abscess (one patient), and pneumonia and bacteremia (one patient). Causative organisms included a variety of enteric gram-negative bacteria, Pseudomonas aeruginosa, and beta-lactamase producing Haemophilus influenzae type b. Clinical and microbiological cure was achieved in 15 of 16 patients (94%). One child with short bowel syndrome and malnutrition did not respond to aztreonam for in situ treatment of a central line infection. Two clinical side effects and 16 abnormal laboratory values possibly or probably related to aztreonam occurred in 12 of 22 patients (55%). All adverse reactions were mild and self-limited and none necessitated discontinuation of the drug. These findings suggest that aztreonam is effective and safe for the treatment of urinary tract infections in children and that aztreonam deserves further evaluation for therapy of other serious infections caused by gram-negative organisms.