Cefuroxime therapy for bacteremic soft-tissue infections in children.

Although it is used extensively in Europe, there is a limited amount of published data concerning pediatric clinical experience with cefuroxime in the United States. Thirty-six children, ranging from 3.5 to 57 months of age, received intravenous cefuroxime (75 mg/kg/day in three divided doses) for soft-tissue infections of the face or epiglottis. Infections treated included preseptal (19 patients) and buccal (13 patients) cellulitis and epiglottitis (four patients). Blood cultures were positive in 22 patients, yielding Haemophilus influenzae type b in 17 (four were beta-lactamase-positive), Streptococcus pneumoniae in four; and beta-lactamase-positive, nontypable H influenzae in one. An additional five patients with buccal cellulitis had negative blood cultures but H influenzae type b antigenuria. A satisfactory clinical response was noted in all patients, and repeated blood cultures performed in initially bacteremic patients were sterile. Cefuroxime therapy was well tolerated, and abnormal laboratory results were infrequent, except for absolute granulocytopenia (granulocytes, less than 1,500/cu mm), which occurred in six patients but could not be ascribed to a drug effect because of the uncontrolled design of our study. Treatment with cefuroxime appears to be a safe and effective therapy for pediatric soft-tissue infections due to H influenzae and S pneumoniae.