Use of pefloxacin after failure of initial antibiotic treatment in children with severe salmonellosis.

Sixteen children (7 males, 9 females) aged 0.1 to 9.5 years (mean 3.6 years) who were hospitalized for severe salmonella infection were treated with conventional antibiotics. In nine children disappearance of fever and bloody diarrhea was obtained 2 to 4 days after the beginning of antibiotic therapy. Although the antibiotic administered was active against the pathogen, after 4 to 8 days the seven other children experienced clinical failure of the initial therapy, with a temperature of over 39 degrees C, bloody diarrhea and positive stool culture in all cases. The seven Salmonella strains isolated (1 S. typhi, 1 S. paratyphi B, 2 S. enteritidis, 3 S. typhimurium) were all sensitive to ampicillin, cotrimoxazole and pefloxacin. These seven children were then given 12 mg/kg/day of pefloxacin orally for 7 days. Apyrexia and complete resolution of diarrhea were obtained within 1 to 3 days in all cases without side effects. Trials are needed to determine the safety and toxicity of quinolones in children, however short-term therapy with pefloxacin could be useful in children with severe invasive salmonellosis after failure of conventional antibiotic therapy.