[Nicolau syndrome caused by penicillin preparations: review of the literature in search for potential risk factors].

The Authors, who in 1977 published the first Italian case report of the Nicolau syndrome (N.S.) from penicillin preparations in the pediatric field, accomplished a thorough search for similar reports in the world literature finding a total of 102 cases, of whom 80 were less than 12-year old. They made a detailed analysis of each case in that series in order to identify or better define potential risk factors or predisposing circumstances worth being taken in consideration for preventive purposes. Indeed, the possible occurrence of N.S., which may include devastating complications such as limb gangrene, paraplegia, or death and have medico-legal implications, is still largely underrated or unrecognised by both physicians and nurses. It is unfortunate in particular that no acknowledgement of that syndrome is available in the teaching programs and textbooks used in professional nurse schools; in addition physicians are not enough zealous in discouraging unqualified lified people as well as patient's relatives from performing intramuscular injections, mainly using certain kinds of drugs such as crystalline suspensions. On the basis of the findings of their analysis as well as of an overall review of the relevant literature the Authors conclude their paper by making a series of specific recommendations and/or proposals addressed to the various operators involved in the matter (prescribing physicians, managers of nursing schools, nurses, pharmaceutical companies, Regulatory Health Authority), with special emphasis on the precautionary measures to be taken in doing intramuscular injection of long-acting penicillins or other drugs in crystalline suspension.