Treatment of anaerobic infections in children with metronidazole

The tolerance and efficacy of metronidazole were studied in 15 pediatric patients who had anaerobic infection. 5 had soft tissue abscess, 4 had aspiration pneumonia, 3 had intracranial abscess and 3 had chronic sinusitis. 45 bacterial isolates were recovered (3 isolates per patient). 40 were anaerobes and included 17 Bacteroides sp. (8 sp.), 16 anaerobic cocci and 6 Fusobacterium nucleatum. Metronidazole was given intravenously at the dose of 30 mg/kd/day or orally in the dose of 40-50 mg/kg/day. The length of therapy was between 14 and 52 days (average 26 days). 7 of the patients received initial parenteral therapy for 5-21 days (average 11.6 days), and subsequently received oral therapy. The minimal inhibitory concentration of 38 of the 41 anaerobic isolates (93%) was equal or less than 2 micrograms/ml. The mean peak concentration of metronidazole on the third day of therapy was 24.2 micrograms/ml range 15.2-30 micrograms/ml) and the mean trough was 7.2 micrograms/ml (range 4-11.6 micrograms/ml). No local or systemic adverse reaction as noted. A good response to therapy with a complete cure occurred in 14 of the 15 children. A fair response was achieved in 1 patient. Metronidazole appears to be effective and safe in the treatment of serious anaerobic infection in children.