Urinary Infections of Children

The introduction of polymyxin B methane sulphonate (1961), ampicillin (1961), cephaloridine (1964), and nalidixic acid (1966) has successively narrowed the therapy gap in the treatment of severe chronic urinary infections in children caused by Gram-negative bacilli, though these gains have been partly offset by the marked increase during recent years in the percentage of strains resistant to ampicillin (R. J. Holt and G. T. Stewart, 1968, unpublished observations). Even so, the addition of these new drugs to the established urinary antibiotics and chemotherapeutics has still left a remainder of pathogenic Gram-negative bacilli resistant to the entire available range. Such resistant organisms quite frequently infect the type of case, complicated with congenital anatomical abnormalities, which constitutes a considerable proportion of the patients in this hospital with urinary infections. Gentamicin is an antibiotic derived from a species of Micromonospora purpurea (Weinstein et al., 1963) and isolated in the research laboratories of the Schering Corporation, New Jersey. Our experience with gentamicin in the treatment of severe systemic infections caused by Gram-negative bacteria (Newman and Holt, 1967) suggested that this antibiotic would be of use in the control of resistant urinary infections. This view was enhanced by our preliminary in vitro studies which showed that gentamicin was active in low concentrations against many strains of enterobacteria and pseudomonads sufficiently resistant to all other likely drugs to suggest that therapy with these agents would be clinically ineffective. Jao and Jackson (1964) have reported successful results in adults with urinary infections but little work has been done with gentamicin in children. We therefore report here the results of treatment of a series of such refractory cases with gentamicin.