The pharmacokinetic parameters of ceftazidime were assessed in six cystic fibrotic patients during eight courses administered for acute exacerbations of pulmonary infection. In order to assess the initial and steady state concentrations of ceftazidime at a dose of 35 mg/kg and to determine the levels found after a higher dose, each ten day course of ceftazidime consisted of eight doses of 35 mg/kg followed by 22 doses of 50 mg/kg, all administered at 8-hourly intervals. Samples of blood and sputum were collected following the 1st, 8th and 9th doses for ceftazidime assay. The mean peak serum concentrations of ceftazidime were 97, 110 and 147 mg/l respectively with corresponding mean concentrations in sputum of 2.7, 2.6 and 1.6 mg/l. The mean clearance rate was calculated on a two compartment model to be 197 ml/min/50 kg lean body mass, the mean volume of distribution was 281/50 kg lean body mass and the mean half life was 1.57 h. There were large inter-patient differences in the pharmacokinetic parameters, however, which suggests that the clinical condition of the patient affects the pharmacokinetics of ceftazidime in cystic fibrosis. In all the patients, even after the doses of 50 mg/kg, the trough serum concentrations were low. Samples of blood were also collected for adverse effects before, during and after each course; there was no evidence of renal, hepatic or haematological changes in response to the drug.

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SHORT REPORTS Brachial plexus neuropathy associated with human parvovirus infectionHuman parvovirus is a recognised cause of arthritis.' A recent report suggests that it may also cause brachial plexus neuropathy.2 We describe a patient who presented with both articular and neurological manifestations of infection.Case report A previously fit 23 year old nurse presented in January 1986 with pain in both arms. Two weeks earlier she had noticed an erythematous rash which spread from the legs to the abdomen and arms but spared the upper trunk and face. Within hours she developed pain in the ankles and knees, and by 48 hours she had pain in the neck and shoulders, weakness of the arms, and numbness and dysaesthesia of the right forearm. There was no history of recent immunisations. She had in the past been immunised against poliomyelitis.On examination she was found to be alert with no fever or meningeal irritation. The rash was no longer apparent and the joints were normal. There was pronounced tenderness of both trapezius muscles, deltoids, and biceps and severe weakness of shoulder abduction. Both biceps reflexes and the left supinator reflex were reduced. An area of sensory loss was detected over the radial border of the right forearm.Full blood count, erythrocyte sedimentation rate, biochemical profile, blood glucose concentration, and serum creatine kinase activity were normal. An autoimmune profile was negative and no circulating immune complexes were detected. Cerebrospinal fluid contained normal amounts of cells and protein.Electromyography showed severe denervation in deltoid, supraspinatus, and infraspinatus muscles bilaterally. The The pain resolved within four weeks but severe wasting of both deltoids and the left supjaspinatus and infraspinatus and right biceps muscles occurred and the biceps and supinator reflexes were completely lost. Six months later wasting and weakness had improved and sensory loss had recovered. CommentAcute neuropathy of the brachial plexus (neuralgic amyotrophy) is characterised by the sudden onset of pain around the shoulder girdle followed by weakness and wasting of periscapular and arm muscles. Sensory impairment is common. Complete recovery taking up to three years is the rule.3 An association with various inoculations, infections, and surgical procedures has been described.3Viraemia due to human parvovirus was first described in 1975, and the virus has subsequently been incriminated as a cause of aplastic crises in people with various chronic haemolytic anaemias, of erythema infectiosum, and of arthralgia or arthritis.45 There have been no reports of neurological illness other than brachial plexus neuropathy due to parvovirus in man.Our patient showed serological evidence of recent parvovirus infection coincident with the development of brachial plexus neuropathy. There was also evidence of adenovirus infection occurring between the two tests; adenovirus, however, have rarely been implicated as a cause ofarthralgia and never as a cause of brachial plexus neuropathy, nor did...