The use of quinolones in children and accumulation of data on the pharmacodynamics of these drugs have been limited and delayed by concern regarding their chondrotoxicity. A comprehensive review of the findings in animals compared with the cumulative published findings in children and adolescents (>7,000 to date) allows the conclusion that such concern is not justified. Prospective controlled studies in children are justifiable in view of a continuing lack of correlation between findings in juvenile animals and those in children and because of the selected therapeutic advantages of the current and newer quinolones.

Pneumococcal otogenic meningitis is a rare postsurgical complication that can develop following stapedectomy or after cochlear implantation. The bacterial infection can be fatal in some instances. A recent increase in the incidence of otogenic meningitis among cochlear implant wearers is of concern. The majority of meningitis cases are associated with a 2-component electrode manufactured by one cochlear implant company. The device with the added ‘positioner’ component has been withdrawn from the market (FDA Public Health Web Notification: Cochlear Implant Recipients may be at Greater Risk for Meningitis, Updated: August 29, 2002, www.fda.gov/cdrh/safety/cochlear.html). Not all cases have been subsequent to otitis media and symptoms have developed from less than 24 h up to a few years after implantation. The purpose of this paper is to review and discuss the pathogenesis, pathology/bacteriology and to elaborate on some clinical features of otogenic meningitis in implanted children and adults. Essential aspects of surgery, electrode design, and cochleostomy seal are discussed. Conclusions are drawn from the available data and recommendations are made for good practice in cochlear implantation and follow-up.

These data suggest that a possible link between some cases of SIDS and infection with P. carinii should be further evaluated and that infection of young infants may serve as an important reservoir for human P. carinii.

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