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SUMMARY Two infants with nephrotic syndrome who developed penicillin resistant pneumococcal peritonitis while receiving penicillin chemoprophylaxis are reported and the problems associated with prophylaxis against pneumococcal infection discussed. It is suggested that penicillin prophylaxis may be hazardous in an environment in which penicillin resistant pneumococci are prevalent.Children with nephrotic syndrome are at an increased risk of developing peritonitis due to Streptococcus pneumoniae. The depressed immune state caused by the nephrotic syndrome is due to decreased serum concentrations of immunoglobulins' and impaired opsonisation,2 cellular immunity,3 and granulocyte chemotaxis.2 Prophylaxis against pneumococcal infection may be attempted with pneumococcal polysaccharide vaccine or with oral penicillin. We report two children with nephrotic syndrome who developed penicillin resistant pneumococcal peritonitis while receiving prophylaxis with oral penicillin. S penumoniae was identified as an a-haemolytic streptococcus sensitive to optochin. Antibiotic sensitivity testing of this organism was performed on 5% sheep blood agar by the Kirby-Bauer disc diffusion method. Penicillin resistance was defined by a zone of inhibition smaller than 20 mm around a 5 ,tg methicillin disc. Case reports CASE 1A 2 month old black boy with histologically confirmed Finnish type congenital nephrotic syndrome was given oral prophylaxis with phenoxymethyl penicillin (62.5 mg twice daily) and co-trimoxazole (2 mg/kg daily of trimethoprim). One week after discharge he was readmitted with vomiting and abdominal distension. Examination showed that his systolic blood pressure was 40 mm Hg and pulse rate was 120/minute. He had poor peripheral perfusion and generalised oedema. Abdominal examination showed ascites, and the liver and spleen edges were palpable 2-5 cm and 1 cm, respectively, below the right and left costal margins. The heart was normal and the lung fields were dull to percussion at both bases. There was neck retraction, a bulging anterior fontanelle, and hypertonia.