The use of sulfomethate sodium colistin for the treatment of infections caused by multiple drug resistant (MDR) Gram-negative microorganisms were studied in a burn unit to evaluate the safety of this drug. A prospective chart review of pediatric patients treated with intravenous colistin in a tertiary burn unit between January 2005 and December 2006 was performed. Forty-five courses of intravenous colistin treatment administered to 45 children were evaluated in the study period. Fourteen patients (31%) were infected by Pseudomonas aeruginosa spp and 20 patients (44.5%) by Acinetobacter spp and an association of both bacteria was found in six patients (13.5%).The mean age of the patients was 52 months (range, 2 to 168 months), and 28 patients (62%) were men. The percentage of burnt body surface was between 9 and 87% (mean, 38%). Forty patients (89%) were infected by MDR organisms. Colistin was empirically indicated in five patients (11%) with burn wound sepsis 7 days after admission to the unit despite negative cultures. Burn wound sepsis was the most frequent focus of infection in 19 patients (42%). In 14 patients (31%), burn wound infection occurred without sepsis. Intravascular catheter-related bacteremia occurred in three patients (7%) and bacteremia in one (2%). Three patients had pneumonia (7%), three osteomyelitis (7%), and two urinary tract infection (4%).The length of treatment with colistin was between 3 and 92 days (median, 21 days). Only one patient (2%) died for reasons other than infection. None of the children developed increases in serum creatinine concentrations or neurological complications during treatment with colistin. Colistin seems to be a safe drug in selected cases of infections with MDR Gram-negative microorganisms. Further studies are needed to confirm these results.

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In this series of burn children age ≤ 4 years, Garces index score 4, colistin use in documented multiresistant infections, mechanical ventilation and graft requirement were identified as independent variables related with mortality.

Osteoarticular infection is unusual in the neonate; however it is associated with an elevated incidence of sequelae. This mandates for a high degree of suspicion to diagnose this potentially disabling entity.

Since the introduction of amphotericin B as an antifungal agent, the morbidity and mortality of pediatric patients with mycotic infections have increased, primarily because of the increased immunocompromised patients. Despite the fact that deoxycholate amphotericin B was once the primary drug used for mycotic infections, its administration to children older than neonates is currently controversial because of its nephrotoxic effects. Three lipid-associated formulations have been developed and have reportedly shown similar efficacy and fewer nephrotoxic effects in adults than conventional amphotericin B, but the conclusions from comparative studies in children evaluating the nephrotoxicity risks of the 4 agents are controversial. Nevertheless, guidelines favor liposomal or lipid complex amphotericin B when polyene antifungal therapy is recommended in this age group. However, high acquisition costs often preclude their prescription in economically poor regions. Thus, physicians must consider all of these factors when determining the most cost-effective polyene antifungal treatment for their pediatric patients. This is particularly pertinent in developing countries where resources are scarce. Adjuvant sodium supplementation has been reported to be effective in protecting kidney function in extremely low birth weight infants prescribed deoxycholate amphotericin B. Further pharmacokinetic and pharmacodynamic studies of the drug in children could also provide information for rational dosing regimens designed to decrease nephrotoxicity. Conventional amphotericin B, with appropriate kidney protective measures, still plays a role in the treatment of empiric invasive mycotic infections in most pediatric patients. Liposomal and lipid complex amphotericin B should be reserved for those receiving long-term nephrotoxic agents or with altered renal function or disease. Antifungal susceptibility, renal compromise and the clinical status of the patient should determine treatment for culture-proven infections. Under the current cost limitations, undertaking and evaluating low-cost, kidney-sparing, deoxycholate amphotericin B treatments for children should be a primary concern.