Development of a clinical prediction model for an ordinal outcome: the World Health Organization Multicentre Study of Clinical Signs and Etiological agents of Pneumonia, Sepsis and Meningitis in Young Infants. WHO/ARI Young Infant Multicentre Study Group.

This paper describes the methodologies used to develop a prediction model to assist health workers in developing countries in facing one of the most difficult health problems in all parts of the world: the presentation of an acutely ill young infant. Statistical approaches for developing the clinical prediction model faced at least two major difficulties. First, the number of predictor variables, especially clinical signs and symptoms, is very large, necessitating the use of data reduction techniques that are blinded to the outcome.

Bacterial meningitis: is there a "best" antimicrobial therapy?

The introduction of several cephalosporins into pediatric practice has provided the physician with a number of choices in the treatment of neonatal and childhood meningitis. Adequate studies are available to indicate that these new drugs are as effective as traditional treatments in terms of survival and major neurologic sequelae but it is not known whether the results are worse or better as far as the incidence of more subtle neurologic changes is concerned. The advantages of the cephalosporins in treatment of childhood meningitis are that they permit single drug therapy, the risks of drug toxicity are reduced, and the problems of penicillin-tolerant pneumococci and ampicillin/chloramphenicol-resistant H.

Some aspects of the diagnosis and management of urinary tract infection in children and adolescents.

While areas of disagreement continue to exist about certain details related to the diagnosis and treatment of UTI, it is possible to devise reasonable approaches to these problems that can be shown to be effective and do not harm the patient on a short or long term basis.

The cephalosporin antibiotics in pediatric therapy.

The cephalosporins have been available for clinical use for nearly 20 years and a large number is presently marketed, including drugs with a wide range of different pharmacokinetic and microbiologic properties. While some of these agents have certain specific uses in which they excel, the cephalosporins have not replaced older antibiotics but do provide the physician with a broader range of choices for the treatment of many infections, allowing greater individualization of therapy.

Developments in diagnosing and treating otitis media.

Acute otitis media is commonly caused by pneumococcus and Hemophilus influenzae. Amoxicillin is recommended as the initial therapy when the causative agent has not been identified. If amoxicillin is ineffective, cefaclor is useful.

Antibiotic drug therapy in the newborn.

The use of antimicrobial agents in newborn infants has always been fraught with uncertainty. Because of the immature excretory and/or metabolic process of infants, it was recognized that detailed pharmacokinetic studies were necessary before these drugs could be used safely and effectively in young infants, but it was only with experience that it became obvious that toxicity remained relatively unpredictable. Babies were found to be more resistant to certain types of adverse reactions (eg, renal damage by aminoglycosides, bacitracin, methicillin, etc) but more susceptible to others (sulfonamides, chloramphenicol, tetracyclines, nitrofurantoin, and so forth).