Oral preparations of cephalosporins are often prescribed for the treatment of otitis media in children. These drugs are usually recommended after failure of therapy with other antibiotics.1 However, many practitioners began treatment of otitis with cefaclor (Ceclor) or cephalexin monohydrate (Keflex). Both cephalexin and cefaclor have a pleasant taste and are effective against common middle ear pathogens including most strains of Haemophilus influenzae and Staphylococcus aureus. Cefaclor is more effective than ampicillin against β-lactamase-producing H influenzae strains.
An objection to the use of oral cephalosporins in infants and young children is their poor penetration of the blood-brain barrier, resulting in a low drug concentration in the CSF. We report a case of pneumococcal meningitis in a child who was receiving cefaclor and a case of H influenzae meningitis in a child who was receiving cephalexin therapy.
Report of Cases.—Case 1.—A 6-month-old boy was brought to his pediatrician