The aim of this study was to assess the necessity of routine contrast administration in brain magnetic resonance imaging (MRI) of pediatric outpatients referred for workup of chronic headache. A retrospective review of consecutive pediatric brain MRI examinations in 30 pediatric outpatients referred for evaluation of chronic headache was done. Independent review was performed by two certified neuroradiologists. The raters reviewed each MRI first as a non-contrast examination (without seeing the post-contrast images) and then with post-contrast images. No abnormalities were found in six patients. One patient had an indeterminate finding of a tubular cerebellar lesion requiring follow-up. In the remaining patients, the findings were subclinical and included: mucosal thickening in the paranasal sinuses, cystic changes of the pineal gland, small developmental venous anomalies, non-specific FLAIR hyperintensities, opacification of the mastoids, and telangiectasia. The subclinical cases that were missed on pre-contrast images were: one small developmental venous anomaly, one telangiectasia and one small pineal cyst, none of which hold clinical significance. Authors concluded that there seems to be little reason to medically justify routine use of intravenous contrast administration to evaluate a brain MRI of pediatric patients referred for chronic headache.

Many preschool　children　develop recurrent, severe episodes of lower respiratory tract illness (LRTI). This randomized double-blind placebo-controlled trial, conducted across 9 US medical centers, evaluated whether early administration of azithromycin, started prior to the onset of severe symptoms, in preschool　children　with recurrent severe LRTIs can prevent the progression of these episodes. Participants were 607 children　aged 12 through 71 months with histories of recurrent, severe LRTIs and minimal day-to-day impairment. Participants were randomly assigned to receive azithromycin (12 mg/kg/d for 5 days) or placebo started early during each predefined respiratory tract infection (RTI) .The primary outcome measure was the number of RTIs not progressing to a severe LRTI. Presence of azithromycin-resistant organisms in oropharyngeal samples, along with adverse events, were among the secondary outcome measures. Azithromycin significantly reduced the risk of progression to severe LRTI relative to placebo. Induction of azithromycin-resistant organisms and adverse events were infrequently observed. It was concluded that among young　children　with histories of recurrent severe LRTIs, the use of azithromycin early during an apparent RTI compared with placebo reduced the likelihood of severe LRTI. More information is needed on the development of antibiotic-resistant pathogens with this strategy.