High plasma urea concentration in babies with lamellar ichthyosis.

Sir, Guiscafre et al have reported two cases of meningitis due to Haemophilus influenzae type b tesistant to ampicillin and chloramphenicol.' In their report they say 'since 1980 eight cases of meningitis. have been reported'. This is not true. In previous reports we have drawn attention to the explosive increase of multiply resistant strains of H. influenzae type b causing invasive and non-invasive infections in Spain.' From January 1981 to December 1984 we have seen over 364 consecutive cases of culture proved bacterial meningitis, 35 of which (9-6'%0) were caused by H. influenzae type b. In 20 cases (57'%o) strains were found to be resistant to ampicillin and chloramphenicol. As this problem has also been described in other parts of Spain we arc led to the conclusion that in our country resistance of H. influenzae b to ampicillin and chloramphenicol could be endemic. Uncontrolled and widespread use of antibiotics in Spain over many years played a role it the emergence of these multiply resistant strains. We cannot use ampicillin and chloramphenicol as initial treatment ol meningitis caused by H. influenzae b and we are currently using cefotaxime as the treatment of choice until susceptibility tests become available. The report from Mexico, like others, remind us of the possibility of emergence of strains resistant to both antibiotics in every country.