Ghorashi et al. Journal of Medical Case Reports 2011, 5:241 http://www.jmedicalcasereports.com/content/5/1/241 Page 3 of 4 Figure 2 Chest X-ray obtained on the seventh day of oral anti- biotic therapy. The lytic lesions in the proximal and distal metaphysis in the right humerus are shown. Figure 3 Chest X-ray showing complete resolution of symptoms at the end of anti-biotic therapy. treatment of K. pneumoniae [11], but reports of highly resistant strains that produce plasmid-mediated, extended-spectrum b-lactamases influenced therapeutic outcomes again [12]. Evidence revealed that K. pneumo- niae infection, especially the nosocomial type, is resis- tant to the majority of antibiotics except for ciprofloxacin and ofloxacin [13]. In the present case report, the isolated K. pneumoniae was resistant to most of the antibiotics except ciprofloxacin and co-trimoxa- zole. Therefore, these two antibiotics were used in the treatment protocol. Because of the quinolone cartilage toxicity potential in experimental juvenile animal mod- els, the use of ciprofloxacin among children has been restricted [13,14]. However, recent data from Bayer’s ciprofloxacin clinical trials database indicate that the role of fluoroquinolones in the treatment of certain ser- ious infections in children does not appear to be com- promised by safety concerns when used appropriately [15]. In such cases, when a micro-organism is resistant to all antibiotics except ciprofloxacin, a dosage of 15 mg/kg/day to 30 mg/kg/day is advised in neonates [16]. After completion of the treatment course, our patient completely improved and achieved normal developmen- tal milestones and weight gain, without adverse effects or hospital readmission during three years of follow-up. Conclusion In neonates with delivery problems, prematurity, low birth weight and prolonged hospital admission, nosoco- mial K. pneumoniae should be considered in the differ- ential diagnosis of septicemia, arthritis, osteomyelitis and meningitis. Considering the multi-drug resistance of nosocomial K. pneumoniae and sensitivity to quinolones, ciprofloxacin, when used appropriately, should be con- sidered a therapeutic option with good outcomes in patients with serious infections with resistant strains of K. pneumoniae, even in neonates and infants. Consent Written informed consent was obtained from the patient’s next-of-kin for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Abbreviations CSF: cerebrospinal fluid; MDR: multi-drug-resistant. Acknowledgements The authors acknowledge the parents of the patient for their collaboration and consent. Author details 1Department of Pediatrics, Tabriz University (Medical Sciences), Tabriz, Iran. 2Drug Applied Research Center, Tabriz University (Medical Sciences), Tabriz, Iran. 3Young Researchers Club, Tabriz Branch, Islamic Azad University, Tabriz,