Acute purulent pericarditis was treated successfully in five children between 
the ages of 27 months and 11 1/2 years during the past 5 years. The responsible 
organism was Hemophilus influenzae, type b, in two cases and Meningococcus, 
Pneumococcus, and coagulase-positive Staphylococcus aureus in one case each. No 
primary source of infection could be identified in two patients. A high index of 
suspicion, combined with immediate echocardiograms and pericardiocentesis, led 
to the diagnosis. Immediate antibiotic therapy was instituted on the basis of 
the gram stain of the pericardial fluid. All five patients had a pericardial 
window established--four through subxyphoid approach and the fifth, because of a 
left pleural effusion, through a left thoracotomy. When the subxyphoid approach 
was used, sump drains were left for postoperative suction and irrigation. All 
five patients survived without sequalae during follow-up periods of from 18 
months to 5 years. We advocate an aggressive approach to the diagnosis and 
treatment of this problem. This report documents the safety, ease, and 
effectiveness of the subxyphoid approach as a means of drainage.