Twenty patients with severe infection, 10 of the urinary tract and the other 10 of the respiratory tract, were enrolled in a clinical trial of aztreonam, a new monobactam antimicrobial agent. For the urinary tract infections, the mean duration of treatment was 7 days, with doses ranging from 0.25 to 1.0 g aztreonam intravenously twice daily. Sustained clinical and microbiological cure was achieved in 9 of the 10 patients. In the group with respiratory infections, the mean duration of treatment was 9.3 days, patients receiving 1 g aztreonam intravenously 3-times daily. Initial clinical cure was achieved in 9 of the patients, the tenth showing an incomplete response. However, bacteriological recurrence, related to the persistent nature of the underlying disease, occurred in 6 of the 10 patients during the 1-month follow-up period. The only side-effects were mild, transient biochemical abnormalities which did not require drug withdrawal in any patient.