Antibiotic treatment of children with community‐acquired pneumonia: Comparison of penicillin or ampicillin versus cefuroxime

Dinur-Schejter, Yael; Cohen‐Cymberknoh, Malena; Tenenbaum, Ariel; Brooks, Rebecca; Averbuch, Diana; Kharasch, Sigmund; Kerem, Eitan

doi:10.1002/ppul.22534

Cited by 17 publications

(20 citation statements)

References 33 publications

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“…Clinical outcomes for children 2 months-18 years hospitalized with CAP were identical for narrow (ampicillin/penicillin) and broad-spectrum (2nd or 3rd generation cephalosporin) IV antibiotics, according to 3 large retrospective series. Primary outcomes were several clinical parameters, such as days of IV treatment, days of oxygen requirement days of hospitalization, and readmission rates [52][53][54]. This has been confirmed in prospective randomized observational studies in pediatric patients with proven lobar pneumonia looking at clinical, laboratory and radiological outcomes (penicillin vs. cefuroxime) [55].…”

Section: Industrialized Country Studiesmentioning

confidence: 74%

Childhood community-acquired pneumonia: A review of etiology- and antimicrobial treatment studies

Tramper-Stranders

2018

Paediatric Respiratory Reviews

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Community acquired pneumonia (CAP) is a leading cause of childhood morbidity worldwide. Because of the rising antimicrobial resistance rates and adverse effects of childhood antibiotic use on the developing microbiome, rational prescribing of antibiotics for CAP is important. This review summarizes and critically reflects on the available evidence for the epidemiology, etiology and antimicrobial management of childhood CAP. Larger prospective studies on antimicrobial management derive mostly from low- or middle-income countries as they have the highest burden of CAP. Optimal antimicrobial management depends on the etiology, age, local vaccination policies and resistance patterns. As long as non-rapid surrogate markers are used to distinguish viral- from bacterial pneumonia, the management is probably suboptimal. For a young child with signs of non-severe pneumonia (with or without wheezing), watchful waiting is recommended because of probable viral etiology. For children with more severe CAP with fever, a five-day oral amoxicillin course would be the first choice therapy and dosage will depend on local resistance rates. There is no clear evidence yet for superiority of a macrolide-based regimen for all ages. For cases with CAP requiring hospitalization, several studies have shown that narrow-spectrum IV beta-lactam therapy is as effective as a broad-spectrum cephalosporin therapy. For most severe disease, broad-spectrum therapy with or without a macrolide is suggested. In case of empyema, rapid IV-to-oral switch seems to be equivalent to prolonged IV treatment.

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Section: Industrialized Country Studiesmentioning

confidence: 74%

Childhood community-acquired pneumonia: A review of etiology- and antimicrobial treatment studies

Tramper-Stranders

2018

Paediatric Respiratory Reviews

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“…Since most of the cases of NP in children are caused by S. pneumoniae , the antibiotic treatment of choice should be intravenous high dose penicillin or ampicillin and this remains the guideline in our centre. Nevertheless, the empirical antibiotic choice on admission consisted of penicillin in only three cases whereas the other three patients received cephalosporins (Cefuroxime or Ceftriaxone).…”

Section: Discussionmentioning

confidence: 99%

Giant lung cysts following necrotizing pneumonia: Resolution with conservative treatment

Gross

Gordon

Cohen‐Cymberknoh³

et al. 2019

Pediatric Pulmonology

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Rationale Necrotizing pneumonia is characterized by destruction and liquefaction of the lung tissue and loss of the normal pulmonary parenchymal architecture. During the course of resolution areas of hyperlucency are formed, sometimes with the development of giant lung cysts that can be a field with fluid resembling lung abscess. There is no consensus on the management of these abnormalities. Objective To assess the prevalence of giant lung cysts as a complication of necrotizing pneumonia and to report our experience with conservative treatment that achieved complete resolution. Methods Medical chart reviews of all children aged 0 to 18 years hospitalized with necrotizing pneumonia in a single tertiary center from 2015 to 2017, demographic data, and clinical course during and after hospitalization as well as serial chest imaging were collected. Results During the study period, 761 children were diagnosed with community‐acquired pneumonia, 16 of 761 (2.3%) had necrotizing pneumonia and 6 of 16 (37.5%) with necrotizing pneumonia complicated by a giant lung cyst or lung abscess. All were closely observed and showed complete clinical and radiographic resolution with antibiotic treatment. Conclusions Treatment of giant lung cyst formation following necrotizing pneumonia by a conservative approach with prolonged antibiotics results in complete recovery with no need for invasive procedures.

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“…Although some studies suggest that penicillins are as effective as broad-spectrum antibiotics for empiric treatment of CAP due to S pneumoniae, few studies have directly compared the 2 regimens. 4,[6][7][8] Evidence showing the effectiveness of narrow-spectrum antibiotic therapy has the potential to improve adherence to the national guideline and minimize the development of bacterial resistance. The objective of this study was to compare the effectiveness of empiric therapy with narrowspectrum antibiotics with empiric therapy with broad-spectrum antibiotics in children hospitalized with uncomplicated CAP.…”

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confidence: 99%

Comparative Effectiveness of Empiric Antibiotics for Community-Acquired Pneumonia

Queen¹,

Myers

Hall

et al. 2014

Pediatrics

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BACKGROUND AND OBJECTIVE: Narrow-spectrum antibiotics are recommended as the first-line agent for children hospitalized with community-acquired pneumonia (CAP). There is little scientific evidence to support that this consensus-based recommendation is as effective as the more commonly used broad-spectrum antibiotics. The objective was to compare the effectiveness of empiric treatment with narrow-spectrum therapy versus broad-spectrum therapy for children hospitalized with uncomplicated CAP. METHODS: This multicenter retrospective cohort study using medical records included children aged 2 months to 18 years at 4 children's hospitals in 2010 with a discharge diagnosis of CAP. Patients receiving either narrow-spectrum or broad-spectrum therapy in the first 2 days of hospitalization were eligible. Patients were matched by using propensity scores that determined each patient’s likelihood of receiving empiric narrow or broad coverage. A multivariate logistic regression analysis evaluated the relationship between antibiotic and hospital length of stay (LOS), 7-day readmission, standardized daily costs, duration of fever, and duration of supplemental oxygen. RESULTS: Among 492 patients, 52% were empirically treated with a narrow-spectrum agent and 48% with a broad-spectrum agent. In the adjusted analysis, the narrow-spectrum group had a 10-hour shorter LOS (P = .04). There was no significant difference in duration of oxygen, duration of fever, or readmission. When modeled for LOS, there was no difference in average daily standardized cost (P = .62) or average daily standardized pharmacy cost (P = .26). CONCLUSIONS: Compared with broad-spectrum agents, narrow-spectrum antibiotic coverage is associated with similar outcomes. Our findings support national consensus recommendations for the use of narrow-spectrum antibiotics in children hospitalized with CAP.

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Antibiotic treatment of children with community‐acquired pneumonia: Comparison of penicillin or ampicillin versus cefuroxime

Abstract: In previously healthy children, parenteral penicillin or ampicillin for treatment of non-complicated CAP in-hospital is as effective as cefuroxime, and should remain the recommended first-line therapy.

Cited by 17 publications

References 33 publications

Childhood community-acquired pneumonia: A review of etiology- and antimicrobial treatment studies

Childhood community-acquired pneumonia: A review of etiology- and antimicrobial treatment studies

Giant lung cysts following necrotizing pneumonia: Resolution with conservative treatment

Comparative Effectiveness of Empiric Antibiotics for Community-Acquired Pneumonia

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