Narrow- versus broad-spectrum parenteral antimicrobials against common infections of childhood: a prospective and randomised comparison between penicillin and cefuroxime

Vuori-Holopainen, Elina; Peltola, Heikki; Kallio, Markku

doi:10.1007/pl00008360

Cited by 38 publications

(20 citation statements)

References 35 publications

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“…There were no differences in outcomes (time to recovery, normalization of laboratory parameters, or treatment failure) between the 2 antibiotic treatment groups. 20 These small trials were conducted in regions with relatively low rates of pneumococcal resistance to penicillins compared with the United States or were not limited to CAP. Thus, their findings may not be directly applicable to children hospitalized with CAP in the United States.…”

Section: Discussionmentioning

confidence: 99%

Narrow Vs Broad-spectrum Antimicrobial Therapy for Children Hospitalized With Pneumonia

et al. 2013

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BACKGROUND: The 2011 Pediatric Infectious Diseases Society/Infectious Diseases Society of America community-acquired pneumonia (CAP) guideline recommends narrow-spectrum antimicrobial therapy for most children hospitalized with CAP. However, few studies have assessed the effectiveness of this strategy. METHODS: Using data from 43 children’s hospitals, we conducted a retrospective cohort study to compare outcomes and resource utilization among children hospitalized with CAP between 2005 and 2011 receiving either parenteral ampicillin/penicillin (narrow spectrum) or ceftriaxone/cefotaxime (broad spectrum). Children with complex chronic conditions, interhospital transfers, recent hospitalization, or the occurrence of any of the following during the first 2 calendar days of hospitalization were excluded: pleural drainage procedure, admission to intensive care, mechanical ventilation, death, or hospital discharge. RESULTS: Overall, 13 954 children received broad-spectrum therapy (89.7%) and 1610 received narrow-spectrum therapy (10.3%). The median length of stay was 3 days (interquartile range 3–4) in the broad- and narrow-spectrum therapy groups (adjusted difference 0.12 days, 95% confidence interval [CI]: –0.02 to 0.26). One hundred fifty-six children (1.1%) receiving broad-spectrum therapy and 13 children (0.8%) receiving narrow-spectrum therapy were admitted to intensive care (adjusted odds ratio 0.85, 95% CI: 0.27 to 2.73). Readmission occurred for 321 children (2.3%) receiving broad-spectrum therapy and 39 children (2.4%) receiving narrow-spectrum therapy (adjusted odds ratio 0.85, 95% CI: 0.45 to 1.63). Median costs for the hospitalization were $3992 and $4375 (adjusted difference –$14.4, 95% CI: –177.1 to 148.3). CONCLUSIONS: Clinical outcomes and costs for children hospitalized with CAP are not different when treatment is with narrow- compared with broad-spectrum therapy.

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Section: Discussionmentioning

confidence: 99%

Narrow Vs Broad-spectrum Antimicrobial Therapy for Children Hospitalized With Pneumonia

et al. 2013

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“…[II] 63 [II] 147 [II] 148 [II] 149 [II] 150 [II] 151 [II] 152 [II] Additionally, newer antibiotics such as levofloxacin153 [II] have shown efficacy in similar studies in the USA. Despite pharmacological differences in oral cephalosporins (cefaclor has an association with skin reactions but, compared with cefalexin, good activity against S pyogenes and S pneumoniae ; cefixime is poorly active against S aureus and cefuroxime axetil has poor oral absorption), no differences in clinical efficacy have been identified.…”

Section: Antibiotic Managementmentioning

confidence: 99%

“…[II] All are from developing countries, except for a trial from Finland which randomised children with pneumonia (a high proportion of which had a bacterial cause) to either 4 or 7 days of parenteral penicillin or cefuroxime, with no difference in outcome 150. [Ib] …”

Section: Antibiotic Managementmentioning

confidence: 99%

British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011

Harris

Clark²,

Coote³

et al. 2011

Thorax

902

1,025

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“…As a consequence, many unnecessary courses of such agents are administered to children with pneumonia, even though parenteral penicillin would usually suffice, especially if used in increased doses [1][2][3][4][5][6].…”

mentioning

confidence: 99%

Reappraisal of Lung Tap: Review of an Old Method for Better Etiologic Diagnosis of Childhood Pneumonia

Vuori-Holopainen

Peltola

2001

Clinical Infectious Diseases

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Identification of the etiology of childhood pneumonia is difficult, even in the cases that most likely have bacterial origins. A positive blood culture result is diagnostic but rare (< 10% of cases), and other noninvasive microbiological methods are nonspecific or are at least shadowed by interpretation problems. However, lung tap (or aspiration), a method developed a century ago, warrants reappraisal, especially since the prevalence of pneumococcal resistance to penicillin is increasing. An analysis of 59 studies that were published in 6 languages led us to conclude that (1) bacterial etiology is disclosed in approximately 50% of cases (virological tests were rarely done); (2) lung tap is safer than is generally considered; (3) potential pneumothorax is mostly symptomless and resolves spontaneously without impairing recovery; and (4) in comparison with routine diagnostic tools, lung tap offers so many advantages that it warrants reconsideration at centers where personnel have experience in handling potential pneumothorax.

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Narrow- versus broad-spectrum parenteral antimicrobials against common infections of childhood: a prospective and randomised comparison between penicillin and cefuroxime

Abstract: Procaine penicillin is as effective and safe as cefuroxime for common community-acquired infections in immunocompetent children.

Cited by 38 publications

References 35 publications

Narrow Vs Broad-spectrum Antimicrobial Therapy for Children Hospitalized With Pneumonia

Narrow Vs Broad-spectrum Antimicrobial Therapy for Children Hospitalized With Pneumonia

British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011

Reappraisal of Lung Tap: Review of an Old Method for Better Etiologic Diagnosis of Childhood Pneumonia

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