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Treatment of presumed bacterial pneumonia in ambulatory children
E Calderon1, R Gatica, G Echániz
1Center for Research on Infectious Diseases, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
Insights
Ampicillin (AMP) treatment for mild community-acquired pneumonia in children was more effective than trimethoprim/rifampin (TMP/R). AMP led to shorter disease duration and fever, with better bacterial eradication rates.
Area of Science:
- Pediatric infectious diseases
- Pharmacology and therapeutics
Background:
- Community-acquired pneumonia (CAP) is a common childhood illness.
- Effective antibiotic treatment is crucial for managing pediatric CAP.
Purpose of the Study:
- To compare the efficacy of ampicillin (AMP) versus trimethoprim/rifampin (TMP/R) for treating mild pediatric CAP.
Main Methods:
- Prospective, randomized, open study.
- 60 children with mild CAP received either oral AMP (150 mg/kg/day) or TMP/R (20 mg/kg/day) twice daily for 10 days.
- Clinical outcomes and nasopharyngeal cultures were assessed.
Main Results:
- The AMP group experienced a shorter overall disease duration (6.0 +/- 1.1 days) compared to the TMP/R group (8.5 +/- 3.6 days).
- Fever resolution was faster in the AMP group (5.2 +/- 1.0 days) versus the TMP/R group (7.0 +/- 1.8 days).
- Nasopharyngeal cultures were negative in all AMP-treated patients but only 25/30 TMP/R-treated patients, with five TMP/R patients showing clinical and microbiologic failure.
Conclusions:
- Ampicillin (AMP) is more effective than trimethoprim/rifampin (TMP/R) for treating mild community-acquired pneumonia in children.
- AMP demonstrated superior clinical cure rates and bacterial pathogen eradication.
- 10-day ampicillin therapy is recommended for mild pediatric CAP.
Abstract:
In a prospective, randomized, open study, a combination of trimethoprim and rifampin (TMP/R) 20 mg/kg/day was compared with ampicillin (AMP) 150 mg/kg/day, both given orally twice daily for 10 days, for the treatment of 60 children who had mild community-acquired pneumonia. The control group comprised 112 healthy children. The overall duration of the disease was 8.5 +/- 3.6 days in the TMP/R group vs 6.0 +/- 1.1 days in the AMP group. Fever persisted for 7.0 +/- 1.8 days in the TMP/R-treated patients vs 5.2 +/- 1.0 days in the AMP-treated patients. At the end of the 10 days, nasopharyngeal cultures were negative in all patients in the AMP group and in 25 of the 30 patients in the TMP/R group. These five patients were clinical and microbiologic failures. We conclude that in infants and children with mild community-acquired pneumonia, treatment with AMP for 10 days is more effective than treatment with a combination of TMP/R for clinical cure and eradication of bacterial pathogens.