Clinical failure among children with nonsevere community-acquired pneumonia treated with amoxicillin
Maria-Socorro H Fontoura1, César A Araújo-Neto, Sandra C S Andrade
1Department of Pediatrics, Federal University of Bahia School of Medicine, Rua Prof. Aristides Novis, 105/1201B, Salvador, CEP 40210-630, Brazil.
Insights
Amoxicillin is effective for nonsevere pneumonia in children, with low clinical failure rates (2.6%) and rare adverse events. Older children showed a slightly higher risk of treatment failure.
Area of Science:
- Pediatric infectious diseases
- Pharmacology and therapeutics
- Respiratory medicine
Background:
- Nonsevere pneumonia is a common childhood illness requiring effective treatment.
- Amoxicillin is a frequently prescribed antibiotic for pediatric pneumonia.
- Understanding treatment outcomes and adverse events is crucial for clinical decision-making.
Purpose of the Study:
- To evaluate the clinical failure rate of amoxicillin in children with nonsevere pneumonia.
- To assess the incidence of adverse events associated with amoxicillin treatment.
- To identify risk factors associated with clinical failure in this pediatric population.
Main Methods:
- Prospective follow-up of 192 children aged 2-59 months diagnosed with nonsevere pneumonia.
- Amoxicillin administered at 50 mg/kg/day, with data collection on clinical status and adverse events.
- Clinical failure defined by persistent symptoms or development of severe disease signs.
Main Results:
- A low clinical failure rate of 2.6% was observed.
- Adverse events occurred in 7.3% of patients, with discontinuation in only 0.5%.
- Older age (p = 0.01) emerged as an independent risk factor for clinical failure.
Conclusions:
- Amoxicillin demonstrates a favorable safety and efficacy profile for nonsevere childhood pneumonia.
- Clinical failures were infrequent, particularly in younger children (< 2 years).
- Discontinuation of amoxicillin due to adverse reactions was rare.
Objective:
To estimate the clinical failure and adverse events in children with nonsevere pneumonia receiving amoxicillin, identifying risk factors.
Research Design/Methods:
192 patients aged 2 - 59 months were prospectively followed up. Pneumonia diagnosis was based on respiratory complaints and radiographic pulmonary infiltrate or pleural effusion. Amoxicillin (50 mg/kg/day) was given. Demographic data and clinical findings on admission, daily evolution up to the 5th day of treatment and 2 - 4 weeks after enrollment were collected.
Main Outcome Measures:
Clinical failure included persistence of fever, difficulty breathing or tachypnea beyond the first 48 h of treatment or of cough beyond the first 96 h of treatment or sign of severe/very severe disease up to the 5th day of treatment.
Results:
Amoxicillin failed in 6 (3.1%) cases. By excluding one child diagnosed with cystic fibrosis after continued follow-up, the final clinical failure rate was 2.6%. The total adverse effect frequency was 14 (7.3%), but amoxicillin was discontinued only in 1 (0.5%) case. No relapse was identified at the 2 - 4-week interval evaluation. By multivariate analysis, age (OR = 1.1; 95% CI 1.01 - 1.19) was an independent risk factor for clinical failure which occurred in older children (47 +/- 9 vs 31 +/- 16 months; p = 0.01).
Conclusions:
Clinical failures were few, especially among those aged < 2 years. Amoxicillin discontinuation due to adverse reaction was rare.
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