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Clinical experience with aztreonam for treatment of infections in children
1Division of Pediatric Infectious Disease, Memorial Miller Children's Hospital, Long Beach, California 90801-1428.
Insights
Aztreonam is effective for treating serious gram-negative bacterial infections in children, showing high cure rates with few adverse effects. This antibiotic is a safe and viable option for pediatric patients.
Area of Science:
- Pediatric Infectious Diseases
- Antibiotic Therapy
- Pharmacology
Background:
- Serious gram-negative bacterial infections pose significant risks in pediatric populations.
- Aztreonam's in vitro activity, pharmacokinetics, and tissue penetration profile suggest potential therapeutic utility.
- Previous studies have indicated aztreonam's efficacy in various pediatric infections.
Purpose of the Study:
- To evaluate the efficacy and safety of aztreonam in treating serious gram-negative bacterial infections in children.
- To assess aztreonam's performance in comparison to other antibiotics and conventional therapies.
- To determine the role of aztreonam as an alternative treatment option for pediatric infections.
Main Methods:
- Analysis of data from several thousand children treated with aztreonam in open and comparative clinical trials.
- Inclusion of diverse infection types: pyelonephritis, bacteremia, meningitis, skeletal infections, pneumonia, and peritonitis.
- Comparative trials for neonatal sepsis and cystic fibrosis pulmonary infections.
Main Results:
- High cure rates (92%-100%) observed across various serious gram-negative infections.
- Aztreonam demonstrated comparable efficacy to amikacin in neonatal sepsis.
- Clinical results were comparable to conventional combined therapy for cystic fibrosis pulmonary infections.
- Adverse effects were uncommon (<2%), including fever, diarrhea, or rash; reversible laboratory abnormalities were occasionally noted.
Conclusions:
- Aztreonam is an appropriate and safe alternative agent for treating serious gram-negative bacterial infections in neonates and children.
- The antibiotic exhibits a favorable safety profile with a low incidence of adverse effects.
- Further comparative trials are warranted to define specific indications and optimize treatment strategies.
Abstract:
The in vitro activity, pharmacokinetics, bactericidal activity, and tissue penetration of aztreonam suggest that it may play a role in therapy for serious gram-negative bacterial infections in children. Several thousand children throughout the world received aztreonam during open or comparative clinical trials for treatment of infections including pyelonephritis, bacteremia, meningitis, skeletal infection, pneumonia, and peritonitis. Cure rates have ranged from 92% to 100%, with relapses seen mainly in children with obstructive renal lesions and those with infections caused by Salmonella. A comparative trial of aztreonam for treatment of neonatal sepsis showed it to be at least as effective as amikacin for this infection. Aztreonam yielded clinical results comparable to those of conventional combined therapy for pulmonary infection in patients with cystic fibrosis. Adverse effects in pediatric trials have been uncommon; fever, diarrhea, or rash occurred in less than 2% of treated children. Reversible laboratory abnormalities have occasionally been noted. On the basis of these data, aztreonam is considered an appropriate alternative agent for the treatment of serious gram-negative bacterial infections in neonates and children. Further comparative clinical trials will delineate specific indications.