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Ampicillin vs. placebo for Yersinia pseudotuberculosis infection in children
1Children's Medical Center, Okayama National Hospital, Japan.
Insights
Early ampicillin treatment for Yersinia pseudotuberculosis infection in children did not improve clinical symptoms. However, ampicillin significantly reduced fecal excretion of the bacteria, aiding in infection control.
Area of Science:
- Pediatrics
- Infectious Diseases
- Gastroenterology
Background:
- Yersinia pseudotuberculosis infection can mimic Kawasaki syndrome in children.
- Early diagnosis and treatment are crucial for managing pediatric infections.
Purpose of the Study:
- To evaluate the efficacy of early ampicillin treatment on the clinical course of Yersinia pseudotuberculosis infection in children.
- To assess ampicillin's impact on symptom duration and bacterial shedding.
Main Methods:
- A randomized controlled trial involving 136 pediatric patients.
- Patients received either ampicillin or placebo.
- Diagnosis based on clinical criteria and laboratory confirmation of Yersinia pseudotuberculosis.
Main Results:
- Ampicillin therapy showed no significant benefit in shortening fever, diarrhea, or abdominal pain duration.
- No significant reduction in rash, erythema nodosum, or acute renal failure was observed.
- Ampicillin significantly reduced fecal excretion of Yersinia pseudotuberculosis after 5 days (0% vs 90% in placebo).
Conclusions:
- Early ampicillin treatment does not offer clinical benefits for Yersinia pseudotuberculosis infection in children.
- Ampicillin effectively reduces fecal shedding of the organism, suggesting a role in limiting transmission.
Abstract:
For evaluation of the efficacy of early treatment with ampicillin on the clinical course of Yersinia pseudotuberculosis infection in children, 136 patients were randomly assigned to receive either ampicillin or placebo. Subjects were those who were diagnosed as having Kawasaki syndrome and those who satisfied three of the following four criteria: fever; rash; abdominal symptoms; and a history of ingestion of untreated drinking water. Fifty-six patients had evidence of Y. pseudotuberculosis infection bacteriologically and/or serologically. Twenty-six were assigned to placebo and 28 to ampicillin. Ampicillin therapy did not show a significant benefit in shortening the duration of fever, diarrhea and abdominal pain or in preventing rash, erythema nodosum and acute renal failure. After 5 days of treatment none of the patients in the ampicillin group excreted the organism in the stool whereas 19 (90%) of 21 in the placebo group did (P less than 0.001). Ampicillin did not show a clinical benefit but reduced the fecal excretion of the organism.