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Once daily ceftriaxone for central nervous system infections and other serious pediatric infections
Insights
Once daily ceftriaxone effectively treated serious pediatric infections, achieving a high cure rate. This antibiotic showed good safety and efficacy in children with conditions like meningitis and sepsis.
Area of Science:
- Pediatric Infectious Diseases
- Pharmacology
- Clinical Medicine
Background:
- Ceftriaxone possesses a prolonged serum half-life and potent in vitro activity against prevalent pediatric pathogens.
- Serious infections in children necessitate effective and safe therapeutic options.
Purpose of the Study:
- To assess the efficacy and safety of a once-daily ceftriaxone regimen in pediatric patients with severe infections.
- To evaluate ceftriaxone's effectiveness across various serious pediatric conditions, including meningitis and sepsis.
Main Methods:
- A cohort of 57 children with serious infections received once-daily ceftriaxone.
- Dosage varied based on infection type: 50 mg/kg for non-CNS infections and a tiered dose (100 mg/kg then 80 mg/kg) for CNS infections.
- Intravenous or intramuscular administration routes were utilized, with comparable serum concentrations observed.
Main Results:
- A high cure rate of 55 out of 57 patients with isolated pathogens was achieved.
- Adjunctive therapies were required in two cases (ventriculitis and liver abscess).
- Minor clinical side effects (diarrhea, fever, rash) and laboratory abnormalities (eosinophilia, thrombocytosis) were reported in a subset of patients.
Conclusions:
- Once-daily ceftriaxone is an effective and generally safe treatment for serious pediatric infections.
- The study supports the use of ceftriaxone as a primary therapeutic agent in pediatric infectious disease management.
- Further monitoring for potential side effects and treatment responses is warranted.
Abstract:
Ceftriaxone has a very long serum half-life and enhanced in vitro activity against common pediatric pathogens. Therefore we evaluated the efficacy and safety of once daily ceftriaxone therapy in 57 children with serious infections including: meningitis (26 patients); ventriculitis (3); pyelonephritis (7); osteomyelitis (6); abscess (4); septic arthritis (3); sepsis (2); and miscellaneous infections (6). The most common isolates were Haemophilus influenzae (23), Escherichia coli (9) and Staphylococcus aureus (8). Ceftriaxone was given intravenously or intramuscularly in a dose of 50 mg/kg for non-central nervous system (CNS) infections. Patients with CNS infections received an initial dose of 100 mg/kg followed by 80 mg/kg 12 hours later and once daily thereafter. In a limited number of patients no major differences in serum ceftriaxone concentrations were found after intravenous or intramuscular injection. Of 57 patients with pathogens isolated 55 were completely cured; in one patient with Klebsiella pneumoniae ventriculitis, intraventricular gentamicin was briefly added to the regimen. Another patient with an anaerobic liver abscess recovered after metronidazole was administered. In three patients a delayed response to ceftriaxone was noted. One patient with previous recurrent infections had a second episode of H. influenzae meningitis 22 days after cessation of therapy. Clinical side effects were noted in 10 of 71 patients (including 14 treated patients who had negative cultures). Seven patients had diarrhea, one each had fever or rash and one had fever, rash and arthralgia. Laboratory side effects in 16 of 71 patients included eosinophilia (7), thrombocytosis (7), elevated liver enzymes (4) and leukopenia and neutropenia (2).(ABSTRACT TRUNCATED AT 250 WORDS)