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Aztreonam therapy for serious gram-negative infections in children
Insights
Aztreonam, a monocyclic beta-lactam antibiotic, effectively treated serious gram-negative infections in children. This open trial showed good clinical cure rates and a favorable safety profile with no significant adverse effects observed.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Therapy
- Pharmacology
Background:
- Serious gram-negative infections pose a significant challenge in pediatric care.
- Aztreonam, a monocyclic beta-lactam, offers a potential treatment option for these infections.
Purpose of the Study:
- To evaluate the efficacy and safety of aztreonam in treating serious gram-negative infections in children.
- To assess the pharmacokinetic profile of aztreonam in pediatric patients.
Main Methods:
- An open trial involving 59 children aged 3 days to 12 years with various gram-negative infections.
- Microbiologic and clinical evaluations were performed, along with pharmacokinetic studies in a subset of patients.
- Standard intravenous aztreonam regimen of 30 mg/kg every 6 or 8 hours was administered.
Main Results:
- Thirty-six infections were microbiologically evaluable, with all causative isolates susceptible to aztreonam and eradicated during therapy.
- Clinical cure was achieved in 31 of 36 children (86.1%).
- Pharmacokinetic studies showed consistent serum concentrations and variables throughout therapy; transient eosinophilia, elevated aminotransferase, and thrombocytosis were noted but not clinically significant.
Conclusions:
- Aztreonam demonstrated effectiveness and safety in treating serious gram-negative infections in children in this initial uncontrolled study.
- The antibiotic is a viable option for pediatric patients with susceptible gram-negative bacterial infections.
- Further controlled studies may be warranted to confirm these findings.
Abstract:
Fifty-nine children were enrolled in an open trial of aztreonam, a monocyclic beta-lactam, therapy for serious gram-negative infections. Thirty-six infections were microbiologically evaluable and received five or more days of therapy. Patients' ages ranged from 3 days to 12 years, and diagnoses included pyelonephritis or cystitis (20), deep soft tissue or joint infection (seven), septicemia (four), pneumonia (three), peritonitis, and epiglottitis. Causative bacteria included Escherichia coli and other Enterobacteriaceae, Pseudomonas aeruginosa, and Haemophilus influenzae. The standard regimen was 30 mg/kg every six or eight hours intravenously. All isolates were aztreonam-susceptible and were eradicated during therapy. Two patients had microbiologic relapses: a patient with Salmonella choleraesuis meningitis who was initially treated for only ten days and a patient with E coli pyelonephritis. Clinical cure was achieved in 31 of 36 children. Pharmacokinetic studies performed in six children demonstrated no difference in serum concentrations or pharmacokinetic variables between day 1 and day 7 of therapy. Although several patients had transient eosinophilia (eight), elevated levels of aminotransferase (seven), or thrombocytosis (ten), no clinically significant adverse effects were noted. In this initial, uncontrolled study, aztreonam was effective and safe in the treatment of a variety of serious gram-negative infections in children.