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Compound sulfamethoxazole for pediatric pertussis: a retrospective cohort study in a region with high macrolide
Lin Li1, Taohong Xie1, Liu Xiao1
1Department of Pediatrics of Ziyang People's Hospital, Ziyang, Sichuan, China.
Background:
In recent years, the incidence of pertussis has been increasing globally. The high prevalence of macrolide-resistant strains has led to a significant rise in both pertussis cases and associated mortality.
Objective:
This retrospective study aimed to evaluate the clinical effectiveness and safety of compound sulfamethoxazole (SMZco) vs. macrolides in pediatric pertussis treatment under real-world clinical conditions, providing evidence for its clinical application.
Methods:
Patients were divided into macrolide and SMZco groups based on treatment regimens. Comparative analyses included overall treatment effectiveness, duration of nocturnal coughing, paroxysmal coughing, post-tussive vomiting, hospitalization length, and adverse drug reactions.
Results:
The macrolide group (n = 23) showed 3 markedly effective, 8 effective, and 12 ineffective cases (total effectiveness rate 47.8%). The SMZco group (n = 79) demonstrated 26 markedly effective, 38 effective, and 15 ineffective cases (total effectiveness rate 81.0%), with significantly superior effectiveness vs. macrolides (P < 0.05). The SMZco group exhibited statistically significant reductions in hospitalization duration (P < 0.05), paroxysmal coughing (P < 0.05), post-tussive vomiting (P < 0.05), and nocturnal coughing (P < 0.05). Gastrointestinal adverse events occurred in 8 macrolide-treated patients vs. 6 SMZco-treated patients (P < 0.05). Rash was observed in 12 SMZco-treated cases but none in the macrolide group (P < 0.05).
Conclusion:
SMZco significantly improves treatment effectiveness, shortens symptom duration and hospitalization, and reduces economic burden in pediatric pertussis. These findings position SMZco as an effective and safe alternative, particularly in regions with high macrolide resistance.
Insights
Compound sulfamethoxazole (SMZco) is a more effective treatment for pediatric pertussis than macrolides, significantly reducing symptoms and hospitalization. This finding offers a vital alternative, especially with rising macrolide resistance in pertussis cases.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Resistance
- Pharmacological Treatments
Background:
- Global increase in pertussis incidence.
- Rising prevalence of macrolide-resistant pertussis strains.
- Associated increase in pertussis cases and mortality.
Purpose of the Study:
- Evaluate clinical effectiveness and safety of compound sulfamethoxazole (SMZco) versus macrolides for pediatric pertussis.
- Provide evidence for SMZco's clinical application in real-world settings.
- Address treatment challenges posed by macrolide resistance.
Main Methods:
- Retrospective study comparing SMZco and macrolide treatment groups.
- Analysis of clinical effectiveness metrics including symptom duration and hospitalization.
- Assessment of adverse drug reactions in both treatment groups.
Main Results:
- SMZco demonstrated significantly higher overall effectiveness (81.0%) compared to macrolides (47.8%).
- SMZco group showed significant reductions in hospitalization duration, paroxysmal coughing, post-tussive vomiting, and nocturnal coughing.
- While SMZco had more rash adverse events, gastrointestinal events were similar, and overall effectiveness was superior.
Conclusions:
- SMZco offers superior clinical effectiveness and safety for pediatric pertussis.
- SMZco shortens symptom duration and hospitalization, reducing patient burden.
- SMZco is a recommended alternative treatment, particularly where macrolide resistance is prevalent.
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