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Parenteral-oral switch in the management of paediatric pneumonia
R Dagan1, G Syrogiannopoulos, S Ashkenazi
1Pediatric Infectious Disease Unit, Soroka Medical Center, Beer-Sheva, Israel.
Insights
A switch from intravenous ceftriaxone to oral cefetamet pivoxil for 1 or 2 days effectively treated childhood pneumonia. This parenteral-oral switch regimen is a safe and feasible option for pediatric community-acquired pneumonia.
Area of Science:
- Pediatric Infectious Diseases
- Pharmacology and Therapeutics
Background:
- Childhood pneumonia remains a significant global health concern.
- Effective and convenient treatment regimens are crucial for pediatric patients.
Purpose of the Study:
- To evaluate the safety and efficacy of a parenteral-to-oral switch strategy for treating pediatric pneumonia.
- To compare a 2-day parenteral ceftriaxone regimen with a 1-day regimen before switching to oral cefetamet pivoxil.
Main Methods:
- Phase I: 56 children (0.8-5 years) with pneumonia received 2 days of IV/IM ceftriaxone followed by 5 days of oral cefetamet pivoxil.
- Phase II: Randomized trial comparing 2 days (Arm A) vs. 1 day (Arm B) of parenteral ceftriaxone followed by oral cefetamet pivoxil for a total of 7 days.
- Clinical cure rates and adverse events were assessed at the end of treatment and during follow-up.
Main Results:
- 100% clinical cure in Arm A and 96% in Arm B at end of treatment.
- Sustained cure rates of 99% (Arm A) and 98% (Arm B).
- Adverse events were low (11% Arm A, 12% Arm B), primarily gastrointestinal.
Conclusions:
- A parenteral-to-oral switch strategy using ceftriaxone followed by cefetamet pivoxil is safe and effective for childhood pneumonia.
- Both 1-day and 2-day parenteral ceftriaxone initiation regimens are feasible treatment options.
- This approach offers a practical and effective treatment for serious pediatric community-acquired pneumonia.
Abstract:
In phase I of a 2-phase study, 56 evaluable children (0.8 to 5 years) with lobar or segmental pneumonia received intravenous or intramuscular ceftriaxone 50 mg/kg/day for 2 days followed by oral cefetamet pivoxil 20 mg/kg/day in 2 divided doses to complete 7 days of treatment. All patients achieved a clinical cure. In phase II, a randomised open multicentre study, 62 children with pneumonia received an identical regimen to phase I (arm A), and 59 children received ceftriaxone 50 mg/kg/day for 1 day followed by 6 days' treatment with cefetamet pivoxil 20 mg/kg/day (arm B). Patients from phase I and arm A were combined giving a total of 118 evaluable patients in arm A. At the end of treatment, 100% of patients in arm A and 96% in arm B achieved a clinical cure; cure was maintained in 99 and 98% of patients, respectively. Two (4%) patients in arm B failed therapy; in both cases, factors other than treatment failure may have accounted for the poor response. 11 and 12% of patients in treatment arms A and B, respectively, experienced adverse events; gastrointestinal events (nausea and/or vomiting) were reported in 9 and 8% of patients, respectively. In conclusion, 1 or 2 days' treatment with parenteral ceftriaxone before switching to oral cefetamet pivoxil was safe and effective in the treatment of childhood pneumonia. Therefore, parenteral-oral switch is a feasible treatment option in the treatment of serious paediatric community-acquired pneumonia.