Background: Adherence to Guidelines for the management of community-acquired pneumonia (CAP) in children is poor. Recently it has been shown that treatment of non-complicated CAP with parenteral penicillin or ampicillin (according to guidelines) is as effective as cefuroxime. Still, this has not been studied in children who failed an oral antibiotic course.
Aim: To compare the outcome of treatment with penicillin or ampicillin to cefuroxime in hospitalized children with CAP who received oral antibiotic treatment prior to their hospitalization.
Patients and methods: A retrospective review of the clinical course and outcome of all previously healthy children from 3 months to 18 years old with non-complicated CAP who received an oral antibiotic course in the community and admitted during 2003–2008, in the pediatric departments of Hadassah Medical centers. Clinical course prior to admission, presenting signs and symptoms, laboratory findings at presentation and clinical outcome parameters including number of febrile days, number of days with IV antibiotics, length of hospital stay, change of antibiotics and clinical course 72 hours and 1 week after admission, were compared.
Results: Of the 337 children admitted with non-complicated CAP after failing an oral antibiotic treatment course in the community, 235 were treated with IV cefuroxime, and 104 with IV penicillin or ampicillin. The two groups were similar regarding age, sex, days of fever prior to admission, type of preadmission oral antibiotic treatment and laboratory indices at admission (p > 0.1). The cefuroxime treated group had significant better outcomes in total number of febrile days, number of days treated with IV antibiotic and total number of hospitalization days (1.2 ±1.1 vs. 1.7±1.6, 3.1±1.3 vs. 3.9±2.0, 3.5±1.5 vs. 4.2±2.0, respectively, p < 0.001). Treatment failure was not significantly different between the two groups (9.79% vs. 14.42%, p > 0.1). The odds ratio for being still hospitalized at 72 hr and 7 days was significantly lower for the cefuroxime group (0.5 and 0.18 respectively, p < 0.05).
Conclusion: In previously healthy children presenting with CAP after failing an oral antibiotic course in the community, treatment with IV cefuroxime appears to be superior to penicillin or ampicillin.
