Penicillin and gentamicin therapyvs amoxicillin/clavulanate in severe hypoxemic pneumonia
Objective: To compare the efficacy of sequential injectable crystalline penicillin (C.pen) and gentamicin combination followed by amoxicillin with sequential IV and oral amoxicillin-clavulanate (amox-clav) in treatment of severe or very severe hypoxemic pneumonia.Methods: Children aged 2–59 months with WHO-defined severe or very severe pneumonia with hypoxemia (SpO2<90%) were included in the study. Patients with fever>10 days, bacterial meningitis, prior antibiotic therapy >24 hours, stridor, heart disease and allergy to any of the study drugs were excluded. They were randomly allocated to two groups—Group A and Group B. Group A received C. pen and gentamicin intravenously (IV), followed by oral amoxicillin and group B got amox-clav IV, followed by oral amox-clav. Minimum duration of IV therapy was 3 days and total 7 days. Respiratory rate, oxygen saturation and chest wall indrawing were monitored 6 hourly.Results: 71 patients were included. There were two (5.2%) blood cultures positive in group A and three (9%) in group B. Organisms isolated wereS. pneumoniae (n=3) andH. influenzae-b (n=2). There was only one treatment failure in each of the groups. One was due to penicillin resistantH. influenzae-b and the other was due to worsening of pneumonia. The mean time taken for normalization of tachypnea, hypoxia, chest wall indrawing and inability to feed was similar (P-N.S). Mean duration of IV therapy in group A was 76±25 hrs and group B was 75±24 hrs (p>0.1).Conclusion: In children of 2–59 months, sequential injectable C. pen and gentamicin combination, followed by oral amoxicillin or sequential IV and oral amox-clav were equally effective for the treatment of severe or very severe hypoxemic community acquired pneumonia.
Key wordsAcute respiratory infections Community acquired pneumonia Penicillin Gentamicin Amoxicillin/clavulanate
Cherian T. Acute respiratory infections in developing countries: current status and future directions.Indian Pediatr
1997; 34: 877–884.PubMedGoogle Scholar
Shann F. Etiology of severe pneumonia in children in developing countries.Pediatr Infect Dis J
1986; 5: 247–252.CrossRefGoogle Scholar
WHO. Programme for control of acute respiratory infections.Acute Respiratory Infections in Children: Case Management in a Small Hospital in Developing Countries—A Manual for Doctors and Senior Health Workers
. Geneva WHO/ARI/90.5.Google Scholar
Vuori-Holopainen E, Peltola H. Reappraisal of lung tap: Review of an old method for better etiologic diagnosis of childhood pneumonia.Clin Infect Dis
2001; 32: 715–726.PubMedCrossRefGoogle Scholar
World Health Organization. Acute respiratory infections: The forgotten pandemic.Bull WHO
1998; 76: 101–103.Google Scholar
McCracken GH Jr. Etiology and treatment of pneumonia.Pediatr Infect Dis J
2000; 19: 373–377.PubMedCrossRefGoogle Scholar
McCracken GH Jr. Diagnosis and management of pneumonia in children.Pediatr Infect Dis J
2000; 19: 924–928.PubMedCrossRefGoogle Scholar
Korppi M. Community acquired pneumonia in children.Pediatr Drugs
2003; 5: 821–832.CrossRefGoogle Scholar
Juven T, Mertsola J, Waris Met al.
Etiology of community acquired pneumonia in 254 hospitalized children.Pediatr Infect Dis J
2000; 19: 293–98.PubMedCrossRefGoogle Scholar
Kosma H, Korppi T, Jokinen Met al.
Etiology of childhood pneumonia: Serologic results of a prospective, population based study.Pediatr Infect Dis J
1998; 17: 986–991.CrossRefGoogle Scholar
McIntosh K. Community acquired pneumonia in children.N Engl J Med
2002; 346: 429–437.PubMedCrossRefGoogle Scholar
Kumar L. Severe acute lower respiratory tract infection. Etiology and management.Indian J Pediatr
1987; 54: 189–98.PubMedCrossRefGoogle Scholar
Tan TQ, Mason EO Jr., Barson WJet al.
Clinical characteristics and outcome of children with pneumonia attributable to penicillin susceptible and penicillin-non-susceptible Streptococcus pneumoniae.Pediatrics
1998; 102: 1369–1375.PubMedCrossRefGoogle Scholar
Pallares R, Linare J, Vakillo Met al.
Resistance to Penicillin and cephalosporin and mortality from severe pneumococcal pneumonia in Barcelona, Spain.New Engl J Med
1995; 333: 474–480.PubMedCrossRefGoogle Scholar
MC Gowan JE Jr and Metchock BG. Penicillin-resistant pneumococci-an emerging threat to successful therapy.J Hosp Infection
1995; 30 (suppl): 472–482.CrossRefGoogle Scholar
Wubbel L, Muniz L, Ahmed Aet al.
Aetiology and treatment of community acquired pneumonia in ambulatory children.Pediatr Infect Dis J
1999; 18: 98–104.PubMedCrossRefGoogle Scholar
Heiskanen-Kosma T, Korppi M, Tokinen Cet al.
Aetiology of childhood pneumonias: serologic results of prospective, population-based study.Pediatr Infect Dis J
1998; 17: 986–991.PubMedCrossRefGoogle Scholar
Singhi S, Jain V and Gupta G. Pediatric emergencies at a tertiary care hospital in India.J Trop Ped
2003; 49: 207–211.CrossRefGoogle Scholar
Kumar L, Kumar V, Mitra SKet al.
Staphylococcal lung disease in children.Indian Pediatr
1974; 11: 793–797.PubMedGoogle Scholar
Rasmussen Z, Pio A and Enarson P. Case management of childhood pneumonia in developing countries: recent relevant research and current initiatives.Int J Tuberc Lung Dis
2000; 4: 807–826.PubMedGoogle Scholar
Easton J, Noble S and Perry CM. Amoxicillin/Clavulanic acid: A review of its use in the management of pediatric patients with acute otitis media.Drugs
2003; 63: 311–340.PubMedCrossRefGoogle Scholar
© Dr. K C Chaudhuri Foundation 2006