Parenteral-oral switch in the management of paediatric pneumonia.
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.
Dagan
R
R
Pediatric Infectious Disease Unit, Soroka Medical Center, Beer-Sheva, Israel.
Syrogiannopoulos
G
G
Ashkenazi
S
S
Engelhard
D
D
Einhorn
M
M
Gatzola-Karavelli
M
M
Shalit
I
I
Amir
J
J
D000284:Administration, Oral; D001682:Biological Availability; D001799:Blood Sedimentation / Q000187:drug effects; D002097:C-Reactive Protein / Q000032:analysis; D015296:Ceftizoxime / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D002443:Ceftriaxone / Q000008:administration & dosage / Q000627:therapeutic use*; D002675:Child, Preschool; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006207:Half-Life; D006801:Humans; D007223:Infant; D007273:Injections, Intramuscular; D007275:Injections, Intravenous; D007958:Leukocyte Count / Q000187:drug effects; D008297:Male; D011018:Pneumonia, Pneumococcal / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D011446:Prospective Studies; D016896:Treatment Outcome
D002443:Ceftriaxone; D002097:C-Reactive Protein; D015296:Ceftizoxime; C047445:cefetamet pivoxyl