Treatment of aspiration or tracheostomy-associated pneumonia in neurologically impaired children: effect of antimicrobials effective against anaerobic bacteria.
The purpose of the present study was to retrospectively review the antibiotic therapy of aspiration or tracheostomy-associated pneumonia in 57 neurologically impaired children (NIC). The antimicrobials used were either ticarcillin-clavulanate or clindamycin, which are effective against penicillin-resistant anaerobic bacteria, or ceftriaxone, which is less effective against these organisms. In those with aspiration pneumonia, a satisfactory clinical and microbiological response was observed in 8/9 (89%) patients who received ticarcillin-clavulanate, and 10/11 (91%) who received clindamycin with or without ceftazidime, as compared to 7/14 (50%) who received ceftriaxone (P < 0.05). For those who experienced tracheostomy-associated pneumonia, a positive response to therapy was observed in 5/6 (83%) who received ticarcillin-clavulanate, and 7/7 (100%) who received clindamycin with or without ceftazidime, as opposed to 4/10 (40%) who were treated with ceftriaxone (P < 0.05). The duration of fever was longer in both cases for those who received ceftriaxone. To summarize, this study illustrates the superiority of antimicrobials effective against penicillin-resistant anaerobic bacteria, as compared to an antibiotic without such coverage, in the therapy of aspiration or tracheostomy-associated pneumonia in NIC.
Brook
I
I
Department of Pediatrics, Georgetown University School of Medicine, Washington, DC, USA.
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001421:Bacteria, Anaerobic / Q000187:drug effects*; D001424:Bacterial Infections / Q000188:drug therapy*; D002442:Ceftazidime / Q000008:administration & dosage / Q000627:therapeutic use; D002443:Ceftriaxone / Q000008:administration & dosage / Q000627:therapeutic use; D002511:Cephalosporins / Q000008:administration & dosage / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D019818:Clavulanic Acid; D002969:Clavulanic Acids / Q000008:administration & dosage / Q000627:therapeutic use; D002981:Clindamycin / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005334:Fever / Q000188:drug therapy; D006801:Humans; D008297:Male; D010406:Penicillins / Q000008:administration & dosage / Q000627:therapeutic use; D011015:Pneumonia, Aspiration / Q000188:drug therapy* / Q000382:microbiology; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000209:etiology; D012189:Retrospective Studies; D012640:Seizures / Q000150:complications*; D013982:Ticarcillin / Q000008:administration & dosage / Q000627:therapeutic use; D014139:Tracheostomy / Q000009:adverse effects*; D014474:Unconsciousness / Q000150:complications*
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D002969:Clavulanic Acids; D010406:Penicillins; D019818:Clavulanic Acid; D002981:Clindamycin; D002443:Ceftriaxone; D002442:Ceftazidime; D013982:Ticarcillin