Successful shortening from seven to four days of parenteral beta-lactam treatment for common childhood infections: a prospective and randomized study.
OBJECTIVE
To explore whether 4-day parenteral beta-lactam therapy is as effective as 7-day therapy for children hospitalized for parenteral antimicrobials.


METHODS
A series of patients aged 3 months to 15 years who fulfilled strict criteria for bacterial pneumonia, other respiratory infections, sepsis-like infections, and other acute infections were prospectively randomized to receive parenteral penicillin or cefuroxime randomly for 4 or 7 days. Besides blood and throat cultures, the etiology was searched by serology for 23 different agents.


RESULTS
Of 154 children analyzed, a probable etiology was established in 96. Of those, a bacterial infection, with or without concomitant viral infection, was disclosed in 80% and 94% in the 4-day and 7-day treatment groups, respectively; pneumococcus being the commonest agent. There was one possible treatment failure in the 4-day group, but with a questionable relation to the short course. Three patients in the 4-day and two in the 7-day group underwent treatment changes, or were rehospitalized within 30 days. All children recovered entirely.


CONCLUSIONS
Shortening parenteral beta-lactam treatment to 4 days in infections for which most parenteral antimicrobials are instituted, is not only safe, but reduces costs, is ecologically sound, and minimizes the risks of nosocomial infections and other adverse effects of treatment.
Peltola
H
H
Helsinki University Central Hospital, Hospital for Children and Adolescents, Helsinki, Finland. heikki.peltola@hus.fi
Vuori-Holopainen
E
E
Kallio
M J
MJ
D000293:Adolescent; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D002444:Cefuroxime / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D010406:Penicillins / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D011008:Pneumococcal Infections / Q000188:drug therapy / Q000382:microbiology; D011897:Random Allocation; D018805:Sepsis / Q000188:drug therapy / Q000382:microbiology; D012698:Serologic Tests; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000302:isolation & purification; D013997:Time Factors; D016896:Treatment Outcome
D010406:Penicillins; D002444:Cefuroxime