Comparative Efficacy of Ceftriaxone Versus Penicillin in the Treatment of Children with Severe CommunityAcquired Pneumonia (CAP)
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2019, Vol 14, Issue 4
Abstract
Objective: Pneumonia is one of the most common cause of childhood morbidity and mortality. Effective and resource compatible antimicrobial management is one of the fundamental aspects of the treatment of severe CAP. Narrow-spectrum antibiotics are recommended as the first-line agent for children hospitalized with severe CAP. Study Design: Randomized control trial. Place & Duration: Department of Pediatric Medicine, King Edward Medical University and Affiliated Hospital, Lahore from June 12, 2017 to December 12, 2017. Patients and methods: All the patients inducted in the study were randomly divided into two groups by using computer generated random number table. One group named as Group-A was given intravenous ceftriaxone at dose of 75mg/kg/day once daily for 10 days. Other group named as Group-B was given intravenous penicillin as per guidelines of WHO 2014. Other supportive care was given equally to all the patients as protocol of treatment. Patients were re-evaluated on 4th day of treatment with antibiotics and efficacy was noted as per operational definition. Results: In this study efficacy of IV Ceftriaxone was significantly higher as compared to Penicillin in treating severe CAP children. i.e. 84.7% vs. 71.8%, p-value=0.04.Conclusion:Ceftriaxoneis more efficacious than penicillin in the treatment of children with severe CAP. Pneumonia is inflammation of lung parenchyma. Communityacquired pneumonia (CAP) is defined clinically as the pneumonia in a previously healthy child due to a bacterial, viral or less commonly fungal infection which has been acquired outside hospital [1]. Incidence of Pneumonia is 10 folds higher in developing countries as compared to developed countries [2]. In the last decade, pneumonia mortality in children has fallen to approximately 1.3 million cases in 2011, with most deaths occurring in low income countries [3]. About 16% childhood mortality under 5 years age in the world is due to pneumonia [4]. Among the various causative agents Streptococcus pneumonia (27-44%), mixed Streptococcus pneumonia and other infection (9-30%), respiratory viruses in 20- 45% while H. Influenza is now rare after vaccination. The diagnosis can be made on basis of clinical examination, chest x-ray and Total leukocyte count(TLC count) [5]. Bacterial pneumonia need adequate antibiotics treatment, but only one third of these children gets proper antibiotics [6]. According to the WHO guidelines, children of 2 month to 5 years diagnosed with severe CAP should be admitted in the hospital and immediate empiric intravenous antibiotic therapy should be administered. Patients of severe CAP put on inadequate initial therapy didn’t improve and survival also remained low after secondary adjustment of antibiotic regimen [7]. In a study clinical efficacy at the end of therapy was 90.6% for amoxicillin-clavulanate and 88.9% for ceftriaxone [5]. No local clinical study is available regarding efficacy of ceftriaxone in comparison with penicillin in the treatment of children with severe community acquired pneumonia. With the emergence of antibiotic resistance, the morbidity and mortality due to community acquired pneumonia in young children is increasing. It can be reduced by early administration of appropriate antibiotic. Material and Methods The study design was randomized controlled trial. The site of the study was Department of Pediatric Medicine, King Edward Medical University and Affiliated Hospital, Lahore. The duration of study was from June 12, 2017 to December 12, 2017.Sample size of 340 patients (170 patients in each group) was calculated with 95% confidence interval. Patients were recruited using non probability consecutive sampling technique. After proper approval from the ethical review committee (ERC) patients of severe CAP meeting the inclusion and exclusion criteria were included in the study after proper informed consent from the parents. Severe CAP was defined respiratory rate more than 49 breaths per minute for age less than one year and more than 39 for age more than one year plus one of the following: sub-costal or intercostal recessions, stridor in a calm child, with no history of hospital admission in last 1 month. Inclusion criteria was patients of both genders from age 2 months to 5 years diagnosed with severe CAP. Patients of severe CAP exposed to any investigational drug within 1 month prior to study entry or enrolled in a concurrent study that may confound results of this study, having a co-morbid conditions like congenital heart disease, Meningitis, Central nervous system abscess, Pericarditis, Endocarditis, Pleural effusion or Empyema, Pneumothorax, Lung abscess, Bronchopleural fistula or Necrotizing pneumonia, or having signs and symptoms of involvement of systems other than respiratory system were excluded from study. Chest x-ray, complete blood count and C-reactive proteins (CRP) was sent along with the base-line investigation of patients enrolled in study. Each patient was evaluated and relevant data according to the predesigned questionnaire was collected and documented. All the patients inducted were randomly divided into two groups by using computer generated random number table. One group named as Group-A was given intravenous ceftriaxone at dose of 75mg/kg/ day once daily for 10 days. Other group named as Group-B was given intravenous penicillin as per guidelines of WHO 2014 i.e. benzyl penicillin: 50,000 units per kg IV every 6 hourly after-testdose for 10 days. Other supportive care (antipyretics, I/V fluids, oxygen inhalation, nebulization and chest physiotherapy) was given equally to all the patients as protocol of treatment. Patients were re-evaluated on 4th day of treatment with antibiotics and efficacy was noted. Efficacy was defined as normalization of respiratory rate for age: Age 2–12 months: <50 /min; Age 1–5 Years: <40/min, settlement of chest in-drawings and stridor. All the data were collected on a preformed proforma. Data was analyzed using SPSS version 25. Mean and standard deviation was calculated for quantitative variables like age, weight, respiratory rate on admission. Frequency and percentages was calculated for qualitative variables like gender and efficacy. Chi square test was used.
Authors and Affiliations
Muhammad Waqas, Iftikhar Ijaz, Abdul Rehman, Ubaidullah M
Keywords
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- EP ID EP594671
- DOI 10.26717/BJSTR.2019.14.002593
- Views 164
- Downloads 0
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