• Clinical efficacy of ceftriaxone during the inpatient treatment of community-acquired pneumonia in children under 5 years

Clinical efficacy of ceftriaxone during the inpatient treatment of community-acquired pneumonia in children under 5 years

SOVREMENNAYA PEDIATRIYA.2017.3(83):117-122; doi 10.15574/SP.2017.83.117

Mokiya-Serbina S. A., Zabolotnyaya N. I., Kizyakovskaya I. P.
SE «Dnipropetrovsk Medical Academy of Health Ministry of Ukraine», Kryvyi Rig
MI of the Dnipropetrovsk Regional Council «State Clinical Hospital No.4», Kryvyi Rig

In pediatric practice, especially in hospitals, the antimicrobial stewardship of severe community-acquired pneumonia is a serious challenge in children under 5 years.

The purpose of the study was to assess the efficiency of starting empirical inpatient treatment with Ceftriaxone in children under 5 years with a verified diagnosis of severe community-acquired pneumonia. The study is retrospective. The analysis of 200 case histories of patients who underwent inpatient care during the period from 2013 to 2015 was performed. Three age groups were identified: children aged 2 to 12 months (n=30), patients from 1 to 3 years (n=70) and from 3 to 5 years (n=100). Assessment of clinical efficiency was carried out in 48–72 hours, 5–7 and 10–14 days from the beginning of drug therapy. Ceftriaxone monotherapy was administrated in 146 (70,3%) children, the combined with other antibiotics (azithromycin, ampicillin, amikacin) treatment was used in 54 (29.7%) children. The administration of combined antibiotic therapy was not associated with the severity of the disease.

Results. The age-dependent clinical efficacy of the starting ceftriaxone therapy was observed. The relatively low clinical efficacy (52.9%) was found in infants, the high one was in the age group of children from one to 3 years of age (78.4%). In children over 3 years of age the clinical efficacy made up 64.1%. Due to the inefficiency of Ceftriaxone, the repeated courses of antibiotics were assigned. The therapeutic effect was achieved within 24–72 hours in 98.9% of children. The high clinical efficacy of combined Ceftriaxone + Azithromycin therapy, either as the starting empirical therapy or in case of ineffectiveness of Ceftriaxone monotherapy. Clinical efficacy of combination Ceftriaxone + Amikacin therapy was achieved in children from one to 3 years in 71.4% of cases, and in age group from 3 to 5 years in 60.0% of patients. There was observed the tendency to Ceftriaxone clinical efficacy decline in all children, regardless of their age since 2014.

Conclusions. The results of the study substantiate the need of revising the standards of the severe community-acquired pneumonia treatment in children of different age groups.

Key words: severe community-acquired pneumonia, children, Ceftriaxone.

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