CC BY
16
Sadikov N.
Akhrorkhonov R.
Yakhudayev E.M.
Andijan state medical institute Uzbekistan, Andijan
CEFTRIAXONE SULBACTAM VERSUS RANDOM ANTIBIOTIC TREATMENT IN EARLY AGE CHILDREN WITH COMMUNITY-
ACQUIRED PNEUMONIA
The purpose of the study was to assess the efficiency of starting empirical treatment with Ceftriaxone sulbactam in children under 3 years in-hospital with a verified diagnosis of severe community-acquired pneumonia. The study is retrospective. The analysis of 65 case histories of patients who were admitted in ARMCCH (Uzbekistan, Andijan), from 2021 to 2022 was made. The clinical efficacy of Ceftriaxone was 68.7% in severe community-acquired pneumonia in children under 3 years. Cef SLB therapy may be helpful for reducing mortality and morbidity of early age children with CAP.
Keywords: Ceftriaxone sulbactam, pneumonia, children, treatment, efficacy.
Background: Community-acquired Pneumonia (CAP) is an infection of the lung parenchyma that is acquired outside of hospital, [1] involved approximately 150 million new cases annually, among children younger than 5 years old worldwide. CAP is caused by bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis or viruses such as influenza virus [2, 3]. The susceptibilities of Streptococcus pneumoniae, Haemophilus influenzae and methicillin-resistant Staphylococcus aureus to P-lactam/p-lactamase inhibitors were reported as 99.5%, 59.3-78.0% and 7.720.2%, and the susceptibilities of these species to third-generation cephalosporins were reported as 96.8, 100 % [2].
Ceftriaxone (CTRX) and ampicillin/sulbactam (ABPC/SBT) are recommended by various guidelines for pneumonia in a number of countries as the first-line antibiotics for CAP [4-8]. According to the International and National Guidelines III generation cephalosporins are the drugs used as starting empirical treatment of uncomplicated severe community-acquired pneumonia in children regardless of age. Ceftriaxone is a drug that has a wide spectrum of antimicrobial activity, low toxicity, and it is easy to dose and economically available. [9, 10]
Methods: The diagnostic criteria for CAP are defined as radiological findings of a new and/or progressive infiltrate(s) and two or more of the following symptoms: cough, sputum or change of sputum character (increased volume and/or purulence), dyspnea, pleuritic chest pain, tachycardia,
documented axillary body temperature > 37.5 °C within the past 24 h, rigors and/or chills, general malaise, abnormal breathing sounds, auscultatory findings consistent with the lung infiltrate on chest examination, and white blood cell (WBC) count < 10*109/ml. Severity of pneumonia was determined according to the pneumonia severity index (PSI) [11].
Exclusion criteria: suspected aspiration pneumonia or hospital-acquired pneumonia; hospitalization within 60 days of symptom onset; active lung cancer (cases other than completely resected ones); terminal illness; immunocompromising disease (human immunodeficiency virus infection, active hematologic malignancies, neutropenia and congenital immunodeficiency) or receipt of immunosuppressive therapy (use of >10 mg of prednisolone -equivalents, and/or immunosuppressants); pregnant or breastfeeding; known allergy to the indicated antibiotics; or presence of other infiltrative diseases such as organizing pneumonia, radiation pneumonitis, drug-induced pneumonia, obstructive pneumonia, tuberculosis or fungal infection, and empyema.
Ceftriaxone monotherapy was appointed 32 (49.3%) children, in combination with other antibiotics (meropenem, ampicillin, amikacin, gentamycin etc) it was used in 44 children (not included in research) and no Cef SLB treatment was observed in 34 patients. Patients were treated using intravenous CTRX/SBT at 50-70 mg/kg every 12 h for 5-14 days, until their body temperature was < 37 °C for 48 h with clinical stability, and improvements were seen in terms of dyspnea, sputum, or C-reactive protein (CRP) levels. When a patient showed a recurrence of fever > 37.5°C after initial improvement of fever, the same antibiotic therapy was continued for 4 days from the first day of recurrence. To evaluate the effects of treatment, clinical findings, chest radiography findings, and laboratory test results were collected before, during, and at end of treatment (EOT; days 7-14). The late response to treatment was evaluated at end of study (EOS; days 14-28)
Results: We had 66 patients under 3 years old. The mean age was 0.87 years. We collected laboratory results (Hb level, glucose value, protein and Ca levels), and mean hospital stay was 7.58 days with maximum range 20 days. Effective response on treatment in control group (CefSLB group) was appointed 68.7% while it was calculated in placebo group (no CefSLB group) 64.7%. We also calculated hospital days of these group patients. Mean length of control group in hospital was 6.59 days where it was equal to 8.55 days in placebo group (p value <0.001).
Tab. 1 Main parameters of both group patients.
N Minimum Maximum Mean Std. Deviation
hospital days 65 3 20 7.58 3.508
Hb level g/l 64 68 100 79.78 7.038
glucose mmol/l 47 2 13 5.14 2.257
protein g/l 64 32 73 50.75 9.189
Ca mmol/l 64 .7 2.4 1.516 .2212
age in years 65 .1 3.0 .870 .9222
Figure L Hospital length of patients.
50
with CefSLB no CcfSLB CcfSLB mono
Tab 2. Mean comparison of hospital days of two groups.
Std. Std. Error P value
CefSLB use N Mean Deviation Mean
hospital days with CefSLB 32 6.59 1.434 .253 <0.001
no CefSLB 33 8.55 4.549 .792 <0.001
Conclusion. Ceftriaxon sulbactam monotherapy has showed more efficacy than random antibiotic treatment and it decreased hospital stay although. It may be helpful for reducing mortality and morbidity of Community-acquired pneumonia among children under 3 years old.
References:
1. Sadikov N, Yue XC, Hong XZ, Odilov B, Hua ZZ. The Effectiveness of Using Prednisolone in Children with Community - Acquired Pneumonia. Asian J Pediatr Res. 2021;5(3):1-8.
2. Yanagihara K, Kadota J, Aoki N, Matsumoto T, Yoshida M, Yagisawa M, et al. Nationwide surveillance of bacterial respiratory pathogens conducted by the surveillance committee of Japanese Society of Chemotherapy, the Japanese Association for Infectious Diseases, and the Japanese Society for Clinical
Microbiology in 2010: general view of the pathogens' antibacterial susceptibility. J Infect Chemother. 2015;21(6):410-20.
3. Niki Y, Hanaki H, Yagisawa M, Kohno S, Aoki N, Watanabe A, et al. The first nationwide surveillance of bacterial respiratory pathogens conducted by the Japanese Society of Chemotherapy. Part 1: a general view of antibacterial susceptibility. J Infect Chemother. 2008;14(4):279-90.
4. American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171(4):388-416.
5. Kohno S, Imamura Y, Shindo Y, Seki M, Ishida T, Teramoto S, et al. Clinical practice guidelines for nursing- and healthcare-associated pneumonia (NHCAP) [complete translation]. Respir Investig. 2013;51(2):103 -26.
6. RS Task Force Report. Guidelines for management of adult community-acquired lower respiratory tract infections. European Respiratory Society. Eur Respir J. 1998;11(4):986-91.
7. Bartlett JG, Dowell SF, Mandell LA, File TM Jr, Musher DM, Fine MJ. Practice guidelines for the management of community-acquired pneumonia in adults. Infectious Diseases Society of America. Clin Infect Dis. 2000;31(2):347 -82.
8. Niederman MS, Mandell LA, Anzueto A, Bass JB, Broughton WA, Campbell GD, et al. Guidelines for the management of adults with community-acquired pneumonia. Diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med. 2001;163(7):1730-54.
9. Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997;336(4):243-50.
10. Communiy-acquired pneumonia in children. Clinical Recommendations. Moskva:Original-maket; 2015. 64 p. Russian
11. Maydannik VG. Clinical Recommendations on prevention and treatment of complications of acute respiratory infections in children. K. 2016;56 p. Russian
