The combination of beta-lactam antibiotics and macrolides is the best choice for the treatment of pneumonia in schoolchildren
Children of advanced school age with community-acquired pneumonia receiving a combination of beta-lactam + macrolide left hospital earlier than patients receiving only a beta-lactam antibiotic.
Older schoolchildren hospitalized for community-acquired pneumonia who received a combination of β-lactam + macrolide were released from hospital earlier than patients who received only a β- antibiotic, according to a retrospective study lactam, and there was no significant difference in the length of stay in a monotherapy appointment hospital and combination treatment in children under 6 years of age.
Similar differences in outcomes were most likely associated with a higher incidence of bacterial infections caused by atypical pathogens in older children.
According to experts from the Children's Hospital Medical Center (Cincinnati, Ohio, United States), the study confirms the advisability of the Pediatric Infectious Disease Society and the Infectious Diseases Society of America by using β- antibiotic lactam and macrolide in the treatment of schoolchildren at risk of pneumonia caused by an atypical pathogen, and monotherapy with a β-lactam antibiotic in the treatment of preschool children develop when, as a rule, there is no reason to assume the etiology atypical of the disease.
According to the authors of the study to identify the groups in which monotherapy with β-lactam antibiotics or their combination with macrolides have the greatest benefits, the choice of an adequate antibacterial therapy for the treatment of children hospitalized for pneumonia community is a difficult task.
Using the Pediatric Health Information Database, the researchers selected 20,743 children aged 1 to 18 years hospitalized for community-acquired pneumonia over a 3-year period. Third generation cephalosporins were most often prescribed both as monotherapy and in combination with macrolide. A total of 4,934 children (24%) received combination therapy.
The main criteria evaluated were the length of stay in hospital and readmission within 14 days of discharge.
The average length of hospital stay in a common cohort was 2 days. In general, compared to children who received only a β-lactam antibiotic, patients who were prescribed β-lactam + macrolide were much less likely to require additional days of hospitalization (risk adjusted relative 0.80).
Age was one of the determining factors. Among children aged 12 to 18 who received combination therapy, the need for additional hospital days was 31% lower than their peers who received monotherapy (RR adjusted 0.69). In children 6 and 11 years of age, the probability of extending hospital treatment was 15% lower (RR adjusted by 0.85). In addition, in children aged 1 to 5 years, combination therapy had no significant effect on the length of stay in hospital (adjusted RR 0.96).
The appointment of combination therapy was not associated with a significant decrease in the number of repeat hospitalizations within 14 days of discharge.
The authors note that the results of their study apply to children hospitalized in hospitals suffering from community-acquired pneumonia, which has a mild course, in the absence of concomitant pathology.