Retrospective Analysis of the Efficacies of Two Different Regimens of Aqueous Penicillin G Administered to Children with Pneumonia

Abstract

dCommunity-acquired pneumonia (CAP) is an important childhood health problem. Penicillin remains appropriate for treating children with CAP. Clinical data are lacking on disease evolution in children treated with different posologic schemes of aqueous penicillin G. To assess if there were differences in disease evolution between children with CAP treated with 6 or 4 daily doses of aqueous penicillin G, we reviewed the medical charts of hospitalized patients 2 months to 11.5 years of age. Pneumonia was radiologically confirmed based on the detection of pulmonary infiltrate or pleural effusion on the chest radiograph taken on admission and read by a pediatric radiologist blinded to the clinical data. The total daily dose of aqueous penicillin G was 200,000 IU/kg of body weight. Data were recorded on admission, during disease evolution up to the 7th day of treatment, and at the final outcome. The results of hospitalization and the daily frequency of physical signs suggestive of pneumonia were assessed. The subgroups comprised 120 and 144 children who received aqueous penicillin G in 6 or 4 daily doses, respectively. Children >5 years of age were more frequent in the 4-daily-doses subgroup (16.0% versus 4.2%; respectively, P ‫؍‬ 0.02). There were no differences between the compared subgroups in terms of final outcomes, lengths of hospitalization, durations of aqueous penicillin G use, frequencies of aqueous penicillin G substitution, or daily frequencies of tachypnea, fever, chest retraction, lower chest recession, nasal flaring, and cyanosis up to the 7th day of treatment. The studied posologic regimens were similarly effective in treating children hospitalized with a radiologically confirmed CAP diagnosis. Aqueous penicillin G (200,000 IU/kg/day) may be given in 4 daily doses to children with CAP. C ommunity-acquired pneumonia (CAP) is an important childhood health problem that accounts for approximately 1.396 million child deaths (1) and 154 million cases (2, 3) annually among children under 5 years old around the world. In clinical practice, it is not routinely possible to identify the etiological agent of the disease (4). Based on a wide range of evidence, Streptococcus pneumoniae is recognized as the most common bacterial agent of CAP (5). This is the rationale behind choosing antibiotics that target this pathogen (4). That is why penicillin and its derivatives remain the appropriate antimicrobial agents to treat children with CAP (6). When hospitalization is required, the first-line drug is intravenous aqueous penicillin G (7).In the 1990s, pneumococcal resistance to penicillin had been widely recognized as a potential problem but the increased dose of penicillin was shown to be effective in overcoming this problem as long as the infection did not affect the central nervous system (8). This finding may be explained by the time-dependent killing characteristic of penicillin (9). That is, the period of time during which the level of penicillin in serum is higher than the MIC is predictive of the therapeutic eff...

Community-acquired pneumonia among children: the latest evidence for an updated management

“…63 Também foi demonstrado que a dosagem diária de 200.000 UI/kg/dia tem a mesma eficácia se dada a cada quatro horas ou a cada seis horas. 64 Quando o tratamento é administrado com maior intervalo entre as doses, é mais confortável para os pacientes e profissionais de saúde, o que aumenta a adesão, além de ser mais barato para as instituições de saúde. Também é relevante comentar como os pacientes hospitalizados com PAC evoluem durante o tratamento com antibióticos.…”

Community‐acquired pneumonia among children: the latest evidence for an updated management

“…48 It has already been demonstrated that patients infected with pneumococcal strains with MIC up to 4 ug/mL present good response when treated with aqueous penicillin G at dosage of 200.000 UI/kg/day. 63 It has also been shown that the daily dosage of 200.000 UI/kg/day has the same efficacy if given every 4 h or every 6 h. 64 When treatment is managed with a larger interval between doses, it is more comfortable for patients and healthcare professionals, which enhances adherence, besides being cheaper for healthcare institutions. It is also relevant to comment on how hospitalized patients with CAP evolve during antibiotic treatment.…”

The radiological diagnosis of pneumonia in children

“…While the WHO radiological protocol [26] has its limitations, it currently remains the only tool for the standardisation of the radiological diagnosis of pneumonia in children. However, reports of studies that have used the protocol in clinical settings have emerged [71,89]. This is of some concern given the protocol is not intended for use in the clinical context.…”