A RANDOMIZED CONTROL TRIAL OF CEFTRIAXONE VS.
AMOXCILLIN IN THE TREATMENT OF PNEUMONIA IN CHILDREN
Chan KJ, Clarke M, Horvath Z, Baldwin G, Phillips B
Pediatric Emergency, 4480 Oak Street, Vancouver, Canada V6H 3V4
There have been few
randomized controlled trials of drug treatment of pneumonia in
children. Pneumonia is a major
cause of morbidity and mortality in the pediatric population, however,
newer antibiotics have not been tested for their efficacy. Ceftriaxone is often used in
the treatment of pneumonia.
Our study was to test if single dose ceftriaxone reduces duration of
fever, cough, work of breathing, wellness, and energy level in children.
Methods: A
prospective randomized controlled trial was conducted of all children
presenting to a tertiary-center pediatric emergency department with
pneumonia not requiring admission.
Patients were given one of two treatments: 1) a dose of intravenous
Ceftriaxone (50 mg/kg) followed by a ten day course of oral amoxicillin (40
mg/kg/day) versus 2) a placebo dose intravenous followed by a ten day of
oral amoxicillin (40 mg/kg/day).
Results:
There were a 37 children evaluated (17 in the early ceftriaxone dose
plus amoxicillin regimen and 20 in the amoxicillin only regimen). Six children were excluded, due to
failure to reach inclusion criteria (3 from each treatment arm). Intravenous ceftriaxone’s
plus amoxicillin’s duration of fever was 0.89 + 2.47 versus oral
amoxicillin’s 0.56 + 0.82 days (p=0.67). There was no difference in cough
(6.09 vs. 5.77 days), work of breathing (4.66 vs. 4.15 days), energy level
(4.70 vs. 4.62 days), and wellness (5.64 vs. 4.92 days). There were side effects in 3
children taking amoxicillin only.
Over 52% of children diagnosed with pneumonia have white blood
counts > 15000. However, no
blood cultures have been positive.
Surprisingly, the accuracy of chest X-ray diagnosis between
radiologists and emergency physicians was only 35%.
Conclusions:
At this stage in our clinical trial, it does not appear that early
dose ceftriaxone has an advantage over straight amoxicillin. Early dose ceftriaxone does not
appear to have additional side effects.