Titre du document / Document title

Comparative randomized trial of azithromycin versus erythromycin and amoxicillin for treatment of community-acquired pneumonia in children

Auteur(s) / Author(s)

KOGAN Ricardo ⁽¹⁾ ; MARTINEZ M. Angélica ⁽²⁾ ; RUBILAR Lilian ⁽¹⁾ ; PAYA Ernesto ⁽¹⁾ ; QUEVEDO Llsa ⁽¹⁾ ; PUPPO Homero ⁽¹⁾ ; GIRARDI Guido ⁽¹⁾ ; CASTRO-RODRIGUEZ José A. ⁽¹⁾ ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

⁽¹⁾ Pediatric Pulmonary Section, Exequiel González Cortés Children's Hospital and the Department of Pediatrics, School of Medicine, University of Chile, Santiago, CHILI
⁽²⁾ Biomedical Sciences Institute, Microbiology Program, School of Medicine, University of Chile, Santiago, CHILI

Résumé / Abstract

Our objective was to compare the clinical efficacy of azithromycin vs. erythromycin and amoxicillin in the treatment of presumed bacterial community-acquired pneumonia in ambulatory children, and to evaluate the etiologies of these illnesses. One hundred and ten children, aged 1 month to 14 years, were enrolled between January 1996-January 1999. Children were distributed into two groups according to clinical and radiological patterns: classic or atypical pneumonia. Patients with classic pneumonia were randomly assigned to receive oral amoxicillin 75 mg/kg/day for 7 days, or azithromycin 10 mg/kg/day for 3 days; patients with atypical pneumonia received azithromycin 10 mg/kg/day for 3 days, or erythromycin 50 mg/kg/day for 14 days. Chest X-ray, clinical, and laboratory parameters were obtained on enrollment. Clinic visits were performed on days 3, 7, and 14, and chest X-ray follow-up on days 7 and 14. Microbiological diagnosis of classic pathogens was based on blood and bronchial secretion cultures. The diagnosis of atypical pathogens C. pneumoniae, C. trachomatis, and M. pneumoniae was based on PCR and serologic tests. Forty-seven children met the criteria for classic pneumonia (23 children received azithromycin, and 24 received amoxicillin), and 59 children had atypical pneumonia (33 children were treated with azithromycin, and 26 with erythromycin). Demographic characteristics at enrollment were similar between children with classic pneumonia treated with azithromycin and erythromycin and children treated with azithromycin and erythromycin for atypical pneumonia. However, on day 7, children with classic pneumonia who received azithromycin normalized their chest X-ray more often than those who received amoxicillin (81.0% vs. 60.9%, respectively, P= 0.009). The same was true for children with atypical pneumonia; their chest X-rays had normalized by day 14 (100% in those with azithromycin vs. 81% in those with erythromycin, P= 0.059). Also, children with atypical pneumonia treated with azithromycin had earlier cessation of cough than children treated with erythromycin (3.6 ± 1.9 vs. 5.5 ± 3.6 days respectively, P= 0.02). There were only three children with side effects (mild diarrhea, all in the erythromycin group). Etiological agents were identified in 41% of children. In conclusion, azithromycin is an effective therapeutic option for the treatment of community-acquired classic and atypical pneumonia in children.

Revue / Journal Title

Pediatric pulmonology   ISSN 8755-6863   CODEN PEPUES 

Source / Source

2003, vol. 35, n^o2, pp. 91-98 [8 page(s) (article)] (22 ref.)

Langue / Language

Anglais

Editeur / Publisher

Wiley-Liss, New York, NY, ETATS-UNIS  (1985) (Revue)

Mots-clés anglais / English Keywords

Chemotherapy ; Lung disease ; Respiratory disease ; Human ; Infection ; β-Lactams ; Penicillin derivatives ; Macrolide ; Child ; Treatment ; Comparative study ; Antibiotic ; Amoxicillin ; Erythromycin ; Azithromycin ; Bacteriosis ; Pneumonia ;

Mots-clés français / French Keywords

Chimiothérapie ; Poumon pathologie ; Appareil respiratoire pathologie ; Homme ; Infection ; β-Lactamines ; Pénicilline dérivé ; Macrolide ; Enfant ; Traitement ; Etude comparative ; Antibiotique ; Amoxicilline ; Erythromycine ; Azithromycine ; Bactériose ; Pneumonie ;

Mots-clés espagnols / Spanish Keywords

Quimioterapia ; Pulmón patología ; Aparato respiratorio patología ; Hombre ; Infección ; β-Lactams ; Penicilinas ; Macrólido ; Niño ; Tratamiento ; Estudio comparativo ; Antibiótico ; Amoxicilina ; Eritromicina ; Azitromicina ; Bacteriosis ; Neumonía ;

Mots-clés d'auteur / Author Keywords

azithromycin ; community-acquired pneumonia ; children ; erythromycin ; amoxicillin ;

Localisation / Location

INIST-CNRS, Cote INIST : 21407, 35400010392109.0040