NEW YORK (Reuters Health) - Twice-daily dosing of oral amoxicillin is as effective as a three-times-a-day approach in treating mild pediatric pneumonia, according to Brazilian researchers.
As Dr. Cristiana Nascimento-Carvalho told Reuters Health by email, "Amoxicillin may be given as a 25 mg/kg/dose twice a day to children with non-severe community-acquired pneumonia because it is not only efficacious but also safe."
Moreover, the results are generally applicable, she added, "because the patients included in this study are similar to patients who seek assistance worldwide."
In a March 19 online paper in the Journal of Antimicrobial Chemotherapy, Dr. Nascimento-Carvalho of the Bahia School of Medicine in Salvador and colleagues note that the standard amoxicillin outpatient thrice-daily regimen is uniformly successful. Fewer doses could mean higher compliance, but twice- and thrice-daily regimens have not been directly compared.
"Although the study was carried out in only one center in Brazil," Dr. Nascimento-Carvalho said, "820 patients were enrolled by applying very strict criteria to diagnose and classify pneumonia as well as its evolution."
In this placebo-controlled study, the children, aged two to 59 months, were randomized to oral amoxicillin 50 mg/kg/day given twice daily or three times daily (at 16.7 mg/kg/dose). They were followed up at two, five, and 14 days.
In intention-to-treat analysis, treatment failure was seen in 23.0% of the twice-daily and 22.8% of the thrice-daily group. Corresponding proportions in per-protocol analysis were 21.3% and 20.1%. Tachypnea, fever, and wheezing were independent predictors of failure and the researchers note that such patients "should be followed up closely."
Pneumonia was radiologically confirmed in 277 (33.8%) patients. Of these, treatment failure was seen in 18.8% of both twice- and thrice-daily groups.
Severe adverse events were rare and "discontinuation was not necessary in the great majority of patients." Diarrhea was the most frequent reaction.
Dr. Nascimento-Carvalho pointed out that although a multicenter approach would have led to faster enrollment of an adequate number of patients, "The fact that the study was conducted in one single center adds the advantage that the procedures for enrolling and following-up the patients were more easily checked for quality control."
In such patients the twice-daily approach is all that's needed, she and her colleagues conclude. "Higher amounts of amoxicillin are unnecessary and money may be saved."
Commenting on the findings, Dr. Zulfiqar A. Bhutta told Reuters Health by email that they "are not surprising given that we know that short course therapy of non-severe pneumonia for two days is as effective as a five-day course."
"The bigger issue with antibiotic therapy for non-severe pneumonia is if antibiotic therapy is required at all," added Dr. Bhutta, of the University of Toronto. "There are preliminary studies now showing that the outcomes in non-severe pneumonia are not affected by antibiotic therapy, given that current diagnostic criteria are unable to distinguish viral and bacterial infections and the issue needs to be resolved with larger trials in representative settings."
Δεν υπάρχουν σχόλια:
Δημοσίευση σχολίου