Abstract

PERALTA, Katia; LOVERA, Dolores  and  ARBO, Antonio. Change of ß-lactam penicillins to cephalosporins third generation (3G) in the treatment of community acquired pneumonia (CAP) in hospitalized children in a reference center. Rev. Inst. Med. Trop. [online]. 2014, vol.9, n.2, pp.21-28. ISSN 1996-3696.

Abstract Background: ß-lactam penicillins (penicillin, ampicillin or amoxicillin / ß-lactamase inhibitor) still represent the first choice in the initial treatment of CAP. Despite the increasing prevalence of S. pneumoniae with reduced susceptibility to penicillin, clinical failures of penicillin ß-lactams in pneumococcal infections are rare extrameníngeas Goals. Determine cases in a population of CAP is hospitalized in a referral center frequency of switching patients from ß-lactam penicillin and cephalosporin-3G analyze the causes that promoted. Materials and methods. Retrospective study based on a review of medical records of children under 15 years of age hospitalized with a diagnosis of CAP in the Pediatrics Institute of Tropical Medicine from June 2006 to August 2007 in which the change was necessary in antibiotic treatment . Results. In the study period, 271 pts were hospitalized. with NAC. 215 pts. (79%) received initial treatment with ß-lactam penicillin. 3G cephalosporin-income noted in 56/271 patients (20.6%), of which 26 pts. were serious immunocompromised (HIV 50%) 6 (11%) suffered from chronic disease (heart disease) and 24 (43%) by Severity Scale (ICU admission). In 7 cases the indication was considered inadequate. 28/56 pts. initially treated with cephalosporin 3-G switched to a ß-lactam penicillin in the first 48 hours. Of the 215 pts. initially treated with penicillin ß-lactams 16 (16/215; 7%) required change to cephalosporin-3G. In 7/16 cases (44%) the decision to change was not related to treatment failure [2 gastroenteritis cases (all with amoxicillin / IBL), and 1 case each for concomitant infection urinary tract, I mielomengocele infected convulsive syndrome, periorbital cellulitis and abscess S. aureus]; in 5 (31%) due to NAC in pts. severely immunocompromised, and four pts. (25%) the indication was inadequate. In any case the change was based on microbiological criteria for failure. Only 3/271 pts. (1%) received vancomycin, in all cases the diagnosis of nosocomial infection. Conclusions. If sts are excluded. severely immunocompromised or concomitant diseases, the need to change the initial therapy of NAC with ß-lactam penicillin is rare. At our institution, 84% of pts. NAC complete the treatment with ß-lactam penicillin. The use of vancomycin is exceptional

Keywords : Infectious diseases; pneumonia; pediatrics.

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