Once-daily ceftriaxone therapy for pediatric bacterial infections
Once-Daily Ceftriaxone Therapy for Pediatric Bacterial Infections Ceftriaxone offers important advantages over current conventional therapy for serious bacterial infections in children. Several studies have demonstrated the safety and efficacy with twice-daily administration of ceftriaxone. This cephalosporin has an extended spectrum of bactericidal activity and increased potency, resulting in drug concentrations in the serum, tissues and cerebrospinal fluid that are many times greater than the minimum inhibitory concentrations for most pathogens implicated in common pediatric infections.
Many clinicians have hypothesized that it may be possible to administer ceftriaxone intravenously or intramuscularly on a once-daily basis to children with serious bacterial infections. This approach offers substantial cost savings and convenience to patients.
Frenkel and associates report on the results of once-daily administration in patients participating in the Multicenter Ceftriaxone Pediatrics Study Group. Clinical trials in 11 hospitals included 201 patients. Ceftriaxone was administered at a dosage of 50 mg per kg per day for all infections except meningitis. Patients with meningitis received 80 mg per kg per day. In addition to meningitis, serious bacterial infections in the study population included epiglottitis, pneumonia, cellulitis, osteomyelitis, septic arthritis, pyelonephritis and sepsis. Twenty-five percent of the group received intramuscular therapy exclusively and 30 percent received both intramuscular and intravenous therapy. The average duration of therapy was 8.1 days.
Excellent cure rates were observed for a wide variety of infections. With the exception of infections caused by Staphylococcus aureus, cure rates were nearly 100 percent. Ceftriaxone was ineffective against Listeria, Pseudomonas and Bacteroides species, methicillin-resistant staphylococci and enterococci.
The only significant adverse effect of ceftriaxone therapy was the development of Pseudomonas cellulitis as a secondary infection. No adverse reactions required discontinuance of therapy.
The authors conclude that selected serious bacterial infections in children may be safely and efficaciously treated with once-daily administration of intramuscular or intravenous ceftriaxone. In this study population, the route of administration was not a determinant of therapeutic outcome. (Pediatrics, September 1988, vol. 82, p. 486.)
COPYRIGHT 1989 American Academy of Family Physicians
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