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Article in Japanese

Evaluation of ampicillin as first-line treatment for pediatric community-acquired pneumonia based on the Japanese Guideline for the Management of respiratory infectious diseases in children

Kento TAKAHASHI1), Tomohiro OISHI1), Tomoki INOUE1), Shoko WAKABAYASHI1), Mina KONO1), Atsushi KATO1), Hideto TERANISHI1), Hiroto AKAIKE1), Takaaki TANAKA2), Ippei MIYATA1), Naoki OHNO1), Takashi NAKANO2), Kazunobu OUCHI1)

The Japanese guideline for the management of respiratory infectious diseases in children was revised in 2016 (GL2017). In GL2017, ampicillin (ABPC) was recommended as the first-line antibiotic for the treatment of community-acquired pneumonia in children. This study compared the efficacy of ABPC with that of sulbactam/ampicillin (SBT/ABPC) and cefotaxime (CTX) against community-acquired pediatric pneumonia. In total, 165 children were recruited. The number in each cohort was 72 (ABPC), 46 (SBT/ABPC) and 43 (CTX). The average age of the patients was 2 years and 1 month; and the ratio of boys to girls was 96: 65. Moderate and severe cases, according to severity diagnostic scores in GL2017, were 85% and 15% of the total, respectively. Seventy-three strains of Streptococcus pneumoniae and 84 of Haemophilus influenzae were isolated from the children. The rate of Penicillin-resistant Streptococcus pneumoniae(PRSP) among patients with S. pneumoniae was 25%; and that of beta-lactamase-nonproducing ampicillin-resistant strain (BLNAR) and beta-lactamase-producing ampicillin-resistant strain (BLPAR) among those with H. influenzae was 25% and 11%, respectively. Furthermore, 92.2% of the cases treated with ABPC were cleared within 48 hours after initiation of therapy. However, this result was not significantly different from that of patients treated with SBT/ABPC or CTX. In conclusion, ABPC was found to be an appropriate first-line antibiotic for treating pediatric community-acquired pneumonia.

1) Department of Pediatrics, Kawasaki Medical School
2) Department of Pediatrics, Kawasaki Medical School General Medical Center

Key words children, community-acquired pneumonia, guideline, ampicillin, treatment
Received March 13, 2020
Accepted September 15, 2020

32 (4):324─332,2020