Outcome of children hospitalized with community‐acquired pneumonia treated with aqueous penicillin G

OBJECTIVE: To describe the evolution and outcome of children hospitalized with community-acquired pneumonia receiving penicillin. METHODS: A search was carried out for all hospitalized community-acquired pneumonia cases in a 37-month period. Inclusion criteria comprised age >2 months, intravenous penicillin G use at 200,000 IU/kg/day for >48 h and chest x-ray results. Confounders leading to exclusion included underlying debilitating or chronic pulmonary illnesses, nosocomial pneumonia or transference to another hospital. Pneumonia was confirmed if a pulmonary infiltrate or pleural effusion was described by an independent radiologist blind to the clinical information. Data on admission and evolution were entered on a standardized form. RESULTS: Of 154 studied cases, 123 (80%) and 40 (26%) had pulmonary infiltrate or pleural effusion, respectively. Penicilli was substituted by other antibiotics in 28 (18%) patients, in whom the sole significant decrease was in the frequency of tachypnea from the first to the second day of treatment (86% vs. 50%, p = 0.008). Among patients treated exclusively with penicillin G, fever (46% vs. 26%, p = 0.002), tachypnea (74% vs. 59%, p = 0.003), chest indrawing (29% vs. 13%, p<0.001) and nasal flaring (10% vs. 1.6%, p = 0.001) frequencies significantly decreased from admission to the first day of treatment. Patients treated with other antimicrobial agents stayed longer in the hospital than those treated solely with penicillin G (16±6 vs. 8±4 days, p<0.001, mean difference (95% confidence interval) 8 (6-10)). None of the studied patients died. CONCLUSION: Penicillin G successfully treated 82% (126/154) of the study group and improvement was marked on the first day of treatment

Aspectos da admissão e evolução de crianças hospitalizadas com suspeita de pneumonia adquirida na comunidade em Salvador

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2013-04-16T19:40:46Z No. of bitstreams: 1 raquel_simbalista_de queiroz. Aspectos da admissao. 2010.pdf: 39174617 bytes, checksum: e35efd5722282aa850fa314a2345a654 (MD5)Made available in DSpace on 2013-04-16T19:40:46Z (GMT). No. of bitstreams: 1 raquel_simbalista_de queiroz. Aspectos da admissao. 2010.pdf: 39174617 bytes, checksum: e35efd5722282aa850fa314a2345a654 (MD5) Previous issue date: 2010Universidade Federal da Bahia. Faculdade de Medicina. Salvador, BA, Brasil / Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, BrasilA pneumonia na infância permanece um assunto relevante, tendo em vista a sua elevada taxa de mortalidade mundial, principalmente nos países em desenvolvimento. Objetivo: Descrever o resultado da hospitalização de crianças internadas com suspeita diagnostica de pneumonia. Desenho do estudo: Coorte retrospectiva. Material e métodos: Foi realizado acompanhamento retrospectivo de pacientes internados com suspeita de pneumonia em um centro pediátrico, de outubro de 2002 a outubro de 2005. A partir dos prontuários médicos, dados demográficos, de história clínica, do exame físico, do tratamento, da evolução e do desfecho foram coletados e registrados em formulário específico para o estudo. Todos os casos incluídos tiveram as radiografias de tórax avaliadas por radiologista cego às informações clínicas, com o objetivo de definir a presença ou não de infiltrado pulmonar e avaliar a presença de alterações radiológicas outras. A população do estudo foi alocada -“m quatro grupos diferente? para que pudessem ter suas variáveis comparadas entre pacientes com características semelhantes. Resultados: No grupo das crianças > 2 meses de idade, internadas com diagnóstico clínico-radiológico de pneumonia e tratadas com penicilina cristalina, as freqüências de febre (46,4% vs. 26,3%, /’=0,002), taquipnéia (73,6% vs. 59,4%, ^=0,003), tiragem subcostal (29,4% vs. 12,7%, /’ 2 meses, com diagnóstico clínico ou clínico-radiológico de pneumonia, tratadas com antibióticos diversos, excluindo-se aquelas pertencentes aos outros grupos, a escolha inicial por penicilina cristalina foi mais frequente. Com relação ao desfecho, 191 (64,1%) dos pacientes receberam alta após cura e 107 (35,2%) após melhora clínica. 13 Finalmente, entre as crianças com idade > 2 meses internadas com diagnóstico clínico ou clínico-radiológico de pneumonia tratadas com penicilina cristalina, o que incluiu aquelas do primeiro grupo, todas foram consideradas curadas (72,6%) ou com melhora clínica (27,4%) no momento da alta hospitalar. A freqüência de cura foi maior entre os pacientes que não modificaram a antibioticoterapia inicial (p 2 months old hospitalized with suspected pneumonia, excluding those of the other three groups, the choice for penicillin G had higher frequencies than the other schemes registered, among all age groups. According to outcome, 191 (64.1%) those children > 2 months old hospitalized with suspected pneumonia, treated with intravenous aqueous penicillin G, what includes children from the first group, all were considered improved (27.4%) or cured (72.6%) at the time of hospital discharge, and there was significantly more cure among those who 15 did not switched therapy (p<0.001). Main conclusions: From the aforementioned data, it is possible to observe that guideline-concordant empiric antibiotic remains an important procedure to an effective treatment of pneumonia among children of all age groups. Besides, the adherence of empiric antibiotic therapy was good among physicians in our study, especially when there was concordance between the clinical and radiological diagnosis; and this approach is one of the keys to an effective treatment of childhood pneumonia