PURPOSE: There is growing concern about emerging pathogens as causal agents of Community-Acquired Pneumonia (CAP) with changing patterns of sensitivity and resistance. Then, is empiric therapy an appropriate decision on current days for children?.
METHODS: We recorded the clinical experience attributable to oral form of ampicillin/sulbactam in children with CAP in several Venezuelan cities, prospectively and on the real life setting as an arm of ECASEN project. Pneumonia and other respiratory tract infections (RTIs) were assessed surveying clinical presentation, scores for Global symptoms (GSyS) and signs (GSiS) severity through a visual analogue scale at initial and final visit. GSyS could be 0-absent to 10-very bothering. GSiS was: 0-absent, 1-Mild, 2-Moderate, 3-Severe, and 4-very severe. Linked diseases, compliance rate, safety, and clinical efficacy of the drug (1-cure, 2-improvement, 3-failure, 4-exacerbation) were also evaluated.
RESULTS: From 234 ambulatory pediatric patients with RTIs, 23.5% had CAP. Patients/relatives featured GSyS as 7.43 ± 1.35 at beginning and 1.02 ± 1,26 at end, being 0: absent and 10: very bothering. GSiS was 2.55 ± 0.60 at starting and 0.18 ± 0.39 at end (p<0,001, respectively - “t” paired test). Allergic Rhinitis was present in 63%. Fever, sneezing, and cough was the most common clinical presentation. Adverse events were found in 11% of subjects: diarrhea and vomiting the usual ones. Rate of compliance was over 75%. Clinical efficacy was 1.56 ± 0.54 and 1.63 ± 0.60 according to Patients/relatives and physician respectively.
CONCLUSION: Empiric therapy, according to local and international guidelines for management of CAP, is effective in children with CAP, and allergic rhinitis may be clearly associated. Response to sultamicillin signals that it may be used in ambulatory setting with some gastrointestinal adverse events.
CLINICAL IMPLICATIONS: Real life setting shows that it is wise to install empiric therapy according to guidelines for management of CAP in children although emergent pathogens could be covered under the usual presentation.
DISCLOSURE: Gemzel Hernandez, Employee Pfizer Venezuela.