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

ABSTRACT

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 percent) and 40 (26 percent) had pulmonary infiltrate or pleural effusion, respectively. Penicilli was substituted by other antibiotics in 28 (18 percent) patients, in whom the sole significant decrease was in the frequency of tachypnea from the first to the second day of treatment (86 percent vs. 50 percent, p = 0.008). Among patients treated exclusively with penicillin G, fever (46 percent vs. 26 percent, p = 0.002), tachypnea (74 percent vs. 59 percent, p = 0.003), chest indrawing (29 percent vs. 13 percent, p<0.001) and nasal flaring (10 percent vs. 1.6 percent, 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 percent confidence interval) 8 (6-10)). None of the studied patients died. CONCLUSION: Penicillin G successfully treated 82 percent (126/154) of the study group and improvement was marked on the first day of treatment.