Azithromycin compared with beta-lactam antibiotic treatment failures in pneumococcal infections of children.

Abstract

OBJECTIVE:

To determine whether treatment failures occurred more commonly with azithromycin than with beta-lactam antibiotics in children who developed invasive pneumococcal disease within 30 days of receiving prior antimicrobial therapy.

METHODS:

Retrospective review of medical records of children evaluated at Texas Children's Hospital between 1996 and 2002 who had received antimicrobials (azithromycin or a beta-lactam antibiotic) and developed invasive pneumococcal disease within 30 days. Treatment failure was defined as invasive pneumococcal infection that occurred while taking antimicrobials or within 3 days of stopping azithromycin treatment or 1 day of stopping beta-lactam treatment. Penicillin and azithromycin susceptibilities were determined and categorized according to National Committee for Clinical Laboratory Standards guidelines.

RESULTS:

We identified 21 and 33 children with similar demographic features who had developed invasive pneumococcal disease within 1 month of receiving azithromycin or a beta-lactam antibiotic, respectively. Eleven (52%) children in the azithromycin group and 11 (33%) in the beta-lactam group met the definition for treatment failures (P = 0.34). Eight treatment failures while receiving azithromycin were caused by pneumococci with the macrolide-resistant (M) phenotype, 2 with the macrolide-, lincosamide- and streptogramin B-resistant (MLSB) phenotype and 1 by a macrolide-susceptible organism. In the beta-lactam group 7 had a penicillin-resistant isolate, 3 had an intermediately susceptible isolate and 1 had a susceptible isolate.

CONCLUSIONS:

Our study suggests that treatment failures among patients who developed invasive disease within 30 days of receiving an antimicrobial occur as frequently in patients who receive beta-lactam antibiotics as in those who receive azithromycin. Furthermore macrolide resistant organisms are not more likely to be recovered after a macrolide treatment failure than a penicillin-nonsusceptible isolate being recovered after a beta-lactam treatment failure (P = 1.0).

• Authors: Blanca E Gonzalez, Gerardo Martinez-Aguilar, Edward O Mason Jr, Sheldon L Kaplan
• Journal: The Pediatric infectious disease journal (Pediatr Infect Dis J) Vol. 23 Issue 5 Pg. 399-405 (May 2004) ISSN: 0891-3668 [Print] United States
• PMID: 15131461 (Publication Type: Comparative Study, Journal Article, Research Support, U.S. Gov't, P.H.S., Review)

Chemical References

• Anti-Bacterial Agents
• Penicillins
• beta-Lactams
• Azithromycin

Topics

• Anti-Bacterial Agents (pharmacology, therapeutic use)
• Azithromycin (pharmacology, therapeutic use)
• Child, Preschool
• Drug Resistance, Bacterial
• Female
• Humans
• Infant
• Male
• Microbial Sensitivity Tests
• Penicillins (pharmacology, therapeutic use)
• Pneumococcal Infections (drug therapy)
• Prospective Studies
• Streptococcus pneumoniae
• Treatment Failure
• beta-Lactams (pharmacology, therapeutic use)