It is generally accepted that the treatment of community-acquired
pneumonia, either in adults or in pediatric patients, is mainly empirical. Thus, the treatment selection must fulfill both the epidemiological requirements, according to the most frequently described pathogens, and the pharmacological criteria to ensure adequate and prolonged
drug concentrations at the
infection site, to reach clinical efficacy.
Cefotaxime has proven to be effective in this indication when traditionally administered three times daily and, more recently, twice daily, as a result of a re-evaluation of its pharmacokinetic/pharmacodynamic features. To gain further evidence using this updated dosing schedule, 258 pediatric patients with lower
respiratory tract infections were treated with
cefotaxime 100 mg/kg/day, administered as a twice daily or three times daily regimen. In the
cefotaxime 50 mg/kg twice-daily group (n = 130), a complete resolution of clinical signs and symptoms were observed in 88.5% of patients. Similarly, in the
cefotaxime 33.3 mg/kg group (n = 128), 93.6% of patients had a complete resolution of clinical signs and symptoms. Both
drug schedules were well tolerated. Pharmacokinetic parameters determined for the two
cefotaxime dosing schedules showed comparability. The serum half-life of
desacetylcefotaxime was marginally longer than for
cefotaxime in both dosage groups (1.64 and 1.36 h for
desacetylcefotaxime versus 1.2 and 0.85 h for
cefotaxime after 50 mg/kg or 33.3 mg/kg doses, respectively). Results from this study support the use of twice-daily
cefotaxime administration for the treatment of lower
respiratory tract infections in pediatric patients.