Clinical use of cefuroxime in paediatric community-acquired pneumonia.

Cefuroxime has been recommended as a component of treatment for community-acquired pneumonia (CAP) in guidelines produced by several groups, including the US and British Thoracic Societies. It is effective in vitro against the major bacterial pathogens in CAP but it needs to be given with an agent that is active against Mycoplasma, Chlamydia or Legionella spp. if the presence of any of these organisms is suspected. Cefuroxime penetrates respiratory tissue effectively after either parenteral or oral administration, and it has a pharmacodynamic profile which suggests that adequate cover can be achieved with oral therapy for respiratory pathogens susceptible to cefuroxime concentrations of 4 mg/L or less. This break-point is applicable to oral monotherapy and to sequential therapy regimens for the treatment of pneumonia. Cefuroxime can be used either orally or parenterally and it is approved in many countries for the treatment of adult pneumonia by either route. The oral form, cefuroxime axetil, has been used extensively in the treatment of children aged over 3 months but its use in paediatric pneumonia has not been reviewed. The present review summarises clinical experience in the treatment of bacterial pneumonia, of varying severity, in children. The data show that children with severe pneumonia, including those with pleural effusion or complications, can be treated with a full course of intravenous cefuroxime therapy, whereas hospitalised children whose pneumonia stabilises rapidly after initial intravenous therapy can change to oral cefuroxime axetil after 24 to 72 hours and may be able to return home. Oral cefuroxime axetil was appropriate for patients with milder pneumonia managed either in hospital or at home.