[Septicemia of children in Japan (1980-1984). Part 4. Antibiotic treatment and prognosis according to causative agents].

Seven hundred and thirteen cases of septicemia whose causative organisms were detected from peripheral blood at 48 pediatric institutions throughout Japan during 1980-1984 were analyzed with respect to their chemotherapeutic outcome relative to causative microorganisms. Against Gram-positive cocci including S. pyogenes, S. agalactiae, S. viridans, S. pneumoniae, E. faecalis, penicillins (PCs) demonstrated excellent results, and cephalosporin antibiotics (CEPs) also showed good results except against E. faecalis. Combinations of PCs and aminoglycosides (AGs) resulted in a significantly high fatality rate in streptococcal infections, and very significantly high fatality rate of 38.7% in infections due to S. aureus. Combinations of CEPs and AGs showed a little lower rate than the above combinations, but monotherapy gave the best result. Infections due to S. epidermidis revealed better prognosis than those due to S. aureus. We recommend that PC II (PCase resistant) and CEP I or II should be combined with fosfomycin (FOM), if necessary, for the treatment of staphylococcal septicemia. For the treatment of septicemia due to H. influenzae, ampicillin (ABPC) is the best drug against sensitive strains and CEP IV or V may also be the drug of choice even against ABPC resistant strains. Against septicemia due to E. coli, although its prognosis is not good in general, monotherapy gave the lowest mortality. Among combined therapies, "CEPs + AGs" resulted in a significantly lower death rate of 13.3% than "PCs + AGs" which showed a death rate of 38.3%. Pseudomonas septicemia is very difficult to treat with by a monotherapy using even PC IV, CEP V or AGs any of which is effective against P. aeruginosa. However, even then, the combination of "beta-lactam + AGs" gave higher mortality than monotherapies.(ABSTRACT TRUNCATED AT 250 WORDS)