A randomized controlled trial of penicillin vs clindamycin for the treatment of aspiration pneumonia in children.

OBJECTIVE

To compare the effectiveness of intravenous penicillin vs clindamycin for the treatment of aspiration pneumonia.

DESIGN

A double-blind, randomized controlled trial.

SETTING

A tertiary care pediatric hospital.

PATIENTS

We enrolled 42 children, aged 6 months to 18 years, who were admitted to the hospital for the treatment of aspiration pneumonia. All of the children had underlying conditions that predispose to aspiration.

INTERVENTION

The patients were randomly assigned to receive intravenous penicillin G sodium, 250,000 U/kg every 24 hours, or intravenous clindamycin phosphate, 30 mg/kg every 24 hours.

MAIN OUTCOME MEASURE

The primary outcome measure was "time to ready for discharge" from the hospital.

RESULTS

In an effectiveness (intention to treat) analysis, the median time (interquartile range) to ready for discharge from the hospital was 4.9 days (range, 2.8-6.5 days) in the penicillin-treated group and 3.4 days (range, 2.3-6.8 days) in the clindamycin-treated group (P = .66). Results were not markedly altered when adjusted for the age difference of the groups or in the efficacy analysis (after the exclusion of 9 patients who withdrew from the trial). Rates for readmission to the hospital were similar in the 2 groups.

CONCLUSION

Penicillin and clindamycin seem to be equally effective for the treatment of aspiration pneumonia in children hospitalized for this illness.