Boccazzi A, Tonelli P, Bellosta C, Careddu P
Pediatric Department 1st, University of Milan Medical School, Italy.
Diagn Microbiol Infect Dis. 1998 Dec;32(4):265-72. doi: 10.1016/s0732-8893(98)00110-2.
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.
一般认为，无论是成人还是儿童社区获得性肺炎的治疗主要是经验性的。因此，治疗选择必须满足根据最常描述的病原体的流行病学要求以及药理学标准，以确保在感染部位有足够且持久的药物浓度，从而达到临床疗效。头孢噻肟在传统上每日给药三次时已被证明在该适应症中有效，最近由于对其药代动力学/药效学特征的重新评估，每日给药两次也有效。为了使用这种更新的给药方案获得更多证据，对258例患有下呼吸道感染的儿科患者使用头孢噻肟100mg/kg/天进行治疗，采用每日两次或每日三次的给药方案。在头孢噻肟50mg/kg每日两次组（n = 130）中，88.5%的患者临床体征和症状完全缓解。同样，在头孢噻肟33.3mg/kg组（n = 128）中，93.6%的患者临床体征和症状完全缓解。两种给药方案的耐受性都很好。两种头孢噻肟给药方案的药代动力学参数具有可比性。在两个剂量组中，去乙酰头孢噻肟的血清半衰期略长于头孢噻肟（50mg/kg或33.3mg/kg剂量后，去乙酰头孢噻肟分别为1.64和1.36小时，头孢噻肟分别为1.2和0.85小时）。本研究结果支持每日两次使用头孢噻肟治疗儿科患者的下呼吸道感染。
