ISSN - 0973-0958

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Efficacy of Oral Amoxicillin versus Parenteral Ceftriaxone in Treatment of Uncomplicated Community Acquired Pneumonia (CAP): A Prospective, Single Blinded, Parallel Design, Randomized Controlled Trial
Sushant S Mane, Vaijnath Sathe, Manas V Pustake, Sagar Walhekar, Sharanya Ramakrishnan.
Department of Pediatrics, Grant Government Medical College and Sir J.J. Group of Hospitals, Byculla, Mumbai, 400008, India.
Abstract
Aim: Community acquired Pneumonia (CAP) is one of the major causes of under-five morbidity and mortality in most of the tropical countries. Management of CAP with an appropriate antibiotic will help reduce the growing antibiotic resistance. The aim of the study was to compare the efficacy of oral amoxicillin with parenteral ceftriaxone in uncomplicated CAP in children aged 6 months to 12 years.
Methods: This was a prospective, single blinded, parallel design, randomized control trial. One hundred children with uncomplicated CAP, aged 6 months to 12 years, admitted in pediatric wards at a tertiary care centre were included in the study. The enrolled patients were randomized in two groups in the ratio of 1:1. Group I received oral amoxicillin and group II received intravenous ceftriaxone for 7 days. Number of days for defervescence, day of settlement of respiratory distress, day of subsidence of cough, duration of hospital stay, step-up to higher antibiotics, adverse drug reactions were compared in both the groups.
Results: Time to deferervescence of fever in Group I was 3.7±0.9 days as compared to 3.66±0.8 days in group II (p=0.81). Settlement of respiratory distress occurred in 3.22±0.85 days in group I as compared to 3±0.67 days in group II (p=0.19). Subsidence of cough occurred in 11.68±0.92 days in group I as compared to 11.14±1.06 days in group II (p=0.74). Duration of hospital stay was 6.02±1.11 days in group I as compared to 7.24±1.18 days in group II (p<0.0001). Step-up to a higher antibiotic was required in 2 (4%) children on oral amoxicillin and 1 (2%) child on IV. ceftriaxone (p=1.00). Two children from oral amoxicillin group had diarrhea without any signs of dehydration on day 2 of treatment, which subsided in 2 days after giving probiotics and oral rehydration solution. This did not require discontinuation of amoxicillin. No side effects were observed from IV ceftriaxone group.
Conclusion: Use of oral amoxicillin for uncomplicated CAP in children has a similar outcome as compared to parenteral cephalosporins. It reduces the duration of hospital stay and thus the cost of treatment. More importantly, it prevents the unnecessary use of a higher-class antibiotic, thereby helping to reduce antibiotic resistance.

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