TY - JOUR
T1 - Etiology and treatment of community-acquired pneumonia in ambulatory children
AU - Wubbel, Loretta
AU - Muniz, Luz
AU - Ahmed, Amina
AU - Trujillo, Monica
AU - Carubelli, Cecilia
AU - Mccoig, Cynthia
AU - Abramo, Tom
AU - Leinonen, Maija
AU - Mccracken, George H.
N1 - Funding Information:
We thank Dr. A. Ikegami (Keio University School of Medicine, Hiyoshi, Yokohama) and Dr. Y. Inoue (The Institute of Physical and Chemical Research, Wako, Saitama) for their continuous support on which this work is based. We also thank Drs. Y. Hamaguchi (Tokyo Institute of Technology, Meguro, Tokyo), S. Nemoto and M. Yamaguchi (Ochanomizu University, Tateyama, Chiba), M. Yamamoto (Okayama University, Ushimado, Okayama), and I. Yasumasu (Waseda University, Shinjuku, Tokyo) for valuable suggestions and the help in obtaining sea urchins, and Mr. M. Hosoda and Mr. K. Atsumi (Hamamatsu Photonics K. K., Hamamatsu, Shizuoka) for extensive support in developing the image-analysis system. This work was supported by grants-in-aid from the Ministry of Education, Science and Culture ofJapan, and by Special Coordination Funds for Promoting Science and Technology from the Agency of Science and Technology of Japan.
PY - 1999/2
Y1 - 1999/2
N2 - Objectives. To determine the etiology of community-acquired pneumonia in ambulatory children and to compare responses to treatment with azithromycin, amoxicillin-clavulanate or erythromycin estolate. Methods. Ambulatory patients with pneumonia were identified at the Children's Medical Center of Dallas, TX. Children age 6 months to 16 years with radiographic and clinical evidence of pneumonia were enrolled and randomized to receive either azithromycin suspension for 5 days or a 10-day course of amoxicillin- clavulanate for those <5 years or erythromycin estolate suspension for those ≥5 years. Blood culture was obtained in all patients and we obtained nasopharyngeal and pharyngeal swabs for culture and polymerase chain reaction (PCR) testing for Chlamydia pneumoniae and Mycoplasma pneumoniae and nasopharyngeal swabs for vital direct fluorescent antibody and culture. Acute and convalescent serum specimens were tested for antibodies to C. pneumoniae, M. pneumoniae and Streptococcus pneumoniae. Patients were evaluated 10 to 37 days later when repeat specimens for serology, PCR and culture were obtained. For comparative purposes healthy children attending the well-child clinic had nasopharyngeal and pharyngeal swabs obtained for PCR and culture for C. pneumoniae and M. pneumoniae. Results. Between February, 1996, and December, 1997, we enrolled 174 patients, 168 of whom fulfilled protocol criteria for evaluation. There were 55% males and 63% were <5 years of age. All blood cultures were sterile and there was no correlation between the white blood cell and differential counts and etiology of pneumonia. Etiologic agents were identified in 73 (43%) of 168 patients. Infection was attributed to M. pneumoniae in 7% (12 of 168), C. pneumoniae in 6% (10 of 168), S. pneumoniae in 27% (35 of 129) and viruses in 20% (31 of 157). None of the swab specimens from 75 healthy control children was positive for C. pneumoniae or M. pneumoniae. Clinical response to therapy was similar for the three antibiotic regimens evaluated, including those with infection attributed to bacterial agents. Conclusion. Although a possible microbial etiology was identified in 43% of the evaluable patients, clinical findings and results of blood cultures, chest radiographs and white blood cell and differential counts did not distinguish patients with a defined etiology from those without a known cause for pneumonia. There were no differences in the clinical responses of patients to the antimicrobial regimens studied.
AB - Objectives. To determine the etiology of community-acquired pneumonia in ambulatory children and to compare responses to treatment with azithromycin, amoxicillin-clavulanate or erythromycin estolate. Methods. Ambulatory patients with pneumonia were identified at the Children's Medical Center of Dallas, TX. Children age 6 months to 16 years with radiographic and clinical evidence of pneumonia were enrolled and randomized to receive either azithromycin suspension for 5 days or a 10-day course of amoxicillin- clavulanate for those <5 years or erythromycin estolate suspension for those ≥5 years. Blood culture was obtained in all patients and we obtained nasopharyngeal and pharyngeal swabs for culture and polymerase chain reaction (PCR) testing for Chlamydia pneumoniae and Mycoplasma pneumoniae and nasopharyngeal swabs for vital direct fluorescent antibody and culture. Acute and convalescent serum specimens were tested for antibodies to C. pneumoniae, M. pneumoniae and Streptococcus pneumoniae. Patients were evaluated 10 to 37 days later when repeat specimens for serology, PCR and culture were obtained. For comparative purposes healthy children attending the well-child clinic had nasopharyngeal and pharyngeal swabs obtained for PCR and culture for C. pneumoniae and M. pneumoniae. Results. Between February, 1996, and December, 1997, we enrolled 174 patients, 168 of whom fulfilled protocol criteria for evaluation. There were 55% males and 63% were <5 years of age. All blood cultures were sterile and there was no correlation between the white blood cell and differential counts and etiology of pneumonia. Etiologic agents were identified in 73 (43%) of 168 patients. Infection was attributed to M. pneumoniae in 7% (12 of 168), C. pneumoniae in 6% (10 of 168), S. pneumoniae in 27% (35 of 129) and viruses in 20% (31 of 157). None of the swab specimens from 75 healthy control children was positive for C. pneumoniae or M. pneumoniae. Clinical response to therapy was similar for the three antibiotic regimens evaluated, including those with infection attributed to bacterial agents. Conclusion. Although a possible microbial etiology was identified in 43% of the evaluable patients, clinical findings and results of blood cultures, chest radiographs and white blood cell and differential counts did not distinguish patients with a defined etiology from those without a known cause for pneumonia. There were no differences in the clinical responses of patients to the antimicrobial regimens studied.
KW - Community-acquired pneumonia
KW - Etiology
KW - Treatment
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U2 - 10.1097/00006454-199902000-00004
DO - 10.1097/00006454-199902000-00004
M3 - Article
C2 - 10048679
AN - SCOPUS:0032990950
SN - 0891-3668
VL - 18
SP - 98
EP - 104
JO - Pediatric Infectious Disease Journal
JF - Pediatric Infectious Disease Journal
IS - 2
ER -