Table 4.
Antimicrobial agents used for treatment of community-acquired pneumonia
| Activity according to paediatric pneumonia trials* |
Efficacy in vitro†72, 73, 74 |
Toxic effects73 | Ease of administration(daily doses)73 | Range of antimicrobial agent costs‡for treatment course (US$)75, 76 | Dosage | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| S pneumoniae | H influenzae | S aureus | Non-typhoidal salmonellae | Atypical pneumonia | ||||||
| Aminopenicillins | ||||||||||
| Amoxicillin | yyy | >90% | 70–90% | <40% | 40–70% | <40% | .. | 2 or 3 | 0·11–0·23 | One 250 mg tablet twice daily |
| High-dose amoxicllin | .. | .. | .. | <40% | .. | .. | .. | 2 or 3 | 0·21–0·45 | Two 250 mg tablets twice daily |
| Ampicillin | yy | 70–90% | 40–70% | <40% | <40% | <40% | Diarrhoea | 4 | 0·21–0·65 | One 250 mg tablet four times daily |
| Amoxicillin–clavulanic acid | yy | >90% | >90% | 40–70% | <40% | <40% | Diarrhoea | 2 or 3 | 0·82–3·10 | Half 500 mg tablet twice daily |
| High-dose amoxicillin–clavulanic acid | .. | >90% | >90% | 40–70% | .. | <40% | Diarrhoea | 2 or 3 | 1·63–6·21 | One 500 mg tablet twice daily |
| Penicillins | ||||||||||
| Oral penicillin | y | 40–70% | <40% | <40% | <40% | <40% | .. | 3 or 4 | 0·05–0·58 | .. |
| Intramuscular penicillin§ | yy | 70–90% | <40% | <40% | <40% | <40% | .. | 4 to 6 | 0·08–0·47 | 1 M units |
| Cephalosporins | ||||||||||
| Cephalexin | .. | 40–70% | <40% | 70–90% | <40% | <40% | .. | 4 | 0·22–0·22 | Half 250 mg dose orally every 6 h |
| Cefaclor | .. | 40–70% | 70–90% | 70–90% | .. | <40% | .. | 3 | .. | Syrup |
| Cefuroxime | yy | 70–90% | 70–90% | 70–90% | .. | <40% | .. | 2 | 1·25–3·44 | Half 250 mg dose orally twice daily |
| Cefprozil | .. | 70–90% | 40–70% | 70–90% | .. | <40% | .. | 2 | .. | Syrup |
| Cefpodoxime | .. | 70–90% | 70–90% | 70–90% | .. | <40% | .. | 1 | .. | Syrup |
| Cefixime | .. | 40–70% | >90% | 40–70% | .. | <40% | .. | 1 | 0·20–0·20 | Half 200 mg tablet daily |
| Ceftibuten | .. | 40–70% | >90% | 40–70% | .. | <40% | .. | 2 | … | Syrup |
| Intramuscular ceftriaxone§ | y | >90% | >90% | 70–90% | 70–90% | <40% | .. | 1 | 1·34–14·44 | 500 mg vial |
| Macrolides | ||||||||||
| Erythromycin | yy | 40–70% | 40–70% | 40–70% | <40% | 70–90% | .. | 4 | 0·10–0·22 | Half 250 mg tablet per dose |
| Clarithromycin | y | 40–70% | 40–70% | 70–90% | <40% | 70–90% | .. | 2 | 0·90–0·90 | Syrup |
| Azithromycin | yy | 40–70% | 70–90% | 70–90% | 40–70% | 70–90% | .. | 1 | 0·15–0·57 | Syrup |
| Fluoroquinolones | ||||||||||
| Ciprofloxacin | .. | <40% | 70–90% | 70–90% | 70–90% | 40–70% | Possible cartilage growth | 2 | 0·07–0·15 | 250 mg tablet twice daily |
| Ofloxacin | .. | <40% | 70–90% | 70–90% | 70–90% | 70–90% | Possible cartilage growth | 2 | 0·09–0·22 | Half 200 mg tablet twice daily |
| Levofloxacin | .. | >90% | >90% | 70–90% | 70–90% | 70–90% | Possible cartilage growth | 1 | .. | Half 250 mg tablet orally every 24 h |
| Moxifloxacin | .. | >90% | >90% | 70–90% | 70–90% | 70–90% | Serious cardiac | .. | .. | No paediatric dosing available |
| Tetracyclines | ||||||||||
| Doxycycline | .. | 70–90% | 70–90% | 40–70% | 40–70% | 70–90% | Tooth discolouration (children <7 years) | 2 | .. | 5 mg/kg daily |
| Other agents | ||||||||||
| Co-trimoxazole | yyy | 40–70% | 40–70% | 40–70% | 40–70% | <40% | .. | 3 | 0·03–0·09 | Half 80 mg tablet orally twice daily (based on trimethoprim) |
| Chloramphenicol | yy | 70–90% | >90% | 40–70% | 70–90% | 40–70% | Bone marrow | 4 | 0·11–0·23 | Syrup |
yyy=multiple trials with strong trial evidence, yy=some trials with good evidence, y=minimal trials and evidence.
Pharmacokinetic/pharmacodynamic (PK/PD) properties are used to help determine the susceptibility breakpoints of antimicrobial agents and therefore the agent's likely efficacy. PK/PD properties for drug classes are as follows: aminopenicillins, penicillins, and cephalosporins=time above minimum inhibitory concentration (MIC) 40%; macrolides and fluoroquinolones=area under the curve/MIC above 30.
Costs for non-oral medications do not include administration, syringe, or needle costs.
Treatment course was 5 days and dose was based on a 10 kg child, except intramuscular penicillin and ceftriaxone, for which cost includes only the drug cost and does not include needles and administration.