Vol.70 No.2 March 2022
Dosage and duration of injectable β-lactam antibiotic treatment for penicillin-susceptible Streptococcus pneumoniae (PSSP) bacteremia after introduction of pneumococcal conjugate vaccine: Focusing on the presence/absence of pneumonia
1)Departmaent of Pharmacy, National Hospital Organization Kokura medical Center, 10-1 Harugaoka Kokura Minami-ku, Kitakyushu, Fukuoka, Japan
2)Departmaent of Pediatrics, National Hospital Organization Kokura medical Center
Abstract
We investigated the relationship of the dosage of antibiotics and duration of antibiotic therapy with the treatment outcomes (death within 30 days and recurrent invasive pneumococcal disease [IPD]) in children with pneumococcal bacteremia with a history of having received vaccination with the pneumococcal conjugate vaccine (PCV). This study was a single-center retrospective study, conducted in children with a history of PCV vaccination who developed pneumococcal bacteremia over 5-year period beginning April 2015.
Eleven patients were included in the study, 10 had no underlying conditions, 9 met the systemic inflammatory response syndrome (SIRS) criteria, and the median time from fever to initiation of appropriate antimicrobial therapy was 1 day. Only penicillin-susceptible Streptococcus pneumoniae strains were isolated in blood cultures in all patients, and the isolates were found to be susceptible to ampicillin, cefotaxime, ceftriaxone, amoxicillin, and clarithromycin, which were the antibiotics administered in the patients. Eight patients received injectable antibiotics throughout the treatment course, while the remaining 3 were eventually switched to oral antibiotics. The median time to recovery from SIRS was 2 days, and there were no deaths within 30 days and no recurrence of IPD. The dosage and duration of injectable antibiotics were significantly higher (195.9 mg/kg/day [IQR: 152.4-209.1] vs. 138.9 mg/kg/day [IQR: 100.2-171.6] [P=0.039]) and longer (10.3 days [IQR: 10.3-11.8] vs. 7 days [IQR: 7-8.2] [P=0.045]), respectively, in the group with pneumonia than in the group without pneumonia.
These results suggest that the duration of administration of injectable β-lactam antibiotics for pneumococcal bacteremia without pneumonia in children with no underlying disease and a history of PCV vaccination may be shortened to 7 days if treatment with injectable β-lactam antibiotics for bacteremia is started at the standard doses early in the disease course.
Key word
penicillin-susceptible Streptococcus pneumoniae, bacteremia, antimicrobial therapy, pneumococcal conjugate vaccine, child
Received
July 20, 2021
Accepted
November 15, 2021
Jpn. J. Chemother. 70 (2): 200-209, 2022
