The Pediatric Infectious Diseases Society of Infectious Diseases Society and the Infectious Diseases Society of America (IDSA) published guidelines for the management of children with community-acquired pneumonia in 2011 [Bradley JS, Byington CL, Shah SS, et al. Management of community-acquired pneumonia in infants and children over 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011; 53: e25-e76]. As a method of optimizing and improving the use of antibiotics, the committee recommended the empirical prescription of narrow-spectrum antibacterial drugs (for example, aminopenicillins or penicillin) in children with uncomplicated community-acquired pneumonia (CAP). At the same time, there is little prospective or comparative data that would evaluate the approach to the use of narrow spectrum drugs compared to commonly used drugs (eg cephalosporins) for the treatment of children hospitalized for community-acquired pneumonia.

A study in the United States used data from 4 children's hospitals. The researchers evaluated the results of the disease in children aged 2 months to 18 years, who were hospitalized in 2010 with a diagnosis of community-acquired pneumonia.

Criteria for inclusion in the study: the diagnosis of community-acquired pneumonia established within the first 48 hours from the time of hospitalization, fever or deviation (up or down) in the number of leukocytes in peripheral blood also in the first 48 hours after hospitalization, the presence of respiratory symptoms and radiological data studies indicating EP. The study did not include children with chronic diseases that could be considered as predisposing to the development of CAP pathologies, as well as in the event of recurrent pneumonia or the development of complications of pneumonia (pleural effusion or abscess).

The main outcome evaluated during the study was the length of hospital stay (in hours) and the frequency of repeat requests for medical care / hospitalization within 7 days of discharge. The duration of the fever and the need for oxygen were also assessed. Narrow spectrum antibiotics meant the use of ampicillin, penicillin or amoxicillin / clavuanate as an initial treatment. A diet in which macrolides have been added to the beta-lactams listed above has also been considered a diet for the use of narrow-spectrum drugs.

During the study, fever was monitored (body temperature above 38 ° C), tachypnea and a deviation in the number of leukocytes in peripheral blood.

Data were obtained from 492 patients, 42% of whom were children 2 months to 2 years of age, 56% were 2 to 12 years of age, and only 2% of children were over 12 years of age. At the time of inclusion, 45% of the children had fever, 22% had shortness of breath, 36% had discrepancies in the number of leukocytes in the peripheral blood and 26% of the children had been diagnosed with bronchiolitis. Before hospitalization in hospital, 24% of children received antibiotics and 18% of patients received macrolides in addition to the antibiotic initially selected.

Despite the absence of randomization, the groups of patients compared were comparable in terms of main clinical characteristics. However, in children receiving broad-spectrum antibacterial drugs, blood samples were more often taken for bacteriological examination, they were prescribed additional macrolides more often, and antibiotics in this group were more often (in 50% of cases) prescribed before hospitalization. In addition, the children in this group were slightly older than the cohort of patients receiving narrow spectrum antibiotics.

When evaluating the results, it turned out that children who received drugs with a narrow spectrum of activity were 10 hours less in hospital than children who received drugs with a broad spectrum of activity. (43 hours vs 52.3 hours). The duration of additional oxygen use and the duration of fever were shorter in the group in the group of antibiotics with a broad spectrum of action, however, these differences were not statistically significant. In addition, the frequency of repeat hospitalizations in hospital within 7 days of discharge did not differ between the two groups compared.

Thus, the researchers conclude that the use of narrow-spectrum antibiotics for the treatment of community-acquired pneumonia in children is not less effective than the use of broad-spectrum drugs.