目的:虽然大多数国家推荐阿莫西林治疗小儿肺炎,在瑞典,青霉素V(PcV)的治疗有着悠久的传统,因此没有经验涵盖流感嗜血杆菌。有,然而,在治疗实践中存在较大的地区差异。目的是比较临床结果(治疗失败和严重并发症),在1至59个月的儿童中,使用PcV与阿莫西林治疗肺炎。
方法:这项基于人群的模拟目标试验纳入了2001-2021年在瑞典出生的所有儿童,利用国家卫生,社会人口统计学,和人口登记。在2005年7月至2021年12月期间,所有来自医院和儿科门诊的1至59个月儿童的肺炎病例均被确定为PcV或阿莫西林门诊患者。治疗失败(新配药抗生素处方或肺炎相关住院第1-14天)和严重并发症(肺部并发症,侵袭性细菌性疾病,入院重症监护病房或死亡第1-28天)通过逻辑回归分析计算。
结果:14,766例患者使用了PcV,和阿莫西林在10566。PcV治疗失败的发生率为7.7%,阿莫西林治疗失败的发生率为4.7%,OR1.76(95%CI:1.54-2.00)。严重的并发症很少见,PcV和阿莫西林之间没有显着差异(0.3%vs.0.2%,OR0.96,95%CI:0.53-1.73)。敏感性和相互作用分析显示出一致的结果。
结论:与阿莫西林相比,PcV治疗,与治疗失败风险增加相关,但与严重并发症无关.两组的不良结局绝对风险均较低,提示流感嗜血杆菌在小儿肺炎中的作用较小。
OBJECTIVE: While most countries recommend amoxicillin for pediatric pneumonia, there is a long tradition of treatment with
penicillin V (PcV) in Sweden, thus not empirically covering Haemophilus influenzae. There are, however, large regional differences in treatment practice. The aim was to compare clinical outcomes (treatment failure and severe complications), in children aged 1 to 59 months treated with PcV versus amoxicillin for pneumonia.
METHODS: This population-based emulated target trial included all children born in Sweden between 2001-2021, utilizing national health, sociodemographic, and population registers. All pneumonia cases from hospitals and pediatric outpatient clinics in children aged 1 to 59 months treated as outpatients with PcV or amoxicillin between July 2005-December 2021, were identified. Adjusted odds ratios (aOR)s and 95% confidence intervals (CI)s for treatment failure (new dispensed antibiotic prescription or pneumonia associated hospitalization day 1-14) and severe complications (lung complications, invasive bacterial disease, admission to intensive care unit or death day 1-28) were calculated with logistic regression analysis.
RESULTS: PcV was prescribed in 14,766 cases, and amoxicillin in 10,566. Treatment failure occurred in 7.7% with PcV versus 4.7% with amoxicillin, aOR 1.76 (95% CI: 1.54-2.00). Severe complications were rare, with no significant difference between PcV and amoxicillin (0.3% vs. 0.2%, aOR 0.96, 95% CI: 0.53-1.73). Sensitivity and interaction analyses showed consistent results.
CONCLUSIONS: PcV treatment compared to amoxicillin, was associated with an increased risk for treatment failure but not for severe complications. The absolute risks for adverse outcomes were low in both groups suggesting a minor role of H. influenzae in pediatric pneumonia.