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Treatment of Neonatal Pneumonia
Neonatal Pneumonia: Comparison of 4 vs 7 Days of Antibiotic Therapy in Term and Near-Term Infants. Engle WD, Jackson GL, Sendelbach D, et al. J Perinatol 2000; 20:421-26.
The diagnosis of pneumonia was made in neonates admitted to the normal newborn nursery who later had signs of respiratory distress and whose chest radiographs were consistent with pneumonia. Infants with moderate or thick meconium-stained fluid, prior antibiotics > 24 hours, or need for supplemental oxygen > 8 hours were excluded. Infants who were asymptomatic after 48 hours of antibiotic therapy were prospectively randomized to a 4-day (n=35) or a 7-day group (n=38). Infants in the 4-day group were observed in hospital for 24 hours following cessation of antibiotics and were seen for follow up within several days of discharge. No study infants had positive blood cultures. The mean reduction in length of hospitalization was 2.1 days with an estimated savings of > $700 per shortened hospitalization. Two infants in the 4-day group developed recurrent tachypnea during the 24 hour observation period. No infants were rehospitalized for sepsis or pneumonia following discharge.
Comment. While it is attractive to consider new ways to reduce costs and limit length of hospitalization in neonates, caution is urged before adopting a shorter treatment for patients with congenital pneumonia. First be aware that 66% (139 of 212) of the infants being treated for pneumonia met exclusion criteria and were not included in the study. It was also concerning that 6% (2 of 35) of the 4-day treatment group had a recurrence of tachypnea after antibiotics were discontinued. One of these patients had persistent infiltrates in xray, and required 5 extra days of hospitalization with antibiotic treatment before resolution. These patients were not considered as treatment failures since the study protocol included a 24 hour post-treatment observation period, but they give me pause in considering the safety of this shorter treatment course.
Andrew B. Kairalla M
Date: 08 Oct 2002
Time: 14:27:29
I thought the standard for treatment of Neonatal Pneumonia was 10 days of antibiotics??
Has that changed??
This study compares 4 day vs 7 day treatment.
Thanks.
UserName: Ravi Agarwal
Institution: GCMC
telephone: 850-747-7712
email: neodoc1@yahoo.com
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