Study Finds Amoxicillin Superior to Penicillin V for Pediatric Pneumonia

Researchers recently assessed the clinical effectiveness of amoxicillin and penicillin V (PcV) in treating juvenile pneumonia through a population-based multicenter trial, which was reported in the journal Clinical Microbiology and Infection. They specifically contrasted the risks of serious side effects and treatment failure for the two antimicrobial medicines. Their results confirm that amoxicillin has a lower treatment failure rate than penicillin V, which supports the global trend of amoxicillin use. It refutes the Scandinavian practice of using penicillin V by emphasizing that the risk of serious consequences was statistically equal for both, even though penicillin V has a smaller antibacterial spectrum than amoxicillin.

A brief overview of the management of pediatric pneumonia

According to estimates from the World Health Organization [WHO], pneumonia is the leading transmissible cause of youth mortality worldwide, accounting for 740,180 child fatalities in 2019 alone (14% of all pediatric deaths). Streptococcus pneumoniae and Haemophilus influenzae have historically been the most common causes of pediatric pneumonia, an upper respiratory tract infection brought on by viruses, fungi, or bacteria. Antibiotics are, regrettably, the main treatment intervention in the majority of pediatric pneumonia cases due to a lack of trustworthy diagnostic diagnostics and the prevalence of pneumonia caused by bacteria.

The most often used antimicrobial treatment to treat juvenile pneumonia is amoxicillin, an aminopenicillin that gained popularity due to its limited microbiological spectrum and great efficiency against gram-positive bacteria, including S. pneumonia and Streptococci sp. However, because amoxicillin is thought to have antibacterial activity against both the target pneumonia pathogen and the beneficial gut flora, several Scandinavian countries (like Sweden) choose to use penicillin V (PcV). It has been demonstrated that PcV has an even more limited microbiological spectrum than amoxicillin, with particular modest effects on the gram-negative gut microbiota.

The disagreement between medical professionals who support PcV and those who support amoxicillin has led to significant differences in treatment approaches throughout Sweden. While PcV is primarily used in Skåne and Västra Götaland, amoxicillin is nearly solely prescribed in Stockholm. Sadly, the therapeutic effectiveness and risk of complications of these medicines have never been confirmed by science.

Concerning the study

In children with laboratory-confirmed pneumonia, the current study aimed to compare clinical outcomes, specifically “severe complications” (lung complications, ICU admissions, or death within 28 days of primary course initiation) and “treatment failure” (defined as antibiotic re-treatment within 14 days of primary course completion or, in severe cases, hospitalization). Children between the ages of one and fifty-nine months were the target age range.

The national health and population registers between 2001 and 2021 provided the medical records and sociodemographic data used in this simulated study. The National Patient Register (NPR), the Swedish Prescribed Drug Register (SPDR), the Medical Birth Register (MBR), the Swedish Intensive Care Registry register (SIR), the Longitudinal Integrated Database for Labour Market Studies (LISA), and the Cause of Death Register (CDR) were among the registries that were questioned.

The initial prescription of each antibiotic was the exposure variable that was being examined. Potential confounders were evaluated and taken into consideration using a directed acyclic graph (relationships between variables and outcomes have been verified in the literature).

Confounding-controlling multivariable logistic regressions were used in the statistical analyses. Based on the amount of amoxicillin prescriptions, three cohorts (<33%, 33-66%, and >66%) were formed from the geographic regions under consideration.”Data on sex and maternal smoking during pregnancy were collected from the MBR. Educational level of parents (primary school i.e. ≤9 years, secondary school i.e. 9-12 years or university studies i.e. >12 years) was collected from LISA. Data on initial hospitalization (<2 days), age and comorbidities were collected from the NPR. Previous asthma was defined based on dispensed prescriptions of asthma medications and doctors diagnosis according to a previously validated algorithm.”