Abstract
Substantial reduction of hospital duration and costs may be achieved with use of an antibiotic with very long serum half-life and enhanced activity against pathogens, allowing once-daily dosing. For that reason, we evaluated the efficacy of once-daily ceftriaxone (CTX) in 40 children with serious infections: meningitis (13), ventriculitis (2), pyelonephritis (7), osteomyelitis (6), arthritis (3), and others (9). Isolates were H. influenzae (9), E. coli (8), S. auveus (6), K. pneumoniae (3), salmonella (3), group A streptococci (3), and others (9). CTX was given IV or IM at 50 mg/kg; CNS infections were treated with a loading dose of 100 mg/kg followed by 80 mg/kg once-daily. 38/40 patients were completely cured by CTX; one patient with K. pneumonias ventriculitis had received intraventricular gentamicin briefly. One strain of B. thetaiotomicron was tolerant to CTX. Trough CTX serum levels were 3–10 μg/ml, while CSF levels were 3.5–15 μg/ml. Reactions included mild discomfort at IM sites (4), diarrhea (3), thrombocytosis (5), eosinophilia (4), mildly elevated liver enzymes (3), and leukopenia with neutropenia (2); all normalized after drug discontinuation. The high cure rate and minimal side effects suggest that once-daily CTX is safe and effective therapy for serious childhood infections. In the DRG era, use of a once-daily regimen combined with home health care or outpatient IV/IM therapy can result in savings of up to 90% of hospital costs.
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Yogev, R., Shulman, S., Chadwick, E. et al. 1181 COST CONTAINMENT BY USE OF ONCE-DAILY CEFTRIAXONE FOR SERIOUS PEDIATRIC INFECTIONS. Pediatr Res 19, 307 (1985). https://doi.org/10.1203/00006450-198504000-01211
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DOI: https://doi.org/10.1203/00006450-198504000-01211