COMPARATIVE EFFECTIVENESS OF CEFTRIAXONE MONOTHERAPY AND COMBINATION THERAPY WITH CLARITHROMYCIN IN PEDIATRIC PATIENTS HOSPITALIZED WITH COMMUNITY-ACQUIRED PNEUMONIA: A PROSPECTIVE STUDY
Main Article Content
Keywords
Community-acquired pneumonia, pediatric patients, ceftriaxone, clarithromycin, antibiotic therapy, clinical outcomes, combination therapy
Abstract
Background: Community-acquired pneumonia (CAP) is a leading cause of hospitalization in children worldwide, particularly in low- and middle-income countries. The standard treatment often involves antibiotics such as Ceftriaxone, either alone or in combination with macrolides like Clarithromycin. However, the comparative effectiveness of these regimens in pediatric patients has not been thoroughly studied.
Objectives: This study aimed to compare the effectiveness of Ceftriaxone monotherapy versus combination therapy with Clarithromycin in pediatric patients hospitalized with CAP, focusing on clinical cure rates, duration of hospital stay, time to clinical stability, and treatment-related adverse events.
Methods: A prospective study was conducted at Department of Paediatrics, KMDC & Abbasi Shaheed Hospital Karachi, Pakistan in the duration from May, 2023 to March, 2024, including 216 pediatric patients aged 1 month to 12 years diagnosed with CAP. Participants were randomly assigned to receive either Ceftriaxone alone (Monotherapy Group) or Ceftriaxone with Clarithromycin (Combination Therapy Group). Data on clinical outcomes, including clinical cure rates, time to clinical stability, and hospital stay duration, were collected. Descriptive statistics, chi-square tests, independent t-tests, logistic regression, Kaplan-Meier survival analysis, and Cox proportional hazards models were used to analyze the data.
Results: The clinical cure rate was significantly higher in the Combination Therapy Group (83.3%) compared to the Monotherapy Group (69.4%) (p = 0.016). Logistic regression analysis indicated that combination therapy was associated with a significantly higher likelihood of clinical cure (OR: 2.25, 95% CI: 1.19-4.23, p = 0.012). Time to clinical stability was shorter in the Combination Therapy Group (mean 3.2 days) compared to the Monotherapy Group (mean 3.8 days) (p = 0.005). Kaplan-Meier analysis and Cox proportional hazards model confirmed the faster time to clinical stability in the Combination Therapy Group (HR: 1.63, 95% CI: 1.21-2.18, p = 0.002). No significant differences were observed in the duration of hospital stay or the incidence of adverse events between groups.
Conclusions: Combining ceftriaxone with clarithromycin proved more effective than ceftriaxone alone in achieving higher cure rates and faster clinical stability in pediatric CAP cases, without raising the risk of adverse events. These results support the use of combination therapy in clinical settings.
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Dr Farhina Nasir
Demonstrator, Pathology Department, KMDC Karachi, Pakistan
Dr Atika Sher
Assistant Professor, Liaquat National Hospital and Medical College, Pakistan
Dr Riffat Farrukh
Assistant Professor, Department of Paediatrics, KMDC & Abbasi Shaheed Hospital Karachi, Pakistan
Dr Waseem Pasha
Assistant Professor, Department of Pediatrics, CMH Kharian Medical College, Kharian Punjab, Pakistan
Qamar Rizvi
Hamdard College of Medicine & Dentistry, Pakistan
Amber Naseer
MCPS, Senior Registrar, Department of Paediatrics, KMDC & Abbasi Shaheed Hospital Karachi, Pakistan