Narrow- versus broad-spectrum parenteral antimicrobials against common infections of childhood : a prospective and randomised comparison between penicillin and cefuroxime

Overuse of broad-spectrum antimicrobials has resulted in increasing bacterial resistance in many countries. We hypothesised that common childhood infections requiring parenteral medication are still curable with narrow-spectrum and inexpensive penicillin. A prospective and randomised study was performed in two referral hospitals in Helsinki. A total of 154 children aged 3 months to 15 years with pneumonia or other lower respiratory infections, sepsis-like infections, or other common acute infections warranting hospitalisation and parenteral antimicrobials were included. At random, 50% of children received procaine penicillin intramuscularly, the other 50% cefuroxime intravenously for 4-7 days. The course of illness was monitored with predetermined laboratory and radiological indices, by filling in a special form daily and a follow-up for 30 days after discharge. The infectious agent was searched for with a large laboratory set-up covering 23 bacterial, viral or protozoan species. The two groups were very similar at presentation. Probable aetiology was disclosed in 56% of the penicillin and in 68% of the cefuroxime recipients, the leading agent in both groups being Pneumococcus. In 8% only a viral aetiology was found. The children recovered with the same speed, regardless of which antimicrobial used, there being one possible failure in each group but no difference in the frequency of needing a physician again within 1 month of discharge. No adverse event was attributable to either drug. Conclusion Procaine penicillin is as effective and safe as cefuroxime for common community-acquired infections in immunocompetent children. [PUBLICATION ABSTRACT]