In phase I of a 2-phase study, 56 evaluable children (0.8 to 5 years)
with lobar or segmental pneumonia received intravenous or intramuscula
r ceftriaxone 50 mg/kg/day for 2 days followed by oral cefetamet pivox
il 20 mg/kg/day in 2 divided doses to complete 7 days of treatment. Al
l patients achieved a clinical cure. In phase II, a randomised open mu
lticentre study, 62 children with pneumonia received an identical regi
men to phase I (arm A), and 59 children received ceftriaxone 50 mg/kg/
day for 1 day followed by 6 days' treatment with cefetamet pivoxil 20
mg/kg/day (arm B). Patients from phase I and arm A were combined givin
g a total of 118 evaluable patients in arm A. At the end of treatment,
100% of patients in arm A and 96% in arm B achieved a clinical cure;
cure was maintained in 99 and 98% of patients, respectively. Two (4%)
patients in arm B failed therapy; in both cases, factors other than tr
eatment failure may have accounted for the poor response. 11 and 12% o
f patients in treatment arms A and B, respectively, experienced advers
e events; gastrointestinal events (nausea and/or vomiting) were report
ed in 9 and 8% of patients, respectively. In conclusion, 1 or 2 days'
treatment with parenteral ceftriaxone before switching to oral cefetam
et pivoxil was safe and effective in the treatment of childhood pneumo
nia. Therefore, parenteral-oral switch is a feasible treatment option
in the treatment of serious paediatric community-acquired pneumonia.