Clinical and pharmacological evaluation of a modified cefotaxime bid regimen versus traditional tid in pediatric lower respiratory tract infections

It is generally accepted that the treatment of community-acquired pneumonia , either in adults or in pediatric patients, is mainly empirical. Thus, the treatment selection must fulfill both the epidemiological requirements, ac cording to the most frequently described pathogens, and the pharmacological criteria to ensure adequate and prolonged drug concentrations at the infec tion site, to reach clinical efficacy. Cefotaxime has proven to be effectiv e in this indication when traditionally administered three times daily and, more recently, twice daily, as a result of a re-evaluation of its pharmaco kinetic/pharmacodynamic features. To gain further evidence using this updat ed dosing schedule, 258 pediatric patients with lower respiratory tract inf ections were treated with cefotaxime 100 mg/kg/day, administered as a twice daily or three times daily regimen. In the cefotaxime 50 mg/kg twice-daily group (n = 130), a complete resolution of clinical signs and symptoms mere observed in 88.5% of patients. Similarly, in the cefotaxime 33.3 mg/kg gro up (n = 128), 93.6% of patients had a complete resolution of clinical signs and symptoms. Both drug schedules were well tolerated. Pharmacokinetic par ameters determined for the two cefotaxime dosing schedules showed comparabi lity. The serum half-life of desacetylcefotaxime was marginally longer than for cefotaxime in both dosage groups (1.64 and 1.36 h for desacetylcefotax ime versus 1.2 and 0.85 h for cefotaxime after 50 mg/kg or 33.3 mg/kg doses , respectively). Results from this study support the rise of twice-daily ce fotaxime administration for the treatment of lower respiratory tract infect ions in pediatric patients. (C) 1998 Elsevier Science Inc.