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 bacteri al resistance in many countries. We hypothesised that common childhood infe ctions requiring parenteral medication are still curable with narrow-spectr um and inexpensive penicillin. A prospective and randomised study was perfo rmed in two referral hospitals in Helsinki. A total of 154 children aged 3 months to 15 years with pneumonia or other lower respiratory infections, se psis-like infections, or other common acute infections warranting hospitali sation and parenteral antimicrobials were included. At random, 50% of child ren received procaine penicillin intramuscularly, the other 50% cefuroxime intravenously for 4-7 days. The course of illness was monitored with predet ermined laboratory and radiological indices, by filling in a special form d aily 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. Proba ble aetiology was disclosed in 56% of the penicillin and in 68% of the cefu roxime recipients, the leading agent in both groups being Pneumococcus. In 8% only a viral aetiology was found. The children recovered with the same s peed, regardless of which antimicrobial used, there being one possible fail ure 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 ei ther drug. Conclusion Procaine penicillin is as effective and safe: as cefuroxime for common community-acquired infections in immunocompetent children.