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July 1997

A Randomized Controlled Trial of Penicillin vs Clindamycin for the Treatment of Aspiration Pneumonia in Children

Author Affiliations

From the Division of General Pediatrics, Pediatric Outcomes Research Team Program, Departments of Pediatrics (Drs Jacobson, Sgro, Feldman, and Macarthur and Ms Winders) and Pharmacy (Mss Griffiths and Diamond), Hospital for Sick Children, and the University of Toronto, Toronto, Ontario.

Arch Pediatr Adolesc Med. 1997;151(7):701-704. doi:10.1001/archpedi.1997.02170440063011

Objective:  To compare the effectiveness of intravenous penicillin vs clindamycin for the treatment of aspiration pneumonia.

Design:  A double-blind, randomized controlled trial.

Setting:  A tertiary care pediatric hospital.

Patients:  We enrolled 42 children, aged 6 months to 18 years, who were admitted to the hospital for the treatment of aspiration pneumonia. All of the children had underlying conditions that predispose to aspiration.

Intervention:  The patients were randomly assigned to receive intravenous penicillin G sodium, 250 000 U/kg every 24 hours, or intravenous clindamycin phosphate, 30 mg/kg every 24 hours.

Main Outcome Measure:  The primary outcome measure was "time to ready for discharge" from the hospital.

Results:  In an effectiveness (intention to treat) analysis, the median time (interquartile range) to ready for discharge from the hospital was 4.9 days (range, 2.8-6.5 days) in the penicillin-treated group and 3.4 days (range, 2.3-6.8 days) in the clindamycin-treated group (P=.66). Results were not markedly altered when adjusted for the age difference of the groups or in the efficacy analysis (after the exclusion of 9 patients who withdrew from the trial). Rates for readmission to the hospital were similar in the 2 groups.

Conclusion:  Penicillin and clindamycin seem to be equally effective for the treatment of aspiration pneumonia in children hospitalized for this illness.Arch Pediatr Adolesc Med. 1997;151:701-704