[Septicemia of children in Japan (1980-1984). Part 3. Antibiotic therapy and prognosis].

Seven hundred and thirteen cases of proved bacteremia experienced at 48 pediatric institutions throughout Japan during 1980-1984 were analyzed with respect to their chemotherapeutic treatment and prognosis. Case fatality rate was the lowest in cases of monotherapy and the highest in those treated with 3 different antibiotics. Those treated with 2 different antibiotics showed significantly higher fatality rate than in cases treated with single antibiotic. Cephalosporins showed a trend to be administered singly more often than penicillins. Of all penicillin prescriptions ampicillin (ABPC) was chosen in 61.1% and in 62.3% of any combination therapies of penicillins. Among combination therapies gentamicin (GM) was most frequently combined with ABPC, i.e., in 58.9%. In 135 cases treated with combination of ABPC and GM or similar combination like ABPC and antipseudomonas aminoglycosides, deaths resulted in 42 cases compared with 108 deaths out of 578 cases treated with other chemotherapy revealing a statistically significant difference (P less than 0.005). The utilization of new cephem antibiotics found in this study clearly paralleled to the trend of the consumption of new injectable cephalosporins in Japan since the appearance of new cephem antibiotics in 1980. The clinical effect of new cephem antibiotics in pediatric bacteremia seems fairly good but will need further observations, particularly when combined with aminoglycosides. A very large difference exists in the choice of chemotherapy for bacteremia in children among different hospitals. In general, those institutions that prefer monotherapy with some combination therapies of other antibiotics than penicillins and aminoglycoside demonstrated better therapeutic results than those that prefer therapies with the orthodox ABPC and GM combination. Further analysis is necessary concerning backgrounds of these cases examined in our study.