IV Penicillin G Is as Effective as IV Cefuroxime in Treating Community-Acquired Pneumonia in Children Gil Amarilyo, MD, 1 Miguel Glatstein, MD, 2 * Arik Alper, MD, 1 Dennis Scolnik, MB ChB, 3 Moran Lavie, MD, 1 Nira Schneebaum, MD, 1 Galia Grisaru-Soen, MD, 4 Ayala Assia, MD, 1 Liat Ben-Sira, MD, 5 and Shimon Reif, MD 1 Overuse of broad-spectrum antimicrobials has resulted in bacterial resistance and increasing use of relatively expensive antibiotics for community-acquired pneumonia (CAP). We hypothesized that CAP requiring parenteral medication is still curable with narrow-spectrum and inexpensive penicillin G. A prospective, randomized study was performed on 58 children aged 3 months to 15 years with CAP. Children were randomly assigned to receive low-dose penicillin G, high penicillin G, or cefuroxime intravenously for 4–7 days. The course of illness was monitored clinically and with predetermined laboratory and radiological indices for 30 days. The children recovered at the same rate with no significant differences in time to defervescence or duration of hospitalization. Observed differences in leukocyte counts and C-reactive protein at discharge were of questionable clinical significance. Penicillin G is as effective and safe as cefuroxime for CAP in otherwise healthy children, even in moderate doses. Keywords: cefuroxime, penicillin G, community-acquired pneumonia, antimicrobial resistance BACKGROUND Community-acquired pneumonia (CAP) is a common disease with an incidence of almost 2% in developed countries. 1 More than 2 million children younger than 5 years of age die from pneumonia each year, accounting for almost 1 in 5 deaths in this age group worldwide. 2 The most commonly implicated bacteria are Strep. pneumoniae (the most common pathogen), Mycoplasma pneumonia, Chlamydia pneumonia, and Haemophilus influenzae. 3 CAP in children usually has a benign course, and most otherwise healthy affected children undergo clinical improvement and normali- zation of body temperature within 1–3 days of treatment, 4 although complications such as empyema and pneumothorax can occur. Broad-spectrum antimicrobials are overused almost everywhere in the world 5 except where their use is limited by economic realities. As a consequence, drug costs and problems with antimicrobial resistance have increased, allergic and other adverse events are common, and patients are subjected to risks they would not have faced had narrower-spectrum antimicrobial agents been used. 6 Prevailing patterns of antimicrobial use are often based on clinicians’ fear of failing to treat 1 Pediatrics Department and 2 Division of Pediatric Emergency Medicine, Dana’s Children Hospital, University of Tel Aviv, Tel Aviv, Israel; 3 Division of Pediatric Emergency Medicine, Depart- ment of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada; 4 Division of Infectious Diisease, Department of Pediatrics, Dana’s Children Hospital, University of Tel Aviv, Tel Aviv, Israel; and 5 Department of Diagnostic Imaging, Ichilov Hospital, University of Tel Aviv, Tel Aviv, Israel. G. Amarilyo and M. Glatstein contributed equally to this work as first authors. The authors declare no conflicts of interest. *Address for correspondence: Division of Pediatric Emergency Medicine, Dana’s Children Hospital, Sackler School of Medicine, 6 Weizman Street, Tel Aviv University, Tel-Aviv 64239, Israel. E-mail: nopasara73@hotmail.com American Journal of Therapeutics 21, 81–84 (2014) 1075–2765 Ó 2012 Lippincott Williams & Wilkins www.americantherapeutics.com