Clinical efficacy of sulbactam/ampicillin in pediatric infections caused by ampicillin-resistant or penicillin-resistant organisms.

Twenty-three children two months to 11 years old were treated with sulbactam/ampicillin or sulbactam/penicillin. Eleven had urinary tract infections (UTI), eight had pus-forming cervical adenitis, and four had lobar pneumonia. Pathogens were isolated from 18 patients: Escherichia coli from 10, Staphylococcus aureus from seven, and Klebsiella pneumoniae from one. All isolates were resistant to ampicillin or penicillin alone. Sulbactam (50 mg/kg per day) plus ampicillin (1:2 or 1:3 ratio) or penicillin (1:1.2 or 1:1.8 ratio) was given by intravenous bolus injection at 6-hr intervals for four to 11 days (mean duration, nine days). All pathogens were eradicated during treatment. Two patients with UTI relapsed after completion of treatment; the isolates were resistant to the combination. Clinical response was rapid and consistent with bacteriologic findings. Twenty-two of 23 children had a favorable clinical response. No systemic or local adverse effects were recorded. One child had eosinophilia and another had neutropenia at the end of treatment. Four children had slight and transient increases in hepatic transaminases. These results indicate that sulbactam/ampicillin may prove safe and effective for the treatment of non-life-threatening pediatric infections.