# Efficacy and Safety of Oral Cloxacillin Versus Amoxicillin-Clavulanic Acid in Treating Pediatric Acute Bacterial Lymphadenitis

## TL;DR

This study compares cloxacillin and amoxicillin-clavulanic acid for treating bacterial lymph node infections in children, finding both drugs similarly effective and safe.

## Contribution

The study provides evidence that cloxacillin is non-inferior to amoxicillin-clavulanic acid in treating pediatric bacterial lymphadenitis.

## Key findings

- Cloxacillin showed non-inferiority to amoxicillin-clavulanic acid in defervescence time.
- Both drugs similarly reduced lymph node size, tenderness, and inflammatory markers.
- Cloxacillin is a viable alternative to amoxicillin-clavulanic acid in pediatric cases.

## Abstract

Aim and objectives

Acute bacterial lymphadenitis is one of the most common causes of lymphadenopathy in children, whose treatment algorithm is not well defined in literature to date. The most commonly used drug for this condition is amoxicillin-clavulanic acid. However, given escalating antibiotic resistance, the use of narrower-spectrum agents like cloxacillin could be preferred. Thus, this study was planned to compare the safety and efficacy of oral cloxacillin and amoxicillin-clavulanic acid in pediatric bacterial lymphadenitis.

Materials and methods

This was a cohort analytical study done on children aged 1-14 years presenting with acute onset of lymphadenopathy. After establishing a bacterial etiology, the patients were randomized to receive either oral amoxicillin-clavulanic acid (Group A) or cloxacillin (Group B) and followed up as per protocol. The primary outcome was the duration of defervescence from the initiation of treatment. Secondary outcomes were a reduction in lymph node size, tenderness, leukocytosis, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP).

Results

A total of 192 patients were diagnosed with acute bacterial lymphadenitis and randomized into Group A (n = 99) and Group B (n = 93). Subjective and objective parameters obtained in both groups were compared before and after the initiation of treatment. The mean defervescence time for Group A was 5.92 days (95% confidence interval (CI): 5.15 to 6.69 days) and for Group B was 5.74 days (95% CI: 4.96 to 6.52 days). The upper bound of 95% CI in Group B (6.52) was only 0.5 days longer than the mean of Group A (5.92). This finding suggests the non-inferiority of cloxacillin in comparison with amoxicillin-clavulanic acid.

Conclusion

Oral cloxacillin is as effective and safe as compared to amoxicillin-clavulanic acid in uncomplicated pediatric bacterial lymphadenitis.