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

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.