Comparative study of piperacillin-tazobactam versus ampicillin in the treatment of severe pneumonia in children: A retrospective study.

Severe pneumonia remains a leading cause of pediatric mortality, with increasing β-lactamase-producing pathogens challenging traditional penicillin efficacy. This study compared the clinical efficacy and safety of piperacillin-tazobactam (PT) versus ampicillin (AMP) in children with severe community-acquired pneumonia (CAP). This retrospective cohort study with propensity score matching (PSM) enrolled children aged 6 months to 5 years with severe CAP from January 2022 to June 2024. After 1:1 PSM, 95 children per group received either PT or AMP. Primary endpoints included early clinical failure rate, end-of-therapy clinical cure rate, and sustained clinical success at test of cure (TOC). Secondary endpoints encompassed symptom resolution time, pathogen eradication rate, and safety profile. The PT group demonstrated significantly lower early clinical failure rate (2.11% vs 9.47%, P = .030; RR = 0.22, 95% CI: 0.05-0.98) and higher end-of-therapy clinical cure rate (88.17% vs 76.74%, P = .044) compared with AMP. PT achieved superior overall pathogen eradication (88.73% vs 73.13%, P = .019), particularly for Haemophilus influenzae (95.83% vs 68.00%, P = .012) and Pseudomonas aeruginosa (100.00% vs 40.00%, P = .038). Hospital stay was shorter in the PT group (8.65 ± 2.30 vs 9.81 ± 2.73 days, P = .002). Adverse event rates were comparable (10.53% vs 9.47%, P = .809). Piperacillin-tazobactam demonstrated superior efficacy over ampicillin for severe pediatric CAP, with comparable safety. These findings suggest PT offers a favorable benefit-risk profile for severe pediatric CAP, particularly in areas with documented β-lactamase-producing bacterial prevalence.