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Rational prescribing of antibacterials in ambulatory children
1Section of Bacteriology, University Children's Hospital, Eberhard Karl University, Tübingen, Germany.
Insights
Rational prescribing of oral antimicrobials for pediatric bacterial infections emphasizes restrictive use to combat resistance. Preferred agents are palatable, once or twice daily, effective, safe, and affordable.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Stewardship
- Clinical Pharmacology
Background:
- Bacterial resistance to antimicrobials is a growing global health concern.
- Appropriate use of oral antimicrobials in ambulatory pediatric care is crucial for effective treatment and resistance mitigation.
- Distinguishing viral from bacterial infections in children is essential for judicious antimicrobial prescribing.
Purpose of the Study:
- To review rational prescribing of oral antimicrobial agents for pediatric bacterial infections in ambulatory settings.
- To advocate for restrictive antimicrobial use and provide guidance on selecting appropriate agents.
- To discuss specific pediatric considerations for common bacterial infections.
Main Methods:
- Review of current literature on antimicrobial prescribing in pediatric ambulatory care.
- Analysis of pharmacokinetic, spectrum, tolerability, dosing, and palatability factors for oral antimicrobial agents.
- Discussion of specific pediatric bacterial infections and their treatment guidelines.
Main Results:
- Restrictive antimicrobial use and accurate diagnosis are key to preventing bacterial resistance.
- Optimal antimicrobial selection considers efficacy, safety, dosing frequency, palatability, and cost.
- Evidence-based treatment strategies for common pediatric infections like otitis media and pneumonia are reviewed.
Conclusions:
- Judicious prescribing of oral antimicrobials in children is vital for combating resistance.
- Selecting palatable, convenient, effective, and safe agents improves pediatric patient compliance.
- Further research into optimal treatment durations and short-course therapies is warranted.
Abstract:
The rational prescribing of oral antimicrobial agents for bacterial infections in children who can be treated in an ambulatory setting is the subject of this review. First, restrictive use of antibacterials is advocated to avoid widespread development of bacterial resistance. The use of simple methods, suitable for office use, to discern viral from bacterial infections is recommended. Second, in selecting an antimicrobial agent, the physician should consider a number of distinctive features of each agent. Besides aspects of pharmacokinetics, antibacterial spectrum and tolerability, the number of daily doses and, of particular importance for children, the palatability of suspensions plays an important role in achieving patient compliance. Agents that can be administered once or twice daily and possess an agreeable taste in addition to proven efficacy, established tolerability and a reasonable price are to be preferred. Specific paediatric aspects in choosing among penicillins, cephalosporins, macrolides and other oral antibacterials are discussed. For pharmacoeconomic reasons, the optimal duration of antibacterial treatment and the role of short course therapy for various bacterial infections should be studied in more detail. Finally, rational antimicrobial treatment of common paediatric bacterial infections, such as streptococcal tonsillopharyngitis, acute otitis media, acute sinusitis, bacterial pneumonia, pertussis, Lyme borreliosis (early stage) and lower urinary tract infection is reviewed.