[Antimicrobial resistance--consequences for ambulatory treatment of infections in children]

Increasing antimicrobial resistance among clinical isolates of Streptococcus pneumoniae calls for a revision of treatment strategies for pediatric infections, particularly for acute otitis media. Restrictive use of antimicrobials is the key strategy for slowing the spread of resistances. Before initiation of antimicrobial therapy, suspected bacterial infections should be confirmed clinically (e.g. by observation of the natural evolution) or microbiologically. For acute otitis media, oral amoxicillin remains the drug of choice because of superior middle ear pharmacokinetics and pharmacodynamics. Treatment failure caused by resistance of the infecting pneumococcus can be overcome be increasing the dose, and not by switching to another class of antibiotics (e.g., cephalosporin, macrolide, cotrimoxazole), which is less likely to achieve middle ear eradication a priori. Widespread macrolide resistance among isolates of S. pneumoniae precludes the use of this class of antimicrobials for empiric therapy of community-acquired pneumonia in children. Aminopenicillins are preferred because of their rapidly bactericidal activity against the most common organisms causing potentially progressive pneumonia in children.