Current concepts in antibiotic resistance

Although antibiotic resistance is not often considered an exciting topic for pediatric surgical subspecialists, we face the consequences of increasing antibiotic resistance daily in our clinical practice. By the very nature that our patients are often referred to us after extended periods of medical therapy, antibiotic resistance becomes a significant factor in management of patients both medically and surgically. Antibiotic resistance is increasing, and a number of organisms demonstrate multiple-drug resistance. The purpose of this review is to outline the scope of antibiotic resistance as it relates to pediatric otolaryngology. Specifically, the mechanisms of resistance, the pharmacodynamics involved, and selected infections are discussed.

The children particularly at risk for infections with resistant organisms are those 2 years of age or younger with exposure to daycare and treatment with antimicrobials within the last 30 days. Although there is increasing resistance to antibiotics commonly used for outpatient infections such as otitis media, sinusitis, and tonsillitis, many of the first-line therapies still show significant therapeutic advantage. Vaccines to pneumococcal bacteria have been shown to decrease severe infections. However, there has been only a slight decline in the number of outpatient otolaryngologic infections after vaccination.

Therefore, children who have received multiple courses of antibiotics, are 2 years of age or younger, attend daycare, or have received antimicrobial therapy within the last 30 days may need high-dose therapy or antimicrobial therapy with an increased spectrum of coverage. Those children with infections that do not respond clinically to appropriate therapy should be treated with the suspicion of multiple-drug resistant strains being present. Continued surveillance of resistance patterns within individual communities, especially areas served by children's hospitals, are important, as there are distinct local and regional differences in antimicrobial resistance.