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Treatment of multidrug-resistant Gram-negative infections in children

Alice J Hsu1, Pranita D Tamma

  • 1Department of Pharmacy, Division of Pediatric Pharmacy, The Johns Hopkins Hospital.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|February 7, 2014
PubMed

Insights

The rise of antibiotic resistance and dwindling drug development threaten a post-antibiotic era. Urgent pediatric-specific data is needed for treating multidrug-resistant Gram-negative infections in children.

Area of Science:

  • Pediatric Infectious Diseases
  • Antimicrobial Resistance
  • Pharmacology

Background:

  • Antibiotic resistance is a growing global threat, potentially leading to a post-antibiotic era.
  • A significant gap exists in pediatric treatment options for multidrug-resistant Gram-negative (MDRGN) infections.
  • Existing adult data is limited and often methodologically flawed, necessitating pediatric-specific research.

Purpose of the Study:

  • To review current treatment considerations for pediatric MDRGN infections.
  • To highlight the urgent need for pediatric-specific pharmacokinetic/pharmacodynamic (PK/PD) data.
  • To emphasize the necessity of improved clinical outcomes studies in children.

Main Methods:

  • Literature review focusing on treatment strategies for MDRGN infections in pediatric populations.
  • Analysis of data extrapolation from adult studies and its limitations.
  • Discussion of therapeutic decisions based on in vitro data, observational studies, and clinical experience.

Main Results:

  • Current treatment relies heavily on extrapolated adult data and limited pediatric evidence.
  • Significant deficiencies in pediatric-specific PK/PD data for relevant antimicrobial agents.
  • Specific challenges in treating infections caused by extended-spectrum β-lactamase (ESBL)-producing organisms, AmpC β-lactamase-producing organisms, carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Pseudomonas aeruginosa, and carbapenem-resistant Acinetobacter baumannii.

Conclusions:

  • There is an urgent need for pediatric-specific research to guide treatment of MDRGN infections.
  • Development of novel antimicrobial agents and robust clinical trials in children are crucial.
  • A collaborative approach is required to address the growing threat of antimicrobial resistance in pediatric populations.

Keywords:
Acinetobacter baumanniiAmpC β-lactamasesPseudomonas aeruginosacarbapenemasesextended-spectrum β-lactamases

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