The dilemma of improving rational antibiotic use in pediatric community-acquired pneumonia
Phuong T K Nguyen1, Paul D Robinson2, Dominic A Fitzgerald2,3
1Department of General Medicine, The Children's Hospital Westmead, Westmead, NSW, Australia.
Insights
Childhood pneumonia is a major killer, especially in poor countries. Reducing unnecessary antibiotic use through better diagnosis and following World Health Organization guidelines is crucial for effective treatment.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Community-acquired childhood pneumonia is a leading cause of mortality in children under five, particularly in resource-limited settings.
- Etiology is diverse, with limited data on local drug resistance profiles.
- Increasing viral contributions to severe pneumonia are noted, especially where bacterial vaccine coverage is high.
Purpose of the Study:
- To review the burden, pathogens, management, and prevention of childhood pneumonia.
- To focus on rational antibiotic use in pediatric respiratory infections.
- To highlight strategies for reducing unnecessary antibiotic prescriptions.
Main Methods:
- Comprehensive literature review.
- Analysis of disease burden, etiology, and drug resistance.
- Evaluation of current management and prevention strategies.
Main Results:
- Respiratory virus activity decreased during COVID-19 restrictions but rebounded afterward.
- Unnecessary antibiotic use is driven by respiratory infection treatment.
- Revised WHO guidelines and inflammatory marker tests (e.g., C-reactive protein) can reduce antibiotic use.
Conclusions:
- Rational antibiotic stewardship is essential for combating childhood pneumonia.
- Adherence to WHO guidelines for managing non-febrile respiratory symptoms can decrease antibiotic prescriptions.
- Improved diagnostic tools and guideline implementation are key to reducing antibiotic resistance and improving outcomes.
Abstract:
Pneumonia is the number one cause of disease and deaths in children under five years old, outside the neonatal period, with the greatest number of cases reported from resource-limited settings. The etiology is variable, with not much information on the local etiology drug resistance profile in many countries. Recent studies suggest an increasing contribution from respiratory viruses, also in children with severe pneumonia, with an increased relative contribution in settings that have good vaccine coverage against common bacterial pathogens. Respiratory virus circulation was greatly reduced during highly restrictive measures to contain the spread of COVID-19 but rebounded once COVID-19 restrictions were relaxed. We conducted a comprehensive literature review of the disease burden, pathogens, case management and current available prevention of community acquired childhood pneumonia, with a focus on rational antibiotic use, since the treatment of respiratory infections is the leading cause of antibiotic use in children. Consistent application of revised World Health Organisation (WHO) guidance that children presenting with coryzal symptoms or wheeze can be managed without antibiotics in the absence of fever, will help to reduce unnecessary antibiotic use, as will increased availability and use of bedside inflammatory marker tests, such as C-reactive protein (CRP) in children with respiratory symptoms and fever.
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