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Rational selection of antimicrobials for pediatric upper respiratory infections
1Combined Division of Pediatric Infectious Diseases, Creighton University Medical Center, Omaha, NE 68131, USA.
Abstract:
Antibiotic selection is complicated by both emerging resistance to traditional antimicrobials in common community-acquired pathogens and increasing numbers of high potency or extended spectrum antimicrobials. This overview outlines a multistep process for antibiotic choice based on antimicrobial activity and patient acceptance. Understanding the infection (the natural history and most likely pathogens) is necessary for choosing a specific antimicrobial. Choices should be based on knowledge of local trends in and mechanisms of antimicrobial resistance. Candidate drugs should also exceed (at the site of infection) the minimum inhibitory concentration for 90% of strains of each most likely pathogen. Ideally the narrowest spectrum drug satisfying this pharmacodynamic requirement is used. However, inadequate compliance dooms even the most potent antibiotic. Therefore infrequent dosing, palatable taste or form, minimal side effects or lower cost may dictate choosing lower potency or narrower spectrum drugs to gain patient acceptance and thereby reasonable compliance.
Insights
Choosing antibiotics requires balancing pathogen resistance and drug potency with patient compliance. Selecting the right antimicrobial involves understanding the infection, local resistance patterns, and patient factors for effective treatment.
Area of Science:
- Pharmacology and Infectious Diseases
Background:
- Emerging antimicrobial resistance in common pathogens complicates antibiotic selection.
- A growing number of high-potency and extended-spectrum antimicrobials present new choices and challenges.
Purpose of the Study:
- To outline a systematic process for selecting appropriate antibiotics.
- To emphasize the dual criteria of antimicrobial activity and patient acceptance in drug choice.
Main Methods:
- Assessing the infection's natural history and likely pathogens.
- Evaluating local antimicrobial resistance trends and resistance mechanisms.
- Selecting drugs that exceed the minimum inhibitory concentration (MIC90) at the infection site.
Main Results:
- The ideal antibiotic is the narrowest spectrum drug meeting pharmacodynamic requirements.
- Patient compliance is critical; inadequate compliance can negate even potent antibiotics.
- Factors like dosing frequency, taste, side effects, and cost influence patient acceptance and compliance.
Conclusions:
- Antibiotic selection necessitates a comprehensive approach considering both microbiological efficacy and patient adherence.
- Prioritizing patient acceptance through factors like dosing and tolerability can improve treatment outcomes, sometimes favoring lower-potency agents.