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Antimicrobial therapy issues facing pediatricians
1Department of Pediatrics, Boston University School of Medicine, Boston City Hospital, MA, USA.
Abstract:
In the field of infectious diseases, the emergence of new pathogens or old diseases in newly recognized forms; changing virulence of pathogens; changing patterns of antimicrobial susceptibility; new diagnostic techniques, drugs or vaccines; changing concepts of chemoprophylaxis; controversies about medical vs. surgical techniques; and the challenge of care of children with infectious diseases within new guidelines of managed care are recently identified areas of change. The increased resistance of Streptococcus pneumoniae to many commonly used antimicrobials and the increased proportion of beta-lactamase-producing nontypable Haemophilus influenzae and Moraxella catarrhalis concern many practitioners. The decreased antibiotic susceptibility of S. pneumoniae is a relatively new phenomenon in the United States. Optimal therapy for mild, moderate or severe pneumococcal disease is dependent on current local susceptibility patterns. Group A streptococci are uniformly susceptible to readily achieved concentrations of all penicillins and cephalosporins. However, recent clusters of cases of rheumatic fever, increased recognition of toxic shock syndrome and bacteremic and localized severe pneumococcal disease have increased concern about the changing ecology of the Streptococcus and the implications for therapy. Finally recognition that many children with acute bacterial otitis media have resolution of disease without use of antimicrobial agents has led to more rigorous study designs for evaluating new drugs.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Emerging antimicrobial resistance in Streptococcus pneumoniae and Haemophilus influenzae necessitates updated treatment guidelines for infectious diseases. Understanding changing pathogen susceptibility is crucial for effective patient care and drug development.
Area of Science:
- Infectious Diseases
- Microbiology
- Public Health
Background:
- The field of infectious diseases is dynamic, with evolving pathogens, antimicrobial resistance, and diagnostic/therapeutic advancements.
- Increasing resistance of Streptococcus pneumoniae to antimicrobials and the rise of beta-lactamase-producing Haemophilus influenzae and Moraxella catarrhalis are significant clinical concerns.
- Changes in antimicrobial susceptibility patterns require continuous monitoring and adaptation of treatment strategies.
Purpose of the Study:
- To highlight recent changes and challenges in the field of infectious diseases.
- To discuss the implications of altered antimicrobial susceptibility patterns for common bacterial pathogens.
- To underscore the need for updated therapeutic approaches and rigorous evaluation of new drugs and treatment strategies.
Main Methods:
- Review of current trends in infectious disease emergence and pathogen characteristics.
- Analysis of antimicrobial susceptibility data for key bacterial pathogens like Streptococcus pneumoniae and Haemophilus influenzae.
- Discussion of clinical implications and therapeutic considerations based on evolving resistance patterns.
Main Results:
- Decreased antibiotic susceptibility in Streptococcus pneumoniae is a growing issue in the United States.
- Optimal therapy for pneumococcal disease depends on local susceptibility patterns.
- Group A streptococci remain susceptible to penicillins and cephalosporins, but concerns exist regarding rheumatic fever and severe invasive disease.
Conclusions:
- The changing ecology of Streptococcus and implications for therapy require careful consideration.
- New diagnostic techniques, drugs, and vaccines are essential to combat emerging infectious disease threats.
- Evidence-based guidelines and rigorous study designs are crucial for evaluating new antimicrobial agents and treatment protocols, especially for conditions like acute bacterial otitis media in children.