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[Resistant pneumococci in pediatrics: therapeutic implications]
1Laboratoire de Microbiologie, Hôpital Robert Debré, Paris.
Insights
Pneumococci infections are common in French children, with increasing antibiotic resistance. Amoxicillin and other antibiotics are recommended for treatment, especially for otitis and meningitis.
Area of Science:
- Bacteriology
- Infectious Diseases
- Pediatrics
Context:
- Pneumococci are a leading cause of pediatric pneumonia and bacteremia in France.
- They are also a significant cause of conjunctivitis, otitis, and meningitis in young children.
- Increasing antibiotic resistance, particularly to beta-lactamines, macrolides, and tetracyclines, complicates treatment.
Purpose:
- To review the epidemiology of pneumococcal infections in children in France.
- To highlight the growing problem of antibiotic resistance in Streptococcus pneumoniae strains.
- To propose therapeutic strategies for common pediatric pneumococcal infections, considering resistance patterns.
Summary:
- Pneumococci are a major pediatric pathogen in France, responsible for pneumonia, bacteremia, otitis, and meningitis.
- High rates of resistance to penicillin, macrolides, tetracyclines, and other antibiotics are reported.
- Therapeutic strategies must account for local resistance prevalence, recommending amoxicillin, pristinamycin, or ceftriaxone for specific infections like otitis and meningitis.
Impact:
- The study underscores the challenge of treating pneumococcal infections due to widespread antibiotic resistance.
- It emphasizes the need for probabilistic treatment approaches based on local resistance data.
- Recommendations for amoxicillin and other antibiotics aim to guide clinicians in managing pediatric pneumococcal infections effectively.
Abstract:
Pneumococci is the number one pathogen causing pneumonia and bacteraemia in children in France. After H. influenzae, it is the second most frequent cause of conjunctivitis and otitis as well as purulent meningitis in 3-month to 3-year-old children (a situation which will undoubtedly be modified by Hib H. influenzae b vaccinations). It also predominates in bronchial superinfections and occult bacteraemia. Penicillin G. has been given for pneumococci infections for years leading the development of resistant strains (20.1% of the strains isolated in France in 1992 were resistant to beta-lactamines. Other resistances include macrolides (44% of the strains), tetracyclins (28%), cotrimoxazol (32%), chloramphenicol (25%) and erythromycin-sulphisoxazol (20%). Thus no other family of oral antibiotics can be successfully substituted for beta-lactamines for routine treatment. Lifestyle and health care organization is a major factor of risk which could explain why the incidence of resistant strains is greater in high density urban populations or in countries were young children are cared for in groups. Therapeutic strategies for easily accessible localizations (septicaemias, pneumonia) can be easily established on the basis of minimal inhibiting concentrations, but for certain sites (otitis, meningitis) more problems are raised. For example, the probability of resistance to penicillin R in acute otitis has been estimated at 75% for children living in the Paris area. We therefore recommend amoxillin (150 to 200 mg/kg/day) or pristinamycin or possibly ceftriaxon (50 mg/kg/day during 3 days). Similar probabilistic strategies are established for purulent meningitis and other childhood pneumococci infections.