Related Experiment Videos
Current issues in upper respiratory tract infections in infants and children: rationale for antibacterial therapy
1Department of Pediatrics, Boston University School of Medicine, MA.
Insights
Recurrent ear infections (otitis media) in children are linked to early onset, family history, daycare, and smoke exposure. Antibiotic choice for otitis media and sinusitis depends on pathogen susceptibility and drug characteristics.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Stewardship
- Clinical Microbiology
Background:
- Otitis media (OM) is a frequent childhood infection, with some children experiencing recurrent or severe disease.
- Risk factors for severe OM include early infection onset, family history, lack of breastfeeding, daycare attendance, and household smoking.
- Sinusitis shares pathogenesis and microbiology with OM, necessitating similar antimicrobial considerations.
Purpose of the Study:
- To review the characteristics of children with recurrent otitis media.
- To discuss the pathogens responsible for otitis media and sinusitis.
- To evaluate antimicrobial agent selection criteria for these infections, including emerging concerns with Group A Streptococcus.
Main Methods:
- Literature review of otitis media and sinusitis epidemiology, microbiology, and treatment.
- Analysis of factors influencing antimicrobial susceptibility and virulence.
- Evaluation of clinical efficacy, dosage, side effects, palatability, and cost of antimicrobial agents.
Main Results:
- Key pathogens for OM are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
- Antimicrobial choice for OM and sinusitis requires consideration of pathogen susceptibility, drug properties, and cost.
- Group A Streptococcus is an increasing concern due to invasive infections and rheumatic fever outbreaks, with cephalosporins and macrolides showing higher pharyngeal eradication rates than penicillin.
Conclusions:
- Optimal antibiotic selection for otitis media and sinusitis balances efficacy, safety, and patient factors.
- Penicillin's role in streptococcal pharyngitis is questioned due to potentially lower eradication rates compared to other agents in high-incidence areas.
- Understanding pathogen resistance and drug characteristics is crucial for effective treatment of pediatric respiratory tract infections.
Abstract:
Otitis media is a common infection in preschool-age children, but selected children have recurrent and severe disease. The characteristics of these children include a first episode of infection at an early age, sibling(s) with a history of ear infections, a history of not having been breast-fed, attending group day care and living in a household with exposure to cigarette smoke. The organisms responsible for otitis media are consistently the pneumococcus, H. influenzae and, in some areas, M. catarrhalis. Changes in antimicrobial susceptibility and differences in virulence govern the choice of antimicrobial agents. Although many drugs have clinical efficacy in children with AOM, the choice of optimal agents should be based on knowledge of microbiologic efficacy against the major pathogens, dosage schedules, side effects, palatability and cost. Sinusitis shares with otitis media similar pathogenesis, microbiology and choices of antimicrobial drugs for treatment. Although there are fewer data on epidemiology and microbiologic efficacy available for sinusitis than for otitis media, antibiotics are important for the clinical improvement and eradication of the bacterial pathogen from the infected sinus. Group A streptococcal infections are an increasing cause of concern because of reports of outbreaks of rheumatic fever in some cities in the United States and fatal or severe invasive infections and toxin-associated disease. Although Group A streptococci remain susceptible to penicillins and cephalosporins, higher rates of eradication of the organism from the pharynx by cephalosporins or by macrolides compared with penicillin have raised doubt as to the continued consideration of penicillin as the drug or choice for patients with streptococcal pharyngitis in communities with high incidence of supperative or nonsupperative disease.