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The management of common infections in ambulatory children
1University of Southern California School of Medicine, Division of Infectious Diseases, Children's Hospital, Los Angeles 90027, USA.
Insights
Pediatric antimicrobial therapy faces challenges from resistance. Reevaluating use, improving diagnostics, and exploring alternatives like vaccines are crucial to prevent a postantibiotic era.
Area of Science:
- Pediatric infectious disease
- Antimicrobial stewardship
- Microbial resistance
Background:
- Antimicrobial therapy is central to pediatric practice.
- Older, inexpensive antibiotics are often preferred despite newer options.
- Widespread antimicrobial use drives the development of drug resistance.
Purpose of the Study:
- To highlight the critical need for reevaluation of antimicrobial use in children.
- To emphasize the importance of developing better diagnostic tools for pathogen identification.
- To advocate for alternative therapeutic strategies to mitigate antimicrobial resistance.
Main Methods:
- Review of current antimicrobial prescribing practices in pediatric ambulatory care.
- Analysis of the impact of antimicrobial use on resistance patterns.
- Exploration of potential alternative strategies, including shorter treatment courses and vaccines.
Main Results:
- Established antimicrobial therapies are widely used, contributing to resistance.
- Current diagnostic methods may not be sufficient for rapid pathogen identification.
- Alternative strategies are needed to reduce selective pressure on microbial flora.
Conclusions:
- Judicious antimicrobial use is essential to preserve treatment efficacy.
- Advancements in diagnostics and alternative therapies are necessary to combat resistance.
- Failure to address these issues risks a future with limited effective antibiotic options, termed the 'postantibiotic era'.
Abstract:
Antimicrobial therapy of infection in ambulatory children remains the cornerstone of the pediatrician's practice. Despite a cornucopia of newer antimicrobial agents, the older "tried and true" drugs continue to be favored based on their history of effectiveness, lack of toxicity, and low price. It also is clear that the widespread use of antimicrobial agents has contributed to the development of resistance. We must reevaluate our antimicrobial use so that we only treat infections likely to benefit from antimicrobials. Better diagnostic techniques should be developed for rapid and accurate identification of pathogens. Finally, alternative therapeutic strategies should be investigated, such as shorter courses of treatment or use of vaccines, to lessen the selective pressure on the microbial flora. To fail to meet this challenge will mean the more rapid transition into the "postantibiotic era".