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Empiric antibiotic selection criteria for respiratory infections in pediatric practice
1Department of Microbiology and Immunology, University of Rochester, NY 14642, USA.
Background:
Respiratory infections in children may occur as a consequence of resistant bacterial pathogens. Streptococcus pneumoniae organisms resistant to penicillin, trimethoprim/sulfamethoxazole and macrolides are increasingly prevalent. Amoxicillin- and macrolide-resistant Haemophilus influenzae and Moraxella (Branhamella) catarrhalis are also more commonly seen. Traditional agents such as amoxicillin and trimethoprim/sulfamethoxazole remain acceptable choices for most children with respiratory infections because currently most patients are not infected by resistant pathogens and there is a high spontaneous cure rate associated with these infections.
Objective:
To analyze the criteria for the selection of extended spectrum antimicrobials as empiric therapy for respiratory infections.
Discussion:
When an extended spectrum antimicrobial is appropriate for empiric therapy, selection should be based on: (1) efficacy; (2) adverse event profile; and (3) compliance-enhancing features (dosing with meals, once or twice daily administration, good palatability in suspension, shortened course of therapy and affordability). A new agent, ceftibuten, has recently joined other extended spectrum cephalosporins and newer macrolides (clarithromycin and azithromycin) as a choice to be considered for empiric therapy for respiratory infections. These antimicrobials are differentiated from each other and traditional agents by differences in activity in vitro against penicillin-resistant pneumococci, relative beta-lactamase stability against Gram-negative bacteria and pharmacodynamic properties. When resistant organisms are isolated or suspected in community-acquired respiratory infections, cautious use of newer antibiotics may have to be considered.
Insights
Choosing antibiotics for pediatric respiratory infections requires balancing efficacy and safety. Newer extended-spectrum antimicrobials offer options when resistant bacteria are suspected, but careful selection is crucial.
Area of Science:
- Pediatric infectious diseases
- Antimicrobial stewardship
- Pharmacology
Background:
- Increasing prevalence of antibiotic-resistant bacterial pathogens like Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in pediatric respiratory infections.
- Traditional antibiotics (amoxicillin, trimethoprim/sulfamethoxazole) remain effective for most cases due to low resistance rates and high spontaneous cure rates.
Purpose of the Study:
- To analyze criteria for selecting extended-spectrum antimicrobials for empiric therapy of respiratory infections in children.
- To guide clinicians in choosing appropriate antimicrobial agents when resistance is a concern.
Main Methods:
- Literature review and analysis of antimicrobial properties.
- Evaluation of efficacy, safety, and patient compliance factors for various antimicrobial agents.
Main Results:
- Extended-spectrum antimicrobials should be chosen based on efficacy, adverse event profile, and compliance-enhancing features.
- Newer agents like ceftibuten, clarithromycin, and azithromycin offer alternatives with distinct in vitro activity and pharmacodynamic properties.
Conclusions:
- Selection of extended-spectrum antimicrobials requires consideration of in vitro activity against resistant strains, beta-lactamase stability, and pharmacodynamics.
- Cautious use of newer antibiotics is recommended when resistant organisms are isolated or suspected in community-acquired respiratory infections.