Selecting therapy for serious infections in children: maximizing safety and efficacy

Serious infections in children represent unique challenges for the treating physician. For the pediatric patient, considerations of drug toxicity are especially critical to avoid potential long-term complications of therapy. There are several advantages associated with using single, broad-spectrum, empiric antibiotic therapy, including reduced potential for drug-mediated toxicity or drug interactions and facilitation of home therapy. Of the antibiotics available for monotherapy, the carbapenems have the broadest spectrum of activity. However, a major obstacle toward the use of the carbapenems in pediatrics has been the risk of seizures occurring during therapy with imipenem/cilastatin. In clinical studies of meningitis and other infections in children, no drug-related seizures were reported when treated with the carbapenem meropenem. Meropenem monotherapy has been shown to be similar to ceftriaxone- and cefotaxime-based single or multiple antibiotic regimens, in terms of clinical and microbiologic efficacy and tolerability. Thus, meropenem represents a favorable treatment choice for the seriously ill child, either as empiric monotherapy or as definitive therapy of polymicrobial or nosocomial infections.