Antimicrobial therapy of pneumonia in infants and children.
To provide optimal management for the child with community-acquired pneumonia, the clinician must take multiple factors into consideration. The etiology of pneumonia is difficult to determine and initial choice of therapy is based on the frequency of pathogens in various age groups, local antibiotic resistance patterns of the organisms, clinical presentation, and epidemiological data. Streptococcus pneumoniae and Haemophilus influenzae remain the most common bacterial pathogens outside the newborn period. Increasing numbers of multidrug-resistant strains of S pneumoniae in the United States and Europe, the decline in H influenzae type b because of current vaccination strategies, and increasing recognition of nontypeable H influenzae as etiologic agents of pneumonia have prompted reconsideration of the drug of choice. Amoxicillin and its derivatives or oral cephalosporins are the drugs of choice for initial therapy for mild to moderate disease. For severe disease or if beta-lactamase producing organisms are a concern, extended spectrum cephalosporins are indicated. Pneumococcal pneumonia unresponsive to penicillin therapy may warrant the use of extended spectrum cephalosporins or vancomycin. For older children in whom mycoplasma is a significant cause of pneumonia, the new macrolides have provided additional options for the clinician. Azithromycin and clarithromycin are efficacious, well tolerated, and require less frequent dosing intervals. The introduction of ceftriaxone, a third-generation cephalosporin with a broad spectrum of activity and prolonged half-life, allows once-a-day intramuscular therapy that can be administered on an outpatient basis. With the availability of parenteral outpatient therapy, hospital admission is no longer required for the treatment of most cases of serious community-acquired pneumonia.
Harris
J A
JA
Maxwell Finland Laboratory for Infectious Disease, Boston City Hospital, MA 02118, USA.
D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008826:Microbial Sensitivity Tests; D011014:Pneumonia / Q000188:drug therapy* / Q000209:etiology; D011379:Prognosis
D000900:Anti-Bacterial Agents