[Pediatric use of carbapenems].
Increasing frequency of infections due to multi-drug resistant organisms is currently observed in the adult and pediatric population. Therapeutic options are unfortunately limited to treat such infections. It is the clinician's responsibility to use wide-spectrum antibiotics when appropriate, but also to limit the use of these drugs to the sole situations where such a potent treatment is required. Carbapenems are the most efficient beta-lactams, especially against gram-negative bacilli, and the most preserved from resistance so far. This review summarizes microbiological, pharmacokinetic and pharmacodynamic characteristics of currently available cabapenems. Their clinical use in different pediatric settings is then discussed, based on available published evidence. In order to maintain their microbiological efficiency and to limit the emergence of carbapem-resistant strains, carbapenems should be exclusively used for infections due to gram-negative bacilli showing resistance to other beta-lactams. In the next years meropenem should logically replace imipenem indications regarding its superior pharmacokinetic-pharmacodynamic properties, its higher tolerance and its easier use in the pediatric population.
Durrmeyer
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X
Réanimation Néonatale et Néonatalogie, Centre Hospitalier Intercommunal de Créteil, 40, Avenue de Verdun, 94000 Créteil, France. xavier.durrmeyer@chicreteil.fr
Cohen
R
R
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy*; D015780:Carbapenems / Q000627:therapeutic use*; D002648:Child; D004361:Drug Tolerance; D006090:Gram-Negative Bacteria / Q000187:drug effects; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy*; D006801:Humans; D000077731:Meropenem; D013845:Thienamycins / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D015780:Carbapenems; D013845:Thienamycins; D000077731:Meropenem