title: Antibiotic therapy for pediatric community-acquired pneumonia: do we know when, what and for how long to treat?
abstract: Community-acquired pneumonia (CAP) is a common cause of morbidity among children in developed countries and accounts for an incidence of 10-40 cases per 1000 children in the first 5 years of life. Given the clinical, social and economic importance of CAP, there is general agreement that prompt and adequate therapy is essential to reduce the impact of the disease. The aim of this discussion paper is to consider critically the available data concerning the treatment of uncomplicated pediatric CAP and to consider when, how and for how long it should be treated. This review has identified the various reasons that make it difficult to establish a rational approach to the treatment of pediatric CAP, including the definition of CAP, the absence of a pediatric CAP severity score, the difficulty of identifying the etiology, limited pharmacokinetic (PK)/pharmacodynamic (PD) studies, the high resistance of the most frequent respiratory pathogens to the most widely used anti-infectious agents and the lack of information concerning the changes in CAP epidemiology following the introduction of new vaccines against respiratory pathogens. More research is clearly required in various areas, such as the etiology of CAP and the reasons for its complications, the better definition of first- and second-line antibiotic therapies (including the doses and duration of parenteral and oral antibiotic treatment), the role of antiviral treatment and on how to follow-up patients with CAP. Finally, further efforts are needed to increase vaccination coverage against respiratory pathogens and to conduct prospective studies of their impact.
authors.affiliation: Department of Maternal and Pediatric Sciences, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. susanna.esposito@unimi.it
authors.forename: Susanna
authors.initials: S
authors.lastname: Esposito
authors.forename: Robert
authors.initials: R
authors.lastname: Cohen
authors.forename: Javier Diez
authors.initials: JD
authors.lastname: Domingo
authors.forename: Oana Falup
authors.initials: OF
authors.lastname: Pecurariu
authors.forename: David
authors.initials: D
authors.lastname: Greenberg
authors.forename: Ulrich
authors.initials: U
authors.lastname: Heininger
authors.forename: Markus
authors.initials: M
authors.lastname: Knuf
authors.forename: Irja
authors.initials: I
authors.lastname: Lutsar
authors.forename: Nicola
authors.initials: N
authors.lastname: Principi
authors.forename: Fernanda
authors.initials: F
authors.lastname: Rodrigues
authors.forename: Mike
authors.initials: M
authors.lastname: Sharland
authors.forename: Vana
authors.initials: V
authors.lastname: Spoulou
authors.forename: George A
authors.initials: GA
authors.lastname: Syrogiannopoulos
authors.forename: Vytautas
authors.initials: V
authors.lastname: Usonis
authors.forename: Anne
authors.initials: A
authors.lastname: Vergison
authors.forename: Urs B
authors.initials: UB
authors.lastname: Schaad
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents