How does one choose the appropriate pharmacotherapy for children with lower respiratory tract infections?

ABSTRACT

Introduction

The definition of acute lower respiratory tract infection (LRTI) includes any infection involving the respiratory tract below the level of the larynx. In children, the most common acute LRTIs, and those with the greatest clinical relevance, are community-acquired pneumonia (CAP), bronchiolitis, bronchitis and tuberculosis (TB). The clinical relevance of LRTIs implies that they must be addressed with the most effective therapy. Antibiotics and antivirals play an essential role in this regard.

Areas covered

In this paper, the most recent advances in the drug treatment of LRTIs in children are discussed.

Expert opinion

Although LRTIs are extremely common and one of the most important causes of hospitalization and death in children, anti-infective therapy for these diseases remains unsatisfactory. For CAP and BR, the most important problem is the overuse and misuse of antibiotics; for BCL, the lack of drugs with demonstrated efficacy, safety and tolerability; for TB, the poor knowledge on the true efficacy and safety of the new drugs specifically planned to overcome the problem of MDR M. tuberculosis strains. There is still a long way to go for the therapy of pediatric LRTIs to be considered satisfactory.

KEYWORDS:

• Antimicrobial stewardship programme
• community-acquired pneumonia
• bronchiolitis
• bronchitis
• lower respiratory tract infection
• tuberculosis

Article highlights

• Lower respiratory tract infections (LRTIs) are common in children and cause a significant healthcare burden.

• Identification of the causative agent in LRTIs is restricted by the poor specificity of clinical manifestations and inadequacy or unavailability of laboratory tests.

• The choice of the best drug regimen for the treatment of paediatric LRTIs is hindered by the lack, at least for some drugs, of adequate knowledge on their pharmacokinetic and pharmacodynamic characteristics in the subjects of different paediatric ages.

• The use of available drugs is frequently followed by the emergence of microbial resistance that necessitates the development of new drugs, with a further increase in dosage problems.

• The development of new drugs is a very slow and expensive process that delays any possible effective therapies and often depends on factors not directly related to the patients’ health demands.

• Prophylaxis with safe and effective vaccines might be the preferred option to reduce the total burden of LRTIs. The examples of H. influenzae type b, pneumococcal conjugate and influenza vaccines clearly demonstrate the tremendous impact of effective prophylaxis. Further advantages in children will be represented by the availability of vaccines against respiratory syncytial virus (RSV).

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript has not been funded.