Current pharmacotherapeutic options for pediatric lower respiratory tract infections with a focus on antimicrobial agents

ABSTRACT

Introduction

Antibiotics are frequently prescribed to children in the community and in nosocomial settings, mainly because of lower respiratory tract infections(LRTIs), which include influenza, bronchitis, bronchiolitis, pneumonia, and tuberculosis, in addition to bronchiectasis and cystic fibrosis lung disease. It is important to note, however, that more than 50% of these prescriptions are unnecessary or inappropriate.

Areas covered

The current choice of antimicrobial therapy for etiological agents of LRTIs is examined and discussed considering each type of LRTI.

Expert opinion

There is a clear need for the appropriate utilization of antibiotics in children. Therefore, accurate drug selection and choice of best dosage and duration of the antibacterial treatment are important to optimize the treatment of LRTIs. It’s fundamental to bear in mind that children differ from adults in how LRTIs manifest and evolve not only because of the diversity in the immunological profiles but also the fundamental age-related differences in absorption, distribution, metabolism, and elimination of drugs. Since comprehensive antibiotic guideline recommendations for the treatment of pediatric LRTIs are generally lacking, there is an undeniable need for the introduction of pediatric antimicrobial stewardship programmes in both community and hospital settings.

KEYWORDS:

• Antibiotic selection
• antimicrobial stewardship programmes
• children
• dose optimisation
• duration of the antibacterial treatment
• lower respiratory tract infections

Article highlights

• LRTIs include influenza, bronchitis, bronchiolitis, pneumonia, and tuberculosis, and also bronchiectasis and cystic fibrosis lung disease.

• Antibiotics are frequently prescribed to children in the community and nosocomial settings, although a great number of these antibiotic prescriptions are unnecessary or inappropriate.

• The choice of antimicrobial therapy for etiological agents of LRTI is straightforward when these agents and their antibiotic susceptibility patterns are known. Better knowledge of likely bacterial pathogens and susceptibility at the point of care, could help to improve antibiotic prescribing decisions and so help limit the unnecessary antibiotic use and antimicrobial resistance.

• Whilst the appropriate utilization of antibiotics in children is a must, accurate drug selection both in the community and nosocomial settings, the choice of best dosage and duration of the antibacterial treatment are important to optimize the treatment of bacterial infections.

• Strategies to preserve the efficacy of existing antibiotics both in hospital and community settings are a public health priority, which must be urgently implemented. Unfortunately, comprehensive antibiotic guideline recommendations for the treatment of pediatric LRTIs are generally lacking.

• There is an undeniable need for supporting the introduction of pediatric ASPs in both community and hospital settings, in terms of reduced antibiotic use, improved quality of prescribing and cost-savings.

• General practice has a major contribution and responsibility toward antibiotic stewardship, since primary care is a driver of antibiotic resistance, but antibiotic stewardship is challenging to implement in community settings. Furthermore, best practices for outpatient antibiotic stewardship are not yet defined.

This box summarizes key points contained in the article.

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 was not funded.