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.

Using Prescription Patterns in Primary Care to Derive New Quality Indicators for Childhood Community Antibiotic Prescribing

“…13 from infancy to preschool age may be partially explained by the increasing use of macrolides with increasing age due to the unresolved questions about the need to cover for atypical pathogens in older children 31 .…”

A comparison of antibiotic use in three specialist paediatric hospitals in France, Latvia and the UK

“…This would be important because there are unanswered questions, for example concerning CAP definition and the growing resistance of the most frequent pathogens,17 and also because CAP is a common cause of morbidity with an incidence in developed countries of 10–40 cases per 1000 children under 5 years of age 18. The high use of piperacillin and tazbactam in Birmingham was due to pseudomonas colonised patients and administration to haematology/oncology patients.…”

Lungenerkrankungen im Kindesalter

“…Die kalkulierte Antibiotikatherapie der Pneumonie bei unbekanntem Erreger entspricht aber der des Kleinkindes. Der früher empfohlene Beginn einer Mykoplasmen-wirksamen Monotherapie mit einem Makrolid wird aufgrund der beobachteten Resistenzbildung von Pneumokokken heute nicht mehr empfohlen [10]. In allen AltersgrupAbb.…”

“…In allen AltersgrupAbb. 3 9 MRT (koronare T2-Blade-Sequenz) des Thorax einer komplizierten Pneumonie mit Pleuraempyem und intrapulmonalen Abszessen links bei einem 18 Monate alten Jungen pen sollten Staphylokokken im Therapieregime kritisch kranker Kindern mit berücksichtigt werden [10], da diese für die Ausbildung von Lungenabszessen verantwortlich sein können.…”