Antimicrobial Therapy in Community-Acquired Pneumonia in Children

Gupta, Samriti; Lodha, Rakesh; Kabra, SK

doi:10.1007/s11908-018-0653-6

Cited by 10 publications

(10 citation statements)

References 59 publications

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“…CAP is a common and potentially severe infection, with high incidence and relevant morbidity and mortality among children ( McIntosh, 2002 ; Gupta et al, 2018 ), and is one of the major causes of admission to the emergency paediatric wards ( Nascimento-Carvalho, 2020 ). Although respiratory viruses are the major causative pathogens in children under 5 years, also bacteria may play a relevant role.…”

Section: Discussionmentioning

confidence: 99%

“…Although respiratory viruses are the major causative pathogens in children under 5 years, also bacteria may play a relevant role. Streptococcus pneumoniae , Haemophilus influenzae , and Mycoplasma pneumoniae represent the most frequent bacterial pathogens ( Gupta et al, 2018 ; Nascimento-Carvalho and Nascimento-Carvalho, 2019 ; Nascimento-Carvalho, 2020 ). Ampicillin represents the first-line antibiotic therapy in hospitalized children with CAP.…”

Section: Discussionmentioning

confidence: 99%

“…Ampicillin represents the first-line antibiotic therapy in hospitalized children with CAP. Vancomycin or linezolid should be considered in presence of CA-MRSA ( Gupta et al, 2018 ; Nascimento-Carvalho, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

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A Proof of Concept of the Role of TDM-Based Clinical Pharmacological Advices in Optimizing Antimicrobial Therapy on Real-Time in Different Paediatric Settings

et al. 2021

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Introduction: Antimicrobial treatment is quite common among hospitalized children. The dynamic age-associated physiological variations coupled with the pathophysiological alterations caused by underlying illness and potential drug-drug interactions makes the implementation of appropriate antimicrobial dosing extremely challenging among paediatrics. Therapeutic drug monitoring (TDM) may represent a valuable tool for assisting clinicians in optimizing antimicrobial exposure. Clinical pharmacological advice (CPA) is an approach based on the correct interpretation of the TDM result by the MD Clinical Pharmacologist in relation to specific underlying conditions, namely the antimicrobial susceptibility of the clinical isolate, the site of infection, the pathophysiological characteristics of the patient and/or the drug-drug interactions of cotreatments. The aim of this study was to assess the role of TDM-based CPAs in providing useful recommendations for the real-time personalization of antimicrobial dosing regimens in various paediatric settings.Materials and methods: Paediatric patients who were admitted to different settings of the IRCCS Azienda Ospedaliero-Universitaria of Bologna, Italy (paediatric intensive care unit [ICU], paediatric onco-haematology, neonatology, and emergency paediatric ward), between January 2021 and June 2021 and who received TDM-based CPAs on real-time for personalization of antimicrobial therapy were retrospectively assessed. Demographic and clinical features, CPAs delivered in relation to different settings and antimicrobials, and type of dosing adjustments were extracted. Two indicators of performance were identified. The number of dosing adjustments provided over the total number of delivered CPAs. The turnaround time (TAT) of CPAs according to a predefined scale (optimal, <12 h; quasi-optimal, between 12–24 h; acceptable, between 24–48 h; suboptimal, >48 h).Results: Overall, 247 CPAs were delivered to 53 paediatric patients (mean 4.7 ± 3.7 CPAs/patient). Most were delivered to onco-haematological patients (39.6%) and to ICU patients (35.8%), and concerned mainly isavuconazole (19.0%) and voriconazole (17.8%). Overall, CPAs suggested dosing adjustments in 37.7% of cases (24.3% increases and 13.4% decreases). Median TAT was 7.5 h (IQR 6.1–8.8 h). Overall, CPAs TAT was optimal in 91.5% of cases, and suboptimal in only 0.8% of cases.Discussion: Our study provides a proof of concept of the helpful role that TDM-based real-time CPAs may have in optimizing antimicrobial exposure in different challenging paediatric scenarios.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A Proof of Concept of the Role of TDM-Based Clinical Pharmacological Advices in Optimizing Antimicrobial Therapy on Real-Time in Different Paediatric Settings

et al. 2021

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“…However, Streptococcus pneumoniae remains an important cause of CAP in children [3]. Most children with CAP can be treated as outpatients, and antibiotics are often prescribed, as there are no widely available biomarkers for the differentiation of viral from bacterial causes [4,5].…”

Section: Introductionmentioning

confidence: 99%

“…The excessive use of broad-spectrum antibiotics promotes the spread of resistance across multiple bacterial species and has a detrimental effect on the host microbiome [6]. Therefore, most guidelines encourage the use of narrow-spectrum and penicillin-based antibiotics in children with (presumed) bacterial CAP [4]. The European Society for Paediatric Infectious Diseases 2012 guidance recommends either penicillin G or aminopenicillins [7] for children with CAP aged 3 months to 5 years.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the effectiveness of penicillin and broad-spectrum β-lactam antibiotics in the treatment of community-acquired pneumonia in children

et al. 2020

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Introduction: Bacterial community-acquired pneumonia (CAP) in children is caused mostly by Streptococcus pneumoniae. The resistance of pneumococci to penicillin is increasing. However, most guidelines still prefer treatment with narrow-spectrum antibiotics. Therefore, we compared the effect of intravenous treatment with penicillin and broad-spectrum β-lactam antibiotics in children with CAP. The objective of our study was to assess the eligibility of treatment of bacterial CAP with intravenous penicillin. Material and methods: We performed a prospective study and included 136 children hospitalised because of bacterial CAP. Patients were treated intravenously with either penicillin G or broad-spectrum β-lactam antibiotic monotherapy. Lung ultrasound and blood tests were performed at admission and after 2 days of treatment. The time interval from the application of antibiotics to permanent defervescence was recorded. Results: Eighty-seven (64.0%) patients were treated with penicillin G, and 49 (36.0%) were treated with broad-spectrum β-lactam antibiotics. The median time to persistent defervescence was 5 h in the penicillin group and 8 h in the broad-spectrum group (p = 0.18). There were no significant differences between the treatment regimens regarding the effect on the consolidation sizes or C-reactive protein levels. However, the decrease in the white blood cell count was marginally greater in the penicillin treatment group (p = 0.05). Conclusions: We have shown that penicillin is as effective as broad-spectrum antibiotics in the treatment of bacterial CAP in children. Although the resistance of pneumococci to antibiotics is increasing, clinicians should still use penicillin and other narrow-spectrum β-lactam antibiotics in the treatment of bacterial CAP in children.

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“Rationalization of Empiric Antibiotic Therapy” – A Move Towards Preventing Emergence of Resistant Infections

Singhal

2020

Indian J Pediatr

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Antimicrobial Therapy in Community-Acquired Pneumonia in Children

Cited by 10 publications

References 59 publications

A Proof of Concept of the Role of TDM-Based Clinical Pharmacological Advices in Optimizing Antimicrobial Therapy on Real-Time in Different Paediatric Settings

A Proof of Concept of the Role of TDM-Based Clinical Pharmacological Advices in Optimizing Antimicrobial Therapy on Real-Time in Different Paediatric Settings

Comparison of the effectiveness of penicillin and broad-spectrum β-lactam antibiotics in the treatment of community-acquired pneumonia in children

“Rationalization of Empiric Antibiotic Therapy” – A Move Towards Preventing Emergence of Resistant Infections

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