Challenges of Empirical Antibiotic Therapy for Community-Acquired Pneumonia in Children

Abstract

BackgroundCommunity-acquired pneumonia (CAP) is a leading cause of morbidity and mortality globally, responsible for more than 14% of deaths in children younger than 5 years of age. Due to difficulties with pathogen identification and diagnostics of CAP in children, targeted antimicrobial therapy is not possible, hence the widespread use of empirical antibiotics, in particular penicillins, cephalosporin, and macrolides.ObjectivesThis review aimed to address medical, societal, and political issues associated with the widespread use of empirical antibiotics for CAP in the United Kingdom, India, and Nigeria.MethodsA literature review was performed identifying the challenges pertaining to the use of widespread empirical antibiotics for CAP in children. A qualitative analysis of included studies identified relevant themes. Empirical guidance was based on guidelines from the World Health Organization, British Thoracic Society, and Infectious Diseases Society of America, used in both industrialized and resource-poor settings.ResultsIn the United Kingdom there was poor adherence to antibiotics guidelines. There was developing antibiotic resistance to penicillins and macrolides in both developing and industrialized regions. There were difficulties accessing the care and treatment when needed in Nigeria. Prevention strategies with vaccination against Streptococcus pneumonia, Haemophilus influenza, and measles are particularly important in these regions.ConclusionsEffective and timely treatment is required for CAP and empirical antibiotics are evidence-based and appropriate in most settings. However, better diagnostics and education to target treatment may help to prevent antibiotic resistance. Ensuring the secure financing of clean food and water, sanitation, and public health infrastructure are also required to reduce the burden of disease in children in developing countries.

Quantifying risks and interventions that have affected the burden of lower respiratory infections among children younger than 5 years: an analysis for the Global Burden of Disease Study 2017

“…An analysis of appropriate antibiotic therapy for child hood pneumonia determined that the availability and acces sibility of WHOrecommended antibiotics is not equitable in some locations with substantial variation within countries. 19 Antibiotic use for symptoms of pneumonia varied greatly among lowincome and middleincome countries, 20 and was estimated at just 18·8% globally, in 2017, in this study. A cohort study consisting of eight sites and a mixture of urban and rural locations found that 61% of children aged 0-2 years with acute LRI received antibiotics, including 69% in rural Tanzania and 86% in urban Bangladesh.…”

Faktor Risiko Kegagalan Antibiotika Empirik pada Pneumonia Anak (Studi Retrospektif)

“…1 Pengamatan respons terapi sangat diperlukan karena tidak semua anak menunjukkan respons yang baik terhadap terapi awal. 2,3 Kegagalan respons pemberian antibiotika empirik di rumah sakit sekitar 9-21%. Anak yang tidak merespon terhadap antibiotika empirik kemungkinan karena adanya penyebab lain termasuk kemungkinan diagnosis banding, adanya penyakit penyerta dan adanya komplikasi pneumonia itu sendiri.…”

A Mathematical Model of Treatment and Vaccination Interventions of Pneumococcal Pneumonia Infection Dynamics

“…Appropriate antibiotics are used for treatment of bacterial pneumonia. Effective and timely treatment together with better diagnostic tools and education prevents antibiotic resistance [20]. According to Wardlaw et al [5], treatment alone could save at least 600,000 children's lives annually at a cost of US $600 million if antibiotic treatment is universally delivered to children with pneumonia.…”