Optimizing antimicrobial therapy in children

Abstract

Management of common infections and optimal use of antimicrobial agents are presented, highlighting new evidence from the medical literature that enlightens practice. Primary therapy of staphylococcal skin abscesses is drainage. Patients who have a large abscess (>5 cm), cellulitis or mixed abscess-cellulitis likely would benefit from additional antibiotic therapy. When choosing an antibiotic for outpatient management, the patient, pathogen and in vitro drug susceptibility as well as tolerability, bioavailability and safety characteristics of antibiotics should be considered. Management of recurrent staphylococcal skin and soft tissue infections is vexing. Focus is best placed on reducing density of the organism on the patient's skin and in the environment, and optimizing a healthy skin barrier. With attention to adherence and optimal dosing, acute uncomplicated osteomyelitis can be managed with early transition from parenteral to oral therapy and with a 3-4 week total course of therapy. Doxycycline should be prescribed when indicated for a child of any age. Its use is not associated with dental staining. Azithromycin should be prescribed for infants when indicated, whilst being alert to an associated ≥2-fold excess risk of pyloric stenosis with use under 6 weeks of age. Beyond the neonatal period, acyclovir is more safely dosed by body surface area (not to exceed 500 mg/m(2)/dose) than by weight. In addition to the concern of antimicrobial resistance, unnecessary use of antibiotics should be avoided because of potential later metabolic effects, thought to be due to perturbation of the host's microbiome.

Association of Antibiotic Treatment Duration With Recurrence of Uncomplicated Urinary Tract Infection in Pediatric Patients

“…In both pediatric and adult UTI, extended antibiotic exposure has been associated with ecological disturbances in normal intestinal flora, the development of metabolic disturbances and obesity, increased rates of symptomatic UTI recurrence, and subsequent infections with more resistant pathogens. [20][21][22] Comparison of our observed 30-day recurrence rate of 5.5% with those reported in previous work is difficult because of methodological differences. Conway et al 23 found an annual rate of recurrence or reinfection of 12% per patient per year in a sample of children aged 6 years or younger, but that study had a mean follow-up of 408 days and included children with VUR.…”

“…In both pediatric and adult UTI, extended antibiotic exposure has been associated with ecological disturbances in normal intestinal flora, the development of metabolic disturbances and obesity, increased rates of symptomatic UTI recurrence, and subsequent infections with more resistant pathogens. 20-22…”

Antibiotic Prescribing for Oro-Facial Infections in the Paediatric Outpatient: A Review

“…When antibiotics are indicated for the treatment of an odontogenic infection, empiric therapy with a broad-spectrum antibiotic is recommended. For abscesses larger than 5 cm, cellulitis or conditions with mixed abscess-cellulitis, drainage and administration of antibiotics are indicated [ 38 ]. Some studies have recommended the use of amoxicillin and metronidazole, or amoxicillin with clavulanic acid, as an empiric treatment for odontogenic infections.…”

Efeito do clareamento de dentes afetados por tetraciclina: relato de caso clínico

“…1 A tetraciclina é considerada agente teratogênico e possui efeitos colaterais: um deles é o manchamento de dentes. [2][3][4][5] O manchamento dental causado pelo uso da tetraciclina depende da dose administrada, duração do tratamento e estágio do desenvolvimento dentário. 2,4,5 Isso ocorre devido à capacidade de formar um complexo com íons de cálcio, chamado de quelação.…”

“…[2][3][4][5] O manchamento dental causado pelo uso da tetraciclina depende da dose administrada, duração do tratamento e estágio do desenvolvimento dentário. 2,4,5 Isso ocorre devido à capacidade de formar um complexo com íons de cálcio, chamado de quelação. 6 Esse processo se dá entre a tetraciclina e íons de cálcio para formar complexos estáveis de ortofosfato de cálcio e tetraciclina, que são depositados nos ossos e dentes, sendo a dentina mais suscetível do que o esmalte.…”