Paediatrics those undergoing broad-spectrum therapy and US$4,375 for those receiving narrowspectrum therapies. The researchers concluded that there were no differences in clinical outcomes or costs for children hospitalized with CAP between treatment using narrow-spectrum therapy and those using broad-spectrum therapies. Eye Infections Eye infections in very young paediatric patients can present some special concerns. Selecting the best treatment depends on the type of eye infection. Distinguishing between the various types of eye infections can be challenging, however, because symptoms can be nonspecific or indeterminate. Conjunctivitis is the most common eye infection to affect children5. There are several types of eye infections, including: • Staphylococcal blepharitis – often caused by S aureus or Staphylococcus epidermidis • Acute bacterial conjunctivitis – often caused by Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis • Neonatal bacterial conjunctivitis – often caused by Chlamydia trachomatis or Neisseria gonorrhoeae • Viral conjunctivitis – adenovirus is the most common cause but may be caused by herpes simplex virus or varicella zoster virus Skin and soft tissue infections The incidence of skin and soft tissue infections has increased in the past decade, largely due to the emergence of community acquired methicillin-resistant Staphylococcus aureus (AC-MRSA). One study shows that invasive MRSA infection in children disproportionately
Recommendations The US Centers for Disease Control (CDC) and American Academy of Pediatrics (AAP) provide specific recommendations to promote appropriate use of antibiotics in paediatric cases in ways that reduce antibiotic resistance. Careful Antibiotic Use – CDC / AAP http://tinyurl.com/p29kqft
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affects young infants. In that study of 876 paediatric cases of invasive MRSA, 39% were among infants6. Infants under the age of 90 days were at special risk when compared with older children, at 43.9 vs. 2.0 per 100,000. The researchers also noted that the incidence of invasive CA-MRSA is declining among adults but that it was rising in children; infection per 100,000 children increased from 1.1 in 2005 to 1.7 in 2010. Selection of the appropriate antimicrobial therapy depends on determining the most likely causative organism. Practitioners should prescribe the most narrowspectrum antibiotic that still covers the likely organisms. Additionally, prescribers should consider the cost, product taste and dosing schedule to ensure compliance among paediatric patients and their parents. It is also essential to ensure the patient has no allergies or sensitivities to the prescribed class of antibiotics. Central Nervous System infections Central nervous system (CNS) infections are life threatening, especially to children. Many agents can cause infection within the central nervous system, often with involvement of the meninges, brain or spinal cord, or present as a space-occupying lesion. Diagnosis relies on epidemiological considerations, cerebrospinal fluid analysis, and appreciation of any presenting clinical syndromes, such as acute bacterial meningitis, acute aseptic meningitis, chronic meningitis or space-occupying lesions. Modern imaging techniques can help define the infected anatomic region, help evaluate treatment efficacy, and pinpoint causes outside of the central nervous system, such as mastoiditis or sinusitis. The effect of an invasive fungal infection can be particularly devastating, especially among immunosuppressed neonates and children. Paediatric patients with primary and secondary immunodeficiencies are at special risk. The most commonly isolated organisms in the paediatric population are candida and Aspergillus. Timely diagnosis and initiation of appropriate antimicrobial therapy is essential for positive treatment outcomes. Choosing among antifungal agents polyenes, azoles, and echinocandins Proper antibiotic prescribing is an important
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medical practice, especially in paediatrics. Antibiotic therapy may be initiated as empiric therapy in the absence of a culture and sensitivity, specific therapy based on C&S, and prophylaxis to prevent illness. There are several ways to classify antibiotics, including bacterial spectrum, type of activity, and chemical structure. Antibiotics within a class generally have similar patterns of effectiveness, toxicity and allergic potential. There are three classes of antifungals currently available for treating systemic fungal infections – polyenes, azoles, and echinocandins. The newest agents offer potentially improved efficacy and less toxicity in difficult infections. Extended-spectrum azoles demonstrate excellent in vitro activity against Aspergillus and improve clinical outcomes. Echinocandins offer a broad spectrum of activity for Candida. Amphotericin is currently the treatment option of choice for zycomycosis, but posaconazole shows tremendous promise as a treatment option7, 8. Polyene antifungal drugs Polyene antifungal drugs, such as Amphotericin, nystatin and pimaricin, interact with sterols in the cell membrane. This interaction forms channels through which small molecules leak from the inside the fungal cell to the exterior of the cell. Polyene antifungal drugs are not absorbed when taken orally, so these drugs effectively treat fungal infections affecting the gastrointestinal tract, including oral thrush. To treat systemic fungal infections, polyene must be administered intravenously9. Azole antifungal drugs Azole antifungal drugs, such as fluconazole, ketoconazole, and itraconazole inhibit cytochrome P450-dependent enzymes. These enzymes, particularly C14 dementhylase, are involved in ergosterol biosynthesis that is critical to fungal cell membrane structure and its function. Azole drugs are broad-spectrum drugs that effectively treat fungal infections of the skin or mouth. Echinocandins antifungal drugs Echinocandins target the fungal cell wall. Echinocandins are lipopeptide molecules, which noncompetitively inhibit beta-dglucan synthase enzyme that forms glucan. Because glucan is a major component of