Antibiotic Therapy for Pediatric Patients

Kim, Kyung Hyo

Abstract

Antibiotics are prescribed to prevent infection and to treat established or presumptive infections. In choosing the appropriate antibiotics, a number of factors must be considered. First, the identity of the infecting organism must be known. Second, the information about the antibiotic susceptibility of the infecting organism must be as accurate as possible. Finally, host factors must be taken into consideration. The pharmacokinetics and pharmacodynamics of antibiotics in children are different from those in adults and are important host factors. The antibiotics may be classified into several groups : the beta-lactams (i.e., penicillins, cephalosporins, carbacephems, and monobactam), glycopeptides (i.e., vancomycin), aminoglycosides, macrolides, and quinolones. This article describes the clinical application of selected antibiotics to infectious diseases with newly available agents in children. The development of new oral agents prescribed as once or twice per day achieves enhanced compliance. These include cefprozil, cefpodoxime, loracarbef, azithromycin, clarithromycin, and fluoroquinolones. Meropenem is also a newly available carbacephem approved for use in children. Antibiotics available but not approved for use in children are imipenem-ci-lastatin, aztreonam, quinolones, and several cephalosporins including "fourth"-generation such as cefipime. Recently the use of once-daily dosing of aminoglycosides has been evaluated in pediatric populations, which appears to be safe and effective, although further studise are warranted. The emergence of antibiotic-resistant bacteria has generally been correlated with the rise of specific antibiotic use in clinical practice. Although the development of resistance may be inevitable, the rate at which it develops may be diminished by the rational use of antibiotics.