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"Child`s Health" 8 (68) 2015

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Current Issues of Antibiotic Use for Acute Infections Treatment in Children

Authors: Duka K.D., Ilchenko S.I., Koreniuk O.S. - Dnipropetrovsk Medical Academy; Degtiar S.P. - Dnipropetrovsk Children Hospital № 2; Fomenkova N.V. - Dnipropetrovsk Children Hospital № 5, Dnipropetrovsk, Ukraine

Categories: Pediatrics/Neonatology

Sections: Clinical researches

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Summary

У статті розглянуті питання проведення антибактеріальної терапії у дітей із гострими респіраторними захворюваннями (ГРЗ): обґрунтованість призначення, вибір стартового антибіотика і методики терапії. Наведено аналіз 369 історій хвороби дітей, які перебували на стаціонарному лікуванні з приводу гострих респіраторних вірусних інфекцій, бронхітів і пневмоній. Відзначено, що у третини дітей із ГРЗ призначення антибактеріальної терапії було необґрунтованим і передчасним. Як стартовий антибіотик при терапії ГРЗ домінують цефалоспорини II і III поколінь. Виявлено нечасте використання тактики ступеневої терапії і переважно парентеральне призначення антибіотиків.

В статье рассмотрены вопросы проведения антибактериальной терапии у детей с острыми респираторными заболеваниями (ОРЗ): обоснованность назначения, выбор стартового антибиотика и методики терапии. Приведен анализ 369 историй болезни детей, находившихся на стационарном лечении по поводу острых респираторных вирусных инфекций, бронхитов и пневмоний. Отмечено, что у трети детей с ОРЗ назначение антибактериальной терапии было необоснованным и преждевременным. В качестве стартового антибиотика при терапии ОРЗ доминируют цефалоспорины II и III поколений. Выявлено редкое использование тактики ступенчатой терапии и преимущественное парентеральное назначение антибиотиков.

In the article we considered the antibacterial therapy in children with acute respiratory disease: rational of administration, the choice of an initial antibiotic and the selection of methods of antibiotic therapy. 369 case records of children with acute respiratory infection, bronchitis and pneumonias were analyzed. It was detected that the prescription of antibacterial therapy was groundless and timeless in 1/3 children with acute respiratory diseases. The Cephalosporins of the II and III generation dominates as a starting treatment of acute respiratory disease in children. We registered the rare use of sequential therapy and prevailing administration of parenteral antibiotics.


Keywords

респіраторні захворювання, антибактеріальна терапія, діти.

респираторные заболевания, антибактериальная терапия, дети.

respiratory diseases, antibiotic therapy, children.

INTRODUCTION. Antibiotic therapy is one of the most important issues of the treatment of acute respiratory diseases in children. The essential problem is a widespread and unwarranted antibiotics administration for uncomplicated forms of acute respiratory disease in children aimed at preventing bacterial complications or reducing of increased levels of parents’ anxiety [3].

The second issue in the treatment of acute respiratory diseases is the choice of an initial antibiotic. As often there is no information about an infectious agent in a particular patient, drug selection is based on the recommendations of empiric initial therapy that takes into account the likely etiology of the disease and the likely sensitivity of the infectious agent in this region [4, 5, 6].

The studies on etiological structure of pneumonia in children conducted by Senatorova H.S. and her co-authors in 2011 demonstrated stable culturing of S.pneumoniae (48.24%), hemolytic streptococcus (49.25%) and K. pneumoniae (48,24%). The decrease of gram-negative microflora among infectious agents of pneumonia (p <0.05) was fixed [6].  Therefore the usage of semisynthetic penicillins as initial medications is highly recommended. But the best option is a combination of semisynthetic penicillins and clavulanic acid [7].

However, in recent years, there has been a growing tendency of spreading of penicillin-resistant’s strains of Str.pneumonia that are resistant to Aminopenicillins, the 1st and the 2nd generations CephaIosporins, but sensitive to the 3rd generation CephaIosporins (Cefpodoxime) [5, 8, 9].

MATERIALS AND METHODS: Our aim was to study the therapeutic tactics in the treatment of acute respiratory disease in the children. We focused on the following issues: the justification of antibiotic therapy, the selection of an initial antibiotic and methods of antibiotic therapy.

We analyzed 369 case records of children with acute respiratory diseases. Three age groups were singled out:  the first year of a child’s life – 148 children; 1-3 year-olds – 129 children; 3-5 year-olds – 92 children.

RESULTS AND DISCUSSION: The particular attention was paid to the analysis of antibacterial therapy administration for children with acute respiratory diseases. The antibiotics were used for the treatment of acute respiratory infection in 29.6% of infants, in 1-3-years-old children – 74.3% and in 3-5-years-old children – 54.5%. We noted more frequent use of antibiotics in the treatment of acute and obstructive bronchitis. Antibacterial therapy was prescribed to infants in 75% of cases; to 1-3-years-old children – 88.9%, аnd to 3-5-years-old children – in 100% of cases.

We are convinced that antibiotic therapy in the treatment of acute respiratory disease in children was not always justified. We think that antibiotic administration was premature in 37.5% of patients. Sometimes antibacterial therapy was prescribed from the first day of the respiratory disease with due account of the early age of a child (1-2 month-old).

It was observed that in most cases the antibacterial therapy of respiratory disease starts  with using a wide spectrum of action drugs  - the 2nd and the 3rd generation CephaIosporins. Cefuroxime and its analogues was used as an initial antibiotic in the treatment of acute respiratory infection and bronchitis in 74.3% cases. The using of amoxycillin/clavulanate and macrolides as an initial antibiotic was rare.

The methods of evidence-based medicine confirmed the reduction of gram-negative microflora in the spectrum of causative agents of most respiratory diseases in children.  We marked the improvement of coccal sensitivity to Cefuroxime (58%), but sensitivity to amoxycillin/clavulanate was much greater (68%). Тhe coccal agents sensitivity to macrolides (azithromycin) did not change [7, 9]. Therefore, using of antibacterial therapy «Step up» in the treatment of uncomplicated forms of bronchitis and pneumonias is more rational.  It is better to use amoxycillin/clavulanate for starting of antibacterial therapy. In the cases of moderate or severe course of a disease it is possible to use «Step down» therapy applying the 2nd and the 3rd generation CephaIosporins.

Analyzing the method of antibiotic therapy in children with respiratory diseases we marked the predominant use of parenteral route of administration of antibiotics. Oral antibiotics were prescribed only to 23.8% of the infants with acute respiratory infection and bronchitis. We observed less frequent use of peroral forms of antibiotics in older age groups of children (11.5% cases). We almost did not observe the use of tactics "sequential therapy". More often step therapy was used as a "switch" therapy in patients with pneumonia. Physicians should emphasize the importance of the sparing therapeutic tactics, especially in infants.

CONCLUSIONS: 1. The administration of antibacterial therapy in children with acute respiratory disease should be justified by significant clinical and laboratory signs of bacterial complications or severe disease, regardless of a child’s age. The fundamental etiopathogenetic rational choice of therapy in children should minimize the use of antibiotics.

2. It’s necessary to pay attention to the sequence of antibiotics use in the treatment of acute respiratory disease that is recommended by clinical protocols. Wouldn’t the common use of the 2nd and the 3rd generation CephaIosporins bring to the formation of antibiotic resistant pathogenic flora?

3. It’s important to recommend a preferential use of classic tactics of "sequential therapy" in the treatment of respiratory diseases in children. In cases of light and moderate course - the use of oral forms of antibiotics. 


Bibliography

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