Principles of antibiotic therapy in pediatric emergency department

Abstract

Infectious diseases are among the most common conditions seen in pediatric emergency departments. Of these, in bacterial infections, appropriate antibiotic therapy should be started quickly. Specific antibiotic therapy is optimally driven by microbiologic diagnosis, predicated on isolation of the pathogenic organism, and supported by antimicrobial susceptibility testing. However, given the inherent difficulties that can arise in collecting specimens from pediatric patients, and given the high risk of mortality and disability associated with serious bacterial infections in very young infants, much of pediatric infectious disease practice is based on a clinical diagnosis with empirical use of antibacterial agents. Therefore, it is important to know the age-appropriate differential diagnosis with respect to likely pathogens. This information affects the choice of antimicrobial agent and also the dose, dosing interval, and route of administration. The patterns of antimicrobial resistance in the community and for the potential causative pathogen being empirically treated must also be considered. Antimicrobial resistance has reached crisis proportions, driven by the emergence of new resistance mechanisms and by overuse of antibiotics. It is important for practitioners to use antibiotics only as necessary, with the narrowest feasible antimicrobial spectrum, to help thwart emergence of resistance. Key Words: Bacterial Infections; Child; Anti-Bacterial Agents; Drug Resistance, Microbial; Emergency Service, Hospital