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Do We Know When, What and For How Long to Treat?: Antibiotic Therapy for Pediatric Community-acquired Pneumonia

Esposito, Susanna MD*; Cohen, Robert MD; Domingo, Javier Diez MD; Pecurariu, Oana Falup MD§; Greenberg, David MD; Heininger, Ulrich MD; Knuf, Markus MD**††; Lutsar, Irja MD‡‡; Principi, Nicola MD*; Rodrigues, Fernanda MD§§; Sharland, Mike MD¶¶; Spoulou, Vana MD║║; Syrogiannopoulos, George A. MD***; Usonis, Vytautas MD†††; Vergison, Anne PhD‡‡‡; Schaad, Urs B. MD

The Pediatric Infectious Disease Journal: June 2012 - Volume 31 - Issue 6 - p e78–e85
doi: 10.1097/INF.0b013e318255dc5b
Antimicrobials in Perspective

Community-acquired pneumonia (CAP) is a common cause of morbidity among children in developed countries and accounts for an incidence of 10–40 cases per 1000 children in the first 5 years of life. Given the clinical, social and economic importance of CAP, there is general agreement that prompt and adequate therapy is essential to reduce the impact of the disease. The aim of this discussion paper is to consider critically the available data concerning the treatment of uncomplicated pediatric CAP and to consider when, how and for how long it should be treated. This review has identified the various reasons that make it difficult to establish a rational approach to the treatment of pediatric CAP, including the definition of CAP, the absence of a pediatric CAP severity score, the difficulty of identifying the etiology, limited pharmacokinetic (PK)/pharmacodynamic (PD) studies, the high resistance of the most frequent respiratory pathogens to the most widely used anti-infectious agents and the lack of information concerning the changes in CAP epidemiology following the introduction of new vaccines against respiratory pathogens. More research is clearly required in various areas, such as the etiology of CAP and the reasons for its complications, the better definition of first- and second-line antibiotic therapies (including the doses and duration of parenteral and oral antibiotic treatment), the role of antiviral treatment and on how to follow-up patients with CAP. Finally, further efforts are needed to increase vaccination coverage against respiratory pathogens and to conduct prospective studies of their impact.

From the *Department of Maternal and Pediatric Sciences, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; Centre Hospitalier Intercommunal de Créteil, Créteil, France; Centro Superior de Investigación en Salud Pública (CSISP), Valencia, Spain; §University Children’s Hospital, Faculty of Medicine, Transilvania University, Brasov, Romania; The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel; the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Pediatrics, University of Basel, Basel, Switzerland; **Department of Pediatrics, University Medicine Hospital, Johannes Gutenberg-University, Mainz, Germany; ††Dr. Horst Schmidt Clinic, Children’s Hospital, Wiesbaden, Germany; ‡‡Institute of Microbiology, University of Tartu, Tartu, Estonia; §§Infectious Diseases Unit & Emergency Service, Hospital Pediátrico de Coimbra, Coimbra, Portugal; ¶¶Pediatric Infectious Disease Unit, St George’s Medical Center, London, UK; ║║1st Department of Paediatrics, Agia Sophia Children’s Hospital, Athens, Greece; ***Department of Pediatrics, General University Hospital of Larissa, Larissa, Greece; †††Clinic of Children’s Diseases, Vilnius University, Vilnius, Lithuania; ‡‡‡Paediatric Infectious Diseases Unit, Infection Control and Epidemiology Unit, Hôpital Universitaire des Enfants Reine Fabiola,Université Libre de Bruxelles, Brussels, Belgium.

Accepted for publication March 15, 2012.

The authors have no conflicts of interest or funding to disclose.

Address for correspondence: Susanna Esposito, MD, Department of Maternal and Pediatric Sciences, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122 Milano, Italy. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.