Primer Outlines Treatment Recommendations for Infections in Pediatric Patients

Hospital pharmacists play a key role in ensuring the proper use of antibiotics for treating common bacterial infections in pediatric patients.

A review article published in the American Journal of Health-System Pharmacy examined common bacterial infections in hospitalized children, including bacterial meningitis, urinary tract infections, neonatal sepsis, community-acquired pneumonia, bone and joint infections and cellulitis and offered guidance on recommended treatment.

The article is co-authored by Nicholas M. Fusco, PharmD, a clinical associate professor at the University at Buffalo School of Pharmacy and Pharmaceutical Sciences, and Kristen Nichols, PharmD, at Butler University College of Pharmacy and Health Sciences, and serves as a primer for antibiotic selection, dosing and monitoring. Pharmacists can improve care particularly in facilities where pediatric patients are not regularly treated, the article notes.

“We commented on preferred antibiotic regimens and recommended durations of treatment which should assist those, particularly pharmacists, in using antibiotics most appropriately in children,” Fusco told Contagion^®.

While treatment is similar to that of adults, the article points out differences in such factors as symptoms, pathogens and adverse effects that should be considered. It notes warnings and contraindications for specific antibiotics based on pediatric age group. It also addresses dosing forms, such as liquid formulations.

“Antibiotics are the class of drugs that children are exposed to the most,” Fusco told Contagion^®. “Viral etiologies are still the major cause of infection in young children (<2 years of age) and still play a role in older children; however, differentiating viral versus bacterial etiologies can be challenging. This may lead to over use of antibiotics, when they are not always indicated. When they are indicated, it’s important to use them at effective doses for the shortest duration. Much data has been generated regarding shorter (vs. longer) durations of treatment and clinical outcomes in adults, but in general data are lacking in children. While we shouldn’t always extrapolate data from adult populations, intuitively it would make sense that we would see comparable outcomes in similar infections (e.g. urinary tract infections) in children. Future research should look to address this question. Hopefully, these data would support shorter durations of antibiotics which would save on costs, minimize adverse effects and reduce the risk of medication non-adherence (with long durations of treatment). Urinary tract infections seem to be an area of need - but there may be hope on the horizon.”

He pointed a noninferior clinical trial, expected to be completed in June, that is evaluating a short course of antimicrobial therapy for urinary tract infection in children compared with the standard course.

Recent studies in adults have supported shorter courses of antibiotics. One recent study in adult men found that those who received longer durations of antibiotic treatment for urinary tract infections were more likely to experience a recurrence within 1 year compared with those who received shorter treatment.

Similarly, another study found that inappropriate treatment for asymptomatic bacteriuria was associated with longer hospital stays.

Treatment courses for uncomplicated gram-negative bloodstream infections also have been the focus of research, with short-course (7 days) therapy found to be noninferior to long-course (14 days) therapy.