Treatment
ÎEmpiric therapy with a third generation parenteral cephalosporin (ceftriaxone/cefotaxime) should be prescribed for hospitalized infants and children who are not fully immunized, or in regions where local epidemiology of invasive pneumococcal strains documents high-level penicillin resistance, or for infants and children with life-threatening infection, including those with empyema (Table 6). (WR-M)
Note: Non–β-lactam agents such as vancomycin have not been shown to be more effective than third generation cephalosporins in the treatment of pneumococcal pneumonia for the degree of resistance noted currently in North America.
ÎEmpiric combination therapy with a macrolide (oral or parenteral)
in addition to a β-lactam antibiotic should be prescribed for the hospitalized child for whom M. pneumoniae and C. pneumoniae are significant considerations. (WR-M)
ÎVancomycin or clindamycin (based on local susceptibility data)
should be provided in addition to β-lactam therapy if clinical, laboratory, or imaging characteristics are consistent with infection caused by S. aureus (Table 6). (SR-L)
Minimizing Resistance
ÎAntibiotic exposure selects for antibiotic resistance. Therefore limiting exposure to any antibiotic, whenever possible, is preferred. (SR-M)
ÎLimiting the spectrum of activity of antimicrobials to that specifically required to treat the identified pathogen is preferred. (SR-L)
ÎUsing the proper dosage of antimicrobial to be able to achieve a minimal effective concentration at the site of infection is important to decrease the development of resistance. (SR-L)
ÎTreatment for the shortest effective duration will minimize exposure of both pathogens and normal microbiota to antimicrobials, and minimize the selection for resistance. (SR-L)
Duration of Antimicrobial Therapy
ÎTreatment courses of 10 days have been best studied, although shorter courses may be just as effective, particularly for more mild disease managed on an outpatient basis. (SR-M)
ÎInfections caused by certain pathogens, notably CA-MRSA, may require longer treatment than those caused by S. pneumoniae. (SR-M)
Follow-up
ÎChildren on adequate therapy should demonstrate clinical and laboratory signs of improvement within 48-72 hours. (SR-M)
Note: For children who deteriorate following admission and initiation of antimicrobial therapy, or show no improvement within 48-72 hours, further investigation should be performed.
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