摘要:

The antibiotic management of infants and children with pneumonia is based on the clinician’s assessment of the most likely infecting pathogens, the susceptibilities of the infecting pathogens and the seriousness of the illness. The bacterial etiology of pneumonia changed significantly following the universal use of protein-conjugated vaccines forHaemophilus influenzaetype b. Similar significant changes are likely to occur with universal use of protein-conjugated vaccines forStreptococcus pneumoniae, requiring the clinician to alter assumptions of the risk of invasive bacterial infection in the child who presents with pneumonia. New strategies are likely to require fewer ancillary tests (e.g. white blood cell count, C-reactive protein and blood culture) and suggest a decreased need for empiric antibiotic therapy.Although the majority of lower respiratory tract infections in children have a viral etiology and are not amenable to antibiotic therapy, for the seriously ill child who is thought to be likely to have pneumonia caused by a bacterial pathogen, recent changes in the susceptibility patterns of both common organisms such asS. pneumoniaeand more unusual pulmonary pathogens such asStaphylococcus aureushave forced changes in the selection of both empiric and definitive antibiotic therapy. Third generation cephalosporins ceftriaxone and cefotaxime appear to be effective therapy for pneumonia caused by virtually all current isolates ofS. pneumoniae. In contrast antibiotic regimens for life-threatening pulmonary infections in whichStaphylococcus aureusis a suspected pathogen should include vancomycin.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The last decade has witnessed a shift in the epidemiology of acute otitis media (AOM) with an earlier onset of disease and a greater proportion of children with recurrent episodes before 1 year of age. In addition antimicrobial resistance to beta-lactams, macrolides and trimethoprim-sulfamethoxazole among otopathogens has increased significantly. Most recently universal administration of a seven valent pneumococcal conjugate vaccine has been endorsed by the American Academy of Pediatrics and the Advisory Committee on Immunization Practices. Earlier onset of disease and the decrease in antimicrobial susceptibility among pediatric respiratory bacterial pathogens is likely to increase the risk of failure among young children with AOM. A seven valent pneumococcal conjugate vaccine (PCV7) has demonstrated efficacy for prevention of serotype-specific pneumococcal otitis; however, increase in disease caused by nonvaccine serotypes andHaemophilus influenzaehas been reported. With these events as the background, I have reviewed the strategies most likely to be successful for the treatment of AOM in 2002.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The focus of rapid diagnosis of infectious diseases of children in the last decade has shifted from variations of the conventional laboratory techniques of antigen detection, microscopy and culture to that of molecular diagnosis of infectious agents. Pediatricians will need to be able to interpret the use, limitations and results of molecular diagnostic techniques as they are increasingly integrated into routine clinical microbiology laboratory protocols. PCR is the best known and most successfully implemented diagnostic molecular technology to date. It can detect specific infectious agents and determine their virulence and antimicrobial genotypes with greater speed, sensitivity and specificity than conventional microbiology methods. Inherent technical limitations of PCR are present, although they are reduced in laboratories that follow suitable validation and quality control procedures. Variations of PCR together with advances in nucleic acid amplification technology have broadened its diagnostic capabilities in clinical infectious disease to now rival and even surpass traditional methods in some situations. Automation of all components of PCR is now possible. The completion of the genome sequencing projects for significant microbial pathogens, in combination with PCR and DNA chip technology, will revolutionize the diagnosis and management of infectious diseases.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID