Journal
CURRENT THERAPEUTIC RESEARCH-CLINICAL AND EXPERIMENTAL
Volume 84, Issue -, Pages E7-E11Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.curtheres.2017.01.002
Keywords
antibiotics; chest infection; community-acquired pneumonia; empirical; lower respiratory tract infection; management
Funding
- Wellcome Trust [109031/Z/15/Z]
- Wellcome Trust [109031/Z/15/Z] Funding Source: Wellcome Trust
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Background: Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality globally, responsible for more than 14% of deaths in children younger than 5 years of age. Due to difficulties with pathogen identification and diagnostics of CAP in children, targeted antimicrobial therapy is not possible, hence the widespread use of empirical antibiotics, in particular penicillins, cephalosporin, and macrolides. Objectives: This review aimed to address medical, societal, and political issues associated with the widespread use of empirical antibiotics for CAP in the United Kingdom, India, and Nigeria. Methods: A literature review was performed identifying the challenges pertaining to the use of widespread empirical antibiotics for CAP in children. A qualitative analysis of included studies identified relevant themes. Empirical guidance was based on guidelines from the World Health Organization, British Thoracic Society, and Infectious Diseases Society of America, used in both industrialized and resource-poor settings. Results: In the United Kingdom there was poor adherence to antibiotics guidelines. There was developing antibiotic resistance to penicillins and macrolides in both developing and industrialized regions. There were difficulties accessing the care and treatment when needed in Nigeria. Prevention strategies with vaccination against Streptococcus pneumonia, Haemophilus influenza, and measles are particularly important in these regions. Conclusions: Effective and timely treatment is required for CAP and empirical antibiotics are evidence-based and appropriate in most settings. However, better diagnostics and education to target treatment may help to prevent antibiotic resistance. Ensuring the secure financing of clean food and water, sanitation, and public health infrastructure are also required to reduce the burden of disease in children in developing countries. (C) 2017. The Authors. Published by Elsevier Inc.
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