RATIONAL PRESCRIBING OF ANTIBACTERIALS IN AMBULATORY CHILDREN

The rational prescribing of oral antimicrobial agents for bacterial in fections in children who can be treated in an ambulatory setting is th e subject of this review. First, restrictive use of antibacterials is advocated to avoid widespread development of bacterial resistance. The use of simple methods, suitable for office use, to discern viral from bacterial infections is recommended. Second, in selecting an antimicr obial agent, the physician should consider a number of distinctive fea tures of each agent. Besides aspects of pharmacokinetics, antibacteria l spectrum and tolerability, the number of daily doses and, of particu lar importance for children, the palatability of suspensions play an i mportant role in achieving patient compliance. Agents that can be admi nistered once or twice daily and possess an agreeable taste in additio n to proven efficacy, established tolerability and a reasonable price are to be preferred. Specific paediatric aspects in choosing among pen icillins, cephalosporins, macrolides and other oral antibacterials are discussed. For pharmacoeconomic reasons, the optimal duration of anti bacterial treatment and the role of short course therapy for various b acterial infections should be studied in more detail. Finally, rationa l antimicrobial treatment of common paediatric bacterial infections su ch as streptococcal tonsillopharyngitis, acute otitis media, acute sin usitis, bacterial pneumonia, pertussis, Lyme borreliosis (early stage) and lower urinary tract infection is reviewed.