RATIONAL PRESCRIBING OF ANTIBACTERIALS IN HOSPITALIZED CHILDREN

The subject of this review is the rational prescribing of antimicrobia l agents for the therapy of serious community-acquired infections in h ospitalised infants and children. First, cost-containment strategies s uch as streamlining of antibacterial therapy, outpatient parenteral an tibacterial therapy and sequential ('stepdown') therapy with parentera l followed by oral therapy are reviewed. In most of these areas, paedi atric studies are scant or lacking. Then specific paediatric aspects o f the choice of parenteral antibacterials such as penicillins, cephalo sporins, aminoglycosides, macrolides and other agents are discussed. W ith particular reference to cost containment, rational treatment strat egies for some serious bacterial infections such as meningitis, occult bacteraemia, endocarditis, osteomyelitis, arthritis, pyelonephritis, Lyme borreliosis (advanced stages) and pneumonia are proposed. In most of these disease, then is potential for cutting treatment costs and s tudies that compare these newer strategies with the traditional treatm ent regimens are urgently needed.