PRACTICAL CONSIDERATIONS WHEN TREATING CHILDREN WITH ANTIMICROBIALS IN THE OUTPATIENT SETTING

Over the past decade new antimicrobial agents have been introduced use d to treat common paediatric infectious diseases such as acute otitis media and sinusitis. These agents vary with respect to their mechanism of action, dosage and duration of therapy, cost, taste and type of ad verse effects. More recently, there has been concern about the overuse of antibiotics and increasing bacterial resistance, particularly Stre ptococcus pneumoniae, to these agents. Dosage and duration of therapy, cost, taste, and adverse effects play important roles in determining success or failure of antimicrobial medications in paediatric patients . Use of potential alternatives and adjuncts to antimicrobial treatmen t, such as vaccination, control of environmental risk factors, surgica l techniques and alternative medical therapies may also be employed, a nd the practitioner must ascertain if their paediatric patients are be ing treated by any of these methods. Rather than listing the therapeut ic challenges for all common outpatient paediatric infectious diseases , acute otitis media (accounting for over 50% of the antimicrobial pre scriptions dispensed in childhood) is used to illustrate each issue. C linicians are faced with a growing number of possible antimicrobial ch oices; concimitantly, there is increasing concern that these agents ar e overused. When prescribing antimicrobial agents, we need to be famil iar with what we can do to optimise the care we provide. By avoiding i nappropriate or trivial use of antimicrobials, we can preserve and eve n strengthen our armamentarium against disease. Simple strategies can improve compliance with therapeutic regimens and improve parental sati sfaction.