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Respiratory tract infections in children: prevention is better than cure

It appears that acute respiratory infections are responsible for the largest number of antibiotic prescriptions. Children are even more likely than adults to receive antibiotic prescription. It has been estimated that about three-quarters of all outpatient antibacterial prescriptions are for RTIs (1).

Antibiotic overuse is an important concern today, causing a significant increase in side-effects. By increasing colonisation with antimicrobial resistant organisms, it rises the risk that any subsequent infection will be unresponsive to standard antibiotic regimens.  Antimicrobial resistance has become a major public health concern worldwide, leading to mounting healthcare costs, patient treatment failure, and deaths. the European Centre for Disease Prevention and Control (ECDC) estimated in 2009 that infections caused by a subset of resistant bacteria are responsible for about 25 000 deaths in Europe annually.

Children are more likely than adults to become infected with resistant pathogens. For example, in the case of S. pneumoniae, the risk factors for infection with resistant strains include: age under 12 years (particularly under 2 years), daycare attendance (child or family member) and recent treatment with certain antibacterials (2).  Resistance rates vary across geographic areas (3).

Legend: Percentage (%) of Streptococcus pneumoniae invasive isolates non-susceptible to macrolides, by country,EU/EEA countries, 2015 (European Centre of Disease Prevention and Control, 2017).

In order to favour a reasoned usage of antibiotics worldwide, several approaches are promoted:

  • Insist on the importance among clinicians to properly diagnose bacterial vs. viral infection to avoid unnecessary antibiotic prescriptions.
  • Educate the public, and in particular parents about the appropriate use of antibiotics
  • Implement preventive measures; vaccination, immunostimulants…

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References

  1. Cunha B.A. Therapeutic Implications of Antibacterial Resistance in Community-Acquired Respiratory Tract Infections in Children. Infection 2004; 32: 98–108
  2. Sherman J. Alter, MD, Navjyot K. Vidwan, MD, Patrick O. Sobande, MD, Abiodun Omoloja, MD, and Jeffrey S. Bennett. Common Childhood Bacterial Infections. Curr Probl Pediatr Adolesc Health Care 2011;41:256-283
  3. European Centre of Disease Prevention and Control, 2017- Antimicrobial resistance surveillance in Europe 2015 (garder lien html: https://ecdc.europa.eu/en/publications-data/antimicrobial-resistance-surveillance-europe-2015)