The
antibiotic management of infants and children with
pneumonia is based on the clinician's assessment of the most likely infecting pathogens, the susceptibilities of the infecting pathogens and the seriousness of the illness. The bacterial etiology of
pneumonia changed significantly following the universal use of
protein-conjugated
vaccines for Haemophilus influenzae type b. Similar significant changes are likely to occur with universal use of
protein-conjugated
vaccines for Streptococcus pneumoniae, requiring the clinician to alter assumptions of the risk of invasive
bacterial infection in the child who presents with
pneumonia. New strategies are likely to require fewer ancillary tests (e.g. white blood cell count,
C-reactive protein and blood culture) and suggest a decreased need for empiric
antibiotic therapy. Although the majority of lower
respiratory tract infections in children have a viral etiology and are not amenable to
antibiotic therapy, for the seriously ill child who is thought to be likely to have
pneumonia caused by a bacterial pathogen, recent changes in the susceptibility patterns of both common organisms such as S. pneumoniae and more unusual pulmonary pathogens such as Staphylococcus aureus have forced changes in the selection of both empiric and definitive
antibiotic therapy.
Third generation cephalosporins ceftriaxone and
cefotaxime appear to be effective
therapy for
pneumonia caused by virtually all current isolates of S. pneumoniae. In contrast
antibiotic regimens for life-threatening pulmonary
infections in which Staphylococcus aureus is a suspected pathogen should include
vancomycin.