RTI in childrens 10:45-10:55 Respiratory tract infections in - - PowerPoint PPT Presentation

• N. Denecker (Brussels - Pharmacy Inspectorate)

RTI in childrens

10:45-10:55 Respiratory tract infections in children (ambulatory and hospital-treated)

RESPIRATORY TRACT RESPIRATORY TRACT INFECTIONS IN CHILDREN INFECTIONS IN CHILDREN

Nathalie Denecker Nathalie Denecker

Tonsillitis/ Tonsillitis/pharyngitis pharyngitis

• Etiology :
• Treatment :

✓ Viruses ✓ Bacteria ✓ “Others”

(Rhinovirus, RSV….) ß-haemolytic Streptococcus group A (S. Pyogenes) (15-30%) (Mycoplasma, Arcanobacterium haemolyticum)

• PENICILLIN (if necessary)
• (Amoxicillin/cephalosporins)
• Macrolides?

Macrolides? Only Only in case of Pen in case of Pen allergy allergy

UPPER RESPIRATORY TRACT INFECTIONS UPPER RESPIRATORY TRACT INFECTIONS

Acute Acute Otitis Otitis Media Media

• Etiology :
• Treatment :

✓ Viruses ✓ Bacteria ✓ “Others”

(Rhinovirus, RSV…./CMV, HSV) (Mycoplasma P., Chlamydia T., Mycobact. T.)

• AMOXICILLIN (if necessary)
• Cephalosporins (2nd (or 3rd) generation)
• Macrolides??

Macrolides?? Only Only in case of proven in case of proven susceptibility susceptibility

• f M.O. in
• f M.O. in cultured middle ear

cultured middle ear fluid fluid

• S. Pneumoniae (30-50%)
• H. Influenzae (nontypable) (20-30%)
• M. Catarrhalis (1-5%)

Group A Streptococcus S.Aureus; Gram-Negative Bacteria Anaerobes

(+clavulanate)

Sinusitis Sinusitis

• Etiology : ✓ Viruses (Rhinovirus….)
• Treatment : - AMOXICILLIN (if necessary) (+clavulanate)
• Cephalosporins (2nd generation)
• Macrolides??

Macrolides??

✓ Bacteria

Group A Streptococcus

• S. Aureus

Anaerobes

• S. Pneumoniae
• H. Influenzae (nontypable)
• M. Catarrhalis

Tracheobronchitis Tracheobronchitis

• Etiology :
• Treatment :

✓ Viruses (RSV, (para) influenzae, adeno..) ✓ Bacteria

(2 ary)

• [Amoxicillin (+clavulanate)] (if necessary)
• Macrolides??

Macrolides??

LOWER RESPIRATORY TRACT INFECTIONS LOWER RESPIRATORY TRACT INFECTIONS

• S. Aureus
• S. Pneumoniae
• H. Influenzae (nontyp.)
• M. Catarrhalis

Recurrent inf.

Pneumonia Pneumonia

• Etiology :

N Ne eo

• n

na at te es s / / i in nf fa an nt ts s ( (0 0-

• 3

3m m) ) Viruses (RSV…) Bacteria

Group B Streptococci

• E. Coli
• S. Pneumoniae
• H. Influenzae (nontyp.)

Chlamydia Trachomatis Bordetella Pertussis

Pneumonia Pneumonia

• Etiology :

N Ne eo

• n

na at te es s / / i in nf fa an nt ts s ( (0 0-

• 3

3m m) ) I In nf fa an nt ts s / / C Ch hi il ld dr re en n ( (3 3m m-

• 5

5y y) ) Viruses (RSV…) Viruses (RSV, influenzae,

adeno…)

Bacteria Bacteria

Group B Streptococci

• S. Pneumoniae
• E. Coli
• H. Influenzae (nontyp.)
• S. Pneumoniae
• M. Catarrhalis
• H. Influenzae (nontyp.)
• S. Aureus (2ary influenza)

Chlamydia Trachomatis Bordetella Pertussis (Mycoplasma Pneumoniae)

Pneumonia Pneumonia

• Etiology :

N Ne eo

• n

na at te es s / / i in nf fa an nt ts s ( (0 0-

• 3

3m m) ) I In nf fa an nt ts s / / C Ch hi il ld dr re en n ( (3 3m m-

• 5

5y y) ) C Ch hi il ld dr re en n ( (5 5y y-

• 1

14 4y y) ) Viruses (RSV…) Viruses (RSV, influenzae,

adeno…)

(Viruses) Bacteria Bacteria Bacteria

Group B Streptococci

• S. Pneumoniae
• S. Pneumoniae
• E. Coli
• H. Influenzae (nontyp.)

(H. Influenzae (nontyp.))

• S. Pneumoniae
• M. Catarrhalis

(M. Catarrhalis)

• H. Influenzae (nontyp.)
• S. Aureus (2ary influenza)

(S. Aureus) Chlamydia Trachomatis Bordetella Pertussis (Mycoplasma Pneumoniae) Mycoplasma P.

Chlamydia P. (>10y)

Pneumonia Pneumonia

• Treatment :
• Amoxicillin + clavulanate
• Ampicillin (+ Cephalosporins (3rd gen.))
• Macrolides?

Macrolides? First choice First choice for for Chlamydia T. Chlamydia T. & & Bordetella Pertussis Bordetella Pertussis C Ch hi il ld dr re en n ( (3 3m m-

• 5

5y y) ) N Ne eo

• n

na at te es s / /i in nf fa an nt ts s ( (0 0-

• 3

3m m) )

• Amoxicillin ( + clavulanate)
• Cephalosporins (2nd (or 3rd) generation)

C Ch hi il ld dr re en n ( (5 5y y-

• 1

14 4y y) )

• Amoxicillin
• Macrolides?

Macrolides? First choice First choice for Mycoplasma for Mycoplasma P. P. & Chlamydia P. & Chlamydia P.

Conclusions on Conclusions on the the use use of

• f macrolides

macrolides in RTI in in RTI in children children

Upper RTI Only Only in case of Pen in case of Pen allergy allergy Tonsillitis Acute otitis media Sinusitis Only Only in case of proven in case of proven susceptibility susceptibility of

• f

M.O. in M.O. in cultured middle ear cultured middle ear fluid fluid ?? ?? Lower RTI First choice First choice for for Chlamydia T. & Chlamydia T. & Bordetella Pertussis Bordetella Pertussis First choice First choice for Mycoplasma for Mycoplasma P. &

• P. &

Chlamydia P. Chlamydia P. Tracheobronchitis Pneumonia ?? ??