RATIONAL SELECTION OF ANTIMICROBIALS FOR PEDIATRIC UPPER RESPIRATORY-INFECTIONS

Antibiotic selection is complicated by both emerging resistance to traditional antimicrobials in common community acquired pathogens and increasing numbers of high potency or extended spectrum antimicrobials. This overview outlines a multistep process for antibiotic choice based on antimicrobial activity and patient acceptance. Understanding the infection (the natural history and most likely pathogens) is necessary for choosing a specific antimicrobial. Choices should be based on knowledge of local trends in and mechanisms of antimicrobial resistance. Candidate drugs should also exceed (at the site of infection) the minimum inhibitory concentration for 90% of strains of each most likely pathogen, Ideally the narrowest spectrum drug satisfying this pharmacodynamic requirement is used. However, inadequate compliance dooms even the most potent antibiotic. Therefore infrequent dosing, palatable taste or form, minimal side effects or lower cost may dictate choosing lower potency or narrower spectrum drugs to gain patient acceptance and thereby reasonable compliance.