So in terms of our therapy,
observation isn’t necessarily bad
in a child who’s not that sick
because 80% of the patients resolve in two
to seven days without any antibiotics.
Now, 90% of them resolve with antibiotics,
so there is a salutary
effect of antibiotics.
But there’s certainly no harm in deferring
antibiotics for 48 to 72 hours,
especially in a patient
that you’re not sure,
you think they may have
just a viral illness.
However, those patients obviously
should be able to be followed closely.
You don’t want to overlook a
child who’s deteriorating
or a child that might develop
meningitis, for example.
And then there’s pain control
and you can certainly give things
like acetaminophen to children.
I would generally stay away from
ibuprofen, except in maybe adults.
And you obviously have to avoid aspirin
because of the possibility in
children of Reye’s syndrome.
So let’s look at what you would choose.
Empirically, you’ve got to pick an agent that
has activity against the three big bugs--
Streptococcus pneumoniae, Haemophilus
influenzae, and Moraxella catarrhalis.
And so, you’re ordinarily going
to treat those without a culture.
So what you’re going to be choosing
for mild to moderate illness
would be amoxicillin alone.
In patients who received bata-lactam in the last 30 days
or on those with concomitant conjunctivitis,
I would use the combination
and that will pick up some of the
organisms that make beta-lactamase.
If the patient is truly
it’s an oral cephalosporin,
one of those would
be the best choice.
Now, in a seriously ill patient
where you actually have cultures,
then you can design and tailor
your therapy accordingly.
How long you treat?
I like to say to my
students the answer is yes.
We’re not sure exactly
how long to treat.
If they’re less than two years
of age, we say the magic 10 days.
If they’re two to five years
of age, five to seven days.
But I can tell you this, that in many
studies of many infectious diseases,
we are finding that fewer days of
antibiotic therapy is sufficient,
and especially when you think
about all the resistant
microorganisms that are
developing in our world.
Shorter duration therapy certainly
seems to be prudent if it’s possible.