Abstract
Streptococcus pneumoniae, Haemophilus influenzae, Moraxella (Branhamella) catarrhalis, Staphylococcus aureus, and Streptococcus pyogenes resistant to multiple antimicrobials cause upper and lower respiratory infections in children. Amoxicillin and trimethoprim-sulfamethoxazole remain useful first line antibiotics, however, they are increasingly ineffective for patients with otitis media, sinusitis, and lower respiratory infections. Newer, extended-spectrum antimicrobials that may be advantageous in selected patients include amoxicillin/clavulanate, cephalosporins (cefprozil, cefuroxime axetil, loracarbef, cefixime, cefpodoxime proxetil, and ceftibuten), and the extended-spectrum macrolides (clarithromycin and azithromycin). These newer antibiotics are differentiated from each other by their activity against penicillin-resistant pneumococci, relative β-lactamase stability, and pharmacokinetic properties. Monitoring local patterns of bacterial susceptibility among respiratory isolates is important in tracking the problem of resistant pathogens. Use of the newer, extended-spectrum antibiotics should take into account their differing spectrum of activity, adverse events profile, cost, and the risks of escalating the pressure on selecting new more resistant bacterial strains.
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