- Limitations in applicability of this article to the patient population
in question: Pakistan vs. US, pneumonia defined as cough & RR >40,
duration of treatment only 3 days, heptavalent pneumococcal vaccine
is not standard of care, therapy success was defined as "clinical
resolution," "improved," or "same."
- When no or few clinical guidelines exist, we must look to consensus
opinion and professional organizations (e.g. AAP) for treatment recommendations.
- Current recommendations for the treatment of S. pneumo and
CAP are heavily based on AOM research and currently published guidelines
for treatment of AOM.2,3
- Is it reasonable to treat these two infections the same? Are they
caused by the same strains of S. pneumo? Is the concentration
of amoxicillin achieved in the lung comparable to (or higher) than that
achieved in middle ear fluid?
- Other factors complicating treatment decisions: 1) antibiotic MICs
are a gradually, but constantly moving, target 2) children will often
have co-infections 3) does in vitro resistance translate to
in vivo resistance?
- Bottom line: Consensus opinion favors treatment of CAP in children
4 mos to 4 yrs with high-dose amoxicillin secondary to increasing S.
pneumo resistance rates, as well as amoxicillin's favorable side
effect, cost, and bioavailability profile.3,4
T, Qazi SA, Bin Nisar Y, Maqbool S, Asghar R, Iqbal I, et al. Comparison
of standard versus double dose of amoxicillin in the treatment of non-severe
pneumonia in children aged 2-59 months: a multi-centre, double blind,
randomised controlled trial in Pakistan. Arch Dis Child, 2007;92:291-7.
Academy of Pediatrics and American Academy of Family Physicians, Subcommittee
on Management of Acute Otits Media. Diagnosis and Management of Acute
Otitis Media. Pediatrics. 2004; 113:1451-65.
Academy of Pediatrics, Committee on Infectious Diseases. Therapy for
Children with Invasive Pneumococcal Infections. Pediatrics.
K. Community Acquired Pneumonia in Children. N Engl J Med.
DE, Pichichero ME, Schaad UB. Optimizing Antibacterial Therapy for Community
Acquired Respiratory Tract Infections in Children in an Era of Bacterial
Resistance. Clinical Pediatrics. 2004;43:135-51.
SI, Hammerschlag MR. Overcoming Current Obstacles in the Management
of Bacterial Community-Acquired Pneumonia in Ambulatory Children. Clinical