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

RTI in childrens 10:45-10:55 Respiratory tract infections in children (ambulatory and hospital-treated) N. Denecker (Brussels - Pharmacy Inspectorate)

RESPIRATORY TRACT RESPIRATORY TRACT INFECTIONS IN CHILDREN INFECTIONS IN CHILDREN Nathalie Denecker Nathalie Denecker

UPPER RESPIRATORY TRACT INFECTIONS UPPER RESPIRATORY TRACT INFECTIONS Tonsillitis/pharyngitis pharyngitis Tonsillitis/ ✓ Viruses • Etiology : (Rhinovirus, RSV….) ✓ Bacteria ß-haemolytic Streptococcus group A (S. Pyogenes) (15-30%) ✓ “Others” (Mycoplasma, Arcanobacterium haemolyticum) • Treatment : - PENICILLIN (if necessary) - (Amoxicillin/cephalosporins) - Macrolides? Macrolides? Only Only in case of Pen in case of Pen allergy allergy

Acute Otitis Otitis Media Media Acute ✓ Viruses • Etiology : (Rhinovirus, RSV…./CMV, HSV) S. Pneumoniae (30-50%) ✓ Bacteria H. Influenzae (nontypable) (20-30%) M. Catarrhalis (1-5%) Group A Streptococcus S.Aureus; Gram-Negative Bacteria Anaerobes ✓ “Others” (Mycoplasma P., Chlamydia T., Mycobact. T.) • Treatment : - AMOXICILLIN (if necessary) (+clavulanate) - Cephalosporins (2 nd (or 3 rd ) generation) Macrolides?? Only Only in case of proven in case of proven susceptibility susceptibility - Macrolides?? of M.O. in cultured middle ear cultured middle ear fluid fluid of M.O. in

Sinusitis Sinusitis • Etiology : ✓ Viruses (Rhinovirus….) S. Pneumoniae ✓ Bacteria H. Influenzae (nontypable) M. Catarrhalis Group A Streptococcus S. Aureus Anaerobes • Treatment : - AMOXICILLIN (if necessary) (+clavulanate) - Cephalosporins (2 nd generation) Macrolides?? - Macrolides??

LOWER RESPIRATORY TRACT INFECTIONS LOWER RESPIRATORY TRACT INFECTIONS Tracheobronchitis Tracheobronchitis ✓ Viruses (RSV, (para) influenzae, adeno..) • Etiology : S. Pneumoniae ✓ Bacteria H. Influenzae (nontyp.) Recurrent inf. M. Catarrhalis (2 ary ) S. Aureus • Treatment : - [Amoxicillin (+clavulanate)] (if necessary) Macrolides?? - Macrolides??

Pneumonia Pneumonia • Etiology : Ne eo on na at te es s / / i in nf fa an nt ts s N (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 : Ne eo on na at te es s / / i in nf fa an nt ts s In nf fa an nt ts s / / C Ch hi il ld dr re en n N I (0 0- -3 3m m) ) (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 S. Aureus (2 ary influenza ) H. Influenzae (nontyp.) Chlamydia Trachomatis Bordetella Pertussis (Mycoplasma Pneumoniae)

Pneumonia Pneumonia • Etiology : Ne eo on na at te es s / / i in nf fa an nt ts s In nf fa an nt ts s / / C Ch hi il ld dr re en n Ch hi il ld dr re en n N I C (0 0- -3 3m m) ) (3 3m m- -5 5y y) ) (5 5y y- -1 14 4y y) ) ( ( ( Viruses (RSV…) Viruses (RSV, influenzae, (Viruses) adeno…) Bacteria Bacteria Bacteria Group B Streptococci S. Pneumoniae S. Pneumoniae E. Coli H. Influenzae (nontyp.) (H. Influenzae (nontyp.)) S. Pneumoniae M. Catarrhalis (M. Catarrhalis) S. Aureus (2 ary influenza ) H. Influenzae (nontyp.) (S. Aureus) Chlamydia Trachomatis (Mycoplasma Pneumoniae) Mycoplasma P. Bordetella Pertussis Chlamydia P. (>10y)

Pneumonia Pneumonia • Treatment : Ne N eo on na at te es s / /i in nf fa an nt ts s - Ampicillin (+ Cephalosporins (3 rd gen.)) (0 ( 0- -3 3m m) ) - Amoxicillin + clavulanate Macrolides? First choice for for Chlamydia T. Chlamydia T. - Macrolides? First choice - & Bordetella Pertussis Bordetella Pertussis & Ch C hi il ld dr re en n - Amoxicillin ( + clavulanate) (3 ( 3m m- -5 5y y) ) - Cephalosporins (2 nd (or 3 rd ) generation) Ch C hi il ld dr re en n - Amoxicillin (5 ( 5y y- -1 14 4y y) ) Macrolides? First choice for Mycoplasma for Mycoplasma P. P. - Macrolides? First choice - & Chlamydia P. & Chlamydia P.

Conclusions on the the use use of of macrolides macrolides Conclusions on in RTI in children children in RTI in Upper RTI Tonsillitis Only in case of Pen in case of Pen allergy allergy Only Acute otitis media Only in case of proven in case of proven susceptibility susceptibility of of Only M.O. in cultured middle ear cultured middle ear fluid fluid M.O. in Sinusitis ?? ?? Lower RTI Tracheobronchitis ?? ?? Pneumonia First choice for for Chlamydia T. & Chlamydia T. & First choice Bordetella Pertussis Bordetella Pertussis First choice for Mycoplasma for Mycoplasma P. & P. & First choice Chlamydia P. Chlamydia P.