1Clinica Pediatrica, IRCCS “Burlo Garofolo”, Trieste
2Professore Emerito, Dipartimento di Scienze della Riproduzione e dello Sviluppo, Università di Trieste
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Key words: Respiratory tract infection, Antibiotic, Therapy, Amoxicillin
It is reasonable to delay the antibiotic treatment of a few days in all the apparently not serious cases of upper respiratory infection. “Risk” groups, in which antibiotics should be used to treat each fever, are: chronic pulmonary, kidney and heart diseases, immunodeficiency, cystic fibrosis, muscular diseases and prematurity. In case of a child with sore throat, if there are other concomitant signs of respiratory infection (nasal secretion, cough) it is certainly a viral disease. If pharyngitis is not accompanied by signs of infection to the upper respiratory tract, perform rapid strep test, it should come out positive in half of cases. Antibiotics are of little help in sinusitis. If the cough that accompanies fever is very severe and the outcome of auscultation is not significant, respiratory rate must be counted. If it is not higher than 45/m (under 2 years) it is not bronchopneumonitis, or at least, the latter is neither significant nor worrying. Waiting is still reasonable. The problem of antibiotic resistance for excessive use is real; it certainly concerns more macrolides than amoxicillin and it is proportional to the antibiotic pressure (which is very high in Italy). The problem of methicillin-resistant Staphylococcus pathology, though quantitatively limited, is growing and may have tragic outcomes. The “complete” resistance of Pneumococcus to amoxicillin is assessed at about 2-3%. An intermediate resistance (between 10% and 15%) can be easily overcome by using, when needed, higher doses of amoxicillin.
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