Acute Respiratory tract infection is the "source of all diseases" of infectious diseases in children
Acute respiratory infection (ARI) is a high incidence of infectious diseases in my country and is one of the complications of many diseases, which is prone to serious infections; children are generally weak in physical condition and are more susceptible to infections of various bacteria [1]. Acute respiratory infection accounts for more than 85% of pediatric outpatient cases [2].
Acute respiratory infection is divided into upper respiratory tract infection and lower respiratory tract infection , of which 70% are upper respiratory tract infections. However, lower respiratory tract infection is prone to cause serious diseases and clinical outcomes, and is the main cause of hospitalization and death in acute respiratory tract infection [3]. Among them, pneumonia is an infectious disease that seriously threatens children's health. According to the survey results of the World Health Organization (WHO), 155 million children suffer from pneumonia each year in the world, and more than two million children under the age of 5 die from pneumonia, accounting for about 29% of the total deaths of children in this age group, which is the main cause of death in children [5].
Acute respiratory infection is the "source of all diseases" of infectious diseases in children [6].
macrolide antibiotics - the initial first choice for lower respiratory tract infection treatment in children
Studies have shown that children with acute respiratory tract infection are mostly Mycoplasma pneumoniae, Chlamydia and viruses, and a few are bacterial infections [1]. According to WHO statistics, about 2/3 of the antibacterial drug prescriptions are used to treat respiratory infections. Among them, the most commonly used drugs include β- lactam , quinolones , macrolides, etc. [7]. The current situation of antibiotic use in children in my country is not optimistic, and the abuse of antibacterial drugs and the increase in multidrug-resistant pathogens have led to the increasing difficulty of treating acute respiratory infections in children [8].
's clear etiological diagnosis and targeted treatment are of great significance to guiding the treatment of respiratory infections, and also have a positive effect on reducing pathogen resistance and adverse drug reactions, and reducing medical costs [7].
Community-acquired pneumonia (CAP) is one of the most common respiratory infections. One study conducted a multi-pathogenic joint test on 4,856 children aged 2-day to 14 years old, and 1131 strains (23.29%) of pathogenic bacteria were isolated. Among them, the sum of the detection rates of Mycoplasma pneumoniae, Chlamydia pneumoniae and Streptococcus pneumoniae reached 24% [9].
macrolide antibiotics are a fast antibacterial drug that has strong antibacterial effects on Gram-positive bacteria and have good activity on some Gram-negative bacteria, Legionella, Mycoplasma and Chlamydia. Since the high rate of atypical pathogen infection in children and quinolones cannot be used in children, macrolide antibiotics are favored in the clinical treatment of pediatric respiratory infections [10].
・ Extracellular pathogens: Staphylococcus aureus, Pseudomonas aeruginosa and E. coli, etc.
・ Facultative intracellular pathogens: Streptococcus pneumoniae, Streptococcus group A, indigenous Haemophilus influenzae , etc.
・ Obligate intracellular pathogens: Legionella pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumoniae, Chlamydia trachoma, Chlamydia trachoma, Mycobacterium tuberculosis, etc.
Figure 1 Crarithromycin is effective against both intracellular and external pathogens, while β-lactams are ineffective against obligate intracellular pathogens
carat hero - clarithromycin treats respiratory infections in children and reduces bacterial resistance
There are reports in China that mycoplasma pneumonia isolates insensitive to macrolides, which should attract the attention of pediatricians 6[2]. Compared with the first-generation macrolide drug erythromycin, the second-generation macrolide drugs (clarithromycin, roxithromycin , azithromycin, etc.) are widely used in the treatment of bacterial infection [2] because of their advantages of lighter gastrointestinal reaction and easy use. But studies have shown that some macrolide drugs (such as azithromycin) have significantly higher selective resistance than other macrolide drugs.
A prospective, open and randomized study included 156 children with upper and lower respiratory tract infections aged 6 months to 16 years old. Among them, 60 cases were randomly assigned to receive clarithromycin (15mg/kg, taken in 2 times) for 7 days of treatment; or azithromycin (10mg/kg, qd) for 3 days of treatment.Throat swab bacteria were cultured every week after treatment (4 weeks in total) and at the 6th week after treatment, and compared the differences in the proportion of drug-resistant bacteria detected orally in children with respiratory infection after receiving different macrolide antibiotics. The study results show that the proportion of children who were detected to be resistant to macrolide antibiotics in the clarithromycin group was significantly lower than that in the azithromycin group; it shows that azithromycin can promote oral bacteria resistance in children with respiratory infections [11].
Similarly, a Canadian study on drug resistance rates of more than 3,300 patients with Streptococcus pneumoniae infection between 1995 and 2002 showed that areas with higher azithromycin usage had higher resistance rates to macrolides, while in areas with lower azithromycin usage rates, macrolides resistance rates were also correspondingly lower [12].
study pointed out that azithromycin is widely used in pediatric clinical work to treat upper respiratory tract infections and acute bronchitis caused by viruses or nonspecific, which may be one of the reasons for the increase in the rate of macrolide resistance [2].
clarithromycin and azithromycin have different high resistance. There are differences in pharmacokinetic characteristics, half-life and bioavailability. As shown in the table below: azithromycin has a longer half-life and is prone to drug resistance; and clarithromycin has good tissue distribution and high bioavailability. The concentrations of lung, bronchial, liver, kidney and spleen are all higher than those of blood drug concentrations, and are ingested by granulocytes and macrophages. The intracellular concentration is high, and the tissue and plasma concentrations after medication are much higher than those of azithromycin.
Table 1 Clarimycin VS. Azithromycin
Domestic and foreign guidelines recommend macrolide antibiotics such as clarithromycin, which are the first choice for the treatment of lower respiratory tract diseases. Among them, the clarithromycin dry suspension has a wide antibacterial spectrum and can cover common pathogens in respiratory tract infections; the colorful fruity flavor of clarithromycin dry suspension is more suitable for children.
Table 2 Domestic and foreign guidelines recommend macrolide antibiotics for the treatment of lower respiratory tract diseases
Table 3 Clarithromycin dry suspension has a wide antibacterial spectrum and can cover common pathogens in respiratory tract infections [18]
Conclusion
Pediatric antibiotic treatment In the treatment of antibiotics for respiratory tract infections, bacterial resistance has brought great challenges to the clinical diagnosis [19]. Macrolide antibiotics are common drugs for the treatment of respiratory infections. Overuse of certain macrolides is closely related to the epidemic of bacterial drug resistance. Therefore, while improving the health knowledge level of the whole people and using different levels such as governments, academic groups, hospitals, infection management, etc. to strengthen scientific guidance, publicity, supervision, management and education, it is imperative to advocate the rational use of macrolide antibiotics [2].
References:
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