Usage of Antibiotics in Pediatric Practice

Antibiotics are very potent weapon to kill a variety of bacteria, but should be used judiciously to avoid life threatening complications. Attempts to treat symptoms of infections without identifying the bacteria or site of infection could be very harmful in infants and children. Selection of antibiotic and its optimal use is the key to effective treatment. There is a need to understand the pharmacologic principals to select an antimicrobial agent and to avoid allergic reactions and toxicity in the patient being treated. The penetration and diffusion of antibiotics in various tissues and spaces should be taken into account while deciding the dose and mode of administration of an antibiotic. All antibiotics cannot treat pyogenic meningitis and purulent exudates. Antibiotics could be classified into three groups for treatment of infectious agents in infants and children:-

1. Penicillins: Ampicillin, amoxicillin, penicillinase, penicillin G &V.
   
2. Alternative of penicillin for patients allergic to penicillin: Cotrimoxazole, erythromycin, tetracyclines, lincomycin etc.
   
3. Antibiotics effective against Gram-negative bacteria: Gentamycin, kanamycin, tobramycin, amikacin etc.
   

Situations where antibiotics should be avoided:

1. Viral infections: Usually viral infections are self limiting and the patient may recover within a week's time. Use of antibiotics for the treatment of chickenpox, measles, mumps and viral URI (upper respiratory infection). However, antibiotics may be helpful in controlling/preventing secondary bacterial infections during viral infections.
   
2. Treatment of pyogenic exudates without surgical drainage: Extensive use of antibiotics to treat purulent exudates without surgical drainage should be avoided since the infection will not come under control without drainage.
   
3. Improper dosage: Both the suboptimal and large doses of antibiotics are harmful and should be avoided.
   
4. Prophylactic use of antibiotics: Antibiotics should be used to treat established disease only and not as prophylactic therapy to prevent infection in patients/children at high risk. However, chemoprophylaxis is helpful in preventing the spread of singe microorganism with single drug but to use multiple antibiotics for prophylaxis could be hazardous.