Antibiotic resistance in Europe and the current use of antibiotics in severe pediatric infections.

The prevalence of antibiotic resistance among bacteria responsible for severe infections in childhood is increasing. In H. influenzae, clinically relevant resistance to ampicillin and chloramphenicol is caused by plasmid mediated enzymatic drug inactivation whereas penicillin resistant pneumococci emerge as the result of alterations in their penicillin binding proteins. In N. meningitidis both mechanisms have recently been implicated in penicillin resistance. Although antibiotic resistant H. influenzae, S. pneumoniae and, to much less extent, N. meningitidis have a widespread distribution, marked geographical variations exist in their prevalence. In areas where these drug resistant bacteria are reported, cefotaxime or ceftriaxone should be used for the empiric treatment of suspected severe bacterial infections in childhood.