Rodrigues Charlene M C
Department of Zoology, University of Oxford, Oxford, United Kingdom.
Department of Paediatric Immunology and Infectious Diseases, Newcastle upon Tyne Hospitals Foundation Trust, Great North Children's Hospital, Newcastle upon Tyne, United Kingdom.
Curr Ther Res Clin Exp. 2017 Jan 16;84:e7-e11. doi: 10.1016/j.curtheres.2017.01.002. eCollection 2017.
Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality globally, responsible for more than 14% of deaths in children younger than 5 years of age. Due to difficulties with pathogen identification and diagnostics of CAP in children, targeted antimicrobial therapy is not possible, hence the widespread use of empirical antibiotics, in particular penicillins, cephalosporin, and macrolides.
This review aimed to address medical, societal, and political issues associated with the widespread use of empirical antibiotics for CAP in the United Kingdom, India, and Nigeria.
A literature review was performed identifying the challenges pertaining to the use of widespread empirical antibiotics for CAP in children. A qualitative analysis of included studies identified relevant themes. Empirical guidance was based on guidelines from the World Health Organization, British Thoracic Society, and Infectious Diseases Society of America, used in both industrialized and resource-poor settings.
In the United Kingdom there was poor adherence to antibiotics guidelines. There was developing antibiotic resistance to penicillins and macrolides in both developing and industrialized regions. There were difficulties accessing the care and treatment when needed in Nigeria. Prevention strategies with vaccination against and measles are particularly important in these regions.
Effective and timely treatment is required for CAP and empirical antibiotics are evidence-based and appropriate in most settings. However, better diagnostics and education to target treatment may help to prevent antibiotic resistance. Ensuring the secure financing of clean food and water, sanitation, and public health infrastructure are also required to reduce the burden of disease in children in developing countries.
社区获得性肺炎（CAP）是全球发病和死亡的主要原因，在5岁以下儿童死亡中占比超过14%。由于儿童CAP病原体鉴定和诊断存在困难，无法进行针对性抗菌治疗，因此经验性抗生素被广泛使用，尤其是青霉素、头孢菌素和大环内酯类药物。
本综述旨在探讨英国、印度和尼日利亚广泛使用经验性抗生素治疗CAP所涉及的医学、社会和政治问题。
进行文献综述，确定儿童广泛使用经验性抗生素治疗CAP所面临的挑战。对纳入研究进行定性分析，确定相关主题。经验性指导基于世界卫生组织、英国胸科学会和美国传染病学会的指南，适用于工业化和资源匮乏地区。
在英国，抗生素指南的依从性较差。在发展中地区和工业化地区，对青霉素和大环内酯类药物的抗生素耐药性都在增加。在尼日利亚，需要时难以获得护理和治疗。在这些地区，接种肺炎疫苗和麻疹疫苗的预防策略尤为重要。
CAP需要有效及时的治疗，经验性抗生素在大多数情况下是基于证据且合适的。然而，更好的诊断和针对性治疗教育可能有助于预防抗生素耐药性。还需要确保清洁食品、水、卫生设施和公共卫生基础设施的资金安全，以减轻发展中国家儿童的疾病负担。
