Gupta Samriti, Lodha Rakesh, Kabra S K
Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
Curr Infect Dis Rep. 2018 Sep 20;20(11):47. doi: 10.1007/s11908-018-0653-6.
Empirical antibiotic therapy remains the cornerstone of treatment in community-acquired pneumonia (CAP). However, the best option for empirical antibiotics for treatment on an ambulatory basis, as well as in those requiring hospitalization, is still unclear. This review tries to answer the question regarding the most appropriate antibiotics in different settings in children with CAP as well as duration of therapy.
Recent studies have provided insights regarding use of oral antibiotics in children with mild to moderate CAP, and severe CAP with lower chest retractions but no hypoxia. In view of rapidly emerging resistance among various causative pathogens, several new drugs have been currently approved, or are under trial for CAP in children. Current knowledge suggests that the choice of antibiotics for ambulatory treatment of CAP is oral amoxicillin with a duration of 3-5 days. Children with CAP with lower chest retractions but no hypoxia can be treated with oral amoxicillin. Severe pneumonia can be treated with intravenous antibiotics consisting of penicillin/ampicillin with or without an aminoglycoside. Several new drugs have been developed and approved for use in CAP caused by multidrug-resistant organisms, but these should be used judiciously to avoid emergence of further resistance. Future research is needed regarding the safety and efficacy of newer drugs in children.
经验性抗生素治疗仍然是社区获得性肺炎（CAP）治疗的基石。然而，对于门诊治疗以及需要住院治疗的患者，经验性抗生素的最佳选择仍不明确。本综述试图回答关于不同情况下儿童CAP最合适的抗生素以及治疗疗程的问题。
近期研究为轻度至中度CAP以及伴有下胸部凹陷但无低氧血症的重度CAP儿童使用口服抗生素提供了见解。鉴于各种致病病原体中耐药性迅速出现，目前已有几种新药获批，或正在儿童CAP中进行试验。目前的知识表明，门诊治疗CAP的抗生素选择是口服阿莫西林，疗程为3 - 5天。伴有下胸部凹陷但无低氧血症的CAP儿童可用口服阿莫西林治疗。重症肺炎可用由青霉素/氨苄西林加或不加氨基糖苷类组成的静脉抗生素治疗。已经研发并批准了几种新药用于治疗由多重耐药菌引起的CAP，但应谨慎使用这些药物以避免进一步耐药的出现。关于新药在儿童中的安全性和有效性，还需要未来的研究。
