Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy.
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy.
Expert Opin Pharmacother. 2021 Jun;22(9):1193-1202. doi: 10.1080/14656566.2021.1882420. Epub 2021 Feb 5.
Despite the amount of new information, the most effective approach for the diagnosis and treatment of infections is not established. In this narrative review the pharmacological options for macrolide-resistant (ML) infections in children are discussed.
Despite significant improvement in the diagnosis and in the definition of diseases potentially associated with this pathogen, not all the problems related to infection are solved. True epidemiology of diseases and the real role of this pathogen in extra-respiratory manifestations is still unestablished. This reflects on therapy. It is not known whether antibiotics are really needed in all the cases, independently of severity and localization. The choice of antibiotic therapy is debated as it is not known whether ML resistance has clinical relevance. Moreover, not precisely defined is the clinical importance of corticosteroids for improvement of severe cases, including those associated with ML-resistant strains.
Improvement in identification is mandatory to reduce antibiotics overuse , especially in the presence of ML-resistant strains. Priority for future studies includes the evaluation of the true benefit of therapeutic approaches including corticosteroids in patients with severe CAP and in those with extra-respiratory diseases.
尽管有大量的新信息，但对于感染的诊断和治疗，尚未确定最有效的方法。在本篇叙述性综述中，讨论了儿童中耐大环内酯（ML）感染的药物治疗选择。
尽管在该病原体相关疾病的诊断和定义方面取得了重大进展，但并非所有与感染相关的问题都得到了解决。真正的疾病流行病学以及该病原体在非呼吸道表现中的实际作用仍未确定。这反映在治疗上。抗生素是否真的需要在所有情况下使用，而不考虑严重程度和定位，这一点并不清楚。抗生素治疗的选择存在争议，因为尚不清楚 ML 耐药性是否具有临床相关性。此外，对于改善严重病例（包括与 ML 耐药株相关的病例）的皮质类固醇的临床重要性也没有明确界定。
必须提高鉴定水平，以减少抗生素的过度使用，尤其是在存在 ML 耐药株的情况下。未来研究的重点包括评估包括皮质类固醇在内的治疗方法在严重 CAP 患者和患有非呼吸道疾病患者中的真正益处。
