Antimicrobial drugs used in the management of anaerobic infections in children.

Optimum antimicrobial therapy effective against anaerobes is required to rapidly resolve infections due to these organisms and to prevent serious complications. Selection of antimicrobial therapy should be based on clinical experience and presumptive evidence until culture and sensitivity tests are available. If an abscess should develop, surgical drainage (when possible) is of paramount importance. Antimicrobial therapy for anaerobic infections should usually be given for prolonged periods because of the tendency for relapse, and should include coverage for aerobic bacteria whenever they are present. Penicillin G remains the drug of choice for most anaerobic infections except those caused by beta-lactamase-producing Bacteroides spp. such as B. fragilis and B. melaninogenicus, and some strains of Fusobacterium varium, which can be resistant. Other antimicrobials which are available for treatment of anaerobic infections in paediatric patients, and are generally active against B. fragilis, are carbenicillin, ticarcillin, chloramphenicol, clindamycin and cefoxitin. Experience in the use of metronidazole suggests that it could be a very valuable antimicrobial agent in the treatment of anaerobic infections. Experience with synergistic antimicrobial combinations in the treatment of anaerobic infections is limited; only experimental data are available suggesting synergism between penicillin and aminoglycosides against some Bacteroides spp. beta-Lactamase-producing anaerobic bacteria may protect other penicillin-susceptible bacteria in mixed infections. This phenomenon may explain penicillin failure in eradicating mixed infections.