Principles of Antibacterial Therapy in Infants and Children

Treatment of bacterial infections of infants and children should be based on an understanding of the pathogenesis of disease and the pharmacology of the drugs prescribed. Although generalisations are often used to formulate guidelines for therapy, the complexities of host-parasite relationships frequently require individualisation of the therapeutic programme. In this chapter, rationales for the selection of antibiotics, and the choice of dose, route of administration and duration of treatment are provided. The scientific basis for these choices depends on knowledge of the cause and natural course of bacterial infections in the paediatric age group as outlined in the following chapters. We do not treat pneumonia, but rather the cause(s) of pneumonia in a particular host. Such treatment programmes may include antipyretics, nutritional therapy, and fluid, electrolyte and acid-base management as well. Surgical debridement, drainage, immobilisation and rest, and removal of foreign bodies may be the most critical components of certain treatment programmes. Careful explanations of rationale and directions to the patient and parents (where indicated) cannot be overemphasised. With these considerations in mind, I shall outline an approach to the choices involved in antibacterial therapy.