Adult Medicine, Child Patients
Increasing reliance upon the day-care center as a surrogate parent has helped to incubate and spread pathogens dangerously resistant to traditional antibiotics, so tempting pediatricians to contemplate the use of a class of antibiotics-fluoroquinolones-previously reserved for adult patients. In a commentary recently published in Clinical Infectious Diseases, a team of medical authorities from the United States, Canada, Switzerland, France, and South Africa strongly caution against this move.
In arguing against the pediatric use of fluoroquinolones, the medical authorities emphasize the difficulty of dealing with various strains of microbes resistant to penicillin and other antibiotics, highlighting particularly the seriousness of the "multi-drug resistance" seen in recent years in "Streptococcus pneumoniae . . . one of the most important respiratory pathogens, playing a major role in both upper and lower respiratory tract infections." "Recently," the authorities remark, "there has been a marked increase in the percentages of pneumococcal isolates that are penicillin resistant. Most worrisome is the propensity for pneumococcal resistance to penicillin . . . to be associated with reduced susceptibility to other drugs . . . . In the United Sates, 58.9% of pneumococcal isolates recovered from blood that are penicillin resistant are also macrolide resistant." Indeed, the researchers stress that "the prevalence of macrolide resistance among pneumococci doubled in the United States between 1995 and 1999."
Infections involving antibiotic-resistant germs can develop among patients of any age. However, the authors of the new commentary point to impressive evidence "that multidrug resistance in pneumococci is related to prescription of antimicrobial agents to a critically important reservoir for these organisms: children." But the medical editorialists do not see the children carrying these potent pathogens evenly distributed throughout society. Rather, they see them especially concentrated in "day care and pediatric chronic care centers," for it is in these institutions that epidemiologists have encountered "a very high prevalence of nasopharyngeal carriage of drug-resistant strains of S. pneuomiae."
To a significant degree, it is because of their need to deal with the super-germs day care has helped to incubate that some pediatricians are now advocating the use of fluoroquinolones-antibiotics previously reserved for adults-among children. But the international panel of authorities responsible for this new commentary warns that such use of fluoroquinolones to treat children "may exacerbate this phenomenon" of antibiotic-resistant microbes. They point out that "children, more often that adults, are colonized with high-density populations of pneumococci in the naspharynx, which raises the specter of rapidly accelerating development of resistance to antimicrobial drugs, including fluoroquinolones, should this class of antimicrobials be overused among children, as they have been among adults."
Rather than give pediatricians a new class of antibiotics to use with children, the authors of the new commentary endorse the view of researchers who have "recommended reducing unnecessary use of antimicrobials in the community as the most appropriate course of action."
The authors of the new commentary do not say exactly how to reduce the inappropriate use of antibiotics. But given the way day care centers have helped drive up that use, it is safe to say that an excellent first step would to be get children out of those centers back into their own homes.
