Clinical meaning
Pediatric antibiotic selection requires understanding that common pathogens differ by age: neonates are susceptible to Group B Streptococcus, E. coli, and Listeria; infants and toddlers to S. pneumoniae, H. influenzae, and M. catarrhalis; school-age children to Group A Streptococcus and S. aureus. Antibiotic pharmacokinetics differ in children due to developmental changes in renal and hepatic clearance, higher volume of distribution, and age-related differences in protein binding. Antimicrobial stewardship is critical because unnecessary antibiotic use promotes resistance, disrupts the developing microbiome (increasing risk of C. difficile, allergic disease, and obesity), and exposes children to adverse effects including tendon damage (fluoroquinolones), tooth discoloration (tetracyclines), and bone marrow suppression (chloramphenicol).
Diagnosis & workup
Diagnostics & workup: - Obtain appropriate cultures BEFORE initiating antibiotics when possible (blood, urine, CSF, wound) - CBC with differential: leukocytosis with left shift suggests bacterial infection; lymphocytosis suggests viral - C-reactive protein (CRP) and procalcitonin for differentiating bacterial from viral infection - Urinalysis and urine culture for UTI (catheterized or suprapubic specimen in non-toilet-trained children) - Rapid strep testing (RADT) with throat culture backup for negative RADT in children with pharyngitis - Chest X-ray for suspected pneumonia (not routinely needed for outpatient community-acquired pneumonia)