Skip to main content
SpringerLink
Log in

Rational Prescribing of Antibacterials in Hospitalised Children

  • Review Article
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Abstract

The subject of this review is the rational prescribing of antimicrobial agents for the therapy of serious community-acquired infections in hospitalised infants and children. First, cost-containment strategies such as streamlining of antibacterial therapy, outpatient parenteral antibacterial therapy and sequential (‘stepdown’) therapy with parenteral followed by oral therapy are reviewed. In most of these areas, paediatric studies are scant or lacking. Then specific paediatric aspects of the choice of parenteral antibacterials such as penicillins, cephalosporins, aminoglycosides, macrolides and other agents are discussed. With particular reference to cost containment. rational treatment strategies for some serious bacterial infections such as meningitis, occult bacteraemia, endocarditis, osteomyelitis, arthritis, pyelonephritis, Lyme borreliosis (advanced stages) and pneumonia are proposed. In most of these disease, there is potential for cutting treatment costs and studies that compare these newer strategies with the traditional treatment regimens are urgently needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Reference

  1. Louie TJ. Intravenous to oral stepdown antibiotic therapy: anothercost-effective strategy in an era of shrinking health caredollars. Can J Infect Dis 1994; 5 Suppl. C: 45C–50C

    Google Scholar 

  2. Eisenberg JM. Clinical economics. JAMA 1989; 262: 2879–86

    Article  PubMed  CAS  Google Scholar 

  3. Kaplan JM, Goretski SA, Keith S, et al. Cost of antibiotic therapy for infants and children. Pediatr Infect Dis J 1990; 9:722–8

    Article  PubMed  CAS  Google Scholar 

  4. Blumer JL. Carbapenems in paediatrics. Scand J Infect Dis 1995; Suppl. 96: 38–44

    Google Scholar 

  5. Quintiliani R. Cooper BW. Briccland LL. et al. Economic impact of streamlining antibiotic administration. Am J Med1987; 82 Suppl. 4A: 391–4

    Google Scholar 

  6. Balinsky W. Nesbill S. Cost-effectiveness of outpatient parenteral antibiotics: a review of the literature. Am J Med 1989;87: 301–5

    Article  PubMed  CAS  Google Scholar 

  7. Williams ON. Bosch D. Boots J. et al. Safety. efficacy. and cost savings in an outpatient intravenous antibiotic program. ClinTher 1993; 15: 169–79

    PubMed  CAS  Google Scholar 

  8. Craig WA. Outpatient parenteral antibiotic therapy-introduction. Eur J C1in Microbiol Infect Dis 1995; 14: 635

    Article  Google Scholar 

  9. Dagan R. Einhorn M. A program of outpatient parenteral antibiotic therapy for serious pediatric bacterial infections. RevInfect Dis 1991; 13 Suppl. 2: 152–5

    Article  Google Scholar 

  10. Nelson JD. Options for outpatient management of serious infections. Pediatr Infect Dis J 1992; 11: 175–8

    Article  PubMed  CAS  Google Scholar 

  11. Craig WA. Antibiotic selection factors and description of a hospital-based outpatient antibiotic therapy program in theUSA. Eur J Clin Microbiollnfect Dis 1995; 14: 636–42

    Article  CAS  Google Scholar 

  12. Janknegt R. van der Meer JWM. Antimicrobial practice: sequential therapy with intravenous and oral cephalosporins. JAntimicrob Chemother 1994; 33: 169–77

    Article  CAS  Google Scholar 

  13. Bradley JS. Ching OK. Hart CL. Invasive bacterial disease in childhood: efficacy of oral antibiotic therapy following shortcourse parenteral therapy in non-central nervous system infections.Pediatr Infect Dis J 1987; 6: 821–5

    Article  PubMed  CAS  Google Scholar 

  14. Dagan R. Syrogiannopoulos G. Ashkenazi S. et al. Parenteraloral switch in the management of paediatric pneumonia.Drugs 1994; 47Suppl.3:43–51

    Article  Google Scholar 

  15. Hendrickson JR. North OS. Pharmacoeconomic benefit of antibiotic step-down therapy: converting patients from intravenousceftriaxone to oral cefpodoxime proxetil. AnnPharmacother 1995; 29: 561–5

    PubMed  CAS  Google Scholar 

  16. Kaplan EL. Benzathine penicillin G for treatment of group A streptococcal pharyngitis: a reappraisal in 1985. Pediatr InfectDis 1985; 4: 592–6

    Article  PubMed  CAS  Google Scholar 

  17. Schreiber JR. Jacobs MR. Antibiotic-resistant pneumococci. PediatrClin North Am 1995; 42: 519–37

    PubMed  CAS  Google Scholar 

  18. Saez-Nieto JA. Lujan R. Berron S. et al. Epidemiology and molecular basis of penicillin-resistant Neisseria mel!ingitidiJin Spain: a 5-year history (1985-1989). Clin Infect Dis 1992;14: 394–402

    Article  PubMed  CAS  Google Scholar 

  19. Vogelman B. Craig WA. Kinetics of antimicrobial activity. J Pediatr 1986; 108: 835–40

    Article  PubMed  CAS  Google Scholar 

  20. Wise R. Antimicrobial agent a widening choice. Lancet 1987; 11: 1251–4

    Article  Google Scholar 

  21. Lieberman JM. Stutman HR. Advances in pediatric antibiotic therapy. In: Engelhard D. Marks MI. Branski D. editors. Pediatricinfectious diseases. Vol. 4. Basel: Karger. 1993: 1–14

    Google Scholar 

  22. Neu HE. Antistaphylococcal penicillins. Med Clin North Am 1982; 66: 51–60

    PubMed  CAS  Google Scholar 

  23. Sutherland R. Beta-Iactamlbeta-Iactamase inhibitor combinations: development. antibacterial activity and clinical applications.Infection 1995; 23: 191–200

    Article  PubMed  CAS  Google Scholar 

  24. Goldfarb J. New antimicrobial agents. Pediatr Clin North Am 1995; 42: 717–35

    PubMed  CAS  Google Scholar 

  25. Schaad UB. Suter S. Gianella-Borradori A. et al. A comparison of ceftriaxone and cefuroxime for the treatment of bacterialmeningitis in children. N Engl J Med 1990; 322: 141–7

    Article  PubMed  CAS  Google Scholar 

  26. Nelson SJ. Boies EG. Shackelford PG. Ceftriaxone in the treatment of infections caused by Staphylococcus aureus in children.Pediatr Infect Dis 1985; 4: 27–31

    Article  PubMed  CAS  Google Scholar 

  27. DonowilZ GR. Mandell GL. Beta-Iactam antibiotics. N Engl J Med 1988; 318: 419–26. 490-500

    Article  Google Scholar 

  28. Craig WA. Interrelationship between pharmacokinetics and pharmacodynamics in determining dosage regimens for broadspectrumcephalosporins. Diagn Microbiol Infect Dis 1995;22: 89–96

    Article  PubMed  CAS  Google Scholar 

  29. Higham M. Cunningham FM. Teele OW. Ceftriaxone administered once or twice a day for treatment of bacterial infectionsof childhood. Pediatr Infect Dis 1985; 4: 22–6

    Article  PubMed  CAS  Google Scholar 

  30. Dagan R. Phillip M. Watemberg NM. et al. Outpatient treatment of serious community-acquired pediatric infections usingonce daily intramuscular ceftriaxone. Pediatr Infect Dis J1987; 6: 1080–4

    PubMed  CAS  Google Scholar 

  31. Powell KP. Mawhorter SO. Outpatient treatment of serious infections in infants and children with ceftriaxone. J Pediatr1987; 110: 898–901

    Article  PubMed  CAS  Google Scholar 

  32. Bradley JS. Ching OK. Phillips SE. Outpatient therapy of serious pediatric infections with ceftriaxone. Pediatr Infect Dis J1988; 7: 160–4

    Article  PubMed  CAS  Google Scholar 

  33. Segev S. Raz R. Rubinstein E. et al. Double-blind randomized study of I g versus 2 g intravenous ceftriaxone daily in thetherapy of community-acquired infections. Eur J Clin MicrobiolInfect Dis 1995; 14: 851–5

    Article  PubMed  CAS  Google Scholar 

  34. Poretz OM. Woolard D. Eron LJ. et al. Outpatient use of ceftriaxone: a cost-benefit analysis. Am J Med 1984; 77Suppl. 4C: 77–80

    Google Scholar 

  35. Lee SP. Lipsky BA. Teefey SA. Gallbladder sludge and antibiotics. Pediatr Infect Dis J 1990; 9: 422–3

    Article  PubMed  CAS  Google Scholar 

  36. Dagan R. Fliss OM. Einhorn M. et al. Outpatient management of chronic suppurative otitis media without cholesteatoma inchildren. Pediatr Infect Dis J 1992; 11: 542–6

    Article  PubMed  CAS  Google Scholar 

  37. Kovarik JM. Hoepelman IM. Verhoef J. Once-daily aminoglycoside administration: new strategies for an old drug. EurJ Clin Microbiol Infect Dis 1989; 8: 761–9

    Article  CAS  Google Scholar 

  38. Gilbert ON. Once-daily aminoglycoside therapy. Antimicrob AgentsChemother 1991; 35: 399–405

    Article  PubMed  CAS  Google Scholar 

  39. Blaser J. Konig C. Once-daily dosing of aminoglycosides. Eur J Clin Microbiol Infect Dis 1995; 14: 1029–38

    Article  PubMed  CAS  Google Scholar 

  40. Wallen L. Zeller WP. Goessler M. et al. Single-dose amikacin treatment of first childhood E. coli lower urinary tract infections.J Pediatr 1983: 103: 316–9

    Article  PubMed  CAS  Google Scholar 

  41. Schaad UB. McCracken GH. Nelson JD. Clinical pharmacology and efficacy of vancomycin in pediatric patient.J Pediatr 1980; 96: 119–26

    Article  PubMed  CAS  Google Scholar 

  42. Trautmann M. Wiedeck H. Ruhnke M. et al. Teicoplanin: 10 years of clinical experience. Infection 1994; 22: 430–6

    Article  PubMed  CAS  Google Scholar 

  43. Dagan R. Einhorn M. Howard CB. et al. Infections due to Gram-positive organisms in children: possible role forteicoplanin. J Antimicrob Chemother 1991; 27 Suppl.B: 37–41

    Google Scholar 

  44. Peller P. Aichholzer B. Fell J. et al. Safety and efficacy of teicoplanin in the treatment of Gram-positive infections inpediatric patients in Germany. Pediatr Infect Dis J 1993; 12:7–9

    Google Scholar 

  45. Dagan R. Einhorn M. Howard CB. et al. Outpatient and inpatient teicoplanin treatment for serious Gram-positive infectionsin children. Pediatr Infect Dis J 1993; 12: 17–20

    Article  Google Scholar 

  46. Schaison GS. Cost effectiveness of teicoplanin plus ceftriaxone: a once daily antibiotic regimen. Pediatr Infect Dis J1993; 12: 14–6

    Google Scholar 

  47. Moellering RC. Editorial: monitoring serum vancomycin levels: climbing the mountain because it is there? Clin Infect Dis1994; 18: 544–6

    Article  PubMed  Google Scholar 

  48. Murphy S. Pinney RJ. Teicoplanin or vancomycin in the treatment of Gram-positive infections? J Clin Pharm Ther 1995;20: 5–11

    Article  PubMed  CAS  Google Scholar 

  49. Wilson APR, Griineberg RN. Use of teicoplanin in community medicine. Eur J Clin Microbiollnfect Dis 1994; 13: 701–10

    Article  CAS  Google Scholar 

  50. Spencer CM, Bryson HM. Teicoplanin: a pharmacoeconomic evaluation of its use in the treatment of Gram-positive infections.Pharmacoeconomics 1995; 7: 357–74

    Article  PubMed  CAS  Google Scholar 

  51. Eichenwald HF. Adverse reactions to erythromycin. Pediatr Inteet OlS 1981:1; 5: 147–50

    Google Scholar 

  52. LeFrock JL, Molavi A, Prince RA. Clindamycin. Med Clin North Am 1982; 66: 103–20

    PubMed  CAS  Google Scholar 

  53. Cunha BA, Sibley CM, Ristuccia AM. Doxycycline. Ther Drug Monit 1982; 4: 115-35

    Article  PubMed  CAS  Google Scholar 

  54. Feder HM, Osier C. Maderazo EG. Chloramphenicol: a review of its use in clinical practice. Rev Infect Dis 1981; 3: 479–91

    Article  PubMed  Google Scholar 

  55. Tunkel AR, Wispelwey B, Scheid WM. Bacterial meningitis: recent advances in pathophysiology and treatment. Ann InternMed 1990; 112:610–23

    PubMed  CAS  Google Scholar 

  56. Tunkel AR, Scheid WM. Acute bacterial meningitis. Lancet 1995; 346: 1675–80

    Article  PubMed  CAS  Google Scholar 

  57. McCracken GH. Current management of bacterial meningitis in infants and children. Pediatr Infect Dis J 1992; 11: 169–74

    Article  PubMed  Google Scholar 

  58. Jordens JZ, Slack MPE. Haemophilus influenzae then and now. Eur J Clin Microbiol Infect Dis 1995; 14: 935–48

    Article  PubMed  CAS  Google Scholar 

  59. Scheid WM. Rationale for optimal dosing of beta-Iactam antibiotics in therapy for bacterial meningitis. Eur J ClinMicrobiol 1984; 3: 579–91

    Article  Google Scholar 

  60. Botha P. Penicillin-resistant Neisseria meningitidis in Southern Africa [letter]. Lancet 1988; 1: 54

    Article  PubMed  CAS  Google Scholar 

  61. Campos J, Trujillo G, Seuba T, et al. Discriminative criteria for Neisseria meningitidis isolates that are moderately susceptibleto penicillin and ampicillin. Antimicrob Agents Chemother1992; 36: 1028–31

    Article  PubMed  CAS  Google Scholar 

  62. de Groot R, Dzoljic-Danilovic 0, van Klingeren B, et al. Antibiotic resistance in Haemophilus inj1uell~(le: mechanisms,cI inical importance and consequences for therapy. Eur J Pediatr1991; 150: 534–46

    Article  PubMed  Google Scholar 

  63. Jorgensen JH. Update on mechanisms and prevalence of antimicrobial resistance in H(lemophiius illfluen:ae. Clin InfectDis 1992; 14: 1119–23

    Article  PubMed  CAS  Google Scholar 

  64. Kayser FH, Morenzoni G, Santanam P. The second European collaborative study on the frequency of antimicrobial resistancein Haemophiius illfluen:ae. Eur J Clin Microbiol InfectDis 1990; 9: 810–7

    Article  PubMed  CAS  Google Scholar 

  65. Paris MP, Ramilo 0, McCracken GH. Management of meningitis caused by penicillin-resistant Streptococcus pneumoniae.Antimicrob Agents Chemother 1995; 39: 2171–5

    Article  PubMed  CAS  Google Scholar 

  66. Friedland IR, Klugman KP. Failure of chloramphenicol therapy in penicillin-resistant pneumococcal meningitis. Lancet1992; 339: 405–8

    Article  PubMed  CAS  Google Scholar 

  67. Friedland IR, McCracken GH. Management of infections caused by antibiotic-resistant Streptococcus plteumoniae. NEngl J Med 1994; 331: 377–82

    Article  CAS  Google Scholar 

  68. Klugman KP, Dagan R. Carbapenem treatment of meningitis. Scand J Infect Dis 1995; Suppl.96: 45–8

    Google Scholar 

  69. Friedland IR, Paris M, Ehretl S, et al. Evaluation of antimicrobial regimens for treatment of experimental penicillin- andcephalosporin-resistant pneumococcal meningitis. AntimicrobAgents Chemother 1993; 37: 1630–6

    Article  PubMed  CAS  Google Scholar 

  70. Radetsky M. Duration of treatment in bacterial meningitis: a historical inquiry. Pediatr Infect Dis J 1990; 9: 2–9

    Article  PubMed  CAS  Google Scholar 

  71. O’Neill P. How long to treat bacterial meningitis. Lancet 1993; 341: 530

    Article  PubMed  Google Scholar 

  72. Waler JA, Rathore MH. Outpatient management of pediatric bacterial meningitis. Pediatr Infect Dis J 1995; 14: 89–92

    Article  PubMed  CAS  Google Scholar 

  73. Steele RW. Marcy SM. Outpatient management of bacterial meningitis. Pediatr Infect Dis J 1989: 8: 258–60

    Google Scholar 

  74. Lieu TA, Schwartz JS, Jaffe OM, et al. Strategies for diagnosis and treatment of children at risk for occult bacteremia: c1inical effectiveness and cost-effectiveness. J Pediatr 1991; 118: 21–9

    Article  PubMed  CAS  Google Scholar 

  75. Dagan R, Branski D. The approach to the febrile child under 2-1 months of age. In: Engelhard 0, Marks MI, Branski D.Pediatric infectious diseases. Pediatric and Adolescent Medicine. Vol. 4. Basel: Karger. 1993: 120–9

    Google Scholar 

  76. Fleisher GR. Management of children with occult bacteremia who are treated in the emergency department. Rev Infed Dis1991; 13 Suppl.2: 156–9

    Article  Google Scholar 

  77. Fleisher GR, Rosenberg N, Vinci R, et al. Intramuscular versus oral antibiotic therapy for the prevention of meningitis and other bacterial sequelae in young, febrile children at risk foroccult bacteremia. J Pediatr 1994; 124: 504–12

    Article  PubMed  CAS  Google Scholar 

  78. Bass JW, Steele RW, Wittler RR, et al. Antimicrobialtreatmcnt of occult bacteremia: a multicenter cooperative Mudy. Pediatr Infect Dis J 1993; 12: 466–73

    Article  PubMed  CAS  Google Scholar 

  79. Starke JR. Infective endocarditis. In: Feigin RD, Cherry JD. editors. Textbook of pediatric infectious diseases. Philaddphia: WB Saunders, 1992: 326–43

    Google Scholar 

  80. Bisno AL, Dismukes WE, Durack DT, et al. Antimicrobial treatment of infective endocarditis due to viridans streptococcienterococci, and staphylococci. JAMA 1989: 261: 1471–7

    Article  PubMed  CAS  Google Scholar 

  81. Baltimore RS. Infective endocarditis in children. Pediatr Infecl DisJ 1992; 11: 907–12

    Article  CAS  Google Scholar 

  82. Working Party of the British Society for Antimicrobial Chemotherapy. Antibiotic treatment of streptococcal and staphylococcalendocarditis. Lancet 1985; 11:815–7

    Google Scholar 

  83. Niebel J. Empfehlungen zur Behandlung der infektiosen Endokarditis. Dtsch Med Wochenschr 1990; 115: 1110–8

    Article  PubMed  CAS  Google Scholar 

  84. Stamboulian D. Outpatient treatment of endocarditis in a c1inicbased program in Argentina. Eur J Clin Microbiol Infect Dis1995; 14: 648–54

    Article  PubMed  CAS  Google Scholar 

  85. Syriopoulou VP, Smith AL. Osteomyelitis and septic arthritis. In: Feigin RD, Cherry JD, editors. Textbook of pediatric infectiousdiseases. Philadelphia: WB Saunders, 1992: 727–40

    Google Scholar 

  86. Prober CG. Current antibiotic therapy of community-acquired bacterial infections in hospitalized children: bone and jointinfections. Pediatr Infect Dis J 1992: 11: 156–9

    Article  PubMed  CAS  Google Scholar 

  87. Dagan R. Management of acute hematogenous osteomyelitis and septic arthritis in the pediatric patient. Pediatr Infect DisJ 1993; 12: 88–93

    Article  CAS  Google Scholar 

  88. Nelson JD. Acute osteomyelitis in children. Infect Dis Clin North Am 1990; 4: 513–22

    PubMed  CAS  Google Scholar 

  89. Kaplan SL. Acute osteomyelitis. In: Kaplan SL, editor. Current therapy in pediatric infectious disease. St. Louis: Mosby-YearBook, 1993: 101–3

    Google Scholar 

  90. Rodriguez W, Ross S, Khan W, et al. Clindamycin in the trealment of osteomyelitis in children. Am J Dis Child 1977: 131:1088–93

    PubMed  CAS  Google Scholar 

  91. Wharton MR, Beddow FH. Clindamycin for acute osteomyelitis in children. Postgrad Med J 1975; 51: 166–8

    Article  Google Scholar 

  92. LeFrock JL, Mader J, Smith B, et al. Bone and joint infections caused by Gram-positive bacteria: treatment with cefotaximc.Infection 1985; 13 Suppl.1: 50–5

    Article  Google Scholar 

  93. Nelson JD, Bucholz RW, Kusmiesz H, et al. Benefits and risks of sequential parenteral-oral cephalosporin therapy for suppurative bone and joint infections. J Pediatr Orthop 1982; 2:255–62

    Article  PubMed  CAS  Google Scholar 

  94. Eisenberg JM, Kitz OS. Savings from outpatient antibiotic therapy for osteomyelitis. JAMA 1986; 255: 1584–8

    Article  PubMed  CAS  Google Scholar 

  95. Syriopoulou VP. Smith AL. Septic anhritis. In: Feigin RD. Cherry JD. editors. Textbook of pediatric infectious diseases.Philadelphia: WB Saunders. 1992: 740–6

    Google Scholar 

  96. Kaplan SL. Suppurative anhritis. In: Kaplan SL. editor. Current therapy in pediatric infectious disease. St. Louis: Mosby-YearBook. 1993: 99–101

    Google Scholar 

  97. Leung AKC. Robson WLM. Urinary tract infection in infancy and childhood. Adv Pediatr 1991: 38: 157–81

    Google Scholar 

  98. Marks MI. Arrieta AC. Pyelonephritis. In: Feigin RD. Cherry JD. editors. Textbook of pediatric infectious diseases. Philadelphia: WB Saunders. 1992:478–94

    Google Scholar 

  99. Shapiro ED. Infections of the urinary tracl. Pediatr Infect Dis J 1991: 11: 165–8

    Google Scholar 

  100. McCracken GH. Options in antimicrobial management of urinary tract infections in infants and children. Pediatr Infect DisJ 1989: 8: 551–5

    Google Scholar 

  101. Sherbotie JR. Confeld D. Management of urinary tract infections in children. Med Clin Nonh Am 1991; 75: 327–38

    CAS  Google Scholar 

  102. Eichenwald HF. Some aspect of the diagnosis and management of urinary tract infection in children and adolescents.Pediatr Infect Dis 1986; 5: 760–5

    Article  PubMed  CAS  Google Scholar 

  103. Weber K. Pfister HW. Clinical management of Lyme borreliosis, Lancet 1994; 343: 1017–20

    Article  PubMed  CAS  Google Scholar 

  104. Comminee on Infectious Diseases. Treatment of Lyme borreliosis. Pediatrics 1991: 88: 176–9

    Google Scholar 

  105. Stechenhcrg BW. Borrelia. Lyme disease. In: Feigin RD. Cherry JD. editors. Texthook of pediatric infectious diseases.Philadelphia: WB Saunders. 1991:1061–7

    Google Scholar 

  106. Shapiro ED. Lyme disease. In: Kaplan SL. editor. Current therapy in pediatric infectious disease. St. Louis: Mosby-YearBook. 1993: 217–9

    Google Scholar 

  107. Christen HJ. Hanefeld F. Eiffen H. et at. Epidemiology and clinical manifestations of Lyme borreliosis in childhood. ActaPaediatr Suppl 1993: 81: 1–75

    Article  Google Scholar 

  108. Goldsmith DP. Benach JL. et al. Childhood Lyme anhritis: experience in an endemic area. J Pediatr 1986:109:753–8

    Article  PubMed  Google Scholar 

  109. Culp RW. Eichenfield AH. Davidson RS. et al. Lyme anhritisin children. J Bone Joint Surg 1997: 69-A: 96–9

    Google Scholar 

  110. Huppenz HI. Karch H. Suschke HJ. et al. Lyme anhritis in European children and adolescents. Anhritis Rheum 1995;38: 361–8

    Article  Google Scholar 

  111. Turcios NL. Infections of the lower respiratory tract in infancy and early childhood. In: Pennington JE. editor.Respiratory infections: diagnosis and managemenl. New York: Raven Press. 1994: 229–55

    Google Scholar 

  112. Editorial. Pneumonia in childhood. Lancet 1988; 1: 741–3

    Google Scholar 

  113. Schutze GE. Jacobs RF. Management of community-acquired bacterial pneumonia in hospitalized children. Pediatr InfectDis J 1992: 11: 160–4

    Article  PubMed  CAS  Google Scholar 

  114. Long SS. Treatment of acute pneumonia in infants and children. Pediatr Clin Nonh Am 1983: 30: 297–321

    CAS  Google Scholar 

  115. Teele D. Pneumonia: antimicrobial therapy for infants and children. Pediatr Infect Dis 1985: 4: 330–5

    Article  PubMed  CAS  Google Scholar 

  116. Dagan R. Antibiotic treatment of pediatric community-acquired lower respiratory tract infections: challenges and possible solutions. Respiration 1993; 60 Suppl. 1: 38–44

    Article  PubMed  Google Scholar 

  117. Wald ER. Acute pneumonia of unknown etiology. In: Kaplan SL. editor. Current therapy in pediatric infectious disease. St.Louis: Mosby-Year Book. 1993: 57–9

    Google Scholar 

  118. Rettig PJ. Chlamydial infections in pediatrics: diagnostic and therapeutic considerations. Pediatr Infect Dis 1986: 5: 158–62

    Article  PubMed  CAS  Google Scholar 

  119. Lister PD. Multiply-resistant pneumococcus: therapeutic problems in the management of serious infections. Eur J ClinMicrobiollnfect Dis 1995; 14 Suppl. 1: 18–25

    Google Scholar 

  120. Klugman KP. Antibiotic-resistant pneumococci: epidemiology and treatment of pneomonia. Chemother J 1995: 4: 19–22

    Google Scholar 

  121. Leibovitz E. Tahachnik E. Fliedel O. et al. Once-daily intramuscular cc:ftriaxonc in the outpatient treatment of severe community-acquired pneumonia in children. Clin Pediatr 1990:19: 634–9

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Bacteriology, University Children’s Hospital, Eberhard Karl University, Rümelinstrasse 23, Tübingen, D-72070, Germany

    Jörg E. Hoppe

Authors
  1. Jörg E. Hoppe
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hoppe, J.E. Rational Prescribing of Antibacterials in Hospitalised Children. Pharmacoeconomics 10, 575–593 (1996). https://doi.org/10.2165/00019053-199610060-00005

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00019053-199610060-00005

Keywords

Search

Navigation