PRESCRIZIONE AMBULATORIALE DEGLI ANTIBIOTICI NELLE INFEZIONI RESPIRATORIE

Guidelines on antibiotic treatment of common respiratory infections were developed by an interdisciplinary group including family paediatricians, hospital paediatricians, community paediatricians, microbiologists and epidemiologists. Systematic literature review, analysis of antibiotic susceptibility patterns and features of the child care system in Italy were taken into account to develop evidence-based and appropriate, feasible guidelines. The main recommendations are the following: Pneumonia: X-ray is not necessary for diagnosis unless complications are suspected or present; antibiotic treatment should be chosen taking into account mainly the age of the patient and the clinical features; amoxycillin is the first choice drug, amoxycillin-clavulanic or third generation cephalosporins must be used if a pyogenic infection is likely. Macrolides must be used if Mycoplasma or Chlamydia infections are suspected. In severe cases, the patient should be admitted to hospital and a combined antibiotic treatment (parenteral cephalosporin and macrolides) should be administered. Pharyngitis: diagnosis must be based on culture from pharyngeal swab. If positive for group A beta-haemolytic Streptococcus, oral penicillin should be given. Otitis: diagnosis must be based on otoscopy. First choice antibiotic is amoxycillin, or amoxycillin-clavulanic if previous antibiotic failure. In children older than 2 years, only paracetamol is needed, with follow-up after 24-48 hours. Sinusitis: diagnosis is clinical (rhinoscopy, signs and symptoms). X-ray are not necessary (low sensitivity and specificity). Antibiotic treatment should be as for otitis. Antimicrobial susceptibility patterns are also included.