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Pediatric Antibiotic Stewardship

Pediatric Antibiotic Stewardship

Pediatric Antibiotic Stewardship

Case Study 2: Antibiotic Stewardship in a Pediatric Patient with Pneumonia

Objective: Explore appropriate antibiotic selection, dosing, and resistance concerns in pediatric care.

Patient Profile:

  • Age: 6
  • Gender: Female
  • Weight: 44 lbs (20 kg)
  • Medical History: Recurrent ear infections, no known drug allergies
  • Current Medications: None
  • Diagnosis: Community-Acquired Pneumonia (CAP)

Instructions for Students:

  1. Identify the most likely pathogens causing pneumonia in this age group and discuss antibiotic options.
  2. Select an appropriate antibiotic regimen, including dosing, route, and frequency, based on guidelines for pediatric CAP.
  3. Evaluate the risk of antibiotic resistance and the importance of antibiotic stewardship in this case.
  4. Monitor: Define what clinical signs/symptoms and laboratory findings should be monitored to ensure the therapy is effective.
  5. Adjust: Outline any considerations if the patient fails to respond to first-line therapy or develops adverse effects.
  6. Counsel: Provide key teaching points for parents on the correct use of antibiotics, potential side effects, and the importance of completing the prescribed course.

Pediatric Antibiotic Stewardship

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APA

Pediatric Antibiotic Stewardship

Likely Pathogens in Pediatric CAP (Age 6)

The most common pathogens causing community-acquired pneumonia (CAP) in a 6-year-old include:

  • Streptococcus pneumoniae (most common bacterial cause)

  • Mycoplasma pneumoniae (more common in school-aged children)

  • Haemophilus influenzae

  • Respiratory viruses (e.g., influenza, RSV, parainfluenza)

Antibiotic Regimen Selection

First-line treatment (per IDSA/AAP Guidelines for Pediatric CAP):

  • Amoxicillin

    • Dose: 90 mg/kg/day divided every 12 hours

    • Route: Oral

    • Frequency: Twice daily (BID)

    • Total daily dose for 20 kg child:

      • 20 kg × 90 mg/kg/day = 1800 mg/day

      • Dose per administration: 900 mg BID

If atypical pathogens (e.g., Mycoplasma pneumoniae) are suspected:

  • Add Azithromycin

    • Dose: 10 mg/kg on day 1, then 5 mg/kg daily for 4 days

    • Route: Oral

Antibiotic Resistance & Stewardship

  • Overuse/misuse of antibiotics increases the risk of resistance.

  • Narrow-spectrum antibiotics like amoxicillin are preferred when S. pneumoniae is likely, minimizing broad-spectrum use.

  • Avoid unnecessary dual therapy unless atypical pneumonia is suspected.

  • Review culture/sensitivity data if available and…