New trends in paediatric antibiotic therapy

Recently many new antibiotics have been marketed for use in paediatrics. Most of them offer no real advantage in comparison to older drugs and their prescription is questionable, particularly because they are highly expensive. Only a few have a number of special characteristics which permit in certain patients a significant improvement of antibiotic therapy. Among these there are some third-generation cephalosporins such as ceftazidime and cefsulodin, aztreonam and the new macrolides. Ceftazidime and cefsulodin are highly active, particularly against Pseudomonas spp., thus offering new therapeutic possibilities in life-threatening infections due to these bacteria. Aztreonam is the first monobactam and has a spectrum of activity limited to the aerobic Gram-negative bacilli. Its indications are therefore very similar to those of the aminoglycosides but its use seems to be safer because it has none of the important side-effects of those drugs. Alone or in combination, it may become the drug of choice to treat children with infection due to Gram-negative bacteria. New macrolides are active against erythromycin-resistant bacteria, have a lower risk of gastrointestinal side-effects and have no interference with concomitant administered drugs such as theophylline. Therefore they may be used with higher compliance and better efficacy, especially in the areas where erythromycin-resistant Gram-positive strains are increasingly evident.