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Old vs. new: Choosing the right treatment for bacterial infections in children
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The development of effective therapies for children has not kept pace with threat of infectious diseases. This is particularly true for drug-resistant bacterial infections. Infectious Diseases in Children asked James B. Wood, MD, MSCI, assistant professor of pediatrics at Indiana University School of Medicine, about treating invasive MRSA infections in pediatric patients using older antibiotics that require close safety monitoring and IV access vs. newer antibiotics that have not been well-studied in children.
The emergence of multidrug-resistant bacteria has made it increasingly challenging for providers to select an antimicrobial regimen with sufficient breadth and safety. The rise of community-acquired MRSA in particular has highlighted this challenge for pediatric providers. In response to this challenge, after years of dormancy, there has been a resurgence in novel anti-staphylococcal antimicrobial development (eg, Teflaro [ceftaroline, Allergan], Dalvance [dalbavancin, Allergan] and iclaprim [Motif Bio]).
Although promising, these novel antimicrobials have not been thoroughly studied in the pediatric population, forcing pediatric providers to choose between established antibiotics, often requiring close safety monitoring (eg, vancomycin), vs. newer antibiotics, often lacking safety data in children. This challenge is not new for pediatric providers, who frequently encounter scenarios with little data to support treatment decisions or are forced to extrapolate data from adult studies. In children with invasive staphylococcal disease (including MRSA), however, the mortality, pathophysiology and antibiotic pharmacokinetics are quite different than in adults. Differences in drug metabolism can have tragic consequences, as seen with the pediatric experience with chloramphenicol, which resulted in significant morbidity in children.
An established antibiotic like vancomycin remains the drug of choice, as recommended by the Infectious Diseases Society of America guidelines for the treatment of MRSA. This recommendation mainly comes from the proven efficacy and safety established with vancomycin against invasive MRSA.
As antibiotic-resistant organisms continue to rise worldwide, providers will increasingly face challenging treatment decisions. The advent of novel antibiotics is promising; however, there remains a critical need for safety and efficacy studies in children. Until these trials are performed, selecting established antibiotics with proven efficacy and safety may be the best option.
- References:
- Goldman JL, et al. Pediatr Infect Dis J. 2014;doi:10.1097/01.inf.0000436281.18687.0c.
- Hamdy RF, et al. Pediatrics. 2017;doi:10.1542/peds.2017-0183.
- Holland TL, et al. Antimicrob Agents Chemother. 2018;doi:10.1128/AAC.02580-17.
- Klieger SB, et al. Infect Control Hosp Epidemiol. 2015;doi:10.1017/ice.2014.91.
- Liu C, et al. Clin Infect Dis. 2011;doi:10.1093/cid/ciq146.
- Sharma R, et al. Pediatr Clin North Am. 2017;doi:10.1016/j.pcl.2017.08.005.
Disclosure: Wood reports no relevant financial disclosures.