Formulations of antibiotics for children in primary care: effects on compliance and efficacy

This review article is designed for pediatricians as well as primary care physicians in the outpatient setting as a clinical guide to antibiotic selection. It emphasizes variables related to compliance as well as efficacy. The aim is to give recommendations as to the choice of antibiotics, depending on factors such as taste, cost, efficacy, and compliance. Common bacterial pathogens causing infections in children are reviewed, along with their susceptibility patterns to antimicrobial agents. Emerging mechanisms of resistance, particularly the increasing resistance of pneumococci to beta-lactam antibiotics, are discussed because of their importance to antibiotic selection. Previously published studies that have examined the treatment of common outpatient infections in children, such as otitis media, streptococcal tonsillopharyngitis, and sinusitis, are summarized. Adverse reactions associated with antibiotics, second in importance only to efficacy, are reviewed. Finally, compliance issues, which include palatability, cost, duration of therapy, and administration frequency, are analyzed using recently published information related to each of these issues. The efficacy of the commonly used antibiotics for urinary tract infections, pneumonia, and streptococcal pharyngitis does not vary significantly; however, for otitis media and sinusitis, some studies have shown that treatment efficacy with the antibiotic does not vary significantly from that with placebo. Likewise, adverse reactions rarely provide a basis for antibiotic selection, since virtually all antibiotics are generally well tolerated. The final factor, compliance, is a major issue in determining both first- and second-line therapy of common outpatient infections in children. Although cost is not a factor in compliance in countries such as the UK where no copayment is required for pediatric drugs, it is of major importance in the US. This is followed by palatability, administration duration and finally administration frequency. As a group, cephalosporins are generally the best tasting but are relatively more expensive than macrolides. Antibiotics that can be given for 5 days, and just once or twice daily, are preferred by most parents and physicians. Since final assessment of antibiotic choice is likely to vary considerably among healthcare personnel, decisions must be made on an individual basis.