What are the causes of acute bacterial infection?

From the Guidelines

Acute bacterial sinusitis in children should be treated with amoxicillin with or without clavulanate as the first-line treatment. The diagnosis of acute bacterial sinusitis is made when a child with an acute upper respiratory tract infection presents with persistent illness, worsening course, or severe onset 1. Clinicians should prescribe antibiotic therapy for acute bacterial sinusitis in children with severe onset or worsening course, and either prescribe antibiotic therapy or offer additional observation for 3 days to children with persistent illness 1.

Some key points to consider in the management of acute bacterial sinusitis include:

• The use of imaging studies is not recommended to distinguish acute bacterial sinusitis from viral URI, except in cases of suspected orbital or central nervous system complications 1.
• Clinicians should reassess initial management if there is either a caregiver report of worsening or failure to improve within 72 hours of initial management 1.
• The choice of empiric antibiotic regimens should be based on the clinical condition of the patients, the individual risk for infection by resistant pathogens, and the local resistance epidemiology 1.
• Patients who have ongoing signs of peritonitis or systemic illness beyond 5-7 days of antibiotic treatment normally warrant a diagnostic investigation to determine whether additional surgical intervention is necessary to address an ongoing uncontrolled source of infection or antimicrobial treatment failure 1.

In terms of antibiotic treatment, some options include:

• Amoxicillin with or without clavulanate as the first-line treatment for acute bacterial sinusitis in children 1.
• Other options such as cefotaxime and ceftriaxone in association with metronidazole, may be used for the treatment of mild IAIs 1.
• Carbapenems offer a wide spectrum of antimicrobial activity against gram-positive and gram-negative aerobic and anaerobic pathogens, but their use should be limited to preserve activity of this class of antibiotics 1.

It is essential to note that the management of acute bacterial sinusitis should prioritize the use of antibiotics that are effective against the most likely pathogens, while also considering the risk of resistance and the potential for side effects 1.

From the FDA Drug Label

To reduce the development of drug-resistant bacteria and maintain the effectiveness of amoxicillin and clavulanate potassium tablets USP, and other antibacterial drugs, amoxicillin and clavulanate potassium should be used only to treat infections that are proven or strongly suspected to be caused by susceptible bacteria Amoxicillin and clavulanate potassium tablets USP is a combination penicillin-class antibacterial and beta-lactamase inhibitor indicated in the treatment of infections due to susceptible isolates of the designated bacteria in the conditions listed below*: Ceftriaxone for Injection is indicated for the treatment of the following infections when caused by susceptible organisms: Azithromycin Tablets, USP are indicated for the treatment of patients with mild to moderate infections (pneumonia: see WARNINGS) caused by susceptible strains of the designated microorganisms in the specific conditions listed below

• Acute bacterial infections can be treated with:
  • Amoxicillin-clavulanate (PO) for infections such as lower respiratory tract infections, acute bacterial otitis media, sinusitis, skin and skin structure infections, and urinary tract infections 2
  • Ceftriaxone (IV) for infections such as lower respiratory tract infections, acute bacterial otitis media, skin and skin structure infections, urinary tract infections, and others 3
  • Azithromycin (PO) for infections such as acute bacterial exacerbations of chronic obstructive pulmonary disease, acute bacterial sinusitis, community-acquired pneumonia, pharyngitis/tonsillitis, and others 4

From the Research

Acute Bacterial Infections

• Acute bacterial infections can be treated with various antibiotics, including ceftriaxone, which has a broad spectrum of activity against Gram-positive and Gram-negative aerobic, and some anaerobic, bacteria 5
• The choice of antibiotic therapy should be guided by the suspected pathogens and the bacteriologic susceptibilities of the medical center 6
• Rapid initiation of antibiotic treatment is crucial in patients with severe infections such as septic shock and bacterial meningitis, but may not be as important for other infectious syndromes 7

Treatment Options

• Ceftriaxone has been effective in treating infections due to susceptible organisms, including complicated and uncomplicated urinary tract infections, lower respiratory tract infections, skin, soft tissue, bone and joint infections, bacteraemia/septicaemia, and paediatric meningitis 5
• Other antibiotics, such as broad-spectrum antibiotics, can be used to treat various infections, but the source of infection and causative organisms should be considered when selecting an antibiotic 6
• Combination antibiotic therapy against gram-negative infections is not routinely required, and combination therapy involving vancomycin and piperacillin/tazobactam is associated with an increase in acute kidney injury 8

Timing of Antibiotic Therapy

• Delaying antibiotic therapy by several hours can be tolerated if it helps to clarify the aetiology and refine the treatment, but in cases of very acute infections, it is necessary to start antibiotic treatment immediately 9
• Withholding antibiotic therapy until diagnostic results are available and a diagnosis has been established (e.g. by 4-8 hours) seems acceptable in most cases unless septic shock or bacterial meningitis are suspected 7
• Cultures should be drawn before antibiotic therapy if it does not significantly delay administration 8