What are the general treatment approaches for common paediatric conditions?

From the Guidelines

Treatment approaches for common pediatric conditions should prioritize supportive care, medication, and preventive measures tailored to children's unique physiology, with a focus on minimizing morbidity, mortality, and improving quality of life. For respiratory infections like community-acquired pneumonia, treatment should follow guidelines such as those from the British Thoracic Society, which recommend oxygen therapy for patients with oxygen saturation below 92% 1, and intravenous antibiotics for severe cases or those not improving with oral antibiotics.

General Management

• The child cared for at home should be reviewed by a general practitioner if deteriorating, or if not improving after 48 hours on treatment 1.
• Families of children who are well enough to be cared for at home need information on managing pyrexia, preventing dehydration, and identifying any deterioration 1.
• Patients whose oxygen saturation is 92% or less while breathing air should be treated with oxygen given by nasal cannulae, head box, or face mask to maintain oxygen saturation above 92% 1.

Antibiotic Treatment

• All cases of pleural infection should be treated with intravenous antibiotics, including cover for Streptococcus pneumoniae, with broader spectrum cover required for hospital-acquired infections or those secondary to surgery, trauma, or aspiration 1.
• Empirical treatment must cover S pneumoniae, S pyogenes, and S aureus, with antistaphylococcal cover mandatory if pneumatocele are evident 1.

Supportive Care

• Treatment should also include analgesia and antipyretics as needed, with consideration of referral to a tertiary center for complex cases 1.
• Physiotherapy is not indicated for children with pneumonia or pleural infection 1.
• The goal of treatment should be to minimize morbidity, mortality, and improve quality of life, with a focus on weight-based medication dosing, child-appropriate formulations, and parental education regarding administration, warning signs, and follow-up care.

From the FDA Drug Label

For the 366 patients who were evaluated for clinical efficacy at the Day 12 visit, the clinical success rate (i.e., cure plus improvement) was 83% for azithromycin and 88% for the control agent. In three double-blind controlled studies, conducted in the United States, azithromycin (12 mg/kg once a day for 5 days) was compared to penicillin V (250 mg three times a day for 10 days) in the treatment of pharyngitis due to documented Group A β-hemolytic streptococci (GABHS or S. pyogenes) Azithromycin was clinically and microbiologically statistically superior to penicillin at Day 14 and Day 30 with the following clinical success (i.e., cure and improvement) and bacteriologic efficacy rates The general treatment approaches for common paediatric conditions, such as acute otitis media and pharyngitis/tonsillitis, may include the use of antibiotics like azithromycin.

• The clinical success rate for azithromycin in the treatment of acute otitis media was 83% at Day 12 and 74% at Day 24 to 28.
• Azithromycin was also effective in the treatment of pharyngitis/tonsillitis, with a clinical success rate of 98% at Day 14 and 94% at Day 30. It is essential to note that the treatment approach may vary depending on the specific condition, patient age, and other factors, and should always be determined by a healthcare professional 2.

From the Research

General Treatment Approaches for Common Paediatric Conditions

The treatment of common paediatric conditions, such as acute otitis media (AOM), involves a combination of pharmacological and non-pharmacological interventions.

• Pain Management: For AOM, pain management is a crucial aspect of treatment. Studies have shown that both paracetamol (acetaminophen) and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are effective in relieving pain in children with AOM 3, 4.
• Antibiotic Therapy: Antibiotics are commonly prescribed for AOM, although their use is not without controversy. Some studies suggest that antibiotics may not be necessary for all cases of AOM, and that an expectant observational approach may be justified in some cases 5, 6.
• Watchful Waiting: Watchful waiting, or delayed antibiotic prescribing, is a strategy that involves monitoring the child's condition and only prescribing antibiotics if the condition worsens or fails to improve. This approach has been shown to be effective in reducing the use of antibiotics and minimizing the risk of adverse effects 6, 7.
• Prevention of Complications: Antibiotic treatment can help prevent serious complications of AOM, such as acute mastoiditis and intracranial complications. However, the number needed to treat (NNT) to prevent these complications is high, while the number needed to harm (NNH) is relatively low 7.

Considerations for Treatment

When considering treatment for common paediatric conditions, it is essential to weigh the benefits and risks of different interventions.

• Risk of Adverse Effects: Antibiotics can increase the risk of adverse effects, such as vomiting, diarrhea, and rash 6, 7.
• Development of Antibiotic Resistance: The overuse of antibiotics can contribute to the development of antibiotic resistance, making it essential to use these medications judiciously 5, 6.
• Individualized Care: Treatment should be individualized based on the child's specific needs and circumstances, taking into account factors such as the severity of symptoms, medical history, and parental preferences 3, 4.