「小児肺炎診療ガイドライン」に関する基礎的検討　　６．　　治療の選択

DOI 被引用文献5件 参考文献14件

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  • Management of childhood pneumonia

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Based on clinical symptoms, physical examination and ordinary laboratory findings, it is difficult to distinguish bacterial pneumonia from viral pneumonia.So, it is important to diagnose offending pathogens.<BR>Our study on pathogenic bacteria using a washed sputum culture has revealed that H.influenzaeand S.pneumoniae are major pathogenic bacteria. The clinical results of antimicrobial agents showed that oral administration of amoxicillin (AMPC) and parenteral administration of ampicillin (ABPC) were effective in childhood pneumonia caused by S.pneumoniae with a penicillin G-minimum inhibitory concentration (MIC) of≤2μg/ml and H.influenzae with an ABPC-MIC of≤ 2μg/ml.Now, it is infrequent that S.pneumoniae with a penicillin G-MIC of≥4μg/ml and β-lactamase negative H.influenzae with an ABPC-MIC of≥4μg/ml are clinically isolated from washed sputum culture.AMPC p.o.and ABPC iv are better than β-lactamase-stable new cephems as the initial treatment in childhood pneumonia, because frequent use of new cephems entails the problem of increase in drug-resistant S.pneumoniae (DRSP), β-lactarnase negative ABPC-resistant H.influenzae (BLNAR) and methicillin-resistant S.aureus (MRSA), which become multiple drug resistant with mutation of penicillin-binding proteins.<BR>An increase in the incidence of infection with M.pneumoniae and C.pneumoniae was found in children older than 5 years of age.A macrolides are drug of choice for children in these age.

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