Antimicrobial Treatment in Children: Benefits, Risks, and Resistance Challenges Thesis

Introduction

Antimicrobial treatment has become common due to its success in treating bacterial and fungal diseases. However, there have been cases where the body has developed resistance to certain antimicrobial treatments, rendering them ineffective. An analysis of the most recent research on the subject will yield valuable information. The literature review will cover the uses of antimicrobial treatment in children, potential long-term effects, and methods to mitigate the effects.

Literature Review

Infectious diseases significantly affect children and contribute to high hospitalization rates in pediatric wards. Antibiotics are the most common treatment method for infectious diseases, and they are used at a rate of 37% in pediatric inpatient settings (Lee et al., 2018). The authors used a qualitative type of research, a review of current and relevant literature. Lee et al. (2018) study showed that clinicians had to prescribe antibiotics based on vitro activity and clinical efficacy.

According to Lee et al. (2018), the use of antibiotics has helped drastically reduce the pneumonia mortality rate in children. The study suggested that antibiotic treatment should not be used for mild cases of pneumonia infection as it can cause resistance and that clinicians should analyze the potential side effects before prescribing antibiotics. This also indicates that certain antimicrobial treatments have a higher risk of enhancing resistance in children (Hum & Shaikh, 2019; Melnikova et al., 2019; Pong et al., 2022). Various studies have shown that children are at a higher risk of developing resistance as they are highly prone to infectious diseases (Cooley et al., 2023; Le Saux et al., 2021; Meyer Sauteur et al., 2019). Therefore, the application of antibiotics and antimicrobial treatments has helped prevent child deaths from certain infectious diseases.

The paper by Qiu et al. reviews the research on antibiotics, including their development and history as well as their efficacy. High incidence rates for diseases such as respiratory infections, diarrheal diseases, parasitic and invasive bacterial infections, and chronic conditions contribute to a rise in the use of antimicrobial treatments (Qiu et al., 2020). These substances can be used alone or in conjunction with other treatments. Qiu et al. (2020) investigated the different antimicrobial agents that can be applied to treat dental caries or tooth decay, which is a common oral disease. The study highlighted the potential of antibiotics such as penicillin, macrolides, and clindamycin in treating several bacterial infections. Guidelines for administering antibiotics have helped eliminate risks that were present in the past.

One widely suggested way to eliminate or reduce the side effects is to develop frameworks that help doctors make the best decisions. According to Williams et al. (2018), the World Health Organization (WHO) provides doctors with a guide on how to administer antimicrobial treatments to children and mitigate the rapid increase of antimicrobial resistance in children (Williams et al.,2018). Williams et al. (2018) “systematically reviewed studies of antimicrobial resistance among children in sub-Saharan Africa since 2005” (p. 33). Empowering clinicians to make the right decisions can reduce the incidences of antibiotic resistance (Avilés‐Robles et al., 2020; Luthander et al., 2019). The necessity of expanding surveillance in order to comprehend the prevalence of AMR and create suitable measures has also been emphasized. Williams et al. (2018) note that developing countries face a challenge in addressing the long-term effects of AMR due to the lack of surveillance.

Constant antibiotic usage can affect the gut microbiota, leading to reduced immunity. Holota et al. (2019) evaluated the effects of antibiotic therapy and found that there was a correlation between antibiotic-associated disruption and the development of inflammatory illnesses. The authors conducted an experimental study using rats treated daily for 14 days with antibiotic ceftriaxone (Holota et al., 2019). The study also found that patients exposed to antibiotics had a higher incidence of C-reactive protein, which shows heightened inflammation (Holota et al., 2019). The findings are backed by another study that analyzed the relationship between the use of antibiotics and obesity.

The sources that connect antibiotic usage to obesity were found after a literature search. Leong’s et al. (2018) research article showed that young children had a higher risk of weight gain due to recurrent use of antibiotics. Additionally, the study showed that antibiotics changed the gut microbiota, which led to an increase in obesity (Leong et al., 2018).

The conclusions in the two papers are drawn from experiments with rats, which show that antibiotic use impacts weight gain. Certain long-term effects that are attributed to antimicrobial treatment may be a result of infectious diseases (Hu et al., 2019; Omenako et al., 2022). According to Leong et al. (2018), the presence of an infection in children or adolescents is directly related to increased odds of obesity. This indicates a need to focus on both the causative agent and the potential effects to generate better insights into the type of treatments to provide patients.

The scientific literature notes that, at the moment, there is a limited number of studies on the use of antibiotics in the treatment of children. Vazouras et al. (2020) aimed to “describe antibiotic prescribing patterns and antimicrobial resistance rates in hospitalized children with febrile and afebrile urinary tract infections” (p. 4). By using 230 patients with urinary tract infections and compiling antibiotic prescriptions and antibiograms, the authors obtained evidence of a more substantial bacterium resistant to some antibiotics. Thus, they pointed out the need to introduce monitoring and antimicrobial stewardship programs to limit the occurrence of antibiotic rejection in children.

During the coronavirus pandemic, antimicrobial medicines to treat children have also become particularly widespread and used. Peng et al. (2020) used a Cox proportional hazards regression analysis to gain the most valuable information. Although the number of drugs that can be used for kids was limited, they were successful in treating coronavirus in youngsters. On the other hand, it was noted that further research is required because of the gap in this area.

Of particular importance is gaining awareness about the difference in the length of treatment of patients with antibiotics. Kuitunen et al. (2023) conducted a meta-analysis “to compare short antibiotic treatment (3-5 days) with longer treatment (7-10 days) among children aged ≥6 months” (p. 1123). Using the results of this study and scientific data, the authors concluded that shorter treatment periods are more effective in treating children with community-acquired pneumonia. On the other hand, clearly monitored care with these medications for a longer time can also show positive results but cause more risks.

In addition to resistance, children may also have allergic reactions to certain drugs, which greatly affects the course of treatment. Süleyman et al. (2022), “case-controlled study, we examined 15 patients with CF who had been confirmed with an antibiotic allergy” (p. 2622). After studying a sample of forty-five patients, the authors received confirmation that beta-lactam antibiotic allergy is one of the most common among children.

Acute otitis media is the type of infection that most often leads minors to antibiotic treatment. Mather et al. (2019) conducted a “systematic review and meta-analysis of bacterial prevalence and antimicrobial resistance in studies of pediatric acute otitis media” (p. 102). Thus, they learned about the possible criteria for the occurrence of resistance and pointed out the need for this kind of research for improved antimicrobial stewardship. The seriousness of this issue is that it can lead to a long search for alternative treatment or complete treatment failure.

Conclusion

In conclusion, the issue of antimicrobial treatment in children has elicited different insights from various researchers: There are indications that the use of antibiotics has helped eliminate the mortality of children for certain infectious diseases. However, the continuous use of antibiotics has been found to increase resistance and negatively affect the gut microbiota. The development of antimicrobial resistance is a significant issue that does not have a comprehensive solution.

The review of the literature has proved that children are at a higher risk of developing AMR as they are more prone to developing infectious diseases. The analysis has shown that doctors have a role in ensuring that patients do not develop antimicrobial resistance: clinicians need to understand the potential risks and benefits of a certain medication before prescribing it. Developing enhanced surveillance systems and making antibiotics available via prescription only can ensure the elimination of AMR globally.

References

Avilés‐Robles, M. J., Reyes‐López, A., Otero‐Mendoza, F. J., Valencia‐Garin, A. U., Peñaloza‐González, J. G., Rosales‐Uribe, R. E., Muñoz-Hernández, O., Garduño-Espinosa, J., Juárez-Villegas, L., & Zapata‐Tarrés, M. (2020). Safety and efficacy of step‐down to oral outpatient treatment versus inpatient antimicrobial treatment in pediatric cancer patients with febrile neutropenia: A noninferiority multicenter randomized clinical trial. Pediatric Blood & Cancer, 67(6), e28251. Web.

Cooley, K. M., Fleck-Derderian, S., McCormick, D. W., & Nelson, C. A. (2023). Plague meningitis: A systematic review of clinical course, antimicrobial treatment, and outcomes. Health Security, 21(1), 22-33. Web.

Holota, Y., Dovbynchuk, T., Kaji, I., Vareniuk, I., Dzyubenko, N., Chervinska, T., Zakordonets, L., Stetska, V., Ostapchenko, L., Serhiychuk, T., &Tolstanova, G. (2019). The long-term consequences of antibiotic therapy: Role of colonic short-chain fatty acids (SCFA) system and intestinal barrier integrity. PLoSOne,14(8). Web.

Hu, H. L., Guo, L. Y., Wu, H. L., Feng, W. Y., Chen, T. M., & Liu, G. (2019). Evaluation of next-generation sequencing for the pathogenic diagnosis of children brain abscesses. Journal of Infection, 78(4), 323-337. Web.

Hum, S. W., & Shaikh, N. (2019). Risk factors for delayed antimicrobial treatment in febrile children with urinary tract infections. The Journal of Pediatrics, 205, 126-129. Web.

Kuitunen, I., Jääskeläinen, J., Korppi, M., & Renko, M. (2023). Antibiotic Treatment Duration for Community-Acquired Pneumonia in Outpatient Children in High-Income Countries—A Systematic Review and Meta-Analysis. Clinical Infectious Diseases, 76(3), e1123-e1128. Web.

Lee, H., Yun, K.W., Lee, H. J., & Choi, E. H. (2018). Antimicrobial therapy of macrolide-resistant Mycoplasma pneumoniae pneumonia in children. Expert Review of Anti-Infective Therapy, 16(1), 23-34. Web.

Leong, K. S., Derraik, J. G., Hofman, P. L., & Cutfield, W. S. (2018). Antibiotics, gut microbiome, and obesity. Clinical Endocrinology, 88(2), 185-200. Web.

Le Saux, N. M., Bowes, J., Viel-Thériault, I., Thampi, N., Blackburn, J., Buba, M., Harrison, M.-A., & Barrowman, N. (2021). Combined influence of practice guidelines and prospective audit and feedback stewardship on antimicrobial treatment of community-acquired pneumonia and empyema in children: 2012 to 2016. Paediatrics & Child Health, 26(4), 234-241. Web.

Luthander, J., Bennet, R., Nilsson, A., & Eriksson, M. (2019). Antimicrobial use in a Swedish pediatric hospital: Results from eight point-prevalence surveys over a 15-year period (2003–2017). The Pediatric Infectious Disease Journal, 38(9), 929-933. Web.

Mather, M. W., Drinnan, M., Perry, J. D., Powell, S., Wilson, J. A., & Powell, J. (2019). A systematic review and meta-analysis of antimicrobial resistance in paediatric acute otitis media. International Journal of Pediatric Otorhinolaryngology, 123, 102-109. Web.

Melnikova, E. A., Zaitseva, E. A., Luchaninova, V. N., Krukovich, E. V., Komenkova, T. S., & Feoktistova, Y. V. (2019). Differentiated approaches to the treatment of urinary tract infection in children taking into account the etiological factor Enterococcus faecalis. Pacific Medical Journal, (4), 60-65. Web.

Meyer Sauteur, P. M., Burkhard, A., Moehrlen, U., Relly, C., Kellenberger, C., Ruoss, K., & Berger, C. (2019). Pleural tap-guided antimicrobial treatment for pneumonia with parapneumonic effusion or pleural empyema in children: A single-center cohort study. Journal of Clinical Medicine, 8(5), 698. Web.

Omenako, K. A., Enimil, A., Marfo, A. F. A., Timire, C., Chinnakali, P., Fenny, A. P., Jeyashree, K., & Buabeng, K. O. (2022). Pattern of antimicrobial susceptibility and antimicrobial treatment of neonates admitted with suspected sepsis in a teaching hospital in Ghana, 2021. International Journal of Environmental Research and Public Health, 19(19). Web.

Peng, H., Gao, P., Xu, Q., Liu, M., Peng, J., Wang, Y., & Xu, H. (2020). Coronavirus disease 2019 in children: Characteristics, antimicrobial treatment, and outcomes. Journal of Clinical Virology, 128. Web.

Pong, S., Fowler, R. A., Murthy, S., Pernica, J. M., Gilfoyle, E., Fontela, P., Rishu, A. H., Mitsakakis, N., Hutchison, J. S., Science, M., Seto, W., Jouvet, P., & Daneman, N. (2022). Antimicrobial treatment duration for uncomplicated bloodstream infections in critically ill children: A multicentre observational study. BMC Pediatrics, 22(1), 1-11. Web.

Qiu, W., Zhou, Y., Li, Z., Huang, T., Xiao, Y., Cheng, L., Peng, X., Zhang, L., & Ren, B. (2020). Application of antibiotics/antimicrobial agents on dental caries. BioMed Research International, 20, 5658212-5658212. Web.

Süleyman, A., Tamay, Z., & Güler, N. (2022). Antibiotic allergy in children with cystic fibrosis: A retrospective case–control study. Pediatric Pulmonology, 57(11), 2622-2628. Web.

Vazouras, K., Velali, K., Tassiou, I., Anastasiou-Katsiardani, A., Athanasopoulou, K., Barbouni, A., Jackson, C., Folgori, L., Zaoutis, T., Basmaci, R., & Hsia, Y. (2020). Antibiotic treatment and antimicrobial resistance in children with urinary tract infections. Journal of Global Antimicrobial Resistance, 20, 4-10. Web.

Williams, P. C., Isaacs, D., & Berkley, J. A. (2018). Antimicrobial resistance among children in sub-Saharan Africa. The Lancet Infectious Diseases, 18(2), e33-e44. Web.