Empiric antibiotic selection criteria for respiratory infections in pediatric practice

Pediatr Infect Dis J. 1997 Mar;16(3 Suppl):S60-4. doi: 10.1097/00006454-199703001-00007.


Background: Respiratory infections in children may occur as a consequence of resistant bacterial pathogens. Streptococcus pneumoniae organisms resistant to penicillin, trimethoprim/sulfamethoxazole and macrolides are increasingly prevalent. Amoxicillin- and macrolide-resistant Haemophilus influenzae and Moraxella (Branhamella) catarrhalis are also more commonly seen. Traditional agents such as amoxicillin and trimethoprim/sulfamethoxazole remain acceptable choices for most children with respiratory infections because currently most patients are not infected by resistant pathogens and there is a high spontaneous cure rate associated with these infections.

Objective: To analyze the criteria for the selection of extended spectrum antimicrobials as empiric therapy for respiratory infections.

Discussion: When an extended spectrum antimicrobial is appropriate for empiric therapy, selection should be based on: (1) efficacy; (2) adverse event profile; and (3) compliance-enhancing features (dosing with meals, once or twice daily administration, good palatability in suspension, shortened course of therapy and affordability). A new agent, ceftibuten, has recently joined other extended spectrum cephalosporins and newer macrolides (clarithromycin and azithromycin) as a choice to be considered for empiric therapy for respiratory infections. These antimicrobials are differentiated from each other and traditional agents by differences in activity in vitro against penicillin-resistant pneumococci, relative beta-lactamase stability against Gram-negative bacteria and pharmacodynamic properties. When resistant organisms are isolated or suspected in community-acquired respiratory infections, cautious use of newer antibiotics may have to be considered.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / adverse effects
  • Anti-Bacterial Agents / therapeutic use*
  • Bacterial Infections / drug therapy*
  • Ceftibuten
  • Cephalosporins / therapeutic use
  • Child
  • Child, Preschool
  • Drug Resistance, Microbial
  • Drug Therapy / methods
  • Empiricism
  • Humans
  • Patient Compliance
  • Penicillin Resistance
  • Respiratory Tract Infections / drug therapy*
  • Respiratory Tract Infections / microbiology
  • Taste
  • beta-Lactamases / metabolism


  • Anti-Bacterial Agents
  • Cephalosporins
  • beta-Lactamases
  • Ceftibuten