Abstract:
Acute respiratory infections are the leading group of illnesses with the highest morbidity and mortality rates in children under 5 years of age. Respiratory infections are divided into two types: upper respiratory tract infections and lower respiratory tract infections. Upper respiratory tract infections are usually mild, caused by viruses, self-limiting, do not require antibiotics, and rarely cause death. Lower respiratory tract infections, especially pneumonia, are often severe and can be fatal, mainly in low- and lower-middle-income countries. Community-acquired pneumonia (CAP) in children is caused by a variety of etiology, including viruses and bacteria. These causes are related to the child's age. The younger the child (under 2 years old), the more common causes are respiratory syncytial virus (RSV) and adenovirus. The older the child (over 5 years old), the more common cause is Mycoplasma pneumoniae. The most common bacteria causing community-acquired pneumonia in children are Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Streptococcus spp., and Mycoplasma pneumoniae. Currently, antibiotic resistance in these bacteria is increasing. In particular, penicillin-resistant Streptococcus pneumoniae and beta-lactamase-producing Haemophilus influenzae are showing an increasing trend of resistance to beta-lactam antibiotics. Numerous guidelines exist for the diagnosis, management, and treatment of community-acquired pneumonia in children, including recommendations on which cases require hospitalization and which can be treated on an outpatient basis, as well as the appropriate use of antibiotics. However, adherence to these guidelines remains low. Several factors contribute to this low adherence rate, such as physicians prioritizing the use of broad-spectrum intravenous antibiotics due to concerns about resistance and to meet family expectations or some physicians report limited access to updated clinical guidelines. This leads to unnecessary hospitalizations and inappropriate antibiotic use. Several measures can address low adherence to treatment guidelines, such as updating national guidelines to reflect local antibiotic resistance patterns or strengthening the activities of rational antibiotic use councils in hospitals. These are the main points of this presentation, based on scientific reports from Vietnam as well as from other countries around the world.
