1-P-2
Heikki Peltola, Helsinki
University Central Hospital, Helsinki, Finland Antimicrobial treatments are
loaded with dogmata which often are not based on scientific data. This fact
is emphasized when one treats severe infections such as septicemia,
meningitis, peritonitis, osteoarticular or cardiovascular infections,
severe pneumonia, or other invasive bacterial diseases. Neonatal infections
and those of immunocompromised patients pose problems of their own. Only
after the clinician has answered all the questions listed below, he/she has
fully understood why so many new antimicrobials are developed, why
treatments only increase in price, why resistance problems expand, and why many
patients are treated suboptimally - and not only in poor countries. 1. Why antimicrobic at all? l
Respiratory infections, esp.
URI and otitis media 2. Why not inexpensive penicillin G,
sulphonamides etc.? 3. 90% of patients need 1 agent only l
Unexpected etiology very
rare l
Additive/synergetic effect
rare l
You realize interactions? 4. Why not orally? l
I cephalosporins l
Clindamycin l
Metronidazol l
Ofloxacin l
Chloramphenicol 5. Why so large dose? l
Eagle effect l
Would probenecid be of
value? 6. Why so long course? l
UTI (3-5 days) l
Meningitis (4-7 days) l
Osteomyelitis (3 wks) l
Septic arthritis (2 wks) l
Acute otitis (3-5 d vs.
1 dose vs nihil)
INEXPENSIVE
TREATMENT OF COMMON BUT SEVERE BACTERIAL INFECTIONS OF CHILDHOOD