Key issues in selecting an antibacterial drug for the treatment of acute respiratory infections in children: A review

Аcute respiratory diseases in children remain an urgent problem in pediatric practice. Most respiratory infections are due to viruses, but some may be due to bacterial pathogens or associations. During the pandemic of a coronavirus infection the number of unjustified prescriptions of antibiotics increased, which significantly complicated the situation with drug resistance of microorganisms and changed the strategy for choosing a starting antibacterial drug in children. Under the current circumstances, timely diagnosis of bacterial inflammation and the adequate choice of drug are the key issues in the practice of a pediatrician. On an outpatient basis it is important for a pediatrician to determine the indications timely and empirically prescribe an effective antibacterial drug. In Russia, in recent years, Federal Clinical Guidelines for various nosologies have been approved, defining indications for systemic antibiotic therapy. According to clinical guidelines, amoxicillin is the first-line antibiotic for most bacterial acute respiratory infections. In addition, there are cohorts of children who are expected to have risk factor as drug-resistant organisms and these children are eligible for protected amoxicillin as a first-line medication. The indications for prescribing macrolides and third-generation oral cephalosporins have fundamentally changed. The article presents the defining indications for systemic antibiotic therapy and the features of the choice of the starting antibacterial drug in children with acute respiratory infections.