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Objective: To analyze the main cause of the irresponsible use of antibiotics at the pediatric level in a very frequent, usually self‐limited, and typically viral condition: upper airway respiratory infections. Sources: Different databases were searched using specific terms related to resistance to antibiotics, upper airway respiratory infections, and pediatrics patients. Summary of the findings: Effectiveness varies depending on the place, the form of intervention, and the resources used. Multiple interventions appear to be more effective. The foundations of treatment are training in technical aspects and in communication skills for the prescribers, and having enough time for each patient; and training through the health clinic and the media for patients/parents. Deferred prescription and the use of rapid diagnostic tests in the primary care setting have been shown to be effective. A fluid relationship based on trust between clinicians and parents/guardians is one of the keystones. Conclusions: Any project that seeks to be totally effective must include a health authority, which in addition to helping implement these measures, has the firm intention of drastically reducing the use of antibiotics in animals and in the environment, as well as favoring research into new antimicrobials. Resumo: Objetivo: Analisar a principal causa do uso irresponsável de antibióticos em nível pediátrico de doenças muito frequentes, normalmente autolimitadas e virais: infecções respiratórias das vias aéreas superiores. Fontes: Diferentes bases de dados foram pesquisadas com termos específicos relacionados à resistência a antibióticos, infecções respiratórias das vias aéreas superiores e pacientes de pediatria. Resumo dos achados: A eficácia varia, depende do local, da forma e dos recursos usados. As formas de múltiplas intervenções parecem mais eficazes. O treinamento em aspectos técnicos e habilidades de comunicação para médicos e tempo suficiente para cada paciente, além do treinamento por meio da clínica e da mídia para pacientes/pais, são a base da eficácia. Prescrições de uso posterior e testes de diagnóstico rápido no ambiente de cuidado primário mostraram ser eficazes. Uma relação de confiança entre médicos e pais ou responsáveis é uma das pedras angulares. Conclusões: Qualquer projeto que busque ser completamente eficaz deve incluir uma autoridade em saúde, que, além de ajudar a implantar as medidas nos pacientes, tem a sólida intenção de reduzir drasticamente o uso de antibióticos em animais e no meio ambiente, além de favorecer a pesquisa sobre novos antimicrobianos. Keywords: Antibiotic resistance, Upper airway infections, Children, Palavras‐chave: Resistência antibiótica, Infecções das vias aéreas superiores, Crianças

Resumen: Se presenta una actualización del documento de consenso sobre el diagnóstico y tratamiento de la faringoamigdalitis aguda, publicado en 2011. Las escalas de predicción clínica no deben ser utilizadas para iniciar antibioterapia, salvo que las pruebas microbiológicas no estén disponibles o exista riesgo de fiebre reumática. No existe ninguna escala que sea mejor que las expuestas en el consenso previo. Se proponen casos en los que se recomienda realizar pruebas microbiológicas, con independencia de los resultados de las escalas. El tratamiento de elección de la faringoamigdalitis estreptocócica es penicilina en dos dosis diarias y durante 10 días. Amoxicilina, en una o dos dosis diarias y durante el mismo tiempo, es la primera alternativa terapéutica. Las cefalosporinas de primera generación son el tratamiento de elección en niños con reacción retardada no grave a penicilina o amoxicilina. En reacciones alérgicas inmediatas deben utilizarse antibióticos no betalactámicos, siendo josamicina y diacetil-midecamicina las mejores opciones. En el fracaso terapéutico bacteriológico, y en el estado de portador, los tratamientos planteados en el consenso previo siguen siendo válidos. Abstract: An update of the Spanish consensus document on the diagnosis and treatment of acute tonsillopharyngitis is presented. Clinical scores should not be used to prescribe antibiotics, unless microbiological tests are not available or there is a child at risk of rheumatic fever. There is no score better than those set out in the previous consensus. Microbiological tests are recommended in proposed cases, regardless of the result of the scores. Penicillin is the treatment of choice, prescribed twice a day for 10 days. Amoxicillin is the first alternative, prescribed once or twice a day for the same time. First-generation cephalosporins are the treatment of choice in children with non-immediate reaction to penicillin or amoxicillin. Josamycin and midecamycin are the best options for children with immediate penicillin allergic reactions, when non-beta-lactam antibiotics should be used. In microbiological treatment failure, and in streptococcal carriers, the treatments proposed in the previous consensus are still applicable.

An update of the Spanish consensus document on the diagnosis and treatment of acute tonsillopharyngitis in 2011 is presented. Clinical scores should not be used to prescribe antibiotics, unless microbiological tests are not available or there is a child at risk of rheumatic fever. There is no score better than those set out in the previous consensus. Microbiological tests are recommended in proposed cases, regardless of the result of the scores. Penicillin is the treatment of choice, prescribed twice a day for 10 days. Amoxicillin is the first alternative, prescribed once or twice a day for the same time. First-generation cephalosporins are the treatment of choice in children with non-immediate reaction to penicillin or amoxicillin. Josamycin and midecamycin are the best options for children with immediate penicillin allergic reactions, when non-beta-lactam antibiotics should be used. In microbiological treatment failure, and in streptococcal carriers, the treatments proposed in the previous consensus are still applicable. Resumen: Se presenta una actualización del documento de consenso sobre el diagnóstico y tratamiento de la faringoamigdalitis aguda, publicado en 2011. Las escalas de predicción clínica no deben ser utilizadas para iniciar antibioterapia, salvo que las pruebas microbiológicas no estén disponibles o exista riesgo de fiebre reumática. No existe ninguna escala que sea mejor que las expuestas en el consenso previo. Se proponen casos en los que se recomienda realizar pruebas microbiológicas, con independencia de los resultados de las escalas. El tratamiento de elección de la faringoamigdalitis estreptocócica es penicilina en dos dosis diarias y durante diez días. Amoxicilina, en una o dos dosis diarias y durante el mismo tiempo, es la primera alternativa terapéutica. Las cefalosporinas de primera generación son el tratamiento de elección en niños con reacción retardada no grave a penicilina o amoxicilina. En reacciones alérgicas inmediatas deben utilizarse antibióticos no betalactámicos, siendo josamicina y diacetil-midecamicina las mejores opciones. En el fracaso terapéutico bacteriológico, y en el estado de portador, los tratamientos planteados en el consenso previo siguen siendo válidos.

Urinary tract infection (UTI) is defined as the growth of microorganisms in a sterile urine culture in a patient with compatible clinical symptoms. The presence of bacteria without any symptoms is known as asymptomatic bacteriuria, and does not require any treatment. In neonates and infants, fever is the guiding sign to suspecting a UTI. Classic urinary tract symptoms become more important in older children. Urine cultures collected before starting antibiotics is always required for diagnosis. Clean-catch (midstream) specimens should be collected for urine culture. In the case of non-toilet-trained children, specimens must be obtained by urinary catheterisation, or suprapubic puncture in neonates and infants. Specimens collected by urine bag should not be used for urine culture. There are no significant differences in the clinical evolution and prognosis between oral versus short intravenous followed by oral antibiotic. Empirical antibiotic therapy should be guided by local susceptibility patterns. Second-generation cephalosporin (children under 6 years) and fosfomycin trometamol (over 6 years), are the empiric therapy recommended in this consensus. In the case of pyelonephritis, recommended antibiotic treatment are third-generation cephalosporins (outpatient care) or, if admission is required, aminoglycosides. Ampicillin should be added in infants less than 3 months old. Antibiotic de-escalation should be always practiced once the result of the urine culture is known. Resumen: La infección del tracto urinario se define como el crecimiento de microorganismos en orina recogida de forma estéril, en un paciente con síntomas clínicos compatibles. En ausencia de sintomatología el aislamiento de bacterias en urocultivo se denomina bacteriuria asintomática y no precisa tratamiento. En neonatos y lactantes el signo guía para sospechar una infección del tracto urinario es la fiebre. En niños continentes los síntomas urinarios clásicos cobran mayor importancia. El diagnóstico requiere siempre la recogida de urocultivo previo al inicio de tratamiento antibiótico. En niños continentes la muestra de orina para urocultivo se debe recoger por micción espontánea. En niños no continentes mediante sondaje vesical, pudiendo optar por punción suprapúbica en neonatos y lactantes pequeños. No se debe enviar para urocultivo una muestra recogida mediante bolsa adhesiva. No se han demostrado diferencias significativas en la evolución clínica y desarrollo de secuelas entre la administración antibiótica oral exclusiva frente a la intravenosa de corta duración seguida de administración oral. La selección de la antibioterapia empírica inicial se basará en el patrón local de susceptibilidad. En la cistitis este consenso recomienda el uso empírico de cefalosporinas de segunda generación en menores de 6 años y fosfomicina trometamol en mayores. La antibioterapia empírica recomendada en pielonefritis que no precisan ingreso son las cefalosporinas de tercera generación. En caso de precisar ingreso se recomiendan los aminoglucósidos. En menores de 3 meses se debe añadir ampicilina. Una vez conocido el resultado del cultivo se debe dirigir el tratamiento de continuación, tanto intravenoso como oral.

Resumen: La infección del tracto urinario se define como el crecimiento de microorganismos en orina recogida de forma estéril, en un paciente con síntomas clínicos compatibles. En ausencia de sintomatología el aislamiento de bacterias en urocultivo se denomina bacteriuria asintomática y no precisa tratamiento. En neonatos y lactantes el signo guía para sospechar una infección del tracto urinario es la fiebre. En niños continentes los síntomas urinarios clásicos cobran mayor importancia. El diagnóstico requiere siempre la recogida de urocultivo previo al inicio de tratamiento antibiótico. En niños continentes la muestra de orina para urocultivo se debe recoger por micción espontánea. En niños no continentes mediante sondaje vesical, pudiendo optar por punción suprapúbica en neonatos y lactantes pequeños. No se debe enviar para urocultivo una muestra recogida mediante bolsa adhesiva. No se han demostrado diferencias significativas en la evolución clínica y desarrollo de secuelas entre la administración antibiótica oral exclusiva frente a la intravenosa de corta duración seguida de administración oral. La selección de la antibioterapia empírica inicial se basará en el patrón local de susceptibilidad. En la cistitis este consenso recomienda el uso empírico de cefalosporinas de segunda generación en menores de 6 años y fosfomicina trometamol en mayores. La antibioterapia empírica recomendada en pielonefritis que no precisan ingreso son las cefalosporinas de tercera generación. En caso de precisar ingreso se recomiendan los aminoglucósidos. En menores de 3 meses se debe añadir ampicilina. Una vez conocido el resultado del cultivo se debe dirigir el tratamiento de continuación, tanto intravenoso como oral. Abstract: Urinary tract infection (UTI) is defined as the growth of microorganisms in a sterile urine culture in a patient with compatible clinical symptoms. The presence of bacteria without any symptoms is known as asymptomatic bacteriuria, and does not require any treatment. In neonates and infants, fever is the guiding sign to suspecting a UTI. Classic urinary tract symptoms become more important in older children. Urine cultures collected before starting antibiotics is always required for diagnosis. Clean-catch (midstream) specimens should be collected for urine culture. In the case of non-toilet-trained children, specimens must be obtained by urinary catheterisation, or suprapubic puncture in neonates and infants. Specimens collected by urine bag should not be used for urine culture. There are no significant differences in the clinical evolution and prognosis between oral versus short intravenous followed by oral antibiotic. Empirical antibiotic therapy should be guided by local susceptibility patterns. Second-generation cephalosporin (children under 6 years) and fosfomycin trometamol (over 6 years), are the empiric therapy recommended in this consensus. In the case of pyelonephritis, recommended antibiotic treatment are third-generation cephalosporins (outpatient care) or, if admission is required, aminoglycosides. Ampicillin should be added in infants less than 3 months old. Antibiotic de-escalation should be always practiced once the result of the urine culture is known.

Background: An epidemiological study of Streptococcus pneumoniae nasopharyngeal carriage in healthy children was carried out five years after the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13). Objectives: Study the impact of pediatric vaccination with PCV13, and other associated epidemiological factors on the status of nasopharyngeal carriage, the circulating pneumococcal serotypes, and the antibiotic susceptibility to more frequently used antibiotics. Methods: A multi-center study was carried out in Primary Health Care, which included 1821 healthy children aged 1 to 4 years old. All isolates were sent to the Spanish Pneumococcal Reference Laboratory for serotyping and antimicrobial susceptibility testing. Results: At least one dose of PCV13 had been received by 71.9% of children and carriage pneumococcal prevalence was 19.7%. The proportion of PCV13 serotypes was low (14.4%), with an observed predominance of non-vaccine serotypes, 23B, 11A, 10A, 35B/F, and 23A were the five most frequent. A high rate of resistance to penicillin, erythromycin, and trimethoprim sulfamethoxazole was found. Conclusions: A low proportion of PCV13 serotypes were detected, confirming the impact of pediatric vaccination for reducing the serotypes vaccine carriage. High resistance rates to clinically important antibiotics were observed.

A multifaceted, participatory, open program based on a qualitative and quantitative approach was developed in the Region of Murcia (Spain) aimed to reduce antibiotic use in children under 3 years of age diagnosed with upper respiratory tract infections (acute otitis media, pharyngitis, and common cold). Antibiotic consumption was measured using the defined daily dose per 1000 inhabitants per day (DHD). Pre-intervention data showed a prevalence of antibiotic prescriptions in the primary care setting of 45.7% and a DHD of 19.05. In 2019, after the first year of implementation of the program, antibiotic consumption was 10.25 DHD with an overall decrease of 48% as compared with 2015. Although antibiotic consumption decreased in all health areas, there was a large variability in the magnitude of decreases across health areas (e.g., 12.97 vs. 4.77 DHD). The intervention program was effective in reducing the use of antibiotics in children under 3 years of age with common upper respiratory diseases, but reductions in antibiotic consumption were not consistent among all health areas involved.