Lower respiratory tract infection in hospitalized children

Objective: The aim of the present study was to investigate the aetiology and antibiotic‐resistance patterns of community‐acquired lower respiratory tract infection (LRTI) in 1999 and compare it with data from 1995 and 1988. Methodology: A prospective observational study of LRTI in hospitalized children at KK Women's & Children's Hospital, Singapore, was undertaken. Results: A positive isolate was found in 58% of patients (671/1158), comprising viruses (n = 477, 41.2%), non‐type B Haemophilus influenzae (n = 101, 8.7%), Streptococcus pneumoniae (n = 66, 5.7%), Mycoplasma pneumoniae (n = 92, 8%), Moraxella catarrhalis (n = 19, 1.6%) and other bacteria (n = 19, 1.6%). Mixed virus‐bacteria (n = 104, 9%) infections were comprised mostly of virus‐H. influenzae combinations. In 1999, S. pneumoniae resistance rates were penicillin 44.6% (17%, 1995), amoxycillin 3% (18%, 1995; MIC 0.5–2 µg/mL reclassified as susceptible in 1999), erythromycin 55% (30%, 1995), trimethoprim‐sulfamethoxazole (TMP/SMX) 60% (23%, 1995). H. influenzae resistance rates were amoxycillin 26.7% (38%, 1995), erythromycin 99% (37%, 1995), TMP/SMX 98% (37%, 1995). There were 15 cases of empyema of which seven were proven S. pneumoniae and there was one pneumococcal death (0.08%). Conclusions: Pneumococcal pneumonia needs to be treated aggressively due to its high morbidity. Amoxycillin still remains useful for treating pneumococcus despite an increasing resistance to penicillin, erythromycin and TMP/SMX. Judicious use of antibiotics is needed to curb the increasing rate of antibiotic‐resistance.