Antibiothérapie des infections ORL sévères du nourrisson et de l’enfant : propositions thérapeutiques du Groupe de pathologie infectieuse pédiatrique (GPIP) de la Société française de pédiatrie

The French Group of Pediatric Infectious Diseases (PID) of the French Society of Pediatrics found necessary to issue in 2011 therapeutic proposals concerning antibiotic treatment in severe ENT infections in children (acute mastoiditis, severe sinusitis, peripharyngeal abscess). They took into account, for each clinical situation, published studies and existing guidelines, the most frequently encountered bacterial species, their usual sensitivity to antibiotics, their pharmacokinetic and pharmacodynamic (PK-PD) characteristics. These propositions aim to ensure the proper use of antibiotics and to limit the development of bacterial resistance to antibiotics by minimizing the use of broadspectrum molecules, especially cephalosporins and penems. These infections are often multi microbial and respond to aerobic flora similar to that found in non severe community acquired ENT infections and soft tissue infections ( Streptococcus pyogenes or group A Streptococcus(GAS), Streptococcus pneumoniae, Staphylococcus aureus and Haemophilus influenzae). Anaerobic flora may be associated and implicated in some situations. In most cases, high-dosage of amoxicillin +/- clavulanic acid offers the best PK/PD profile and allows to avoid the overuse of injectable third-generation cephalosporins.