Antibiothérapie des infections à bactéries atypiques de l'enfant

Atypical bacteria responsible for infections in children are mainly Mycoplasma pneumoniae, Chlamydia pneumoniae and Legionella pneumophila. Atypical pneumonia is a frequent disease in children. Until recently, the outcome was thought to be rather benign and antibiotherapy to have only a minor impact on the prognosis. Recent studies have demonstrated that M. pneumoniae and C. pneumoniae were involved in a variety of infections, including acute upper airway disease, otitis and pharyngitis under five. Antibiotherapy was proven able to decrease the rate of complications and recurrence, notably episodes of wheezing and exacerbations of asthma. Atypical bacteria infections may be severe in immunocompromised children and children with underlying disease such as sickle cell anaemia. Whenever bacteriological documentation is lacking, one of the critical issues in choosing an antibiotic is to consider its activity against Streptococcus pneumoniae, especially in lower respiratory tract infections. The main available molecules are reviewed and discussed, with a special emphasis on ketolides, a newer family of molecules active on both atypical bacteria and S. pneumoniae.