Der Merkurstab | März/April 2020 | 16,00 Euro (inkl. Mwst., zzgl. Versandkosten)
Artikel | Community-acquired bacterial pneumonia in a child treated without antibiotics: a case report |
Autoren | Erhard Fujiwara-Pichler, Ulf-Jürgen Beckmann, René Madeleyn |
Seiten | 95-101 |
Volume | 73 |
Zusammenfassung
Introduction: Evolving antibiotic resistance among
bacterial pathogens as well as increasing evidence has
led to a more differentiated use in otitis media and
bacterial sinusitis. In bacterial pneumonia in children,
antibiotics are currently the standard treatment.
The present report describes a pediatric case without
their use, whereas recent literature is only about
adults.
Case presentation: A 4 ½ year old Caucasian boy
presented with community-acquired bacterial pneumonia
(CAP), preceded by a mixed viral and strepto -
coccal throat infection. He had tachypnea, right lung
bronchial breathing, dull percussion over the right
chest wall and a high temperature. There was complete
white-out on a chest X-ray of the right mid and lower
zone. Blood infection markers were high and he had an
accompanying syndrome of inappropriate antidiuretic
hormone hypersecretion. Non-antibiotic treatment
used a combination of supportive measures, including
anthroposophic and homeopathic medications, and
external (phytotherapeutic) applications. This followed
a standard treatment plan (adapted for his state of
disease), successfully used for over 30 years at our
hospital. He required oxygen support for the first night.
His temperature fell continuously, whilst an antipyretic
given once caused transient hypothermia. His vital
parameters showed no deterioration and he clinically
improved steadily. He could be discharged in a stable
condition after 1 week.
Conclusions: Bacterial CAP in a young child without
medical preconditions and in previous good health was
effectively and safely treated without the use of antibiotics.
Important factors are a differentiated decision
process, experienced pediatricians prepared to frequently
reassess the child, nursing staff familiar with
this treatment, parental support and wider public
acceptance of individual treatment plans.
Homeopathic or anthroposophic therapies should
be delivered in appropriate facilities, which are wellprepared,
competent and specialized for this kind of
treatment, including highly trained personnel and
sufficient staffing to reduce the risk of complications
including death. It is clear that without these conditions,
management recommended in such cases is the
administration of antibiotics and related support care.