Know the common pathogens of children in sepsis and meningitis.

0–1 month  

  • Group B streptococcus
  • Escherichia coli
  • Listeria monocytogenes
  • Viral (e.g., herpes simplex virus)
  • Coagulase-negative staphylococcus—nosocomial
  • Gram (−) bacteria (e.g., Pseudomonas spp., Enterobacter spp.)
  • nosocomial

1–3 months

  • Neonatal pathogens (see above)
  • Haemophilus influenzae type B
  • Neisseria meningitidis
  • Streptococcus pneumoniae

3 months–12 years

  • H. influenzae type Ba
  • N. meningitidis
  • S. pneumoniae

> 12 years

  • N. meningitidis
  • S. pneumonia

Not to hard to figure out correct?  Keep in mind that H. flu is less and less due to immunizations.  I suppose if you live in an area where vaccination is the devil, you may find more of this organism.

 

Potential Antibiotic Regimens

Age                                                                         Regimen

0–1 month                                                            Ampicillin + gentamicin OR ampicillin + cefotaxime

1–3 months                                                          Ampicillin + cefotaxime/ceftriaxone

3 months–12 years                                             Ceftriaxone ± vancomycina

> 12 years                                                             Ceftriaxone ± vancomycina

**Addition of vancomycin should be based on the regional incidence of resistant S. pneumoniae.

                               

Regimens for Chemoprophylaxis  (I will have to reformat this later)

Drug                      Neisseria meningitidis                                                                       Haemophilus influenzae

Rifampin            < 1 month old: 5 mg/kg/dose PO every 12 hours × 2 days                       20 mg/kg/dose (maximum 600 mg)

> 1 month old: 10 mg/kg/dose PO every 12 hours × 2 days                   daily x 4 days

Adults: 600 mg PO every 12 hours × 2 days

 

 

Ceftriaxone             < 15 years old: 125 mg IM × 1 dose                                                               Not indicated

> 15 years old: 250 mg IM × 1 dose

 

**Ciprofloxacin and azithromycin are possible alternatives although not routinely recommended.

 

RSV – Identify the drugs available for preventing and treating respiratory syncytial virus.

Prophylaxis

  1. Nonpharmacologic: Avoid crowds during RSV season and conscientiously use good hand-washing practice.
  2. RSV IVIG (RespiGam): No longer marketed in the United States (didn’t see on the test ;))
  3. Palivizumab (Synagis)
  • a. Dosing: 15 mg/kg/dose intramuscularly; given monthly during RSV season
  • b. Effects on outcomes

i. A 55% reduction in hospitalizations for RSV

ii. Safe in patients with cyanotic congenital heart disease

iii. No reduction in overall mortality

iv. Does not interfere with the response to vaccines

v. Not recommended for the prevention of nosocomial transmission of RSV

Know this:  Supportive care.  Treatment is supportive care only.

 

American Academy of Pediatrics Palivizumab approval:  (you WILL see this)

 

i. Premature infants born before 32 weeks’ gestation (i.e., 31 weeks, 6 days or earlier) who are 6 months old or younger at the beginning of RSV season

(a) Infants born at less than 28 weeks’ gestation may benefit up to 12 months of age.

(b) Eligible for a maximum of five doses of palivizumab during RSV season

 

ii. Infants with chronic lung disease who are 2 years or younger and who required medical management of their chronic lung disease in the previous 6 months – Eligible for a maximum of five doses of palivizumab during RSV season

 

iii. 32 and 35 weeks’ gestation (i.e., 32 weeks, 0 days through 34 weeks, 6 days) who are 3 months or younger at the beginning of RSV season

(a) With at least one of the following risk factors may benefit: infant attends childcare or sibling younger than 5 yo in same household

(b) Eligible for a maximum of three doses of palivizumab during RSV season

 

iv. Infants 24 months and younger with hemodynamically significant congenital heart disease

(a) Eligible for a maximum of five doses of palivizumab during RSV season

(b) There is a 58% decrease in palivizumab serum concentration after cardiopulmonary bypass; therefore, a postoperative dose of palivizumab is recommended as soon as the patient is medically stable.

 

v. Infants 12 months and younger with congenital abnormalities of the airway or neuromuscular disease that compromises the handling of respiratory tract secretions – Eligible for a maximum of five doses of palivizumab during RSV

 

Tomorrow will continue with otitis media…