By John S. Bradley MD, John D. Nelson MD Emeritus
Read or Download 2010-2011 Nelson's Pocket Book of Pediatric Antimicrobial Therapy PDF
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Additional resources for 2010-2011 Nelson's Pocket Book of Pediatric Antimicrobial Therapy
Cultures are critical. Empiric therapy also monas, and gram-positive based on child’s prior colonization/infection. 5 mg/kg/day IM, IV div q8h (AII), OR cefepime aminoglycoside.
AIII) 21 d. CT scan to confirm cure. 5 mg/kg/day IM, IV, or amikacin 15–20 mg/kg/ alternatives (no clinical data). Very poor outcomes. day IM, IV div q8h x 10–14 d (AIII) Ceftriaxone 50 mg/kg q24h IV, IM (AIII) Treatment course x 10–14 d – Staphylococcal Vancomycin 40 mg/kg/day IV div q8h pending susceptibility testing; oxacillin 150 mg/kg/day IV div q6h if susceptible (AIII) – Empiric therapy following Vancomycin 40 mg/kg/day IV div q8h AND ceftazidime open globe injury 150 mg/kg/day IV div q8h (AIII) Endophthalmitis56,57 NOTE: Subconjunctival/subtenon antibiotics usually needed; steroids commonly used; Refer to ophthalmologist; vitrectomy may be necessary for requires anterior chamber or vitreous tap for microbiological diagnosis advanced endophthalmitis Dacryocystitis No antibiotic usually needed; oral therapy for more Warm compresses; may require surgical probing of symptomatic infection, based on Gram stain and nasolacrimal duct culture of pus; topical therapy as for conjunctivitis may be helpful Conjunctivitis, herpetic54,55 Trifluridine 1% ophth soln OR acyclovir 3% ophth Refer to ophthalmologist.
Indd 25 Wound cleaning and debridement vital IVIG (200–400 mg/kg) is an alternative if TIG not available; equine tetanus antitoxin not available in US but is alternative to TIG Corticosteroids (1 mg/kg/day div q12h) if active chorioretinitis or CSF protein >1 g/dL (AIII) Start sulfa after neonatal jaundice has resolved. Therapy is only effective against active trophozoites, not cysts. Metronidazole IV/PO (alternative: penicillin G IV) x 10–14 d (AIII) Human TIG 3,000–6,000 U IM x 1 (AIII) Sulfadiazine 100 mg/kg/day PO div q12h AND pyrimethamine 2 mg/kg PO daily x 2 (loading dose), then 1 mg/kg PO q24h for 2–6 months, then 3 times weekly (M-W-F) up to 1 yr (AIII) Folinic acid (leukovorin) 10 mg 3 times weekly (AIII) Initial empiric therapy with ampicillin AND gentamicin; OR ampicillin AND cefotaxime pending culture and susceptibility test results x 7–10 days Tetanus neonatorum88 Toxoplasmosis, congenital89,90 Urinary tract infection91 Ampicillin used for susceptible organisms Aminoglycoside needed with ampicillin or vancomycin for bactericidal activity (assuming organisms susceptible to an aminoglycoside).