Antibiotics 101 <ul><li>Etiology & Treatment of Bacterial Infections in Children </li></ul>
Antibiotics 101 <ul><li>Preamble </li></ul><ul><li>Keys to Prudent Antibiotic Use </li></ul><ul><li>Specific Recommendatio...
 
 
 
 
 
 
 
 
Keys to Prudent Antibiotic Use <ul><li>Recognize the  probable site of infection </li></ul><ul><li>Know the usual pathogen...
 
Specific Infections <ul><li>Pharyngitis </li></ul><ul><li>Otitis Media & Sinusitis </li></ul><ul><li>Pneumonia </li></ul><...
 
<ul><li>Penicillin V  50 mg/kg/day; Q 6-8 hours </li></ul><ul><li>Benzathine Penicillin 25,000 U/kg </li></ul><ul><li>Ceph...
 
Etiology of Acute Otitis Media <ul><li>Streptococcus pneumoniae </li></ul><ul><li>Nontypeable Haemophilus influenzae </li>...
Spontaneous Bacteriologic Resolution of Acute Otitis Media Pathogen   % Resolved    Day 5 MCAT   75% Haemophilus   50% Pne...
Categories of  S. pneumoniae Susceptible to penicillin  ...........  ≤ 0.06 ug/ml Intermediate to penicillin  ........... ...
Prevalence of “Beta-Lactam Challenged” Pneumococci <ul><li>National average 51% </li></ul><ul><li>< 6 years of age 60% </l...
Oral Antibiotics vs. Penicillin-intermediate  S. pneumoniae
Bacteriologic  Failure  Rates in Acute Otitis Media Antibiotic   Haemophilus  Pneumococcus Amoxicillin 28%   5% Augmentin ...
Recommended Antibiotic Therapy of Acute Otitis Media First Line Amoxicillin     (80-90 mg/kg/day; Q 8-12 hours)  Second Li...
Individualizing Therapy of Acute Otitis Media 5 days of therapy Older child Summer months Otitis-free (or poor) past Mild ...
The diagnosis of acute bacterial sinusitis should be based on clinical criteria in children who present with upper respira...
Suspect Acute Bacterial Sinusitis <ul><li>Persistent Symptoms </li></ul><ul><li>10 – 30 days </li></ul><ul><li>Nasal disch...
Etiology of Acute Sinusitis <ul><li>Streptococcus pneumoniae </li></ul><ul><li>Nontypable Haemophilus influenzae </li></ul...
Therapy of Acute Sinusitis <ul><li>Amoxicillin 45-90 mg/kg/day </li></ul><ul><li>Alternatives:  cefuroxime, cefpodoxime,  ...
 
Etiology of Pneumonia <ul><li>Majority of cases are viral </li></ul><ul><li>If  non-viral, etiology depends on age of pati...
Determinants of Therapy of Pneumonia <ul><ul><li>Age of host </li></ul></ul><ul><ul><li>Laboratory investigations </li></u...
Etiology of Septicemia <ul><li>Neisseria meningitidis </li></ul><ul><li>Streptococcus pneumoniae * </li></ul><ul><li>Haemo...
Therapy of Septicemia <ul><li>Cefotaxime 150 mg/kg/day; Q 6 hours  </li></ul><ul><li>if adolescent , Nafcillin 150 mg/kg/d...
 
Etiology of Bacterial Meningitis <ul><li>Neisseria meningitidis </li></ul><ul><li>Streptococcus pneumoniae  * </li></ul><u...
<ul><li>Cefotaxime 200 mg/kg/day; Q6 hours </li></ul><ul><li>Ceftriaxone 100 mg/kg/day; Q12 hours </li></ul><ul><li>Vancom...
 
Etiology of Cellulitis <ul><li>Streptococcus pyogenes </li></ul><ul><li>Staphylococcus aureus </li></ul>
Therapy of Cellulitis <ul><li>Nafcillin 150 mg/kg/day; Q 6 hours </li></ul><ul><li>Penicillin 100,000 Units/kg/day; Q 6 ho...
 
Etiology of Acute Hematogenous Osteomyelitis <ul><li>Staphylococcus aureus </li></ul><ul><li>Haemophilus influenzae * </li...
<ul><li>Nafcillin </li></ul><ul><li>150 mg/kg/day; Q 6 hours </li></ul><ul><li>In young, “incompletely” vaccinated ,  </li...
 
Etiology of Septic Arthritis <ul><li>Staphylococcus aureus </li></ul><ul><li>Neiserria meningitidis </li></ul><ul><li>Stre...
<ul><li>Cefuroxime 150 mg/kg/day; Q 8 hours </li></ul>Therapy of Septic Arthritis
 
Etiology of Urinary Tract Infections <ul><li>Enterobacteriaceae </li></ul><ul><li>Group D streptococci </li></ul>
<ul><li>Sulfisoxazole </li></ul><ul><li>150 mg/kg/day; Q 6 hours </li></ul><ul><li>If pyelonephritis : </li></ul><ul><li>A...
 
Etiology of Early Onset Neonatal Sepsis <ul><li>Group B streptococci </li></ul><ul><li>Escherichia coli , et al. </li></ul...
<ul><li>Ampicillin 50-200 mg/kg/day; Q 6-12 hours </li></ul><ul><li>Gentamicin 2.5-7.5 mg/kg/day; Q 8-24 hours </li></ul>T...
 
<ul><li>Coagulase negative staphylococci </li></ul><ul><li>Nosocomial enteric organisms </li></ul><ul><li>Group B streptoc...
<ul><li>Vancomycin 15-30 mg/kg/day; Q 8≥24 hours </li></ul><ul><li>Cefotaxime 100-150 mg/kg/day; Q 8-12 hours </li></ul>Th...
 
 
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Antibiotics Etiology & Treatment Of Bacterial Infections In Children

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  • Antibiotics Etiology & Treatment Of Bacterial Infections In Children

    1. 1. Antibiotics 101 <ul><li>Etiology & Treatment of Bacterial Infections in Children </li></ul>
    2. 2. Antibiotics 101 <ul><li>Preamble </li></ul><ul><li>Keys to Prudent Antibiotic Use </li></ul><ul><li>Specific Recommendations </li></ul>
    3. 11. Keys to Prudent Antibiotic Use <ul><li>Recognize the probable site of infection </li></ul><ul><li>Know the usual pathogens </li></ul><ul><li>Know local pathogen sensitivities </li></ul><ul><li>Understand drug kinetics </li></ul><ul><li>Anticipate drug adverse effects </li></ul><ul><li>Limit your personal formulary </li></ul>
    4. 13. Specific Infections <ul><li>Pharyngitis </li></ul><ul><li>Otitis Media & Sinusitis </li></ul><ul><li>Pneumonia </li></ul><ul><li>Septicemia </li></ul><ul><li>Meningitis </li></ul><ul><li>Cellulitis </li></ul><ul><li>Bone & Joint Infections </li></ul><ul><li>Urinary Tract Infections </li></ul><ul><li>Neonatal Infections </li></ul>
    5. 15. <ul><li>Penicillin V 50 mg/kg/day; Q 6-8 hours </li></ul><ul><li>Benzathine Penicillin 25,000 U/kg </li></ul><ul><li>Cephalexin 50 mg/kg/day; Q 6-8 hours </li></ul><ul><li>Clindamycin 30 mg/kg/day; Q 6 hours </li></ul>Therapy of GAS Pharyngitis
    6. 17. Etiology of Acute Otitis Media <ul><li>Streptococcus pneumoniae </li></ul><ul><li>Nontypeable Haemophilus influenzae </li></ul><ul><li>Moraxella catarrhalis </li></ul>
    7. 18. Spontaneous Bacteriologic Resolution of Acute Otitis Media Pathogen % Resolved Day 5 MCAT 75% Haemophilus 50% Pneumococcus 16%
    8. 19. Categories of S. pneumoniae Susceptible to penicillin ........... ≤ 0.06 ug/ml Intermediate to penicillin ........... 0.1-1.0 ug/ml Resistant to penicillin ............ ≥ 2.0 ug/ml
    9. 20. Prevalence of “Beta-Lactam Challenged” Pneumococci <ul><li>National average 51% </li></ul><ul><li>< 6 years of age 60% </li></ul><ul><li>DCC attendance 65% </li></ul><ul><li>Recent Antibiotic Rx 65% </li></ul><ul><li>Some US populations 80% </li></ul>
    10. 21. Oral Antibiotics vs. Penicillin-intermediate S. pneumoniae
    11. 22. Bacteriologic Failure Rates in Acute Otitis Media Antibiotic Haemophilus Pneumococcus Amoxicillin 28% 5% Augmentin 22% 6% Cefaclor 38% 18% Cefuroxime 15% 8% Cefprozil 53% 8% Cefixime 3% 32% Azithromycin 80% 6% Placebo 25-50% 75-85%
    12. 23. Recommended Antibiotic Therapy of Acute Otitis Media First Line Amoxicillin (80-90 mg/kg/day; Q 8-12 hours) Second Line Augmentin (80-90 mg/kg/day; Q 8-12 hours) Cefuroxime (30 mg/kg/day; Q 12 hours) CDC Working Group on DRSP-AOM, 1998
    13. 24. Individualizing Therapy of Acute Otitis Media 5 days of therapy Older child Summer months Otitis-free (or poor) past Mild episode Prompt improvement 10 days of therapy Younger child Winter months Otitis-rich past Severe episode Slow improvement
    14. 25. The diagnosis of acute bacterial sinusitis should be based on clinical criteria in children who present with upper respiratory symptoms that are either persistent or severe.
    15. 26. Suspect Acute Bacterial Sinusitis <ul><li>Persistent Symptoms </li></ul><ul><li>10 – 30 days </li></ul><ul><li>Nasal discharge (any quality) </li></ul><ul><li>Daytime cough (worse at night) </li></ul><ul><li>Fever (variable) </li></ul><ul><li>Headache & facial pain (variable) </li></ul><ul><li>Severe Symptoms </li></ul><ul><li> Temperature > 39 o </li></ul><ul><li> Purulent nasal discharge, 3-4 days </li></ul>
    16. 27. Etiology of Acute Sinusitis <ul><li>Streptococcus pneumoniae </li></ul><ul><li>Nontypable Haemophilus influenzae </li></ul><ul><li>Moraxella catarrhalis </li></ul>
    17. 28. Therapy of Acute Sinusitis <ul><li>Amoxicillin 45-90 mg/kg/day </li></ul><ul><li>Alternatives: cefuroxime, cefpodoxime, cefdinir, clarithromycin, azithromycin </li></ul>
    18. 30. Etiology of Pneumonia <ul><li>Majority of cases are viral </li></ul><ul><li>If non-viral, etiology depends on age of patient </li></ul><ul><li>In neonate , consider causes of sepsis </li></ul><ul><li>In infant , also consider Staphylococcus aureus </li></ul><ul><li>In toddler * , consider Pneumococcus and Haemophilus </li></ul><ul><li>In school aged child , consider Mycoplasma </li></ul><ul><li>* If incompletely vaccinated </li></ul>
    19. 31. Determinants of Therapy of Pneumonia <ul><ul><li>Age of host </li></ul></ul><ul><ul><li>Laboratory investigations </li></ul></ul><ul><ul><li>Severity of infection </li></ul></ul>
    20. 32. Etiology of Septicemia <ul><li>Neisseria meningitidis </li></ul><ul><li>Streptococcus pneumoniae * </li></ul><ul><li>Haemophilus influenzae type b * </li></ul><ul><li>Staphylococcus aureus, if adolescent </li></ul><ul><li> * if incompletely vaccinated </li></ul>
    21. 33. Therapy of Septicemia <ul><li>Cefotaxime 150 mg/kg/day; Q 6 hours </li></ul><ul><li>if adolescent , Nafcillin 150 mg/kg/day; Q 6 hours </li></ul>
    22. 35. Etiology of Bacterial Meningitis <ul><li>Neisseria meningitidis </li></ul><ul><li>Streptococcus pneumoniae * </li></ul><ul><li>Haemophilus influenzae type b * </li></ul><ul><li> </li></ul><ul><li> * if incompletely vaccinated </li></ul>
    23. 36. <ul><li>Cefotaxime 200 mg/kg/day; Q6 hours </li></ul><ul><li>Ceftriaxone 100 mg/kg/day; Q12 hours </li></ul><ul><li>Vancomycin ± rifampin </li></ul><ul><ul><li>60 mg/kg/day; Q 6 hours </li></ul></ul><ul><ul><li>20 mg/kg/day; Q12 hours </li></ul></ul>Therapy of Bacterial Meningitis
    24. 38. Etiology of Cellulitis <ul><li>Streptococcus pyogenes </li></ul><ul><li>Staphylococcus aureus </li></ul>
    25. 39. Therapy of Cellulitis <ul><li>Nafcillin 150 mg/kg/day; Q 6 hours </li></ul><ul><li>Penicillin 100,000 Units/kg/day; Q 6 hours </li></ul><ul><li>± Clindamycin </li></ul><ul><li>40 mg/kg/day; Q 6 hours </li></ul>
    26. 41. Etiology of Acute Hematogenous Osteomyelitis <ul><li>Staphylococcus aureus </li></ul><ul><li>Haemophilus influenzae * </li></ul><ul><li>* If incompletely vaccinated </li></ul>
    27. 42. <ul><li>Nafcillin </li></ul><ul><li>150 mg/kg/day; Q 6 hours </li></ul><ul><li>In young, “incompletely” vaccinated , </li></ul><ul><li>Cefuroxime 150 mg/kg/day; Q 8 hours </li></ul>Therapy of Acute Hematogenous Osteomyelitis
    28. 44. Etiology of Septic Arthritis <ul><li>Staphylococcus aureus </li></ul><ul><li>Neiserria meningitidis </li></ul><ul><li>Streptococcus pneumoniae * </li></ul><ul><li>Haemophilus influenzae type b * </li></ul><ul><li>* If “incompletely” vaccinated </li></ul>
    29. 45. <ul><li>Cefuroxime 150 mg/kg/day; Q 8 hours </li></ul>Therapy of Septic Arthritis
    30. 47. Etiology of Urinary Tract Infections <ul><li>Enterobacteriaceae </li></ul><ul><li>Group D streptococci </li></ul>
    31. 48. <ul><li>Sulfisoxazole </li></ul><ul><li>150 mg/kg/day; Q 6 hours </li></ul><ul><li>If pyelonephritis : </li></ul><ul><li>Ampicillin 150 mg/kg/day; Q 6 hours </li></ul><ul><li>Gentamicin 6 mg/kg/day; Q 8 hours </li></ul>Treatment of Urinary Tract Infections
    32. 50. Etiology of Early Onset Neonatal Sepsis <ul><li>Group B streptococci </li></ul><ul><li>Escherichia coli , et al. </li></ul><ul><li>Listeria monocytogenes </li></ul>
    33. 51. <ul><li>Ampicillin 50-200 mg/kg/day; Q 6-12 hours </li></ul><ul><li>Gentamicin 2.5-7.5 mg/kg/day; Q 8-24 hours </li></ul>Therapy of Early Onset Neonatal Sepsis Dose varies according to weight, gestational age, chronologic age, & site of infection
    34. 53. <ul><li>Coagulase negative staphylococci </li></ul><ul><li>Nosocomial enteric organisms </li></ul><ul><li>Group B streptococci </li></ul><ul><li>Listeria monocytogenes </li></ul>Etiology of Late Onset Neonatal Sepsis
    35. 54. <ul><li>Vancomycin 15-30 mg/kg/day; Q 8≥24 hours </li></ul><ul><li>Cefotaxime 100-150 mg/kg/day; Q 8-12 hours </li></ul>Therapy of Late Onset Neonatal Sepsis Dose varies according to weight, gestational age, chronologic age, & site of infection

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