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By Russell W. Steele

Within the care of pediatric sufferers, infectious illnesses include over 50% of the medical diagnoses. as a result, it really is necessary to have a easy knowing of infectious strategies and to maintain abreast of latest advancements within the box. This reference stands as a handy and time-saving reference for clinicians at the prognosis, remedy, and prevention of pediatric infections ailments and is totally up to date to incorporate the most recent instructions from esteemed societies similar to the Infectious illness Society of the USA, the facilities for illness keep an eye on and Prevention, the yank Thoracic Society, and the yank Academy of Pediatrics.

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Treatment, however, must be instituted as early as possible, usually based on clinical suspicion rather than culture results. The treatment prescribed varies with severity of disease as well as duration of symptoms prior to starting treatment (Table 19). Prognosis depends on the patient’s age, the location and extent of the diphtheritic membrane, and the promptness with which antitoxin is given. Consideration must also be given to other persons exposed to the index case; treatment varies with the immune status of these individuals (Table 20).

The course of severe GBS may be influenced by early recognition and the availability of intensive care, in particular ventilatory support (Table 23). With such support, all children with GBS should survive with a favorable outcome. The most common pediatric complications of GBS are respiratory arrest, aspiration pneumonia, autonomic dysfunction, and iatrogenic complications of prolonged ventilation. Intravenous immunoglobulin has been shown to prevent progression of more severe disease and decrease the development of late-stage GBS.

Prognosis depends on the patient’s age, the location and extent of the diphtheritic membrane, and the promptness with which antitoxin is given. Consideration must also be given to other persons exposed to the index case; treatment varies with the immune status of these individuals (Table 20). 1 µg/mL) and does not produce b-lactamase; vancomycin should be used in patients with immediate-type hypersensitivity reactions to b-lactam antibiotics; cefazolin may be substituted for nafcillin or oxacillin in patients with nonimmediate-type hypersensitivity reactions to penicillins Pediatric dose: 40 mg/kg per 24 h IV in 2 or 3 equally divided doses Prosthetic valve Oxacillin-susceptible strains Nafcillin or oxacillin 200 mg/kg per 24 h IV in 4–6 equally divided doses; (Continued ) 24 Pediatric Infectious Disease TABLE 13 Therapy for Endocarditis Caused by Staphylococcus aureus (Continued ) Regimen plus Rifampin plus Gentamicin Oxacillin-resistant strains Vancomycin plus Rifampin plus Gentamicin TABLE 14 Regimen Dosage and route Duration 20 mg/kg per 24 h IV/PO in 3 equally divided doses; ≥6 Comments 3 mg/kg per 24 h IV/IM in 3 equally divided doses 40 mg/kg per 24 h IV in 2 or 3 equally divided doses; ≥6 20 mg/kg per 24 h IV/PO in 3 equally divided doses (up to adult dose); ≥6 3 mg/kg per 24 h IV or IM in 3 equally divided doses 2 Adjust vancomycin to achieve 1-h serum concentration of 30–45 µg/ mL and trough concentration of 10–15 µg/mL (see text for gentamicin alternatives) Therapy for Native Valve or Prosthetic Valve Enterococcal Endocarditis Dosage and route Duration (wks) Comments Caused by strains susceptible to penicillin, gentamicin, and vanconmycin 4–6 Native valve: 4-wk therapy recommended Ampicillin sodium 300 mg/kg per 24 hr IV for patients with symptoms of illness in 4–6 equally divided ≤3 mo; 6-wk therapy recommended for doses; patients with symptoms >3 mo or Aqueous crystalline Penicillin 300,000 U/kg 4–6 Prosthetic valve or other prosthetic cardiac penicillin G sodium per 24 hr IV in 4–6 material: minimum of 6 wk of therapy equally divided doses recommended plus Gentamicin sulfate 3 mg/kg per 24 hr IV/IM 4–6 in 3 equally divided doses Vancomycin 40 mg/kg per 24 hr IV in 6 Vancomycin therapy recommended only hydrochloride 2 or 3 equally divided for patients unable to tolerate penicillin doses or ampicillin plus Gentamicin sulfate 3 mg/kg per 24 hr IV/IM 6 6 wk of vancomycin therapy recommended in 3 equally divided because of decreased activity against doses enterococci (Continued ) 25 Infectious Disease Emergencies with Multiorgan Involvement TABLE 14 Therapy for Native Valve or Prosthetic Valve Enterococcal Endocarditis (Continued ) Regimen Dosage and route Duration (wks) Comments Caused by strains susceptible to penicillin, streptomycin, and vancomycin and resistant to gentamicin Ampicillin sodium 300 mg/kg per 24 hrs IV 4–6 Native valve: 4-wk therapy in 4–6 equally divided recommended for patients with doses; symptoms of illness <3 mo; 6-wk therapy recommended for patients with symptoms >3 mo or 4–6 Aqueous crystalline penicillin 300,000 U/kg penicillin G sodium per 24 hrs IV in 4–6 equally divided doses; plus Streptomycin sulfate streptomycin 20–30 mg/ 4–6 Prosthetic valve or other prosthetic cardiac kg per 24 hrs IV/IM in material: minimum of 6 wk of therapy 2 equally divided recommended doses Vancomycin 40 mg/kg per 24 hrs IV 6 Vancomycin therapy recommended only hydrochloride in 2 or 3 equally for patients unable to tolerate penicillin divided doses or ampicillin plus Streptomycin sulfate 20–30 mg/kg per 24 hrs 6 IV/IM in 2 equally divided doses Caused by strains resistent to pencillin and susceptible to aminoglycoside and vancomycin b-Lactamase–producing strain Ampicillin-sulbactam plus Gentamicin sulfate Vancomycin hydrochloride plus Gentamicin sulfate 300 mg/kg per 24 hrs IV in 4 equally divided doses 6 3 mg/kg per 24 hrs IV/IM in 3 equally divided doses 40 mg/kg per 24 hrs in 2 or 3 equally divided doses; 6 3 mg/kg per 24 hrs IV/IM in 3 equally divided doses gentamicin 3 mg/kg per 24 hrs IV/IM in 3 equally divided doses 6 6 Unlikely that the strain will be susceptible to gentamicin; if strain is gentamicin resistant, then >6 wk of ampicillin-sulbactam therapy will be needed Vancomycin therapy recommended only for patients unable to tolerate ampicillinsulbactam Intrinsic penicillin resistance Vancomycin hydrochloride plus Gentamicin sulfate 40 mg/kg per 24 hrs IV in 2 or 3 equally divided doses 6 3 mg/kg per 24 hrs IV/IM in 3 equally divided doses 6 Consultation with a specialist in infectious diseases recommended (Continued ) 26 TABLE 14 Regimen Pediatric Infectious Disease Therapy for Native Valve or Prosthetic Valve Enterococcal Endocarditis (Continued ) Dosage and route Duration (wks) Comments Caused by strains resistant to penicillin, aminoglycoside, and vancomycin E faecium ≥8 Patients with endocarditis caused by these Linezolid Linezolid 30 mg/kg per strains should be treated in consultation 24 hrs IV/PO in 3 with an infectious diseases specialist; equally divided doses; cardiac valve replacement may be necessary for bacteriologic cure; cure with antimicrobial therapy alone may be <50%; severe, usually reversible thrombocytopenia may occur with use of linezolid, especially after 2 wk of therapy; quinupristin-dalfopristin only effective against E faecium and can cause severe myalgias, which may require discontinuation of therapy; only small no.

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