Antibiotics use

in pediatric patients
.
.

4 2557

Outline
antibiotic

5 Steps use of antibiotics

Step I Diagnosis and severity

Step II Cause (organism)
Step III Host (age, immune)
Step IV Appropriate use (drug, duration)
Step V Communication



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Otitis media
Pharyngitis

Rhinosinusitis

Cough/Bronchitis

Diarrhea




()
(Pharynx)

Otitis media
Rhinosinusitis

Pharyngitis

Cough/Bronchitis




Group A
Beta hemolytic streptocococcus
(GABHS/GAS)




80

(8 10 )

Pharyngitis
Virus (85%)
Bacteria (10-15%)
group A beta-hemolytic Streptococci (GABHS)
Mycoplasma pneumoniae
Chlamydia pneumoniae
Haemophilus influenzae
Moraxella catarrhalis

(8 10 )

Features suggestive of GAS

Acute onset
Very sore throat
Headache
Fever
Absence of coryza

Tonsillar swelling or exudates

Petechiae of soft palate
Age > 3 years

Antibiotic for GAS

Drug

Dose

Duration

Penicillin V

250 mg bid-tid

10 days

Amoxicillin

40-50 mg/kg bid-tid

10 days

Penicillin G

600,000 U IM

Single dose

Erythromycin

40-50 mg/kg tid-qid

10 days

Roxithromycin

100 mg bid

10 days

Allergic to Pen

Redbook 2012

Rhinitis versus sinusitis

Children have 2-9 viral respiratory illnesses/yr

In uncomplicated colds,
cough and nasal discharge may persist for 10 days
after other symptoms have resolved

Characterization of the natural history and time course of fever and

respiratory symptoms associated with an uncomplicated viral upper
respiratory infection (URI) in children

Dr Ellen Wald; adapted from Gwaltney et al. and Rosenfeld at al.

Bacterial or virus
A. 10 days without improvement
B. severe symptoms (facial pain, purulent
discharge and high fever 39 C) 3 days
C. worsening symptoms after 5-6 days
(2nd bacterial inf.)

Risk for resistance

2 years of age
Previous antibiotic exposure ( 3 months)
Daycare attendance
Recent hospitalization past 5 days

Antibiotic selection
1st line
Amox(40-50)
Amox(80-90)

2nd line

3rd line

Amox-clav(80-90)
Cefdinir(14)
Cefuroxime(30)
Cefditoren

Clinda or Amoxy
PLUS
3rd gen ceph
Ceftriaxine(50)

Penicillin allergy
Cephalosporin
OR
Azithro/Clarithro

Clindamycin
PLUS
3rd gen ceph or
TMP/SMX

Duration
Uncomplicated ABRS in adults : 57 days
Children : 1014 days or 7 days after
resolution

Acute otitis media

Virus: 10-40%
RSV, rhinovirus, coronavirus, influenzae virus,
enterovirus and adenovirus

Bacteria :
Streptococcus pneumoniae
H. influenzae
M. catarrhalis

Acute otitis media

Sign/symptom
Ear pain
Fever
Bulging yellow or red tympanic membrane

Treatment

Antibiotic selection
First-line therapy
Treatment Failure
at 48-72 hr

High risk

Low risk

High-dose Amoxicillin
(80-90 MKday) 10 days

Amoxicillin
(40 MKday) 5-7 days

High-dose amoxicillin/clavulanate
(80-90/6.4 MKday)
Cefuroxime(30)
Cefdinir(14)
Ceftriaxone IM(50) x3 days
+/-Tympanocentesis

Risk Factors for AOM Caused

by Resistant Pathogens

2 years of age
Previous antibiotic exposure ( 3 months)
Daycare attendance
Hx AOM

Dowell SF, et al. Pediatr Infect Dis J. 1999;18:1-9.

Chartrand SA, et al. Pediatr Ann. 1998;27:86-95.
Pichichero ME, et al. Ann Otol Rhinol Laryngol. 2000;109:2-12

Cough illness/Bronchitis

Principally caused by viral pathogens

Airway inflammation and sputum production
are non-specific and do not imply a bacterial
etiology

Cough illness/Bronchitis
Do not use antibiotics for:
Cough <10-14 days in well-appearing child
without signs of pneumonia
Consider antibiotics only for:
Suspected pneumonia
Prolonged cough (>10-14 days without
improvement)
Macrolide when mycoplasma is suspected

Acute diarrhea
Virus

Bacteria

Protozoa

Rotavirus

Salmonella

Giardia lamblia

Enteric adenovirus

Shigella

Cryptosporidium

Norwalk-like virus

Vibrio cholerae

E. histolytica

Calicivirus

Clostridium difficile

Strongyloides

Astrovirus

E. coli

Balantidium coli

Coronavirus

Campylobacter
jejuni

Bacteria or virus
Bacteria
High fever (>39C)
Overt faecal blood
Abdominal pain
CNS involvement : irritability, apathy, seizures

Virus
Significant vomiting
Respiratory symptoms

Antibiotic use in acute diarrhea

Shigella dysentery ()
Cholera ()
Salmonella gastroenteritis
Age < 3 months
Immune-compromised
Severe

Antibiotic use in acute diarrhea

Activated charcoal
1 30 . 2-4
2 4

Zinc sulphate oral solution

20 10-14 5

Question?

Thank you