Professional Documents
Culture Documents
Agenda
Discuss the pharmacological management of the
following pediatric disease states:
1
Case 1
Sepsis/Meningitis - Pathogens
Age Organism
0 - 1 month Group B Streptococcus, E. coli,
Listeria, viral, nosocomial
Case 1
2
Case 1
Case 2
Culture results reveal gram positive cocci in the
cerebral spinal fluid.
Which recommendation regarding antibiotic
prophylaxis is most appropriate?
a. 5-month old sister is at high risk and should
receive rifampin
b. The patient should receive rifampin to
eliminate nasal carriage
c. Antibiotic prophylaxis is not indicated
d. All close contacts should receive rifampin
Page 6
Chemoprophylaxis
3
Case 2
Culture results reveal gram positive cocci in the
cerebral spinal fluid.
Which recommendation regarding antibiotic
prophylaxis is most appropriate?
a. 5-month old sister is at high risk and should
receive rifampin
b. The patient should receive rifampin to
eliminate nasal carriage
c. Antibiotic prophylaxis is not indicated
d. All close contacts should receive rifampin
Page 6
Case 2
Culture results reveal gram positive cocci in the
cerebral spinal fluid.
Which recommendation regarding antibiotic
prophylaxis is most appropriate?
a. 5-month old sister is at high risk and should
receive rifampin
b. The patient should receive rifampin to
eliminate nasal carriage
c. Antibiotic prophylaxis is not indicated
d. All close contacts should receive rifampin
Page 6
Case 3
A baby born at 36 weeks gestation develops
respiratory distress, hypotension, and mottling at
five hours of life. The baby is transported to the
NICU and cultures drawn.
Most appropriate empiric antibiotic regimen?
a. Vancomycin
b. Ampicillin + gentamicin
c. Ampicillin + ceftriaxone
d. Ceftazidime + gentamicin
Page 6
4
Sepsis/Meningitis - Pathogens
Age Organism
0 - 1 month Group B Streptococcus, E. coli,
Listeria, viral, nosocomial
Case 3
A baby born at 36 weeks gestation develops
respiratory distress, hypotension, and mottling at
five hours of life. The baby is transported to the
NICU and cultures drawn.
Most appropriate empiric antibiotic regimen?
a. Vancomycin
b. Ampicillin + gentamicin
c. Ampicillin + ceftriaxone
d. Ceftazidime + gentamicin
Page 6
Case 4
You are screening babies during RSV season
for risk factors associated with the development
of severe RSV infection.
Page 7
5
Case 4
Risk Factors
premature birth
chronic lung disease (CLD)
cyanotic or complicated congenital heart dz
immunodeficiency
airway abnormalities
other: low socioeconomic status, passive
smoking, day care, siblings
Page 7
6
Case 4
Case 4
Case 5
18-month-old with history of premature birth
and CLD is admitted to the PICU with
respiratory distress requiring intubation, fever,
and a 3-dayy historyy of cold-like symptoms.
y p A
nasal swab is positive for respiratory syncytial
virus.
Page 8
7
Case 5
What intervention do you recommend?
a. Palivizumab
b. Corticosteroids
c. Cefuroxime
C f i
d. Intravenous fluids and supportive care
Case 5
What intervention do you recommend?
a. Palivizumab
b. Corticosteroids
c. Cefuroxime
C f i
d. Intravenous fluids and supportive care
Case 6
8
Otitis Media
Common pathogens
viral
Streptococcus pneumoniae
nontypeable Haemophilus influenzae
Moraxella catarrhalis
Page 9
Otitis Media
Treatment Principles
clinical resolution in a significant # of cases
i
immediate
di t antibiotics
tibi ti if b
bulging
l i TM
Case 6
9
Case 6
Case 7
4 yo diagnosed with his 4th case of otitis
media in 12 months. No evidence of hearing
loss or delayed language skills.
Case 7
4 yo diagnosed with his 4th case of otitis
media in 12 months. No evidence of hearing
loss or delayed language skills.
10
Case 8
27 weeks gestation infant received IVIG on
DOL 2. Now 2 months old, still hospitalized and
due for immunizations.
Most appropriate recommendation?
a. All age appropriate vaccines except rotavirus
b. DTaP and Tdap vaccine products are
interchangeable
c. All vaccines should be withheld due to recent
IVIG
d. All vaccines should be withheld until 40
weeks post-conceptional age
Page 11
Immunizations
Page 11
Page 15
11
Page 16
Immunizations
Page 13
Immunizations
Special populations
Preterm infants
immunize based on chronologic age
Imm nocompromised children
Immunocompromised
no live vaccines
Patients receiving corticosteroids
recommendations depend on steroid dose / duration
HIV-infected patients
recommendations depend on degree of
immunocompromise
Page 14
12
Case 8
27 weeks gestation infant received IVIG on
DOL 2. Now 2 months old, still hospitalized and
due for immunizations.
Most appropriate recommendation?
a. All age appropriate vaccines except rotavirus
b. DTaP and Tdap vaccine products are
interchangeable
c. All vaccines should be withheld due to recent
IVIG
d. All vaccines should be withheld until 40
weeks post-conceptional age
Page 11
Case 8
27 weeks gestation infant received IVIG on
DOL 2. Now 2 months old, still hospitalized and
due for immunizations.
Most appropriate recommendation?
a. All age appropriate vaccines except rotavirus
b. DTaP and Tdap vaccine products are
interchangeable
c. All vaccines should be withheld due to recent
IVIG
d. All vaccines should be withheld until 40
weeks post-conceptional age
Page 11
Case 9
a. 12
12-month
month old boy who recently completed a
cycle chemotherapy for ALL
b. 6-month old girl on amoxicillin for otitis media
c. 12-month old, HIV-positive boy with CD4 >1000
d. 12-year old girl completing a prednisone burst
(1 mg/kg/day) for an asthma exacerbation
Page 13
13
Immunizations
Special populations
Preterm infants
immunize based on chronologic age
Imm nocompromised children
Immunocompromised
no live vaccines
Patients receiving corticosteroids
recommendations depend on steroid dose / duration
HIV-infected patients
recommendations depend on degree of
immunocompromise
Page 14
Case 9
a. 12
12-month
month old boy who recently completed a
cycle chemotherapy for ALL
b. 6-month old girl on amoxicillin for otitis media
c. 12-month old, HIV-positive boy with CD4 >1000
d. 12-year old girl completing a prednisone burst
(1 mg/kg/day) for an asthma exacerbation
Page 13
Case 9
a. 12-month
12 month old boy who recently completed a
cycle chemotherapy for ALL
b. 6-month old girl on amoxicillin for otitis media
c. 12-month old, HIV-positive boy with CD4 >1000
d. 12-year old girl completing a prednisone burst
(1 mg/kg/day) for an asthma exacerbation
Page 13
14
Case 10
14 yo moderately obese girl complains of
erythematous pruritic rash. She was started on
oxcarbazepine three weeks ago for partial
seizures. Sexually active + contraception.
Pediatric Seizures
Seizure type Drugs of Choice Alternatives
Partial
VPA, CBZ, PHT PB, Gabapentin, Lamotrigine,
Tiagabine, Topiramate,
Oxcarbazepine, Zonisamide,
Levetiracetam
Generalized
Tonic-clonic
VPA, CBZ, PHT Lamotrigine, Topiramate,
Zonisamide Levetiracetam
Zonisamide,
Myoclonic
VPA Topiramate, Zonisamide,
Levetiracetam
Absence
Ethosuximide, VPA Lamotrigine, Zonisamide,
Levetiracetam
Lennox-Gastaut
VPA, Topiramate, Felbamate, Zonisamide
Lamotrigine
Infantile spasms
ACTH Lamotrigine, tiagabine,
topiramate, VPA, zonisamide
Page 17
Pediatric Seizures
Rash Weight gain
Carbamazepine Valproic acid
Oxcarbazepine Gabapentin
Lamotrigine
Weight loss
Phenytoin
Topiramate
Phenobarbital
Zonisamide
Zonisamide
Cognitive/CNS effects
Menstrual irregularities
Phenobarbital
Valproic acid
Topiramate
Levetiracetam
Page 17 & 18
15
Case 10
14 yo moderately obese girl complains of
erythematous pruritic rash. She was started on
oxcarbazepine three weeks ago for partial
seizures. Sexually active + contraception.
Case 10
14 yo moderately obese girl complains of
erythematous pruritic rash. She was started on
oxcarbazepine three weeks ago for partial
seizures. Sexually active + contraception.
Case 11
9 yo boy is newly diagnosed with ADHD
symptoms at home and school.
16
Drug Therapy for ADHD
Stimulants
Methylphenidate-containing products
Amphetamine-containing products
Non-stimulants
Page 20 - 22
Methylphenidate-containing products
duration of effect
short = Ritalin and Focalin
intermediate = Metadate ER and Ritalin SR
long = Concerta, Metadate CD, Ritalin LA
side effects
insomnia, loss of appetite, headache, may
exacerbate tics
Page 20 - 21
Amphetamine-containing products
duration of effect
Adderall vs. Adderall XR
side effects
insomnia, loss of appetite, nervousness,
exacerbation of hypertension and tics
potential association with sudden cardiac death
Page 21 - 22
17
Drug Therapy for ADHD
Non-stimulant medications
Atomoxetine (Strattera)
potential association with severe liver injury
does not exacerbate tics
Clonidine
more effective for hyperactivity than inattention
lessens the severity of tics
sedation
Guanfacine
sedation and duration than clonidine
Page 22
Case 11
9 yo boy is newly diagnosed with ADHD
symptoms at home and school.
Case 11
9 yo boy is newly diagnosed with ADHD
symptoms at home and school.
18
Case 12
Case 12
Questions
19