Pediatrics

Treatment:

• Mostly supportive care
• Ribavirin – only in select patients (complicated congenital heart disease, chronic lung disease, bronchopulmonary dysplasia, immunocompromised patients)
• Beta-agonists or race epinephrine – not usually used
• Corticosteroids, hypertonic saline or antibiotics are also not usually used.

Prophylaxis:

• Palivizumab: 15 mg/kg/dose; prophylaxis is not recommended if > 29 weeks gestation (risk factors not considered)
• Neonates born at less than 29 weeks may get prophylaxis during their 2nd RSV season too. Not based on history alone.
• Discontinue prophylaxis if hospitalized.
• Other factors:
  • Lung disease requiring 21% oxygen or more in 1st 28 days (consider prophylaxis for a second season if lung disease within 6 months of season start)
  • Congenital heart disease that will require surgery, but surgery not yet performed
  • Pulmonary HTN, congenital abnormalities of airway, neuromuscular disease or immunocompromised.

Signs and Symptoms:

• Brudzinski sign and Kernig Sign
• Fever, altered mental status, neck, stiffness, seizures, neurological deficits

Treatment:

• <1-month-old – ampicillin (listeria coverage) and cefotaxime or gent
  Common pathogens: Group B Strep, E. coli, K. pneumoniae, Enterobacter, Listeria monocytogenes
• 1-23 months old – vancomycin and ceftriaxone or cefotaxime
  Common pathogens: S. pneumoniae, N. meningitidis, H. influenzae
• 18-50 years –  vancomycin and ceftriaxone or cefotaxime
  Common pathogens: S. pneumoniae, N. meningitidis
• 50+ or any age with predisposing conditions – vancomycin and ceftriaxone or cefotaxime + ampicillin
  Common pathogens:  S. pneumoniae, N. meningitidis, H. influenzae, Listeria monocytogenes
• Cover pseudomonas in penetrating trauma, post-surgical and shunts: vancomycin and cefepime or meropenam
• Dexamethasone: If used, administer the first dose within 10-20 minutes before or concomitant with first antimicrobial dose. Only continue if S. pneumonia, decreases complicaitions in peds especially.Who gets prophylaxis:
• If H. influenzae or N. meningitidis, household contacts and direct contacts should get prophylaxis.
  • N. meningitidis
    • Rifampin 5-10 BID for 2 days in kids
    • Rifampin 600 mg BID for 2 days in adults
    • Ceftriaxone 125 mg IM times 1 < 15 years old
    • Ceftriaxone 250 mg IM times 1 >15 years old
    • Ciprofloxacin 20 mg/kg up to 500 mg times 1
  • H. influenzae
    • Rifampin 20 mg/kg per dose up to 600 mg times 4 days

Bactrim can replace ampicillin in penicillin allergy

Must Know:

***Remember always treat for S. pneumoniae, N. meningitidis, vanc, except in newborns + a cephalosporin), listeria for the old and young (ampicillin)***

• Analgesia: APAP, NSAIDS, rarely opioids. Avoid ASA in kids.
• Antihistamines and decongestants are not usually recommended.
• Antibiotics only if:
  • Bulging tympanic membrane, perforation or otorrhea
  • Delay unless fever or otalgia > 48-72 hours in kids > 2 years.
  • Not usually for otitis media with effusion, only if greater than 3 months
  • Not for the persistence of middle ear fluid.
• Treatment doses:
  • Amoxil 80-90 mg/kg/day for 7-10 days
  • Azithromycin 10 mg/kg X 1 then 5mg/kg/day for 5 days.
• Common pathogens:
  • Viral
  • S. pneumonia
  • H. influenzae
  • Moraxella catarrhalis