By John S. Bradley MD, John D. Nelson MD Emeritus
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Additional info for 2010-2011 Nelson's Pocket Book of Pediatric Antimicrobial Therapy
Reliable follow-up important if only a single dose of benzathine penicillin given Evaluation to determine type and duration of therapy: CSF analysis (VDRL, cell count, protein) CBC and platelet count. Other tests as clinically indicated, including long-bone radiographs, chest radiograph, liver function tests, cranial ultrasound, ophthalmologic exam, and hearing test (auditory brainstem response) Proven or highly probable disease: (1) abnormal physical exam; (2) serum quantitative non treponemal serologic titer that is 4-fold higher than the mother’s titer; or (3) a positive darkfield or fluorescent antibody test of body fluid(s).
38,39 Osteomyelitis33,34,37,43-45 Comments Therapy (evidence grade) Clinical Diagnosis 36 — Skeletal Infections 1/28/10 3:08 PM C. indd 37 Conjunctivitis, acute Polymyxin/trimethoprim ophth soln OR polymyxin/ Other topical antibiotics (gentamicin, erythromycin, (Haemophilus and bacitracin ophth ointment OR tobramycin ophth moxifloxacin, norfloxacin, ofloxacin, levofloxacin) may pneumococcus soln OR ciprofloxacin ophth soln (CII), x 7–10 days offer advantages for particular pathogens (CII) For neonatal infection, see Chapter 5.
Cystic fibrosis, acute Ceftazidime 150–200 mg/kg/day div q6–8h or Larger than normal dosages of antibiotics required in exacerbation piperacillin 300–400 mg/kg/day IV div q4h, AND most patients with cystic fibrosis; monitor peak serum (P aeruginosa primarily; also tobramycin 6–10 mg/kg/day IM, IV div q6–8h (BII). 100,111–114 40–60 mg/kg/day div q8h for S aureus (AIII) Consider H influenzae type b For suspect Mycoplasma/atypical pneumonia agents, pneumococcus: no need to add empiric vancomycin in the unimmunized child.
2010-2011 Nelson's Pocket Book of Pediatric Antimicrobial Therapy by John S. Bradley MD, John D. Nelson MD Emeritus