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Approach to Antimicrobial therapy in paediaterics

Approach to Antimicrobial therapy in paediaterics. By/. Dr. Nagwan Said Mohamed Registrar Paediatrician Paediatric Department . Cedars jebel Ali International Hospital. Case presentation.

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Approach to Antimicrobial therapy in paediaterics

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  1. ApproachtoAntimicrobialtherapyin paediaterics By/ Dr. Nagwan Said Mohamed Registrar Paediatrician PaediatricDepartment. CedarsjebelAli International Hospital

  2. Case presentation • A parent brings her two year old son to your office because of a chief complaint of fussiness and tugging at his right ear for the past two days. He has had coughing and runny nose for about 5 days that has been treated with an over-the-counter cold medicine. He also has a low-grade fever of about 101 degrees axillary (38.3C).for the past two days. Both parents smoke cigarettes. He attends daycare. His past medical history is significant for ear infections in the past, with his last otitis media being 5 months ago treated with amoxicillin. His immunizations are up to date, including heptavalent pneumococcal vaccine. • Exam: VS T 38.4, P 100, RR 28, BP 100/65. He is active, alert to his surroundings and otherwise in no distress. HEENT: Right tympanic membrane is erythematous and bulging with poor mobility ,Left TM is clear with good mobility. Throat is non-erythematous. There are shotty cervical lymph nodes. Lungs are clear to auscultation. The rest of the examination is normal. • He is diagnosed with acute right otitis media. He is prescribed amoxicillin and acetaminophen. A follow-up visit is scheduled in 10 days

  3. Acute Otitis Media

  4. Antibiotics are one of the most important classes of medications prescribed by physicians. • The most important item of information is to be able to use an antibiotic which satis factorily cures the patient of an infection. . Antibiotic therapy is initiated in three basic ways: 1) empiric therapy. 2) specific therapy. 3) prophylaxis.

  5. Empiric therapy is the selection of treatment based on clinical and laboratory information with the exception of culture and sensitivity information. • Specific therapy is the selection of an antibiotic based on the culture and sensitivity testing of the organism causing the infection. • Prophylaxis is the use of antibiotics to prevent an infection which is anticipated .

  6. StepsforempiricalAntibiotictreatment: • Final Diagnosis (systemaffected & Causativeorganism). • Specialsituations. • Follow up.

  7. (1) Final Diagnosis:(localization of systemaffected & organism) It is very important to localize theaffectedsystem in ordertochoosethemostefficientantibioticwithleast adverse effectsonthissystem and thebody.

  8. (1) Final Diagnosis:(localization of systemaffected & organism) I- Respiratory system

  9. (1) Final Diagnosis:(localization of systemaffected & organism) Antibioticsusedforrespiratorytractinfection: * Quinolones are contraindicated for children below 16 years old ?!

  10. (1) Final Diagnosis:(localization of systemaffected & organism) II- Gastrointestinal tract (GIT) Gastroentritis • Causative organisms: • E.coli • Campylobacter. • shigella. • salmonella * Chloramphenicole is not advised nowadays as 1st line for children ?!

  11. (1) Final Diagnosis:(localization of systemaffected & organism) III- Central Nervous system(CNS) Encephalitis & menenigitis • Causative organisms: • In Neonates.GBS.,E.coli,andListeriamonocytogenes. • In Infants and children: S.Pneumoniae,H.influenza,andMeningeococci.

  12. (1) Final Diagnosis:(localization of systemaffected & organism) IV- Urinary tract (UTI) • Causative organisms: • E.coli. • pseudomonas. • Klebsiela.

  13. (2) Specialsituations:

  14. (3) Specificantibioticttt: Prescribing antibiotic therapy should be in terms of:

  15. (3) Specificantibioticttt: Take Care!!! • Oral administration is the rule EXCEPT: • Indications for parentral administrations are: • severe cases ?! • contraindication to oral route e.g. persistent vomiting & diarrhea. • certain drugs available only parentral e.g. 3rd generation cepahlosporine.

  16. (3) Specificantibioticttt:

  17. (3) Specificantibioticttt:

  18. (3) Specificantibioticttt:

  19. (3) Specificantibioticttt:

  20. (4) Follow up:

  21. (4) Follow up: (Sideeffects)

  22. (4) Follow up: (Sideeffects)

  23. Drug rashes (Amoxicillin).

  24. (4) Follow up: (Response)

  25. (4) Follow up: What if no response??!

  26. Don’tforget!! • Empirical antibiotic use is: • Not random. • According to Guidelines. • Combination therapy is indicated to cover both gram +ve and –ve bacteria.

  27. “Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing” Voltaire…

  28. Thank You…

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