Sepsis/Meningitis Peds

Early vs Late Onset

Early onset: within 1st 5 days of life

                  Meningitis <10% of cases

Late onset: after 1st week of life

                 Meningitis >60%

CSF Fluid Values

Normal child

(wbc,neutrophils,glucose,protein,rbc)

• wbc             0-6
• neutrophils      0
• glucose       40-80
• protein        20-30
• rbc               0-2

Sepsis/Meningitis

Common pathogens

0-1 month

• group b strep
• E. coli
• Listeria
• Viral
• Coag-neg staph-nosocomial
• Gm neg bacteria (pseudomonas, enterobacter)-nosocomial
• candida

• H. influenzae
• n. meningitidis
• s. pneumoniae

• N. meningitidis
• S. pneumoniae

Sepsis/Meningitis

Treatment Regimens

0-1 month

ampicillin + gent 

or

ampicillin +cefotaxime

ceftriaxone +/- vanco

add vanco based on regional incidence of resistant s. pneumoniae

Why and who?

• why:  To prevent spread of H.influ and N. meningitidis
• who: high risk groups, household contacts, day care centers, direct contact with index patients secretions

Chemoprophylaxis of Bacterial Meningitis

N. meningitidis

Which Drugs?

Rifampin po

ceftriaxone im

Chemoprophylaxis of Bacterial Meningitis

H. Influ

Which Drugs?

Chemoprophylaxis of Bacterial Meningitis

N. meningitidis

Drug doses per age range (3)

</= 1 month: Rifampin 5mg/kg/dose po 12h x2 days

>1 month: 10mg/kg/dose po q12h x2 daysChemoprophylaxis of Bacterial Meningitis

N. meningitidis

Which Drugs?

 adults: 600mg po q12h 2 days

Ceftriaxone: <12 125mg im x1

                   >12 250mg im x1

Chemoprophylaxis of Bacterial Meningitis

H. Influ

Drug doses?

Rimampin:

20mg/kg/dose (max 600mg)  daily x4 days

Contraindications to receiving vaccines

(6)

Anaphylactic rxn:

      a. Neomycin in inactivated polio,mmr                  varicella

       b. egg proteins in influenza,  (note                     mmr grown in chick embryo                   tissue, egg allergy not a                         contraindication) 

Acute moderate or severe febrile illness

Immunodeficiency with oral polio,mmr                      and varicella

Pregnancy with mmr, varicella

recent admin of immune globulin :                              mmr,varicella

Encephalopathy within 7 days after admin                  of a previous dose of DTap

Misconceptions regarding contraindications to vaccination

(7)

1. Mild acute illness
2. current abx therapy
3. rxn to DTap involving only soreness, redness or swelling at the site
4. pregnancy of the mother of the  vaccine            recipient
5. brestfeeding
6. allergies to abx other than neomycin or streptomycin
7. family hx of an adverse effect after vaccine admin

Vaccine considerations in special populations:

preterm infants

(3)

1. Immunize on the basis of chronologic age
2. do not reduce vaccine doses
3. delay HepB because of reduced response until patient 2kg or older than 30 days unless mother is positive

Vaccine considerations in special populations:

Immunocompromised

(2)

1. should not receive live vaccines                   (mmr,varicella, oral polio,rotavirus)inactivated vaccines & immune globs ok
2. household contacts should not receive         oral polio, but mmr, influenza, varicella     and rotavirus are recommended

Vaccine considerations in special populations:

Receiving corticosteroids

(3)

Live vaccines: may admin to pat  receiving          a. topical steroids

         b. physiologic maint doses

         c. low or mod doses (<2mg/kg/day                 of prednisone equiv.)

Immed after high doses  (>2mg/kg/day) have been discontinued if on for <14 days

1 month after high doses (>2mg/kg/day)

have been discontinued if on for >14 days

Vaccine considerations in special populations:

HIV

(3)

MMR should be admin unless patient            severely immunocompromised

Varicella in asymptomatic or mildly  symptomatic patients

Inactivated vacines should be admin  routinely

Pediatric seizures

 drugs of choice

Partial

Valproic acid

carbamazepine

phenytoin

Pediatric seizures

 drugs of choice

Tonic-Clonic

Valproic acid

caramazepine

phenytoin

Pediatric seizures

 drugs of choice

Myoclonic

Pediatric seizures

 drugs of choice

Absence

Ethosuximide

valproic acid

Pediatric seizures

 drugs of choice

Lennox-Gastaut

valproic acid

topiramate

lamotrigine

Pediatric seizures

 drugs of choice

Infantile spasms

Pediatric seizures

 Alternatives

Partial

phenobarb

gabapentin

lamotrigine

tigabine

topiramate

oxcarbazepine

zonismide

levetiracetam

Pediatric seizures

 Alternatives

Tonic-Clonic

lamotrigine

opiramate

zonisamide

levetiracetam

Pediatric seizures

 Alternatives

Myoclonic

Topriamte

zonisamide

levetiracetam

Pediatric seizures

 Alternatives

Absence

lamotrigine

zonisamide

levetiracetam

Pediatric seizures

 Alternatives

Lennox-Gastaut

Felbamate

zonisamide

Pediatric seizures

 Alternatives

Infantile spasms

Vigabatrin

lamotrigine

tiagabine

topiramate

valproic acid

zonisamide

Phenobarb

Adverse Effects (4)

&

Pharmacokinetic considerations (2)

Adverse Effects

 Cognitive dysfuction

 Sedation

 rash

 Decreased bone density

Pharmacokinetic

 Linear kinetics

 decreased effectiveness of oc

ADHD

Stimulent meds

Methylphenidate

long acting (6)

ADHD

Stimulant

Amphetamine

Mixed amphetamine salts (Adderall XR)

 Duration 10-12 hrs

 may be opened and sprinkled on food

Lisdexamfetamine dimesylate (Vyvanse)

 Duration 10 hrs

ADHD

SCD and  Stimulants

No evidence of causative relationship between stimulants and SCD.

AAP recommends targeted cardiac hx and careful exam before starting.

Routine ECG not recommended unless hx and physical suggest caridac disease

ADHD

Non-Stimulant Meds types

atomoxetine

antidepressants - not FDA approved

  noradrenergic

  tricyclics

alpha-adreneric receptor agonists

  clonidine - not FDA approved

  Guanfacine - FDA approved