Pediatrics Flashcards
SIRS & sepsis criteria in children
2/4 of following with at least 1 being temperature or leukocyte count
-Temp >38.5C or <36C
-Tachycardia over 30 min- 4 hours or bradycardia over 30 min
-Tachypnea
-Leukocyte elevation or depression, or >10% immature neutrophils
If active infection - then it is considered sepsis
Septic shock in children
severe sepsis (sepsis + end organ failure, ards) persists AFTER 40ml/kg fluid bolus
Need for vasopressors
metabolic acidosis
oliguria
increased lactacte
prolonged capillary refill
core to peripheral gap >3C
Bacterial VS Viral meningitis CSF in children
WBC:
>1000 (bacterial) 100-500 (viral)
Neutrophils:
>50 (bacterial) >40 (viral)
Glucose:
<30 (bacterial) >30 (viral)
Protein:
>100 (bacterial) 50-100 (viral)
RBC:
0-10 (bacterial) 0-2 (viral)
0-1 month old common pathogens for meningitis/sepsis, preferred empiric tx
Early onset:
GBS* most common
E. coli
L. monocytogenes
Late onset:
Viral
CNS
Gram-negatives (Klebsiella, Pseudomonas, Enterobacter)
Ampicillin + gentamicin
may consider ampicillin + ceftazidime if concern for meningitis
1-3 month old common pathogens for meningitis/sepsis
GBS* most common
E. coli
L. monocytogenes
H. flu (less now b/c of vaccine)
N. meningitidis
S. pneumo
Ampicillin OR vancomycin + ceftriaxone or cefotaxime or ceftazidime
No concern for meningitis = leave out vanco.
3mo-12 year common pathogens for meningitis/sepsis
H. flu (les b/c of vaccine)
N. meningitidis
S. pneumo
Ceftriaxone + vancomycin
Add antipseudomonal agent if nosocomial infection
> 12 y/o common pathogens for meningitis/sepsis
N. meningitidis* most common
S. pneumo
Ceftriaxone + vancomycin
Add antipseudomonal agent if nosocomial infection
Steroids in pediatric meningitis
May reduce hearing loss from Hib only
Administer before or at same time as first antibiotic
Dexamethasone 0.15mg/kg/dose q6H x2days
Ex to use: child with s/s of meningitis has recent Hib exposure
N. meningitidis chemoprophylaxis
Preferred: Rifampin
<1 mo: 5mg/kg/dose q12h x2 days
>=1 mo: 10mg/kg/dose q12h x2 days
Alt: Ceftriaxone 125mg IM (>=15 y/o = 250mg)
Alt: Ciprofloxacin 20mg/kg/dose PO x1
H. flu chemoprophylaxis
<1mo: rifampin 10 mg/kg/dose daily x4 days
>=1 mo: 20 mg/kg/dose daily x4 days
“high risk group” that need chemoprophylaxis from N. meningitidis and H.flu
household contacts
daycare
direct contact w/ secretions 7 days before or 24 hours after ABX
prolonged contact (4-8 hours) in 7 days before
neonatal meningitic symptoms
bulging fontanelle, seizures
infant/children meningitis symptoms
nuchal rigidity, kernig sign, brudzinski sign, photophobia, HA, AMS, seizure, bulging fontanelle
Nirsevimab
MAB indicated for RSV prophylaxis
Indicated for all infants <8mo. during their first RSV season
indicated from 8-19 mo during second RSV season IF high risk factors
<5kg: 50mg
>5kg: 100mg
8-19mo: 200mg
During RSV season (oct -late jan) administer within first week of life
Can administer with other vaccines
Palivizumab
MAB for RSV prophylaxis
ONLY recommended for high risk infants IF nirsevimab is unavailable
High risk = extremely premature, chronic lung disease, congenital heart disease, pulmonary HTN, immunocompromised
15mg/kg/dose IM monthly during RSV season for 5 doses
RSV treatment
Supportive cares
Ribavirin in select high risk patients but routine use not recommended
No treatments are shown to improve outcomes or mortality (bronchodilators, racemic epi, steroids, inhaled hypertonic saline)
Acute Otitis Media definition
Middle ear effusion (bulging tympanic membrane, decreased mobility of tympanic membrane, purulent fluid in middle ear)
PLUS
Evidence of middle ear inflammation
Otitis Media with Effusion (OME)
Fluid in middle ear without evidence of local or systemic illness
Recurrent AOM
> =3 episodes of AOM within 6 months OR
4 episodes within 1 year with 1 episode in past 6 months
When immediate antibiotic therapy warranted for AOM
Bulging tympanic membrane, perforation, otorrhea
Delayed antibiotic prescribing for AOM
> 2 y/o without severe systemic symptoms
or 6mo-2 year if mild and unilateral
Treat only if:
-oltagia x48-72 hours
-temp >102.2F in past 48 hr
Analgesics for otalgia recommended (more beneficial than ABX)
OME treatment
Antibiotics not generally given b/c will spontaneously resolve
Only give if bilateral effusion for more than 3 months
Do not give steroids, antihistamines, or decongestants
First line AOM antibiotics
Amoxicillin 80-90mg/kg/day divided BID
If amox given in past 30 days, give augmentin 14:1
PCN allergy: cefdinir, cefuroxime, cefpodoxime, ceftriaxone (50mg/kg daily x3 days)
If treatment failure can consider clindamycin 10mg/kg q8h +/- 3rd gen cephalosporin
AOM duration
< 2y/o or severe: 10 days
2-5 with mild-moderate symptoms: 7 days
>=6 y/o with mild-mod: 5-7 days
