Presentacin

Approach to Antimicrobial therapy in paediatericsDr. Nagwan Said MohamedRegistrar PaediatricianPaediatric Department.Cedars jebel Ali International HospitalBy/

Case presentationA 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

Acute Otitis Media

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.

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 .

Steps for empirical Antibiotic treatment:Final Diagnosis (system affected & Causative organism). Special situations.Follow up.

(1) Final Diagnosis:(localization of system affected & organism)It is very important to localize the affected system in order to choose the most efficient antibiotic with least adverse effects on this system and the body.

(1) Final Diagnosis:(localization of system affected & organism)I- Respiratory system

Antibiotics used for respiratory tract infection:

(1) Final Diagnosis:(localization of system affected & organism)* Quinolones are contraindicated for children below 16 years old ?!

(1) Final Diagnosis:(localization of system affected & organism)II- Gastrointestinal tract (GIT)GastroentritisCausative organisms: E.coliCampylobacter. shigella. salmonella* Chloramphenicole is not advised nowadays as 1st line for children ?!

(1) Final Diagnosis:(localization of system affected & organism)III- Central Nervous system(CNS)Encephalitis & menenigitisCausative organisms:In Neonates.GBS.,E.coli,and Listeria monocytogenes.In Infants and children: S.Pneumoniae,H.influenza,and Meningeococci.

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

(2) Special situations:

(3) Specific antibiotic ttt:

Prescribing antibiotic therapy should be in terms of:

(3) Specific antibiotic ttt:

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.

(3) Specific antibiotic ttt:

(3) Specific antibiotic ttt:

(3) Specific antibiotic ttt:

(3) Specific antibiotic ttt:

(4) Follow up:

(4) Follow up:

(Side effects)

(4) Follow up:

(Side effects)

Drug rashes (Amoxicillin).

(4) Follow up:

(Response)

(4) Follow up:

What if no response??!

Dont forget!!Empirical antibiotic use is:

Not random.

According to Guidelines.

Combination therapy is indicated to cover both gram +ve and ve bacteria.

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 nothingVoltaire

Thank You