Lecture 10 Pediatric Pharmacology 2.pdf

ANTIBIOTICS 23 § Uses: § Bacterial conjunctivitis § Corneal ulcer § Corneal abrasion § Conjunctivitis 2^ nasolacrimal duct obstruction (NLDO) § Considerations: § Culturing not routine in children § Broad spectrum A b to cover most common bugs § Long acting § C...

ANTIBIOTICS 23 § Uses: § Bacterial conjunctivitis § Corneal ulcer § Corneal abrasion § Conjunctivitis 2^ nasolacrimal duct obstruction (NLDO) § Considerations: § Culturing not routine in children § Broad spectrum A b to cover most common bugs § Long acting § Cost 24  § MOA: Inhibits bacterial DNA gyrase § (1) Ciloxan (Ciprofloxacin 0.3%) – ung or gtt, >2 yrs à cheapest § (2) Ocuflox (Ofloxacin 0.3%) >1 yr § (3) Quixin (Levofloxacin 0.5%) >6 yrs à not typically prescribing § (4) Zymar (Gatifloxacin 0.3%) >1 yr § (4) Vigamox (Moxifloxacin 0.5%) all ages § (4) Moxeza (Moxifloxacin 0.5%) ≥4 mos § (5) Besivance (Besifloxacin 0.6%) >1 yr -don’t memorize the generations all of them! -know which one has the youngest approval, which is the cheapest 25 Aminoglycosides § MOA: Inhibit protein synthesis (30S ribo) § Tobrex (Tobramycin 0.3%) soln and ung; infants ≥ 2 mos à don’t use by itself, usually use in combo § Neomycin (only in combination) – NE § Gentam icin; ≥ 6 years à pediatricians love to use this Macrolides à larger subunit § MOA: Inhibits protein synthesis (50S ribo) § *Erythromycin 0.5%; ung, oral and IV; infants/newborns à ointment so its lubricating § Azasite (Azithromycin 1%); ≥ 1 year; good dosing à BID so tw ice a day but it is expensive so not prescribed as m uch 26 Polytrim (Polymixin B + Bacitracin (ung) Trimethoprim) § MOA: Inhibits bacterial cell wall synthesis § Polymixin B MOA: disrupts § Ung integrity of cell wall membrane § NE § Trimethoprim MOA: inhibits folic acid synthesis Polysporin (Bacitracin + § Approved for ≥ 2 mos Polymixin B) § *MRSA susceptible to § Ung Trimethoprim § NE Mupirocin – skin infections Sulfacetamide 10%, 15% (rarely used) 27 Oral Antibiotics Commonly Used in Children § Penicillins § Inhibit bacterial wall formation § i.e. Amoxicillin, dicloxacillin § C om m on allergy* § Cephalosporin § Similar structure and action in P C N § i.e. cefazolin, cefaclor, ceftriaxone § C om m on allergy* § Macrolides § Erythromycin § Tetracyclines – NOT used in children under age 8: permanent darkening of teeth, delays in osteogenesis 28 -3 YO boy here for urgent vision and eyelid was getting worse by day -preceptal cellulitis formed from hordeolum -pt was sent immediately to the hospital 29 § Septum forms barrier: deep orbital soft tissue v. superficial structures § Inflammation limited by septum: preseptal cellulitis v. posterior to septum: orbital cellulitis 30 § Paranasal sinuses are most common cause of orbital cellulitis § Ethmoidal sinusitis has been reported in 84-100% of orbital cellulitis § Breaches in skin barrier: trauma, insect bites are most common cause of preseptal cellulitis but also adjacent infections: hordeolum, dacryocystitis § Staphylococcus Aureus and Streptococcus bacteria are majority of causes of preseptal or orbital cellulitis 31 § Only ethmoid sinuses are well developed at birth § Maxillary sinus develops within first 2 years but not fully developed until 6 years of age § This explains why almost exclusively, orbital cellulitis is caused by ethmoidal sinusitis in first 5 years of life § Ethmoidal, maxillary, and frontal sinusitis are causes in children over 7 years of age 32 33 § Prescribed empirically, as pathogen is not identified § Typically 2^ local trauma or infection, oral antibiotics are tx of choice § Amoxicillin + Clavulanate (Augmentin) à commonly used § 250-500 mg po TID or 875 mg po BID § Cephalexin (Keflex) § 250-500 mg po TID § Must note PCN and sulfa allergy precautions § If PCN allergy – Azithromycin “Z-Pak” or Levofloxacin § 500mg po § No tetracyclines < 8 years § In severe cases or < 5 years, hospitalization and IV antibiotics are indicated 34 § Nasal decongestants if sinusitis is present § Polysporin or Erythromycin if conjunctivitis present § Abscess § Surgical drainage 35  Internal hordeolum Orbital fracture Amoxicillin/clavulanate (Augmentin) Cephalexin (Keflex) Cephalexin (Keflex) Amoxicillin/clavulanate (Augmentin) Sulfamethoxazole/trimethoprim (Bactrim) Preseptal cellulitis Amoxicillin/clavulanate (Augmentin) Inclusion conjunctivitis Sulfamethoxazole/trimethoprim (Bactrim) Azithromycin Dacryocystitis Posterior blepharitis Amoxicillin/clavulanate (Augmentin) Doxycycline*** Sulfamethoxazole/trimethoprim (Bactrim) Azithromycin Dacryoadenitis Toxoplasmosis Amoxicillin/clavulanate (Augmentin) Sulfamethoxazole/trimethoprim (Bactrim) Cephalexin (Keflex) Hyperacute bacterial conjunctivitis Canaliculitus (nongonococcal) Cephalexin (Keflex) Cephalexin (Keflex) -cheat sheet for peds oral antibiotics -good slide to know! 36  § Follow FDA guidelines § Need to know: § Child’s weight in kilograms § Formulations of medications § Call Pharmacist and/or patient’s Pediatrician § 1tsp = 5mL § E.g. Augmentin: 20-40 mg/kg/day, 3 doses § Determine max and min mg/kg -ex. 5YO and want to prescribe augmentin (weighs 40lbs or 18kg) -20mg/kg * 18kg = 360 mg/day à min -40mg/kg*18kg = 720 mg/day à max -need to prescribe between 360 and 720 and you need prescribe 3 doses and our options are 250 and 500. 250 would be too much so you would cut the 250mg in half and provide 125 3 doses -know how to do this calculation for the final! 37