2015 Nelson's Pediatric Antimicrobial Therapy

263 Pages·2015·2.53 MB·English

by  John S. Bradley

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1. Choosing Among Antibiotics Within a Class: Beta-lactams, Macrolides, Aminoglycosides, and Fluoroquinolones 2
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2. Choosing Among Antifungal Agents: Polyenes, Azoles, and Echinocandins 5 N N N
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3. How Antibiotic Dosages Are Determined Using Susceptibility Data, Pharmacodynamics, and Treatment Outcomes on OH
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4. Community-Associated Methicillin-Resistant Staphylococcus aureus ed
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5. Antimicrobial Therapy for Newborns ic
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6. Antimicrobial Therapy According to Clinical Syndromes tim Nelson’s Pediatric
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7. Preferred Therapy for Specific Bacterial and Mycobacterial Pathogens o
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8. Preferred Therapy for Specific Fungal Pathogens l T
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9. Preferred Therapy for Specific Viral Pathogens py John S. Bradley, MD
10. Preferred Therapy for Specific Parasitic Pathogens 2 EJodihtonr inD C. hNieef lson, MD
11. Alphabetic Listing of Antimicrobials 1
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12. Antibiotic Therapy for Obese Children it
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15. Adverse Reactions to Antimicrobial Agents le
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16. Drug Interactions e William J. Steinbach, MD
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Appendix: Nomogram for Determining Body Surface Area
References
Index
AAP
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2015
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Nelson’s Pediatric
Antimicrobial Therapy
21st Edition
John S. Bradley, MD
Editor in Chief
John D. Nelson, MD
Emeritus
Joseph B. Cantey, MD
David W. Kimberlin, MD
John A.D. Leake, MD, MPH
Paul E. Palumbo, MD
Jason Sauberan, PharmD
William J. Steinbach, MD
Contributing Editors
NELSON 2015.indb 1 12/19/14 3:39 PM
American Academy of Pediatrics Departments of Publishing and Marketing and Sales Staff
Mark Grimes, Director, Department of Publishing
Alain Park, Senior Product Development Editor
Carrie Peters, Editorial Assistant
Sandi King, MS, Director, Division of Editorial and Production Services
Shannan Martin, Publishing and Production Services Specialist
Linda Diamond, Manager, Art Direction and Production
Jason Crase, Manager, Editorial Services
Houston Adams, Digital Content and Production Specialist
Mary Lou White, Director, Department of Marketing and Sales
Linda Smessaert, MSIMC, Brand Manager, Clinical and Professional Publications
Published by the American Academy of Pediatrics
141 Northwest Point Blvd, Elk Grove Village, IL 60007-1019
847/434-4000
Fax: [phone]
www.aap.org
ISSN: 2164-9278 (print)
ISSN: 2164-9286 (electronic)
ISBN: 978-1-58110-918-4
eBook: 978-1-58110-917-7
MA0746
The recommendations in this publication do not indicate an exclusive course of treatment or serve as a
standard of medical care. Variations, taking into account individual circumstances, may be appropriate.
This book has been developed by the American Academy of Pediatrics. The authors, editors, and
contributors are expert authorities in the field of pediatrics. No commercial involvement of any kind
has been solicited or accepted in the development of the content of this publication.
Every effort has been made to ensure that the drug selection and dosages set forth in this text are in
accordance with the current recommendations and practice at the time of the publication. It is the
responsibility of the health care professional to check the package insert of each drug for any change
in indications or dosage and for added warnings and precautions.
Brand names are furnished for identifying purposes only. No endorsement of the manufacturers or
products listed is implied.
Please see our Web site for content-related notices and updates: www.aap.org/nelsonsabx.
Copyright © 2015 John S. Bradley and John D. Nelson
Publishing rights, American Academy of Pediatrics. All rights reserved. No part of this publication may
be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic,
mechanical, photocopying, recording, or otherwise, without prior permission from the authors.
First edition published in 1975.
9-360
1 2 3 4 5 6 7 8 9 10
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iii
Editor in Chief Emeritus
John S. Bradley, MD John D. Nelson, MD
Professor of Pediatrics Professor Emeritus of Pediatrics
Chief, Division of Infectious Diseases, The University of Texas
Department of Pediatrics Southwestern Medical Center at Dallas
University of California, San Diego, Southwestern Medical School
School of Medicine Dallas, TX
Director, Division of Infectious Diseases,
Rady Children’s Hospital San Diego
San Diego, CA
Contributing Editors
Joseph B. Cantey, MD Paul E. Palumbo, MD
Assistant Professor of Pediatrics Professor of Pediatrics and Medicine
Divisions of Neonatology and Infectious Geisel School of Medicine at Dartmouth
Diseases, Department of Pediatrics Director, International Pediatric HIV Program
UT Southwestern Dartmouth-Hitchcock Medical Center
Dallas, TX Lebanon, NH
David W. Kimberlin, MD Jason Sauberan, PharmD
Professor of Pediatrics Assistant Clinical Professor
Codirector, Division of Pediatric University of California, San Diego,
Infectious Diseases Skaggs School of Pharmacy and
Sergio Stagno Endowed Chair in Pharmaceutical Sciences
Pediatric Infectious Diseases Rady Children’s Hospital San Diego
University of Alabama at Birmingham San Diego, CA
Birmingham, AL
William J. Steinbach, MD
John A.D. Leake, MD, MPH Associate Professor of Pediatrics,
Professor of Pediatrics Division of Pediatric Infectious Diseases
Division of Infectious Diseases, Associate Professor of Molecular Genetics
Department of Pediatrics and Microbiology
University of California, San Diego, Director, International Pediatric Fungal
School of Medicine Network
Division of Infectious Diseases, Duke University School of Medicine
Rady Children’s Hospital San Diego Durham, NC
San Diego, CA
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v
Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
1. Choosing Among Antibiotics Within a Class: Beta-lactams, Macrolides,
Aminoglycosides, and Fluoroquinolones ................................................1
2. Choosing Among Antifungal Agents: Polyenes, Azoles, and Echinocandins ......7
3. How Antibiotic Dosages Are Determined Using Susceptibility Data,
Pharmacodynamics, and Treatment Outcomes .......................................13
4. Community-Associated Methicillin-Resistant Staphylococcus aureus ............15
5. Antimicrobial Therapy for Newborns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
A. Recommended Therapy for Selected Newborn Conditions .......................20
B. Antimicrobial Dosages for Neonates. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
C. Aminoglycosides. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
D. Vancomycin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
E. Use of Antimicrobials During Pregnancy or Breastfeeding .......................40
6. Antimicrobial Therapy According to Clinical Syndromes ............................41
A. Skin and Soft Tissue Infections ........................................................43
B. Skeletal Infections .......................................................................47
C. Eye Infections ............................................................................49
D. Ear and Sinus Infections ................................................................52
E. Oropharyngeal Infections ..............................................................55
F. Lower Respiratory Tract Infections ....................................................58
G. Cardiovascular Infections ..............................................................69
H. Gastrointestinal Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
I. Genital and Sexually Transmitted Infections ........................................79
J. Central Nervous System Infections ....................................................83
K. Urinary Tract Infections .................................................................87
L. Miscellaneous Systemic Infections ...................................................88
7. Preferred Therapy for Specific Bacterial and Mycobacterial Pathogens. . . . . . . . . . 95
A. Common Bacterial Pathogens and Usual Pattern of Susceptibility to
Antibiotics (Gram Positive) .............................................................96
B. Common Bacterial Pathogens and Usual Pattern of Susceptibility to
Antibiotics (Gram Negative) ............................................................98
C. Common Bacterial Pathogens and Usual Pattern of Susceptibility to
Antibiotics (Anaerobes). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .100
D. Preferred Therapy for Specific Bacterial and Mycobacterial Pathogens ........102
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vi — Contents
8. Preferred Therapy for Specific Fungal Pathogens ...................................117
A. Overview of Fungal Pathogens and Usual Pattern of Susceptibility
to Antifungals ...........................................................................118
B. Systemic Infections .....................................................................120
C. Localized Mucocutaneous Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .129
9. Preferred Therapy for Specific Viral Pathogens ......................................131
A. Overview of Non-HIV Viral Pathogens and Usual Pattern of
Susceptibility to Antivirals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .132
B. Preferred Therapy for Specific Viral Pathogens. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .133
10. Preferred Therapy for Specific Parasitic Pathogens .................................143
11. Alphabetic Listing of Antimicrobials ...................................................157
A. Systemic Antimicrobials With Dosage Forms and Usual Dosages ...............158
B. Topical Antimicrobials (Skin, Eye, Ear) ...............................................175
12. Antibiotic Therapy for Obese Children ................................................183
13. Sequential Parenteral-Oral Antibiotic Therapy (Oral Step-down Therapy)
for Serious Infections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .187
14. Antimicrobial Prophylaxis/Prevention of Symptomatic Infection ...............189
A. Postexposure Prophylaxis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .191
B. Long-term Symptomatic Disease Prophylaxis .....................................197
C. Preemptive Treatment/Latent Infection Treatment
(“Prophylaxis of Symptomatic Infection”) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .198
D. Surgical/Procedure Prophylaxis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .198
15. Adverse Reactions to Antimicrobial Agents ..........................................203
16. Drug Interactions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .211
Appendix: Nomogram for Determining Body Surface Area ............................215
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
Index ..............................................................................................237
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vii
Introduction
Welcome to the 21st edition: Nelson’s Pediatric Antimicrobial Therapy 2015! Our
collaboration with the American Academy of Pediatrics (AAP) has become stronger
and more integrated as we work closely with our AAP editor, Alain Park. The book is
at a crossroads, trying to decide whether to stay small and concise or to expand and
give our contributing editors free rein to make recommendations as well as tell us all
why the recommendations are being made. In addition, the AAP has interviewed a
number of health care professionals who own this book to provide some valuable advice
on which sections should be expanded and which should be deleted, helping us write a
more focused set of chapters. Along those lines, we have created some new tables that
provide a quick at-a-glance overview of bacterial and fungal pathogen susceptibilities
to commonly used antimicrobials.
The iPhone/iPad app has been very successful. The Android version of the app (which
we have used) was not updated for the 2014 edition of the book, but if we get enough
requests for this version of the app in the future, we may develop one for subsequent
editions. However, we were very pleased to learn in our survey that many still prefer
the book format.
The collective advice and experience of the editors is still backed up by grading our
recommendations: our assessment of how strongly we feel about a recommendation
and the strength of the evidence to support our recommendation (noted below).
Strength of Recommendation Description
A Strongly recommended
B Recommended as a good choice
C One option for therapy that is adequate, perhaps
among many other adequate therapies
Level of Evidence Description
I Based on well-designed, prospective, randomized,
and controlled studies in an appropriate population
of children
II Based on data derived from prospectively collected,
small comparative trials, or noncomparative
prospective trials, or reasonable retrospective data
from clinical trials in children, or data from other
populations (eg, adults)
III Based on case reports, case series, consensus
statements, or expert opinion for situations in
which sound data do not exist
NELSON 2015.indb 7 12/19/14 3:39 PM
viii — Introduction
For this edition, Joseph B. (JB) Cantey is taking over work on Chapter 5, Antimicrobial
Therapy for Newborns, from Pablo Sanchez, whose role on creating the chapter on
newborns goes back decades. We wish Pablo the best of luck in his new position in
Columbus, OH. JB follows in Pablo’s footsteps with expertise as a double-trained
infectious diseases/neonatologist. Jason Sauberan continues to carefully update the
Antimicrobial Dosages for Neonates with the tremendous amount of new information
becoming available. The neonatal pharmacology field gets ever more complicated with
new drugs and our increasing understanding of organ system maturation and drug dis-
tribution. We are very happy to have John van den Anker, a neonatologist/pharmacologist
from Children’s National Medical Center, working with us again this year on the neonatal
dosage table; he is personally responsible for much of the new information we have on
neonatal developmental pharmacology.
We are extremely fortunate to have as editors some of the best clinicians in pediatric
infectious diseases out there. They take the time to partner with the AAP and provide
amazing advice and insight in their particular areas of interest, knowledge, and
experience. David Kimberlin, John Leake, Jason Sauberan, and Bill Steinbach
are each exceptionally talented and collaborative!
As we state each year, many of the recommendations by the editors for specific situations
have not been systematically evaluated in controlled, prospective, comparative clinical
trials. Many of the recommendations may be supported by published data, but for many
possible reasons, the data have never been presented to or reviewed by the US Food
and Drug Administration (FDA) and therefore are not in the package label. We in
pediatrics find ourselves in this situation frequently. Many of us are working closely
with the FDA to try to narrow the gap in our knowledge of antimicrobial agents
between adults and children.
We are deeply grateful for the hard work and tireless efforts of Alain Park, our AAP
senior product development editor, who challenges us to come up with new ways to
share our information with pediatric health care professionals. How about an AAP
Nelson’s Editors’ Infectious Diseases Update continuing medical education program?
We have wonderful supporters in the AAP Departments of Marketing and Publications—
Jeff Mahony, Mark Grimes, Linda Smessaert, and Maureen DeRosa—who make
certain that all our recommendations make it to everyone as effectively and
effortlessly as possible.
John S. Bradley, MD, FAAP
John D. Nelson, MD
NELSON 2015.indb 8 12/19/14 3:39 PM
2015 Nelson’s Pediatric Antimicrobial Therapy — 1
1. Choosing Among Antibiotics Within a Class: Beta-lactams,
1
Macrolides, Aminoglycosides, and Fluoroquinolones
New drugs should be compared with others in the same class regarding (1) antimicro- ones
ol
bial spectrum; (2) degree of antibiotic exposure (a function of the pharmacokinetics of uin
the nonprotein-bound drug at the site of infection and the pharmacodynamic prop- oq
or
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benefit for efficacy or safety, one should opt for using an older, more familiar, and less des, a
expensive drug with the narrowest spectrum of activity required to treat the infection. osi
Beta-lactams oglyc
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Oral Cephalosporins (cephalexin, cefadroxil, cefaclor, cefprozil, cefuroxime, cefixime, Ami
cefdinir, cefpodoxime, cefditoren [tablet only], and ceftibuten). As a class, the oral des,
cephalosporins have the advantages over oral penicillins of somewhat greater safety oli
and greater palatability of the suspension formulations (penicillins have a bitter taste). Macr
The serum half-lives of cefpodoxime, ceftibuten, and cefixime are greater than 2 hours. ms,
Thdflceuofsiiudser s poh phxaeailmfrr- mldeif,aa eycc e iofsfok dlriiin knceeeitrlryi,t c cat efoienfi ab xitenium dmreiecu ,aa cccthecio folpnouosnn,dg tpose axrfr oittmrhi cateuhn, lea at nrhfaldeyc csto eettrfthituaiibmst umt htheeeandyl f ih-mala,i afvweye.h btCeheree egf aaitvcdhleveona rm n,i nctiaed 1gfdp eolr eoro- vez2eia l rr, Class: Beta-lacta
cephalexin and cefadroxil (the “first-generation cephalosporins”) of enhanced coverage n a
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for Haemophilus influenzae (including beta-lactamase–producing strains) and some Wit
ednistaedrivca gnrtaamge- onfe gleastsi vaec tbiavcitiyll ia; ghaoinwsetv Setrr,e cpetftociboucctuens pannedu cmeofinxiiamee t hina np athrtei coutlhaerr hs,a pvae rt-h e biotics
ticularly against penicillin (beta-lactam) non-susceptible strains. None of the currently Anti
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available oral cephalosporins have activity against Pseudomonas or methicillin-resistant n
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Staphylococcus aureus (MRSA). The palatability of generic versions of these products A
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may not have the same pleasant characteristics as the original products. osin
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Parenteral Cephalosporins. First-generation cephalosporins, such as cefazolin, are Ch
used mainly for treatment of gram-positive infections (excluding MRSA) and for
surgical prophylaxis; the gram-negative spectrum is limited. Cefazolin is well tolerated
on intramuscular or intravenous injection.
A second-generation cephalosporin (cefuroxime) and the cephamycins (cefoxitin and
cefotetan) provide increased activity against many gram-negative organisms, particularly
Haemophilus and Escherichia coli. Cefoxitin has, in addition, activity against approxi-
mately 80% of strains of Bacteroides fragilis and can be considered for use in place of
metronidazole, clindamycin, or carbapenems when that organism is implicated in
non–life-threatening disease.
Third-generation cephalosporins (cefotaxime, ceftriaxone, and ceftazidime) all have
enhanced potency against many enteric gram-negative bacilli. They are inactive
against enterococci and Listeria and only ceftazidime has significant activity against
Pseudomonas. Cefotaxime and ceftriaxone have been used very successfully to treat
NELSON 2015.indb 1 12/19/14 3:39 PM