Evidence-based Pediatric Infectious Diseases PDF
Preview Evidence-based Pediatric Infectious Diseases
BLUK089-Isaacs June10,2007 10:37 Evidence-based Pediatric Infectious Diseases i BLUK089-Isaacs June10,2007 10:37 Professor David Isaacs ii BLUK089-Isaacs June10,2007 10:37 Evidence-based Pediatric Infectious Diseases By David Isaacs ClinicalProfessorofPaediatricInfectiousDiseases UniversityofSydneyandSeniorStaffPhysician inPediatricInfectiousDiseasesandImmunology TheChildren’sHospitalatWestmead Sydney Australia Consultant Editors: Elizabeth Elliott Ruth Gilbert Virginia Moyer Michael Pichichero iii BLUK089-Isaacs June10,2007 10:37 (cid:2)C 2007DavidIsaacs PublishedbyBlackwellPublishing BMJBooksisanimprintoftheBMJPublishingGroupLimited,usedunderlicence BlackwellPublishing,Inc.,350MainStreet,Malden,Massachusetts02148-5020,USA BlackwellPublishingLtd,9600GarsingtonRoad,OxfordOX42DQ,UK BlackwellPublishingAsiaPtyLtd,550SwanstonStreet,Carlton,Victoria3053,Australia TherightoftheAuthortobeidentifiedastheAuthorofthisWorkhasbeenassertedin accordancewiththeCopyright,DesignsandPatentsAct1988. Allrightsreserved.Nopartofthispublicationmaybereproduced,storedinaretrieval system,ortransmitted,inanyformorbyanymeans,electronic,mechanical, photocopying,recordingorotherwise,exceptaspermittedbytheUKCopyright,Designs andPatentsAct1988,withoutthepriorpermissionofthepublisher. Firstpublished2007 1 2007 LibraryofCongressCataloging-in-PublicationData Isaacs,David,MD. Evidence-basedpediatricinfectiousdiseases/byDavidIsaacs;with consultants,ElizabethElliott...[etal.]. p.;cm. “BMJbooks.” IncludesbibliographicalreferencesandIndex. ISBN978-1-4051-4858-0(pbk.:alk.paper) 1.Communicablediseasesinchildren. 2.Evidence-basedpediatrics. I.Elliott,ElizabethJ.II.Title. [DNLM:1.CommunicableDiseases–Handbooks. 2.Adolescent. 3.Child. 4.Evidence-BasedMedicine–Handbooks. WC39I73e2007] RJ401.I832007 618.92(cid:3)9–dc22 2007008364 ISBN:978-1-4051-4858-0 AcataloguerecordforthistitleisavailablefromtheBritishLibrary Setin9.5/12ptMinionbyAptaraInc.,NewDelhi,India PrintedandboundinSingaporebyUtopiaPressPteLtd CommissioningEditor:MaryBanks EditorialAssistant:VictoriaPittman DevelopmentEditor:LaurenBrindley ProductionController:RachelEdwards ForfurtherinformationonBlackwellPublishing,visitourwebsite: http://www.blackwellpublishing.com Thepublisher’spolicyistousepermanentpaperfrommillsthatoperateasustainable forestrypolicy,andwhichhasbeenmanufacturedfrompulpprocessedusingacid-freeand elementarychlorine-freepractices.Furthermore,thepublisherensuresthatthetextpaper andcoverboardusedhavemetacceptableenvironmentalaccreditationstandards. BlackwellPublishingmakesnorepresentation,expressorimplied,thatthedrugdosagesin thisbookarecorrect.Readersmustthereforealwayscheckthatanyproductmentionedin thispublicationisusedinaccordancewiththeprescribinginformationpreparedbythe manufacturers.Theauthorandthepublishersdonotacceptresponsibilityorlegalliability foranyerrorsinthetextorforthemisuseormisapplicationofmaterialinthisbook. iv BLUK089-Isaacs June10,2007 10:37 Contents Abouttheauthors,vii 11 Osteomyelitisandsepticarthritis,156 Preface,viii 12 Respiratoryinfections,166 Acknowledgements,x 13 Sexuallytransmittedandgenitalinfections,211 Abbreviations,xii 14 Skinandsofttissueinfections,224 15 Systemicsepsis,243 1 Evidence-basedpractice,1 16 Tropicalinfectionsandtravel,256 2 Rationalantibioticuse,9 17 Urinarytractinfections,271 3 Cardiacinfections,14 18 Viralinfections,283 4 Cervicalinfections,29 Appendix1 Renalimpairmentand 5 Eyeinfections,40 antimicrobials,299 6 Fever,55 Appendix2 Aminoglycosides:dosingand monitoringbloodlevels,301 7 Gastrointestinalinfections,74 Appendix3 Antimicrobialdrugdose 8 HIVinfection,102 recommendations,306 9 Immunedeficiency,117 Index,321 10 Meningitisandcentralnervoussystem infections,132 v BLUK089-Isaacs June10,2007 10:37 About the authors DavidIsaacsisaseniorstaffphysicianinpediatricin- mosis, and for neonatal group B streptococcal infec- fectious diseases and immunology at The Children’s tion.SheiscoauthorofEvidence-BasedPediatricsand Hospital at Westmead, Sydney, and Clinical Profes- ChildHealth,byMoyerVetal.Ruthteachesevidence- sorofPaediatricInfectiousDiseasesattheUniversity basedmedicine,haspublishedCochranereviews,and of Sydney. He has published 10 books and over 200 isareviewerfortheCochraneCollaboration. peer-reviewedpublications.Hisresearchinterestsare MichaelE.PichicheroisProfessorofMicrobiologyand neonatal infections, respiratory virus infections, im- Immunology,PediatricsandMedicineattheUniver- munizations, and ethics. He has published also on sityofRochesterinNewYork.Heisboardcertifiedin medicalethicsandseveralhumorousarticles.Professor pediatrics,inadultandpediatricallergyandimmunol- Isaacsisonmultiplenationalandinternationalcom- ogy,andinpediatricinfectiousdisease.Dr.Pichichero mitteesoninfectiousdiseasesandimmunizationsand is a partner in the Elmwood Pediatric Group; a re- isareviewerfortheCochraneCollaboration. cipientofnumerousawards,hehasover500publica- ElizabethElliottisProfessorofPaediatricsandChild tions in infectious disease, immunology, and allergy. Health, University of Sydney; Consultant Paediatri- His major practice and research interests are in vac- cian,TheChildren’sHospitalatWestmead;Director, cinedevelopment,streptococcalinfections,andotitis CentreforEvidenceBasedPaediatrics,Gastroenterol- media. ogyandNutrition;andPractitionerFellow,National VirginiaMoyerisProfessorofPediatricsandSection HealthandMedicalResearchCouncilofAustralia.She Head,AcademicGeneralPediatricsatBaylorCollege is Director of the Australian Paediatric Surveillance ofMedicineandTexasChildren’sHospitalinHouston, UnitandpastConvenoroftheInternationalNetwork Texas. Dr. Moyer has particular interests in teaching of Paediatric Surveillance Units. She is Senior Asso- clinical epidemiology and studying the use of diag- ciateEditorandco-authorofEvidenceBasedPediatrics nostic tests in clinical care. She is a member of the andChildHealth(MoyerV,ed.,BMJBooks2000,2nd Evidence-BasedMedicineWorkingGroup,theUnited edition,2004). StatesPreventiveServicesTaskForce,andtheInterna- Ruth Gilbert is Reader in Clinical Epidemiology at tionalAdvisoryBoardfortheCochraneCollaboration the Institute of Child Health, London, having com- ChildHealthField.SheisEditorinChiefofthebook pletedhertraininginpediatrics.Shehaspublishedex- Evidence-BasedPediatricsandChildHealth(2ndedi- tensively on the epidemiology of infectious diseases, tion), and the journal Current Problems in Pediatrics both original papers and textbooks. She coordinates andAdolescentHealthCare,andisafoundingAssociate researchprogramsontheevaluationofscreeningand EditorofEvidence-BasedChildHealth:ACochraneRe- diagnostictestsandtreatmentforcongenitaltoxoplas- viewJournal. vii BLUK089-Isaacs June10,2007 10:37 Preface Somebooksprovidecomprehensiverecommendations changedwithincreasingemphasisonrandomizedcon- withoutgivingtheevidence.Somebooksprovidecom- trolledtrials,meta-analysesofrandomizedcontrolled prehensiveevidencewithoutgivinganyrecommenda- trials,systematicreviewsoftheevidenceandtherig- tions. orousapproachtoassessingthequalityofrandomized There is a tension between providing useful man- controlledtrialsincludedintheCochranereviews,and agementrecommendationsandbetweenprovidingde- withtheavailabilityofelectronicsearchenginestofind tailedevidencethatallowsclinicianstomaketheirown theevidence. decisions.Booksonmanaginginfections,liketheex- SomehaveespousedEBMwholeheartedlyandeven, cellentAntibioticGuidelines1andtheRedBook,2give dareonesayit,somehaveadvocatedituncritically.It recommendationsaboutwhichantibioticstouseand hasbeenfuntosatirizethisoveremphasisonEBM.4,5In thedoses,butnottheevidencesupportingtherecom- reality,EBMhasstrengthsandweaknesses.Weshould mendations. This is deliberate, to keep the books to useitsstrengthswhileacknowledgingitsweaknesses. a manageable length. In contrast, books such as that When evidence is lacking, we still need to decide editedbyVirginiaMoyer3 attempttoanalyzetheevi- what to do with our patient. In infectious diseases, denceforclinicaldecisionsindepth.Sourcesofsum- do we give antibiotics now or watch carefully? What marizedevidence,suchastheBMJ’simportantClini- aboutadjunctivetherapy,steroids,orintravenousim- calEvidenceseries,providedetailedevidencewithout munoglobulin,whichmighthelpincriticalsituations? recommendationsandleaveittothebusyclinicianto ReadinganyofthespateofPracticeGuidelinespub- weightheevidencepresentedanddecideabouttreat- lishedrecentlyissobering,becausesomanyoftherec- ment. While helpful, the depth of the analysis of the ommendationsarebasedon“consensusexpertopin- evidencemeansthatthesesourcescandealonlywitha ion”intheabsenceofgoodtrialdata. limitednumberofclinicalsituations. Inthisbookwepresenttheevidenceformanagement The fundamental principle of the current book is ofmanypediatricinfectiousdiseasesaffectingchildren tocombinethestrengthsofbothapproaches,byan- in industrialized and developing countries, travelers, alyzingtheevidenceonmanagement(treatmentand, andrefugees.Ourrecommendationsarebasedoncur- whererelevant,diagnosisandprevention)ifthisiscon- rent evidence about efficacy and safety, but also the troversialoruncertain,presentingtheevidencebriefly likelyeffectsonantibioticresistance,thecosts,adverse and then our recommendations about management. effects,ethicalandanyotherrelevantconsiderations. Thebusycliniciancanthenweighupthestrengthofthe DavidIsaacs evidenceforourrecommendations,anddecidehowto act.Clinicianscanalsoreviewtheliteraturethemselves, iftheyhavetime. References Evidence-basedmedicine(EBM)hasgreatstrengths. Foryears,manyofusthoughtwewerepractisingEBM, 1 TherapeuticGuidelinesLtd.TherapeuticGuidelines:Antibiotic, butthebestevidencewasnoteasilyaccessible.Thathas 13thedn.Melbourne:TherapeuticGuidelinesLtd.,2006. viii BLUK089-Isaacs June10,2007 10:37 Preface 2 AmericanAcademyofPediatrics.In:PickeringLK(ed.),Red 4 IsaacsD,FitzgeraldD.Sevenalternativestoevidence-based Book:2003ReportoftheCommitteeonInfectiousDiseases,26th medicine.BMJ1999;319:1618. edn.ElkGroveVillage,IL:AmericanAcademyofPediatrics, 5 SmithGCS,PellJP.Parachuteusetopreventdeathandma- 2003. jortraumarelatedtogravitationalchallenge:systematicre- 3 MoyerVA,(ed).Evidence-BasedPediatricsandChildHealth, view of randomised controlled trials. BMJ 2003;327:1459– 2ndedn.London:BMJBooks,2004. 61. ix BLUK089-Isaacs June10,2007 10:37 Acknowledgements Wewouldliketothankthefollowingforreadingchap- from the fields of infectious diseases, microbiology, ters and for their helpful comments: Henry Kilham, tropical medicine, general practice, and pharmacol- generalpediatricianatTheChildren’sHospitalatWest- ogy,meetsregularlytoreviewtheevidenceanddiscuss mead (CHW), Sydney, Australia; Elisabeth Hodson treatment. andJonathanCraig,pediatricnephrologistsatCHW; TherecommendationsinTGAfocusalmostentirely David Schell, pediatric intensivist at CHW; Alyson on antimicrobial use, rather than diagnosis or other KakakiosandMelanieWong,pediatricimmunologists aspectsofmanagement.Whilethebookyouarecur- atCHW;AlisonKesson,microbiologistandinfectious rently reading has considered the evidence indepen- diseasesspecialistatCHW;PeterShaw,oncologistat dently of TGA, and also addresses diagnosis and ad- CHW; Paul Tait, child protection specialist at CHW; junctivetherapies,thepresentationofantibioticdoses ChrisBlyth,pediatricimmunologyandinfectiousdis- giveninboxedformatusesanalmostidenticalformat eases physician at Sydney Children’s Hospital; Rana tothatusedbyTGA,andwewouldliketoacknowledge Chakraborty,pediatricinfectiousdiseasesspecialistat this.Wehaveadoptedthisformat,whichhasevolved StGeorge’sHospital,London;MaryIsaacs(neeCum- over28years,becauseitexpressessoclearlyandun- mins), general pediatrician at Ealing Hospital, UK; ambiguously which antibiotics should be prescribed AnnaIsaacs,medicalstudentatSydneyUniversityand andhowoften.Inaddition,theactualpediatricdoses EmilyIsaacs,medicalstudentatBirminghamUniver- werecommendaresimilarbutnotalwaysidenticalto sity,UK. thoseusedinTGA.DIwouldliketoacknowledgehis DIhasbeenamemberofthewritinggroupforthe indebtednesstohiscolleaguesontheTGAcommittees book Therapeutic Guidelines: Antibiotic (TGA) from fortheirwisdomandexperience,sharedsoselflessly. 1994,whenthe8theditionwaspublisheduntilnow, While hesitating to single out any one colleague, DI the13theditionhavingbeenpublishedin2006.These wouldlikeparticularlytoacknowledgeProfessorJohn books are the work of Therapeutic Guidelines Lim- TurnidgefromAdelaide,forhisadviceonantibioticuse ited, a non-profit-making organization, which pub- inchildren.DIwouldalsoliketoacknowledgethestaff lishes evidence-based guideline books on many dif- ofTherapeuticGuidelinesLimited,notablyJonathan ferentareasofmedicine.ThefirsteditionofTGAwas DartnellandJennyJohnstonefortheirexpertsupport publishedin1978,andwastheoriginofTherapeutic andassistanceandMaryHemmingforheropensup- GuidelinesLimited.TheaimofTGA,thenandnow, port. Therapeutic Guidelines Limited has given per- is to promote good antibiotic prescribing, which in- missionforustousetheirmaterialtohelpdirectour cludes making recommendations that will minimize thinkingandforustoincludesomeoftheirantibiotic antibioticresistance,andalso,thoughlessimportantly, guidelines, and we gratefully acknowledge their gen- considercostasafactor.Acommitteeofexperts,drawn erosity. x BLUK089-Isaacs June10,2007 10:37 Acknowledgements TherapeuticGuidelines:Antibiotic,Version13,2006 Telephone:61393291566 (ISBN9780975739341andISSN1329-5039),ispub- Fax:61393265632 lished in print and electronically and distributed by E-mail:[email protected] Therapeutic Guidelines Limited, 23-47 Villiers St, Website:www.tg.com.au NorthMelbourne,Vic3051,Australia. xi
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