Manual of Childhood Infections

912 Pages·2011·3.322 MB·English

by  Delane Shingadia, Mike Sharland, Andrew Cant, E. Graham Davies, David A. C. Elliman, Susanna Esposito, Adam Finn

Manual of
Childhood
Infections
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Manual of
Childhood
Infections
Third edition
Chief Editor
Mike Sharland
Profess or of Paediatric Infectious Diseases,
St George’s Hospital, London, UK
1
1
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Oxford University Press makes no representation, express or implied, that the
drug dosages in this book are correct. Readers must therefore always check the
product information and clinical procedures with the most up-to-date published
product information and data sheets provided by the manufacturers and the most
recent codes of conduct and safety regulations. The authors and publishers do not
accept responsibility or legal liability for any errors in the text or for the misuse or
misapplication of material in this work. Except where otherwise stated, drug dosages
and recommendations are for the non-pregnant adult who is not breastfeeding.
v
Foreword by Professor
Terrence Stephenson
President of The Royal College of
Paediatrics and Child Health,
United Kingdom
I am delighted to write a foreword for the third edition of The Manual of
Childhood Infections . The last edition was ten years ago. This new edition
has been completely re-written and updated. The aim of the book is to
provide a practical, evidence-based handbook approach to the manage-
ment of both common and unusual infections in children. The editorial
board found nearly two hundred authors to write the one hundred and
twenty chapters of this new edition. The book has been written by paedia-
tricians, microbiologists and a wide range of international experts in paedi-
atric infectious diseases. The book is aimed at both trainee and practising
hospital and community based paediatricians, nursing and other medical
staff caring for children in the United Kingdom, Europe and internation-
ally. It provides an up-to-date reference guide, including common differ-
ential diagnoses, practical management hints and information for over one
hundred drugs. The overall aim of the book is to improve the evidence-
base for the management of childhood infections.
In the United Kingdom, a recent confi dential enquiry into maternal and
child health notes infection still to be the largest single cause of death in
children dying of an acute illness. Overall, infection was a contributory
cause in at least twenty per cent of all childhood deaths, and this was over
one quarter of all deaths in children between one and four years of age.
Despite the success of recent immunisation campaigns, nearly two thirds of
these deaths are still due to bacterial infection. Prompt diagnosis of serious
bacterial infections remains a major challenge in paediatrics globally. In
both healthy children and in those with underlying medical conditions,
still too many children die of unrecognised infections, particularly children
with long-term medical conditions, including prematurity. There is still
much to be done to prevent nosocomial and opportunistic infections.
Paediatricians also have a duty in not over-treating or over-managing
children with minor, self-limiting infectious illness. There has been a rise
of around forty per cent of short stay admissions to hospital of less than
two days in England in the last decade. The majority of these are for minor
illnesses, particularly infections that could be managed more appropriately
in the community. Antibiotics remain a precious and fi nite resource. The
rise of antimicrobial resistance is now recognised by the UK Departments
of Health, the European CDC and World Health Organization as a major
threat to human health in the future. The antibiotic ‘pipeline’ particularly
for agents acting against gram negative infections, is worryingly sparse.
Gram negative resistance is becoming increasingly common in hospital
vi
FOREWORD BY PROFESSOR TERRENCE STEPHENSON
acquired infection and the optimal use of our current antibiotics becomes
ever more important. Prudent use of antibiotics and antibiotic stewardship
are ever more necessary now. Imported infections and new global
pandemics will remain a continued threat, so the Manual also highlights
the early recognition and prompt management of less common infections.
The new edition has been produced in collaboration with the European
Society for Paediatric Infectious Diseases (ESPID) and the Royal College
welcomes the development of collaborative educational initiatives
between the United Kingdom and Europe.
vii
Foreword by Professor
Ulrich Heininger
President of the European Society for
Paediatric Infectious Diseases (ESPID)
The European Society for Paediatric Infectious Diseases is delighted to
be working in partnership with the Royal College of Paediatrics and Child
Health in this third edition of the Manual of Childhood Infections – the
Blue Book . This edition has a strong European and global focus and has
tried to defi ne the evidence-base for the management of common child-
hood infectious diseases. There is still much variation in the practice and
management of childhood infections across Europe today. ESPID accepts
and welcomes this diversity of care, much of which refl ects cultural differ-
ences in child care across Europe. Moreover, there are variations in the
prevalence of specifi c infectious diseases and variations in antimicrobial
resistance patterns across Europe. Clearly evidence-based guidelines will
continue to vary across European countries for many years to come.
This manual has therefore attempted to be a synthesis of the published
evidence, collating wherever possible, Cochrane and other systematic
reviews, and has as its core an up to date evidence base. It does not aim to
replace local, regional or country-specifi c guidance for either the hospital
or offi ce-based paediatrician but rather has been produced as a teaching
tool for trainees across Europe, and for practising paediatricians. It should
be used as a source to check, look up or think about the management
plan, the differential diagnosis or recent epidemiology. In many cases,
chapters defi ne clearly what we do not know, and authors have tried to
outline areas of important research for the future. ESPID hopes to be
taking forward some of these ideas through its new research committee.
The Blue Book also recognises that antimicrobial dosing varies considerably
across Europe. The drug, the dose and the duration of treatment are often
poorly evidence-based in paediatrics, especially in neonatal medicine.
The B lue Book formulary again, does not replace local guidelines, but is
designed to be a short, easy to use, pragmatic and reasonable summary
of the published evidence for each drug. It is hoped that further work
in defi ning variations in guidelines, drug dosing and indication, can be
fed into initiatives such as the European Medicines Agency’s Priority Drug
List. Collaborative research projects across Europe will hopefully in time
improve the evidence-base for both old and new antimicrobials used in
children.
viii
FOREWORD BY PROFESSOR ULRICH HEININGER
The B lue Book is part of ESPID’s mission, aiming at improving the
education of paediatricians and the optimal management of infectious
diseases. We recognise that not everyone will agree with everything
written in this edition and we encourage your comments, suggestions for
improvements and contributions for the next edition. The B lue Book is
still a relatively new venture (on its third edition whereas the R ed Book
is on its twenty seventh edition) but I am confi dent that over time it will
become a core part of the management of paediatric infectious diseases
across Europe.
ix
Contents

Section editors xiv
Contributors xv
Abbreviations and symbols xxiv
Section 1 Clinical syndromes
1 Antibiotics and resistance 3
2 Antifungal drugs 10
3 Antiparasitics 20
4 Antivirals 25
5 Bone and joint infections 38
6 Cardiac infections: endocarditis 44
7 Cardiac infections: myocarditis and pericarditis 54
8 Central venous catheter infections 68
9 Chronic fatigue syndrome 73
10 Congenital infections 77
11 Conjunctivitis 90
12 Diarrhoea and vomiting 97
13 Emerging and re-emerging infections 102
14 Encephalitis 107
15 Enlarged lymph nodes 116
16 Haemolytic-uraemic syndrome 131
17 Healthcare-associated infections 137
18 Acute hepatitis 148
19 Human immunodefi ciency virus infection 153
20 Immunocompromised children with infection 163
21 Infection control in community settings 172
22 Intra-abdominal infections 178
23 Invasive fungal infection 193