Influenza in children

Asthma Adverse reactions occurring in more than 3% of patients include headache and influenza. In children 6 to 14 years of age, the following events occurred with a frequency of 2% Diarrhea, laryngitis, pharyngitis, nausea, otitis, sinusitis, viral infections. In children 2 to 5 years of age the following events occurred with a frequency of 2% Rhinorrhea, otitis, ear pain, bronchitis, leg pain, thirst, sneezing. 

Dacryocystitis occnrs when the lacrimal drainage system is blocked and bacteria from the tears infect the lacrimal sac. Bacterial etiology includes staphylococci. Streptococcus pneumoniae, and H. influenzae in children, all of which are susceptible to oral amoxicillin/ clavulanate. More serious infections require intravenous administration of ampicillin/sulbactam. This bacterial infection needs to be treated before nasolacrimal duct irrigation, probing, or surgery is performed. 

Whitley RJ, Hayden FG, Reisinger KS, Young N, Dutkowski R, Ipe D, Mills RG, Ward P. Oral oseltamivir treatment of influenza in children. Pediatr Infect Dis J 2001 20(2) 127-33. 

Rimantadine hydrochloride, an alpha-methyl derivative of amantadine (alpha-methyl-l-adamantane methylamine hydrochloride), is more active than amantadine against influenza A viruses in vitro and in laboratory animals. It is an alternative to amantadine for the prevention and treatment of influenza A virus infections in adults and for the prevention of influenza in children. Adverse effects have been considered to be less common with rimantadine (SEDA-8, 143), and it is generally tolerated better than amantadine, because it causes fewer nervous system adverse effects (1). Unfortunately, rimantadine is more costly, which has led many institutions to develop influenza treatment guidelines. Both drugs work by blocking the M2 ion channel, which is needed to affect a pH change that helps to initiate viral uncoating. 

Studies suggest that the use of salicylates (especially aspirin) maybe involved in the development of Reye s syndrome in children with chickenpox or influenza. This rare but life-threatening disorder is characterized by vomiting and lethargy, progressing to coma. Therefore, use of salicylates in children with chickenpox, fever, or flulikesymptomsisnot recommended. Acetaminophen is recommended for the management of symptoms associated with these disorders... 

Kiso M, Mitamura K, Sakai-Tagawa Y, Shiraishi K, Kawakami C, Kimura K, Hayden FG, Sugaya N, Kawaoka Y (2004) Resistant influenza A viruses in children treated with oseltamivir descriptive study. Lancet 364 759-765... 

Prior to the introduction of the Hib conjugate vaccine, H. influenzae type b was the most common cause of bacterial meningitis in the United States.5 Routine inoculation of pediatric patients against Hib since 1991 has reduced the incidence of invasive Hib disease (i.e., meningitis and sepsis) in children younger than 5 years of age by 99%,6 with mortality from Hib... 

Viruses are a common cause of CAP in children (-65%) and much less common in adults ( 15%).8 Viruses often associated with pneumonia in adults include influenza A and B and adenoviruses, whereas less common causes include rhinoviruses, enteroviruses, cytomegalovirus, varicella-zoster virus, herpes simplex virus, and others. In children, viral pneumonia is caused more commonly by respiratory syncyntial virus, influenza A virus, and parainfluenza virus. The viruses associated with CAP in adults are much less common causes of pneumonia in children. 

Haemophilus influenzae is a bacterial respiratory pathogen that causes a wide spectrum of disease ranging from colonization of the airways to bacterial meningitis. It causes considerable morbidity and mortality, especially in children less than 5 years of age. H. influenzae is either encapsulated or unencapsulated. The encapsulated strains can be further differentiated into six antigenically distinct serotypes, a through f. H. influenzae type b was primarily found in cerebrospinal fluid and blood of children with meningitis, while the unencapsulated strains were found in the upper respiratory tract of adults. Before the introduction of the vaccine, H. influenzae was responsible for 20,000 to 25,000 cases of invasive disease annually and was the most common cause of bacterial meningitis. Since the introduction of the vaccine, invasive disease due to H. influenzae type b has been nearly eliminated. 

The first H. influenzae type b vaccine was an aqueous solution of capsular polysaccharide, polyribosylribitol phosphate. As with all polysaccharide vaccines, it showed poor immuno-genicity in children less than 2 years of age. This vaccine is no longer used. 

Influenza is a contagious viral respiratory infection that usually occurs during the winter months in the Northern Hemisphere and all year round in the Southern Hemisphere. All age groups are affected by influenza however, children have the highest rate of infection. Serious illness and death due to influenza usually occurs in extremes of age, those over 65 years or under 2 years. Influenza is responsible for approximately 36,000 deaths annually in the United States.7... 

Household contacts of immunocompromised persons should have all routine vaccines as scheduled, including yearly influenza vaccination. Children in the household may receive live virus vaccines without special precautions however, if a rash develops following varicella vaccination, contact should be avoided with the immunocompromised host until the rash resolves. 

The vaccination rate in adults is much lower than that in children. Only 50% to 60% of adults who meet criteria have received pneumococcal or influenza vaccination. Comprehensive initiatives need to be implemented to increase the adult vaccination rate. Some proven concepts are providing reminders to patients that vaccines are due and implementation of standing orders for vaccines. This latter concept allows nurses and pharmacists to screen patients to see if pneumococcal, influenza, or other vaccines are needed and to vaccinate without a physician s order. 

In the past, H. influenzae was the most common cause of meningitis in children 6 months to 3 years of age, but this has declined dramatically since the introduction of effective vaccines. 

Influenza vaccine is recommended in children with chronic medical conditions. All... 

Chiidren In children, rimantadine is recommended for the prophylaxis of influenza A. Safety and efficacy of rimantadine in the treatment of symptomatic influenza... 

Drug resistance - In clinical studies of naturally acquired infection with influenza virus, 1.3% of posttreatment isolates in adults and adolescents, and 8.6% in children from 1 to 12 years of age showed emergence of influenza variants with decreased neuraminidase susceptibility to oseltamivir carboxylate. 

Acute otitis media in children - Acute otitis media in children due to susceptible strains of Haemophilus influenzae or Streptococcus pneumoniae. There are limited data on the safety of repeated use in children younger than 2 years of age. Not indicated for prophylactic use or prolonged administration. 

Er hromycin Sulfisoxazole (Eryzole, Pediazole) [Anti-infective, Macrolide/Sulfonamide] Uses Upper lower resp tract bacterial Infxns H. influenzae otitis media in children Infxns in PCN-allergic pts Action Macrolide antibiotic w/ sulfonamide Dose Adults. Based on erythromycin content 400 mg erythromycin/1200 mg sulfisoxazole PO q6h Feds > 2 mo. 40-50 mg/kg/d erythromycin 150 mg/kg/d sulfisoxazole PO -s- q6h max 2 g/d erythromycin or 6 g/d sulfisoxazole x 10 d in renal impair Caution [C (D if near term), +] w/ PO anticoagulants, hypoglycemics, phenytoin, cyclosporine Contra Infants <2 mo Disp Susp SE GI upset Additional Interactions T Effects of sulfonamides W/ ASA, diuretics, NSAIDs, probenecid EMS See Erythromycin OD See Erythromycin... 

Uses Prevention Rx influenza A (including 2009 Novel HlNl ) B, Action -1- Viral neuraminida.se Dose AduUs. Tx 75 mg PO bid X 5 d Prophylaxis 75 mg PO daily X 10 d Peds >1 yr. (Authorized 2009 by FDA for emergency use in <1 y) PO bid dosing <15 kg 30 mg 15-23 kg 45 mg 24-40 kg 60 mg >40 kg Adult dose -1- w/ renal impair Caution [C, /—] Contra Component allergy Disp Caps SE NA, insomnia, rqjorts of neuropsychiatric events in children (self-injury, confusion, delirium) caution urged in children as SEs are often more severe that the HlNl influenza Interaction T Effects W/ probenecid EMS Beware acute neuropsychiatric effects esp in children OD May cause NA symptomatic and supportive... 

Aspirin is epidemiologically associated with Reye s syndrome, a rare but often fatal consequence of infection with varicella, influenza and various other viruses, and salicylates are therefore contraindicated in children with chicken pox or influenza. 

The majority of sepsis cases, especially the more severe forms, have bacterial etiologies. Common bacterial species include Staphylococcus aureus. Streptococcus pneumoniae, Escherichia coli. Salmonella typhi (and other enterobacterial species). Pseudomonas species and haemolytic streptococci in children Haemophilus influenzae and Neisseria meningitidis are important whereas nosocomial episodes of sepsis are frequently caused by Staphylococcus epidermidis. Streptococcus faecalis (syn. enterococci), yeasts and anaerobes. 

Acute otitis media (AOM) in children is mostly caused by pneumococci and H. influenzae. It should be differentiated from otitis media with effusion (OME) in which there are no symptoms of acute infection. Furuncles of the nose are caused by S. aureus. It has to be differentiated from diphteria (in unvaccinated children) caused by Corynebac-terium diphteriae and from mononucleosis infec-tiosa caused by Epstein-Barr virus. Chronic ear infections are caused by S. aureus and gram-negative bacillae. Malignant otitis externa in diabetics is caused by P. aeruginosa. 

The use of aspirin in children and teenagers with either chickenpox or influenza is contraindicated, since there is evidence linking the use of the salicylates in such diseases to Reye s syndrome, a potentially fatal disease accompanied by liver damage and encephalopathy. The mechanism by which the use of salicylates increases the chances for development of Reye s syndrome is not known. 

The answer is e. (Hardman, pp 1094—1095.) Penicillins were used in the treatment of meningitis because of their ability to pass across an inflamed blood-brain barrier. The third-generation cephalosporin, ceftriaxone, is preferred because it is effective against P-lactamase producing strains of H. influenzae that may cause meningitis in children. 

Haemophilus influenzae is a bacteria which exists in many forms. The type B form called Hib, commonly produces disease in humans by colonizing the upper respiratory tract of up to 80 percent of the population and is major cause of infection and mortality in children. 

Oseltamivir formulation (additional indication) For Prophylaxis of influenzae in adult and children >14 years of age... 

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