Diarrhea pediatric patients

Rifaximin, a nonabsorbable derivative of rifamycin, has shown promising bactericidal action against both aerobes and anaerobes, such as bacterioides, lactobacilli and clostridia [33, 34], The development of resistance to this antibiotic can occur, but resistant strains rapidly disappear from the intestine thus allowing cyclic administration of rifaximin. Controlled clinical trials showed efficacy of rifaximin in adult and pediatric patients with infectious diarrhea [36,37], hepatic encephalopathy [38], post-surgical complications [39] and colonic diverticulosis [40], Only recently was the efficacy of rifaximin in the treatment of SIBO demonstrated [41-43]. 

Adverse reactions occurring in at least 3% of pediatric patients include diarrhea, vomiting, and rash (mostly diaper-area moniliasis). 

Children - Clinical adverse experiences observed in 10% or more of pediatric patients 3 to 16 years of age who received efavirenz capsules were the following Rash, diarrhea/loose stools, fever, cough, dizziness/lightheadedness/fainting ache/pain/discomfort, nausea/vomiting, headache. 

Although our military experience managing toxicity from nerve agent exposure is limited, exposures to related chemicals such as the OP class occur commonly each year in the USA. In 2006, there were a total of approximately 5,400 OP exposures across the USA (Bronstein et al, 2007). OPs, such as malathion, are commonly used as pesticides. OP toxicity manifests in a similar fashion as toxicity from nerve agents however, this chemical class is considerably less toxic. One case series of 16 children who experienced poisonings with OPs confirmed that pediatric patients present with toxicity differently than adults (Lifshitz et al, 1999). These children often did not manifest the classic muscarinic effects (such as salivary secretions and diarrhea) seen in adults. 

Trimethoprim-sulfamethoxazole (TMP-SMX) (20 mg/kg/day of trimethoprim) is the treatment of choice for P. carinii pneumonia (PCP). Oral therapy with TMP-SMX is reserved for children with mild PCP who do not have malabsorption or diarrhea. Intravenous pentamidine (4 mg/kg/day, given once a day) can be given to children with PCP who are intolerant of TMP-SMX or who have not responded after 5 days of TMP-SMX therapy. Other treatment regimens that may be considered for patients who are intolerant of or fail TMP-SMX and pentimidine are (1) atovaquone (40 mg/kg/ day, in two divided doses) for mild/moderate PCP only (2) dapsone with trimethoprim (3) trimetrexate with leucovorin and (4) clindamycin and primaquine. These alternate treatments have limited experience in pediatric patients. 

Tipranavir PI2 Must be taken with ritonavir to achieve effective levels tipranavir 500 mg bid/ritonavir 200 mg bid. Avoid use in hepatic insufficiency. Approved for pediatric usage Take with food. Separate from ddl by at least 2 h. Avoid antacids. Avoid in patients with sulfa allergy. Refrigeration required Diarrhea, nausea, vomiting, abdominal pain, rash, t liver enzymes, hypercholesterolemia, hypertriglyceridemia See footnote 4 for contraindicated medications. Avoid concurrent fosamprenavir, saquinavir. Do not administer to patients at risk for bleeding... 

Green, M., Cooke, R. E. and Lattanzi, W., Occurrence of chronic diarrhea in three patients with ganglioneuromas. Pediatrics 23, 951 (1959). 

Ruel MT, Rivera JA, Santizo MC, Lonnerdal B, Brown KH (1997) Impact of zinc supplementation on morbidity from diarrhea and respiratory infections among Guatemalan children. Pediatrics 99 808-813 Markowitz L, Nzilambi N, Driskell WJ, Sension MG, Rovira EZ, Nieburg P, Ryder RW (1989) Vitamin A levels and mortality among hospitalized measles patients, Kinshasa, Zaire. J Trap Pediat 35 109-112 Barclay AJG, Foster A, Sommer A (1987) Vitamin A supplements and mortality related to measles a randomised clinical trial. Brit J Med 323 160-164... 

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