Penicillins pediatric patients

Higher dose amoxicillin, amoxicillin-davulanate (eg., 90 mg/kg/day) is used for penicillin-resistant Streptococcus pneumoniae fluoroquinolones are avoided in pediatric patients because of the potential for cartilage damage however, their use in pediatrics is emerging. Doses shown are extrapolated from adults and will require further study. 

For penicillin-allergic patients, use clindamycin 150-300 mg orally every 6-8 hours (pediatric dosing 10-30 mg/kg/day in three to four divided doses). 

It has also been reported that patients with allergic-like events after penicillin treatment have had a markedly risk of events after subsequent cephalosporin antibiotics. Cross-reactivity is not an adequate explanation for this increased risk and the data obtained indicate that cephalosporins can be considered for patients with penicillin allergy <2006MI354.ell>. Comparisons of parenteral broad-spectrum cephalosporins have been tested against bacteria isolated from pediatric patients. The results have indicated that cefepime has been the most broad-spectrum cephalosporin analyzed and it is a very potent alternative for the treatment of contemporary pediatric infections in North America <2007MI109>. The historical safety of the most commonly used oral cephalosporins has been reviewed <2007MIS67>. The antimicrobial spectrum and in vitro potency of the most frequently prescribed orally administered cephalosporins (cefaclor, cefdinir, cefpodoxime, cefprozil, cefuroxime axetil and cephalexin has also been reviewed <2007MIS5>. 

Pichichero ME. A review of evidence supporting the American Academy of Pediatrics recommendation for prescribing cephalosporin antibiotics for penicillin-allergic patients. Pediatrics 2005 115 1048-1057. 

Anderson JA. Cross-sensitivity to cephalosporins in patients allergic to penicillin. Pediatr Infect Dis 1986 5(5) 557-61. 

Serum drug concentrations should be monitored for drugs with narrow therapeutic indices and ehminated largely by the kidney (e.g., aminoglycosides and vancomycin) to optimize therapy in pediatric patients with renal dysfunction. For drugs with wide therapeutic ranges (e.g., penicillins and cephalosporins), dosage adjustment may be necessary only in moderate to severe renal failure. 

Since staphylococcal and streptococcal cellulitis are indistinguishable clinically," administration of a semisynthetic penicillin (nafcillin or oxacillin) is recommended until a definitive diagnosis, by skin or blood cultures, can be made " " (Table 108-3). Mild to moderate infections not associated with systemic symptoms may be treated orally with dicloxacillin. If documented to be a mild cellulitis secondary to streptococci, oral penicillin VK or intramuscular procaine penicillin may be administered. More severe infections, either staphylococcal or streptococcal, should be treated initially with intravenous antibiotic regimens. Ceftriaxone 50-100 mg/kg as a single daily dose is efficacious in the treatment of celluMs in pediatric patients. The usual duration of therapy for cellulitis is 7 to 10 days. " ... 

Rechallenge in pediatric patients diagnosed with delayed hypersensitivity to penicillins. J Investig AUergol CUn Immunol 2013 23(5) 359-70. 

All patients and parents of children with SCD should have a plan for what to do in the event of symptoms of infection or pain. Obtain a medication history when patients are admitted to the hospital. Assess compliance with prophylactic penicillin and childhood immunization schedules in all pediatric SCD patients. 

Aqueous crystalline pen- Pediatric dcv penicillin 200,000 urnls/kg per 24 hours IV in four to six equally divided doses ceftriaxone 100 mg/kg per 24 hours IV/IM in one dose 12-18 million units/24 h IV either continuously or in six equally divided 2 IB 2-week regimen not intended for patients with known cardiac or extracar-... 

Vancomycin hydrochloride s 30 m kg per 24 hours IV in two equally divided doses not to exceed 2 g 24 hours unless serum concentrations are inappropriately low Pediatric dose 40 mg/kg 24 hours in two or three equally divided doses 4 IB Vancomycin S therapy recommended only for patients unable to tolerate penicillin or ceftriaxone therapy... 

Which bacteriocidal penicillin may be given orally to pediatric and geriatric patients ... 

Veltman G (1959) Zur Kenntnis des Adalinexanthems. Z Haut Geschlkrh 27 11 Walsh JR, Zimmerman HJ (1953) The demonstration of the L.E. -phenomenon in patients with penicillin hypersensitivity. Blood 8 65 Watts JC (1962) A fatal case of erythema multiforme exsudativum (Stevens-Johnson syndrome) following therapy with Dilantin. Pediatrics 30 592 Webster AW, Thompson (1974) The ampicillin rash lymphocyte transformation by ampicillin polymer. Clin Exp Immunol 18 553 Weirich EG (1957) Das Pyrazolonexanthem. Dtsch Med Wochenschr 1011 Welsh AL (1961) The fixed eruption. Thomas, Springfield... 

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