[ Pobierz całość w formacie PDF ]
IV, penicillin allergic: clindamycin plus gentamicin
Human Bites:
Most likely organisms: Streptococci, Staph aureus,
Eikenella corrodens, anaerobes.
Oral: amoxicillin-clavulanate
Oral, penicillin allergic: trimethoprim-sulfamethoxazole
plus clindamycin
IV: ampicillin-sulbactam
IV, penicillin allergic: extended-spectrum
cephalosporins or trimethoprim-sulfamethoxazole plus
clindamycin
Antibiotic Dosages:
-Amoxicillin/clavulanate (Augmentin)
40 mg/kg/day of amoxicillin PO tid, max 500 mg/dose
[elixir 125 mg/5 mL, 250 mg/5 mL; tabs: 250, 500
mg; tabs, chew: 125, 250 mg] OR
-Amoxicillin/clavulanate (Augmentin BID)
40 mg/kg/day PO bid, max 875 mg (amoxicillin)/dose
[susp: 200 mg/5 mL, 400 mg/5 mL; tab: 875 mg;
tabs, chew: 200, 400 mg]
-Cefpodoxime (Vantin)
6 months-12 years: 10 mg/kg/day PO bid, max 800
mg/day
12 years: 100-400 mg PO bid
[susp: 50 mg/5 mL, 100 mg/5 mL; tabs: 100 mg, 200
mg] OR
-Cefprozil (Cefzil)
30 mg/kg/day PO bid, max 1 gm/day
[susp 125 mg/5 mL, 250 mg/5 mL; tabs: 250, 500
mg] OR
-Cefixime (Suprax)
8 mg/kg/day PO bid-qd, max 400 mg/day
[susp: 100 mg/5 mL; tab: 400 mg]
-Trimethoprim/Sulfamethoxazole (Bactrim, Septra)
6-8 mg/kg/day of TMP PO/IV bid, max 320 mg
TMP/day
[inj per mL: TMP 16 mg/SMX 80 mg; susp per 5 mL:
TMP 40 mg/SMX 200 mg; tab DS: TMP 160 mg/SMX
800 mg; tab SS: TMP 80mg/SMX 400 mg]
-Clindamycin (Cleocin) 10-30 mg/kg/day PO q6-8h,
max 1800 mg/day or 25-40 mg/kg/day IV/IM q6-8h,
max 4.8 gm/day [cap: 75, 150, 300 mg; soln: 75
mg/5mL]
-Ampicillin-sulbactam (Unasyn) 100-200 mg/kg/day
ampicillin IV/IM q6h, max 12 gm ampicillin/day
[1.5 gm (ampicillin 1 gm and sulbactam 0.5 gm; 3 gm
(ampicillin 2 gm and sulbactam 1 gm)]
-Cefotaxime (Claforan) 100-150 mg/kg/day IV/IM q6
8h, max 12 gm/day
-Ceftriaxone (Rocephin) 50 mg/kg/day IV/IM qd, max
2 gm/day
-Gentamicin (Garamycin); (normal renal function):
5 years (except neonates): 7.5 mg/kg/day IV/IM
q8h.
5-10 years: 6.0 mg/kg/day IV/IM q8h.
10 years: 5.0 mg/kg/day IV/IM q8h.
Additional Considerations:
-Sponge away visible dirt. Irrigate with a copious
volume of sterile saline by high-pressure syringe
irrigation but do not irrigate puncture wounds.
Débride any devitalized tissue.
-Wound cultures are not indicated unless signs of
infection exist. Followup
with physician.
-Tetanus immunization if not up to date.
-Assess risk of rabies from animal bites and risk of
hepatitis and HIV from human bites.
10. Symptomatic medications:
-Ibuprofen (Motrin) 5-10 mg/kg/dose PO q6-8h prn OR
-Acetaminophen (Tylenol) 15 mg/kg PO/PR q4h prn
temp 38°C or pain.
11. Extras and X-rays: X-ray views of site of injury.
12. Labs: CBC, SMA 7, wound culture.
Bronchiolitis
1. Admit to:
2. Diagnosis: Bronchiolitis.
3. Condition:
4. Vital signs: Call MD if:
5. Activity:
6. Nursing: Pulse oximeter, peak-flow rate. Respiratory
isolation.
7. Diet:
8. IV fluids:
9. Special medications:
-Oxygen, humidified 1-4 L/min by NC or 40-60% by
mask, keep sat 92%.
Nebulized Beta2-Agonists:
-Albuterol (Ventolin, Proventil [5 mg/mL soln]) nebu
lized 0.2-0.5 mL in 2 mL NS (0.10-0.15 mg/kg) q1-4h
prn.
Treatment of Respiratory Syncytial Virus (severe lung
disease or underlying cardiopulmonary disease):
-Ribavirin (Virazole) therapy should be considered in
high-risk children 2 years with chronic lung disease
or with history of premature birth less than 35 weeks
gestational age. Ribavirin is administered as 6 gm,
aerosolized by SPAG nebulizer over 18-20h qd x 3-5
days or 2 gm over 2 hrs q8h x 3-5 days.
-Synagis is not indicated for treatment of RSV disease.
Prophylaxis Against Respiratory Syncytial Virus:
-Consider use in high-risk children 2 years with BPD
who required medical management within the past
six months, or with history of premature birth less
than or equal to 28 weeks gestational age who are
less than one year of age at start of RSV season, or
with history of premature birth 29-32 weeks
gestational age who are less than six months of age
at start of RSV season.
-Palivizumab (Synagis) 15 mg/kg IM once a month
throughout RSV season (usually October-March)
-RSV-IVIG (RespiGam) 750 mg/kg IV once a month
throughout RSV season (usually from October to
March).
Influenza:
-Oseltamivir (Tamiflu)
1-12 years
15 kg: 2 mg/kg/dose PO bid
15.1-23 kg: 45 mg PO bid
23.1-40 kg: 60 mg PO bid
40 kg: 75 mg PO bid
13 years: 75 mg PO bid
[cap: 75 mg; susp: 12 mg/mL]
Treatment duration is 5 days. Approved for treatment
of uncomplicated influenza A or B when patient has
been symptomatic no longer than 48 hrs. OR
-Rimantadine (Flumadine)
10 years: 5 mg/kg/day PO qd, max 150 mg/day
10 years: 100 mg PO bid
[syrup: 50 mg/5 mL; tab: 100 mg].
Approved for treatment or prophylaxis of Influenza A.
Not effective against Influenza B. OR
-Amantadine (Symmetrel)
1-9 years: 5 mg/kg/day PO qd-bid, max 150 mg/day
9 years: 5 mg/kg/day PO qd-bid, max 200 mg/day
[cap: 100 mg; syrup: 50 mg/5 mL; tab: 100 mg].
Approved for treatment or prophylaxis of Influenza A.
Not effective against Influenza B.
Pertussis:
The estolate salt is preferred due to greater penetration.
[ Pobierz całość w formacie PDF ]