(BQ) Part 1 book “2019 Nelson’s pediatric antimicrobial therapy” has contents: Choosing among antibiotics within a class - beta lactams and beta lactamase inhibitors, macrolides, aminoglycosides, and fluoroquinolones; antimicrobial therapy according to clinical syndromes, antimicrobial therapy for newborns, preferred therapy for specific bacterial and mycobacterial pathogens,…and other contents.
2 Choosing Among Antifungal Agents: Polyenes, Azoles, and Echinocandins How Antibiotic Dosages Are Determined Using Susceptibility Data, Pharmacodynamics, and Treatment Outcomes Approach to Antibiotic Therapy of Drug-Resistant Gram-negative Bacilli and Methicillin-Resistant Staphylococcus aureus Antimicrobial Therapy for Newborns Antimicrobial Therapy According to Clinical Syndromes Preferred Therapy for Specific Bacterial and Mycobacterial Pathogens Preferred Therapy for Specific Fungal Pathogens Preferred Therapy for Specific Viral Pathogens 10 Preferred Therapy for Specific Parasitic Pathogens 11 Alphabetic Listing of Antimicrobials 13 Sequential Parenteral-Oral Antibiotic Therapy (Oral Step-down Therapy) for Serious Infections 14 Antimicrobial Prophylaxis/Prevention of Symptomatic Infection References Bradley Nelson Appendix: Nomogram for Determining Body Surface Area 25th Edition 12 Antibiotic Therapy for Children Who Are Obese 2019 Nelson’s Pediatric Antimicrobial Therapy Choosing Among Antibiotics Within a Class: Beta-lactams and Beta-lactamase Inhibitors, Macrolides, Aminoglycosides, and Fluoroquinolones 2019 Nelson’s Pediatric Antimicrobial Therapy John S Bradley, MD Editor in Chief John D Nelson, MD Emeritus 25 TH EDITION Elizabeth D Barnett, MD Joseph B Cantey, MD David W Kimberlin, MD Paul E Palumbo, MD Jason Sauberan, PharmD J Howard Smart, MD William J Steinbach, MD Contributing Editors Index AAP NELSON PEDIATRIC SPREAD 2019 FINAL.indd All Pages 11/13/18 2:39 PM 2019 Nelson’s Pediatric Antimicrobial Therapy John S Bradley, MD 25th Edition Editor in Chief John D Nelson, MD Emeritus Elizabeth D Barnett, MD Joseph B Cantey, MD David W Kimberlin, MD Paul E Palumbo, MD Jason Sauberan, PharmD J Howard Smart, MD William J Steinbach, MD Contributing Editors ch00-Nelson-2019_FM_i-xii.indd 11/12/18 2:51 PM American Academy of Pediatrics Publishing Staff Mary Lou White, Chief Product and Services Officer/SVP, Membership, Marketing, and Publishing Mark Grimes, Vice President, Publishing Peter Lynch, Senior Manager, Digital Strategy and Product Development Mary Kelly, Senior Editor, Professional and Clinical Publishing Shannan Martin, Production Manager, Consumer Publications Jason Crase, Manager, Editorial Services Linda Smessaert, MSIMC, Senior Marketing Manager, Professional Resources Mary Louise Carr, MBA, Marketing Manager, Clinical Publications Published by the American Academy of Pediatrics 345 Park Blvd Itasca, IL 60143 Telephone: 630/626-6000 Facsimile: 847/434-8000 www.aap.org The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of infants, children, adolescents, and young adults The recommendations in this publication not indicate an exclusive course of treatment or serve as a standard of medical care Variations, taking into account individual circumstances, may be appropriate Statements and opinions expressed are those of the authors and not necessarily those of the American Academy of Pediatrics Products and Web sites are mentioned for informational purposes only and not imply an endorsement by the American Academy of Pediatrics Web site addresses are as current as possible but may change at any time Brand names are furnished for identifying purposes only No endorsement of the manufacturers or products listed is implied The publishers have made every effort to trace the copyright holders for borrowed materials If they have inadvertently overlooked any, they will be pleased to make the necessary arrangements at the first opportunity This publication has been developed by the American Academy of Pediatrics The authors, editors, and contributors are expert authorities in the field of pediatrics No commercial involvement of any kind has been solicited or accepted in the development of the content of this publication Disclosures: Dr Kimberlin disclosed a consulting relationship with Slack Incorporated Dr Palumbo disclosed a safety monitoring board relationship with Janssen Pharmaceutical Companies Dr Steinbach disclosed an advisory board relationship with Merck & Company and Astellas Pharma, Inc Every effort has been made to ensure that the drug selection and dosages set forth in this text are in accordance with current recommendations and practice at the time of publication It is the responsibility of the health care professional to check the package insert of each drug for any change in indications or dosage and for added warnings and precautions, and to review newly published, peer-reviewed data in the medical literature for current data on safety and efficacy Special discounts are available for bulk purchases of this publication E-mail Special Sales at aapsales@aap.org for more information © 2019 John S Bradley and John D Nelson Publishing rights, American Academy of Pediatrics All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means—electronic, mechanical, photocopying, recording, or otherwise—without prior permission from the authors First edition published in 1975 Printed in the United States of America 9-422/1218 10 MA0881 ISSN: 2164-9278 (print) ISSN: 2164-9286 (electronic) ISBN: 978-1-61002-210-1 eBook: 978-1-61002-226-2 ch00-Nelson-2019_FM_i-xii.indd 11/12/18 2:51 PM iii Editor in Chief Emeritus John S Bradley, MD Professor of Pediatrics Chief, Division of Infectious Diseases, Department of Pediatrics University of California, San Diego, School of Medicine Director, Division of Infectious Diseases, Rady Children’s Hospital San Diego San Diego, CA John D Nelson, MD Professor Emeritus of Pediatrics The University of Texas Southwestern Medical Center at Dallas Southwestern Medical School Dallas, TX Contributing Editors Elizabeth D Barnett, MD Professor of Pediatrics Boston University School of Medicine Director, International Clinic and Refugee Health Assessment Program, Boston Medical Center GeoSentinel Surveillance Network, Boston Medical Center Boston, MA Joseph B Cantey, MD Assistant Professor of Pediatrics Divisions of Pediatric Infectious Diseases and Neonatology/Perinatal Medicine University of Texas Health Science Center at San Antonio San Antonio, TX David W Kimberlin, MD Editor, Red Book: 2018–2021 Report of the Committee on Infectious Diseases, 31st Edition Professor of Pediatrics Codirector, Division of Pediatric Infectious Diseases Sergio Stagno Endowed Chair in Pediatric Infectious Diseases University of Alabama at Birmingham Birmingham, AL ch00-Nelson-2019_FM_i-xii.indd Paul E Palumbo, MD Professor of Pediatrics and Medicine Geisel School of Medicine at Dartmouth Director, International Pediatric HIV Program Dartmouth-Hitchcock Medical Center Lebanon, NH Jason Sauberan, PharmD Assistant Clinical Professor University of California, San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences Rady Children’s Hospital San Diego San Diego, CA J Howard Smart, MD Chairman, Department of Pediatrics Sharp Rees-Stealy Medical Group Assistant Clinical Professor of Pediatrics University of California, San Diego School of Medicine San Diego, CA William J Steinbach, MD Professor of Pediatrics Professor in Molecular Genetics and Microbiology Chief, Division of Pediatric Infectious Diseases Director, Duke Pediatric Immunocompromised Host Program Director, International Pediatric Fungal Network Duke University School of Medicine Durham, NC 11/12/18 2:51 PM ch00-Nelson-2019_FM_i-xii.indd 11/12/18 2:51 PM v Contents Introduction vii Notable Changes to 2019 Nelson’s Pediatric Antimicrobial Therapy, 25th Edition xi Choosing Among Antibiotics Within a Class: Beta-lactams and Beta-lactamase Inhibitors, Macrolides, Aminoglycosides, and Fluoroquinolones Choosing Among Antifungal Agents: Polyenes, Azoles, and Echinocandins How Antibiotic Dosages Are Determined Using Susceptibility Data, Pharmacodynamics, and Treatment Outcomes 17 Approach to Antibiotic Therapy of Drug-Resistant Gram-negative Bacilli and Methicillin-Resistant Staphylococcus aureus 21 Antimicrobial Therapy for Newborns 29 A Recommended Therapy for Selected Newborn Conditions 30 B Antimicrobial Dosages for Neonates 51 C Aminoglycosides 55 D Vancomycin 56 E Use of Antimicrobials During Pregnancy or Breastfeeding 56 Antimicrobial Therapy According to Clinical Syndromes 59 A Skin and Soft Tissue Infections 62 B Skeletal Infections 68 C Eye Infections 71 D Ear and Sinus Infections 75 E Oropharyngeal Infections 78 F Lower Respiratory Tract Infections 81 G Cardiovascular Infections 94 H Gastrointestinal Infections 101 I Genital and Sexually Transmitted Infections 108 J Central Nervous System Infections 112 K Urinary Tract Infections 117 L Miscellaneous Systemic Infections 119 Preferred Therapy for Specific Bacterial and Mycobacterial Pathogens .127 A Common Bacterial Pathogens and Usual Pattern of Susceptibility to Antibiotics (Gram Positive) 128 B Common Bacterial Pathogens and Usual Pattern of Susceptibility to Antibiotics (Gram Negative) 130 C Common Bacterial Pathogens and Usual Pattern of Susceptibility to Antibiotics (Anaerobes) 132 D Preferred Therapy for Specific Bacterial and Mycobacterial Pathogens 134 ch00-Nelson-2019_FM_i-xii.indd 11/12/18 2:51 PM vi — Contents Preferred Therapy for Specific Fungal Pathogens 155 A Overview of More Common Fungal Pathogens and Their Usual Pattern of Antifungal Susceptibilities 156 B Systemic Infections 158 C Localized Mucocutaneous Infections 172 Preferred Therapy for Specific Viral Pathogens 173 A Overview of Non-HIV, Non-Hepatitis B or C Viral Pathogens and Usual Pattern of Susceptibility to Antivirals 174 B Overview of Hepatitis B or C Viral Pathogens and Usual Pattern of Susceptibility to Antivirals .174 C Preferred Therapy for Specific Viral Pathogens .176 10 Preferred Therapy for Specific Parasitic Pathogens 189 A Selected Common Pathogenic Parasites and Suggested Agents for Treatment 190 B Preferred Therapy for Specific Parasitic Pathogens .192 11 Alphabetic Listing of Antimicrobials 211 A Systemic Antimicrobials With Dosage Forms and Usual Dosages 213 B Topical Antimicrobials (Skin, Eye, Ear, Mucosa) 234 12 Antibiotic Therapy for Children Who Are Obese 241 13 Sequential Parenteral-Oral Antibiotic Therapy (Oral Step-down Therapy) for Serious Infections .245 14 Antimicrobial Prophylaxis/Prevention of Symptomatic Infection 247 A Postexposure Antimicrobial Prophylaxis to Prevent Infection 249 B Long-term Antimicrobial Prophylaxis to Prevent Symptomatic New Infection .256 C Prophylaxis of Symptomatic Disease in Children Who Have Asymptomatic Infection/Latent Infection 257 D Surgical/Procedure Prophylaxis 258 Appendix: Nomogram for Determining Body Surface Area 263 References .265 Index 289 ch00-Nelson-2019_FM_i-xii.indd 11/12/18 2:51 PM vii Introduction We are now in our 25th edition of Nelson’s Pediatric Antimicrobial Therapy, a tribute to John Nelson’s belief that advice on treatment of children with infections should be clear and concise! Although no new oral anti-infective agents have been approved in the United States recently, several antibiotics in many classes that completed adult studies are now entering pediatric clinical trials, particularly those for multidrug-resistant Gram-negative bacilli The contributing editors, all very active in clinical work, have updates in their sections with relevant new recommendations based on current published data, guidelines, and clinical experience We hope that the reference list for each chapter provides the available evidence to support our recommendations, for those who wish to see the data For those who use the Nelson’s app, you may have noticed a new “feel” to the app, which is now written in one of the Apple programing languages by Dr Howard Smart, a fulltime office-based pediatrician and the chief of pediatrics at the Sharp Rees-Stealy multispecialty medical group in San Diego, CA With the support of the American Academy of Pediatrics (AAP) (particularly Peter Lynch) and the editors, we are putting more of Howard’s enhancements in this 2019 edition So substantial are his contributions to the app, the book (from the perspective of an office-based pediatrician), and the development of future Nelson’s digital versions that the editors and the AAP have unanimously asked Howard to join us officially as a contributing editor We believe that his skills (clinical and digital) are an essential part of what we all hope the AAP Nelson’s book can and should be Recognizing the talent in collaborators/colleagues of the editors and their substantial and ongoing contributions to the quality of the material that is presented in this book, we wish to continue to acknowledge their advice each year in this Introduction We con tinue to receive valuable suggestions from Drs John van den Anker and Pablo Sanchez on antimicrobial therapy of the newborn, in support of the work done by JB Cantey and Jason Sauberan in Chapter A pediatric hospital medicine consulting editor who is with us again this year is Dr Brian Williams, a pediatric/adult hospitalist who trained with us at the University of California, San Diego, School of Medicine/Rady Children’s Hospital San Diego and is now in Madison, WI His continuing advice on organizing information for both the book and the app has been invaluable He is focused, practical, and very collaborative We continue to harmonize the Nelson’s book with Red Book: 2018–2021 Report of the Committee on Infectious Diseases, 31st Edition (easy to understand, given that Dr David Kimberlin is also the editor of the Red Book) We are virtually always in sync but often with additional explanations (that not necessarily represent AAP policy) to allow the reader to understand the basis for recommendations ch00-Nelson-2019_FM_i-xii.indd 11/12/18 2:51 PM viii — Introduction We continue to provide grading of our recommendations—our assessment of how strongly we feel about a recommendation and the strength of the evidence to support our recommendation (noted in the Table) Strength of Recommendation Description A Strongly recommended B Recommended as a good choice C One option for therapy that is adequate, perhaps among many other adequate therapies Level of Evidence Description I Based on well-designed, prospective, randomized, and controlled studies in an appropriate population of children II Based on data derived from prospectively collected, small comparative trials, or noncomparative prospective trials, or reasonable retrospective data from clinical trials in children, or data from other populations (eg, adults) III Based on case reports, case series, consensus statements, or expert opinion for situations in which sound data not exist As we state each year, many of the recommendations by the editors for specific situations have not been systematically evaluated in controlled, prospective, comparative clinical trials Many of the recommendations may be supported by published data, but the data may never have been presented to or reviewed by the US Food and Drug Administration (FDA) and, therefore, are not in the package label We all find ourselves in this situation frequently Many of us are working closely with the FDA to try to narrow the gap in our knowledge of antimicrobial agents between adults and children; the FDA pediatric infectious diseases staff is providing an exceptional effort to shed light on the doses that are safe and effective for neonates, infants, and children, with major efforts to place important new data on safety and efficacy in the antibiotic package labels for all to use in clinical practice Barrett Winston, our primary AAP editorial contact for the past few years, has done an amazing job of organizing all the AAP staff, as well as the contributing and consulting editors, but has now moved to other responsibilities within the AAP and is turning over the editorial tasks to Mary Kelly, who has an impressive track record in publications Mary will now keep us all moving forward with the 2019 edition upgrades and enhancements as we keep looking to the long-term future of the book in partnership with the ch00-Nelson-2019_FM_i-xii.indd 11/12/18 2:51 PM Introduction — ix AAP Peter Lynch continues to work on developing Nelson’s online, as well as the app, and has shared considerable AAP resources with us We continue to appreciate the teamwork of all those at the AAP who make sure this book gets to all the clinicians who may benefit Thanks to Mark Grimes, vice president, Publishing, and our steadfast friends and supporters in AAP Membership, Marketing, and Publishing—Jeff Mahony, director, professional and consumer publishing; Linda Smessaert, senior marketing manager, professional resources; and the entire staff—who make certain that the considerable information in Nelson’s makes it to those who are actually caring for children We are still very interested to learn from readers/users if there are new chapters or sections you wish for us to develop—and whether you find certain sections particularly helpful, so we don’t change or delete them! From the feedback we have received, the chapter on adverse drug reactions is no longer included in this edition We are focusing on more common antimicrobial drug issues, such as dosing in obesity Please send your suggestions to nelsonabx@aap.org John S Bradley, MD ch00-Nelson-2019_FM_i-xii.indd 11/12/18 2:51 PM ... in 19 75 Printed in the United States of America 9-422 /12 18 10 MA08 81 ISSN: 216 4-9278 (print) ISSN: 216 4-9286 (electronic) ISBN: 978 -1- 610 02- 210 -1 eBook: 978 -1- 610 02-226-2 ch00-Nelson -2 019 _ FM_i-xii.indd... ch00-Nelson -2 019 _ FM_i-xii.indd 10 11 /12 /18 2: 51 PM xi Notable Changes to 2 019 Nelson’s Pediatric Antimicrobial Therapy, 25th Edition Nelson’s Pediatric Antimicrobial Therapy has been updated to... 11 /12 /18 11 :46 AM Preferred Therapy for Specific Bacterial and Mycobacterial Pathogens 2 019 Nelson’s Pediatric Antimicrobial Therapy — 14 1 Meningitis Francisella tularensis85,86 D PREFERRED THERAPY