SÁCH HARIET LANE LÀ QUỂN SÁCH KINH ĐIỂN TRONG GIỚI Y KHOA, SỬ DỤNG TRA CỨU KHÁNG SINH LIỀU DÙNG, ĐƯỜNG DÙNG, THẢI QUA GAN, QUA THẬN, QUA SỮA MẸ, HƯỚNG DẪN CHI TIẾT LỰA CHỌN KHÁNG SINH THEO TÁC NHÂN, THEO BỆNH CẢNH LÂM SÀNG, GIẢM LIỀU TRONG BỆNH NHÂN SUY THẬN, SUY GAN.
THE HARRIET LANE HANDBOOK OF PEDIATRIC ANTIMICROBIAL THERAPY ZZZPHGLOLEURVFRP THE HARRIET LANE HANDBOOK OF PEDIATRIC ANTIMICROBIAL THERAPY Second Edition Julia A McMillan, MD Professor of Pediatrics Associate Dean for Graduate Medical Education Johns Hopkins University School of Medicine Baltimore, Maryland Carlton K K Lee, PharmD, MPH Clinical Pharmacy Specialist, Pediatrics Program Director, Pediatric Pharmacy Residency Department of Pharmacy The Johns Hopkins Hospital; Associate Professor, Pediatrics Johns Hopkins University School of Medicine Baltimore, Maryland George K Siberry, MD, MPH Assistant Professor Department of Pediatrics Johns Hopkins University School of Medicine Baltimore, Maryland Karen C Carroll, MD Director, Division of Medical Microbiology Director, Medical Microbiology Fellowship Program Professor of Pathology Johns Hopkins University School of Medicine Baltimore, Maryland 1600 John F Kennedy Blvd Ste 1800 Philadelphia, PA 19103-2899 THE HARRIET LANE HANDBOOK OF PEDIATRIC ANTIMICROBIAL THERAPY, SECOND EDITION ISBN: 978-0-323-11247-5 Copyright © 2014 by Saunders, an imprint of Elsevier Inc No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein) NOTICES Knowledge and best practice in this field are constantly changing As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein Previous edition copyrighted 2009 Library of Congress Cataloging-in-Publication Data The Harriet Lane handbook of pediatric antimicrobial therapy / [edited by] Julia A McMillan … [et al.].—2nd ed p ; cm Handbook of pediatric antimicrobial therapy Includes bibliographical references and index ISBN 978-0-323-11247-5 (pbk.) I. McMillan, Julia A. II. Johns Hopkins Hospital Children’s Center. III. Title: Handbook of pediatric antimicrobial therapy [DNLM: 1. Anti-Infective Agents—therapeutic use—Handbooks. 2. Adolescent. 3. Child. 4. Infant QV 39] RM262 615′.1—dc23 2013003412 Content Strategist: James Merritt Content Development Specialist: Andrea Vosburgh Publishing Services Manager: Pat Joiner Design Manager: Steven Stave Printed in the United States of America Last digit is the print number: 9 8 7 6 5 4 3 2 Working together to grow libraries in developing countries www.elsevier.com | www.bookaid.org | www.sabre.org DEDICATION We dedicate this second edition of The Harriet Lane Handbook of Pediatric Antimicrobial Therapy to the clinicians and investigators whose work has allowed continued improvement in our ability to treat and to prevent infections in infants and children Contributors Karen C Carroll, MD Director, Division of Medical Microbiology Director, Medical Microbiology Fellowship Program Professor of Pathology Johns Hopkins University School of Medicine Baltimore, Maryland Lisa A Degnan, PharmD, BCPS Clinical Assistant Professor Ernst Mario School of Pharmacy Rutgers, The State University of New Jersey; Clinical Pharmacy Specialist, Pediatrics Hackensack University Medical Center Hackensack, New Jersey Swathi Gowtham, MD Clinical Fellow Division of Pediatric Infectious Diseases Division of Clinical Pharmacology Johns Hopkins University School of Medicine Baltimore, Maryland Angela M Helder, PharmD, BCPS Clinical Pharmacy Specialist Pediatric Emergency Medicine Department of Pharmacy The Johns Hopkins Hospital Baltimore, Maryland Hiwot Hiruy, MD Clinical Fellow Division of Pediatric Infectious Diseases Johns Hopkins University School of Medicine Baltimore, Maryland Carlton K K Lee, PharmD, MPH Clinical Pharmacy Specialist, Pediatrics Program Director, Pediatric Pharmacy Residency Department of Pharmacy The Johns Hopkins Hospital; Associate Professor, Pediatrics Johns Hopkins University School of Medicine Baltimore, Maryland vii viii Contributors Melissa D Makii, PharmD, BCPS Clinical Pharmacy Specialist Pediatric Oncology Department of Pharmacy Rainbow Babies and Children’s Hospital Cleveland, Ohio Julia A McMillan, MD Professor of Pediatrics Associate Dean for Graduate Medical Education Johns Hopkins University School of Medicine Baltimore, Maryland Kristine A Parbuoni, PharmD, BCPS Clinical Pharmacy Specialist Pediatric Critical Care University of Maryland Medical Center Baltimore, Maryland George K Siberry, MD, MPH Assistant Professor Department of Pediatrics Johns Hopkins University School of Medicine Baltimore, Maryland Elizabeth A Sinclair, PharmD, BCPS Clinical Pharmacist Pediatric Critical Care Riley Hospital for Children at Indiana University Health Indianapolis, Indiana Paul K Sue, MD Clinical Fellow Division of Pediatric Infectious Diseases Johns Hopkins University School of Medicine Baltimore, Maryland Preface This second edition of The Harriet Lane Handbook of Pediatric Antimicrobial Therapy was, like the first edition, a collaboration that included the disciplines of pediatric infectious diseases, microbiology, and clinical pharmacology We recognize that decisions regarding effective antimicrobial therapy require the knowledge and experience of all three of these disciplines, particularly when caring for children whose infections are complications of underlying conditions or the compromised immunity that results from chemotherapy or surgery For this edition, our microbiology expert was Dr Karen C Carroll, who kindly agreed to replace Dr James Dick, who is now retired Dr Carroll reviewed and significantly revised Chapter 4, Mechanisms of Action and Routes of Administration of Antimicrobial Agents, and Chapter 5, Mechanisms of Drug Resistance The other faculty authors for the first edition have participated in this one, but the pediatric infectious diseases fellows, Drs Hiwot Hiruy, Swathi Gowtham, and Paul K Sue, all contributed for the first time Their dedication to excellence in the care of their patients is reflected in the care with which they have reviewed and revised Chapter 2, Recommended Empiric Antimicrobial Therapy for Selected Clinical Syndromes Because decision-making about antimicrobial selection and dosage requires more than matching a “drug” to a “bug,” we are particularly proud to that Dr Carlton K K Lee was able to recruit former Pediatric Pharmacy residents Drs Lisa A Degnan, Angela M Helder, Melissa D Makii, Elizabeth A Sinclair, and Kristine A Parbuoni to assist in revising Chapter 3, Drug Dosing in Special Circumstances; Chapter 6, Therapeutic Drug Monitoring; Chapter 7, Adverse Drug Reactions; and Chapter 9, Antimicrobial Desensitization Protocols We have reviewed available evidence and current guidelines from expert panels to provide recommendations that are as accurate and as contemporary as is possible We realize, however, that new evidence and guidelines will emerge during the life of this second edition, so we urge readers to consult additional resources, particularly for unusual infections or for suspected antimicrobial resistance ix x Preface Decisions regarding antimicrobial therapy for children require an understanding of biologic development, mechanisms of resistance, and pharmacology We hope that this handbook will help clinicians in their efforts to provide the most effective therapy for each individual circumstance Karen C Carroll, MD Carlton K K Lee, PharmD, MPH Julia A McMillan, MD George K Siberry, MD, MPH Swathi Gowtham, MD Hiwot Hiruy, MD Paul K Sue, MD Lisa A Degnan, PharmD, BCPS Angela M Helder, PharmD, BCPS Melissa D Makii, PharmD, BCPS Kristine A Parbuoni, PharmD, BCPS Elizabeth A Sinclair, PharmD, BCPS 556 Chapter 10 Formulary TIPRANAVIR continued Adverse effects: GI disturbances, fatigue, headache, rash, vomiting, and elevated LFTs, cholesterol, and triglycerides are common in children and adults Rash occurs more frequent in children than adults Fat redistribution, immune reconstitution syndrome, hepatitis, hepatic decompensation, and elevated transaminases in patients with hepatitis B or C, or already elevated transaminates have been reported See earlier Warnings/Precautions Drug interactions: Substrate and inhibitor of cytochrome P450 3A May reduce levels of amprenavir, lopinavir, saquinavir, raltegravir, and valproic acid Carbamazepine, phenobarbital, phenytoin, and rifampin may decrease effects of tipranavir Ritonavir boosts tipranavir levels and is also a substrate and inhibitor of CYP P450 3A See earlier Contraindications and Warnings/Precautions sections Always check the potential for other drug interactions when either initiating therapy or adding new drugs onto an existing regimen Drug administration: Drug is always given in combination with ritonavir Administer all doses with a meal or light snack If given together, separate dose from didanosine by at least hours TOBRAMYCIN Nebcin, Tobrex, AKTob, TOBI, TOBI Podhaler, and others Antibiotic, aminoglycoside No Yes B/D Injection: 10, 40 mg/mL; may contain phenol and bisulfites Premixed injection: 80 mg in 100 mL NS Powder for injection: 1.2 g; preservative free Ophthalmic ointment (Tobrex, AKTob): 0.3% (3.5 g) In combination with dexamethasone (TobraDex): 0.3% tobramycin with 0.1% dexamethasone (3.5 g); contains 0.5% chlorbutanol Ophthalmic solution (Tobrex): 0.3% (5 mL) In combination with dexamethasone: 0.3% tobramycin with 0.1% dexamethasone (2.5, 5, 10 mL); contains 0.01% benzalkonium chloride and EDTA Nebulizer solution: 300 mg/5 mL (TOBI, preservative free) (56s), 170 mg/3.4 mL (mixed in 0.45% NS, preservative free, use with eFlow/Trio nebulizer ) Powder for inhalation (TOBI Podhaler): 28 mg capsules (224 capsules in weekly packs) Initial empiric dosage; patient-specific dosage defined by therapeutic drug monitoring (see remarks): Neonate, IM/IV (see following table): Postconceptional Age (wk) ≤29* 30–33 34–37 ≥38 Postnatal Age (days) Dose (mg/kg/dose) Interval (hr) 0–7 8–28 >28 0–7 >7 0–7 >7 0–7 >7 4 4.5 4 4 48 36 24 36 24 24 18–24 24† 12–18 *Or significant asphyxia, PDA, indomethacin use, poor cardiac output, reduced renal function † Use Q36 hr interval for HIE patients receiving whole-body therapeutic cooling Continued Chapter 10 Formulary 557 Contraindications: Hypersensitivity to aminoglycosides or any other components in the formulation Warnings/Precautions: Use with caution in combination with neurotoxic, ototoxic, or nephrotoxic drugs; anesthetics or neuromuscular blocking agents; preexisting renal, vestibular, or auditory impairment; and in patients with neuromuscular disorders Higher doses are recommended in patients with cystic fibrosis, neutropenia, or burns Adjust dose in renal failure (see Chapter 3) Monitor peak and trough levels Therapeutic peak levels with conventional Q8 hr dosing: 6–10 mg/L in general 8–10 mg/L in pulmonary infections, neutropenia, osteomyelitis, and severe sepsis Therapeutic trough levels with conventional Q8 hr dosing: