Transcript Management & Prophylaxis of Cardio

Management & Prophylaxis of
Cardio-respiratory illnesses
DR SWATI BHAVE
Senior consultant
Pediatric & Adolescent medicine
Indraprastha Apollo Hospital New Delhi
Member
Standing committee ASPID
( Asian Society of Pediatric infectious disease ( 2000-03) )
Standing committee IPA
( International Pediatric Association 2001-07)
President 2000 Indian Academy of Pediatrics
Prophylactic antibiotics for
cystic fibrosis




Three studies, totaling 177patients aged 0-7 years on enrollment,
were suitable for inclusion in the review.
A reduced prevalence of Staphylococcus aureus in the respiratory
secretions was seen in children receiving anti-staphylococcal
antibiotic prophylaxis, although no effect was seen on other
common pathogens.
One eligible study showed a shorter duration of hospital admissions
in the second year ofl ife, in patients receiving prophylaxis. No
effect on infant lung function has been shown after one year of
prophylactic treatment.
Data are not available on adverse effects of the interventions.
There was a trend towards a lower cumulative isolation
Update
of:
Cochrane Database Syst Rev. 2000;(2):CD001912. . Smyth A, Walters S.
Prophylactic antibiotics for
cystic fibrosis



There was a trend towards a lower cumulative isolation rate of P
aeruginosa in the prophylaxis group,after three years.
However, as the duration of the studies reviewed has been oft hree
years or less, conclusions cannot be drawn about the long term
effects of prophylaxis on acquisition of P. aeruginosa and survival.
REVIEWER'SCONCLUSIONS: Anti-staphylococcal antibiotic
prophylaxis may be of benefit when commenced early in infancy
and continued up to three years of age. There is insufficient
evidence from this review to say whether use in older children, or
adults, or for periods of over three years is beneficial.
Update
of:
Cochrane Database Syst Rev. 2000;(2):CD001912. . Smyth A, Walters S.
Prophylactic antibiotics for
cystic fibrosis: objectives .




(1)
improves clinical status, lung function and
survival
(2) causes adverse effects (e.g. diarrhea,skin
rash, candidiasis)
(3) leads to fewer isolates of common
pathogens from respiratory secretions
(4) leads to the emergence of antibiotic
resistance and the colonization of the
respiratory tract with organisms, e.g.
Pseudomonas aeruginosa.
Smith
A, Walters S . Cochrane Database Syst Rev. 2003;(3):CD001912.
Anti-staphylococcal antibiotic
prophylaxis



leads to fewer children having isolates of Staph. aureus,
when commenced early in infancy and continued up to
six years of age. The clinical importance of this finding is
uncertain.
Further research may establish whether the trend
towards more children with CF with Pseudomonas
aeruginosa, after four to six years of prophylaxis, is a
chance finding.
Future work should explore whether choice of
prophylactic antibiotic or duration of treatment might
influence infection with P aeruginosa.
Vaccine development for capsulate
bacteria causing pneumonia.
Hib vaccine can prevent pneumonia in developing
countries. SP conjugate vaccine prevents X-ray
confirmed pneumonia in low incident populations, but
protection appears more marginal in high incident
populations.
Non-vaccine SP stenotypes have demonstrated increased
carriage and mucosal disease, but not invasive disease
following vaccination.
GBS vaccines are in the early stages of clinical
development as prenatal or antenatal vaccines.
Russell FM, Buttery J. Curr Opin Pulm Med. 2003 May;9(3):227-32.
Selective decontamination of the digestive tract.



Ventilator-associated pneumonia usually
originates : patient's oropharyngeal microflora.
In selective digestive decontamination, topical
antibiotics : applied to the oropharynx and
stomach for prevention of pneumonia and other
infections,
Also used for the prevention of gut-derived
infections in acute necrotizing pancreatitis and
liver transplantation
Krueger
WA, Unertl KE. Curr Opin Crit Care. 2002 Apr;8(2):139-44.
Selective decontamination of the digestive tract.
Remains controversial



Reduction of the incidence of pneumonias
accepted, but the extent of reduction is debated.
Mortality was not reduced in most individual
trials.increased resistance & shift to Gram-positive
selection of appropriate groups of patients for
underlying diseases and severity of illness, &
and selection of ICUs, based on the endemic
resistance patterns
Krueger
WA, Unertl KE. Curr Opin Crit Care. 2002 Apr;8(2):139-44.
Prospects for the prevention and control of
pseudomonal infection in children with cystic
fibrosis.

by eliminating cross-infection and by
early aggressive antibiotic treatment of
the first positive sputum culture and of
subsequent intermittent colonisation. By
using chronic suppressive antibiotic
maintenance therapy and antiinflammatory drugs it is however, possible
to maintain the lung function of these
patients for a number of years.
Hoiby N Paediatr Drugs. 2000 Nov-Dec;2(6):451-63.
Antibiotics for preventing pneumonia in
children with measles.

The quality of the trials reviewed was
poor, and they provide very weak
evidence for giving antibiotics to all
children with measles. Available evidence
suggests that antibiotics should be given
only if a child has clinical signs of
pneumonia or other evidence of sepsis.
Shann F, D'Souza RM, D'Souza R., Cochrane Database Syst Rev. 2000;(2):CD001477.
Vaccine development for capsulate
bacteria causing pneumonia.
Hib vaccine can prevent pneumonia in developing
countries. SP conjugate vaccine prevents X-ray
confirmed pneumonia in low incident populations, but
protection appears more marginal in high incident
populations.
Non-vaccine SP stenotypes have demonstrated increased
carriage and mucosal disease, but not invasive disease
following vaccination.
GBS vaccines are in the early stages of clinical
development as prenatal or antenatal vaccines.
Russell FM, Buttery J. Curr Opin Pulm Med. 2003 May;9(3):227-32.
Pulmonary fungal infections in
immuno-compromised children.
Treatment is usually successful if
initiate dearly, although pulmonary
aspergillosis and zygomycosis are
portentous ailments unless surgical
resection or prompt immunologic
recovery ensue.
Shenep
JL, Flynn PM. Curr Opin Pediatr. 1997 Jun;9(3):213-8.
Use of prophylactic antibiotics
in cancer patients .
Severe neutropenia < 100/mm3) for> 2
weeks should receive oral antibiotic
prophylaxis.
 At present, trimethoprim
sulfamethoxazole in combination with
either nystatin or amphotericin B is the
best regimen for reducing the incidence of
serious infections.

Wolff
LJ. Am J Pediatr Hematol Oncol. 1984 Fall;6(3):267-76.
THERAPY HAS IMPORTANT
ROLE
Management of valvular heart dis-ease:
 stabilization of patients until the time of
surgery, treatment of the underlying
 cause,and prevention of bacterial
endocarditis and rheumatic fever
 it is still not proven to alter the course of
valvular heart disease or the time of surgery
when a serious structural abnormality is
Cleveland clinic journal of medicine volume 68 • number 10 october 2001881rug
ANTIBIOTIC
PROPHYLAXIS in Rheumatic disease
Prophylaxis is indicated if
 echocardiography shows evidence of a
rheumatic etiology of valve disease
Summary
Prophylactic antibiotics should be
judiciously used
 There are recommendations based on
good research studies
 A protocol should be standardized for
each setup that should be strictly
followed by all the concerned
personalle
