Pediatric Considerations in Infectious Disease

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giddyupp
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64006
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Pediatric Considerations in Infectious Disease
Updated:
2011-02-04 11:48:16
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Pediatric Considerations Infectious Disease PHPR523 Test2
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Pediatric Considerations in Infectious Disease
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  1. What are the pediatric differences in absorption that influence pharmacokinetics?
    • Low gastric pH until 2 yr (effects penicillin, ampicillin)
    • Delayed gastric emptying until 6-8 mo
    • ↓ bile acids and pancreatic enzymes until 3 mo (effects clindamycin and chloramphenicol)
    • IM inj not preferred (low blood flow and muscle mass)
  2. What are the pediatric differences in distribution that influence pharmacokinetics?
    • Higher water content and lower body fat than adults → larger VD for hydrophilic drugs (AG, Vanco)
    • ↓ PPB → kernicterus risk from drugs that compete with bilirubin for binding (sulfonamides and Ceftriaxone)
    • BBB more permeable (AG, Vanco)
    • RBC membrane more permeable (ribavirin, 5-flucytosine) allows for more SE such as anemia d/t drug-enduced cell lysis
  3. What are the pediatric differences in metabolism that influence pharmacokinetics?
    • Limited glucuronidation ability until 3-4yo → gray baby syndrome from chloramphenicol
    • Sulfation and methylation are well developed in neonates (used to metabolize APAP in neonates)
    • Low alcohol dehydrogenase activity until 5yo:
    • trouble metabolizing benzyl alcohol
    • ↑ risk of disulfiram rxn with metronidazole when administered with alcohol-containing products
  4. What are the pediatric differences in elimination that influence pharmacokinetics?
    • GFR:
    • maturity by 3yo
    • low until 36wks gestation, then increase in first couple weeks after birth
    • Big increase in tubular secretion after birth (affects pens and cephs)
    • Can use urine output as indicator of renal fxn (at least 1 mL/kg/hr is normal)
    • Can estimate CrCl if have two serum drug concentrations (eg AG)
    • CrCl equations:
    • Schwartz for 6 mo-21yo
    • Traub and Johnson for 1-18yo
    • Shull for 1-18yo
  5. What are the major differences in pharmacokinetics between children and adults for aminoglycosides and Vancomycin?
    • Larger VD → need a higher dose/kg to obtain the same concentrations as adults
    • Higher clearance in children and adolescents
    • Lower clearance in neonates and infants → need less frequent dosing
  6. Why should Sulfonamides be avoided in pediatric patients?
    • Highly PPB normally (In neonates, displaces bilirubin → ↑ risk of kericterus)
    • CI until >2mo
  7. Why should Ceftriaxone be avoided in pediatric patients?
    Highly PPB normally. In neonates, displaces bilirubin → ↑ risk of kericterus CI until >2mo
  8. Why should Chloramphenicol be avoided in pediatric patients?
    • Immature glucuronyl transferase → gray baby syndrome
    • Avoid until at least 3yo
  9. Why should TCNs by avoided in pediatric patients?
    • Teeth discoloration, altered bone development and growth
    • Avoid until at least 8yo
  10. Why should FQ be avoided in pediatric patients?
    • Cartilage malformations in animal studies
    • Not approved for < 18yo except for complicated UTIs in >1yo
  11. Why should nitrofurantoin be avoided in pediatric patients?
    • Immature RBC production and ↑ sensitivity to damage → hemolytic anemia
    • CI until > 1mo

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