Paediatric microbio Flashcards
UTI - E coli Tx
IV CEFUROXIME for 7 DAYS (esp if vomiting/suspected pylonephritis)
can potentially switch to oral trimethoprim if kid tolerates
Fever in under 3 MONTHS old
ADMIT to HOSPITAL
There’s more in the guidelines (Fever in UNDER 5 y/o NICE guidleines)
How to check UTI in <3 months
URINE MICROSCOPY
(can’t do dipstick in under 3 months)
Also do bloods (fbc, crp, U+E + Cultures)
If baby presents with Fever, vomiting, generally miserable -> what to do
- Bloods
- Urine microscopy
- Lumbar puncture (pretty much always for <1 month - blood brain barrier not developed enough)
sputum/stool as required
Be concerned they may be septic
Abx for baby presenting with fever
CEFOTAXIME or CEFTRIAXONE
- 3rd gen cephalosporins (PENETRATE BLOOD BRAIN BARRIER unlike 2nd gen Cefuroxime)
Further investigations for UTIs in babies after bloods/urine microscopy
KUB USS - low threshold as don’t know if the kid may have kidney abnormalites etc
Less commonly:
- DMSA
- MCUG (to check for uretric reflux)
Look at guidleines for uti management in under 6 months
Tx for UTI with ESBL E coli
MEROPENEM
(Extended spectrum beta-lactamase producers are resistant to all penicillins and cephalosporins)
Ciprofloxacin and gentamicin also work against ESBL BUT not liscenced in under 1s as they have significant side effects (may need to use anyway if nothing else working)
If child is not improving with treatment what to consider
- Adherence (is the kid actually getting the treatment?)
- Resistance
What is osteomyelitis in kids often preceeded by
MINOR TRAUMA (bugs can get in through scratches and tend to go to areas which are already damaged)
Osteomyelitis Dx
x-ray
- BLOOD CULTURES (only get circulating microbes in around 10% tho)
Most common causative organism of osteomyelitis
STAPH AUREUS
(makes a lot of toxins/enzymes so v virulent)
Osteomyelitis/Septic Arthritis Tx
IV CEFUROXIME for 6 WEEKS
- can switch to ORAL FLUCLOXACILLIN so they don’t have to stay in hospital for 6 weeks
Consider: Outpatient A? THerapy (come in once a day to get IV injection)
If under 3 months - typically go down fever pathway
Bacterial meningitis/meningococcal sepsis Tx
IV CEFOTAXIME
Not particularlly resistant so if suspected just give IV 3rd gen cephalosporin as soon as possible
Meningococcal sepsis Dx
- Blood cultures (immediately)
- EDTA blood for PCR (for meningococcal/pneumococcal specifically)
- CSF (consider delaying till stable)
GIVE TREATMENT EVEN BEFORE GETTING RESULTS
What public health action must be taken if a case of meningitis/encephalitis occurs
NOTIFY LOCAL HEALTH PROTECTION UNIT (PHE)
- available 24/7
- they give prophylaxis
Neisseria meningitidis prophylaxis
CIPROFLOXACIN
or ORAL Rifampicin
Vaccine for meningitis
Gram positive cocci in pairs (in wheezy, febrile kids)
STREP PNEUMONIAE
most common cause of lobar pneumonia
Strep pneumonniae Tx
IV BENZYLPENICILLIN or ORAL AMOXICILLIN - depending on severity
Typically around 5 DAYS but longer if not responding as well
Why may kids initially get better and them deteriorate after a few days of pneumonia treatment?
Infection may have spread to pleural space -> 2ndry EMYEMA
- will require source control (chest drains for emyema)
Commonest cause of pharyngitis/tonsilitis
Bacteria = Gp A strep
Viral: Adenovirus; EBV
Epiglotitis
Haemophilus influenza B
Whooping chough
pertussis
Otitis media
Pneumococcus
Haemophilus influenza
Group A strep
Moraxella
Croup
Parainfluenza
Tracheitis
- Strep aureus
- Strep A
- Haemophilius influ
Pneumonia
Strep A
Pneumococcus
Staph
Haemophilius
TB
RSV
Atypical pneumonia
Mycoplasma
