This week WAidid suggets the reading of a study that investigates the clinical practice of using 30 mg/kg/day of clindamycin as an alternative for outpatient dosing. The review was published on June 2016, 10th on Pediatric Infectious Disease Journal.
An increasing body of evidence suggests that oral antibiotic therapy following parenteral antibiotic use is effective in the treatment of pediatric musculoskeletal infection, including osteomyelitis.
Guidelines of the Infectious Diseases Society of America (IDSA) for the management of children and adolescents with methicillin-resistant Staphylococcus aureus (MRSA) infections suggest parenteral and oral dosing from 30 to 40 mg/kg/day. However, there is limited evidence to guide the decision as to which end of the spectrum of dosing is appropriate for continued oral therapy following hospitalization. Clindamycin provides high bone concentrations that exceed the minimum inhibitory concentration of MRSA irrespective of formulation or regimen utilized. The purpose of this study was to assess the relative risk of readmission due to residual or recurrent infection using a dosing strategy of 30 mg/kg/day (10 mg/kg/dose every 8 hours) of clindamycin for outpatient oral therapy following inpatient intravenous dosing of 40 mg/kg/day for children with deep infections in an MRSA prevalent community. Among 215 children studied, the average outpatient duration of treatment was 32.8 days. There was no significant difference in the rate of readmission between dosing cohorts. Oral dosing of 30 mg/kg/day was effective for musculoskeletal infection in children in an MRSA prevalent community. Illness severity appeared to have greater impact on readmission and sequelae than did antibiotic dosing.
Erickson CM, Sue PK, Stewart K, Thomas MI, Lindsay EA, Jo C, Copley LA
To read the article online click HERE
This week WAidid suggests the Systematic Review published on Pediatric Infectious Diseases Journal on May 31st, 2016 on Rotavirus effects.
Diarrheal disease is a leading cause of childhood morbidity and mortality globally. Rotavirus is the leading cause of vaccine-preventable diarrhea among children under-five and is associated with approximately 28% of diarrheal deaths. WHO recommends the inclusion of rotavirus vaccination in all national immunization programs. There are two licensed oral live-attenuated rotavirus vaccines currently available globally: a monovalent human rotavirus vaccine (Rotarix (RV1) ) and a pentavalent bovine–human reassortant rotavirus vaccine (RotaTeq (RV5)). In 2011, a systematic review of published vaccine efficacy trials and effectiveness studies estimated that rotavirus vaccines reduced severe rotavirus diarrhea by 91% in developed countries, 88% in low-mortality countries in Asia and North Africa, 81% in Latin America, and 50% in sub Saharan Africa. In this systematic review, the authours aimed to expand upon the existing evidence base for the efficacy and effectiveness of rotavirus vaccination against morbidity and mortality among children <5 years of age. The results of our systematic review confirm the protective efficacy and effectiveness of rotavirus vaccination against rotavirus and all diarrheal outcomes among children under-five globally. efficacy was highest in the developed region followed by East/Southeastern Asia, Latin America and the Caribbean, South Asia and Sub Saharan Africa (Figure 2), and effectiveness estimates followed a similar regional pattern. Possible explanations for varying levels of protection include regional differences in gut microbiome, environmental enteropathy, inhibitory maternal antibodies and/or interactions with other viruses in the gut. Though the protective effects conferred by rotavirus vaccines are greater in higher income settings, rotavirus vaccination has the potential to avert more severe childhood diarrhea cases and deaths in low-income regions where the incidence of severe rotavirus is highest and adequate diarrhea management is less accessible.
Lamberti LM, Ashraf S, Walker CL, Black RE