Treatment options for nontuberculous mycobacterial adenitis in children.
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Anti-Bacterial Agents↗
Biomedical subjects
Ann M Loeffler
Publications and source records attributed to Ann M Loeffler.
Pediatric tuberculosis.
Pediatric tuberculosis (TB) is different than that in adults in several ways. (1) The diagnosis of TB is more difficult in children due to non-specific or complete absence of symptoms and difficulty in confirming the diagnosis microbiologically. (2) Young children suffer more extrapulmonary and disseminated TB than adults. (3) Treatment of TB in children is challenging due to the lack of pediatric drug formulations and challenges in monitoring for toxicity. Fortunately, children generally do very well with treatment and tolerate the medications well. Treatment regimens are very similar to those used in adults. Four drug treatment should be initiated for treatment of presumed active TB if there are any risks of drug resistance in the child or adult source case (including residence or travel to an area where there is > 4% resistance to INH). (4) Children should be TB skin tested only if they have risks for TB infection, are likely to progress to active TB, or are suspected of having active TB. Unlike adults, all children should be treated for latent TB infection if identified because the therapy is very safe in young people, they were likely to have been infected relatively recently, and they have a long time to reactivate their latent infection. (5) Young children are not contagious with active TB and acquired their disease from shared airspace with adolescents or adults with pulmonary TB or ingestion of unpasturized milk products (M. bovis).
Adolescent↗
Safety and efficacy of quinupristin/dalfopristin for treatment of invasive Gram-positive infections in pediatric patients.
BACKGROUND: Antibiotic-resistant Gram-positive pathogens are an increasingly common cause of serious pediatric infections. Although quinupristin/dalfopristin demonstrates favorable activity against resistant Gram-positive pathogens (including many vancomycin-resistant and methicillin-resistant staphylococci), published experience in the pediatric patient population is limited. METHODS: We retrospectively analyzed data from the global quinupristin/dalfopristin Emergency-Use Program, which enrolled patients with serious Gram-positive infections who had no further therapy options because of resistance to, failure on or intolerance to standard antibiotic treatments. Our subset included safety and efficacy data from pediatric patients (age <18 years). There were no restrictions on underlying diseases, severity of illness or prior/concomitant antimicrobial use. RESULTS: Between May 1995 and October 1999, 127 pediatric patients with 131 infections were enrolled. Microbiologic confirmation of etiology was available in 124 patients. All patients had 1 or more concomitant conditions, including malignancy and solid organ or bone marrow transplantation. The most frequent causative pathogens were vancomycin-resistant (80%), spp. (7%), methicillin-resistant (6%) and (4%). All but 21 patients received intravenous quinupristin/dalfopristin 7.5 mg/kg every 8 h. The favorable clinical response rate of quinupristin/dalfopristin was 86 of 124 (69%); the favorable microbiologic response rate was 97 of 124 (78%). Eleven patients (8%) had nonvenous adverse events classified as possibly or probably related to quinupristin/dalfopristin. CONCLUSIONS: Quinupristin/dalfopristin demonstrated favorable response rates and was reasonably well-tolerated in pediatric patients with serious Gram-positive infections unable to receive alternative therapy. In our opinion quinupristin/dalfopristin is a therapeutic option for the management of such infections.
Adolescent↗
Identifying the sources of tuberculosis in young children: a multistate investigation.
To better understand the molecular epidemiology of tuberculosis (TB) transmission for culture-confirmed patients <5 years of age, data were analyzed from a population-based study conducted in seven U.S. sites from 1996 to 2000. Mycobacterium tuberculosis isolates were genotyped with IS6110-based restriction fragment length polymorphism analysis and spoligotyping. Case-patient data were obtained from the Centers for Disease Control and Prevention s national tuberculosis registry and health department records. Routine public health investigations conducted by local health departments identified suspected source patients for 57 (51%) of 111 culture-confirmed patients <5 years of age. For 8 (15%) of 52 culture-confirmed patients <5 years of age and their suspected source patients with complete genotyping results, genotypes suggested infection with different TB strains. Potential differences between sources for patients <5 years of age and source patients that transmitted TB to adolescent and adult patients were identified.
Adolescent↗