[e-farmacos] Dudas sobre claritromicina y ceftriaxona (cont.)

["Roitter, Claudia" <croitter@daspu.com.ar>]

Estimado Rafael Buteler,

Sobre su cuestión: "Ninho de 3 anhos con neumonia bacteriana que no tolera antibioticos por boca y se niega a tomarlos. Le indico ceftriaxona a 50 mgs por kg, pero cuantos dias le tengo que dar?"

Lo que esta mas abajo es extraido de las guias australianas (Therapeutic 
Guidelines Limited (19, July 2006)). (SIN TRADUCCION)

Atte.,

Claudia Roitter
Comision de Medicamentos
DASPU Cordoba
(Argentina)

Introduction
In neonates, most early-onset pneumonia (in the first 3 days after birth) is 
acquired from the maternal perineal flora, with group B streptococcus 
(Streptococcus agalactiae) and Escherichia coli the most common pathogens. 
After the neonatal period, most cases are viral in origin, but bacterial 
pneumonia can occur and may be life-threatening. In a child with widespread 
pulmonary wheeze and/or crackles without focal changes on chest X-ray, 
symptomatic treatment may be all that is necessary.
Streptococcus pneumoniae is the most common cause of acute bacterial 
pneumonia in children. Less common causes include Mycoplasma pneumoniae, 
nontypeable Haemophilus influenzae (particularly in those with underlying 
lung disease) and Staphylococcus aureus. Chlamydia trachomatis should be 
considered in infants up to 3 months of age, particularly if there is 
concomitant eye discharge. S. aureus pneumonia is characterised by signs of 
systemic toxicity as well as empyema and/or pneumatoceles on chest 
X-ray?empirical therapy should include antistaphylococcal antibiotics and 
the possibility of community-acquired MRSA should be considered (see 
Staphylococcal pneumonia) when this pathogen is suspected, and in severely 
ill infants. M. pneumoniae infection is more common once school age is 
reached. Oral antibiotics are preferred in mild cases and are used to 
complete the treatment in more serious cases. Children with moderate to 
severe pneumonia usually require parenteral therapy, at least initially. 
Infants and children with pre-existing cardiac or pulmonary disease require 
earlier and more intensive treatment than would be given in an uncomplicated 
case

4 months to <5 years
Most cases are viral; however, if bacterial infection is suspected on the 
basis of investigations, antibacterial therapy is warranted.
For mild disease, use:
 amoxycillin 25 mg/kg orally, 8-hourly for 7 days.     

For moderate disease (eg lobar or lobular consolidation, pleural effusion), 
use:
 benzylpenicillin 30 mg/kg IV, 6-hourly for 7 days.      

For severe disease (systemic toxicity and/or oxygen dependence), use:
cefotaxime 25 mg/kg IV, 8-hourly for 7 days
OR THE COMBINATION OF 
ceftriaxone 25 mg/kg IV, daily for 7 days  
 PLUS EITHER 
 dicloxacillin 50 mg/kg IV, 6-hourly for 7 days    
 OR 
 flucloxacillin 50 mg/kg IV, 6-hourly for 7 days.     

If staphylococcal pneumonia is suspected on clinical grounds (eg very severe 
disease, large pleural effusion, pneumatoceles) or ethnicity (increased 
incidence in Indigenous and Pacific Island children), see Staphylococcal 
pneumonia.
5 to 15 years
While Streptococcus pneumoniae is the commonest organism, Mycoplasma 
pneumoniae is also prominent in this age group, but occurs in 3- to 4-yearly 
cycles.
For mild disease, use:
 amoxycillin 25 mg/kg up to 1 g orally, 8-hourly for 7 days.

If you also intend to treat for Mycoplasma pneumoniae or Chlamydophila 
(Chlamydia) pneumoniae, add:
clarithromycin 7.5 mg/kg up to 250 mg orally, 12-hourly for 7 days  
 OR 
roxithromycin 4 mg/kg up to 150 mg orally, 12-hourly for 5 days.    

For more serious disease, use:
 benzylpenicillin 30 mg/kg up to 1.2 g IV, 6-hourly for 7 days     
    
 PLUS EITHER 
clarithromycin 12.5 mg/kg up to 500 mg orally, 12-hourly for 7 days     
 OR
roxithromycin 4 mg/kg up to 150 mg orally, 12-hourly for 5 days.