Zoliflodacin: A Promising Oral Therapy for Antibiotic-Resistant Gonorrhoea
December 16, 2025
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Background
Sepsis in the pediatric population, like in adults, refers to a spectrum of diseases resulting from infection with bacteria, viruses, fungi or parasites, or toxins produced by any of these organisms. This condition can include bloodstream infections like bacteremia, viremia, fungemia, or parasitemia which while causing fever it may not be accompanied by other symptoms of circulatory failure or end-organ dysfunction.
Sepsis management in infants and children is particularly challenging due to multiple factors. However, early identification and management are important to enhance the prognosis of such patients. Most children with sepsis are going to require ICU admission; the initial approach should therefore be to assess and correct any metabolic, circulatory, or respiratory derangements.
In moderate to severe cases, critical care of the patient is important, and in some cases, an Infectious Diseases Specialist consultation may be required. In a report by the CDC involving 246 adult patients and 79 pediatric septic patients with severe sepsis or septic shock, of which 31 were infants under one year and 48 children between one and 17 years, 80% of the cases occurred in community settings.
Epidemiology
Newborns are at the highest risk for developing sepsis; bacterial sepsis in neonates ranges from 1 to 10 per 1000 live births in the U. S. Sepsis does not appear to follow any gender bias, although urosepsis is statistically more common in females and uncircumcised males. The differences in sepsis by race are less significant, although Eskimos and American Indians are especially vulnerable to invasive bacterial diseases.
Maternal and neonatal care from the year 1993 and 2012 was analyzed and it was found that there was no change in late-onset sepsis from 1993 to 2004 but there was a downtrend from 2005 to 2012. In the study by McMullan et al., SAB was determined in children and adolescents from Australasia with the median age of 57 months by the time of the diagnosis of 1,073 patient. The incidence per annum was 8. 3 per 100,000 in Australia, with higher incidence of the disease in indigenous children. Mortality rates were 2.6% at seven days and 4.7% at 30 days.
Anatomy
Pathophysiology
Initial Response: Sepsis is a condition that develops due to an acute inflammation caused by a bacterial infection. There is also initial evidence of compromised circulation or even shock as evidenced by the tachycardia, tachypnea, and changes in vessels’ behavior such as vasodilation and augmented permeability.
Systemic Inflammatory Response Syndrome (SIRS): Sepsis is a severe form of SIRS, this is a systemic inflammatory response syndrome, a condition that results from inflammation throughout the whole body due to infection or other injurious process eg trauma, chemical injury, cancer etc. Synchronous inflammatory response is the main mechanism of SIRS; this cause cytokines to be released leading to the injury of blood vessels and metabolism.
Circulatory and Metabolic Changes:
Vascular Changes: Capillary permeability and blood vessel dilation are allowed to rise with the implication being that fluid will leak out into the tissues and lower the blood pressure and circulation levels.
Metabolic Effects: It results in metabolic acidosis, the body has increased metabolism, and tissues require more oxygen and release more by-products.
Progression to Severe Sepsis: SIRS if not well addressed will result to severe sepsis characterized by extreme dysfunction of the organs and their failure.
Multiple Organ Dysfunction Syndrome (MODS): Further increase in inflammation and inadequate blood circulation leads to MODS in which many organs are unable to work well because of poor blood supply and tissue damage.
Etiology
Bacterial Infections: Some of the bacteria are Streptococcus pneumoniae, Staphylococcus aureus and Escherichia Coli.
Viral Infections: Some of the viruses are respiratory syncytial virus (RSV), and influenza.
Fungal Infections: Like Candida especially in immunocomporised children.
Parasitic Infections: It includes Malaria in endemic Areas.
Genetics
Prognostic Factors
The mortality rate of pediatric sepsis ranges between 9 to 35% and depends on the classification of sepsis according to the type of infection. Another important factor that has been proved to influence survival rate is the immune status of the host. Neonatal sepsis alone accounts for nearly 40% of neonatal mortality, but due to the progress in diagnostic and treatment techniques the mortality has reduced, especially in preterm neonates. A study in the United States among 9,816 children with severe sepsis showed greater mortality among Black children as 18.4% while among Whites, the percentage was 13.4% and the Hispanics 13.7%. Black children were also diagnosed to have significant increased risks of sepsis mortality as compared to White children with odds ratios of 1.19.
Clinical History
Neonates (0-28 days)
Presentation: Vague signs such as poor appetite, decreased activity, increased irritability, temperature changes (fever or hypothermia), difficulty breathing, yellowing of the eyes and skin, and lengthy pauses in breathing.
Associated Comorbidities: Preterm birth, intrauterine growth restriction, maternal infection, congenital abnormality.
Acuity: High; newborns are vulnerable to clinical deterioration and have signs that may be difficult to recognize prior septic shock.
Newborns (0-1 months), Babies (1 month – 1 year)
Presentation: Generally, these would include fever, increased irritability, vomiting, poor feeding, respiratory problems such as tachypnea, grunting, decreased urine output, and confusion or lethargy.
Associated Comorbidities: This indicates that children with congenital heart disease, immunodeficiencies and those who had been hospitalized or operated in the recent past are at a higher risk.
Acuity: Moderate: The condition can worsen to severe sepsis, or septic shock within the shortest period of time, if the signs are not noticed early enough and treatment started.
Toddlers and young children 1-5 years of age
Presentation: Fever, increased heart rate, shortness of breath, drowsiness, poor feeding, diarrhoea, vomiting, stomach-ache, skin rash (tiny red or red-brown spots on skin).
Associated Comorbidities: Asthma, diabetes, immunodeficiency, other chronic diseases, and recent infections as pneumonia, urinary tract infections.
Acuity: Moderate to high; despite relatively higher manifestations than in neonates, children still present for acute sepsis and need immediate management to avoid transition to severe sepsis or septic shock stages.
Older Children and Adolescents (5-12+ years)
Presentation: The symptoms are fever, chills, weakness, muscle aches, joint pains, headaches, tachycardia, hypotension, exertional dyspnea, drowsiness, and abdominal pain.
Associated Comorbidities: Pregnancy/lactation, chronic disease (such as asthma, CF, diabetes), immunocompromised state (cancer treatment, HIV/AIDS), trauma/surgery within the last 7 days.
Acuity: Moderate; Children above this age may present complaints verbally well but the condition can worsen very fast and needs the attention of a doctor.
Physical Examination
Vital Signs: Evaluate the patient for fever or hypothermia, tachycardia and/or tachypnea, hypotension (a very late sign), and oxygen level.
General Appearance: When evaluating the child consider the level of consciousness, skin color whether pale, mottled or cyanotic and activity level showing signs of lethargy or irritability.
Skin: Look for capillary refill delay, rashes including petechial and purpuric rash, cold extremities, and signs of oedema.
Cardiovascular: Assess for variations or irregularities in heart sounds; strength of pulse; and lack of nutrient and oxygen delivery to tissues.
Respiratory: Look for an increased respiratory rate that is not related to age, listen for abnormal breath sounds, observe the child for retractions, grunting or if they are working harder than normal to breathe.
Gastrointestinal: Palpate for abdominal swelling, pain and changes in tone and pitch of bowel sounds if present.
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Group A Streptococcal (GAS) Infections
Pediatric Adrenal Insufficiency (Addison Disease)
Pediatric Aseptic Meningitis
Pediatric Bacterial Meningitis
Pediatric Enterococcal Infection
Pediatric Fungal Endocarditis
Pediatric Herpes Simplex Virus Infection
Bacteremia
Necrotizing Enterocolitis Imaging
Pediatric Candidiasis
Pediatric Escherichia Coli Infections
Pediatric Haemophilus Influenzae Infection
Pediatric Infective Pericarditis
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Early Recognition and Assessment: Quicker and accurate recognition of sepsis from signs that may include fever, confusion, tachycardia, increased rate of breathing, and mottled skin. Employment of physical screening tools such as the Pediatric Early Warning Score (PEWS) to facilitate early identification.
Immediate Resuscitation: Intravenous administration of large volumes of isotonic fluids, such as normal saline solution or lactated Ringer’s solution at 20 mL/kg, initially and titrated according to the patient’s clinical condition. If continuous fluid administration does not enhance perfusion, the use of inotropes or vasopressors should be started as soon as possible.
Antibiotic Therapy: Antibiotics should be administered within the first hour of sepsis recognition and should be broad-spectrum antibiotics. The decision depends on the possible origin of infection and antibiotic resistance in the region. As per the culture reports and clinical response, it is crucial to utilize antibiotics of lesser spectrum to decrease resistance and related side effects.
Source Control: Further imaging or surgical intervention may have to be undertaken to define and treat the source of infection (for example abscess debridement; removal of infected catheters). Treatment of the cause of infection involves invasive procedures such as surgeries or procedures.
Supportive Care: To ensure that the patients have sufficient oxygenation, it may be necessary to use non-invasive or invasive ventilation if necessary due to respiratory distress. Nursing care involves frequent measurements of the patient’s blood pressure, heart rate, urine output, and other vital signs to determine the adequacy of daily fluid and vasopressor requirements.
by Stage
by Modality
Chemotherapy
Radiation Therapy
Surgical Interventions
Hormone Therapy
Immunotherapy
Hyperthermia
Photodynamic Therapy
Stem Cell Transplant
Targeted Therapy
Palliative Care
use-of-a-non-pharmacological-approach-for-treating-pediatric-sepsis
Fluid Resuscitation: Treatment options may include giving intravenous fluids to replenish lost blood volume and to ensure sufficient blood flow to vital body organs.
Nutritional Support: Supplementation with sufficient nutrients for meeting the metabolic demands of the body and helping patient with recovery.
Temperature Regulation: To reduce the risk of complications resulting from either fever or hypothermia while the patient is in the intensive care unit.
Monitoring and Supportive Care: Observation of the patient’s temperature, pulse, respiration rate, and blood pressure; oxygen saturation; liver and kidney function. have supportive care such as ventilation support and normalizing of electrolyte abnormalities.
Infection Control: Having measures in place to minimize cross transmission of infection and inflammation and putting in place measures such as protection gear to minimize secondary infections.
Role of Antibiotics
Ampicillin and Sulbactam (Unasyn): Sulbactam can be combined with ampicillin to form a single drug, which contains a beta-lactamase inhibitor. It has been effective due to its action that interferes with the formation of bacterial cell wall while the bacteria cells are actively dividing which in turn exhibit bactericidal activity towards susceptible bacteria. This makes it an effective replacement for amoxicillin especially for patients who cannot use oral formulations. This drug acts against skin flora, enteric bacteria and obligate anaerobes but is less useful in treating hospital acquired infections.
Vancomycin: It is known for its potent activity against gram-positive bacteria, specifically having good coverage against hospital-efficient MRSA. With the increase in the prevalence of MRSA, usage of vancomycin has also grown. It is suggested for patients with septic implanted devices or catheters, especially for skin and soft tissue infections.
Ceftriaxone (Rocephin): It is a third-generation cephalosporin, which offers activity mainly against gram-negative microorganisms. It has moderate activity against Gram-positive bacteria but is effective against resistant isolates.It is a beta-lactam antibiotic that interferes with the synthesis of bacterial cell wall by binding to penicillin binding proteins and causes the cells to rupture as construction of the cell wall proceeds.
Gentamicin: It is an aminoglycoside antibiotic used to treat gram-negative bacteria, especially Escherichia coli, Pseudomonas, Proteus, Serratia species, etc. It is even more effective when prescribed together with ampicillin to treat the Group B Streptococci and Enterococcus. In the present guidelines, it is recommended that newborns with suspected sepsis should receive gentamicin with ampicillin.
Cefotaxime (Claforan): It belongs to third-generation cephalosporin that show very good activity against Group B Streptococcus, E.coli, and other gram negative Enteric bacilli. It also attains very high levels in serum and CSF mainly due to its lipophilic nature and ability to easily cross the blood brain barrier. However, use of cefotaxime in the second generation may contribute to the development of drug resistant gram-negative bacteria in contrast to traditional penicillin and aminoglycoside therapy.
Role of Systemic Antifungals
Caspofungin: It is a novel antifungal drug and the first representative of a new class of drugs called the glucan synthesis inhibitors. It operates by inhibiting the formation of beta-(1,3)-D-glucan, a component of the fungal cell wall that is essential. This mechanism makes it effective in treating cases of refractory invasive aspergillosis Invasive aspergillosis is a life-threatening infection caused by a type of mold called Aspergillus.
Posaconazole (Noxafil): It belongs to the group of triazole antifungal agents and shares some similarities with itraconazole. This compound slows down the enzyme called lanosterol 14-alpha-demethylase which affects the ergosterol synthesis and causes disruption of the cell membrane among other effects. Posaconazole is available as oral suspension 200 mg/5ml and used for the prevention of invasive aspergillosis and Candida infection in patients with severe immunosuppressed.
Voriconazole (Vfend): It is a triazole antifungal which inhibit the fungal CYP450 isoenzymes, particularly at the point of 14 alpha-lanosterol demethylation, a process that is critical in ergosterol synthesis in the fungal cell membrane. This has demonstrated effectiveness in managing disseminated disease or meningitis that is not manageable by first-line drugs.
Itraconazole (Sporanox): It is a triazole derivative of ketoconazole is highly preferred for this condition because of greater efficacy and lesser toxicity. It is formulated in an intravenous form, however, there is less information concerning its long-term usage. The absorption of the active pharmaceutical ingredient within the oral solution is more controlled compared to the capsule while the latter must be taken with a full meal to have ideal absorption while the former thrives on an empty stomach.
Fluconazole (Diflucan): It is related to other synthetic triazole antifungal and acts on fungal CYP450 as well as, the sterol C-14 alpha-demethylation of preference of lanosterol to ergosterol. It is employed in the management of mild to moderate systemic infections or severe ones in patients who cannot tolerate AMB due to its nephrotoxic effects; it has a prolonged terminal half-life in patients with chronic renal failure.
Amphotericin B Lipid Complex (ABLC, Abelcet): It is a polyene antifungal with poor absorptibility by the oral route, it makes the fungal cell membrane form a complex with sterols like ergosterol which results to swelling foam of the cell with the leakage of components along with the death of the cell. Nevertheless, it can also become toxic to human made cells or other cells which accompany the cancer cells.
Role of Antivirals
Ganciclovir (Cytovene): It is a synthetic guanine derivative with effective antiviral properties against cytomegalovirus (CMV). It is a compound that’s an acyclic nucleoside analog of 2’-deoxyguanosine and it functions to prevent the herpesviruses from replicating both in the test tube and in vivo. Ganciclovir triphosphate concentrations in CMV-infected cells can be 100 times greater than in uninfected cells, which is thought to be due to selective phosphorylation in virus-infected cells.
Foscarnet: It is an organic pyrophosphate analog that acts as a potent antiviral agent against several herpesviruses, including the CMV, HSV-1, and HSV-2. It works by inhibiting viral replication and this is at the pyrophosphate-binding site on virus-specific DNA polymerases. In the case where patients show suboptimal clinical response or they continue to positive viral shedding, there could be viral resistance. Patients who can metabolize foscarnet without significant toxicity may be started on maintenance therapy at a dose of 120 mg/kg/day with dose adjustment based on renal impairment.
Role of Corticosteroids
Methylprednisolone (A-Methapred, Solu-Medrol, Depo-Medrol): The intravenous/intramuscular and oral preparations are available. It is used to control acute inflammation, corrects capillary permeability and weakens movements of polymorphonuclear leukocytes.
Dexamethasone (Baycadron): They are used for the management of inflammation for various pathological processes. It is lessening inflammation in that it stops the movement of polymorphonuclear leukocytes and provides a reversal of increased capillary permeability.
Role of Hemorheologic Agents
Pentoxifylline (Trental): It can change the dynamics of the flow of red blood cells which are useful in decreasing viscosity of the blood. Thus over all it accelerates fibrinolysis, increases flexibility of red blood cells and inhibits platelet aggregation.
Role of Immune Globulins
Intravenous Immunoglobulin: It achieves its function through the application of anti-idiotypic antibodies which help in eliminating myelin antibodies in circulation. It is involved in the negative regulation of cells that increase inflammation, including interferon gamma. IVIG also reduces the binding of Fc receptors on macrophages, reduces the activity of inducer T cells as well as B cells, and improves the function of suppressor T cells. Further, it inhibits the complement cascade, promotes remyelination, and might increase CSF IgG by 10%.
use-of-intervention-with-a-procedure-in-treating-pediatric-sepsis
Central Venous Catheterization: They obviously support the administration of medicine and feeding, giving of fluids and meals as well as to withdraw blood samples for tests.
Intra-abdominal Pressure Monitoring: In certain clinical situations like in patients with suspected intra-abdominal sepsis, ACS, etc. it may be beneficial to monitor IAP occasionally.
Endotracheal Intubation: Therefore, when sepsis leads to severe respiratory deterioration or respiratory arrest, it becomes usual for patients to be intubated and put on a ventilator.
Dialysis: Dialysis may be needed in the patients with acute or chronic kidney disease with significant decrease in renal function or kidney failure to address electrolyte imbalance or to eliminate toxins.
use-of-phases-in-managing-pediatric-sepsis
Initial Assessment and Recognition: Identification of the sepsis signs through clinical features at an escalated rate. Initially, the patient’s airway, breathing, and circulation must be assessed, followed by their history and physical exam.
Resuscitation: Give intravenous fluids to correct hypovolemia and support microcirculation. Start the broad-spectrum antibiotics, as soon as possible probably within the first one hour. Ensure the continuity of monitoring the patient’s condition and the support of the hemodynamic status using vasoactive agents.
Source Control: Implement interventions that focus on controlling the source of infection (such as abscess drainage, removal of an infected device).
Supportive Care: Ensure adequate oxygenation (supplements if necessary) and ventilation (assistance thru mechanical ventilation, if necessary). Supervise and balance metabolic requirements such as the feeding aspect.
Medication
Future Trends
Sepsis in the pediatric population, like in adults, refers to a spectrum of diseases resulting from infection with bacteria, viruses, fungi or parasites, or toxins produced by any of these organisms. This condition can include bloodstream infections like bacteremia, viremia, fungemia, or parasitemia which while causing fever it may not be accompanied by other symptoms of circulatory failure or end-organ dysfunction.
Sepsis management in infants and children is particularly challenging due to multiple factors. However, early identification and management are important to enhance the prognosis of such patients. Most children with sepsis are going to require ICU admission; the initial approach should therefore be to assess and correct any metabolic, circulatory, or respiratory derangements.
In moderate to severe cases, critical care of the patient is important, and in some cases, an Infectious Diseases Specialist consultation may be required. In a report by the CDC involving 246 adult patients and 79 pediatric septic patients with severe sepsis or septic shock, of which 31 were infants under one year and 48 children between one and 17 years, 80% of the cases occurred in community settings.
Newborns are at the highest risk for developing sepsis; bacterial sepsis in neonates ranges from 1 to 10 per 1000 live births in the U. S. Sepsis does not appear to follow any gender bias, although urosepsis is statistically more common in females and uncircumcised males. The differences in sepsis by race are less significant, although Eskimos and American Indians are especially vulnerable to invasive bacterial diseases.
Maternal and neonatal care from the year 1993 and 2012 was analyzed and it was found that there was no change in late-onset sepsis from 1993 to 2004 but there was a downtrend from 2005 to 2012. In the study by McMullan et al., SAB was determined in children and adolescents from Australasia with the median age of 57 months by the time of the diagnosis of 1,073 patient. The incidence per annum was 8. 3 per 100,000 in Australia, with higher incidence of the disease in indigenous children. Mortality rates were 2.6% at seven days and 4.7% at 30 days.
Initial Response: Sepsis is a condition that develops due to an acute inflammation caused by a bacterial infection. There is also initial evidence of compromised circulation or even shock as evidenced by the tachycardia, tachypnea, and changes in vessels’ behavior such as vasodilation and augmented permeability.
Systemic Inflammatory Response Syndrome (SIRS): Sepsis is a severe form of SIRS, this is a systemic inflammatory response syndrome, a condition that results from inflammation throughout the whole body due to infection or other injurious process eg trauma, chemical injury, cancer etc. Synchronous inflammatory response is the main mechanism of SIRS; this cause cytokines to be released leading to the injury of blood vessels and metabolism.
Circulatory and Metabolic Changes:
Vascular Changes: Capillary permeability and blood vessel dilation are allowed to rise with the implication being that fluid will leak out into the tissues and lower the blood pressure and circulation levels.
Metabolic Effects: It results in metabolic acidosis, the body has increased metabolism, and tissues require more oxygen and release more by-products.
Progression to Severe Sepsis: SIRS if not well addressed will result to severe sepsis characterized by extreme dysfunction of the organs and their failure.
Multiple Organ Dysfunction Syndrome (MODS): Further increase in inflammation and inadequate blood circulation leads to MODS in which many organs are unable to work well because of poor blood supply and tissue damage.
Bacterial Infections: Some of the bacteria are Streptococcus pneumoniae, Staphylococcus aureus and Escherichia Coli.
Viral Infections: Some of the viruses are respiratory syncytial virus (RSV), and influenza.
Fungal Infections: Like Candida especially in immunocomporised children.
Parasitic Infections: It includes Malaria in endemic Areas.
The mortality rate of pediatric sepsis ranges between 9 to 35% and depends on the classification of sepsis according to the type of infection. Another important factor that has been proved to influence survival rate is the immune status of the host. Neonatal sepsis alone accounts for nearly 40% of neonatal mortality, but due to the progress in diagnostic and treatment techniques the mortality has reduced, especially in preterm neonates. A study in the United States among 9,816 children with severe sepsis showed greater mortality among Black children as 18.4% while among Whites, the percentage was 13.4% and the Hispanics 13.7%. Black children were also diagnosed to have significant increased risks of sepsis mortality as compared to White children with odds ratios of 1.19.
Neonates (0-28 days)
Presentation: Vague signs such as poor appetite, decreased activity, increased irritability, temperature changes (fever or hypothermia), difficulty breathing, yellowing of the eyes and skin, and lengthy pauses in breathing.
Associated Comorbidities: Preterm birth, intrauterine growth restriction, maternal infection, congenital abnormality.
Acuity: High; newborns are vulnerable to clinical deterioration and have signs that may be difficult to recognize prior septic shock.
Newborns (0-1 months), Babies (1 month – 1 year)
Presentation: Generally, these would include fever, increased irritability, vomiting, poor feeding, respiratory problems such as tachypnea, grunting, decreased urine output, and confusion or lethargy.
Associated Comorbidities: This indicates that children with congenital heart disease, immunodeficiencies and those who had been hospitalized or operated in the recent past are at a higher risk.
Acuity: Moderate: The condition can worsen to severe sepsis, or septic shock within the shortest period of time, if the signs are not noticed early enough and treatment started.
Toddlers and young children 1-5 years of age
Presentation: Fever, increased heart rate, shortness of breath, drowsiness, poor feeding, diarrhoea, vomiting, stomach-ache, skin rash (tiny red or red-brown spots on skin).
Associated Comorbidities: Asthma, diabetes, immunodeficiency, other chronic diseases, and recent infections as pneumonia, urinary tract infections.
Acuity: Moderate to high; despite relatively higher manifestations than in neonates, children still present for acute sepsis and need immediate management to avoid transition to severe sepsis or septic shock stages.
Older Children and Adolescents (5-12+ years)
Presentation: The symptoms are fever, chills, weakness, muscle aches, joint pains, headaches, tachycardia, hypotension, exertional dyspnea, drowsiness, and abdominal pain.
Associated Comorbidities: Pregnancy/lactation, chronic disease (such as asthma, CF, diabetes), immunocompromised state (cancer treatment, HIV/AIDS), trauma/surgery within the last 7 days.
Acuity: Moderate; Children above this age may present complaints verbally well but the condition can worsen very fast and needs the attention of a doctor.
Vital Signs: Evaluate the patient for fever or hypothermia, tachycardia and/or tachypnea, hypotension (a very late sign), and oxygen level.
General Appearance: When evaluating the child consider the level of consciousness, skin color whether pale, mottled or cyanotic and activity level showing signs of lethargy or irritability.
Skin: Look for capillary refill delay, rashes including petechial and purpuric rash, cold extremities, and signs of oedema.
Cardiovascular: Assess for variations or irregularities in heart sounds; strength of pulse; and lack of nutrient and oxygen delivery to tissues.
Respiratory: Look for an increased respiratory rate that is not related to age, listen for abnormal breath sounds, observe the child for retractions, grunting or if they are working harder than normal to breathe.
Gastrointestinal: Palpate for abdominal swelling, pain and changes in tone and pitch of bowel sounds if present.
Group A Streptococcal (GAS) Infections
Pediatric Adrenal Insufficiency (Addison Disease)
Pediatric Aseptic Meningitis
Pediatric Bacterial Meningitis
Pediatric Enterococcal Infection
Pediatric Fungal Endocarditis
Pediatric Herpes Simplex Virus Infection
Bacteremia
Necrotizing Enterocolitis Imaging
Pediatric Candidiasis
Pediatric Escherichia Coli Infections
Pediatric Haemophilus Influenzae Infection
Pediatric Infective Pericarditis
Early Recognition and Assessment: Quicker and accurate recognition of sepsis from signs that may include fever, confusion, tachycardia, increased rate of breathing, and mottled skin. Employment of physical screening tools such as the Pediatric Early Warning Score (PEWS) to facilitate early identification.
Immediate Resuscitation: Intravenous administration of large volumes of isotonic fluids, such as normal saline solution or lactated Ringer’s solution at 20 mL/kg, initially and titrated according to the patient’s clinical condition. If continuous fluid administration does not enhance perfusion, the use of inotropes or vasopressors should be started as soon as possible.
Antibiotic Therapy: Antibiotics should be administered within the first hour of sepsis recognition and should be broad-spectrum antibiotics. The decision depends on the possible origin of infection and antibiotic resistance in the region. As per the culture reports and clinical response, it is crucial to utilize antibiotics of lesser spectrum to decrease resistance and related side effects.
Source Control: Further imaging or surgical intervention may have to be undertaken to define and treat the source of infection (for example abscess debridement; removal of infected catheters). Treatment of the cause of infection involves invasive procedures such as surgeries or procedures.
Supportive Care: To ensure that the patients have sufficient oxygenation, it may be necessary to use non-invasive or invasive ventilation if necessary due to respiratory distress. Nursing care involves frequent measurements of the patient’s blood pressure, heart rate, urine output, and other vital signs to determine the adequacy of daily fluid and vasopressor requirements.
Pediatrics, General
Fluid Resuscitation: Treatment options may include giving intravenous fluids to replenish lost blood volume and to ensure sufficient blood flow to vital body organs.
Nutritional Support: Supplementation with sufficient nutrients for meeting the metabolic demands of the body and helping patient with recovery.
Temperature Regulation: To reduce the risk of complications resulting from either fever or hypothermia while the patient is in the intensive care unit.
Monitoring and Supportive Care: Observation of the patient’s temperature, pulse, respiration rate, and blood pressure; oxygen saturation; liver and kidney function. have supportive care such as ventilation support and normalizing of electrolyte abnormalities.
Infection Control: Having measures in place to minimize cross transmission of infection and inflammation and putting in place measures such as protection gear to minimize secondary infections.
Pediatrics, General
Ampicillin and Sulbactam (Unasyn): Sulbactam can be combined with ampicillin to form a single drug, which contains a beta-lactamase inhibitor. It has been effective due to its action that interferes with the formation of bacterial cell wall while the bacteria cells are actively dividing which in turn exhibit bactericidal activity towards susceptible bacteria. This makes it an effective replacement for amoxicillin especially for patients who cannot use oral formulations. This drug acts against skin flora, enteric bacteria and obligate anaerobes but is less useful in treating hospital acquired infections.
Vancomycin: It is known for its potent activity against gram-positive bacteria, specifically having good coverage against hospital-efficient MRSA. With the increase in the prevalence of MRSA, usage of vancomycin has also grown. It is suggested for patients with septic implanted devices or catheters, especially for skin and soft tissue infections.
Ceftriaxone (Rocephin): It is a third-generation cephalosporin, which offers activity mainly against gram-negative microorganisms. It has moderate activity against Gram-positive bacteria but is effective against resistant isolates.It is a beta-lactam antibiotic that interferes with the synthesis of bacterial cell wall by binding to penicillin binding proteins and causes the cells to rupture as construction of the cell wall proceeds.
Gentamicin: It is an aminoglycoside antibiotic used to treat gram-negative bacteria, especially Escherichia coli, Pseudomonas, Proteus, Serratia species, etc. It is even more effective when prescribed together with ampicillin to treat the Group B Streptococci and Enterococcus. In the present guidelines, it is recommended that newborns with suspected sepsis should receive gentamicin with ampicillin.
Cefotaxime (Claforan): It belongs to third-generation cephalosporin that show very good activity against Group B Streptococcus, E.coli, and other gram negative Enteric bacilli. It also attains very high levels in serum and CSF mainly due to its lipophilic nature and ability to easily cross the blood brain barrier. However, use of cefotaxime in the second generation may contribute to the development of drug resistant gram-negative bacteria in contrast to traditional penicillin and aminoglycoside therapy.
Pediatrics, General
Caspofungin: It is a novel antifungal drug and the first representative of a new class of drugs called the glucan synthesis inhibitors. It operates by inhibiting the formation of beta-(1,3)-D-glucan, a component of the fungal cell wall that is essential. This mechanism makes it effective in treating cases of refractory invasive aspergillosis Invasive aspergillosis is a life-threatening infection caused by a type of mold called Aspergillus.
Posaconazole (Noxafil): It belongs to the group of triazole antifungal agents and shares some similarities with itraconazole. This compound slows down the enzyme called lanosterol 14-alpha-demethylase which affects the ergosterol synthesis and causes disruption of the cell membrane among other effects. Posaconazole is available as oral suspension 200 mg/5ml and used for the prevention of invasive aspergillosis and Candida infection in patients with severe immunosuppressed.
Voriconazole (Vfend): It is a triazole antifungal which inhibit the fungal CYP450 isoenzymes, particularly at the point of 14 alpha-lanosterol demethylation, a process that is critical in ergosterol synthesis in the fungal cell membrane. This has demonstrated effectiveness in managing disseminated disease or meningitis that is not manageable by first-line drugs.
Itraconazole (Sporanox): It is a triazole derivative of ketoconazole is highly preferred for this condition because of greater efficacy and lesser toxicity. It is formulated in an intravenous form, however, there is less information concerning its long-term usage. The absorption of the active pharmaceutical ingredient within the oral solution is more controlled compared to the capsule while the latter must be taken with a full meal to have ideal absorption while the former thrives on an empty stomach.
Fluconazole (Diflucan): It is related to other synthetic triazole antifungal and acts on fungal CYP450 as well as, the sterol C-14 alpha-demethylation of preference of lanosterol to ergosterol. It is employed in the management of mild to moderate systemic infections or severe ones in patients who cannot tolerate AMB due to its nephrotoxic effects; it has a prolonged terminal half-life in patients with chronic renal failure.
Amphotericin B Lipid Complex (ABLC, Abelcet): It is a polyene antifungal with poor absorptibility by the oral route, it makes the fungal cell membrane form a complex with sterols like ergosterol which results to swelling foam of the cell with the leakage of components along with the death of the cell. Nevertheless, it can also become toxic to human made cells or other cells which accompany the cancer cells.
Pediatrics, General
Ganciclovir (Cytovene): It is a synthetic guanine derivative with effective antiviral properties against cytomegalovirus (CMV). It is a compound that’s an acyclic nucleoside analog of 2’-deoxyguanosine and it functions to prevent the herpesviruses from replicating both in the test tube and in vivo. Ganciclovir triphosphate concentrations in CMV-infected cells can be 100 times greater than in uninfected cells, which is thought to be due to selective phosphorylation in virus-infected cells.
Foscarnet: It is an organic pyrophosphate analog that acts as a potent antiviral agent against several herpesviruses, including the CMV, HSV-1, and HSV-2. It works by inhibiting viral replication and this is at the pyrophosphate-binding site on virus-specific DNA polymerases. In the case where patients show suboptimal clinical response or they continue to positive viral shedding, there could be viral resistance. Patients who can metabolize foscarnet without significant toxicity may be started on maintenance therapy at a dose of 120 mg/kg/day with dose adjustment based on renal impairment.
Pediatrics, General
Methylprednisolone (A-Methapred, Solu-Medrol, Depo-Medrol): The intravenous/intramuscular and oral preparations are available. It is used to control acute inflammation, corrects capillary permeability and weakens movements of polymorphonuclear leukocytes.
Dexamethasone (Baycadron): They are used for the management of inflammation for various pathological processes. It is lessening inflammation in that it stops the movement of polymorphonuclear leukocytes and provides a reversal of increased capillary permeability.
Pediatrics, General
Pentoxifylline (Trental): It can change the dynamics of the flow of red blood cells which are useful in decreasing viscosity of the blood. Thus over all it accelerates fibrinolysis, increases flexibility of red blood cells and inhibits platelet aggregation.
Pediatrics, General
Intravenous Immunoglobulin: It achieves its function through the application of anti-idiotypic antibodies which help in eliminating myelin antibodies in circulation. It is involved in the negative regulation of cells that increase inflammation, including interferon gamma. IVIG also reduces the binding of Fc receptors on macrophages, reduces the activity of inducer T cells as well as B cells, and improves the function of suppressor T cells. Further, it inhibits the complement cascade, promotes remyelination, and might increase CSF IgG by 10%.
Pediatrics, General
Central Venous Catheterization: They obviously support the administration of medicine and feeding, giving of fluids and meals as well as to withdraw blood samples for tests.
Intra-abdominal Pressure Monitoring: In certain clinical situations like in patients with suspected intra-abdominal sepsis, ACS, etc. it may be beneficial to monitor IAP occasionally.
Endotracheal Intubation: Therefore, when sepsis leads to severe respiratory deterioration or respiratory arrest, it becomes usual for patients to be intubated and put on a ventilator.
Dialysis: Dialysis may be needed in the patients with acute or chronic kidney disease with significant decrease in renal function or kidney failure to address electrolyte imbalance or to eliminate toxins.
Pediatrics, General
Initial Assessment and Recognition: Identification of the sepsis signs through clinical features at an escalated rate. Initially, the patient’s airway, breathing, and circulation must be assessed, followed by their history and physical exam.
Resuscitation: Give intravenous fluids to correct hypovolemia and support microcirculation. Start the broad-spectrum antibiotics, as soon as possible probably within the first one hour. Ensure the continuity of monitoring the patient’s condition and the support of the hemodynamic status using vasoactive agents.
Source Control: Implement interventions that focus on controlling the source of infection (such as abscess drainage, removal of an infected device).
Supportive Care: Ensure adequate oxygenation (supplements if necessary) and ventilation (assistance thru mechanical ventilation, if necessary). Supervise and balance metabolic requirements such as the feeding aspect.
Sepsis in the pediatric population, like in adults, refers to a spectrum of diseases resulting from infection with bacteria, viruses, fungi or parasites, or toxins produced by any of these organisms. This condition can include bloodstream infections like bacteremia, viremia, fungemia, or parasitemia which while causing fever it may not be accompanied by other symptoms of circulatory failure or end-organ dysfunction.
Sepsis management in infants and children is particularly challenging due to multiple factors. However, early identification and management are important to enhance the prognosis of such patients. Most children with sepsis are going to require ICU admission; the initial approach should therefore be to assess and correct any metabolic, circulatory, or respiratory derangements.
In moderate to severe cases, critical care of the patient is important, and in some cases, an Infectious Diseases Specialist consultation may be required. In a report by the CDC involving 246 adult patients and 79 pediatric septic patients with severe sepsis or septic shock, of which 31 were infants under one year and 48 children between one and 17 years, 80% of the cases occurred in community settings.
Newborns are at the highest risk for developing sepsis; bacterial sepsis in neonates ranges from 1 to 10 per 1000 live births in the U. S. Sepsis does not appear to follow any gender bias, although urosepsis is statistically more common in females and uncircumcised males. The differences in sepsis by race are less significant, although Eskimos and American Indians are especially vulnerable to invasive bacterial diseases.
Maternal and neonatal care from the year 1993 and 2012 was analyzed and it was found that there was no change in late-onset sepsis from 1993 to 2004 but there was a downtrend from 2005 to 2012. In the study by McMullan et al., SAB was determined in children and adolescents from Australasia with the median age of 57 months by the time of the diagnosis of 1,073 patient. The incidence per annum was 8. 3 per 100,000 in Australia, with higher incidence of the disease in indigenous children. Mortality rates were 2.6% at seven days and 4.7% at 30 days.
Initial Response: Sepsis is a condition that develops due to an acute inflammation caused by a bacterial infection. There is also initial evidence of compromised circulation or even shock as evidenced by the tachycardia, tachypnea, and changes in vessels’ behavior such as vasodilation and augmented permeability.
Systemic Inflammatory Response Syndrome (SIRS): Sepsis is a severe form of SIRS, this is a systemic inflammatory response syndrome, a condition that results from inflammation throughout the whole body due to infection or other injurious process eg trauma, chemical injury, cancer etc. Synchronous inflammatory response is the main mechanism of SIRS; this cause cytokines to be released leading to the injury of blood vessels and metabolism.
Circulatory and Metabolic Changes:
Vascular Changes: Capillary permeability and blood vessel dilation are allowed to rise with the implication being that fluid will leak out into the tissues and lower the blood pressure and circulation levels.
Metabolic Effects: It results in metabolic acidosis, the body has increased metabolism, and tissues require more oxygen and release more by-products.
Progression to Severe Sepsis: SIRS if not well addressed will result to severe sepsis characterized by extreme dysfunction of the organs and their failure.
Multiple Organ Dysfunction Syndrome (MODS): Further increase in inflammation and inadequate blood circulation leads to MODS in which many organs are unable to work well because of poor blood supply and tissue damage.
Bacterial Infections: Some of the bacteria are Streptococcus pneumoniae, Staphylococcus aureus and Escherichia Coli.
Viral Infections: Some of the viruses are respiratory syncytial virus (RSV), and influenza.
Fungal Infections: Like Candida especially in immunocomporised children.
Parasitic Infections: It includes Malaria in endemic Areas.
The mortality rate of pediatric sepsis ranges between 9 to 35% and depends on the classification of sepsis according to the type of infection. Another important factor that has been proved to influence survival rate is the immune status of the host. Neonatal sepsis alone accounts for nearly 40% of neonatal mortality, but due to the progress in diagnostic and treatment techniques the mortality has reduced, especially in preterm neonates. A study in the United States among 9,816 children with severe sepsis showed greater mortality among Black children as 18.4% while among Whites, the percentage was 13.4% and the Hispanics 13.7%. Black children were also diagnosed to have significant increased risks of sepsis mortality as compared to White children with odds ratios of 1.19.
Neonates (0-28 days)
Presentation: Vague signs such as poor appetite, decreased activity, increased irritability, temperature changes (fever or hypothermia), difficulty breathing, yellowing of the eyes and skin, and lengthy pauses in breathing.
Associated Comorbidities: Preterm birth, intrauterine growth restriction, maternal infection, congenital abnormality.
Acuity: High; newborns are vulnerable to clinical deterioration and have signs that may be difficult to recognize prior septic shock.
Newborns (0-1 months), Babies (1 month – 1 year)
Presentation: Generally, these would include fever, increased irritability, vomiting, poor feeding, respiratory problems such as tachypnea, grunting, decreased urine output, and confusion or lethargy.
Associated Comorbidities: This indicates that children with congenital heart disease, immunodeficiencies and those who had been hospitalized or operated in the recent past are at a higher risk.
Acuity: Moderate: The condition can worsen to severe sepsis, or septic shock within the shortest period of time, if the signs are not noticed early enough and treatment started.
Toddlers and young children 1-5 years of age
Presentation: Fever, increased heart rate, shortness of breath, drowsiness, poor feeding, diarrhoea, vomiting, stomach-ache, skin rash (tiny red or red-brown spots on skin).
Associated Comorbidities: Asthma, diabetes, immunodeficiency, other chronic diseases, and recent infections as pneumonia, urinary tract infections.
Acuity: Moderate to high; despite relatively higher manifestations than in neonates, children still present for acute sepsis and need immediate management to avoid transition to severe sepsis or septic shock stages.
Older Children and Adolescents (5-12+ years)
Presentation: The symptoms are fever, chills, weakness, muscle aches, joint pains, headaches, tachycardia, hypotension, exertional dyspnea, drowsiness, and abdominal pain.
Associated Comorbidities: Pregnancy/lactation, chronic disease (such as asthma, CF, diabetes), immunocompromised state (cancer treatment, HIV/AIDS), trauma/surgery within the last 7 days.
Acuity: Moderate; Children above this age may present complaints verbally well but the condition can worsen very fast and needs the attention of a doctor.
Vital Signs: Evaluate the patient for fever or hypothermia, tachycardia and/or tachypnea, hypotension (a very late sign), and oxygen level.
General Appearance: When evaluating the child consider the level of consciousness, skin color whether pale, mottled or cyanotic and activity level showing signs of lethargy or irritability.
Skin: Look for capillary refill delay, rashes including petechial and purpuric rash, cold extremities, and signs of oedema.
Cardiovascular: Assess for variations or irregularities in heart sounds; strength of pulse; and lack of nutrient and oxygen delivery to tissues.
Respiratory: Look for an increased respiratory rate that is not related to age, listen for abnormal breath sounds, observe the child for retractions, grunting or if they are working harder than normal to breathe.
Gastrointestinal: Palpate for abdominal swelling, pain and changes in tone and pitch of bowel sounds if present.
Group A Streptococcal (GAS) Infections
Pediatric Adrenal Insufficiency (Addison Disease)
Pediatric Aseptic Meningitis
Pediatric Bacterial Meningitis
Pediatric Enterococcal Infection
Pediatric Fungal Endocarditis
Pediatric Herpes Simplex Virus Infection
Bacteremia
Necrotizing Enterocolitis Imaging
Pediatric Candidiasis
Pediatric Escherichia Coli Infections
Pediatric Haemophilus Influenzae Infection
Pediatric Infective Pericarditis
Early Recognition and Assessment: Quicker and accurate recognition of sepsis from signs that may include fever, confusion, tachycardia, increased rate of breathing, and mottled skin. Employment of physical screening tools such as the Pediatric Early Warning Score (PEWS) to facilitate early identification.
Immediate Resuscitation: Intravenous administration of large volumes of isotonic fluids, such as normal saline solution or lactated Ringer’s solution at 20 mL/kg, initially and titrated according to the patient’s clinical condition. If continuous fluid administration does not enhance perfusion, the use of inotropes or vasopressors should be started as soon as possible.
Antibiotic Therapy: Antibiotics should be administered within the first hour of sepsis recognition and should be broad-spectrum antibiotics. The decision depends on the possible origin of infection and antibiotic resistance in the region. As per the culture reports and clinical response, it is crucial to utilize antibiotics of lesser spectrum to decrease resistance and related side effects.
Source Control: Further imaging or surgical intervention may have to be undertaken to define and treat the source of infection (for example abscess debridement; removal of infected catheters). Treatment of the cause of infection involves invasive procedures such as surgeries or procedures.
Supportive Care: To ensure that the patients have sufficient oxygenation, it may be necessary to use non-invasive or invasive ventilation if necessary due to respiratory distress. Nursing care involves frequent measurements of the patient’s blood pressure, heart rate, urine output, and other vital signs to determine the adequacy of daily fluid and vasopressor requirements.
Pediatrics, General
Fluid Resuscitation: Treatment options may include giving intravenous fluids to replenish lost blood volume and to ensure sufficient blood flow to vital body organs.
Nutritional Support: Supplementation with sufficient nutrients for meeting the metabolic demands of the body and helping patient with recovery.
Temperature Regulation: To reduce the risk of complications resulting from either fever or hypothermia while the patient is in the intensive care unit.
Monitoring and Supportive Care: Observation of the patient’s temperature, pulse, respiration rate, and blood pressure; oxygen saturation; liver and kidney function. have supportive care such as ventilation support and normalizing of electrolyte abnormalities.
Infection Control: Having measures in place to minimize cross transmission of infection and inflammation and putting in place measures such as protection gear to minimize secondary infections.
Pediatrics, General
Ampicillin and Sulbactam (Unasyn): Sulbactam can be combined with ampicillin to form a single drug, which contains a beta-lactamase inhibitor. It has been effective due to its action that interferes with the formation of bacterial cell wall while the bacteria cells are actively dividing which in turn exhibit bactericidal activity towards susceptible bacteria. This makes it an effective replacement for amoxicillin especially for patients who cannot use oral formulations. This drug acts against skin flora, enteric bacteria and obligate anaerobes but is less useful in treating hospital acquired infections.
Vancomycin: It is known for its potent activity against gram-positive bacteria, specifically having good coverage against hospital-efficient MRSA. With the increase in the prevalence of MRSA, usage of vancomycin has also grown. It is suggested for patients with septic implanted devices or catheters, especially for skin and soft tissue infections.
Ceftriaxone (Rocephin): It is a third-generation cephalosporin, which offers activity mainly against gram-negative microorganisms. It has moderate activity against Gram-positive bacteria but is effective against resistant isolates.It is a beta-lactam antibiotic that interferes with the synthesis of bacterial cell wall by binding to penicillin binding proteins and causes the cells to rupture as construction of the cell wall proceeds.
Gentamicin: It is an aminoglycoside antibiotic used to treat gram-negative bacteria, especially Escherichia coli, Pseudomonas, Proteus, Serratia species, etc. It is even more effective when prescribed together with ampicillin to treat the Group B Streptococci and Enterococcus. In the present guidelines, it is recommended that newborns with suspected sepsis should receive gentamicin with ampicillin.
Cefotaxime (Claforan): It belongs to third-generation cephalosporin that show very good activity against Group B Streptococcus, E.coli, and other gram negative Enteric bacilli. It also attains very high levels in serum and CSF mainly due to its lipophilic nature and ability to easily cross the blood brain barrier. However, use of cefotaxime in the second generation may contribute to the development of drug resistant gram-negative bacteria in contrast to traditional penicillin and aminoglycoside therapy.
Pediatrics, General
Caspofungin: It is a novel antifungal drug and the first representative of a new class of drugs called the glucan synthesis inhibitors. It operates by inhibiting the formation of beta-(1,3)-D-glucan, a component of the fungal cell wall that is essential. This mechanism makes it effective in treating cases of refractory invasive aspergillosis Invasive aspergillosis is a life-threatening infection caused by a type of mold called Aspergillus.
Posaconazole (Noxafil): It belongs to the group of triazole antifungal agents and shares some similarities with itraconazole. This compound slows down the enzyme called lanosterol 14-alpha-demethylase which affects the ergosterol synthesis and causes disruption of the cell membrane among other effects. Posaconazole is available as oral suspension 200 mg/5ml and used for the prevention of invasive aspergillosis and Candida infection in patients with severe immunosuppressed.
Voriconazole (Vfend): It is a triazole antifungal which inhibit the fungal CYP450 isoenzymes, particularly at the point of 14 alpha-lanosterol demethylation, a process that is critical in ergosterol synthesis in the fungal cell membrane. This has demonstrated effectiveness in managing disseminated disease or meningitis that is not manageable by first-line drugs.
Itraconazole (Sporanox): It is a triazole derivative of ketoconazole is highly preferred for this condition because of greater efficacy and lesser toxicity. It is formulated in an intravenous form, however, there is less information concerning its long-term usage. The absorption of the active pharmaceutical ingredient within the oral solution is more controlled compared to the capsule while the latter must be taken with a full meal to have ideal absorption while the former thrives on an empty stomach.
Fluconazole (Diflucan): It is related to other synthetic triazole antifungal and acts on fungal CYP450 as well as, the sterol C-14 alpha-demethylation of preference of lanosterol to ergosterol. It is employed in the management of mild to moderate systemic infections or severe ones in patients who cannot tolerate AMB due to its nephrotoxic effects; it has a prolonged terminal half-life in patients with chronic renal failure.
Amphotericin B Lipid Complex (ABLC, Abelcet): It is a polyene antifungal with poor absorptibility by the oral route, it makes the fungal cell membrane form a complex with sterols like ergosterol which results to swelling foam of the cell with the leakage of components along with the death of the cell. Nevertheless, it can also become toxic to human made cells or other cells which accompany the cancer cells.
Pediatrics, General
Ganciclovir (Cytovene): It is a synthetic guanine derivative with effective antiviral properties against cytomegalovirus (CMV). It is a compound that’s an acyclic nucleoside analog of 2’-deoxyguanosine and it functions to prevent the herpesviruses from replicating both in the test tube and in vivo. Ganciclovir triphosphate concentrations in CMV-infected cells can be 100 times greater than in uninfected cells, which is thought to be due to selective phosphorylation in virus-infected cells.
Foscarnet: It is an organic pyrophosphate analog that acts as a potent antiviral agent against several herpesviruses, including the CMV, HSV-1, and HSV-2. It works by inhibiting viral replication and this is at the pyrophosphate-binding site on virus-specific DNA polymerases. In the case where patients show suboptimal clinical response or they continue to positive viral shedding, there could be viral resistance. Patients who can metabolize foscarnet without significant toxicity may be started on maintenance therapy at a dose of 120 mg/kg/day with dose adjustment based on renal impairment.
Pediatrics, General
Methylprednisolone (A-Methapred, Solu-Medrol, Depo-Medrol): The intravenous/intramuscular and oral preparations are available. It is used to control acute inflammation, corrects capillary permeability and weakens movements of polymorphonuclear leukocytes.
Dexamethasone (Baycadron): They are used for the management of inflammation for various pathological processes. It is lessening inflammation in that it stops the movement of polymorphonuclear leukocytes and provides a reversal of increased capillary permeability.
Pediatrics, General
Pentoxifylline (Trental): It can change the dynamics of the flow of red blood cells which are useful in decreasing viscosity of the blood. Thus over all it accelerates fibrinolysis, increases flexibility of red blood cells and inhibits platelet aggregation.
Pediatrics, General
Intravenous Immunoglobulin: It achieves its function through the application of anti-idiotypic antibodies which help in eliminating myelin antibodies in circulation. It is involved in the negative regulation of cells that increase inflammation, including interferon gamma. IVIG also reduces the binding of Fc receptors on macrophages, reduces the activity of inducer T cells as well as B cells, and improves the function of suppressor T cells. Further, it inhibits the complement cascade, promotes remyelination, and might increase CSF IgG by 10%.
Pediatrics, General
Central Venous Catheterization: They obviously support the administration of medicine and feeding, giving of fluids and meals as well as to withdraw blood samples for tests.
Intra-abdominal Pressure Monitoring: In certain clinical situations like in patients with suspected intra-abdominal sepsis, ACS, etc. it may be beneficial to monitor IAP occasionally.
Endotracheal Intubation: Therefore, when sepsis leads to severe respiratory deterioration or respiratory arrest, it becomes usual for patients to be intubated and put on a ventilator.
Dialysis: Dialysis may be needed in the patients with acute or chronic kidney disease with significant decrease in renal function or kidney failure to address electrolyte imbalance or to eliminate toxins.
Pediatrics, General
Initial Assessment and Recognition: Identification of the sepsis signs through clinical features at an escalated rate. Initially, the patient’s airway, breathing, and circulation must be assessed, followed by their history and physical exam.
Resuscitation: Give intravenous fluids to correct hypovolemia and support microcirculation. Start the broad-spectrum antibiotics, as soon as possible probably within the first one hour. Ensure the continuity of monitoring the patient’s condition and the support of the hemodynamic status using vasoactive agents.
Source Control: Implement interventions that focus on controlling the source of infection (such as abscess drainage, removal of an infected device).
Supportive Care: Ensure adequate oxygenation (supplements if necessary) and ventilation (assistance thru mechanical ventilation, if necessary). Supervise and balance metabolic requirements such as the feeding aspect.
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