Ebook Nelson’s pediatric antimicrobial therapy (26th Edition) present the content: choosing among antibiotics within a class: beta-lactams and beta-lactamase inhibitors, macrolides, aminoglycosides, and fluoroquinolones; antimicrobial therapy for newborns; antimicrobial therapy according to clinical syndromes; preferred therapy for specific bacterial and mycobacterial pathogens; preferred therapy for specific fungal pathogens; preferred therapy for specific parasitic pathogens...
2020 Nelson’s Pediatric Antimicrobial Therapy Choosing Among Antifungal Agents: Polyenes, Azoles, and Echinocandins How Antibiotic Dosages Are Determined Using Susceptibility Data, Pharmacodynamics, and Treatment Outcomes Approach to Antibiotic Therapy of Drug-Resistant Gram-negative Bacilli and Methicillin-Resistant Staphylococcus aureus Antimicrobial Therapy for Newborns Antimicrobial Therapy According to Clinical Syndromes Preferred Therapy for Specific Bacterial and Mycobacterial Pathogens Preferred Therapy for Specific Fungal Pathogens Preferred Therapy for Specific Viral Pathogens 10 Preferred Therapy for Specific Parasitic Pathogens 11 Alphabetic Listing of Antimicrobials 2020 Nelson’s Pediatric Antimicrobial Therapy Choosing Among Antibiotics Within a Class: Beta-lactams and Beta-lactamase Inhibitors, Macrolides, Aminoglycosides, and Fluoroquinolones 2020 Nelson’s Pediatric Antimicrobial Therapy John S Bradley, MD 26th Edition Editor in Chief John D Nelson, MD Emeritus 26th Edition 12 Antibiotic Therapy for Children Who Are Obese 13 Sequential Parenteral-Oral Antibiotic Therapy (Oral Step-down Therapy) for Serious Infections 14 Antimicrobial Prophylaxis/Prevention of Symptomatic Infection Bradley Nelson Appendix: Nomogram for Determining Body Surface Area References Elizabeth D Barnett, MD Joseph B Cantey, MD David W Kimberlin, MD Paul E Palumbo, MD Jason Sauberan, PharmD J Howard Smart, MD William J Steinbach, MD Contributing Editors Index ISBN 978-1-61002-352-8 90000> 781610 023528 NELSON-2020_CoverSpread.indd AAP 11/22/19 3:05 PM American Academy of Pediatrics Publishing Staff Mary Lou White, Chief Product and Services Officer/SVP, Membership, Marketing, and Publishing Mark Grimes, Vice President, Publishing Peter Lynch, Senior Manager, Publishing Acquisitions and Digital Strategy Mary Kelly, Senior Editor, Professional and Clinical Publishing Shannan Martin, Production Manager, Consumer Publications Jason Crase, Manager, Editorial Services Linda Smessaert, MSIMC, Senior Marketing Manager, Professional Resources Mary Louise Carr, MBA, Marketing Manager, Clinical Publications Published by the American Academy of Pediatrics 345 Park Blvd Itasca, IL 60143 Telephone: 630/626-6000 Facsimile: 847/434-8000 www.aap.org The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of infants, children, adolescents, and young adults The recommendations in this publication not indicate an exclusive course of treatment or serve as a standard of medical care Variations, taking into account individual circumstances, may be appropriate Statements and opinions expressed are those of the authors and not necessarily those of the American Academy of Pediatrics Any websites, brand names, products, or manufacturers are mentioned for informational and identification purposes only and not imply an endorsement by the American Academy of Pediatrics (AAP) The AAP is not responsible for the content of external resources Information was current at the time of publication The publishers have made every effort to trace the copyright holders for borrowed materials If they have inadvertently overlooked any, they will be pleased to make the necessary arrangements at the first opportunity This publication has been developed by the American Academy of Pediatrics The authors, editors, and contributors are expert authorities in the field of pediatrics No commercial involvement of any kind has been solicited or accepted in the development of the content of this publication Disclosures: Dr Kimberlin disclosed a consulting relationship with Slack Incorporated Dr Palumbo disclosed a safety monitoring board relationship with Janssen Pharmaceutical Companies Dr Steinbach disclosed an advisory board relationship with Merck & Company and Astellas Pharma, Inc Every effort has been made to ensure that the drug selection and dosages set forth in this text are in accordance with current recommendations and practice at the time of publication It is the responsibility of the health care professional to check the package insert of each drug for any change in indications or dosage and for added warnings and precautions, and to review newly published, peer-reviewed data in the medical literature for current data on safety and efficacy Special discounts are available for bulk purchases of this publication Email Special Sales at aapsales@aap.org for more information © 2020 John S Bradley and John D Nelson Publishing rights, American Academy of Pediatrics All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means—electronic, mechanical, photocopying, recording, or otherwise—without prior permission from the authors First edition published in 1975 Printed in the United States of America 9-442/1219 10 MA0935 ISSN: 2164-9278 (print) ISSN: 2164-9286 (electronic) ISBN: 978-1-61002-352-8 eBook: 978-1-61002-353-5 ch00-Nelson-2020_FM_i-xii.indd 11/21/19 8:17 AM iii Editor in Chief Emeritus John S Bradley, MD, FAAP John D Nelson, MD Distinguished Professor of Pediatrics Division of Infectious Diseases, Department of Pediatrics University of California, San Diego, School of Medicine Director, Division of Infectious Diseases, Rady Children’s Hospital San Diego San Diego, CA Chapters 1, 3, 4, 6, 7, 13, and 14 Professor Emeritus of Pediatrics The University of Texas Southwestern Medical Center at Dallas Southwestern Medical School Dallas, TX Contributing Editors Elizabeth D Barnett, MD, FAAP Jason Sauberan, PharmD Professor of Pediatrics Boston University School of Medicine Director, International Clinic and Refugee Health Assessment Program, Boston Medical Center GeoSentinel Surveillance Network, Boston Medical Center Boston, MA Chapter 10 Assistant Clinical Professor University of California, San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences Rady Children’s Hospital San Diego San Diego, CA Chapters 5, 11, and 12 Joseph B Cantey, MD, FAAP Chairman, Department of Pediatrics Sharp Rees-Stealy Medical Group Assistant Clinical Professor of Pediatrics University of California, San Diego, School of Medicine San Diego, CA App development Assistant Professor of Pediatrics Divisions of Pediatric Infectious Diseases and Neonatology/Perinatal Medicine University of Texas Health Science Center at San Antonio San Antonio, TX Chapter David W Kimberlin, MD, FAAP Editor, Red Book: 2018–2021 Report of the Committee on Infectious Diseases, 31st Edition Professor of Pediatrics Co-Director, Division of Pediatric Infectious Diseases Sergio Stagno Endowed Chair in Pediatric Infectious Diseases University of Alabama at Birmingham Birmingham, AL Chapter J Howard Smart, MD, FAAP William J Steinbach, MD, FAAP Samuel L Katz Professor of Pediatrics Professor in Molecular Genetics and Microbiology Chief, Division of Pediatric Infectious Diseases Director, Duke Pediatric Immunocompromised Host Program Director, International Pediatric Fungal Network Duke University School of Medicine Durham, NC Chapters and Paul E Palumbo, MD Professor of Pediatrics and Medicine Geisel School of Medicine at Dartmouth Director, International Pediatric HIV Program Dartmouth-Hitchcock Medical Center Lebanon, NH HIV treatment ch00-Nelson-2020_FM_i-xii.indd 11/21/19 8:17 AM ch00-Nelson-2020_FM_i-xii.indd 11/21/19 8:17 AM v Contents Introduction vii Notable Changes to 2020 Nelson’s Pediatric Antimicrobial Therapy, 26th Edition xi Choosing Among Antibiotics Within a Class: Beta-lactams and Beta-lactamase Inhibitors, Macrolides, Aminoglycosides, and Fluoroquinolones Choosing Among Antifungal Agents: Polyenes, Azoles, and Echinocandins How Antibiotic Dosages Are Determined Using Susceptibility Data, Pharmacodynamics, and Treatment Outcomes 19 Approach to Antibiotic Therapy of Drug-Resistant Gram-negative Bacilli and Methicillin-Resistant Staphylococcus aureus 23 Antimicrobial Therapy for Newborns 31 A Recommended Therapy for Selected Newborn Conditions 33 B Antimicrobial Dosages for Neonates 55 C Aminoglycosides 59 D Vancomycin 60 E Use of Antimicrobials During Pregnancy or Breastfeeding 60 Antimicrobial Therapy According to Clinical Syndromes 63 A Skin and Soft Tissue Infections 66 B Skeletal Infections 72 C Eye Infections 75 D Ear and Sinus Infections 79 E Oropharyngeal Infections 82 F Lower Respiratory Tract Infections 85 G Cardiovascular Infections 98 H Gastrointestinal Infections 105 I Genital and Sexually Transmitted Infections 112 J Central Nervous System Infections 116 K Urinary Tract Infections 121 L Miscellaneous Systemic Infections 123 Preferred Therapy for Specific Bacterial and Mycobacterial Pathogens .131 A Common Bacterial Pathogens and Usual Pattern of Susceptibility to Antibiotics (Gram Positive) 132 B Common Bacterial Pathogens and Usual Pattern of Susceptibility to Antibiotics (Gram Negative) 134 C Common Bacterial Pathogens and Usual Pattern of Susceptibility to Antibiotics (Anaerobes) 136 D Preferred Therapy for Specific Bacterial and Mycobacterial Pathogens 138 ch00-Nelson-2020_FM_i-xii.indd 11/21/19 8:17 AM vi — Contents Preferred Therapy for Specific Fungal Pathogens 159 A Overview of More Common Fungal Pathogens and Their Usual Pattern of Antifungal Susceptibilities 160 B Systemic Infections 162 C Localized Mucocutaneous Infections 176 Preferred Therapy for Specific Viral Pathogens 177 A Overview of Non-HIV, Non-Hepatitis B or C Viral Pathogens and Usual Pattern of Susceptibility to Antivirals 178 B Overview of Hepatitis B or C Viral Pathogens and Usual Pattern of Susceptibility to Antivirals .178 C Preferred Therapy for Specific Viral Pathogens .180 10 Preferred Therapy for Specific Parasitic Pathogens 195 A Selected Common Pathogenic Parasites and Suggested Agents for Treatment 196 B Preferred Therapy for Specific Parasitic Pathogens .198 11 Alphabetic Listing of Antimicrobials 219 A Systemic Antimicrobials With Dosage Forms and Usual Dosages 221 B Topical Antimicrobials (Skin, Eye, Ear, Mucosa) 244 12 Antibiotic Therapy for Children Who Are Obese 251 13 Sequential Parenteral-Oral Antibiotic Therapy (Oral Step-down Therapy) for Serious Infections .255 14 Antimicrobial Prophylaxis/Prevention of Symptomatic Infection 257 A Postexposure Antimicrobial Prophylaxis to Prevent Infection 259 B Long-term Antimicrobial Prophylaxis to Prevent Symptomatic New Infection .265 C Prophylaxis of Symptomatic Disease in Children Who Have Asymptomatic Infection/Latent Infection 266 D Surgical/Procedure Prophylaxis 269 Appendix: Nomogram for Determining Body Surface Area 275 References .277 Index 301 ch00-Nelson-2020_FM_i-xii.indd 11/21/19 8:17 AM vii Introduction Hard to believe, but we are now in our 26th edition of Nelson’s Pediatric Antimicrobial Therapy—and more than a decade with the American Academy of Pediatrics (AAP)! We had the incredible opportunity late last year to publicly thank John Nelson for his many contributions to the field of pediatric infectious diseases over his decades-long career, including his creation of the Pocket Book of Pediatric Antimicrobial Therapy, which was the predecessor of Nelson’s and the model for the Sanford guide for adults Clinicians did not have so many options for antibiotic therapy when he was first recruited to Dallas, where he recruited George McCracken to join him We have trained John on the iPhone app for his book, but he still prefers the printed version We are working with the AAP to further enhance the ability of clinicians to access treatment recommendations easily and allow us to bring important new advances in the field of pediatric anti-infective therapy more often than once yearly A number of new antibiotics, antivirals, and antifungals have been recently approved by the US Food and Drug Administration (FDA) for pediatric age groups and are highlighted in the Notable Changes Some new agents only have approvals for children 12 years and older, but virtually all have federal mandates for clinical trials through all pediatric age groups, including neonates Most of the newly approved antibacterial agents are for drug-resistant pathogens, not for pneumococcus or Haemophilus influenzae type b, given the spectacular success of the protein-conjugated vaccines For the community, Escherichia coli is now giving us headaches with increasing resistance; for hospital pathogens, everything is getting more resistant The contributing editors, all very active in clinical work, have updates in their sections with relevant new recommendations (beyond FDA approvals) based on current published data, guidelines, and clinical experience We believe that the reference list for each chapter provides the available evidence to support our recommendations, for those who wish to see the actual clinical trial and in vitro data The Nelson’s app has made significant advances this past year thanks to the Apple programing abilities of our contributing editor, Dr Howard Smart, a full-time officebased pediatrician and the chief of pediatrics at the Sharp Rees-Stealy multispecialty medical group in San Diego, CA With the support of the AAP (particularly Peter Lynch) and the editors, we are putting even more of Howard’s enhancements in this 2020 edition I use the app during rounds now, and we have provided the app to all our residents There are clear advantages to the app over the printed book, but as with all software, glitches may pop up, so if your app doesn’t work, please let us know at nelsonabx@aap.org so we can fix the bugs! ch00-Nelson-2020_FM_i-xii.indd 11/21/19 8:17 AM viii — Introduction We always appreciate the talent and advice of our collaborators/colleagues who take the time to see if what we are sharing “makes sense.” In particular, we wish to thank Drs John van den Anker and Pablo Sanchez for their valuable suggestions on antimicrobial therapy of the newborn in support of the work done by JB Cantey and Jason Sauberan in Chapter We are also fortunate to have reviewers for the entire book and app this year Returning to assist us is Dr Brian Williams, a pediatric/adult hospitalist who recently moved from San Diego to Madison, WI Brian’s suggestions are always focused and practical, traits that John Nelson specifically values and promotes New for this year, to help us with the user experience of the app, we welcome input from Dr Juan Chapparro, who is double boarded in pediatric infectious diseases and biomedical informatics, and Dr Daniel Sklansky, a pediatric hospitalist at the University of Wisconsin We continue to harmonize the Nelson’s book with Red Book: 2018–2021 Report of the Committee on Infectious Diseases, 31st Edition (easy to understand, given that Dr David Kimberlin is also the editor of the Red Book) We are virtually always in sync but often with additional explanations (that not necessarily represent AAP policy) to allow the reader to understand the basis for recommendations We continue to provide grading of our recommendations—our assessment of how strongly we feel about a recommendation and the strength of the evidence to support our recommendation (noted in the Table) This is not the GRADE method (Grading of Recommendations Assessment, Development, and Evaluation) but certainly uses the concepts on which GRADE is based: the strength of recommendation and level of evidence Similar to GRADE, we review the literature (and the most important manuscripts are referenced), but importantly, we work within the context of professional society recommendations (eg, the AAP) and our experience The data may never have been presented to or reviewed by the FDA and, therefore, are not in the package label We all find ourselves in this situation frequently Many of us are working closely with the FDA to try to narrow the gap in our knowledge of antimicrobial agents between adults and children; the FDA pediatric infectious diseases staff is providing an exceptional effort to shed light on the doses that are safe and effective for neonates, infants, and children, with major efforts, supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (with Dr Danny Benjamin from Duke leading the charge), to place important new data on safety and efficacy in the antibiotic package labels for all to use in clinical practice ch00-Nelson-2020_FM_i-xii.indd 11/21/19 8:17 AM Introduction — ix Strength of Recommendation Description A Strongly recommended B Recommended as a good choice C One option for therapy that is adequate, perhaps among many other adequate therapies Level of Evidence Description I Based on well-designed, prospective, randomized, and controlled studies in an appropriate population of children II Based on data derived from prospectively collected, small comparative trials, or noncomparative prospective trials, or reasonable retrospective data from clinical trials in children, or data from other populations (eg, adults) III Based on case reports, case series, consensus statements, or expert opinion for situations in which sound data not exist As we state each year, many of the recommendations by the editors for specific situations have not been systematically evaluated in controlled, prospective, comparative clinical trials Mary Kelly, our senior editor at the AAP, has done an impressive job organizing the editors and being an outstanding advocate for us and the clinician-users of the book She was also instrumental in helping to launch the Nelson’s Neonatal Antimicrobial Therapy manual in spring 2019 Peter Lynch (AAP senior manager, publishing acquisitions and digital strategy) continues to work on developing Nelson’s online, as well as working with Howard and the editors to enhance the functionality of the app Thanks to Mark Grimes, vice president, Publishing, and our steadfast friends and supporters in AAP Membership, Marketing, and Publishing—Jeff Mahony, director, professional and consumer publishing (who has been with us since we first joined with the AAP a decade ago); Linda Smessaert, senior marketing manager, professional resources; and the entire staff—who make certain that the considerable information in Nelson’s makes it to those who are actually caring for children We continue to be very interested to learn from readers/users if there are new chapters or sections you wish for us to develop—and whether you find certain sections particularly helpful, so we don’t change or delete them! Please feel free to share your suggestions with us at nelsonabx@aap.org John S Bradley, MD ch00-Nelson-2020_FM_i-xii.indd 11/21/19 8:17 AM ch00-Nelson-2020_FM_i-xii.indd 10 11/21/19 8:17 AM ... possible relapse after completion of therapy (AIII) 2020 Nelson’s Pediatric Antimicrobial Therapy — 35 11/22/19 2:34 PM Antimicrobial Therapy for Newborns A RECOMMENDED THERAPY FOR SELECTED NEWBORN CONDITIONS... of congenital cutaneous candidiasis 2020 Nelson’s Pediatric Antimicrobial Therapy — 37 11/22/19 2:34 PM Antimicrobial Therapy for Newborns A RECOMMENDED THERAPY FOR SELECTED NEWBORN CONDITIONS... 11/19/19 8:42 AM ch04-Nelson-2020_023-030.indd 30 11/19/19 8:42 AM 2020 Nelson’s Pediatric Antimicrobial Therapy — 31 Antimicrobial Therapy for Newborns NOTES • The recommended antibiotic dosages and