Pocket Emergency Paediatric Care - part 6

Thuốc cephalosporin thế hệ thứ ba của sự lựa chọn cho Haemophilus influenzae và meningococcus sinh vật mặc dù, nếu loại trừ chi phí thay thế chloramphenicol, chấp nhận được. Khuẩn cầu phổi kháng với penicillin và để chloramphenicol là phổ biến, và các cephalosporin thế hệ thứ ba sau đó là thuốc lựa chọn. | NEUROLOGICAL 99 Third generation cephalosporins drugs of choice for Haemophilus influenzae and meningococcus organisms although if precluded on cost chloramphenicol acceptable alternative. Pneumococci resistant to penicillin and to chloramphenicol are widespread and third generation cephalosporins are then drugs of choice. However pneumococcal resistance to third generation cephalosporins is found requiring addition of vancomycin or rifampicin to third generation cephalosporins. In neonates ceftazidime which is active against pseudomonas is useful. Give antibiotics in neonates 14-21 days children 10 days for pneumococcal and haemophilus 7 days for meningococcal infections. Dexamethasone 150 micrograms kg 6 hourly for 2 days. First dose with or max. 4 hours after first antibiotic dose. In TB meningitis dexamethasone 150 micrograms kg 6 hourly for 2-3 weeks tailing down the dose over a further 2-3 weeks. Do not use steroids in the newborn suspected cerebral malaria or viral encephalitis. Typical findings in CSF See table on page 100. Supportive care Fluids correct shock or dehydration initially IV later by NG tube or orally. Avoid overhydration by careful fluid balance and in particular avoid IV fluids with low sodium levels such as 5 dextrose. Use 0-9 saline plus 10 glucose. Maintain serum Na high normal range 135 mmol L. NG tube if unconscious or vomiting to protect airway. Milk 1 ml kgh to prevent gastric erosions and improve bowel function. Urine output monitored particularly if unconscious. Condition White cell count X107L Cell differential Protein g L Glucose mmol L Normal 0-5 22 in full term 30 in preterm PMN 2 15 neonate 0-5 2 3 blood glucose Acute bacterial meningitis 100- 300 000 Mostly PMN Monocytes in Listeria sp. 1-0 2-5 Tuberculosis meningitis 50-500 sometimes higher Lymphocytes but PMN early 1-0 2-5 usually 0 Herpes encephalitis Usually 500 Mostly lymphocytes PMN early in the disease 0-5 Normal Cerebral abscess 10-200 PMN or lymphocytes 1-0 Normal .