EIN members recently discussed several difficult pediatric cases and related treatment options.

In one case, a member from Atlanta sought suggestions for a case of disseminated herpesvirus 6 (HHV-6) infection in a 5-week-old infant. Within days of birth, the baby developed a diffuse erythematous rash, thrombocytopenia, and required oxygen. Following empiric antibiotics, the infant developed oral blisters, transaminitis, and petechiae.

Subsequent treatment included acyclovir and additional empiric antimicrobials, and the infant now needs daily platelet transfusions and exhibits “notable hepatosplenomegaly, borderline neutropenia, and transaminitis,” the member wrote.

Three members suggested intravenous immunoglobulin (IVIG) therapy, while also noting the lack of data to guide treatment in this particular case. “The hypothetical benefit [from IVIG] is derived from the neonatal enteroviral sepsis story, where IVIG MAY have a role,” a respondent in Pennsylvania wrote. “The infant may or may not have neutralizing antibodies.” A West Virginia member reported finding few case reports describing IVIG and HHV-6, “but I would consider a trial if all else fails.”

In another pediatric discussion, a member in Quebec described an 11-year-old patient who developed pasteurellosis and osteomyelitis from a cat bite on his right forearm. “I would like to treat him as a patient with a chronic osteomyelitis with ceftriaxone 100 mg/kg IV for at least 6 weeks, followed by prolonged high dose oral PenV until his lytic lesion fills in,” the member wrote. “This could take months.”

Ceftriaxone once daily would make the patient’s initial home IV antibiotic treatment easier, and “the family may not be so reliable in learning complicated therapies, and once daily therapy would be ideal. But I have repeatedly read that this hasn't been well studied in vivo and that I should not rely on in vitro ceftriaxone sensitivities for Pasteurella species. Any suggestions as to ceftriaxone or penicillin IV in this case?”

Amoxicillin, with or without probenecid, should work fine, a member in Ohio responded. “If you are concerned about compliance, measurement of drug levels could be done, if your lab can do them.”

A New Hampshire respondent reported good results with ceftriaxone for P. multocida tendon/joint infections, noting that ertapenem “might be an option, too, but it is unlikely that this would add anything over ceftriaxone.” Several other members also suggested ceftriaxone.

“Do you have the ability to use a programmable infusion pump?” the New Hampshire member asked. “It’s somewhat of a hassle, but at least then you could stick with the ‘drug of choice,’ if that’s what you really wanted to do, and the family wouldn’t have to get up in the middle of the night to give antibiotics.”

Along the same lines, a respondent in New York suggested “treating with IV penicillin G using a computer pump cassette, which holds 6 doses for Q 4 hour infusions over a 24 hour period.” A member in Michigan supported a similar approach, while an Illinois respondent suggested trying ampicillin with such a pump.

Wrapping up the discussion, the EIN member from Quebec shared the eventual treatment strategy chosen: “After considering all the choices and your answers and the literature, I have decided to go with ceftriaxone 100 mg/kg every 24 hours for at least 6 weeks and to complete the therapy with oral high dose PenV until the debrided bone abscess cavity fills in.”

The Emerging Infections Network (EIN) is a provider-based sentinel network designed to help the public health community detect trends in emerging infectious diseases.

A joint project of IDSA and the Pediatric Infectious Diseases Society (PIDS) with funding from the Centers for Disease Control and Prevention (CDC), EIN tracks emerging infectious diseases and keeps the public health community up to date with new disease trends, difficult cases, and other issues affecting members’ clinical practices. The Network provides a great opportunity for members to share knowledge quickly across large geographical distances. Both IDSA and PIDS members are eligible to join. Click here for more information or to join EIN.

 

How useful is this article?

< Previous Article | Next Article >