Antibiotic choices are limited
compared to choices for adults due to the lack of extensive study on
safety and effectiveness in pediatric patients. IV
antibiotic dose reduction is common for children versus
adults. Not all antibiotics have been adequately
tested in children. Some examples of differences in
recommendations between adults and children include:
- Vancomycin might be used in
adults for MRSA infections at 30 mg/kg/day in two
divided doses while the recommended dose for
children is 40 mg/kg/day in four divided doses.
- Linezolid is recommended at
600 mg every 12 hours for adults and at 10 mg/kg
every 12 hours for children.
- Fluoroquinolones are
contraindicated for children and tetracycline,
doxyclycline, and ciprofloxacin are not usually used
in children under 8 years of age.
Diabetes Care Considerations
Infected foot ulcers are a common
and costly complication in diabetic patients. Fifteen
percent
of diabetic patients may experience foot ulceration and
are at higher risk for lower-extremity amputation. This
is related to peripheral neuropathy and the
inability to feel the warning sensations of pressure.
Approximately one-fourth of all hospital admissions for
diabetics are related to foot ulcerations. Infected soft
tissues of the foot may require and account for most of
the extended hospital stays in order to deal with
diabetic complications. Thus, appropriate prevention and
care for diabetic foot infections have the potential to
reduce hospitalizations, decrease lengths of stay, and
infection-related complications, including amputations.
Home care treatment can include infection
control, evaluation and improvement of vascular
perfusion of the area, pressure relief, and
antimicrobial therapy. An emphasis should be placed on
patient/caregiver education to learn routine
preventative care to reduce the incidence of diabetic foot infections.
Complications of foot ulceration
include poor glycemic control, vascular disease,
and immunologic disturbances. The most common pathogen
is S. aureus. Multiple pathogens
are more common in non-healing wounds, especially when
there is a recent history of antibiotic use. There
may be an increasing prevalence of MRSA infections and more severe cases may include spread of
infection to bone tissues, resulting in osteitis and
osteomyelitis requiring both surgical and intravenous
antibiotic therapies (Rao 2005).
Foot infections in the diabetic
patient are categorized by severity, the
tissues that are involved, adequacy of blood supply to
the localized area, and presence of systemic toxicity or
complicating metabolic issues. Skin biopsies that may be
deemed unnecessary in non-diabetic patients may be
helpful to determine appropriate therapies for cellulitis in this population.
Simplified regimens can help the
patients and caregivers administer therapies more
successfully.
A comparison of ertapenem and piperacillin/tazobactam
therapies for foot infections was explored in a
randomized, double-blinded study of 586 diabetic adults
with moderate to severe foot infection (Lipsky et al.
2005). This study suggested that both therapies had
equivalent cure rates and similar adverse reaction
rates. The authors suggested that the once-daily regimen
of piperacillin/tazobactam could be considered for IV
therapy of diabetic foot infections.
Additional considerations should
include the potential to exacerbate metabolic or other
potential adverse effects in diabetes. For instance,
long-term diabetic patients may be at a higher risk of
opportunistic infection or carriage of nasal
Staphylococcus aureus, particularly if they are on
insulin therapy or have recently used antibiotics
(Tamer, Karabay, & Ekerbicer 2006).