sultamicillin unasyn
Transcription
sultamicillin unasyn
'I . • : : •• " I 1~f)'lilVtJ1Q iJI.ij 11(;1~~mJl 3 l$ltJ'W .fJll(;111'Wl 12 i l Ill'! tl.m~'hftli '\U'('!'U(;11 f'IJ1J'j~111'Wl~\rtJVM llilv 11liihfl~f) t1~H1'll~~'iJ'iJl'j~1Jf)~ llieJill ~'jl'iJ'il'!fllV VIS: BT 39°C, BP 90/60 mmHg, PR 160/min, RR SO/min Skin: generalized erythematous maculopapular rash, mild edema of lower extremities s;1'!~1J CBC Hb 12.6 gm/dL, Hct 37.0%, WBC 4,080 cells/cu.mm (PMN 40%, L 49%, M 10%) platelet J 76,000 /cu.mm " (~11HIl'J'l1'Wl I I ,ob'et: 1 X 3 H. pa"ainfluenzae E. eoli P~G'teus s~p. @MEIACT (cerdltoron plvoxll) R kllelbsiella spp. Salrmol'i\..ella ~pp. SIilI,gella pp. N. meningifidis N. gOfilor:rtiloe..ae pC 16) Sultamicillin 250mg/5ml Powder for Oral Suspension • . '. 1 big spoonful 1 small spoonful 2.5 ml 10 ml ~'Ido, lur rJr Itt 1Jflrr..Jgll - IT'1f5"" Dose 25-50 mg/kg/day in 2 divided dose (For children dose weight <30kg) Cherry flavor is easily taken for children After reconstitution can be stored in refrigerator up to 14 days Unasyn :Sultamicillin is a double ester in which ampicillin and the beta lactamase inhibitor, sulbactam, are linked via methylene group Therapeutic indication: URTI, LRTI including sinusitis, otitis media and epiglottitis; bacterial pneumonias, UTI and pyelonephritis; intra-abdominal infections, skin, soft tissue, bone and joint infection and gonococcal infections. Dose recommendation: Sultamicillin in adult (including elderly patient) is 375-750mg twice daily. In children weighing less than 30 kg is sultamicillin 25-50mg/kg/d orally in 2 divided dose depending on severity of the infection Contraindication: individuals with a history of an allergic reaction to any of the penicillins Undesirable effects: Sultamicillin is generally well tolerated. The majority of side effect observed were of mild or moderate severity and were normally tolerated with continued treatment Instruction for use/handling:The reconstituted oral suspension must be stored under refrigeration and discarded after 14 days Warning: do not use in patients hypersensitivity to this drug, this drug may cause hypersentivity reaction and may be fatal, stop using the drug and consult a doctor if rash, irritation or edema occurs LPD revision no. 1.2 Further information is available upon request UNA pas 04 078 l1Jtl'tC}jl\llT~~rnlL\'l1J~ ~A.9;8/;550. ,j1'J~-:lf>l3J Vl3J'fl ID & ~3J1~n PIDST . f1mr:UUL6ltJ rJA.VmJ.'t1AUa v , etd. 9J d QI • d 'Uru~'Vll'UCJ'WI9l'l-m 1J1J'W Ufl.lltJav a'lJU'iltU (aiiGlL11f) tI d I (12-16 :JJ'W lrUJ 2553) '1111 m~:JJ. :JJmlm~'Vl:JJ'YJ fl9HJCJ1~:JJlfl .J.J d ~ d 91' ci lIJ9J fl1J fll 'J '\{:JJ'\..j:JJ'U El ~fl 'WlffEllll9l~ 'll' ~ '111 n 1 fldl ~ ~ m 'J 'il1J 1J 'W 'il ~ 1I~:JJ El ~ Ell'W 1'J 1flfl ~ 119l 'Vll~ El El fl QI I QI I QI . ~ ~ ~ , fJ:JJ 1 'J lll~ 'Vl CJ II ~ ~ IVl V 'W 'ff 3J 1'li f1 'YJ f1 'I'll 'W ~I d "" " " lU'W'Vll'JCJ1J'JElCJlWl l'illu'J~l')ruWl'J '1 I9lVlW!'Wl " ~ '1-u'Ul~'I1'Wl I" " El~11V'W19l1:JJ ~~ l~'YJf1El~l~l'i'v~m'W 'il1Jflf1J liYCJ'\Ii ~l'WV1J'Jm~CJ~~'W "Update on Pediatric Infectious Diseases 2010" li'iV ~I ~ 'l 9 " .d d'od., 'UVlu'W f1l~~ 'ill 'I1ll~V'WllVl'Vl(J'Vl1 'J n~CJl1Jl1:l 1'W~ . ,~ " •1 m·il 10-12 fl:JJml~'W1j 2553 , QI 'Vl~'I1:JJ19l "'" 1Jl'Wl:JJV~'il~ tJtll'n\1l9l~h ~11'J:JJ'ffl'Jl:JJeJii 'I , ~" "" ",) 'UV 9" 1'I1'il1Jfl'W19l1CJI9l11lEl~ 420 'Vll'W 'I1'Wlll'W'Wl'11'W'YJfl tJ Q,I' , 'I11nlfl~ 9JQ,I , ('lel L'll'~flUI9l) 9J Q.I 19l'.i1Jfll1:JJ~fl~1J iJN'l.ul~l:JJtJ'.i~'11:JJ " , ll1J 119l:JJIVlCJ1J'W~fI~ ci d .. eJ.t]~1'1l ~na.JIf)1f1f1 (tJ 'J ~1i 1'W El'\..j m 'J:JJ fll '.iN flEl1J'J:JJll~~'ffEl1JEl'\..j m'U lfJ:JJl'J n'11 fl'l'ffI9l{hfl~I9lI~El ~l:JJn1J eJ.fiUtl1{ ~1iun~ (h~VWl1Jl1:l~V'l'lmmtU) eJ.~''.i 1.:jflll'1ll'~ 0 .dt ~V'l'1"1 d I 9J I 11~~IVlV'W 'Vl'l1l 'J 'YJ f1'Vll'W 'Vl19l V~'lillJ vllmrl~~l~'l 'l'Wl'I1\9lf1l'JtU1'Wl1lJflf.:ld 'W Vfl 'illfltl Q.f • .::::l,d 'V 9Jd ~ o<:::l 'D..1J1J'W :JJ~1 'J CJ f1'J V.:l:JJl:JJl f1l '11~ V If1'W ('ffm'tJ'Wt11'JlfY'W'.il~'J) ll~~ U'V'l.1ll'ilW 1~t1a.J~~lIn'.i ('~l'wm~1JlI9l~'VllJl m~.'ff1i.) \1l9lfll'J El1J 'J:JJ 'J ~1J 119l ~'Vl CJl'~h '11 f 1J IIVl'Vl6tJ 'J ~ ~l,j' 1'W ~ ElCJ ElI9l 'ffl'U 1fJ1Jl'J 11'lifl'l 'ff19l n'.i fI~ I9lI~El ~ 'W fI f~ ¥iv ll'JfllW~El'W fl:JJmi'WTI 2553 iJN'I'li'l~l:JJEl1J'J:JJ 15 Vll'W tll'i'fm\'l'11:JJll~~~I9l'l'il'illflN'l.ul~l:JJ ' " " 'J~CJ~i'W~~l'W:JJl 'I11dl'il~\J f1 'l'il'YJf1'l fI'W tw tJ'J~'\i:JJll~1Jlfl'il~~ '1 'UvlM\1I9l~V'ltJBfl'W~fl~ 111:l~iJ'I~lj:JJV1JtJ'J~fllfYi1CJ'tJI9l'J 'l'W1'W~ MV~tJ'.i~'\{:JJfYHW!'Wlilfl~ , fJ:JJmi'WTI 2553 ru . 4'W 9 flV~fJ:JJlm'11m'.i:JJ vlm'Ji'11'.iil~l'Jlm , 9J dl 9 d do d. ~ ~ ~, 'JVl.Vl'J~:JJ~fJ~lflm 'll'~ l'Wl'Wll9llJlfl'W'W:JJfll'J1J'J'JCJ1CJVHfYfJl'JEl~ Hot QI QI 23 topics in Pediatric Infectious Diseases in USA." LI9lCJ Prof. Phillip A. Brunell 'illfltJ'J~I'VlfY'ff'l1f~Vl:JJ~fll IW~ LH1~I9lI~v~'tJ~lmJ1'WtJ'.i~I'VlfY'1'VlCJ LI9lCJ 1 m:JJflJ1Jl'):JJ 'Jflm~'Vln~'ffl1il'.iru,,!'U 'V'lty.1'.itll l'I1~3.:l~eJU d do 9Jc. l d" fJ:JJl'.ilIVl'VlCJI9l119l'W'UV~'VlluIVI'll'CJ tid , d ... ~ll'tIlf1'.i (Outstanding Asian dl v.v.I:JJ-Wirurul'll ~ ..s 'W ll'Jfl"1 ~ljl'llrV~ What's new in Reclbook 2009 'l'W~l'WV1J'J:JJ 111:l~'Uml'W~'I11flV~:JJ'\.rlmJ "mUI1'11" 1:lV~ 19l1:JJ ~ V 1tJ IrVCJ'l 91.. . '1 c:;; 111 'W tJ 'J ~ LCJ'11tl ~ V vi 1'W <v lV~ll~~~UltJll'l flm 1J '" 1J'J'Jrul1if1l'.i 'illfl-fflUfl hfl~l9l~v~'tJ~lmJ Q,I fl:JJ~19l19l19l1m1J'\i ~flflflfll'l1:JJV'WlI9l:JJ 'IllltlVl'il:JJl'lfl'l1'11VCJlI~I'i'V~'UV'UCJ1CJml:JJ¥lVll eJ.eJ'lll q H W dl QI 1.'I'~tJ'illfl l'J~i'lJ "1W!'W1'.i 11'l'11 . 'UV~l'Jl 'Mf1J'Jl~1~ Award 2009) tI .J Pediatrician c:;; Q 'illfl Prof. Sanath P. 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Disseminated disease 'V~'lJ'lrXLJ~:;;mrufvCJ'J:;; 25 Vlm~ v .:::::, mlJJl{l'V~ HSV Neonatal Herpes simplex virus (HSV) infection: neonatal HSV I 1"~JJfl11JJwrJ~\ilVm~\il~I'lJ'V 1'lJ' fetal scalp monitoring - Duration of rupture of membrane m~~{)~f)'W m~~~l~{) ~"~'lJtJ{)CJirXllti mlJJl~v~'Uv~nU~~I~vl'U (hi'l'lf primary infection) 'Vll~nn1J:;;'J~'J~ ~lCJ~~1J:;;'MN'J~ infection , neonatal HSV infection JJlnf1'"ll'Vll~nYiflM~1JlnJJ1~~lV1iJm~~~ rX1CJ <::lo.d HSV infection irXllti .J HSV lesions I~JJ1,r,fl~V1V 9J c::: 411JJ~) ,f~;il~vl,r'11~n~iJvlm~LJn~'lrX 24-48 J<i dd ~ c::: d (DIC), hepatitis ll'J:;;'W'lJiJ Central nervous system (CNS) involve fW'lJ'lJl'Ul~1'U'U l'Umru'1m~~lJJ{)lm~'Uv~ genital HSV 11J'Um~!l~n ment M()~f{)CJ'J:;; 60-75 ~1'lJ'V1'lJ'lty'lJl~'11'Ull'U:;;'U QI 9J 2. Encephalitis (CNS disease) QI 'W'lJLJ~:;;JJ1rufvCJ'J:;; 30 ~1J1CJ QI.r=2 'j.I JJnJJ1~1CJ{)lm~'lJ'n 'liJJ irritability, poor feeding, temperature instability "~'lJ 3. 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Q.I~ d9Jc!1 o . . ~91Q.1dl' rm.w'ilmm hf'en acyclovir 111.w'ill'jru 11111'WmW~Cl thHl fllll 'Wg;'Wl'li~11l'W I~ 'j 19;:IJ'U Cl"~ ~'j g; 1 ~fleJ fll'j 'Vl i;]:lJf):IJ fI'W 'Vl 'ff ~ N1'W 'il 1fl 'VllJfl~~ skin vesicles ~Cllfll'jifl~'Wll';i~ ~'jg;~tJ ALT 'Q'lmfl~~ tlfl~ ~Cllfll'j sepsis-like '~lJfI~mJ:HJmfl~~tlfl~ 'l1!Cl I'WmW~fIl'j :IJl'j~lm'il '1 tl'jtJm'Wfll'j'fffl'li;]li~'lJtl'W~eJ pertussis I 'W'Vll'jfl'l1~~i'tJ1flq)'W . o \?I'j'J'il'Wl tl if Q.I Q.I . '" ~l I mononuclear IlJ'W'l1(;lfl ( 'Wmru'W a, d Q.I 'U'ff'W'l1(;l'lV~tJI9Hj(;l'li'W~ d .. d Treatment of Candidiasis: nfll'j tli'tJltl~V'Wf111l'Wg;tJl~~V'JtltJfll'ji'flEil , I" 'ff~tll~VcJeJ ~ltl~V'Wlltl~~ii~~d Cll'il~Cl'liU'il.Q(JlWfll 'jfl'illfl enteroviral infection 1'i'1tJ) candidiasis Recommendation for use of PalivizumabT\J for RSV prophylaxis: Mucous membrane and skin infection 'ffl:IJ1'jt1 I~ voriconazole IWg; fIl'j Itl ~tJ'Wlltl (;l ~'l1 ~fl'l ~ n'U Cl 'I rll11'Wg;tJlti Cl n fllJ tl i'tJ Itl~ tJ'W 'U Cl 'l'lh ~ mn~.w'il 1'j ru 11~:IJ 111tJ 1I 'W ll~fIl~ 'j g;tJl~ I ~ tJ 'ilg;1l1'1 fl~ 1'1 tl'W 'I tl1'11:IJ . ll~(;lg;,r Cl'l~'l 'W tl 'j g;1'VlfW'l1i'! , '" I'WCl'l'illflVl I 'W ~d 'ilg; h;'UClfl~l'J I 'W 'j ltJ~g;IVtJ~ v 'd _I tl 'VlV ~'ff'W 'il 'W'W ~1:IJ:IJ 'li 'WlJ'jg;I'Vlfl' . . T\l Pallvlzumab' 'fflmHl'l11'jlV~g;IVtJ~I~:IJl~:lJtMI'W l "I "I v varicella vaccine 1'U:IJ'Vl 2 ~1l'Wg;tJll11 ACIP ~ J' A .,d d 'Vl~'WI'WCl'lm'illflfll'j'~~tJ:IJ d breakthrough infection fllV'l1~~fIl'j '11'i'i'tJ1flq)'WI-¥;V'l I 1~:IJ I~V,.~tJmfli:l~fCltJ(;lg; ~Cl1] 'l1!Cltl'jg;mrufCltJ~g; 7.3 ~Cl 0.2-2.3 v d Q.I do through infection 'lJfI:lJCllfll'j 3J I 3J :IJ~'Wll'j'l , '11 l~v,t'Jtltl 10 1] ~ "d tl ' break- , 0 Cllfll'j 1'U'Vl'Q'lflJl 39 C 3.1 I ~" l~ ~, I 'WClVflJl'jClV(;lg; 10 :lJfl:IJI9J:lJ1'11:IJ1'1'J'WClVflJl 50 19J:IJ llml breakthrough . '" '1- d infection 'ilg;:lJCllfll'j ~ 1:IJ~'WII'j~ , "~ ,oj , ll\?lfl'ff'jl'llJ11]'l1l I ' '" I'liCl lJ'Q1Jflfl(;lCl'W (breakthrough. infection I 'l'W 3 tl'jg;mru ~ " ~, l~ fll'jll~'j Cll'VlI'li'W dd '~:lJi)l'Jg; oropharyngeal candidiasis Vl I 'W fl~:IJ echinocandin 'fflm'jt1tJl'lJl o , • ~ ~ 'Wmru refractory azole-resistance 'l1'jClmru'Vl:IJfll'j\?l~I'liCl~'WII'j'l 1'li""1"1 ..:'::! d t::1dd. C> 1~'W~'W Invasive disease fld'j.w1l1'jru I'll l~ ~ll tl~fltl(;lCl:IJI'W ~l'lfllV~tJ'JVClClfl Redbook 'JlDtJ1] fl.fI' 2009 nfll'jfl~1'Ji:l'lf1111'Wg;tJl'UCl'l IDSA guideline '0'1 lJ fl.fI'. 2009 0 oj ~"v d I~VI'j'J'~'ff~ q ~ "v '" :II ~ "I "_'I posaconazole IlJ'WV1'ffl'jCl'l l~ 'W~lJ'JV immunocompromised ') Varicella vaccine: d '~~'WI~Cl 'l1'ffCl~fl~eJ~fltJ , 'I " , mm'jml~'jmg;'illtJ ~ 'UCl'lfll'j~~I91Cl\?ll:IJ'[j'j'j:IJ'lil~) l~fl"h;'fflm'jt11tl "-'I" '1"~ 0 1l~g;~~fll'jfl~i):lJfl:IJfl'W'UCl~NlJ'JtJm'Vll 'U q cu 9 d l'Wmru'UCl'l .. :II v neonatal invasive disease Vl amphotericin B (AMB) V'lfl'lllJ'WVl , ~ d'" 9"Vd ~ 'li'W~II'jm~WClfll'li 'Vl'l'WCll'il~'illJrul I" d 'l1 lipid formulation '1"1 ~ 'Wmru ~m:IJ1'jt1I'1~fll'j~~I~Cl~t'W'l19f'W fll'j~~I~Cl~'jg;tJtJtl'j g; [(1'Vl mm " ' = I'li" CleJfl '1-lJ1'1 ~" fIl'j 9I'll'Vlf1~:IJ echinocandin 9l'Wl~fIll'jfllflV1f1d'j oj I'i''JVfI11m g;1JV1'jg; 1'1 invasive disease '" I 'Wfl~:IJ ' 'I1'jeJtJl llftg;I11'Wl'WCJ~l'lUCJV 3 1:ltl~lt1 l'UmW 9 "-'I dd v oj '" _I ~ 1'W~lJ'JV'Vl:IJ'jg;~tJl:IJ~I~Cl~'Ul'JlJfll'1 echinocandin tJl fluconazole dOL 'l11'lillJ'W'U'Wl'Wll'i,fl "9 " :II IlJ'WtJl'VlIl'Wg;'Wl :II (amphotericin B 1~'WVlrll'jCl'l) 1l~g;'jg;tJg;nml'Wfll'ji'flEIll,jfl1'j1'11 fl1l 2 iYtl~111'l1~~'iJlfl~m:lJl'jt1r11~~I~Cl ltl'illflmg;~WI~Cl~ 'll'i' hj~ ~rllf111]tieJfll'j,flmtJfldl'lJ~'W'l 'il'UCl~ ~tl ~fl'jCl 'l~'l11'l 'll1llriCl1JI'1'j'l1m'W '11'i'i'tJ 1f1q)'Wll~'J n'ilg; tl,jI~'W I 'jfl echinocandin 'l1'jCl lipid formulation AMB ~'lU'W I 'Wtl'jg;I'Vlfl''ff'l1i'~m:IJ1 fll~~~fllJ 1l'Wg;tJ1I'W1] fl. fI'. 2007'l11 vari 'jg;tJ::;nm1'U f)l'j ~flEil I'W mwVi 'I,jij metastatic foci ClVl'lUmJfl1'j I,d cella vaccine 2 1'U:lJllfll~fl 'W'!'Jfl'li'J'lCllQ I'WCl~'illfl varicella vaccine 2 V'l~~I~'W 1flq)'W'Vll'lI~Clflrll'l1i'tJl~fll'VlV tl'j:;l'Vlfl'l'Vl tJfl'l~ Cl 'l'~ 'ill'j ru 1'j lfllVl'W 1'i'1tJ l'j 'li1 V'W lI'i'mj'll'ilg;nCllflWWeW oj oj 2 1'U:IJ ~ fld'j~'ill'j ,oj v I' ~ v fll'j.w'illJru 1hf'1flq)'W I 'l1!Cl "_ I oj I'dCl'l'illflij ~ I 'Wl~ fll~ flCll'ill ~:IJe.lD~ fll'j ru'UCl 'lfll'Jg;ifl'il lfl HI d ~ 9JQ.I ~ lil ' Pertussis: 11J'W"1';ifl'W l~tJ'Vl'J Itl'Jl pertussis typical I~V1J~n'li'J'l v v '" ~ n!'W Q Q.I whoop eJ\?I'jlfll'j ~ Cll'Vl ddtl" 1Jflll1~'jfl9fCl'W'Vllfl~'U'Wfl:IJ ~mfl 9J d Co .J 1'li'W respiratory failure, secondary pneumonia, pulmonary hyperten sion I~'W ~'W 'il 1fl fll 'j ~flEll~tJ 11 1J 'il ~(Jl~V 'l~ rllf111]'U Cl 'I fll'j dl~ '" d d" pertussis I'W'Vll'j fl '1~llflfll'j'Vlm'j~l:IJCllQ'WClV , J5- J9 '0'1lJ) ('jg;'l1'Jl'l fll'j~m'j~liiCllfll'jtlClm'W 1'W:IJlflfl1l I~Cl'l'illfl'Vll'j fl~CllCJ'W ClV 7 1'W • fl1l 2 l$ieJ'W V~'l,j'ffl:lJl'jt1\'l~1flq)'WtJCl'ltl'W'M tJCl~tl'W~,.fl 'M 'Mllfl primary series I 'Wl~flCllQ q ll~g; 0 ~'lU'W:IJl\?l'jfll'jfll'j fllmi'lJfldl:IJfl'jCltJfl~:IJ'UCl'lfll'jij~1flq)'WDTP oj mg;~'W I 'W1~fl1V~'W q 9 " oj 2 I~Cl'W- 6 lJ fIl'jll'Wg;'Wg;!'l1 Tdap 1'U:IJ ClltJ 11-12 1] q '0'1 '" fll'j'~'ill'jrul hf'1fl9i'Wllf)tJflfl~~Cl~cu q , 'I I _'I ~ 'jCltJ'l 'Vll'jfl ClVl'l 'jfl\?ll:IJfllJ 'l1'Jfl9f'WlJeJ'lfl'W pertussis Ilfl'l1tlJ~ ~ ~'l " :II I 'WlJ'il~tJ'WflV'l:IJ ~ ~~ "d 1'1'lfl'j'ji) 1l:IJ'Jl'ilg;:IJ ~llJ'W contraindication 1~:IJ oj "v d v , • v u " , Q.f Q.I IlJ'UCl'U~1Jll'jfl IWg; 1:l'l.l~ lt1m1''l1l1fl~ 'ffl:lJl'j t1 r11 ~~I~CJ 'l11'11:IJV1 '1 'I.l 'ill fl mg;llm~{)V1 • Congenital CMV infection: v oj v r-.i I r-2 0 0 d UI :lJfll'jfl~l'Jt1~mll'Wg;'WllflV'JfltJfll'j • " V congenital CMV infection ~~'ff~lJ 1~~'l'W Cll'il I 'l1fll'j'jflEllfll1g; I'jI ~'ill'jun 'l1fll'j'jflEll~'JVVl ganciclovir 'li'W~'\l~ (6 mg/kg/dose '!'Jfl _1~"Vd v ~ I 'W1~fl'Vll'jfl'W'WCllfll'j:IJfl ~ 1,j~ClVV~tJn catarrhal i'W I '1 l'UlJflEll\?l'J 'W 1'j~~VltJl~'ff'l " II'Wg;tJ1111Vl I 'W fI~:IJ ~I ..:! :II Cll'illl'Wg;tJ1hf'H'I~'W fll'j \'l~I~'lJ~'ffCl'llriClCllQ 4-6 1] 'hj ~'Ul'J~lIWg;~Cllfll'j ~'Wll 'j 'l:lJlfl ru llmg;\?I~ 'ff'W 'il ';i1:IJfltJ ~lJ flfl'j Cl'l'UeJ'll~ flllJ'W 'jlV1Jflfl (;l rll'l1i'tJ1fl9i'W 'j1:IJ Mumps-Measles-Rubella- Varicella (M MR V) c;; tJ 'Jv~ih~~I~Cl 12 ~ 'jI Q.I ~'J 1:IJ'l) 1~'Wnm'Wl'W 6 d iYtl~lt1 I'W'Vll'ifl~ijCllfll'iIWg;n CNS ,:f~dl~Cl'l11'ltl 'j g; IV'liU'l 'W fll'j ~~ fll'i If)~m 1:IJ~ ~tl fl~ invol vemenl 'Vll'lfll'j llPW'WIl~g;,;r\ilJ'Wlfll'j~mQ 1-2 1] fl'J'j.w'ill'jru 11~'W'jlV1Jflfl(;l '1 :IJ"1"~1l'Wg;'Wl I'l1'VllJfl'!'JmltJ " d I'WCl'l'illfltJl:IJN~'Ul'llflV~flCl'W'Ul~:IJlfl 'l11fl 0 d" d , " 1l~'Vl6.w'ill'jrul'ilg;MtJli'flEil fld'j~tJl~:lJtJlfllV1'W I l$ieJ'W'l1~'lfl~Cl~ fll'j.w'il 1'j ill 111'Vll'j fl~ ~ fl11:IJ ~~tl fl~ 'U Cl'l fll 'j '11PW'W1-¥;tJ ~ ClV 1 ~l~ V1fld'j , , . 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I ~ 'ffu~lml~g; 1-2 iYtl~lM Treatment of uncomplicated gonococcal infection among . . ,d children beyond the newborn pedod and adolescents: l'lHn'iJlfl ~ d' QJQ ~D\91fll'HU'IJeJ':]I'lm gonococcus 9 I \9IeJ\91eJVl l'Wfl~)J ~ I fluoroquinolone (FQN) mfl~'W l'WtI'iJ~DWJl'l'Wfl~)J FQN \lfll91\91eJeJfl'iJlflJl(Jfll'Wl~II'W~'I11 ~ 9 "'9 "'9 1'l1 I'll l'Wfll'J'JfllJl GC 9 .1 ~ ~ '" l'WlJ'J~li1f1'fl'm~eH)J'JfllUm (2007) Vl'Yl extended spectrum cephalosporins eJl'Yl'" 1'll'W ceftriaxone, cefixime lW~ cefotaxime !\9IV ceftriaxone U'W~'I11 9"'9 ~9~ l'WeJ 9JQ.lO 0 1'l1fl'eJ\9Ifl~eJ':]flDmU'W~'Wl'UeJ~ 'i 0 'l '" I\9lVU'W~'Wl 'l1 prophylaxis American Heart Association (AHA) a l'lnn~flJtu '" dental procedure (VflWflfll'J 'l,r'l'W flJ Wtf\91tl fll'J~l~Vlrl1J'J~DD'Yll':]I~'W tll'l11'J 'Yll':]I~'Wtlfl'ml~ 'l1~ eJ 'Yll':]l~'W'l11V'l'iJ) hfltfl'l'iJ~fl')Jm'J'W'iJl'Jtul'l,r prophylaxis 'I~un flJW ' r ' V , ""I '" '9 ' 11'W~'Wl 91'l1"'9I'll \9IllflVll'Wfl~)J o d Prevention of bacterial endocarditis: iJfll'J tJ i'1Jl,j~v'Wf11U 'W~'I11 0 a '9 d 0'l'" "'9' aa 'l 'IIfl'~UlJ~fllJ~eJ)J "'''' .1 .1 'l 'Wfll'J'b'eJ)J~'W'l11 ' ' ' ' ~ 91'iJ 'Yl)Jfll'J endocarditis mneJ'W 'I \9Illfl '" , "'.'1 '" '" ~lJ1V'YllflV)J infective dl'W~tJ1Vtfl'l'\l'Wfllm~nl1U\9l~fl')Jm'J'I~ '1 "I '" "'.'1 'i ~ 'l '" '0 '" ~ a d ~ ~lJ1V l'Jfl'l11 'iJ'Wfll'JU\91flll'W\9I'15'W\9Il\9lVl'YlV':] )J \91 I'll l'WflJtu GC 'IJeJ~'l'Jfl\9llU'l1'W~l'Wl\9lfllW~~ 1'l1l\J cefixime 11'W~'Wl 'II prophylaxis 'l'WflJW uncomplicated GC 'IJeJ.:] cervix, urethra lW~ rectum lW~ ~ '~""1 'U ( 'I'~ ~I '~""I 'U) 'JDfll'JNlI'l\9lUfl )J'W1J'Jl)J palliative shunt llJ'Wfll'JN1\91\91Ufl U'W~'I11'l'lf''l'WflJW GC opthalmia, scalp abscess ll~~ ~{j lV! 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Susceptibility of pneumococcal isolates: d N~fll'J\9IeJ(Jl'UEJ~l'lleJ .¢I. iJfll'JtJi'DltJ~V'Wfll'JUtJ~ , r-i 'l '" '" ~ Streptococcus pneumoniae l'WEJ 'l1fl'eJ\9Ifl~eJ~flD f11U'W~'I11'l'l1JJ!\9IV Clinical and Laboratory Standards Institute (CLSI) ~':]lW\9l':]l'W\?ml':] 100,000 IU 1'W'Yll'JfleJ1V'J~'l111':] 6-11 l~eJ'W lW~ 50,000 IU 'l'W 'Yll'Jflm~'l1'eJVflil 6 l~eJ~ !\9I(J'l,rl'W~~ Drug and Isolate Location I i'lf.:] ~\9I~eJrl'W 2 1'W Susceptible Non susceptible (mcg/mL) (mcg/mL) Intermediate Resistant ~ 0.06 O. I 2-1.0 ~ 2.0 ~ 2.0 4.0 ~ 8.0 ~ 0.06 None ~ 0.12 Nonmeningeal ~ 1.0 2.0 ~ 4.0 Meningeal ~ 0.5 1.0 ~ 2.0 Penicillin (oral) Penicillin (IV) Nonmeningeal Meningeal Cefotaxime OR ceftriaxone Prevention of gon?coccal ophthalmia: '" _'1 ~ '" n. 'l1 VeJ \9I\9111~)J 'lJJiJfll1)J ~ 11 ~'W '1 ' 0'l '" ~ ~ lJ'iJ~D'W )JU'W~'Wl 'l1'l1VEJ~ a '~.I '" . D'YlViiJ'l'l1JJ'l'W Redbook 'i),Duu'Mun Fusobacterium infec U~~ Vl silver nitrate l'WeJlJeJ':]fl'Wfll'Jlfl\91 GC ophthalmia tlfl\91eJ llJ Vl'Yl tions including Lemierre disease, Human Bocavirus ""1 \9IUfl '" ,0.5% erythromycin ointment 'l1'JeJ '" I % tetracycline ophthalm ic solution ~':]Vl~':]fl'eJ.:]iJtJ'J~iY,~ ~m"'H'I'i1l'VlV)Jrl'W'l'W fll'J viruses 'l 'W~li''iJ~ 'lJJ'UEJfl~ll~':]I,jeJ':]'iJlfl'WD M'lJJDeJV 'l 'WtJ'J~l'Ylf1''l 'Yll'J 9 ":"1 U'W~'Wll'l11'll o iJeJ ~ rl'W 1 'Jfl 1'W fl'J W'Yll'J flU 'J fllfl\91 ~ fl~eJ \91 'iJ 1fl)J 1'J \9Il~ 'l~i'D fll'J Polyoma vrfl''W 1'iJ fl'1)J l'Jtl'l11V l'Wl ~)Jl~)J 'M'l'W Redbook ~ lU'iJ'ilvl1l~'W GC u~~m'J\9IliJ.:]'lJJ'l~i'Dfll'Ji'mJl m'J'W'iJl'Jtul Mfll'Ji'mJl'Yll'Jfl~lVfll'JMceftriaxone ~\9IleUlfl~l)J I 1~fl' U,j'il 'Yll'J fl'iJ ~iJ.:] 'lJJiJ eJ 1fll'J 9 ~ l'Wfll'J'JfllJl n~ 'J l~ flJ Wli'Vl'l1VeJ \9I\9111Y1V,:] eJ Vl':]I~V 1 'lJJ'l ~N ~ '1 "'~ ~ '" a '" U~~'l11fl'Yll'Jfl \9I'JDfll'J'JflEll\9l1VfllH!\9IVllWl fll'J I. American Academy of Pediatrics. In: Pickering LK, Baker CJ, Kimberlin OW. Long SS, eds. Red Book: 2009 Report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2009. ~HnUf)l'Hl1 l~f1'lflI'JDl~ 6 1J 10 l${eJ'W Jll1Uf1 21 1J~f1fJll~emieJlJJll'vdleJ~~fleJ~lu'UllmlJ1\91 l~lJ ci~m i1'1 11i\91 eJlJ'ff'W eJ~~eJ nl'l i'nEJ 11'lJ'J1il1nl 'l \91 'lJ'il 'I1l'fflml9ll ~eJl ~lJl~lJ I~H rl iiloU' Mi'lJl'Jl CBC, ESR, CRP, PPD, EBV, CMV, HIV l~'W~'W I:J~eJI'JH'W~U1 M nhf1i'lJ 1Jfi1hw~lJll1ml'J'lfu\911unm 3 iY1J\911'l1 o 1J'i~1fl 3 iY1J\911'l1rleJuiiloU' iineJu~rwl'hw'\mmlJ l~lJ fleJlVI'J~I1J ~l'W'Ull 11Jl'llJH 'W'VlcJ~ h ~lWl1Jl'lmi~'I1~~ I~i'lJl'Jl amoxicillin Q.I Q.I iY1J\911'l1H'l f1m:1~i'lJ1J'l~'Vll'W1'J1Dlnl'J~~'W ')1 d ~ .J d H'l~ f1 eJ'W 'Vlfl eJ lJ llH'illJ'U'W eJ f1 loU''l\91'l~ 'lfl~ 8 1'W HI91I91 eJmii "loU'v f1 l~\911'W'l~ (l50 lJf1.) I ,~ ~')1 ~ ~lVn'W ~ i'lJ1J'l~'Vll'W 'l~ ii~'WHI'I~ 2 I" 'I1'l~'I1V\91Vl \91 ~ d~;V 10 1'W eJlnl'lI'l'\J'W ~ ,,~ 'lfeJ'W'lfll'W'l~ clarithromycin (l25 lJf1/lJ'l.) I Q.I H'W'VlcJI~l1J~V'WVll~'W r1'W\911lJI'l1 f1eJ'WVlJ'l~ Q.I nB'W~fleJ~l'W'\Jlll\91~'Wvf1' ~ ~ ,I fl'l~ 'llJlJ'l~'Vll'WVl '1"1'1 ""I '\J'\J'WeJf111'l~ "« "" lJ ~ ~ 2 1'W "" "", I'"I'IH\9I'WeJV " t1leJlnl'l " I\9"1 ,!eJnlmn\91nl'lH'W'\J1lJn~lJ'WlJ I BV1~~'Wm ~ d.d d 9l.d ~eJlJJlmtleJ~~1'1eJDm'fflJl'Wl~f1 cil'Wl'11t)jl~'W process (feJV'l~ 87-100)' H'l~iTf1'il~'I1lVI~W~Jllvl'W 4-6 iY1J 1'1 1'l1' , ~1 'Wl'il~llJ'W amoxicillin ~r dd I llJ'Wl'Jl'VllJ'ffl'WN'fflJ'\JeJ~ . amoxicillin 1'WD\91'llcil'W~ll\9lf11911~ iinl'l~f1fJl1J'l~rr'Vlinll'l , '" clavulanic acid 4: I \9Iell'lfeJ Staphylococcus H'l~ aureus l'llJl1 minimal inhibitory concentration (MIC) '\JeJ~1'J1 'fflm'lt1erlJ5~l~eJI~ H~l'Jl~iiiY\91cil'W~'W "1 , l'lf'W 7: I ~ I H'l~ benign 9J lJN'W'Vl'l1'W ll1'leJl'leJI'I1V Q.I ~.:i d 0 acute otitis media philus ~ infllle~zae lW~ 'I1~eJ 14: I ii Q.I '\JeJlqJm1'lf1fJlnl'l\9l\91I'lfeJ'Vl'ffll'lW'\JeJ~c ommunity '" d 'lHllHl'YIfl1'i'YI'illJ '" ~I non IgE mediated hypersensitivity \91~'W'W'fflm'lt1 ~ ~ 9 " llJ'W !'If clavulanic acid 'j} , 'UeJ~~eJlJJlmtleJ~11~nmlJ '" '" cephalosporin ,!\91l'JlJ maculopapu!ar rash 'I1'leJ Amoxicillin-clavulanate 'UeJ~Vl 2 1'W extension 1'lJ'l HVln~lJ~'W5 1'W IV '" benign 'I1'leJ malignant process IgE mediated hypersensitivity I:Jl'l1'l1~1'J11'Wn~lJ beta-Iactam lW~ d " ..d ~~'\J'WH'I'j'VlV l\91l1J'lV'Wl1J'W cefuroxime (250 lJf1.) I llJl'Il'W'l~ 2 m~ d .d ll'WllJ'WN'WHlJlJ urticatia H'W'VlcJ'1~~~~lVVl clindamycin fl#~ l~f1i'lJ1J'l~'Vll'WI1il~ulVlmfl'W 3 " I '\'J" 'lJlJ\9111'J 'j}.?1 fleJlPll'W'Ulll\91'ilj~ CBC: WBC 17,900 cells/cu.mm. (PMN 73%, L27%), platelet 370,000 /cu.mm., ESR 40 mm/hr ":1 ~lJ11'J'VlH'W1'J1 Vl penicillin lJlml'il~h~'WVl1Jl'll'llJl~'Wl91tJlJJlmtleJ~~ 10 1'Wl91eJm I lJ'fflm'ltHWn ' vndJ'W'l'W1Jl~'llvvi'll~eJ~ M I QJ m~'Wl'W 2 llnl~ 11Jmf1rvhl'lH ~ 'j} 'lfeJ'W'lfll'W'l~ clavulanate (457 lJf1./5lJ'l.) I rI <J} Q.I 1~leJ'l\9l'l1'lf11\91 '" 'illm'lfeJ Streptococcus pneumoniae, Hemo Moraxella cartarrhalis .c...::!:i acquired pneumonia '''''' I1'"1 1l\91'I lJlJ'\JeJlqJ'lf1l'l 67 'lnEJ1f1l'l\91l'1l'lfeJ StaphylococccliS allrells . 'fflmI911'Wl~f1ln\91 'illf1nl'lfl\91l~ell~'W cil'W '1 'I1ru l~eJ~I~'W 'fflm\91H1J~ r U $I ( j , o dd QI Q.I q .::\1 \911lJ\911H 'I1'W ~'VllJnl'l eJ m 'fflJ 1'1 ~ 'W ~eJlJJlmtleJ~~fleJ 2 oU'l~ Dm'ff1Jl~VlJ'Wt1'W (Jllvl'W 2 l'llJ1JeJV~'ff1'l, Inl'l'illf1nl'lfll'll~eJ I li''ffl'W'Vll~l~'W'I1lV 1'ilcil'W I. iY1J1'l1'l1) ~I cervical lymphadenitis in children. Am Fam Physician 2008;78: ~ ' 9' "" 9 gitis "1 \91\9111' "" J ",'I !'W~lJ1V lJ'WllJ'W'ffl'W !'I1t)j 'WeJf1'il1f1'W'!'m 1097-8. gr. A Streptococcal pharyn 2. Swanson OS, Edwards MS, Torchia MM. Etiology and clinical ~eJlJJlmtleJ~~1'1eJ.u1~l~V1Dm'fflJl~VlJ'Wt1'W 2. manifestations of cervical lymphadenitis in children. www.update.com (i1ll'Jl'W 2 ~ QJ,..1 rI 'j) 'leJl'J'l~ 'fflJl'Il'l1) ~ .t:::\ 40-80 lf1\91'illnl'lfeJ S. aurells lW~ gr. A streptococcus I" , '" 'Vll'llJ'leJ~'l~lJl \91lln Streptococcus eJ'W 'j/, ~ , I. Dulin MF, Kennard TP, Leach L, Williams R. Management of t a! 'ffl'Wl'lfeJeJ'W "1 "1 H'l~ enitis in children. Seminars in Pediatric Surgery 2006; 15:99-106. anaerobes iTf1ii1J 'l ~ 1fl Vl 'WN ~ llJ~ lV ~eJ~JlmtleJ~~1'1eJ 2 .ul~Dnl'fflJlfeJi'~ (mf1f111 2 iY1J\911'l1) 3. 3. Gosche JR, Vick L. Acute, subacute, and chronic cervical lymphad , d. 4. Swanson OS, Drutz JE, Kaplan SL, Friedman EM, Torchia MM, Torchia MM. Diagnostic approach to and initial treatment of cervical 191 l'lfeJ'Vl'WlJlJeJl'J I'IHf1 EBV, CMV, TB, HIV, Toxoplasma, Syphilis 11J'W\9I'W ,J d r d I ~, , 0 6l ')1 d ~ d .d QI cv \91eJlJ'W1m'leJ~'Vll'leJ'\Jl~I\91VleJm'fflJl'leJ'l~ , 4. ')1 , (lJ1f1nJl 2 I" , 'fflJ\911'l1) l'lfeJ'VlV~lJlJeJl'J \91Hf1 Non tuberculous mycobacteria, Bartonella ~ Q.I.... I cI 6l <::.i ~ henselae, 'WVlJ'Vll 9l Livingstone, Philadelphia 2005 T~, Toxo;l~sma cit 0 61 dcv l'Jf1n'W'lll'J'Vl\91eJlJ'Wll'l1'leJ~lJ'lf1EJru~ , of Staphylococcus aureus towards amoxycillin-clavulanic acid, fluctuation 'If\91l'il'W 1'11'l '" i1'l\91eJlJ'ff'WeJ~~eJnl'li'nEJ1JllI'J1'W 6. Skov R, Frimodt-M?ller N, Espersen F. In vitro susceptibility Q.I ~, I'lJI 'Vll needle aspiration l'WeJW1'l1'WeJ~m\9l'lJ'ill'Wl~l'lfeJ H\9I l'Wl~n~iiDlnl'l "l.u 1Jl\91mlJ 11\91~feJ'W~~eJlJJ1mtleJ~~1'1eJ9f\91I'il'W iTf1 1"r'V11J fi1h'W~1'1 'l eJlJ 1'1~lJl ~eJ ~ 111 'il~l ~ 'W 'fflml9l cil'W 1'I1t)jl1J rleJ'W o Principles and Practice of Infectious Diseases, 6th edition. Churchill , '" '" I'"\91lln l'lfeJeJ'W"1 nl'l\91'lJ'il iU'il'itVI~eJ'I1ll~eJ~h~'W'fflm\9l1 , , 'W'l~V~ll 'lniTn '11i 0 5. Andes DR, Craig W. Cephalosporins. In Mandell, Bennett, & Dolin: t ~ .c:::. lymphadenitis in children. www.update.com '" 48-72 il IlJ~ " ~ !\911'J1~1 penicillin-clavulanic acid, dicloxacillin and cefuroxime. APMIS 2002; 110:559-64. 7. Easton J, Noble S, Perry CM. Amoxicillin/clavulanic acid: A review ll'W~Ull"r'~eJMmlJ of its use in the management of pediatric patients with acute otitis 10-14 1'W 'I1~eJeJtimreJl'J 5 1'W 'I1t1~'il1nDlnnl.u 1Jll'lmlJHI'I~'I11I'JI1J media. Drugs 2003;63:311-40. . • j'@GMENT,iiES ula~ a:aXICillinIcla at' I powder for oral suspension ~ES can cover major pathogens in ADM and sinusitis 1 ,2 Streptococcus pneumoniae, (penicillin MIC < 4 Ilglml) Haemophilus influenzae Moraxella catarrha is GlaxoSmithKlinc Wll1fqrJJI'1tMu,LI'ri 11"_ 851/2552 AES 01/06 TH09.-211OMl9 bh'lfhU"l1tJtl:lDlJfIlilslLiiwtulen"11h~a!"a::UIO.,.,,;,nuU1 Tl - >SFf.AS.aUWS FfSIWthJ~" n1A51j1vCl~b5nEJ1 • 1 Aru=IIWnEJFl1CfVlSASS11jWEnU1Cl UP\VlCl 1 fl:nU(11:lJ11'tirl'f) 1~ Lnl1lfliJ AJJnU~(11:lJ11'tiiJ'f)~nu 11'fl q S. pneumoniae rl'f)hflU'f)tJh.l'Vll1'n, L~nd~n LL'~:; ~ ~(1--1ll1tJ ur,y~tJl um1'rl'il hfl~~1 ~ru~(1l1l'lJ'il--1b~'ild ~'il bbmj'1i~ ~'f) bL'ilU~U'il~~iJmlJJ~ILvn:;~mL~tl~~ ~ 'tI Ii q ~ '\J L1JU~I'llYl~bb'1iflm h~ iJflrum.J1:wiLLlULb'f)U~Lr,yU'llUl1lbbl1ln~l--1nu " q vh 1~(11:lJ1l'mLU--1L:U'il1a1'il~I--1UmJ 91 :nhVi'tJ1J I fll1JJ1'ULL1'--11 u m1'rl'il hflll1r,y~unU'lJUll1l'lJ'il--1LLfltl'1i~ :nhVi'tJ1J 3 iJLbfltl'1i~'l,ljU1 ~--11'Ubb 1'--1~(1l1l ~lu:nhVi'tJ1J 3? bbfltl'1i~U1--1~--11~1'UbbN LLfltl'1i~ r,y:;Yll'1,1jUl~trmiml1'~uilull1ltJ alveolar macrophage L:Ul1l b~'f)l1l'lJl1 PMN lULdm~'f)LL~:;L~'f)l1l ~Ul1b~'f)~'f)~lUL~'f)l1lr,y:; tru~--1m1'~uilull1ltJL:Ul1lb~'ill1l'lJl1:lJ1nnl1L~'il~'il~l1l1JJLdm~'il ?h L~'f)L 'ihm:;bb(1 L~'f)11l1 uflu~1~iJfliJ AJJnur,y:;'5Ul1l1'ltJ:lJ1n L'V'l1'I:; L~m:; Lr,y';b1J L~JJ~lUdU'il~I--1nl1lL~lYll1 ~Lil l1l\l11'~l1l L~'ill UL~'ill1l 'I,Ij;'-'f)1 UL~'f)~JJ(1JJ'f)--1 L;'-tJnll invasive pneumococcal disease (IPO) 'V'lU1a11J'iltJ1UL~nll1tJ~lnll 2 U LL~:;iJoJJ'ilJJ~m1'~'ilm 'lJ'f)--1L~'ilL~JJ~ur,yULLluub1J'l,ljl1um1'fmn q ~ 'I 'I ~ 'U 'U q ~ ~ heptavalent pneumococcal iJmnh conjugate pediatric vaccine PCV? m1'~boJJ11UUb1J:U1fl:nU'I,Ij~mLv1--1'll1~ (EPI) lutl1':;L'VlV1~l--1 'l nl1 20 tll':;LYlV1vi'11~n 1a1LLrl tll':;LYlV1 (1'1,1jfJ''ilLJJ';m LLflU1l1l1 '5~n~M cJ*~bV1(1 LtJ'f)1'lJU U'f)1'Ll~ 'il'f)(1Ll1l1'L~tJ bb~::;b:un;nln bLlu~u 1~:nU PCV? - tll':;n'ilU~ltJ ? :nhVi'tJ1J~'V'lUrl'f)hfllu L~nJJln~~l1ll'u~'l,ljf~'f)LJJ';mbb~:;"hul'1,1jruLLluL~'f)~m.n ~'f) 19F, q... ~ 14, 6B, 23F, 9V, 18C, 4 'I,Ij~--1r,yln~iJmnh1fl:nu PCV? boJJ1:lJ11oll1utl1':;L'VlV1 (1'1,1j¥~mJJ~m ~--1bb~U fl.V1. 2000 l~L~nYlnflu~iJ'il1t.JU'iltJnll ... q , 5 U 'V'lul1m1'Lill1l IPO ~l1l~--1 1~L\l'V'l1:;LL~luL~n~1a1¥u1fl:nU LL~iJm1'~l1l~~ 1U~~--1'il1tJ~1~ lfltJ1a1¥u1fl:nUa11t.J 2 (herd immu nity) L'V'l1'l:; L~n~1a1fu1 fl:nU r,y:;~ l1l\l1l'LL'V'l1\ ~'il1tltr--1 ~1'\t1ru1J1 m1'~fliJ AJJnU~l:lJ11'tiiJ'f)--1nu IPO LUUbbUU~l L'V'll:; ~'f):nhVi'mJ v1--1JU1fl:nu~iJ'l,ljmtJ 'l :nhVi'tJ1J LLlu~lutl1':;n'ilU~--1tllr,y:;iJ n11=Bmv1ns::llalat>A1UAunluiJniJAunu~::6u~S1a _ . "1 U1n IWS1::lfit>~::I~SryIWU"1U~Ut>ei1\1S~AIS~ .hln tl1':;~'Vlfifll'V'llunll'iJ'f)--1nUll'fl~~U ~ q q q ~ ~~ q ~ ~ IOAn1siijAI8t>lUlat>Anst>lUl§m1'uaut>\I .san::i1 • invasive pneumococcal disease (IPO) q ~ " , , "" '1.1 "" "" v ~ l'll'fl "" n1l'Y'lmn bUlJl'::;lVlY'l'l VltlVllnm6]J'fl,mU S. pneumo ~'1lltJn1~"Vln~thtJ niae '\J IPD 1'Ul~n~iJll1ml'fltlnl1 , PCVlO _ 70.3% ========~'~PC~V7~=~70~.30~Yo~~i!!..:..:~~ tJ3 5 , 16 ¥ul'ih¥mn1ulH\"ImU1f1~~n'll "Vv:l'lf1'1nl'ru .niJ'I,Aj'n'fli?1'ntlli?1'll , '\J' ~'16]Jf11Ufl~UVlf ~mUU~6]Jm'l,Ajl~mlv1'1'lll~hJvnl'l:Ui1 ll'n::;l1''1 , 'l,AjmU1'n~u 1 'U'fl'lm::;Vll"N~lDll'ru~'U li?1m~'fl~vhn1l'Vli?1~'flU = • PCV13 = 81.2% 14 '"... " OJ> 0 .,; z 12 - 10 - - 1 - - - - 1 - - - - -21 ..,,.,-1---+----+-------;--1].---- 8 -H~I%,----I-----+----:------+---...-- - .''Io--II----I-iJ!.'%-;----+-----;.-.- 6 'l~:lJ1"VlnVlnm , fl'U'fl'lUl'::; lVl m::;vdl'1l~'flUJJml flJJ 'I,Aj. Y'l. 2543 'I,Aj.Y'l. ilI1'flth'l 'l,AjUl1 serotype ("v1JJlt1D'Ilfl:TIu PCV7 1~un 1, 5, tJ ~l'UdU~'l~U 2548 1'1JJ'J'::;tJ::;l1f11 5 fi'UdlflJJ PCV7, PCV 10 ~lJ~l'Udu:nhVlm:h~JJ:lJ1n~u~n 3 ll'n::; 7F) 'U'fl'l coverage 115 PCV13 'llUi?1 , ("v1:lJ1tJD'Ilf1:nu PCVlO ~l'U1u:nhVlm'h~JJ:lJ1n~u~n 3 'llUi?1 1~lln 3, 6A, ~i1t1'n::; 73.9, 77.4 ll'n::; 87.8 l?11JJ~1~U ('J'U~ 1) 19A) ViiJ ~'fl PCV10 = 77.4%. V • Quellung reaction .0 immunological ~1JJ1'ab1(i"1'a1"l1~"llm;'fl~l'rn::;'LIU blood agar Jlt.J1 ~1.jj'Vl~~'flU~tl II '1)U~:jj*JJ~lJ fl11JJ~1 b'l,Ajl:; ~'flllflU'n'6'l6]J'1)'l pneu mococci Vln:'TIhYfmJ l~'1)"v1t.Ji?1U'flU~:jj~JJ'o'l'l1u~~lJnUl~'fl~~'l~tJ ll?1'1"l:;d'1i?1uBmt.J1Uln~:;n'flUl{'ln 1 (precipitation) ld'flUl1'1"l~ 20.0 :; 2O"k ~ "C ~ 15% q 12.2 10.4 lOOA.. 5% 0.9 0 0 " ~" "> ~1t.Jn?1'1)'l"V'rIVl'a'aY'lUfhK'l'lJt.J1t.J 10 , q} 100 'Vh'lV;li4u~nBru::;f1?11t.J li4u 1~o)fi?1l"IU Mapled Irom Phoogsaman W. at 31. Vaccme. 2007:25:1275-1280. sLJrt 1: A31UijnVEhll8a S. pneumoniae (;I1Un1SnS~Q1BVa\l 5rsnB(Jffi8IuucbuLls~naulu5A5u PCV?, PCV10 lIa~ PCV13 • S~tfd1\1U W.A. 25430\1 2548 nl'J'~nBl1UUl'::; lVl Y'11VltJ f1~'l1"v1~ ~l~ i?1 Vi 11 W~1lJi~ tJ 4 , ~1u1"v1qJ8'1fl'llLlu X llflU~f1'1,Aj'fl'l'1)'fln (capsule swelling) "v1~'1)llflU~'rIiJ6]JUli?1'l"v1q)llf1:; ",'S' Serotypes V V " f>l '1DUblJ'UfI1'a'Vli?1~'1)Ui?11tJ 4::o.qq reaction 27.8 "o ~ 25% ~ "l sLJrt 2: A31UijnVa\ll8a S. pneumoniae (;I1Un1SnS~Q1BVa\l 5IsnB(Jfi18IuucbuLls~naulu5A5u PCV?, PCV1 0 lIa~ PCV13 PCV13 _ 87.8% • 35% 30% • Vaccine serotype (Sterile sites) • Vaccine serotype (Non-sterile sites) Adapl&d from: S.Snleungtung Vacc,ne 2010 S~I"i:j1\1tJ W.fT. 2549 0\1 2552 '\J PCV7 = 73.9% , Sterile sites; n=64 Non'Sterile sites: n=42 '\J ll~ i?1'l11'lV;~'rIU1nnUfI1l'Vli?1~'flU n1l'~li1'UllflU'n'n lJ6]Juli?11"v1q)~'Ulti'fl~"llm~mili?1u5fWt.J1~n~::;il'1)'Ul{'ln 1 1u'I,Aj'1)n ~U~b'1rullfltJ'n'6'lll?11'vh1V;~'llt1V1m"v1 (refractive index) 'lJ'1)'lll~'l 'lun?1'fl'l"l'rlVlnf1UbU~t.J'UllU'rI'l1U CJ , ~ ~ b'eln~l~'eh~~.:l network 1. Park IH, Pritchard DG, Cartree R, et al. Discovery of a l"v1lJ'fl'Ul~Wl'n:::iJh'l'l,AjtJ1U1'r1~U'1 hJJ~1tJ~n 10 llv1'l (l'fln'llu 6 llv1'l, ¥~Ul'r1 4 llv1'l) li?1m~i1~v1ln1'J'Vli?1~'flu1~"VlnWtht.l , , new capsular serotype (6C) within serogroup 6 of Strepto pneumococcal collaborative ~ ~ IPD ~ ~ ~ '1 4 w: qc:l 'lI 'Y~.Y'1, 2549 - nJJm~ufi 'Y'i.Y'1, 2552 , ll'rl::;luul~'flill1mh'l "!lmu'l,Ajl::;u~nrum!Plnf11'1 and indirect effects of routine vaccination of I Uf1::; lJJtl1 lml::;"v1r-J'rIn1'J' V'lnBl lmn::; b'Uli?1nVlJJll1t1Uilt.Jn11 , 5 tI 'J'::;Wh'll~'flUlJmlf1lJ coccus pneumoniae, J Clin Microbiol 2007;45;1225-33. 2. Direct children with 7-valent pneumococcal conjugate vaccine on incidence of invasive pneumococcal disease-United States, 1998-2003. MMWR 2005;54:893-7. ~'1"v11i?1 ~'fl 3 Phongsamart W, Srifeungfung S, Dejsirilert S, et 01. Serotype ll'n::;UUVllj'a ViU11 serotype coverage distribution and antimicrobial susceptibility of S pneumo 'lI'fl'l PCV7, PCVlO U'rI::; PCV13 ltlU~'flt.Jf1::; 70.3, 70.3 ll'rl::; niae causing invasive disease in Thai children younger (?11JJ~1~U (l'U~ 2) ;'l"V::;li4u1~11 PCV7 ll'n::; PCVlO f1'J''flUfl'nJJ:nhVlmJ1~ lvh~'u U'rI::; PCV13 fl'J''flUfl'rlJJl , , ~JJ:lJ1n~u 4. Srifeungfung S, Tribuddharat C, Comerungsee S, et 01, fI~'llVl'l,Aj"1 81 ,2 .1 UfI'J'lJ~lJ "" 3 I '\J ~1ur-J'rIn1'J'~nBl'U'fl'll~'fl~lJ~ru~JJtWl~'fltJ1UD:;'hu::; 'l,AjUll PCV7 ~l:lJ1l'b1f1'J''flUfI'rIW~'fl~~m.n penicillin 1~~'i)t.J'rI::; 83 ll'rl::; , cefotaxime 1~~'flt.J'rI::; 100 l?11JJ~1~U than 5 years old, 2000-2005, Vaccine 2007;25: 1275-80 Serotype coverage of pneumococcal conjugate vaccine and drug isolated susceptibility of Streptococcus pneumoniae from invasive or non-invasive diseases in central Thailand, 2006-2009. 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IQR) '1JtJ.:JtJ1~ tJ 12.3 (10.9-13.4) ') J1'l1tJfl 32.0 (25.5-39.5) flfl. ,f'W~~h iI~11 lW~ HIY 'Yl(lJJl'I1(l'J'il1flfll11flEJ1WWCJ1'!\?l1 non-nucleoside reverse f1lCJ 1.1 (1.0-1.3) lJ- transcriptase inhibitor-based highly active antiretroviral therapy (NNRTI (65%) lW::; 45 11CJ (83%) iJ HIY RNA <50 lW~ <400 copies/lJ~. ~1 based HAART) fIl(JM Thai National AIDS Program (NAP) ll~ iT'liCJ~l'W (IQR) '1JtJ.:J'1J'W1\?lCJl LPY '1Jt\!~!vi'f1JCJ1vi''W1l1J1Jll(l~CJ1'ff1iTtJ! l~lJCJ1 'IJ~,r'Yl 255 (230-289) ll(l::; 282 (247-299) lJf1./lJ /f1f.:J ~liT'IiCJ~l'W (IQR) ~.:JmlJ11t1'lMCJ1'l'W'1J'Wl\?lmJJl~ '1JtJ.:J 1::;(J::;l'J ~ 11::; '11 'J1.:J I \?l11J CJ1 \?l 'Wll'IJ 1Jll (l~ CJ1 'ff1lJ tJ! 'fl1.:J i!\?l 'Yl1CJtI.:J 'Ut\!::; LPY/r ~'l'lf'fflfJl'l'Wlm.:Jf1l11~'WCJ1vi''W1l1J1J Abbot, soft-gel capsule 133/33 lJfl.) 'fflJ 'Ml\?lCJ 'hivi'tJ.:JI'1\?l1l'!J.:Jl~\?lCJ1 (Kaletra, ~tJlJ1l~tJ.:J'il1fl.:J'lJtJ1~JJlt\!iJ~ln\?l 1m .:Jf1l1~.:J'MltJ~CJ'WCJ1l~'WCJ1'ff1iTtJ! (Nii\?lI\?lCJ'IJ~,r'Yl Matrix, Q.I 'fl~ .:Jl~\?lI~tJ 'lMlvi'f'IJCJ1 'l'W '1J'W l\?l~mJJl~'fflJ fYflfJlltJ~CJ'IJlYiCJm::;~'IJCJ1 u B'Wl~CJ, 4 Q 9J}1 d i d \;1 'J}Q.I d Cj) I 9J'.:J'il~JJf;ju'JCJl\?lfl'ff'J'W'I1'W.:J \?l11J(J1'Yl\?ltJ.:J\?l\?lllm tablet 200/50 lJfl.) lW~(J1'ff1iTW 'Yl1.:J '1J t\!~dcJ.:J llJiJ'li'tJ1;j(lf1l1 'l'W~tJ'JCJ1~fl~1vi'f'IJCJ1 LPY/r vi''Wll'IJ'IJ LPY 1'JlJ~.:JNtJ'JCJ~ lvi'f'IJCJ1'Yl\?l1l'Yl'W ci'J'W'I1~.:J~.:J lJ1f1tJ'W ~ ~ll~'Wvi'tJ.:J lvi'f'IJCJ1~vi'tJ.:JI'1\?l1l'!J.:J'fl~ .:Jl~\?l':hiJN(l~tJ1 ::;~'IJCJ1 CD4% 22.5 (20.0-28.5) % f;ju'JCJ 35 11CJ ~ 2 lit I l'il1~1~tJ\?l ~ 9J <j}Q.I Q.I ll~::; 12.8 (12.0-13.6) "'" 12.4 (11.8-13.4) i''Jl:lJ.:J Q.I 'W1J~1 lrough <j} Q.I 1l\?lfl~Nn'WtJV1.:J'bjiJtJCJ~Y1f1tJ! [7.3 (4.4-9.8) lW~ 6.7 (5.0-9.9) lJfl./~., P 0.86] I\?lCJiJ~1£Y'lJtJ1~-ff'Ylt'1Jtl.:Jm1lJN'WutJ1 64% U~~ o Q.I 9J~rl .J e:v d \?lllJm\?l1J 'W1Jf;ju'JCJ 13 11CJ 9J'.:Jm::;\?l1JCJl LPY >10 lJfl./(l. 49% '1Jt\!~ ll"\?l f1JCJ1miTtJ! 2 l~\?l/'flf.:J iJllCJ'Wfi1EJ~lW~tJll~CJ'W I\?lCJtJ1f1l1'111CJltJ .:t d.1: 1 d 9J 1:lJtJ(l\?l'U'W1\?lCJ1ltJ'Wm.:J(l~ 1"21JJ\?l f;jtJ'J(J 23 11CJ (43%) lW~ 27 11CJ (51 %) iJ cholesterol ll~~ triglyceride lfl'W 200 lJfl./\?l~. I\?lCJlti Q.I 4'.Q. d ll~::;'flt\!::; 'WtJ!. 'Ii'WCJ'J1 J,]'Ii'Wfl'il 14tJ HIY tll~UtJCJfl11 18 lIJ 91 gJ,"1 .r::9 0 C::::.e. Q.I 1\?l'Yl1f1l1fl'flfJlf;ju'JCJl\?lfl\?l\?l tJ ~.:J !vi'f'IJCJ1,!m QJ rlQJ d Q.I 'ff:lJ'W'W'lifl1Jf1l1m~\?l1JCJ1 LPY >10 lJfl./~. 'WCJ1'lJl~ .e..:i I.c::. lW~ 'fftll'IJ'W i!'1JfIl'Wl\?l fHl'I1.:J'li1\?llJ 'I1l11'li'W lJt:)'W1(J'W--ff.:J'I11'fllJ f1.fl'. 2008 ~ I 1::;'I1'J1.:Jl\?l tJ'W I\?lCJf1\?lI~tJflm'W1~~tJ'JCJ~.:Jlvi'f'IJCJ1 LPY/ ~ ~ r '1J'W1\?l 230-300 lJfl./lJ /f1f.:J '1JtJ.:J(J1 LPY 1'W(l~ 2 'flf.:J 'W1Wfl'W 4 2 "~,, 1'W1::;CJ::;mfllJf;ju'JCJ '1 m'IJCJ1\?l'WII'IJ'IJ 42 'fl'W " 9 (p >0.05) LPY/r based HAART tl.fhhltl: f1l1fflEJ1~tJ'JCJ1~fl~\?l14tJ c:::: Q.I 'ffu\?ll'l1 d I LPY 'I1~tl'hi ~. 1 9J '1 9J '1Jt\!~ \?l11JCJ1\?l'W1l1J1Jll~~CJ1'ff1lJtJ! ~ lJ'liCJ'il1'W (IQR) 'UtJ.:J C Q.I "" ".'1 ~ i ".'1 ~ 0 I\?lCJf;ju'J(J'W1'l1'Wfl HAART I\?lCJf1l1'lMeJlmiTtJ! LPY/r ~'JCJCJ1,!m LPY/r based '\J'Wl\?l\?lllJ'lh.:JJl'l1tJfl'UtJ.:J~tJ'J(J HIY 1\?l(JiJ~tJ'JCJl~flci'J'W'I1~.:J!vi'f'IJ(J1~vi'tJ.:JI'1\?l1l'!J.:J'fl~.:Jl~\?l1'~1J111~~'IJCJ1LPY 'l'W'Wm'fflJ1'UtJ.:JNtJ'JCJ~1~f1JCJlmiTwtJv'l'W1::;~'IJ~Hl'Wf1l1fflEJ111'fl u ~ ~ !vi' 'ltill\?lfl~l.:J 'il1flCJlvi''WI11J1J lw~iJfln m~'il1(J'UtJ.:J1~~1JCJll 'Wl~tJ\?l'1JtJ.:J~ 18-35 flfl. lvi'f'IJCJ1 2 llfltJ'll(l ll~::; >35 flfl. lvi'f'IJCJ1 3 llfltJ'll(l 1'W(l~ tJ 'JV~ lf1'11 'lMCJ1vi'Wl1J1J ~tJJJll~ltJ~CJW~'t-W1'ff1iTtJ! I\?lCJiJ~tJ'JCJ~I'li'llf1t\!c0' f1l1fYflfJl l~lJ~m'JlJl~'W 54 f1'W ~tJ'J(JJ1'l1tJfl 15-25 flfl.'l~f'IJCJ1 I l~\?l 'illf): 2 'flf.:J ~ 1JI 'j)cv Q.I I d 'W1'l1'Wfl 25-35 flfl. 1\?l1'IJCJ1 1"2 l1J\?l ll~::; ~ Q.I lIJ 'J}Q.I Puthanakit T, Chokephaibulkit K, Suntarattiwong P, et al. 'W1'l1'Wfl >35 flfl. 1\?l1'IJCJ1 d ~ d gJ dllJ j}Q.I ~ 1 d 2 llJ\?l 'J'W(l~ 2 m.:J lJf;jtJ'JCJ 21 11(J (38.9%) 'Yl 1\?l1'IJCJ1m.:J(l~ 1"21JJ\?l Therapeutic drug monitoring of lopinavir in human immunoclefi ciency virus-infected children receiving adult tablets. Pediatr Infect \?l1'J'ill\?l1::;~'IJCJ1~1'ff\?l 'l'W9i~lJ Dis J 2010;29:79-82. I Q.I (LPY trough plasma concentration, C q 1~1~1 ) aJ'CV"",.o::t Happy Birthday fl'U~f)f>I~~ 1 I f>I~ ~-:jtGi3J~113J3jiiiGlii11(;Nluflla~3Jlfl'ifu , uGiflthtGi3J~lU1UtJ~3Jlfl'ifU(;NluiiiGl ttlu..nh~"ll f1-:j t';il~~~'W~l";~u~ut~h1~ 13J1"lfl'lt!1~"llfl-:j ~u~u~~~'th ~113J t"li'11~1u~-:j~ t';il'W~ ~ ~ Th£! TJ'£!fJ1JJJ£!JJ1 uf C'UJJJJJJJJJJi1y .IJtljJJiJ'£!d R£!spinJiuJ'Y 11'£Jt11JJjEt1iuJJ:r!: h Idr bd 4-40 eiqh or 5-8 mg/kg/day roxithromycin Good Clinical Response in upper & lower respiratory tract infection and skin infection 1,3,4 Convenience1,2 BID Dose, Small tablet easy to swallow Low side effect 1,3,4 *caused by organism!' sensilivc 10 roxithromycin ~~~~i'\\:M1~~ce. Suppl55 (pp 117-118) LRI. SSTfs, genital inlections, restricted to non-gonococcal. oro-dental and arc cxcrcled in bfu,omIiand'\b"r"",mco,mmjii1ik'OA'3~~~~ l. ~~~~tl~o~~t~lt~~r~~11 ~~~l~tt~:r~~~:~h:~;~t~ e[a~,~~rr~:r~~j~i~~tt~mmcnded with ergot alkaloids. tcrfel1adinc. astemlzolc, cisapridc or pimozidc. TH.IMD.07.11(02) ...... Clawan -. . 0.5& Claforan is indicated for the treatment Gram-Positive E. coli Klebsiella spp. Proteus mirabilis (Indole-negative) Proteus spp. (Indole-positive) H. injluenzae Salmonella spp. Citrobacter spp. N. meningitidis N. gonorrhoea Branhamella catarrhalis Serratia spp. Providentia spp. Morganella morganii Enterobacter spp. Streptococcus Group A. B S. pneumoniae S. epidermidis S. aureus Anaerobes Peptococcus Peptostreptococcus Clostridium spp. (except C. diflicile) Bacteroides spp. (including some strains 01 B. ji"agilis) l->11.h~rin.l110i'l:::lUlt~LfilJl~1Jlllmni'f11{h~v,H'lU"'un1J\!'irUU(1::::mnffl"irilrrum lumlt\ll~hnJ('Ulm'\lYl <j.lff. 1075/2550 TH.IMD.07.11(02) , • Dosage Recommendations Premature babies and newborns 1 50 mg/kg/day in 2 doses Infants and children up to 12 years old 50-100 mg/kg/day Severe infections maximum :.. 150-200 mg/kg/day in 2-4 doses in 3-4 doses C'IIlJ*lrio.:OjgC1,a(O)faIl«'Cll:lUlSOJNICdClW.lIIX'IOdI..mtorrrspon.li1lJ1oOJICrfob.llm.:.I.O,i-l.1afor:uJtOIIlalll$l.MFCd"o:.u.mx$OJlIllJlCQl'l"~1010; CdOU>.imc.20ICb(onnfOOUiN2096lccrClW.lmc~wn~IrI$I020ICc{ou.,imc 10d>(arif<u:ln(tdiOClS,rrt$p~·tncllt>("~ofENT.1n{«llllltJo{ l:iJDc)"'lIr1IW)·UXIand'cpI"oducl'\·ccqwinclU(!lO'IlOOO'Tbou.SqltICanlUl.Ent»."Mllnu..mc~u:gtfi, InrcttlOft)ofbotl<1..tf""IU.llm...s)Ol\rr~AbJDrrull&llll(ccticcll rOlpmoJltl1lJ\'tpropll)b.\lsirlpitintls"bozrcalinae~nlJc(tOIIlln(~JlldfOllbt~·LL,jsoflllfc(llOmlll~bt'nlS"'lthrtJuet,lttSisulJi:e.Coolralndlcallon: ~~~~~~~sor~;:~~~t~'~=~~h~Il~I~~~j,~g~~;~::;rl:=~~:~=:~~~'1:;; IllOCIllOmlllll'3llnltS\l'Ca:NNlXOlIlIta:lly ..lI.b:anllllOll:l)W$.4:s.,\d\crwcrrl'(t:OlS ..'thall~aIlngJtl)~lU(hOlS!Janrt~!JOltJ.coMnopI>11 ...... dn.i~(C\<:f. ~,·luiJ. trw.icnlICl.lC~ ~~' be ol&m-td. aW t=lICllI rue orSGOT Illll SGPT.nausa. \1llllIti~ abJownaI plNl andJ..atrtle1n:ayoo.'"lII. L,li=NIOr}' .mWlOl1-.! poamal1he'I:CO('~ l.IIICDctiolll:b)·&larlllimllic....:-reuon.lbcroll(lll'TmI~ofl'robctxf'ldanrn:asn.lbcknllllg,u~~aodproloctpduraboao( CWcna A falk poolb\'t r~t fcc rhc Coombs' tal =)"",."111' J)O"IC:doA.c. mo,k aad (~"yof adIrumilnl_&pcnd OltW j,f'\Wl:yoftbc illfa"lJOll.>lIl«pIiblbryoi' the paUq.·nlull<icc.-d,tion ofl!lc 1"I>ml.l'rcmmJre 10fWICJ." rnutnMll $O~'\.. da) di'l4ed 10 2 obn.lor*=ltl..:l dlddrrn lIf'lO 12 )~old~ SG-IOO llIi kJ,'da)'wnJcld 1D 2· ~~~~"St=:ls:;c:::~~~~'=~~L~~=:::~:o!c21~ocrdu~~~~2~~2~~.~;;a"llOllS2.1~~ Kdc,clK'I':I.Pxbicllll<:f1l(lll Further in/ormation (lyailable on requcst sanofi-avenlis (Thailand! ltd. 87/2 eRe Tower 24/ h Floor, All Seasolls Place. Wireless Roml, LlIInpi"i, Pot!llImwo/l, aangkok 10330, Thailand Tel: 66(0) 2264 9999 Fox: 66(012264 9997 sanofi aventis sanoFi pasteur -- --- Thc vaccines division of sanofi-avcntis Group TN' R-XGNT PR-G "T 5 ~" DX:i'A:i':i • Diphtheria • Poliomyelitis AGAXtf:iT G"' • Tetanus • Pertussis • Haemophilus influenzae type b PENIAXIM ADSORBED DIPHTHERIA, TETANUS. ACEllULAR PERTUSSIS, INACTIVATED POLIOMYELITIS VACCINE AND CONJUGATE HAEMOPHILUS INflUENZAE TYPE b VACCINE COMPQsmON The te:UYe Ingledle1lll at, n '1ItI1ows : Diptrlhe:na toxoid > 30 LU. Tetanus taxoo > 40 l..U, Bortletella pertunll andgens : Toxoid 25 micrograms Rtamentous ttaemaoglulinkl 25 mlctoorams lnadMted pOIlOmyefitlS ytrus I'ype 1 40 O.U: Inaaiv3led pOUomyeIllls virus Iype 2 8 O.U: lnactJVa!ed pcAtomydilis virus I'fPe 3 32 O.U: HaernophikJs ifIfIumzae type b potysac:cI"laM conjugaled wtth Tetanus proleln 10 microgram9 lor ooe 0.5 ml dose alllr f8C0nsUlution • O.U.: 0 anllgen unit. 0( eQuNi1lefIt quantity of II'1Do&n dNfmilled u~ 3 witablo Imml.H1Odlemlc:al memocs. The otht1lno~ are SLIO'ose. trometamoI. aIun'li'IIkrn hydrmQde. phe1IoI red . free Hanks In;erc:tion In 0.5 mf pre·filed fYMoe$ In bOxt$ Of 1 Of 20. PfHTAXJM is RticaIed to ~ PfO:ect )'OUr cM:f I7lIhe Haemophilus 1nltuenz3e rypo lJ baCterium (menJnom, b600cJ 1n1eeUOn. etc.) In ChildtJl'l 'rom 2 monthS of aoe, II does 'nOC prated ~ Intectiorts due to 0Chet typeS of ~ Inl\.Ienlae or other mlcro-ofaanlsfT'la, 2. INFORMATION REQUIRED BEFORE USlf'JG PENTAXIM Do not .". PfHTAXIM : H your ctlifd sutfers 'rom COfMdSanI or non·eoowtsanr proor~ ~ (neurologic:al disease).• jf )'ClUr mKJ has experienoed a strono reacfun medium. lormakl'etlyde. pneooxyethanol ana water lor InteetiOns. I. WHAT JS PENTAXIM AND WHEN IS IT USED? PEHTAX.IM IS ptesented In the form 01 a powdet 800 ISUSptflSiOn '01 agall1Sl dipntherQ. letIflU9. pelf1JS$I$, pollomyeSltis and ~nst 1nv.1StYe Inlectlon5 caused ag3inil menlngms caused by occur~ within 48 hours loUowino a previous vacclnatlOO: lever aboYe or equal fa 40?C. perSISlenJ crylog syndrome, lebriie or norHebrile coovubfoo, hypotnoltS • hoJpofC3dMy 6yndrome.l1 your dUId has tetallus, pertussis. poIiomyerrtis and Haemoptulus inlluenzae rype b InledJons.1f your dlild is aIie~OIe to route (the needle musl nol enter a blood vessel) or by the Imrad8fmal rOUI!. vaccMatlon lhould be poItponed In ehlldf80 sullerina Irom ltwf a previooS"tacdnallon. it 15 partJeulafty Important 10 ThIS vacelno may bo admlnisteff.d a{ mon~o( ~ <WI allergic /ll3CtIOn appearing aI1er a the aetlw IllQfedl«llJ, iIt1Y 01 the exdpienf1. neomycin, streplor'l"ltfdn rod P'*Imlxln S, Tiki sptdll PflK:lIIt:IonI wtth PEMTAXJM : ensure thai Of pnMOlIS w vacctne vaeana1ion ~ diphtheria IS not irIjcc1ed Dy Ihu ifTtJao.'3SClJW acute diStalO. par1iWfafty inledJool; disease Of Pfoore&$IYe et'Ironic dISeaSe. sJ your child has a history 01 te.brile COf'IYU~ nol refa!ed 10 lhe hlmpetalure In !he 48 houl'5 following: lhe vaccination and admlnlsU'r an antipyretic IrtallJ1«l'l to reduce the lever rooulafty lor 48 hOUfS, Un at e.ldpJenta whit IInGwn e1fedl : FomukJefryde Use of oCfllr PcellMti : the same time as ROR VJU{ vaccine Of HB,VAX DNA 5 10/115 mI vaec:tM. bill at two ~ sites. II )'OUr chad is 10 be Y3Cdnated with PfHTAXfM Md ~ 0Ch8t lhan those mtfl'IJOOed above at the gne Ii'ne. ask your doctor or your ptlarrnactst for fOO(ll InformatIOn. Inform your doctor or your pharrNCl$l II your child i5 taking or llas taken ~ oltlef moalcinal produC!. even In tOe case Of non·presa1pllon rnedidn3l prOOuCtS. 3. HOW TO USE PENTAXIM ? POIOJogy ; The ~ recommended SChedule lodudes a Pf'a'naIy vaccination In 3 injectiona one or Two monUl Inrorval from 2 monlhs 01 age. fOl!clWed by a bOOSIer Ir1jectiOn during me second yfW 01 1110. Admlnlstr8Uon melhod : Sanofi Pasteur Limited 87/2 CRC Tower 23 rd Floor, All Seasons Place Wireless Road, Lumpini, Pathumwan Bangkok 10330 Tel: +66 (0) 2264 9999 Fax: +66 (0) 2264 8800
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