[Infections in immunosuppressed children].
BACKGROUND
Children undergoing transplantation or treatment for cancer have periods with severe immunosuppression; hence they are very susceptible to infections. A bacterial infection can rapidly become life threatening, and it is crucial to promptly start antibiotic treatment.


METHODS
The background for this article is a two-day discussion among Norwegian paediatricians about infections in immunosuppressed children. In addition we have reviewed the literature by searches in PubMed, reference books and international guidelines.


CONCLUSIONS
When a neutropenic patient becomes febrile, one should quickly do a thorough clinical examination, secure relevant microbiological samples, and start treatment with broad-spectrum antibiotics. As standard treatment for Norwegian children we recommend a combination of intravenous ampicillin and gentamicin. Patients who have clinical signs of septic shock should be given cefotaxime and gentamicin. If they get worse or show no signs of recovery after 3 to 5 days, a change to monotherapy with cefotaxime is recommended. Patients already treated with cefotaxime should be switched to meropenem, possibly in combination with vancomycin. Antifungal and/or anti-anaerobic treatment should also be considered.
Wiger
Karianne
K
Barnemedisinsk avdeling, Ullevål universitetssykehus, 0407 Oslo. karianne.wiger@medisin.uio.no
Høiby
E Arne
EA
Wathne
Karl-Olaf
KO
D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D000935:Antifungal Agents / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000276:immunology / Q000382:microbiology; D016026:Bone Marrow Transplantation / Q000276:immunology; D002648:Child; D004359:Drug Therapy, Combination; D005334:Fever / Q000188:drug therapy; D006801:Humans; D016867:Immunocompromised Host; D007153:Immunologic Deficiency Syndromes / Q000150:complications; D007166:Immunosuppressive Agents / Q000009:adverse effects; D009181:Mycoses / Q000188:drug therapy* / Q000276:immunology / Q000382:microbiology; D009369:Neoplasms / Q000276:immunology; D009503:Neutropenia / Q000188:drug therapy; D009894:Opportunistic Infections / Q000188:drug therapy* / Q000276:immunology / Q000382:microbiology; D016377:Organ Transplantation; D014777:Virus Diseases / Q000188:drug therapy* / Q000276:immunology / Q000382:microbiology
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D000935:Antifungal Agents; D007166:Immunosuppressive Agents