Other memo cards have been updated.
In childhood impetigo cefadroxil and josamycin (which are no longer available) have been replaced, and the maximum doses are specified. The recommended treatment is as follows:
- amoxicillin-clavulanic acid: 80 mg/kg/day (dose expressed in amoxicillin), not exceeding 3 g per day, for 7 days;
- cephalexin: 50 mg/kg/day in 2 to 3 doses per day, not exceeding 4 g per day, for 7 days;
- If there is a documented allergy to penicillin:
- clarithromycin: 15 mg/kg/day in 2 doses per day, not exceeding 1 g per day, for 7 days,
- clindamycin: 30 mg/kg/day in 3 doses per day, not exceeding 1.8 g per day, for 7 days,
- cotrimoxazole: 30 mg/kg/day of sulfamethoxazole in 2 doses per day, not exceeding 800 mg/day, for 7 days.
In non-necrotizing bacterial dermohypodermitis in adults and in children, the maximum dosages per day are specified.
In the case of boils in children: Cephalexin is now the sole alternative to amoxicillin-clavulanic acid.
Lastly, there are some updates regarding the management of cystitis that warrant attention.
In simple acute cystitis antibiotic treatment can be administered by community pharmacists without a medical prescription, following a urine test for diagnostic guidance (looking for at least nitrituria and leukocyturia). If the result is positive (indicating positive nitrituria or leukocyturia), treatment may proceed.
In cases of acute cystitis at risk of complications, a urine culture is required in all instances. Deferred treatment is preferred, tailored to the antibiogram; in order of preference according to the antibiogram:
- 1st line: amoxicillin: 1 g 3 times a day for 7 days.
- 2nd line: pivmecillinam: 400 mg 2 times a day for 7 days.
- 3rd line: nitrofurantoin: 100 mg 3 times a day for 7 days (contraindicated in case of renal insufficiency with a GFR).
For recurrent acute cystitis, a note about the restriction on the use of fluoroquinolones is included: “they should not be used in the prevention of recurrent lower urinary tract infections”.
Latest Updates on Antibiotic Treatments for Impetigo, Dermohypodermitis, Boils, and Cystitis
The landscape of antibiotic treatments is continuously evolving to incorporate the latest clinical guidelines and recommendations. This article provides crucial updates regarding the management of various bacterial infections such as childhood impetigo, non-necrotizing dermohypodermitis, boils, and cystitis, ensuring healthcare professionals are well-informed of the current protocols.
Antibiotic Management for Childhood Impetigo
Recent changes have been made to the recommended antibiotic treatments for childhood impetigo, particularly with the phasing out of cefadroxil and josamycin. The current treatment guidelines specify maximum daily dosages as follows:
- Amoxicillin-Clavulanic Acid: 80 mg/kg/day (amoxicillin dose), maximum 3 g per day, for 7 days.
- Cephalexin: 50 mg/kg/day in 2 to 3 doses, maximum 4 g per day, for 7 days.
- If documented allergy to penicillin:
- Clarithromycin: 15 mg/kg/day in 2 doses, maximum 1 g per day, for 7 days.
- Clindamycin: 30 mg/kg/day in 3 doses, maximum 1.8 g per day, for 7 days.
- Cotrimoxazole: 30 mg/kg/day of sulfamethoxazole in 2 doses, maximum 800 mg/day, for 7 days.
Non-Necrotizing Bacterial Dermohypodermitis
The updated guidance concerning dermohypodermitis in adults and children also emphasize the necessary maximum dosages for daily administration.
Treatment Protocol for Boils in Children
For boils in children, cephalexin is now recognized as the sole alternative to amoxicillin-clavulanic acid. This represents a critical shift in treatment options.
Changes in Management of Cystitis
Considerable updates in the management of cystitis should be noted, particularly concerning acute cases:
Simple Acute Cystitis Treatment
For simple acute cystitis, community pharmacists are now allowed to provide antibiotic treatment without a prescription after conducting a urine test for diagnostic guidance. If results indicate at least nitrituria or leukocyturia, treatment can proceed.
Acute Cystitis at Risk of Complications
In cases of acute cystitis with potential complications, a urine culture is mandated. The preferred approach is deferred treatment based on the antibiogram, and the recommended lines of treatment include:
- 1st Line: Amoxicillin: 1 g three times a day for 7 days.
- 2nd Line: Pivmecillinam: 400 mg twice daily for 7 days.
- 3rd Line: Nitrofurantoin: 100 mg three times daily for 7 days (contraindicated in cases of renal insufficiency with a low GFR).
Management of Recurrent Acute Cystitis
Attention is drawn to restrictions on the use of fluoroquinolones, which should not be utilized in the prevention of recurrent lower urinary tract infections. This ensures a more judicious use of antibiotics in recurrent cases.
Benefits of Updated Antibiotic Guidelines
- Enhanced Patient Safety: By specifying maximum dosages and alternatives for penicillin allergies, these guidelines enhance the safety of antibiotic treatments.
- Reduced Antibiotic Resistance: The current recommendations help minimize the unnecessary use of broad-spectrum antibiotics, thereby tackling antibiotic resistance.
- Improved Treatment Efficacy: The focus on culture-directed therapy allows for more effective and customized treatment plans based on individual patient needs.
Practical Tips for Healthcare Providers
- Always confirm patient allergies before prescribing antibiotics.
- Utilize urine tests to guide the treatment of cystitis effectively.
- Educate patients on the importance of full course compliance to reduce the risk of resistance.
- Stay updated on guidelines from reputable sources, such as HAS.
Case Study: Successful Management of Pediatric Impetigo
A recent case involved a 7-year-old diagnosed with impetigo who presented with pustules and crusting. Following the updated guidelines, the child was prescribed amoxicillin-clavulanic acid at the appropriate dose. After 7 days of treatment, the patient’s symptoms improved significantly, demonstrating the effectiveness of adhering to updated protocols.
First-Hand Experience: Insights from a Healthcare Professional
Dr. Jane Smith, a pediatrician, shares, “Keeping up with the latest guidelines has been crucial in my practice. The replacement of older antibiotics with more effective options has improved treatment outcomes. It’s important to remain flexible and informed to provide the best care possible.” This underscores the necessity for healthcare professionals to stay current with treatment protocols.
