What I learnt in the last Pediatric Meeting - using Rifaximin in Indian Children - clinical pearl by Dr B R Thapa

I am just going to discuss a clinical pearl of wisdom that I learnt from Dr B R Thapa regarding using a relatively new antibiotic Rifaximin  (available in India as SIBOFIX - Dr Reddy's) during his talk in August 2014 at our Chandigarh quarterly meeting of Pediatricians from the tricity of Chandigarh Panchkula & Mohali.

When I asked him about when to use this particular antibiotic in children with diarrhea, here is what he said - as I understood it...

"In the monsoon months, there is a higher incidence of bacterial diarrhea due to water and food contamination, in India. hence if my clinical judgement I feel that the child is having a bacterial diarrhea - high fever, significant stomach pain, unwell look, then it may be possible to use Rifaximin. The benefits of using Rifaximin are that it is completely non-absorbable, hence the chances of side-effects are less, and it is very safe for kids (licensed above 2 years age at present in India). Also, there is little chance of antibiotic resistance developing given that there is no absorption in the body. Finally, since it stays in the body for a long time, ONLY three days of medicine is good enough to treat most infections"

I have been using this medicine in my practice after this discussion, and have found good results in diarrhea with possible bacterial infection.

I would be happy to know the experience of other pediatricians who have used this drug, especially in Indian children.

Just as an aside, Rifaximin is also recommended for use in cases of traveler's diarrhea, for people traveling across the world.

Please remember that this is just my opinion, and how I remember the conversation. Any errors are mine.

Vaccination FAQs - Reaction to Pentaxim and mixing different vaccines, what to do?

Query : 
My baby D.O.B is 26th October 2014.

He got Pentaxim{DTaP},Rotavirus,Heb B2 ,prevenar 13 {PCV13} and Polio drop on 8th Oct 2014. But he was crying so much and there was so much swelling in his leg where injection has been injected.

My current paed has given Hept B2 plus DTap plus prevenar in a single shot by mixing all the vaccine in single syringe.

Did this practice is approved or not because this time i went to another doctor on 9th Nov 2014 for vaccine and he said it is not good to mix all the vaccine in one shot. Kindly guide me what is correct way to inject vaccine.

Ans :

It is NOT correct to give different vaccines like Dtap & Prevenar mixed in a single syringe.

This may lead to problems in the efficacy of the vaccines (they may not work well) and may lead to more side-effects too,

The vaccines should be injected separately. If there was a significant reaction to Pentaxim, you could try taking QUINVAXEM - a DTwP brand that may have possibly lower or similar reaction, or you may try taking Pentaxim again.

Regards

Dr Gupta, MD

New guidelines for managing bronchiolitis (Double Pneumonia in common Indian Parlance) issued by AAP, Oct 2014

A new clinical practice guideline that offers physicians guidance for the diagnosis and management of infants with bronchiolitis was published online Oct. 27 in Pediatrics.

Shawn L. Ralston, M.D., from the American Academy of Pediatrics Subcommittee on Bronchiolitis, and colleagues evaluated published evidence to revise the 2006 clinical practice guideline relating to diagnosis and management of bronchiolitis.

The researchers note that bronchiolitis should be diagnosed based on history and physical examination; risk factors for severe disease should be assessed when physicians are making decisions about evaluation and management of children with bronchiolitis. Radiographic and laboratory studies should not be obtained routinely. Forinfants and children with a diagnosis of bronchiolitis, albuterol (or salbutamol) and epinephrine should not be administered; nebulized hypertonic saline should not be administered to infants in the emergency department but may be administered to infants and children who are hospitalized. Systemic corticosteroids should not be administered to infants in any setting. For prevention of bronchiolitis, palivizumab should not be administered to otherwise healthy infants with a gestational age of 29 weeks or older and should be administered to infants with hemodynamically significant heart disease or chronic lung disease of prematurity during the first year of life.

"The goal of this guideline is to provide an evidence-based approach to the diagnosis, management, and prevention of bronchiolitis in children from 1 month through 23 months of age," the authors write.

 Explore further: Peds bronchiolitis guideline can cut resource use, costs

More information: Abstract
Full Text

Journal reference: Pediatrics  

Source

Comment: After reading these guidelines, I am actually confused as to what will work in bronchiolitis. Everything that we use, from Adrenaline, to Salbutamol & steroids have been shown to be not effective! I guess moving forward we need to look at more options to manage this vexing condition.