The last blog entry for 2012 asks you, the reading audience, which article is your favorite? Which one impacted your daily practice the most? Which one did you hate the most? Please post in your comments below.
For example, I know the article that has changed my practice the most was the one on the IDSA (Infectious Disease Society of America) inaugral August 2012 pediatric pneumonia guidelines for vaccinated children.
My favorite article was the Dr. Citron suggested right chest pain MI predictivity article, and the article I found most "scary" was the Dr. Fuller suggested concussion guidelines.
As always, thanks for all the past suggestions and commentary.
Linwood Watson, MD Rex Express Care Blog Director
Saturday, December 29, 2012
Friday, December 28, 2012
New Tamiflu Guidelines for Children Less than One Year Old
http://www.medscape.com/viewarticle/776564?src=nl_newsalert
Well, flu season is here in all its challenging glory. While most phyisicians are aware, especially after the 2010 swine flu outbreak, of the risk of secondary bacterial pneumonia in certain age groups, mainly children less than 5 years old, one caveat has been that Tamiflu has not been aproved for children less than 1 year old.
Recently-12/21/12 in fact- the FDA approved Tamiflu for children less than 1 year old. Now, if you have a sick child, say a 9 month old, presenting in the initial 48 hours of influenza, you can write for the dosing. A few pearls from the short, but helpful, article:
-Remind parents Tamiflu only shortens the flu, it does not "cure" the flu. As such, parents must still brace themselves for a few evenings of 103 degree fussiness.
-The main clinical focus of Tamiflu use in this age group is for children, less than 6 months old, who have much higher rates of flu complications, like bacterial pneumonia. For our practices, this would be the 4month to 6month age group.
- I highly suggest perusing the article before writing a script, but note that the dose is 3mg/kg po bid for 5 days. A key issue here is that the pharmacist will have to give a different dispenser than the one that currently comes with the standard pediatric solution of Tamiflu that is 6mg/ml in concentration.
-As a real world practical issue, in a child between 4 months and 1 year old who has the flu in our clinic and is not dehydrated or in respiratory distress, I would humbly suggest that one still obtain a chest x-ray. This allows confirmation that the child has not already developed a "full blown" bacterial appearing pneumonia (lobar consolidation and not the standard "perhilar pneumonitis") and helps to cofirm that the child does not also require concomitant antibiotics (see the previous blog on pediatric pneumonia guidelines for vaccinated children). Also, especially if a child gets worse and returns to urgent care or the Rex ER, it allows a baseline to be present. Make no mistake, I am all for limiting prediatric radiation exposure, but this population and the flu are a lethal mix.
-My final tip is a reminder to take a full 30 seconds to 1 minute, and watch the child breath and take a full respiratory rate timing at the bedside, and document it in your note! The close, meticulous observation allow a better clinical picture for you and it conveys concern to the parent.
-Again, review the article BEFORE writing your first prescription, and be sure to give clear signs of worsening in your discharge instructions to the parents to guide them properly.
Well, flu season is here in all its challenging glory. While most phyisicians are aware, especially after the 2010 swine flu outbreak, of the risk of secondary bacterial pneumonia in certain age groups, mainly children less than 5 years old, one caveat has been that Tamiflu has not been aproved for children less than 1 year old.
Recently-12/21/12 in fact- the FDA approved Tamiflu for children less than 1 year old. Now, if you have a sick child, say a 9 month old, presenting in the initial 48 hours of influenza, you can write for the dosing. A few pearls from the short, but helpful, article:
-Remind parents Tamiflu only shortens the flu, it does not "cure" the flu. As such, parents must still brace themselves for a few evenings of 103 degree fussiness.
-The main clinical focus of Tamiflu use in this age group is for children, less than 6 months old, who have much higher rates of flu complications, like bacterial pneumonia. For our practices, this would be the 4month to 6month age group.
- I highly suggest perusing the article before writing a script, but note that the dose is 3mg/kg po bid for 5 days. A key issue here is that the pharmacist will have to give a different dispenser than the one that currently comes with the standard pediatric solution of Tamiflu that is 6mg/ml in concentration.
-As a real world practical issue, in a child between 4 months and 1 year old who has the flu in our clinic and is not dehydrated or in respiratory distress, I would humbly suggest that one still obtain a chest x-ray. This allows confirmation that the child has not already developed a "full blown" bacterial appearing pneumonia (lobar consolidation and not the standard "perhilar pneumonitis") and helps to cofirm that the child does not also require concomitant antibiotics (see the previous blog on pediatric pneumonia guidelines for vaccinated children). Also, especially if a child gets worse and returns to urgent care or the Rex ER, it allows a baseline to be present. Make no mistake, I am all for limiting prediatric radiation exposure, but this population and the flu are a lethal mix.
-My final tip is a reminder to take a full 30 seconds to 1 minute, and watch the child breath and take a full respiratory rate timing at the bedside, and document it in your note! The close, meticulous observation allow a better clinical picture for you and it conveys concern to the parent.
-Again, review the article BEFORE writing your first prescription, and be sure to give clear signs of worsening in your discharge instructions to the parents to guide them properly.
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