Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0029713 (immaturity)
 4,335 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Guidelines for the use of antibiotics in infants and children must take into account drug absorption, distribution, metabolism, and excretion. In the developing human being, these factors may differ significantly from those in the adult, and so there are differences in therapeutic efficacy and toxicity. Certain drugs should be avoided in the neonate because of known toxicity; these include the sulfonamides, tetracycline, and high doses of chloramphenicol. Antibiotic therapy should be modified in neonates in several ways because of the biologic immaturity of systems important for the termination of drug action, such as the liver and kidney. Because of poor conjugation, inactivation, or excretion, the administration of many antibiotics results in higher and more prolonged serum levels than those produced in older infants. Thus, in the neonate, the dosages of many antibiotics have to be lower and intervals between administration longer. In the case of gentamicin, studies in the 6-month to adult age group have shown that children less than 5 years old require almost twice as much of the drug as do children older than 10 years or adults to achieve similar peak concentrations. The appearance throughout the United States of strains of Haemophilus influenzae, type b, that are resistant to ampicillin has necessitated a change in the initial antibiotic therapy given to children with bacterial meningitis. There are few uses for tetracycline in pediatric practice.
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PMID:Antibiotic therapy for severe infections in infants and children. 30 30

In infants and children, the absorption, distribution, metabolism, and excretion of drugs may differ considerably in comparison with these factors in adults; consequently, differences exist in therapeutic efficacy and toxicity of various antibiotic agents. Because of known toxicity, certain drugs--such as chloramphenicol in high doses, the sulfonamides, and tetracycline--should not be used in neonates. Antibiotic therapy should be modified in neonates because of biologic immaturity of organs important for the termination of drug action. Because of poor conjugation, inactivation, or excretion, the serum concentrations of many antibiotics may be higher and more prolonged in neonates than in older infants; thus, lower doses and longer intervals between administration may be necessary. In this article, we suggest dosages of antimicrobial agents for severe infections in children, older infants, and neonates. Included in the discussion are the cephalosporins, especially the third-generation cephalosporins that have assumed an important role in empiric treatment of bacterial meningitis in pediatric patients because of their ability to penetrate the central nervous system and their effectiveness against beta-lactamase-positive and negative strains of Haemophilus influenzae type b, Streptococcus pneumoniae, Neisseria meningitidis, and many gram-negative bacteria in the Enterobacteriaceae group. In patients with congenital or acquired immunodeficiencies, antifungal, antiviral, or anti-Pneumocystis agents are often added to the antimicrobial regimen for severe infections. We review the agents available for such treatment in children, the drugs used for childhood tuberculosis, and certain new antibiotics (aztreonam, ticarcillin-clavulanate, ciprofloxacin, and imipenem-cilastatin) that have proved useful in select cases but whose precise role in pediatric practice will necessitate additional clinical experience.
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PMID:Antibiotic therapy for severe infections in infants and children. 173 93

In infants and children, drug absorption, distribution, metabolism, and excretion may differ considerably from these factors in adults; thus, differences also exist in therapeutic efficacy and toxicity of various antibiotics. Because of known toxicity, certain drugs--such as chloramphenicol in high doses, the sulfonamides, and tetracycline--should not be used in neonates. Antibiotic therapy should be modified in neonates because of biologic immaturity of organs important for the termination of drug action. Because of poor conjugation, inactivation, or excretion, the serum concentrations of many antibiotics may be higher and more prolonged in neonates than in older infants. Thus, the dosages of many antibiotics must be lower and the intervals between administration must be longer. The appearance of strains of ampicillin-resistant Haemophilus influenzae, the slow development of resistance to chloramphenicol among gram-negative and gram-positive bacteria, and the development of improved analytic methods to measure chloramphenicol have all resulted in the use of this drug in select cases of serious infection in children beyond the neonatal age. Third-generation cephalosporins have an important role in empiric treatment of pediatric bacterial meningitis because of their ability to penetrate the central nervous system and their effectiveness against ampicillin- or chloramphenicol-resistant Haemophilus strains and against many gram-negative bacteria in the Enterobacteriaceae group.
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PMID:Antibiotic therapy for severe infections in infants and children. 331 52

We examined the diagnostic value of C-reactive protein (CRP) in cerebrospinal fluid (CSF) on initial lumbar puncture in a prospective study including 126 patients (30 neonates, 96 infants and children) suspected of having meningitis. Twenty patients were considered to have bacterial and 25 were considered to have viral meningitis. In infants and children, a retrospectively chosen cut-off CRP titre of 4 (i.e. approximately equal to 0.4 mg/l CRP) had a sensitivity of 100% and a specificity of 94% for differentiating bacterial meningitis from both viral meningitis and normal. It was a more sensitive and selective test for differentiating bacterial from viral meningitis on initial CSF examination than was the CSF leucocyte count, glucose concentration or protein concentration. In neonates, no such cut-off CRP titre could be found, presumably due to the immaturity of the blood-CSF-barrier (B1-CSF-B) during the first weeks of life. In a parallel study including a non-selected group of 13 infants and children (4 without, 9 with bacterial meningitis), the serum/CSF CRP concentration ratios were determined and inserted in the individual B1-CSF-B diagrams according to Felgenhauer. The results were fully consistent with the hypothesis that the CRP concentration in CSF reflects the normal permeability characteristics of the B1-CSF-B, or the degree of its impairment. Based on our results, we recommend the CSF CRP estimation in the routine evaluation of infants and children suspected of having meningitis.
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PMID:Cerebrospinal fluid C-reactive protein in meningitis: diagnostic value and pathophysiology. 376 91

Hydrocephalus is most commonly diagnosed in the first few months of life, though cases also arise in later life. Cerebrospinal fluid shunts used to control the condition are prone to colonization particularly by Staphylococcus epidermidis. The incidence is very much higher in infancy than in older age groups, and this is probably due to prolonged hospital stay as a result of the underlying pathology, combined with the propensity for a high skin bacterial density with more adherent strains, rather than to any immune immaturity. Diagnosis of shunt colonization is often very difficult and serological tests have an important role to play even in infancy. There are several pitfalls in diagnosis, particularly in the elderly. Treatment of shunt infections should include removal of the colonized shunt, though regimens to avoid this are currently being investigated. Intraventricular therapy with vancomycin along with intravenous rifampicin offers the best changes of success at the first attempt. Shunted patients who contract purulent bacterial meningitis should not have their shunts removed but should be treated in the same way as those without shunts.
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PMID:Hydrocephalus shunt infections. 784 76