Sunil K Sood MD Chief of Pediatric Infectious Disease Schneider Children's Hospital DrMDK
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Interviewer: If you saw a kid that had a skin infection, what would make you think, it was a staph, potentially a resistant staph at least as to mersa which is willing for us to a staph that probably resistant to the closical staph drugs. What would be your index to suspicion? Interviewee: Again, there is no way from just looking at the lesion and trying to take the mersa -- Interviewer: Let us say you are suspicious, what would be your-- Interviewee: Right, but some of the characteristics of this new community acquired mersa’s are that they keep in to cause more extensive and more rapidly spreading cellulitis. Large abscesses and in some cases these ulcerative necrotic lesions that have been compared to spider bites. So, if you see those more aggressive manifestations in this stated age, you should suspect community acquired MRSA and we think treat with one of the antibiotics against such as the neomycin to right from the start. Interviewer: So clyndamycin is painless with some indication that maybe some other classes of drugs. Interviewee: With the MRSA? Interviewer: Yes. Interviewee: It was in trimester for himself and the toxins will die of tetra, cipro, does have activity against the MRSA. Interviewer: So off soak with medicine, something else to-- Interviewee: Doxycycline, all the tetracyclines that are being used in adult medicine to MRSA. Interviewer: So you keep away from penicillin derivatives and cephalosporin seem to be not working with-- Interviewee: They are not working so once the MRSA, you can pretty much count on no penicillin or any derivative working. Interviewer: What about cipro-- Interviewee: There is also, there is failure rate, high resistance rate and is recommended not to use -- Interviewer: So clindamycin, and how much per kg would you use on a kid. Interviewee: Usually it is for 25 mg/kg/day. Interviewer: So the big dose. Interviewee: Yes. Interviewer: Per kg. Interviewee: In some kind of soft tissues can resolve-- Interviewer: She is normally is 10 to 20 we are going a little bit above that now will we not? Interviewee: I have not really distinguished a different dose whenever I say; we tend to all these use the higher dose. Interviewer: So about 20 to 25? Interviewee: Yes. Interviewer: And what would make you decide this kid cannot be treated in the outside, what would make you go into a hospital situation? Interviewee: Right, a failure of responsive in 24 hours rapidly spreading area of redness, any high fever, any generalized rash that does not seem to be from any other cause. May actually be due to toxin production by the staph that is causing glottal infection but spreading a toxin systemically which could rapidly result in occurrence of toxic shock in similar manifestation so we do have to be careful with this newly emerging MRSA. They are not only more locally invasive but they actually have some toxin production that can cause rapid sepsis and even death. Interviewer: So if the kid start to spread quickly was on clindamycin, you put it on the hospital, what would you try to do with the hospital that is different? Interviewee: Generally, if the child came in failed clindamycin or got worse, we would usually use vancomycin. Interviewer: We have not found in the vancomycin resistant in New York area? Interviewee: There has been actually one reported case of three confirmed nationally so fortunately it is still the lead is on that but we do not know what lies in the future but right now, the only drug to fall back on is vancomycin. Interviewer: Is there already drugs potentially coming down the road that -- Interviewee: There are some vancomycin family glycopeptide and related antibiotics and even a new cephalosporin that does have activity against MRSA. Interviewer: The cephalosporins on the market now? Interviewee: Not on the market right now. Interviewer: Is there a vaccine on the works, I heard there is a potential vaccine coming now? Interviewee: I think there is now increase research doll
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