Nelson's Pediatric Antimicrobial Therapy Updates

Because interim COVID guidance continues to evolve at a rapid pace (including potential new therapeutics), we are adding a link to the AAP COVID-19 guidance page (www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/).

Mpox (Monkeypox)

Following consultation with the CDC, treatment may be considered in patients experiencing severe disease that prompts hospitalization or in patients likely to experience severe disease (ie, immunocompromised patients, children <8 y, pregnant/breastfeeding women) as follows:

CDC-held Emergency Access Investigational New Drug protocol allows use of tecovirimat, oral and parenteral, for treatment of non–variola Orthopoxvirus infection (eg, mpox).

CDC-held Emergency Access Investigational New Drug Protocol allows use of vaccinia immune globulin intravenous for treatment of non–variola Orthopoxvirus infection (eg, mpox).

Cidofovir and brincidofovir may be effective, but no data exist on either drug for treatment of mpox in humans (www.cdc.gov/poxvirus/monkeypox/clinicians/treatment.html; updated October 31, 2022; accessed December 5, 2022).

Ceftolozane/Tazobactam Receives FDA Approval

Ceftolozane/tazobactam was approved by the FDA in April 2022 for all pediatric and adolescent age-groups from birth up to 18 years. Ceftolozane is more active than some of the other antipseudomonal cephalosporins, ceftazidime and cefepime, against Pseudomonas aeruginosa, including some strains that are meropenem resistant. Ceftolozane is also active against most enteric bacilli (eg, Escherichia coli, Klebsiella, Enterobacter), similar to ceftriaxone but with stability to the ampC beta-lactamases that inactivate ceftriaxone and ceftazidime. Ceftolozane is paired with tazobactam (a beta-lactamase inhibitor that has been available with piperacillin for several years), allowing for additional activity against ESBL-producing enteric bacilli but lacking stability to carbapenemases. Although the anaerobic spectrum is quite reasonable, ceftolozane/tazobactam was paired with metronidazole in the initial adult studies for complicated intra-abdominal infection that were designed by Cubist Pharmaceuticals for FDA approval. These adult studies succeeded, so pediatric studies used the same clinical trial design.

Following are the FDA package label indications for pediatrics: complicated intra-abdominal infections, used in combination with metronidazole, and complicated urinary tract infections, including pyelonephritis. Pediatric studies for nosocomial pneumonia, sponsored by Merck, are ongoing.