Drug Category: Antiviral agents

For management of herpetic infections and to treat AD in patients who develop chickenpox.Drug 1) Name Acyclovir (Zovirax)

Description Inhibits activity of both HSV-1 and HSV-2. Has affinity for viral thymidine kinase and, once phosphorylated, causes DNA-chain termination when acted on by DNA polymerase. Patients experience less pain and faster resolution of cutaneous lesions when used within 48 h of rash onset. May prevent recurrent outbreaks. Early initiation of therapy is imperative. Zoster dose is 4 times higher than that for herpes simplex. Duration of therapy varies.

Adult Dose 200-800 mg PO qid for 5-10 d started within 24 h of appearance of rash

Pediatric Dose 5-20 mg/kg PO qid for 5-10 d (susp 200 mg/5 mL) started within 24 h of appearance of rash

Contraindications Documented hypersensitivity

Interactions Concomitant use of probenecid or zidovudine prolongs half-life and increases CNS toxicity

Pregnancy B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions Caution in renal failure or when using nephrotoxic drugs; has caused mutagenesis in some studies at high concentrations

Drug Category: Antibiotics

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting. For the treatment of clinical infection by S aureus, cloxacillin or cephalexin is used. In streptococcal infections, cephalexin is preferred. If not effective, penicillin and clindamycin in combination are effective. Consider staphylococcal infection in every flare of AD.

1) Drug Name Cephalexin (Keflex)

Description First-generation cephalosporin arrests bacterial growth by inhibiting bacterial cell wall synthesis. Bactericidal activity against rapidly growing organisms. Primary activity against skin flora; used for skin infections or prophylaxis in minor procedures.

Available susp include mauve granules (125 mg/5 mL) and peach granules (250 mg/5 mL).

Adult Dose 1-4 g/d PO in divided doses

Pediatric Dose 25-50 mg/kg/d PO divided q6h

Contraindications Documented hypersensitivity

Interactions Coadministration with aminoglycosides increase nephrotoxic potential

Pregnancy B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions Adjust dose in severe renal insufficiency (high doses may cause CNS toxicity); superinfections and promotion of nonsusceptible organisms may occur with prolonged use or repeated therapy

2) Drug Name Cloxacillin (Cloxapen, Tegopen)

Description For treatment of infections caused by penicillinase-producing staphylococci. May be used to initiate therapy when a staphylococcal infection is suspected.

Adult Dose 250-500 mg PO q6h

Pediatric Dose <20 kg: 50-100 mg/kg/d PO divided q6h

>20 kg: 250 mg PO q6h

Contraindications Documented hypersensitivity

Interactions May decrease effects of anticoagulants; probenecid and disulfiram may increase penicillin levels

Pregnancy B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions Monitor PT in patients taking anticoagulant medications; toxicity may increase in renal impairment

3) Drug Name Penicillin VK (Beepen-VK, Betapen-VK, Veetids)

Description Inhibits biosynthesis of cell wall mucopeptide. Bactericidal against sensitive organisms when adequate concentrations are reached, and most effective during stage of active multiplication. Inadequate concentrations may produce only bacteriostatic effects.

Adult Dose 500 mg PO q6h for 10d

Pediatric Dose <12 years: 25-50 mg/kg/d divided tid/qid up to 3 g/d

>12 years: Administer as in adults

Contraindications Documented hypersensitivity

Interactions Probenecid may increase effectiveness by decreasing clearance; tetracyclines are bacteriostatic, causing a decrease in the effectiveness of penicillins when administered concurrently

Pregnancy B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions Caution in renal impairment

3) Drug Name Clindamycin (Cleocin)

Description Lincosamide for treatment of serious skin and soft tissue staphylococcal infections. Also effective against aerobic and anaerobic streptococci (except enterococci). Inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

Adult Dose 150-450 mg/dose PO q6-8h; not to exceed 1.8 g/d

Pediatric Dose 8-20 mg/kg/d PO as hydrochloride or 8-25 mg/kg/d as palmitate divided tid/qid

Contraindications Documented hypersensitivity; regional enteritis, ulcerative colitis, hepatic impairment, antibiotic-associated colitis

Interactions Increases duration of neuromuscular blockade induced by tubocurarine and pancuronium; erythromycin may antagonize effects; antidiarrheals may delay absorption

Pregnancy B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions Adjust dose in severe hepatic dysfunction; no adjustment necessary in renal insufficiency; associated with severe and possibly fatal colitis by allowing overgrowth of Clostridium difficile.

Complications

• If topical corticosteroids are used inappropriately or if superpotent steroids are used in teenagers during rapid growth, striae may occur. Skin thinning can result if steroids are used inappropriately in older patients.
• Whether verrucae vulgaris and mollusca contagiosa are more frequent is difficult to assess, but they are more widespread and difficult to eliminate.
• Tachyphylaxis to topical steroids occurs if they are not used on a stop-start basis.

Prognosis

• Most patients improve; this can occur at any age. While the frequency of AD is as high as 20% in childhood,15 it is 0.9% in adults.
• One third of patients develop allergic rhinitis.
• One third of patients develop asthma.

Typical atopic dermatitis on the face of an infant.

Flexural involvement in childhood atopic dermatitis.

Irritation around mouth of an infant with atopic dermatitis.

Дата добавления: 2015-10-29