ANTIVIRAL TREATMENT IN CHILDHOOD

Some viral illnesses that cause

more serious disease, such

as measles, are less common now due to widespread immunization.

Most childhood viral infections are not serious and include such diverse illnesses as colds with a sore throat, vomiting and diarrhea, and fever with a rash.

RESPIRATORY TRACT INFECTIONS

Most respiratory virus infections in early childhood are confined to the respiratory tract, leading to symptoms of the common cold, with coryza, cough, and hoarseness.

In some cases, symptoms and signs of otitis media occur, such as earache, tenderness of the tragus upon pressure, and a red bulging tympanic membrane upon inspection.

ANTIVIRAL MEDICATIONS

For influenza A and B viruses, the neuraminidase inhibitors oseltamivir and zanamivir are licensed as antiviral drugs but only for patients between the ages of 1 and 5 years, respectively, and not for infants.

These drugs can be used for postexposure prophylaxis and the treatment of influenza virus (IV) if they can be given within 48 h after exposure or 36 h after first symptoms.

ANTIVIRAL MEDICATIONS

Oseltamivir – is widely known as TAMIFLU (it's comercial name).

Zanamivir – comercially known as RELENZA.

DOSAGE (TAMIFLU)

DOSAGE (TAMIFLU)

DOSAGE (RELENZA)

SIDE EFECTS

Some minor side effects of zanamivir and oseltamivir include:

Diarrhea.

Nausea and vomiting. This side effect tends to occur with oseltamivir. Taking the medicine with food may reduce the risk.

Swelling of the sinuses (sinusitis).

A small number of people, especially children, have shown behavior changes after taking oseltamivir or zanamivir.4, 5 These include:

Attempts to hurt themselves.

Confusion or delirium.

ANTIVIRAL MEDICATIONS

Ribavirin is an antiviral drug that is very effective against RSV in vitro and is licensed for use by inhalation for severe RSV bronchiolitis.

It is used also use with hepatitis C infection.

DOSAGE

TABLETS:

5 years or older:

In combination with peginterferon alfa-2a 180 mcg/1.73 m2 x body surface area (BSA) subcutaneously once a week (maximum dose: 180 mcg):

23 to 33 kg: 400 mg/day orally in 2 divided doses

34 to 46 kg: 600 mg/day orally in 2 divided doses

47 to 59 kg: 800 mg/day orally in 2 divided doses

60 to 74 kg: 1000 mg/day orally in 2 divided doses

75 kg or more: 1200 mg/day orally in 2 divided doses

SIDE EFECTS

problems with vision; severe pain in your upper stomach spreading to

back, nausea and vomiting, fast heart rate; stabbing chest pain, wheezing, feeling short of breath; chest pain or heavy feeling, pain spreading to the arm or

nausea, sweating, general ill feeling pale or yellowed skin, dark colored urine, easy bruising

or bleeding, confusion, or unusual weakness.

ANTIVIRAL MEDICATIONS

The anti-RSV antibody palivizumab, although not technically an antiviral drug, reduces the number of RSV cases requiring hospitalization for at-risk infants by 55% if given prophylactically.

DOSAGE

The recommended dose of Synagis is 15 mg per kg of body weight given monthly by intramuscular injection.

The first dose of Synagis should be administered prior to commencement of the RSV season and the remaining doses should be administered monthly throughout the RSV season.

Children who develop an RSV infection should continue to receive monthly doses throughout the RSV season. In the northern hemisphere, the RSV season typically commences in November and lasts through April, but it may begin earlier or persist later in certain communities.

SIDE EFECT

high fever, ear pain or drainage, tugging at the ear;

warmth or swelling of the ear;

crying or fussiness, especially while lying down;

change in sleeping patterns;

poor feeding or loss of appetite;

easy bruising or bleeding; or

trouble breathing.

Bronchodilators, Corticosteroids, Antibiotics, and Other Treatments

In the absence of effective antivirals for severe infant LRTI, medical treatment is focused on drugs designed to overcome airway obstruction and the resulting respiratory distress

AMPICILINE DOSAGE IN CHILDREN

I.M., I.V.: 100-150 mg/kg/day in divided doses every 6 hours (maximum: 2-4 g/day) .

Oral: 50-100 mg/kg/day in doses divided every 6 hours (maximum: 2-4 g/day) .

Severe infections/meningitis: I.M., I.V.: 200-400 mg/kg/day in divided doses every 6 hours (maximum: 6-12 g/day)

HUMAN INTERFERONS TREATMENT

Human interferons are availeble, as a drops for nose or ear.

Dosage 4drops, 4times a day

SYMPTOMATIC TREATMENT

Many viral infections result in fever and body aches or discomfort. Doctors treat these symptoms with paracetamol or ibuprofen

Aspirin is not given to children or adolescents with these symptoms, because it increases the risk of Reye's syndrome in those who have certain viral infections.

SYMPTOMATIC TREATMENT

Ibuprofen is in a class of medications called NSAIDs. It works by stopping the body's production of a substance that causes pain, fever, and inflammation.

Dosage for children is 5-10mg/Kg

SYMPTOMATIC TREATMENT

Paracetamol is approved for reducing fever in people of all ages.

The World Health Organization (WHO) recommends that paracetamol only be used to treat fever in children if their temperature is greater than 38.5 °C

Dosage for children 10-15mg/Kg

SYMPTOMATIC TREATMENT

HERPES INFECTIONS IN CHILDHOOD

Herpes simplex virus (HSV) is a common virus that can cause cold sores and fever blisters, gingivostomatitis (mouth ulcers), genital ulcers and other skin infections. It can also cause serious infections in newborns and encephalitis

HERPES INFECTIONS IN CHILDHOOD

Treatment is usually with intravenous, high dose (60mg/kg/d) acyclovir for 14-21 days

OTHER INFECTIONS

There is no effective treatment for such a serious infection as measles. However, some measures can be taken to protect vulnerable individuals who have been exposed to the virus.

Post-exposure vaccination. Nonimmunized people, including infants, may be given the measles vaccination within 72 hours of exposure to the measles virus, to provide protection against the disease. If measles still develops, the illness usually has milder symptoms and lasts for a shorter time.

Immune serum globulin. Pregnant women, infants and people with weakened immune systems who are exposed to the virus may receive an injection of proteins (antibodies) called immune serum globulin. When given within six days of exposure to the virus, these antibodies can prevent measles or make symptoms less severe.

Jakub Zubko & Marta Szliwa

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