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Evidence based Pediatric Infectious Diseases
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Evidence based Pediatric, Infectious Diseases, Professor David Isaacs. Evidence based Pediatric, Infectious Diseases, David Isaacs. Clinical Professor of Paediatric Infectious Diseases. University of Sydney and Senior Staff Physician, in Pediatric Infectious Diseases and Immunology. The Children s Hospital at Westmead, Consultant Editors. Elizabeth Elliott, Ruth Gilbert, Virginia Moyer, Michael Pichichero.
C 2007 David Isaacs, Published by Blackwell Publishing. BMJ Books is an imprint of the BMJ Publishing Group Limited used under licence. Blackwell Publishing Inc 350 Main Street Malden Massachusetts 02148 5020 USA. Blackwell Publishing Ltd 9600 Garsington Road Oxford OX4 2DQ UK. Blackwell Publishing Asia Pty Ltd 550 Swanston Street Carlton Victoria 3053 Australia. The right of the Author to be identi ed as the Author of this Work has been asserted in. accordance with the Copyright Designs and Patents Act 1988. All rights reserved No part of this publication may be reproduced stored in a retrieval. system or transmitted in any form or by any means electronic mechanical. photocopying recording or otherwise except as permitted by the UK Copyright Designs. and Patents Act 1988 without the prior permission of the publisher. First published 2007, Library of Congress Cataloging in Publication Data. Isaacs David MD, Evidence based pediatric infectious diseases by David Isaacs with. consultants Elizabeth Elliott et al, Includes bibliographical references and Index. ISBN 978 1 4051 4858 0 pbk alk paper, 1 Communicable diseases in children 2 Evidence based pediatrics.
I Elliott Elizabeth J II Title, DNLM 1 Communicable Diseases Handbooks 2 Adolescent 3 Child. 4 Evidence Based Medicine Handbooks WC 39 I73e 2007. RJ401 I83 2007, 618 92 9 dc22, 2007008364, ISBN 978 1 4051 4858 0. A catalogue record for this title is available from the British Library. Set in 9 5 12pt Minion by Aptara Inc New Delhi India. Printed and bound in Singapore by Utopia Press Pte Ltd. Commissioning Editor Mary Banks, Editorial Assistant Victoria Pittman. Development Editor Lauren Brindley, Production Controller Rachel Edwards. For further information on Blackwell Publishing visit our website. http www blackwellpublishing com, The publisher s policy is to use permanent paper from mills that operate a sustainable.
forestry policy and which has been manufactured from pulp processed using acid free and. elementary chlorine free practices Furthermore the publisher ensures that the text paper. and cover board used have met acceptable environmental accreditation standards. Blackwell Publishing makes no representation express or implied that the drug dosages in. this book are correct Readers must therefore always check that any product mentioned in. this publication is used in accordance with the prescribing information prepared by the. manufacturers The author and the publishers do not accept responsibility or legal liability. for any errors in the text or for the misuse or misapplication of material in this book. About the authors vii 11 Osteomyelitis and septic arthritis 156. Preface viii 12 Respiratory infections 166, Acknowledgements x 13 Sexually transmitted and genital infections 211. Abbreviations xii 14 Skin and soft tissue infections 224. 15 Systemic sepsis 243, 1 Evidence based practice 1. 16 Tropical infections and travel 256, 2 Rational antibiotic use 9. 17 Urinary tract infections 271, 3 Cardiac infections 14. 18 Viral infections 283, 4 Cervical infections 29, Appendix 1 Renal impairment and.
5 Eye infections 40 antimicrobials 299, 6 Fever 55 Appendix 2 Aminoglycosides dosing and. monitoring blood levels 301, 7 Gastrointestinal infections 74. Appendix 3 Antimicrobial drug dose, 8 HIV infection 102. recommendations 306, 9 Immune de ciency 117, 10 Meningitis and central nervous system. infections 132, About the authors, David Isaacs is a senior staff physician in pediatric in mosis and for neonatal group B streptococcal infec.
fectious diseases and immunology at The Children s tion She is coauthor of Evidence Based Pediatrics and. Hospital at Westmead Sydney and Clinical Profes Child Health by Moyer V et al Ruth teaches evidence. sor of Paediatric Infectious Diseases at the University based medicine has published Cochrane reviews and. of Sydney He has published 10 books and over 200 is a reviewer for the Cochrane Collaboration. peer reviewed publications His research interests are. MichaelE Pichichero is Professor of Microbiology and. neonatal infections respiratory virus infections im. Immunology Pediatrics and Medicine at the Univer, munizations and ethics He has published also on. sity of Rochester in New York He is board certi ed in. medical ethics and several humorous articles Professor. pediatrics in adult and pediatric allergy and immunol. Isaacs is on multiple national and international com. ogy and in pediatric infectious disease Dr Pichichero. mittees on infectious diseases and immunizations and. is a partner in the Elmwood Pediatric Group a re, is a reviewer for the Cochrane Collaboration. cipient of numerous awards he has over 500 publica. Elizabeth Elliott is Professor of Paediatrics and Child tions in infectious disease immunology and allergy. Health University of Sydney Consultant Paediatri His major practice and research interests are in vac. cian The Children s Hospital at Westmead Director cine development streptococcal infections and otitis. Centre for Evidence Based Paediatrics Gastroenterol media. ogy and Nutrition and Practitioner Fellow National. Virginia Moyer is Professor of Pediatrics and Section. Health and Medical Research Council of Australia She. Head Academic General Pediatrics at Baylor College. is Director of the Australian Paediatric Surveillance. of Medicine and Texas Children s Hospital in Houston. Unit and past Convenor of the International Network. Texas Dr Moyer has particular interests in teaching. of Paediatric Surveillance Units She is Senior Asso. clinical epidemiology and studying the use of diag. ciate Editor and co author of Evidence Based Pediatrics. nostic tests in clinical care She is a member of the. and Child Health Moyer V ed BMJ Books 2000 2nd, Evidence Based Medicine Working Group the United. edition 2004, States Preventive Services Task Force and the Interna. Ruth Gilbert is Reader in Clinical Epidemiology at tional Advisory Board for the Cochrane Collaboration. the Institute of Child Health London having com Child Health Field She is Editor in Chief of the book. pleted her training in pediatrics She has published ex Evidence Based Pediatrics and Child Health 2nd edi. tensively on the epidemiology of infectious diseases tion and the journal Current Problems in Pediatrics. both original papers and textbooks She coordinates and Adolescent Health Care and is a founding Associate. research programs on the evaluation of screening and Editor of Evidence Based Child Health A Cochrane Re. diagnostic tests and treatment for congenital toxoplas view Journal. Some books provide comprehensive recommendations changed with increasing emphasis on randomized con. without giving the evidence Some books provide com trolled trials meta analyses of randomized controlled. prehensive evidence without giving any recommenda trials systematic reviews of the evidence and the rig. tions orous approach to assessing the quality of randomized. There is a tension between providing useful man controlled trials included in the Cochrane reviews and. agement recommendations and between providing de with the availability of electronic search engines to nd. tailed evidence that allows clinicians to make their own the evidence. decisions Books on managing infections like the ex Some have espoused EBM wholeheartedly and even. cellent Antibiotic Guidelines1 and the Red Book 2 give dare one say it some have advocated it uncritically It. recommendations about which antibiotics to use and has been fun to satirize this overemphasis on EBM 4 5 In. the doses but not the evidence supporting the recom reality EBM has strengths and weaknesses We should. mendations This is deliberate to keep the books to use its strengths while acknowledging its weaknesses. a manageable length In contrast books such as that When evidence is lacking we still need to decide. edited by Virginia Moyer3 attempt to analyze the evi what to do with our patient In infectious diseases. dence for clinical decisions in depth Sources of sum do we give antibiotics now or watch carefully What. marized evidence such as the BMJ s important Clini about adjunctive therapy steroids or intravenous im. cal Evidence series provide detailed evidence without munoglobulin which might help in critical situations. recommendations and leave it to the busy clinician to Reading any of the spate of Practice Guidelines pub. weigh the evidence presented and decide about treat lished recently is sobering because so many of the rec. ment While helpful the depth of the analysis of the ommendations are based on consensus expert opin. evidence means that these sources can deal only with a ion in the absence of good trial data. limited number of clinical situations In this book we present the evidence for management. The fundamental principle of the current book is of many pediatric infectious diseases affecting children. to combine the strengths of both approaches by an in industrialized and developing countries travelers. alyzing the evidence on management treatment and and refugees Our recommendations are based on cur. where relevant diagnosis and prevention if this is con rent evidence about ef cacy and safety but also the. troversial or uncertain presenting the evidence brie y likely effects on antibiotic resistance the costs adverse. and then our recommendations about management effects ethical and any other relevant considerations. The busy clinician can then weigh up the strength of the. David Isaacs, evidence for our recommendations and decide how to.
act Clinicians can also review the literature themselves. if they have time, Evidence based medicine EBM has great strengths References. For years many of us thought we were practising EBM 1 Therapeutic Guidelines Ltd Therapeutic Guidelines Antibiotic. but the best evidence was not easily accessible That has 13th edn Melbourne Therapeutic Guidelines Ltd 2006. 2 American Academy of Pediatrics In Pickering LK ed Red 4 Isaacs D Fitzgerald D Seven alternatives to evidence based. Book 2003 Report of the Committee on Infectious Diseases 26th medicine BMJ 1999 319 1618. edn Elk Grove Village IL American Academy of Pediatrics 5 Smith GCS Pell JP Parachute use to prevent death and ma. 2003 jor trauma related to gravitational challenge systematic re. 3 Moyer VA ed Evidence Based Pediatrics and Child Health view of randomised controlled trials BMJ 2003 327 1459. 2nd edn London BMJ Books 2004 61, Acknowledgements. We would like to thank the following for reading chap from the elds of infectious diseases microbiology. ters and for their helpful comments Henry Kilham tropical medicine general practice and pharmacol. general pediatrician at The Children s Hospital at West ogy meets regularly to review the evidence and discuss. mead CHW Sydney Australia Elisabeth Hodson treatment. and Jonathan Craig pediatric nephrologists at CHW The recommendations in TGA focus almost entirely. David Schell pediatric intensivist at CHW Alyson on antimicrobial use rather than diagnosis or other. Kakakios and Melanie Wong pediatric immunologists aspects of management While the book you are cur. at CHW Alison Kesson microbiologist and infectious rently reading has considered the evidence indepen. diseases specialist at CHW Peter Shaw oncologist at dently of TGA and also addresses diagnosis and ad. CHW Paul Tait child protection specialist at CHW junctive therapies the presentation of antibiotic doses. Chris Blyth pediatric immunology and infectious dis given in boxed format uses an almost identical format. eases physician at Sydney Children s Hospital Rana to that used by TGA and we would like to acknowledge. Chakraborty pediatric infectious diseases specialist at this We have adopted this format which has evolved. St George s Hospital London Mary Isaacs nee Cum over 28 years because it expresses so clearly and un. mins general pediatrician at Ealing Hospital UK ambiguously which antibiotics should be prescribed. Anna Isaacs medical student at Sydney University and and how often In addition the actual pediatric doses. Emily Isaacs medical student at Birmingham Univer we recommend are similar but not always identical to. sity UK those used in TGA DI would like to acknowledge his. DI has been a member of the writing group for the indebtedness to his colleagues on the TGA committees. book Therapeutic Guidelines Antibiotic TGA from for their wisdom and experience shared so sel essly. 1994 when the 8th edition was published until now While hesitating to single out any one colleague DI. the 13th edition having been published in 2006 These would like particularly to acknowledge Professor John. books are the work of Therapeutic Guidelines Lim Turnidge from Adelaide for his advice on antibiotic use. ited a non pro t making organization which pub in children DI would also like to acknowledge the staff. lishes evidence based guideline books on many dif of Therapeutic Guidelines Limited notably Jonathan. Evidence based Pediatric Infectious Diseases By David Isaacs MoyerV ed BMJBooks2000 2nd edition 2004 Ruth Gilbert is Reader in Clinical Epidemiology at

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