Choosing theright antibiotic and antifungal · Choosing the right antibiotic and antifungal Dr....
Transcript of Choosing theright antibiotic and antifungal · Choosing the right antibiotic and antifungal Dr....
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Choosing the right antibiotic and antifungal
Dr. Srilal De Silva
Dr. Srikanth Giri
Dr. Poonam Dalal
Dr. Arun Shah
Dr. Jatinder
Dr. Prakash Sanghvi
Moderator : Arvind Shenoi
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More than 50 publications/presentations(National/International)
Certified instructor: FBNC, Basic & Advanced NRPand Indian Academy of Pediatrics (IAP)-ALS, IAP-ALS-MAP
Co-investigator: Nation-wide project titled
Dr. Poonam DalalMBBS, MD (Pediatrics)
Professor, Deptt of PediatricsPt. BDS, PGIMS, Rohtak, Haryana
Special Interest: NEONATOLOGY
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CV- Dr Prakash SanghaviName : Dr. Prakash B. Sanghavi
Qualification : MB , DCH, FCPS (Ped. ) MNAMS, FIAP
Designation : Neonatologist & Pediatrician ,
Vice President - COMHAD International (Asia)
Ex- President - COMHAD India Chapter
Ex President - Maharashtra – NNF
Chairman – Swastik - Komal Health Care Limited
Chairman – Sanghavi Hospital , Kolhapur
National Co-ordinator – NALS
National Co-ordinator - KMC
Institution : Sanghavi Hospital & Premature Baby Care Centre, Kolhapur.
Swastik - Komal Health Care Limited, Kolhapur.
Area of Interest : Research In Neonatology
Prevention of Developmental Disability
Community Neonatology
Early Intervention in Developmental Disability
Publications : Maternal & Child Health Care, Vaccination, New-born Care, Prematurity,
Breast feeding, New-born Feeding, Neonatal sepsis,, Genetic Disorders,
New-born screening, Cerebral Palsy, literatures on Polio Eradication Programs.
Awards: Many Awards in Special Innovations in Neonatology,
FIAP by Indian Academy of Pediatrics
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Head of Pediatric Department (Prasad Hospital)
Consultant Pediatrician Muzaffarpur
Dr Arun ShahMD DCH FRCP FIAP FNNF FIAMS
Area of interest : Neonatology
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Arvind Shenoi
Consultant neonatologist and Medical DirectorCloudnine Hospital Bangalore
MD (Pediatrics) DM Neonatology(PGIMER)
Neonatal sepsis, Vitamin D in neonatal nutrition
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Learning objectives
• Early onset and late onset sepsis
• Multi-drug resistant sepsis
• When to fungal infection/ mixed infection?
• Fungal meningitis & arthritis
• Culture negative sepsis
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Case 1
• A 35 week 1.3 kg male neonate – 36 hours ROM, foul smelling liquourwith a mother with febrile UTI
• What antibiotic/s and why
• GBS – do you screen ? Role of prophylaxis
• When not to give antibiotics ?
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Case 2
• Full term 2.3 Kg female neonate – admitted to NICU with hypoglycemia, feeding issues, worsened on day 5 with signs of shock, tachypnea and increasing feed intolerance.
• Which antibiotic?
• Will you consider an antifungal?
• If this neonate was 2 weeks old and had oral thrush
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Case 3
• Baby born in a peripheral hospital- 2.7kg term, had respiratory distress at birth – given iv fluids, oxygen.
• Deteriorated on the 4 th day, shifted to your NICU
• Blood c/s Acinetobacter – R to Ampicillin, Amikacin, Gentamicin, carbepenems, & cephalosporins
• What antibiotic to use?
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Case 4
• 1.2 kg neonate born at a small hospital in rural area, had respiratory distress treated with hood oxygen and iv fluids given ceftazidime and amikacin.
• Deteriorated on day 3 with shock and bleeding started on meropenem and Piperacillin and vancomycin
• Referred to your NICU on day 4
• Which antibiotic to give
• Culture negative
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Case 5
• A 40 day ex 28 week ( CGA 34 week) recovering from NEC on Ceftazidine and Amikacin developed increasing lethargy.
• Which antibiotic?
• When will you consider fungal infection?
• Urine shows fungal hyphae
• CSF – suspicion of fungal invasion
• Ankle Joint swelling noted 2 days later
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Key messages
• When not to give antibiotics
• EOS and LOS
• MDR organisms – concept of reserve antibiotics
• Fungal sepsis
• Oral thrush as a pointer to fungal colonization
• Therapy for fungal septicemia, meningitis, arthritis