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Empirical oral antibiotic therapy for the most common acute community-acquired bacterial infections in children

MUDr. Marek Štefan, MBA, PharmDr. Jindřich Havránek, PharmDr. Markéta Petrželová, Mgr. Jitka Gambacorta, Mgr. Markéta Kulakowská, PharmDr. Šárka Nováková, PharmDr. Dagmar Dolinská, Mgr. Antónia Modráková, PharmDr. Alena Valko, MUDr. Otakar Nyč, Ph.D., MUDr. Jana Tejnická, MBA, doc. MUDr. Jakub Zieg, Ph.D., MUDr. Petra Dytrych, Ph.D., MUDr. Milan Trojánek, Ph.D., MUDr. Jitka Müllerová-Dissou, MBA

Pediatr. praxi. 2024;25(4):206-212 | DOI: 10.36290/ped.2024.041

This article addresses the issue of empirical oral antibiotic therapy for the most common acute community-acquired bacterial infections in children, specifically tonsillitis, otitis media, sinusitis, pneumonia, cystitis, pyelonephritis, erysipelas, cellulitis, impetigo, and erythema migrans. In addition to first-choice antibiotics, alternatives are provided in cases of antibiotic shortages or allergies. The recommendations also include magistral (compounded, pharmacist-prepared) formulas for selected antibiotics. The article further focuses on the AWaRe classification of antibiotics, which divides available antibiotics into three groups according to the risk of inducing bacterial resistance.

New options for treating oral candidiasis in children by using compounded medications

PharmDr.Zbyněk Sklenář, Ph.D., MBA, MUDr.Vladimír Ščigel, Ph.D., MBA, MVDr.Mgr.Kateřina Horáčková

Pediatr. praxi. 2015;16(3):168-171

Oral candidiasis treatment in neonates and infants is still a current issue. Until recently, the therapeutic solution of this disease has been consisting mainly in using extemporaneously prepared medicinal products in the oromucosal cavity containing non-specific antifungal agents. Although oromucosal gels and suspensions containing specific antifungal agents are not available as registered products in the Czech Republic, during the past five years got to enrichment of the portfolio for compounding with new substances. Nystatin and miconazole are newly available for compounding and even they can be successfully used for the treatment of oromucosal candidiasis in neonates, infants, children and adults. The paper aim is to inform physicians of treatment possibilities, oromucosal candidiasis compounded preparations. The paper provides an overview of the available products. It focuses on the new substances - nystatin and miconazole - and presents the current magistral formulas that can be used for the treatment of oromucosal candidiasis (thrush) and that could thus completely replace the widely prescribed preparations with gentian (methyl) violet. Presented formulas were created by the authors, who also checked in practice, the active substance for the extemporaneous preparation are currently available for routine prescription and yet fully covered by public health insurance.

Necrotic skin folliculitis

MUDr. Lesia Kollárová, MUDr. Tereza Gregorová, doc. MUDr. Eva Sticová, Ph.D., MUDr. Jiří Havránek, MUDr. Simona Kontuľová, MUDr. Andrea Navrátilová, MUDr. Julia Formanová

Pediatr. praxi. 2025;26(1):53-55 | DOI: 10.36290/ped.2025.011

The authors present the case of a 11-years old girl who came for a deep pyogenic and gangrenous affection in the area above the left soulder blade. The lesion was located in the area of acne comedonica. The overall condition was not altered. The diagnostic reasoning was broad and we also used the possibility of histopatological examination.

Methods of preventing and treating viral respiratory tract diseases

PharmDr. MVDr. Vilma Vranová, Ph.D.

Pediatr. praxi. 2022;23(5):331-335

The airways are continuously exposed to the effects of harmful substances and environmental respiratory pathogens. Although the basic preventive methods are hardening, staying in the fresh air, and a balanced diet, patients and parents of children often prefer purchasing dietary supplements. The paper deals with the need for supplementation with vitamins C and D, selenium, zinc, and some herbal extracts; also discussed are other possible methods of preventing and treating respiratory tract infections.

Migraine in children and its treatment

MUC. Tereza Strnadová, MUDr. Petra Matalová, Ph.D.

Pediatr. praxi. 2022;23(6):383-393 | DOI: 10.36290/ped.2022.069

Headache is a common problem in adults, but also in children. It occurs in nearly every child. The most common type of headache is migraine, which is described as a chronic paroxysmal disease of a benign nature. Migraine is one of the primary headaches. It leads to deterioration in the quality of life in childhood and it can also cause increased stress for parents and negatively affect the family life. The article summarizes the epidemiology, classification, specifics and therapeutic procedures in migraine.

Common and rare complications of gastroenteitis

MUDr. Martin Gregora

Pediatr. praxi. 2021;22(2):125-128 | DOI: 10.36290/ped.2021.023

Every pediatrician examines dozens, perhaps hundereds of children with gastroenteritis each year. Based on experiance and anamnestic data, he can often estimate the etiology, predict the course and set adequate treatment. Most children with this diegnosis do not require hospitalization. However, enteritis also brings complications, common and rare, which are difficult to predict. And it is far from just a risk of dehydration.

The new possibilities for extemporaneous cutaneous preparations in pediatrics

PharmDr.Zbyněk Sklenář, Ph.D., MBA, Mgr.Kateřina Horáčková, doc.MUDr.Ondřej Slanař, Ph.D.

Pediatr. praxi. 2012;13(4):247-249

In recent years magistral preparation has been enriched with several new substances. This paper presents some possibilities of extemporaneous preparation – semisolid preparations intended for the skin or mucosa application with local effect, suitable for pediatric use. It introduces in detail three substances – dexpanthenol, sodium lactate solution and almond oil. The article presents examples of suitable recipes for pediatric use: water-in-oil (w/o) cream with dexpanthenol and urea for infants, epithelizing ointment with vitamine E, oil-in-water (o/w) cream with glycerine, nasal emulsion gel with vitamine E (Nasopanthil), ointment containing purified almond oil, zinc oxide, dimeticone and vitamine E, cooling emolient cream and as suitable topical antimycotic an oil gel with nystatine is introduced.

The new possibilities of compounded oral and rectal preparations in pediatrics

PharmDr.Zbyněk Sklenář, Ph.D., MBA, Mgr.Kateřina Horáčková, doc.MUDr.Ondřej Slanař, Ph.D.

Pediatr. praxi. 2013;14(3):174-176

This paper offers extemporaneous preparation possibilities of non-sterile dosage forms intended for gastrointestinal application with systemic effect for children in five compounds newly available for magistral preparation in pharmacies. These new substances are domperidon, propranolol hydrochloride, sotalol hydrochloride, promethazine hydrochloride and alpha tocopherol acetate. This increases treatment possibilities with these new substances, and the doses can be customized to the paediatric patient. This article gives brief information about these compounds and presents examples of compounded formulas suitable for use in paediatric practice.

Dermatitis perioralis with children

MUDr. Zuzana Nevoralová, Ph.D.

Pediatr. praxi. 2020;21(3):156-159 | DOI: 10.36290/ped.2020.031

Perioral dermatitis is a chronic facial dermatosis characterized by small papules and pustules on a red, sometimes scaled skin typically affected area of nasobuccal sulci and a of a chin, with sparing a narrow area round lips. It can be manifested also perinasal and at lateral parts of both eyes. Subjective symptoms include tingling and burning, pruritus is rare. Causative agents at children are most often overusage of tooth-pastes with fluor, various emmolients and local corticoids. For healing an elimination of causative agents and local treatments are necessary. Peroral treatment with children is used only exceptionally. Less severe forms of perioral dermatitis can be treated by a general practitioner as far as this physician has a good knowledge of this diagnosis. More severe forms have to be treated by a dermatologist.

Severe hypernatremia in an infant with a central nervous system developmental disorder

MUDr. Petr Jabandžiev, Ph.D., MUDr. Jakub Pecl, MUDr. Martin Jouza, MUDr. Jiří Štarha, Ph.D., MUDr. Jan Papež, MUDr. Milan Urík, Ph.D., MUDr. Anna Seehofnerová, MUDr. Ondřej Horák

Pediatr. praxi. 2020;21(4):290-294

We present acase report of an infant with septooptic dysplasia variant (holoprosencephaly spectrum) with accidentally found severe hypernatremia. The case report points to the possibility of coincidence of hypopituitarism in patients with this form of forebrain malformation. Combined primary endocrine deficits in neonates and infants may result in derangement of body internal environment. Severe hypernatremia due to central diabetes insipidus is one of the potentially fatal complications requiring avery gradual, strictly controlled correction of the internal environment parameters. This is the only way to prevent serious neurological complications due to the rapidly changing internal environment.

Formic acid burns – two cases of terrible medication administration error

MUDr. Lucie Holická, MUDr. Štěpánka Dočekalová, MUDr. Radek Štichhauer, Ph.D., MUDr. Pavel Rozsíval, MUDr. Lukáš Eimer, PharmDr. Petra Rozsívalová

Pediatr. praxi 2019; 20(2): 114-117 | DOI: 10.36290/ped.2019.024

Formic acid of 10–90% concentration has been used for its caustic effect as one of the methods of treatment of viral warts. Although
nowadays considered obsolete for the risk of irritant dermatitis, burns and necrosis followed by scarring, the topical treatment is
still being prescribed by dermatologists. The authors report two cases of burns in infants. The cause was common to both cases,
the unfortunate erroneous administration of topical solution orally. The patients suffered significant burns affecting the face,
neck, oral cavity and oesophagus. In both cases, the systemic effects of concentrated formic acid were expressed differently.

Treatment options for atopic dermatitis in children

MUDr. Stanislava Polášková

Pediatr. praxi 2019; 20(3): 148-151 | DOI: 10.36290/ped.2019.030

The article summarizes the treatment options and principles for atopic dermatitis (AD) in children which are based on the knowledge of
aetiopathogenesis and pathophysiology of AD. The mainstays of AD treatment have remained the same; however, some recommendations
have changed due to updated knowledge (e. g. atopic skin hygiene, pattern of use of local corticosteroids and local immunomodulators).
Due to updated knowledge on AD and a wide choice of local agents, the management of atopic patients can be individualized and
continues to improve. Biological therapy, which is still in the phase of clinical trials, appears to be most effective in the most severe cases.

Risky medications in paediatric dermatological extemporaneous formulation and their suitable alternatives

PharmDr.Zbyněk Sklenář, Ph.D.

Pediatr. praxi. 2010;11(4):232-235

When prescribing local dermatological medicinal products prepared individually at the pharmacy for paediatric patients, it must be kept in mind that some medications are currently qualified as problematic or even considered obsolete in paediatrics. However, in an effort to prescribe a suitable alternative, the physician lacks appropriate specialized literature that would address this issue. The paper presents selected active substances used in extemporaneous formulations which, in terms of contemporary therapy, are considered hazardous or contraindicated in paediatric patients, and offers prospective suitable alternatives in the form of individually prepared medicinal products. septonex, chlorhexidine, nystatin.

New trends in paediatric skin care

MUDr.Kateřina Macháčková

Pediatr. praxi. 2010;11(2):99-102

The specific features of physiology and anatomy of neonatal and paediatric skin require a thorough knowledge of pharmacokinetics of dermatological external drugs. An ideal drug should be rapid-acting, safe, and in a cosmetically acceptable galenic form. The article deals with the options of local treatment in paediatric age, highlights the treatment-associated risks, and offers safe alternatives of both proprietary medicinal products and extemporaneous preparations.

Intranasal application of drugs at children

Eva Kašáková, MUDr. Viktor Kašák

Pediatr. praxi 2018; 19(1): 23-26 | DOI: 10.36290/ped.2018.005

Intranasal application of drugs represents primarily a topical treatment. Education in correct application technique is very important,because correct application technique increases compliance of patients to treatment.

Yeast infection in childhood from view of pediatric and adolescent gynecologist

MUDr. Hana Kosová, Ph.D.

Pediatr. praxi 2018; 19(3): 134-138 | DOI: 10.36290/ped.2018.079

Infection of external genitalis is the most common gynecologal problem in children. Child is not smaller adult, and this is reasonof different etiology, diagnostic´s method and treatment compared with kolpitis in adult. Yeast infection is typical example. Thisillnes is the most common inflammation of vagina in adult, in rest period we cannot meet it. Vagina is not influenced by femalehormons in rest period, we cannot find out typical vaginal microbiom, so pH of vagina is higher, epitel cells are without glycogen.The most often we can find in vagina during childhood patogenic bacterias from GIT tract and upper respiratory tract. Duringsexual development according to higher level of female hormons occure physiological mircrobiom, pH of vagina is low. This isreason, why yeast infection in sexual development period occures quitte often, but we must exclude bacterial vaginosis andaerobic kolpitis.

Topical therapy of acne vulgaris

MUDr. Kateřina Macháčková

Pediatr. praxi 2018; 19(4): 200-205

Acne vulgaris is a very common skin problem in young population. Its social impact is very seriousThe pillar of acne treatment istopical therapy, patients with severe forms of acne are indicated for the use of systemic treatment. Some methods of correctivedermatology are presented.

Unlicensed drug use in examples from paediatric practise

PharmDr. Kateřina Ládová, Ph.D., PharmDr. Josef Malý, Ph.D., Mgr. Milan Vegerbauer, PharmDr. Petra Thomson

Pediatr. praxi. 2017;18(1):22-26 | DOI: 10.36290/ped.2017.005

The number of medicinal products for human use, which are not registered in the Czech Republic but used nevertheless, is constantly increasing. There are various reasons behind the use of unlicensed medicines, notably due to medicine manufacturing and distribution causes. This problem in the field of paediatrics arises also from the fact that clinical trials involving children are more intricate. So as to minimize medication errors, it is crucial for healthcare professionals as well as the patients and their caregivers to follow the good practice procedures linked with the handling of unlicensed and off-label medicines. The aim of this article is to provide an overview of management of handling the unlicensed medicines which entails the import of unregistered medicines, specific treatment programs and off-label use along with a few examples from the current paediatric practice.

Local therapy of psoriasis

MUDr. Naděžda Vojáčková

Pediatr. praxi 2017; 18(6): 360-363

Psoriasis has traditionally been viewed as a primary skin condition that is treated with local agents. In light of new knowledgeon the aetiopathogenesis, psoriasis is considered to be a multifactorial disease with a number of comorbidities; therefore, theestablished patterns are gradually changing, with systemic therapy being chosen more frequently and earlier. Still, local therapycontinues to be predominant in mild and moderate forms and, in moderate and severe forms, it is an adjunct to phototherapyand systemic therapy. Traditional external medications, such as tar and cignolin, are being replaced by modern agents such asvitamin D derivatives, immunomodulators, combined drugs with corticosteroids, and retinoids.

Pharmacotherapy of cough in a nutshell

doc.PharmDr.Jan Juřica, Ph.D.

Pediatr. praxi. 2016;17(5):306-311

The article presents in tabular form the types of cough in terms of their symptomatology and the thus recommended pharmacotherapeutic group. Mucoactive agents can be classified into expectorants, mucolytics, mucokinetics, and mucoregulating drugs according to the effect on the composition and amount of sputum produced. Antitussives are divided into centrally and peripherally acting ones. The article presents the crucial pharmacological properties of each substance and/or extracts of medicinal plants. In conclusion, the basic pharmacotherapeutic approaches in treating dry and productive cough are summarized and recommendations concerning the combinations of antitussives and mucoactive agents are provided.

Premedication in children

MUDr.Petr Vojtíšek

Pediatr. praxi. 2015;16(6):375-378

Pharmacological premedication is preparing a patient for anesthesia (resp. surgery). Premedication should follow the development of anesthesia. There are a lot of bad practices from the past witch already have no place in our hospitals. There were many goals premedication with regard to side effects of anesthesia. Today is main aim of inducing anxiolysis. Preoperative psychological condition causes a number of problems – circulating dysregulation (e. g. tachycardia), disorders of breathing, postoperative analgetics consumption. PONV (Post Operative Nausea and Vomiting) is often associated with fear and stress. Last but not least salivation and bradycardia prevention is optional in special cases. The most commonly used drug for premedication in children and adolescents is midazolam.

Skin and mucosa candidosis in infants

MUDr.Eva Dortová, doc.MUDr.Jiří Dort, Ph.D.

Pediatr. praxi. 2012;13(3):153-154

This article deals with candida infections in infants, its clinical manifestation on the skin and oral mucosa, the possibilities of prevention even during pregnancy, after birth in infants and local treatment.

Skin barrier function: a new perspective in child skin care

MUDr.Kateřina Macháčková

Pediatr. praxi. 2012;13(1):16-18

Care of the uppermost layer of the skin is crucial in maintaining the stability of the skin‘s ecosystem, prevents the development of numerous skin diseases, and plays an essential role in the treatment and stabilization of chronic skin conditions with a defective skin barrier function, with atopic dermatitis being the most widely spread. In the Czech Republic, about 0.8 million inhabitants have a history of atopic eczema and approximately 0.6 million people report a history of bronchial asthma. Although there are genetic predispositions to developing the condition, impairment of skin barrier function is among important pathogenetic factors.

Premature infant in the care of a pediatric practitioner

doc.MUDr.Jiří Dort, Ph.D., MUDr.Eva Dortová

Pediatr. praxi. 2011;12(3):171-176

A review article on the care for premature infants in a pediatric office, focused on very-low-birth-weight infants who attract the main attention. Besides common treatment and prevention measures they need solving of health problems that may last from peri-neonatal period for a long time. A special care is realized by PP in cooperation with neonatal developmental care centre. In the successful management of somatic diseases (anemia, nutritional and growth compromise, gastroesophageal reflux, osteopathy, bronchopulmonary dysplasia etc.) and impairment of sensorial and psychomotor development other medical as well as non-medical professionals are often needed. Specific features of vaccination in preterm infants are described further.

Clinical use of specific antifungals

PharmDr.Petr Horák

Pediatr. praxi. 2011;12(4):242-246

The incidence of systemic fungal infections especially has been growing in last decades. It is related to the expansion of HIV/AIDS pandemic and also to the development of therapy of many diseases that affect immunity. It has resulted in the development of new drugs and new therapeutic classes, or changes in the administration and indications of formerly known drugs. Moreover, new therapeutic approaches have also been employed in the therapy of topical mycoses, and this article is devoted to them, too.

Severly malnutrished infant

MUDr.Markéta Nowaková, doc.MUDr.Michal Hladík, CSc.1

Pediatr. praxi. 2010;11(4):257-260

Malnutrition is defined as the imbalance between supply of nutrients and energy and the body‘s demand for them. It affects every organ systems, particularly in a growing organism. In this article, a case report of a severly malnutrished one-year-old boy is presented.

Local administration of drugs in children with upper airway disease in otorhinolaryngology

prof.MUDr.Jaromír Astl, CSc.

Pediatr. praxi. 2010;11(5):312-316

The present overview of upper airway inflammations deals with the development and symptoms of the diseases in the practice and their possible treatment. The treatment of complications is beyond the scope of this paper. The most commonly used groups of locally administered medications are described which are used for the treatment of patients with an emphasis on symptomatic treatment, particularly the options of administering local medications in the form of sprays and drops.

Paliative care in children with cancer

MUDr.Petr Lokaj

Pediatr. praxi. 2010;11(3):183-185

The following pages focus on problems that are encountered while taking care of children and teenagers in the last stages of their illness and suggest this solution. The problems are lined up in alphabetical order not according percent occurence or importance.

SPECIFICS OF SKIN CARE IN CHILDHOOD

MUDr. Kateřina Macháčková

Pediatr. praxi. 2008;9(5):298-300

The article calls attention to therapeutic strategies that used to be frequent but nowadays seem to be very risky. The article presents a review of dermatological external medications that can after a systemic absorption lead to serious or lethal intoxication of organism and presents their safe alternatives.

THE MOST FREQUENT SKIN DISEASES IN CHILDHOOD AND THEIR THERAPY

MUDr. Štěpánka Čapková

Pediatr. praxi. 2008;9(6):369-375

In offices of primary care pediatricians at least 20 % patients suffer from skin diseases. In last decades we observe an increase in allergic skin manifestations, constitutional dermatitis involves at least 5–15 % of pediatric population. Seborrheic dermatitis precedes frequently constitutional dermatitis already in first weeks of life. Preschool and school children with respect to their social contacts and numerous sport activities suffer by a number of skin infections, mainly impetigo. The most frequent skin disease of babies is surprisingly diaper dermatitis. The author summarizes clinical information about these diseases and discusses options of their modern and safe treatment.

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