Pediatric Splenomegaly Medication: Vaccines, Antibiotics

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Sections Pediatric Splenomegaly
Overview
Presentation
- History
- Physical
- Causes
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DDx
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Medication

Medication Summary

The choice of therapy depends on the specific etiology of the splenomegaly.

Class Summary

Active immunization increases resistance to infection. Vaccines consist of microorganisms or cellular components, which act as antigens. Administration of the vaccine stimulates the production of antibodies with specific protective properties. Patients with decreased or absent splenic function are at increased risk for several vaccine-preventable infections.

Preferred sites for IM injection are the anterolateral aspect of the thigh in infants or the deltoid muscle of the upper arm in toddlers and young children. Do not inject in the gluteal area or areas with a major nerve trunk or blood vessel.

Minor illnesses (eg, mild upper respiratory tract infection with or without low-grade fever) are not generally contraindications.

If possible, administration of pneumococcal, meningococcal, and Hib vaccines should be performed at least 14 days prior to elective splenectomy. In the absence of preoperative vaccinations, inoculations should be given postprocedurally immediately after the patient’s condition stabilizes.

The CDC ACIP recommends that all children receive one of the conjugate vaccines licensed for use in infants beginning routinely at age 2 mo.

Pneumococcal 7-valent conjugate vaccine (Prevnar)

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Sterile solution of saccharides of capsular antigens of S pneumoniae serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F individually conjugated to diphtheria CRM197 protein. These 7 serotypes responsible for >80% of invasive pneumococcal disease in children < 6 y in the United States and account for 74% of penicillin-nonsusceptible S pneumoniae (PNSP) and 100% of pneumococci with high-level penicillin resistance.

Customary age for first dose is 2 mo, but can be administered as young as 6 wk. Preferred sites for IM injection are anterolateral aspect of thigh in infants or deltoid muscle of upper arm in toddlers and young children. Do not inject in gluteal area or areas with a major nerve trunk or blood vessel.

Number of 0.5-mL doses is 3 for infants aged 7-11 mo (4 wk apart; third dose after first birthday), 2 for those aged 12-23 mo (2 mo apart), and 1 for those aged 2-5 y.

Minor illnesses (eg, mild upper respiratory tract infection with or without low-grade fever) are not generally contraindications.

Pneumococcal vaccine polyvalent (Pneumovax-23)

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Polyvalent vaccine used for prophylaxis against infection from S pneumoniae. Used in populations at increased risk of pneumococcal pneumonia (ie, >55 y, chronic infection, asplenia, immunocompromise).

Meningococcal vaccine (Menomune A/C/Y/W-135, Menactra)

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Capsular polysaccharide antigens (groups A, C, Y, and W-135) of Neisseria meningitidis. For active immunization against invasive meningococcal disease caused by inclusive serogroups. May be used to prevent and control outbreaks of serogroup C meningococcal disease according to Centers for Disease Control and Prevention (CDC) guidelines.

Routine vaccination recommended for high-risk groups (eg, patients with deficiencies in late complement components [C3, C5-C-9], functional or actual asplenia, or laboratory or industrial exposure to N meningitidis aerosols; travelers or residents of hyperendemic areas).

Vaccine induces antibody response for serogroup A in individuals as young as 3 mo, but poorly immunogenic for serogroup C in recipients < 18-24 mo.

Haemophilus influenza type b vaccine (PedvaxHIB, HibTITER, ActHIB)

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For routine immunization of children against invasive diseases caused by H influenzae type B by decreasing nasopharyngeal colonization. The CDC ACIP recommends that all children receive one of the conjugate vaccines licensed for use in infants beginning routinely at age 2 mo.

Class Summary

Daily antibiotic prophylaxis with penicillin is recommended to prevent pneumococcal septicemia in selected populations of anatomically or functionally asplenic children.

Penicillin VK (V-Cillin K, Veetids, Pen-Vee K)

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Inhibits biosynthesis of cell-wall mucopeptide. Bactericidal against sensitive organisms when adequate concentrations reached. Most effective during stage of active multiplication. Low concentrations produce bacteriostatic effects.

Follow-up

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Author

Trisha Simone Natanya Tavares, MD Contract Clinical Hematologist and Oncologist, Department of Pediatric Hematology and Oncology, Presbyterian Healthcare; Volunteer Hematology/Oncology Physician, St Vincent de Paul Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

James L Harper, MD Associate Professor, Department of Pediatrics, Division of Hematology/Oncology and Bone Marrow Transplantation, Associate Chairman for Education, Department of Pediatrics, University of Nebraska Medical Center; Associate Clinical Professor, Department of Pediatrics, Creighton University School of Medicine; Director, Continuing Medical Education, Children's Memorial Hospital; Pediatric Director, Nebraska Regional Hemophilia Treatment Center

James L Harper, MD is a member of the following medical societies: American Society of Pediatric Hematology/Oncology, American Federation for Clinical Research, Council on Medical Student Education in Pediatrics, Hemophilia and Thrombosis Research Society, American Academy of Pediatrics, American Association for Cancer Research, American Society of Hematology

Disclosure: Nothing to disclose.

Chief Editor

Vikramjit S Kanwar, MBBS, MBA, MRCP(UK), FRCPCH, FAAP Professor Emeritus of Pediatrics, Albany Medical College; Chief of Pediatric Oncology, Homi Bhabha Cancer Hospital, Varanasi, India

Vikramjit S Kanwar, MBBS, MBA, MRCP(UK), FRCPCH, FAAP is a member of the following medical societies: Children's Oncology Group, Indian Academy of Pediatrics, International Society of Pediatric Oncology

Disclosure: Nothing to disclose.

Additional Contributors

J Martin Johnston, MD Associate Professor of Pediatrics, Mercer University School of Medicine; Director of Hematology/Oncology, The Children's Hospital at Memorial University Medical Center; Consulting Oncologist/Hematologist, St Damien's Pediatric Hospital

J Martin Johnston, MD is a member of the following medical societies: American Academy of Pediatrics, American Society of Pediatric Hematology/Oncology, International Society of Paediatric Oncology

Disclosure: Nothing to disclose.

Richard H Sills, MD Professor of Pediatrics, State University of New York Upstate Medical University

Richard H Sills, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society of Hematology, American Society of Pediatric Hematology/Oncology

Disclosure: Nothing to disclose.

Mundeep K Kainth, DO, MPH, FAAP Attending Physician in Pediatric Infectious Diseases, Co-Lead of Antimicrobial Stewardship Program, Cohen Children's Medical Center; Assistant Professor, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Instructor, Feinstein Institute for Medical Research, Northwell Health

Mundeep K Kainth, DO, MPH, FAAP is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Alexander Gozman, MD Assistant Professor, Department of Pediatrics, Division of Hematology/Oncology, Albany Medical Center

Alexander Gozman, MD is a member of the following medical societies: American Medical Association, American Society of Clinical Oncology, American Society of Hematology, American Society of Pediatric Hematology/Oncology, Children's Oncology Group

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Wayne Hioe, MD, and Mundeep K Kainth, DO, to the development and writing of this article.

Sections Pediatric Splenomegaly
Overview
Presentation
- History
- Physical
- Causes
- Show All
DDx
Workup
Treatment
Medication
Follow-up
References

Pediatric Splenomegaly Medication

Medication Summary

Vaccines

Class Summary

Pneumococcal 7-valent conjugate vaccine (Prevnar)

Pneumococcal 7-valent conjugate vaccine (Prevnar)

Pneumococcal vaccine polyvalent (Pneumovax-23)

Pneumococcal vaccine polyvalent (Pneumovax-23)

Meningococcal vaccine (Menomune A/C/Y/W-135, Menactra)

Meningococcal vaccine (Menomune A/C/Y/W-135, Menactra)

Haemophilus influenza type b vaccine (PedvaxHIB, HibTITER, ActHIB)

Haemophilus influenza type b vaccine (PedvaxHIB, HibTITER, ActHIB)

Antibiotics

Class Summary

Penicillin VK (V-Cillin K, Veetids, Pen-Vee K)

Penicillin VK (V-Cillin K, Veetids, Pen-Vee K)

References

Tables

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