Pediatric Infections

Methods of taking temperature:  digital, temporal artery, ear (not as good), pacifiers (not as good)
When to treat:

  • If the child is under 3 months of age:  seek immediate attention when 100.4 or higher (rectally)
    • Also seek immediate attention if there are signs of a serious infection or other illness
  • Treat if the temp is 102+   (under 102 is not always treated)
    • Febrile seizures may occur in kids (usually 6 mo-3 years) with temps > 102;  these don’t appear to have any long term effects

How to treat:

  • Hydration
  • APAP: 10 mg/kg q 4 h
  • IBU: 10 mg/kg q 6 h                                (never give ASA due to risk of reye’s syndrome)


  • Leading cause of severe diarrhea & dehydration in the US
  • Is stable in the environment & is transmitted via fecal-oral transmission
  • RotaTeq is a 3 dose oral rotavirus vaccine


  • Leading cause of bacterial diarrhea in the US
  • Gram-negative rod most commonly found in undercooked poultry, unpasteurized milk, & contaminated water


  • Gram negative rod most commonly found  in undercooked eggs, undercooked meat & contaminated water
  • Salmonellosis:  ingested bacteria penetrate intestinal cells (toxins cause a loss of intestinal cells)
    • The use of antibiotics is controversial but Cipro is recommended for newborns & immunosuppressed

E. Coli

  • Most strains are useful (normal flora that suppress other bacterial growth & synthesize vitamins)
  • This toxin can damage the intestinal lining & can be found in undercooked hamburger, unpasteurized dairy products, contaminated water
    • Known for causing hemorrhagic diarrhea
    • Also known for causing hemolytic-uremic syndrome (most common cause of acute kidney failure in children)
      • Antibiotics may increase the risk of developing hemolytic-uremic syndrome


  • Gram negative rod that’s transmitted via the fecal-oral route
  • Antibiotics may shorten the illness for the very young

Most of the damage associated with bacterial diarrhea is associated with the acute inflammation phase i.e ulceration (PG synthesis, the release of enterotoxins & cytokines)
Treatment:  electrolyte replacement & solids as tolerated (no anti-diarrheal agents)
Giardia duodenalis & cryptosporidium Oocyst are the most common causes of parasitic diarrhea  (fecal–>oral transmission usually associated w/ contaminated food/water)

  • Giardia treatment:  tinidazole, metronidazole, furazolindone, nitazoxanide
  • Cryptosporidium:  nitazoxanide

Enterobius vermicularis (pinworm)

  • Transmitted via person-to-person contact
  • Mainly prophylaxis is to wash
  • Treatment:  mebendazole (vermox)

Head Lice

  • Treatment:
    • Permethrin (Nix)–1st line treatment of choice
    • Pyrethrins/piperonyl butoxide (Rid)
      • These options aren’t effective against nits
    • Don’t use Ovide w/ hairdryers or curling irons (b/c you can light a person’s hair on fire)
    • Lindane (last line of defense) is associated with liability (neurotoxicity, seizures & death) & shouldn’t be used in kids under 50 kg

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