Head lice infestations: A clinical update.

Head lice (Pediculus humanus capitis) infestations are not a primary health hazard or a vector for disease, but they are a societal problem with substantial costs. Diagnosis of head lice infestation requires the detection of a living louse. Although pyrethrins and permethrin remain first-line treatments in Canada, isopropyl myristate/ST-cyclomethicone solution and dimeticone can be considered as second-line therapies when there is evidence of treatment failure.

Newborn male circumcision.

The circumcision of newborn males in Canada has become a less frequent practice over the past few decades. This change has been significantly influenced by past recommendations from the Canadian Paediatric Society and the American Academy of Pediatrics, who both affirmed that the procedure was not medically indicated. Recent evidence suggesting the potential benefit of circumcision in preventing urinary tract infection and some sexually transmitted infections, including HIV, has prompted the Canadian Paediatric Society to review the current medical literature in this regard. While there may be a benefit for some boys in high-risk populations and circumstances where the procedure could be considered for disease reduction or treatment, the Canadian Paediatric Society does not recommend the routine circumcision of every newborn male.

Au Canada, la circoncision néonatale est moins fréquente depuis quelques décennies. Ce changement est considérablement influencé par les recommandations antérieures de la Société canadienne de pédiatrie et de l'American Academy of Pediatrics, qui ont toutes deux conclu que l'intervention n'était pas indiquée sur le plan médical. Selon des données probantes à jour, la circoncision préviendrait les infections urinaires et certaines infections transmises sexuellement, y compris le virus de l'immunodéficience humaine (VIH), ce qui a incité la Société canadienne de pédiatrie à analyser les publications scientifiques récentes sur le sujet. Bien qu'elle puisse constituer un avantage pour certains garçons de populations à haut risque et dans des situations où l'intervention pourrait atténuer ou traiter des maladies, la Société canadienne de pédiatrie ne recommande pas la circoncision systématique des nouveau-nés.

Prophylactic antibiotics for children with recurrent urinary tract infections.

Prophylactic antibiotics for urinary tract infections are no longer routinely recommended. A large number of children must be given prophylaxis to prevent one infection and antibiotic resistance is a major concern when treating community-acquired urinary tract infections. The results of three recent significant studies are examined, with focus on the efficacy of prophylaxis, and recommendations are made.

La prophylaxie antibiotique n'est plus recommandée systématiquement en cas d'infections urinaires. Un grand nombre d'enfants doivent recevoir une prophylaxie pour prévenir une infection, et l'antibiorésistance est une préoccupation importante dans le traitement des infections urinaires d'origine communautaire. Les auteurs examinent les résultats de trois grandes études récentes, en s'attardant sur l'efficacité de la prophylaxie, et présentent des recommandations.

Urinary tract infections in infants and children: Diagnosis and management.

Recent studies have resulted in major changes in the management of urinary tract infections (UTIs) in children. The present statement focuses on the diagnosis and management of infants and children >2 months of age with an acute UTI and no known underlying urinary tract pathology or risk factors for a neurogenic bladder. UTI should be ruled out in preverbal children with unexplained fever and in older children with symptoms suggestive of UTI (dysuria, urinary frequency, hematuria, abdominal pain, back pain or new daytime incontinence). A midstream urine sample should be collected for urinalysis and culture in toilet-trained children; others should have urine collected by catheter or by suprapubic aspirate. UTI is unlikely if the urinalysis is completely normal. A bagged urine sample may be used for urinalysis but should not be used for urine culture. Antibiotic treatment for seven to 10 days is recommended for febrile UTI. Oral antibiotics may be offered as initial treatment when the child is not seriously ill and is likely to receive and tolerate every dose. Children <2 years of age should be investigated after their first febrile UTI with a renal/bladder ultrasound to identify any significant renal abnormalities. A voiding cystourethrogram is not required for children with a first UTI unless the renal/bladder ultrasound reveals findings suggestive of vesicoureteral reflux, selected renal anomalies or obstructive uropathy.

De récentes études ont suscité des changements majeurs dans la prise en charge des infections urinaires chez les enfants. Le présent document de principes porte sur le diagnostic et la prise en charge des nourrissons et des enfants de plus de deux mois atteints d'une infection urinaire aiguë, sans affection sous-jacente connue des voies urinaires ou facteurs de risque de vessie neurogène. Il convient d'écarter la possibilité d'infection urinaire chez les enfants atteints d'une fièvre inexpliquée qui ne savent pas encore parler et chez les enfants plus âgés ayant des symptômes évocateurs de ce type d'infection (dysurie, urgences mictionnelles, hématurie, douleur abdominale, douleur lombaire ou nouvelle incontinence diurne). Chez les enfants qui sont propres, il faut faire un prélèvement d'urine à mi-jet pour analyse et culture. Chez les autres, le prélèvement par cathéter ou par ponction sus-pubienne est préconisé. L'infection urinaire est peu probable si l'analyse d'urine est complètement normale. La collecte d'urine dans un sac peut être utilisée pour analyse, mais pas pour culture. Une antibiothérapie de sept à dix jours est recommandée en cas d'infection urinaire fébrile. Si l'enfant n'est pas gravement malade et qu'il est susceptible de recevoir et de tolérer chaque dose, on peut lui donner un traitement initial d'antibiotiques par voie orale. Il faudrait soumettre les enfants de moins de deux ans à une échographie des reins et de la vessie après leur première infection urinaire fébrile, afin de déceler toute anomalie rénale d'importance. Lors d'une première infection urinaire, la cysto-urétrographie mictionnelle (CUGM) est inutile, à moins que l'échographie des reins et de la vessie ne donne des résultats évocateurs d'un reflux vésico-urétéral, de certaines anomalies rénales ou d'une uropathie obstructive.

Role of Tonsillectomy in PFAPA Syndrome.

OBJECTIVE: To examine the efficacy of tonsillectomy in ameliorating symptoms and preventing recurrence of episodes in children with PFAPA syndrome (periodic fever, aphthous stomatitis, pharyngitis, and adenitis). DESIGN: Retrospective case series. SETTING: Tertiary care children's hospital. PATIENTS: Patients who presented to a major tertiary teaching hospital in Vancouver, British Columbia, Canada, between 2000 and 2004 with the diagnosis of PFAPA syndrome or for whom the diagnosis was made on their initial consultation. INTERVENTION: Tonsillectomy. MAIN OUTCOME MEASURES: Resolution of symptoms at 3, 12, and 24 months after tonsillectomy. RESULTS: Eight of the 9 patients achieved complete remission within 3 months. In the remaining patient, the frequency of episodes decreased from every 2 weeks to once every 3 to 4 months. This patient eventually had resolution of symptoms at 2 years after tonsillectomy. No complications resulted from the tonsillectomy. CONCLUSION: Tonsillectomy is a viable treatment option for patients with PFAPA syndrome.

A review of the antimicrobial activity of clavulanate.

Clavulanate is a broad-spectrum beta-lactamase inhibitor, with activity against many of the chromosomally and plasmid-mediated beta-lactamases of both Gram-positive and Gram-negative bacteria. Although clavulanate has minimal antibacterial activity in vitro, accumulating evidence suggests that it may have an effect on pathogenic bacteria regardless of beta-lactamase production. Like other beta-lactams, clavulanate has been shown to bind to penicillin-binding proteins (PBPs) in Gram-positive and Gram-negative bacteria. It was found to bind selectively to PBP3 in Streptococcus pneumoniae. It has been suggested that complementary binding to different PBPs and subsequent effects on autolysis contribute to the enhancement of the activity of other beta-lactams by clavulanate. In addition, co-amoxiclav has been shown to enhance the intracellular killing functions of human polymorphonuclear cells (PMNs) in studies undertaken with beta-lactamase-producing and non-beta-lactamase-producing strains of bacteria. These data from in vitro and cell culture systems have been reflected in vivo, where clavulanate enhanced the activity of amoxicillin against non-beta-lactamase-producing organisms. Further studies are required to determine whether the effects seen within in vitro and in vivo animal studies have clinical significance.