What is the recommended treatment and prophylaxis for salmonella lymphadenitis associated with congenital Interleukin (IL) deficiency in an 8-year-old child weighing 22kg?

From the Guidelines

For an 8-year-old child weighing 22kg with salmonella lymphadenitis associated with congenital IL deficiency, the recommended treatment includes a prolonged course of antibiotics with trimethoprim-sulfamethoxazole (TMP-SMX) at 8-12mg/kg/day of the TMP component divided twice daily, as it is the drug of choice for preventing recurrence of Salmonella septicemia in immunocompromised children 1. The choice of antibiotic is crucial in this case, and while ciprofloxacin may be considered, its use should be cautious and only if no alternatives exist, due to potential side effects and resistance issues 1.

• Alternative antibiotics include ampicillin or chloramphenicol if the organism is susceptible, but fluoroquinolones like ciprofloxacin should be used with caution 1.
• For severe infections, initial intravenous therapy with ceftriaxone (50-75mg/kg/day) or cefotaxime (150-200mg/kg/day divided every 6-8 hours) may be necessary before transitioning to oral antibiotics.
• Long-term prophylaxis is essential after completing treatment, typically using TMP-SMX (5mg/kg/day of TMP component) given daily, to prevent recurrence of Salmonella septicemia 1.
• Regular monitoring of liver function, complete blood count, and renal function is necessary during treatment.
• Surgical drainage may be required for suppurative lymph nodes. This aggressive approach is necessary because children with IL deficiencies have impaired immunity against intracellular pathogens like salmonella, making infections more severe and recurrent 1.
• Immunological consultation is crucial, and adjunctive therapy with recombinant human interferon-gamma may be beneficial in specific IL deficiencies to enhance macrophage killing of intracellular pathogens.

From the FDA Drug Label

For the treatment of serious miscellaneous infections other than meningitis, the recommended total daily dose is 50 to 75 mg/kg, given in divided doses every 12 hours. The total daily dose should not exceed 2 grams Pediatric patients For the treatment of skin and skin structure infections, the recommended total daily dose is 50 to 75 mg/kg given once a day (or in equally divided doses twice a day). The usual duration of therapy is 7 to 14 days

The recommended treatment for salmonella lymphadenitis associated with congenital Interleukin (IL) deficiency in an 8-year-old child weighing 22kg is 50 to 75 mg/kg of ceftriaxone per day, given in divided doses every 12 hours, with a maximum daily dose of 2 grams. The usual duration of therapy is 7 to 14 days. 2

From the Research

Treatment for Salmonella Lymphadenitis

• The recommended treatment for salmonella lymphadenitis associated with congenital Interleukin (IL) deficiency is not directly stated in the provided studies. However, based on the available evidence, ceftriaxone therapy may be effective in treating salmonella infections, including those with extraintestinal complications such as lymphadenitis 3, 4, 5, 6.
• A study published in 1997 found that ceftriaxone treatment resulted in a significant reduction in the rate of clearance of Salmonella from stools in children with non-typhoid Salmonella enterocolitis 3.
• Another study published in 2000 highlighted the emergence of ceftriaxone-resistant Salmonella strains, which is a concern for public health, especially in children 7.
• Ceftriaxone has been shown to be effective in treating multidrug-resistant Salmonella osteomyelitis, with a case report published in 1987 demonstrating successful treatment with prosthesis removal and once-daily ceftriaxone 4.
• Randomized treatment studies have compared ceftriaxone to chloramphenicol in patients with typhoid fever, with results suggesting that ceftriaxone may be a promising alternative to traditional treatments 5, 6.

Prophylaxis for Salmonella Lymphadenitis

• There is limited information available on prophylaxis for salmonella lymphadenitis associated with congenital Interleukin (IL) deficiency.
• However, it is essential to note that the use of antibiotics, including ceftriaxone, should be judicious and based on the severity of the infection and the risk of complications 3, 7.
• Further studies are needed to determine the efficacy and safety of ceftriaxone and other antibiotics in preventing salmonella lymphadenitis in children with congenital Interleukin (IL) deficiency.

Considerations for Treatment in an 8-year-old Child Weighing 22kg

• The dosage of ceftriaxone for an 8-year-old child weighing 22kg would depend on the severity of the infection and the recommended dosage regimen.
• According to the studies, ceftriaxone dosages ranging from 50 to 75 mg/kg per day have been used in children with salmonella infections 3, 5, 6.
• It is crucial to consult with a healthcare professional to determine the appropriate treatment and dosage regimen for the child.