Infections in immunosuppressed children]

Children undergoing transplantation or treatment for cancer have periods with severe immunosuppression; hence they are very susceptible to infections. A bacterial infection can rapidly become life threatening, and it is crucial to promptly start antibiotic treatment.The background for this article is a two-day discussion among Norwegian paediatricians about infections in immunosuppressed children. In addition we have reviewed the literature by searches in PubMed, reference books and international guidelines.When a neutropenic patient becomes febrile, one should quickly do a thorough clinical examination, secure relevant microbiological samples, and start treatment with broad-spectrum antibiotics. As standard treatment for Norwegian children we recommend a combination of intravenous ampicillin and gentamicin. Patients who have clinical signs of septic shock should be given cefotaxime and gentamicin. If they get worse or show no signs of recovery after 3 to 5 days, a change to monotherapy with cefotaxime is recommended. Patients already treated with cefotaxime should be switched to meropenem, possibly in combination with vancomycin. Antifungal and/or anti-anaerobic treatment should also be considered.