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Vancomycin reactions in preterm infants
334
Editorial correspondence
REFERENCES
1.
Borkowsky W, Steele C J, Grubman S, Moore T, La Russa P, Krasinski K. Antibody responses to bacterial toxoids in children infected with human immunodeficiency virus. J PEDXATR 1987;110:563-6. 2. Krasinski K, Borkowsky W, Krugman S. Antibody following measles immunization in children infected with human T-cell lymphotropic virus-type III/lymphadenopathy associated virus (HTLV-III/LAV). Paris: International Conference on Acquired Immunodeficiency Syndrome, June 23-25, 1986. 3. Centers for Disease Control. Recommendation of the Immunization Practices Ad'~isory Committee (ACIP): Immunization of childre~n infected with human T-lymphotropic virus type III/lymphadenopathy-associated virus. M M W R 1986;35:595-8,603-6. 4. Committee on Infectious Diseases. Health guidelines for the attendance in day-care and foster care settings of children int'ected with human immunodeficiency virus. Pediatrics 1987;79:466-71.
Reply To the Editor: The comments of Onorato and Orenstein are well taken. We agree that the impaired responses to vaccines by some children infected with the human immunodeficiency virus (HIV) should not dissuade those individuals cacing for them from immunizing them.-In fact, although we were pessimistic about the likelihood that HIV-infected children would respond to inactivated polio vaccine (IPV), our initial finding of protective levels Of antibody in three of three individuals immunized with IPV is heartening? Nevertheless, further studies concerning the efficacy and safety of routine vaccination in HIV-infected children are necessary. Until that time, a useful caveat is not to assume that such vaccinated children are truly protected from disease. William Borkowsky, MD Associate Professor of Pediatrics Director, Infectious Disease Unit New York University Medical Center New York, N Y 10016
The Journal of Pediatrics February 1988
REFERENCES
1.
Krasinski K, Borkowsky W. Response to polio vaccination in children infected with human immunodeficiency virus [abstract]. Pediatr Res 1987;22:925A.
Vancomycin reactions in preterm infants To the Editor." I read with interest the article by Lacouture et al. (J PEDIATR 1987; 111:615-6), describing hypotension and rash in two neonates after vancomycin infusion. The authors suggest that decreasing the rate of infusion should decrease the risk of vancomycininduced side effects. Both infants were prematurely born, after 34 and 31 weeks gestation, and each received the recommended 15 mg/kg per dose. Recent data, however, support the use of 10 mg/kg every 12 hours for preterm infants <36 weeks gestation. I New evidence in adults indicates that lower individual doses of vancomycin may decrease the incidence of the "red neck" syndrome. 2 1 propose consideration of reduction of individual pediatric doses, as well as rate of infusion, to reduce the risk of adverse reactions to vancomycin. Leslie L. Barton, MD Associate Professor Department of Pediatrics/Pediatric Infectious Diseases St. Louis University School of Medicine St. Louis, MO 63103 REFERENCES
1. Reed, MD, Kliegman RM, Weiner JS, Huang M, Yamashita TS, Blumer JL. The clinical pharmacology of vancomycin in seriously ill preterm infants. Pediatr Res 1987;22:360-3. 2. Hermans PE, Wilhelm MP. Vancomycin. In: Symposium on Antimicrobial Agents. II. Mayo Ctin Proc 1987;62:901-29.
Editorial correspondence
REFERENCES
1.
Borkowsky W, Steele C J, Grubman S, Moore T, La Russa P, Krasinski K. Antibody responses to bacterial toxoids in children infected with human immunodeficiency virus. J PEDXATR 1987;110:563-6. 2. Krasinski K, Borkowsky W, Krugman S. Antibody following measles immunization in children infected with human T-cell lymphotropic virus-type III/lymphadenopathy associated virus (HTLV-III/LAV). Paris: International Conference on Acquired Immunodeficiency Syndrome, June 23-25, 1986. 3. Centers for Disease Control. Recommendation of the Immunization Practices Ad'~isory Committee (ACIP): Immunization of childre~n infected with human T-lymphotropic virus type III/lymphadenopathy-associated virus. M M W R 1986;35:595-8,603-6. 4. Committee on Infectious Diseases. Health guidelines for the attendance in day-care and foster care settings of children int'ected with human immunodeficiency virus. Pediatrics 1987;79:466-71.
Reply To the Editor: The comments of Onorato and Orenstein are well taken. We agree that the impaired responses to vaccines by some children infected with the human immunodeficiency virus (HIV) should not dissuade those individuals cacing for them from immunizing them.-In fact, although we were pessimistic about the likelihood that HIV-infected children would respond to inactivated polio vaccine (IPV), our initial finding of protective levels Of antibody in three of three individuals immunized with IPV is heartening? Nevertheless, further studies concerning the efficacy and safety of routine vaccination in HIV-infected children are necessary. Until that time, a useful caveat is not to assume that such vaccinated children are truly protected from disease. William Borkowsky, MD Associate Professor of Pediatrics Director, Infectious Disease Unit New York University Medical Center New York, N Y 10016
The Journal of Pediatrics February 1988
REFERENCES
1.
Krasinski K, Borkowsky W. Response to polio vaccination in children infected with human immunodeficiency virus [abstract]. Pediatr Res 1987;22:925A.
Vancomycin reactions in preterm infants To the Editor." I read with interest the article by Lacouture et al. (J PEDIATR 1987; 111:615-6), describing hypotension and rash in two neonates after vancomycin infusion. The authors suggest that decreasing the rate of infusion should decrease the risk of vancomycininduced side effects. Both infants were prematurely born, after 34 and 31 weeks gestation, and each received the recommended 15 mg/kg per dose. Recent data, however, support the use of 10 mg/kg every 12 hours for preterm infants <36 weeks gestation. I New evidence in adults indicates that lower individual doses of vancomycin may decrease the incidence of the "red neck" syndrome. 2 1 propose consideration of reduction of individual pediatric doses, as well as rate of infusion, to reduce the risk of adverse reactions to vancomycin. Leslie L. Barton, MD Associate Professor Department of Pediatrics/Pediatric Infectious Diseases St. Louis University School of Medicine St. Louis, MO 63103 REFERENCES
1. Reed, MD, Kliegman RM, Weiner JS, Huang M, Yamashita TS, Blumer JL. The clinical pharmacology of vancomycin in seriously ill preterm infants. Pediatr Res 1987;22:360-3. 2. Hermans PE, Wilhelm MP. Vancomycin. In: Symposium on Antimicrobial Agents. II. Mayo Ctin Proc 1987;62:901-29.