DRUG THERAPY REVIEW OF SEPSIS IN

PEDIATRICS

(CASE STUDY)
Presenter: Pharm. Khulsum Mas’ud
Preceptor: Pharm. Grace Ogwuche
WUSE DISTRICT HOSPITAL PHARMACY.
 OUTLINES
Introduction
Epidemiology
Pathophysiology
Risk factors
Prevalence of Sepsis
Stages and Diagnosis of sepsis
Complications and Prognosis
National guideline
Drug treatment in sepsis
Case study
References
OBJECTIVES
INTRODUCTION
Sepsis is the severe inflammation
caused by the body’s extreme response
to an infection and triggers a chain of
reaction in the body (tissue damage and
organ failure).
Sepsis is a life-threatening reaction to
an infection.

It happens when the immune system

overreacts to an infection and starts to
damage your body's own tissues and
organs.
 INTRODUCTION
Pediatric sepsis can be caused by various types of
infections, such as bacterial, viral, or fungal infections,
and it can progress rapidly, causing organ damage and
failure.
Early recognition and treatment of pediatric sepsis are
critical for the best possible outcome, as delays in
diagnosis and treatment can lead to severe complications
and even death.
 INTRODUCTION
In this context, understanding the signs and symptoms of
pediatric sepsis, as well as the available diagnostic and
treatment options, is essential for healthcare providers, parents
and caregivers to ensure the timely identification and
management of this condition.
The infection that leads to sepsis could originate from
anywhere but most common sites are lungs, urinary tract, skin
or gastrointestinal tract (CDC, 2019).
Sepsis is a medical emergency
 EPIDEMIOLOGY
Sepsis affects approximately 1.7 million adults in the United
States each year and potentially contributes to more deaths
(Rhee et al 2022)
Sepsis or infection causing sepsis starts before a patient goes to
the hospital in nearly 87% of cases (CDC, 2019).
AFRICA: Estimated 1 million cases in Africa and 250,000
deaths each year. Factors that influence epidemiology in Africa:
poor hygiene, inadequate sanitation, malnutrition and high
burden of infectious diseases (global health report, 2020).
 EPIDEMIOLOGY
NIGERIA
The epidemiology of pediatric sepsis in Nigeria is not well
documented. But a study by Dedeke et al found that sepsis
had a mortality rate of 36% among Nigerian children
(dedeke et al, 2017).
Bwari General hospital
The prevalence of sepsis in pediatric ward in the month of
May, 2024 is 30%. so, for every 10 admission at least 3 are
sepsis cases.
 RISK FACTORS
Children younger than one
People with weakened immune system
Chronic medical conditions such as diabetes, lung
disease, cancer and kidney disease.
People with recent severe illness or hospitalization
People who survived sepsis
Age 65 or older
PREVALENCE OF SEPSIS
 STAGES OF SEPSIS
1st Stage: the micro-organism gets into the blood stream
and causes inflammation in the body.
2nd Stage: the micro-organism multiplies and colonize an
organ.
3rd Stage: infection starts affecting organ function.
 Septic shock
Septic shock: A dangerously low blood pressure
(hypotension) that may result from sepsis or infection
This can occur through the action of a bacterial cell walls
called endotoxins.
Endotoxins release inflammatory mediators (systemic
inflammatory response) causing vasodilation, weakening of
blood vessels & increase capillary permeability leading to
↓blood volume & low BP
Mortality associated with septic shock is very high (50-70%)
 SEPSIS CRITERIA FOR DIAGNOSIS
There are 2 sets
1. SYSTEMIC INFLAMMATORY RESPONSE
SYNDROME (SIRS)
When patients meet 2 or more of the following:
Fever > 100.4°F (38°C)
Heart Rate of more than 90 beats per minute
Respiratory rate above 20 breaths per minutes
Abnormal WBC count
 DIAGNOSIS contd
2. quick SEQUENTIAL ORGAN FAILURE ASSSESMENT
(qSOFA)
Low BP < 100mmHg SBP
Increased Respiratory Rate above 22 breaths per minute
Glasgow coma scale score of 14 or lower, to determine
level of consciousness.
 COMPLICATIONS
Kidney failure
Tissue death (gangrene)
Permanent lung damage from acute respiratory distress
syndrome
Permanent brain damage
Damage to heart valves
SEPTIC SHOCK
DEATH
 PROGNOSIS
The mortality rate for severe sepsis pediatrics is about 35%
(Shankar et al, 2024)
Among those who survive, about 50% deal with long-term
effects of the illness, such as insomnia, muscle or joint pain,
fatigue, decreased cognitive function and poor concentration
(Valencia et al, 2022)
Because it takes time for immune system to strengthen after
sepsis, there’s risk of recurrence.
 GUIDELINES FOR HIGH RISK
CHILDREN
BEHAVIOR
No response to social cues
Appears ill to a healthcare professional
Does not wake, or if roused does not stay awake
weak high-pitched or continuous cry
 GUILDELINES CONTINUE
HEART RATE
Aged under 1 year: 160 beats per minute or more
Aged 1–2 years: 150 beats per minute or more
Aged 3–4 years: 140 beats per minute or more.
 Guidelines contd
Respiratory rate
Aged under 1 year: 60 breaths per minute or more
Aged 1–2 years: 50 breaths per minute or more
Aged 3–4 years: 40 breaths per minute or more
Cyanosis of skin, lips or tongue
Rash of skin

Temperature
Aged under 3 months: 38°C or more
 Drug treatment in pediatric sepsis
Neonates and infants of 6-8 weeks,
 1st line: Beta lactam and Aminoglycoside e.g Ampicillin and
Gentamycin.
 2nd line: Beta lactam and Cephalosporins e.g Ampicillin and
ceftriaxone
Older infants and Children
 3rd generation Cephalosporins and Vancomycin
 3rd generation Cephalosporins and Clindamycin if S. aureus is
present
 Management of septic shock
1.Find the source of the infection

2. Broad spectrum agents before culture (eg I.V. Cefriaxone)

3. I.V fluids (N/S, Ringers lactate)

4. Plasma expanders (albumin)

5. Vasoconstrictors e.g Vasopressin

6. Maximize O2 delivery
 CASE STUDY
A.G was apparently well until 14 days ago when the mother
noticed a small swelling on the ear, the swelling
progressively increased in size and became reddish, non-
discharging and painful, then progressed to cough, cattarh,
fever. No stooling, no vomiting.

DEMOGRAPHY: A.G is a 2month old female, who is the

first daughter of her parents.
 PATIENT HISTORY
HISTORY OF PRESENT ILLNESS
Presented with ear swelling, pain.
Intermittent fever with chills and rigors for 10 days
Persistent crying and restlessness for 3days
 PAST MEDICAL HISTORY
Allergic history: Nil
Social history: Nil
Previous medications: Nil
 PRENATAL, POSTNATAL &
ANTENATAL HISTORY
Pregnancy was desired and spontaneously achieved.
She had complete ANC
Blood measurements: BP, RBC, WBC were normal
Mother does not know HIV, HbsAg & HCV status
Received TT in 4 months and 5 months of pregnancy.
Doesn’t know if she received IPT
Mother was on herbal medicine on the first trimester
without knowing her pregnancy status.
A.G cried immediately after delivery
Birth time cannot be remembered
No fever, pain or bleeding after postnatal
A.G developed jaundice and was exposed to the sun for 3
days.
NUTRITIONAL HISTORY
A.G was breast fed after delivery.
Presently A.G is on fortified pap, cerelac and breast
milk
 OBJECTIVE DATA
PHYSICAL EXAMINATION
A.G is looking chronically ill and in severe pain.
The ears were swollen and covered with plaster
A.G is persistently coughing, has cattarh
REVIEW OF SYSTEM
CNS: persistent fever, lethargy.
Respiratory system: cough, noisy breath, faint breathing,
Digestive system: bloody stool, dark colored stool and
constipation
CVS: difficulty in breathing, low diastolic (hypotension)
 LABORATORY INVESTIGATIONS
Weight: 6.8kg, temp: 39.1°C, SPO2 : 96%
PCV: 31 (34 - 45)
WBC: 197 X 109 (155 - 467x 109)
Neu: 32 x 109
Hb: 10.1 g/L (13.8 – 17.2 gm/dL)
RBC: 4.12 X 1012 (male: 4.7 – 6.1, female: 4.2 -5.4 x
1012)
Hematocrit : 28.1% (32% - 42%)
MCV: 68.5 (80 – 95 femtoliter)
MCH: 21.3g (27 to 31 pg/cell)
MCHC: 33gm/dL (32 – 36 gm/dl)
Platelet count: 253 x 103 (150-450 X 103)
Malaria Parasite:++
Ear swab : Gram + cocci
 ASSESSMENT
 Sepsis
 Malaria
 Otitis Media
 PLAN
S/N MEDICATION CLASS RATIONALE REMARK DOSAGE
1 Normal saline Plasma Electrolyte - 1L
expander imbalance
2 Kofol cough Cough syrup continue 2.5mls tds 5/7
syrup
3 Syrup ibuprofen NSAID Pain, continue 5mls tds 3/7
hyperthemia
4 I.V clindamycin Lincomycin Bacterial stop qds
antibiotics infection
5 Cefixime cephalosporin Bacterial continue 36mg bd 7/7
infection
6 Syrup Vitamin C Mineral Strengthen Continued 5mls bd 7/7
immune system after discharge
7 ACT20/120 Artemeter/ Antimalarial - 10mg/kg/day
lumefantrin
 PLAN
S/N MEDICATION CLASS RATIONALE REMARK DOSAGE
1 IV Amoxicillin Beta Antibacterial continue 3.9mls bd
and clavulanic lactam
acid 457mg
2 Cefixime Cephalosp Bacterial continue 36mg bd
orin infection 7/7
 DRUG THERAPY REVIEW
Drug interation between Antimalarial and Vitamin C
There is no contraindications between lincosamide and
cephalosporine class of antibiotic.
Vitamin C does not react with clindamycin and ceftriaxone
antibiotics but recent studies have advice against the
concomitant use.
Kofol cough syrup is a herbal medication containing
liquorice, turmeric and ginger.
Clindamycin was switched to Amoxiclav as they are 1 st line
in Otitis media.
 GOAL OF THERAPY
Restore fluid and electrolyte imbalance
Reduce pain, fever and associated discomfort
Eradicate causative organism
Prevent complications and reoccurrence
To improve quality of life
To reduce morbidity and mortality accord to sepsis.
 CARE PLAN
To encourage A.G care giver to continue to adhere to
her medications
To closely monitor A.G therapeutic outcomes and
advice for workout test as prone to sepsis.
Consistent check of blood volume and electrolyte levels
Refer patient to ENT examination.
 Non-pharmacological Treatment
Educate A.G caregiver on the knowledge of disease and
their comorbidity
Educating the care giver on the need for a healthy
environment and proper hygiene
To ensure A.G sleeps in treated mosquito net
Educate A.G care giver on the need for adherence to
medication
Vaccination
Advise Care giver to monitor A.G to avoid oral contamination
from sucking her hands
A.G caregiver should ensure proper hygiene when preparing
and giving her food
Advise A.G care givers to be cautious while bathing her to
avoid water entering the ears.
Ensure the antibiotics are taken at the right dosage, appropriate
interval, and appropriate storage conditions
Vitamin C syrup should be taken after the antimalarial
treatment.
 ROLE OF PHARMACIST IN TREATMENT OF SEPSIS
 Initial Assessment and Rapid Antimicrobial Therapy
Pharmacists assist in selecting the appropriate empiric antibiotics, considering factors such as suspected
source of infection, patient history, and local resistance patterns. .

 Therapeutic Drug Monitoring (TDM)

Pharmacists should provide TDM, adjusting doses to achieve optimal therapeutic levels without causing
toxicity, especially in patients with sepsis-related organ dysfunction.

 Antimicrobial Stewardship
Pharmacists help streamline or de-escalate antibiotic therapy to more targeted agents. This reduces
broad-spectrum antibiotic use, minimizes side effects, and decreases the risk of antimicrobial resistance.

 Monitoring for Adverse Drug Reactions and Toxicities

Pharmacists monitor for potential side effects and toxicity, especially from antibiotics, sedatives,
analgesics, and anticoagulants, adjusting dosages as needed.
CONCLUSION
 REFERENCES
Center for disease controll and prevention, CDC. (2019).Sepsis: Defination,
trearment, signs and symptims. Dio:https://www.cdc.gov/sepsis/what-is-
sepsis.html
Dedeke, I., Arowosegbe, A., Shittu, O., Ojo, D., & Akingbade, O. (2017).
Neonatal sepsis in a Nigerian tertiary hospital: clinical features, clinical
outcome, aetiology and antibiotic susceptibility pattern. Southern African
Journal of Infectious Diseases, 32(4), 127-131.
Global health report. (2020).Global report on the epidemiology and burden
of sepsis: Current evidence, identifying gaps and future directions. 231:12
National institute for health and care excellence, NICE. (2017). Guidelines
for management and diagnosis of sepsis Dio:
https://www.nice.org.uk/guidance/ng51/chapter/Recommendations
National journal of clinical practice (2017). Infection burden and prevalence

pattern in Nigeria. 5:44-49.

Valencia. H, & Jane. Y.S. (2022). Sepsis: symptoms, diagnosis and prognosis.

Everydayhealth .

Rhee C, Dantes R, Epstein L, et al; CDC Prevention Epicenter Program.

Incidence and trends of sepsis in US hospitals using clinical vs claims data,

2009-2022 JAMA. 2017;318(13):1241-1249.