Terapi Pediatric

Kejang Demam

Meningitis
Pathophysiology : Bacteria gain entry to the CSF through the choroid plexus of the lateral
ventricles and the meninges and then circulate to the extracerebral CSF and subarachnoid space.
Bacteria rapidly multiply because the CSF concentrations of complement and antibody are
inadequate to contain bacterial proliferation
Therapy:
-Antibiotic
- Corticosteroid : intravenous dexamethasone, 0.15 mg/kg/dose given every 6 hr for 2 days,

Rheumatic Fever

Therapy:
-

Bed rest
Aspirin
Prednisolone
Benzylpenicilline (25mg/kg IM or IV)
Sydenhams chorea : prednisolone (2 mg/kg/day) 4 weeks; then taper.

Encephalitis
HSV Encephalitis : intravenous acyclovir (10 mg/kg every 8 hr given over a 1 hr infusion for
1421 days). Treatment for increased intracranial pressure, management of seizures, and
respiratory compromise may be required. (Nelson 18th edition)
Bronkopneumonia
Pathogenesis:
Viral pneumonia results from spread of infection along the airways, accompanied by direct
injury of the respiratory epithelium, resulting in airway obstruction from swelling, abnormal
secretions, and cellular debris. The small caliber of airways in young infants makes them
particularly susceptible to severe infection. Atelectasis, interstitial edema, and ventilationperfusion mismatch causing significant hypoxemia often accompany airway obstruction.
Bacterial infection is established in the lung parenchyma, the pathologic process varies
according to the invading organism. M. pneumoniae attaches to the respiratory epithelium,
inhibits ciliary action, and leads to cellular destruction and an inflammatory response in the
submucosa. As the infection progresses, sloughed cellular debris, inflammatory cells, and mucus
cause airway obstruction, with spread of infection occurring along the bronchial tree, as it does
in viral pneumonia.
Therapy:
-

For mildly ill children who do not require hospitalization, amoxicillin

In communities with a high percentage of penicillin-resistant pneumococci, high doses of

amoxicillin (8090 mg/kg/24 hr

For school-aged children and in those in whom infection with M. pneumoniae or C.

pneumoniae (atypical pneumonias) is suggested, a macrolide antibiotic such as
azithromycin is an appropriate choice.

The empirical treatment of suspected bacterial pneumonia in a hospitalized child

Parenteral cefuroxime (150 mg/kg/24 hr), cefotaxime, or ceftriaxone is the mainstay of
therapy when bacterial pneumonia is suggested.

If clinical features suggest staphylococcal pneumonia (pneumatoceles, empyema), initial

antimicrobial therapy should also include vancomycin or clindamycin.
(Nelson 18th edition)

Eritromisin(250mg/ml; 2,5ml/6H PO if 2 years, 5ml/6H co-amoxiclav 5 hari

Amoxicillin <40mg/kg/12H (max 4g/day);

Once daily : Azithromycin 10mg/kg/PO ac 3x a week; gentamicin 7mg/kg/once daily +

ampicillin 50mg/kg/6H
(Clinical Specialitis)

Diare
Diare akut

(Nelson 18th Edition)

Diare Kronik

Sindroma Nefrotik
-

Severe symptomatic edema, including large pleural effusions, ascites, or severe genital
edema, should be hospitalized

Diuresis may be augmented by administration of chlorothiazide (10 mg/kg/dose IV every

12 hr) or metolazone (0.1 mg/kg/dose PO bid) followed by furosemide 30 min later (12
mg/kg/dose IV q 12 hr).

when fluid restriction and parenteral diuretics are not effective IV administration of
25% human albumin (0.5 g/kg/dose q 612 hr administered over 12 hr) followed by
furosemide (12 mg/kg/dose IV)

In children with presumed MCNS, prednisone should be administered (after confirming a

negative PPD test) at a dose of 60 mg/m2/day (maximum daily dose, 80 mg divided into
23 doses) for at least 4 consecutive weeks, after 6 weeks tapering of to 40 mg single
morning dose.

Konstipasi
Tatalaksana: (Pedoman Pelayanan Medis Anak IDAI)
-

Edukasi kepada orang tua

Pembersihan skibala:
1.
obat oral
Obat oral : mineral oil, larutan polietilen glikol, laktulosa, sorbitol.
Mineral oil (paraffin liquid) 15-30 m;/tahun (maks 240 ml sehari) kecuali pada bayi.
Larutan polietilen glikol (PEG) 20 ml/kg/jam (maksimum 1000ml/jam) diberikan dengan
pipa nasogastrik selama 4 jam per hari.
2.
Obat rectal
Enema fosfat hipertonik (3ml/kg BB 1-2 kali sehari maksimum 6 kali enema), enema
garam fisiologis (600-1000 ml) atau 120 ml mineral oil. Pada bayi digunakan
supositoria/enema gliserin 2-5ml, program evakuasi tinja dilakukan selama 3 hari
berturut-turut agar evakuasi tinja sempurna.
Terapi rumatan:

Demam Tifoid

Tata laksana :
(Pedoman Pelayanan Medis IDAI)

Antibiotik
Kloramfenikol (drug of choice) 50-100 mg/kgbb/hari, oral atau IV, dibagi dalam 4 dosis
selama 10-14 hari
Amoxicillin 100 mg/kgbb/hari, oral atau intravena selama 10 hari
Cotrimoxazole 6 mg/kgbb/hari, oral selama 10 hari
Ceftriaxone 80 mg/kgbb/hari, oral selama 10 hari
Cefixime 10mg/kgbb/hari, oral dibagi dalam 2 dosis selama 10 hari

-Kortikosteroid diberikan pada kasus berat dengan gangguan kesadaa: dexametason 1-3
mg/kgbb/hari intravena, dibagi 3 dosis hingga kesadaran membaik
(Nelson 18th)
-

Adequate res, hydration, and attention are important to correct fluid-electrolyte

imbalance.
Antipyretic therapy (acetaminophen 120750 mg every 46 hr PO) should be provided as
required

A soft, easily digestible diet should be continued unless the patient has abdominal
distention or ileus.
Antibiotic therapy is critical to minimize complications

Demam Berdarah Dengue

Tatalaksana Demam Berdarah Dengue pada Anak
Tatalaksana Demam Berdarah Dengue tanpa syok Anak dirawat di rumah sakit
-

Berikan anak banyak minum larutan oralit atau jus buah, air tajin, air sirup, susu, untuk

mengganti cairan yang hilang

Berikan parasetamol bila demam.
Berikan infus sesuai dengan dehidrasi sedang:
1) Berikan hanya larutan isotonik seperti Ringer laktat/asetat
2) Kebutuhan cairan parenteral
Berat badan < 15 kg : 7 ml/kgBB/jam
Berat badan 15-40 kg : 5 ml/kgBB/jam
Berat badan > 40 kg : 3 ml/kgBB/jam

Pantau tanda vital dan diuresis setiap jam, serta periksa laboratorium (hematokrit,
trombosit, leukosit dan hemoglobin) tiap 6 jam

Apabila terjadi penurunan hematokrit dan klinis membaik, turunkan jumlah cairan secara
bertahap sampai keadaan stabil. Cairan intravena biasanya hanya memerlukan waktu 24

48 jam sejak kebocoran pembuluh kapiler spontan setelah pemberian cairan

Apabila terjadi perburukan klinis berikan tatalaksana sesuai dengan tatalaksana syok
terkompensasi (compensated shock).

Tatalaksana Demam Berdarah Dengue dengan Syok

-

Berikan oksigen 2-4L/menit secara nasal. Berikan 20 ml/kg larutan kristaloid seperti

Ringer laktat/asetat secepatnya.

Jika tidak menunjukkan perbaikan klinis, ulangi pemberian kristaloid 20ml/kgBB
secepatnya

(maksimal

30 menit) atau pertimbangkan

pemberian koloid

10-

20ml/kgBB/jam maksimal 30 ml/kgBB/24 jam.

Jika tidak ada perbaikan klinis tetapi hematokrit dan hemoglobin menurun pertimbangkan

terjadinya perdarahan tersembunyi; berikan transfusi darah/komponen.

Jika terdapat perbaikan klinis (pengisian kapiler dan perfusi perifer mulai membaik,
tekanan nadi melebar), jumlah cairan dikurangi hingga 10 ml/kgBB/jam dalam 2-4 jam

dan secara bertahap diturunkan tiap 4-6 jam sesuai kondisi klinis dan laboratorium.
Dalam banyak kasus, cairan intravena dapat dihentikan setelah 36-48 jam.

Bronkiolitis
Nebulized salbutamol (0,15mg/kg) 15 menit kemudian Dexametason 0,6 mg/kg IM
Asma
Step 1: Occasional -agonist via pMDI. If needed >~ 3x/week, add step 2 (also if >5 year and
many exacerbations, or asthma wakes from sleep > once/week)
Step 2 : Add inhaled steroid, eg: beclometasone: specifity brand. As potencies vary : Clenil
Modulite 50g is a lover-potency CFC-free inhaler, Qyar 50 g (CFC free) is high potency. Use
up to 200g of Clenile/12h
Step 3 : Review diagnosis; check inhaler use/concordane; eliminate triggers, monitor height. If
< 5 yrs Add 1 evening doses montelukast 4mg as a mouth-dissolving capsule. If > 5 yrs: Add
inhaled salmeterol 50/12h (long acting agonist); monitor closely; stop if no help. If
symptomatic inhaled steroid and try montelukast 5mg or theofilin, eg SloPhyllin 125-250
mg/12h PO if 6-12 years.
Step 4 : Refer to specialist (CXR), inhaled steroid (Clinile 400g/12h)
Step 5: Add prednisolone (if > 5 yrs) at lowest dose that work
Dose example : agonists : Salbutamol 100 g via pMID as needed, with spacer.
Anti muscarinic : Ipratropium 20g/8h by aerosol if ~ 6 yrs old; 40g/8h if older

Treating severe asthma : give these treatment if the above life threatening signs are present, or if
not improving 15-30 min after Px starts.

Paten Ductus Arteriosus

Therapy:
-Dexamethason in preterm labour help close PDAs
-Ibuprofen 10mg/kg slow IV, then 5 mg/kg after 24 and 48 hr
-Surgical or catheter closure
Dehidrasi

(Nelson 18th)