Prescribed amikacin injection. Having fever. Suggested to stop amikacin and give advent drops. Guide?

Posted on Mon, 21 Oct 2013 in Child Health
Question: my 11 month old daughter was prescribed amikacin injection for 5 days by our paed. she was having fever and had a high blood count of 0000. we wer enot sure if this was correct treatment. after taking 3 doses we had gone for a 2nd opinion. the new doctor advised us to stop amikacin and give advent drops for 2 days and then do further investigations. as per him blood count only is not sufficient to go for amikacin and it shoudl be investigated further. Our old doctor had insisted that to complete for 5 and not stop at 3 days and told us it might relapse etc. We are thoroughly confused on what should be the correct decision. pla respond asap
Answered by Dr. E Venkata Ramana 37 minutes later
Brief Answer:
Re-examination & tests to know focus of infection.

Detailed Answer:

Thank you for your query on Healthcare Magic.

Fever with high white cell count of 0000 is suggestive of some bacterial infection like most common being throat infection, middle ear infection, or bacterial sepsis.

My advise is to look for focus of bacterial infection by examination and further investigations like complete urine examination, urine for culture and sensitivity, CRP, and blood cultures.

If the clinical examination is suggestive of throat infection or middle ear infection, then, the complete course of Advent antibiotic is sufficient as prescribed.

But if the reports are suggestive of presence of urinary tract infection, then amikacin injection to be continued in addition to Advent.

And if there is any positive blood or urine culture report the antibiotic can be modified depending on the sensitivity report.

Therefore I suggest you to consult your pediatrician for reassessment to look for the focus of infection and to investigate the child with appropriate investigations to know the site of infection.

Hope I have answered your query, if you have any clarification please let me know.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. E Venkata Ramana 23 hours later
Thank you Doctor for the response. In fact your response is in line with the 2nd opinion we had solicited. He has suggested to do all blood, urine tests, culture etc - as you have advised - we have already given the samples yesterday - We are expecting results on Monday.

Meanwhile yesterday we were under tremendous stress and confusion - Problem is our original doctor had scared us by saying if we discontinue Amikacin, then it might relapse and this has happened due to drug resistance and we should continue for 5 injections. We were thoroughly confused and reached out again to the 2nd Doctor over phone and asked if we can complete the course - he suggested if we want to - then we can go ahead and complete the course of 5 Amikacin injections - and its not harmful. I went and discussed this our original paed. He agreed to stop Monocef Injection 750 - (which was also been given with Amikacin 500 - through IV line). Hence we removed the IV line which was a great relief for my 11 month old daughter.

But as he again suggested to continue with Amikacin for 2 more days - and we were left with no option ( I had also not got this response from you by then) - we agreed to complete Amikacin and gave it yesterday by a simple prick injection. Today again I will be going for final dose of Amikacin. Also he suggested to give Ziprax-50 syrup 3.5 ml morning and 2.5 ml in evening for 5 days - which we are giving.

We did not give Advent as advised by 2nd Doc, as we were not sure if it can be given with Amikacin and we could not reach out to the 2nd Doc again for advisement - and it was already night - and we had to give some medication.

We have decided to complete this treatment phase - which thankfully ends today - syrup will end on Monday - and then plan to seek further advisement from 2nd doctor after all reports come in on Monday

Please let me know if whatever we have done is OK and

1 - if Amikacin of 2 more doses is fine and if Amikacin itself is not going to create any problems for my daughter in future.
2 - Also if giving Monocef for 3 days and stopping was OK - now that we cant undo anything - just wanted to know your thoughts.
3 - And if giving Ziprax instead of Advent is also OK.

I guess we have given a lot of antibiotics to my baby till now. We will never again agree to any Paed asking to giving injections/IV unless further tests/culture is done.

I will seek advisement from 2nd doctor with all reports on Monday for further advisement and check back.

Answered by Dr. E Venkata Ramana 42 minutes later
Brief Answer:
Stop worrying about drugs, follow up with reports.

Detailed Answer:

Thank you for getting back.

I suggest you to stop worrying about the drugs.

Amikacin for 2 more doses is fine in the prescribed dose as per her weight. And usually it is not going to create any problems to your daughter in the future.

Nothing to worry about the stopping of Monocef after 3 days of its administration. This action may not going to do harm her.

And coming to Ziprax, it is also an antibiotic and giving Ziprax instead of Advent is okay.

What I advise you is to be in follow up with one pediatrician only regularly.

Review and follow up with two or more pediatricians will create confusion among the medications as there may be differences in the methods of individual practices.

And the most important thing is monitor child activity, temperature, hydration, and nutrition and if you find any problem consult the pediatrician.

Continue the medication as you are giving now, monitor the child, and consult the pediatrician once you get the reports for any modification in the treatment.

Hope I have answered your query. If you have any clarifications I will be happy to answer.

Wish your child a speedy recovery.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. E Venkata Ramana 20 hours later
Thank you Doctor for your quick response yesterday. It surely helped in calming nerves.

As advised by you, we would surely do a complete reassessment once all reports come in on Monday and stick to one line of advisement. I will also share reports and seek your opinion once the reports come in on Monday.

Just last query:
- She is having cough and sneezing since yesterday, whereas all docs we had shown had told that - her chest, ear, nose and throat are clear.
-Also she is crying a lot when we remove diapers and clean her during potty. She never used to create any fuss before. Its been two days now that she seems petrified of getting cleaned up.

She was a healthy and active child - sometimes we felt she was over active. But due to this illness over month she has become weak, lost weight (she is now 7.9 at 11+ months). Hope we get all answers with the reports on Monday and take further action to cure her.

Thanks again for your clarifications till now.

Answered by Dr. E Venkata Ramana 3 hours later
Brief Answer:
Look for rash in nappy area.

Detailed Answer:

Thank you for getting back.

For cold and cough you can give oral medications consisting of antihistamines like Maxtra or Tmnic drops in prescribed dose.

Crying while removing diapers may be because of development of nappy rash which is causing pain there.

Examine the area for any redness or soreness. Keep the area dry. After cleaning potty, that area can be touched with a soft clean clothe to dry it. Avoid rubbing.

You can apply creams like Ezinapi or Siloderm for soothing effect on nappy area.

Try to maintain her hydration and nutrition by giving oral fluids and soft diet.

Hope I have answered your query, if you have any clarification please let me know.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. E Venkata Ramana 2 days later
Thank you Doctor for the advice. I have got the test reports for my daughter as produced below. These had been advised by the 2nd Doctor we had visited.

Kindly provide your thoughts on these values reported and any pointers for our discussion with him later today which will help in complete reassessment and curing my daughter completely for now and also taking precaution for future.

Parameter      Observed Values      Normal Values
---------- ---------------- -------------

Hemoglobin     - 10.9 g/dl      2 months – 6 years: 9.0 – 14.0
Total Count      - 0000 c/cmm      2 months – 1 years: 5000 – 0000
WBC Differential count          
•     Neutrophil     26%      54-62%
•     Lymphocyte 68%      25-33%
•     Eosinophil     03%      01-06%
•     Monocyte     03%      03-07%
•     Basophil     00%      1-03%
RBC Count     - 4.6 cm/mm      6months-2years:3.7-5.3
Packed Cell Volume - 30%      2months-6years:28-42
Platelet Count - 3.6 lakh/cmm      1.4-4.0Lakh/cmm
M.C.V      - 66 fl      1month-6years:70-86
M.C.H      - 23pg      0days-2years:30-36
M.C.H.C - 35gm/dl      6months-6years:23-31

CRP     - 3.0mg/L      Upto 6mg/L
Total Calcium - 10.0 mg/dl      8.4-10.4 mg/dl

*25 Hydroxy VIT D2 - 5.35 ng/mL     
*25 Hydroxy VIT D3 - 15.3 ng/mL     
*25 Hydroxy D Total (D2+D3) - 20.65 ng/mL      20-80 ng/mL

FERRITIN(Chemiluminescence)     28.70 mcg/L     Women:13-150

Culture & Sensitivity - Normal commensals of the perineum     

Specimen :     BLOOD     

Antibiotics     Sensitivity     
---------- ----------
Penicillin      Resistant     
Cefoxitin      Sensitive     
Gentamicin      Sensitive     
Ciprofloxacin     Sensitive     
Levofloxacin     Sensitive     
Erythromycin     Sensitive     
Clindamycin      Resistant     
Linezolid      Sensitive     
Daptomycin      -     
Teicoplanin      Sensitive     
Vancomycin      Sensitive     
Tetracyline      Sensitive     
Tigecycline      Sensitive     
Nitrofurantoin     Sensitive     
Rifampicin      Sensitive     
Trimethoprim/Sulfamethoxazole     Sensitive     

Is Penicilin resistant a thing to worry or accepted value. From a layman point of view we think Penicilin is a common antibiotic. And it being resistant - does it create any problem?

Answered by Dr. E Venkata Ramana 2 hours later
Brief Answer:
Sensitive antibiotic to be give if fever persists.

Detailed Answer:

Thank you for getting back.

My views on her reports are:

1.Her hematology report is normal except for the predominance of lymphocytes and with a mild decrease of MCV and MCH values. Lymphocytes predominance is normally seen in children. MCV and MCH are related to red blood cells which are not related to her fever at present and these values can be improved by supplementing iron XXXXXXX foods in her diet.

2. Her biochemistry reports like CRP, vitamin D levels, ferritin levels are in normal range.

3.Urine culture report is suggestive of no growth of infecting bacteria.

4.Coming to her blood culture report, it showed the growth of a bacteria-Staphylococcus Sciuri. But its capacity of causing infection in humans is controversial. This bacterial is known to cause infections in animals but its pathogenicity and infecting ability in humans is controversial.

Resistant to penicillin is suggestive that the bacteria will not respond to treatment with penicillin antibiotic.

Being resistant, penicillin will not work for this bacteria.

Sensitive indicates that this bacteria can be treated with that particular antibiotic.

If this report is clinically correlated with her symptoms and if this report is significant clinically, the a good antibiotic can be selected from the given list of sensitive antibiotics.

Therefore I advise you to consult the pediatrician for assessing the child clinically for fever and general condition and to correlate the reports with her clinical findings and to advise the further management.

Hope I have answered your query, if you have any clarification please let me know.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. E Venkata Ramana 24 hours later
Hello Doctor,

We had been to the Paed yesterday who had advised these tests. (He is the one we had gone for 2nd opinion). He checked the reports and said everything is fine...and that the child has been already given a lot of medications....and as per him..she is a healthy child and we should not worry much. He prescribed the following medicines:

1 - Calcinol Sachets - 1 XXXXXXX once a week for 8 weeks
2 - Kidicare Drops - 1.0 ml twice daily for 1 month
3 - Zinsy Syrup - 5.0 ml once daily for 10 days.

I asked about that bacteria - he said is present in skin and its not responsible for the fever she had. When i asked anything to do for that - he told us - do you want me to prescribe more medicines - she has been through a lot of antibiotics......she is healthy and let it be....just give these iron and calcium medicines.....thats it...similarly for cough, sneezing, etc...he checked and said nothing to worry....just no more medicines....

We are happy that our daughter is fine and also were not in favour of more antibiotics or medicines.....but we did not get any clarity on:

1 - Why did the fever happen the first time? what was the cause? Why was it getting relapsed - total happened 3 times in a month.
2 - Was there any other bacteria - as WBC count was high and that it got cured by amikacin....then what was it...we couldn't find out.....not knowing the root cause - is it a concern area?
3 - This Staphylococcus Sciuri bacteria that has come out in blood culture - what about it - why did he not give anything for it assumes that it will get cured on its own and should not be worried it harmful

Kindly let me know your thoughts on these. Thanks once again for your responses.

Answered by Dr. E Venkata Ramana 2 hours later
Brief Answer:
Yes, I agree with your doctor.

Detailed Answer:

Thank you for getting back.

Yes, I agree with the doctor as the bacterial grown in the culture could be due to contamination from the skin.

Further antibiotics are not required if the child is healthy and having no symptoms of infection such as fever.

My suggestions to your queries are:

1.The fever first time occurred could be due to some bacterial infection such as throat infection. Frequent infections especially upper respiratory tract infections and other viral infections are common in children below the age of 6 years. Three times fever in a month may be due to different infections.

2.High WBC count is suggestive of some bacterial infection, but every time it is very difficult to identify the causative bacteria and it is not required if the child improved with empirical antibiotic treatment. Nothing to worry as it is not a concerning thing.

3. Staphylococcus Sciuri is a skin commensal bacteria which means that it is not associated with infection and disease in humans, so treating this bacteria with antibiotics is not requited. Generally it is not a harmful bacteria in humans.

Hope I have answered your query, if you have any clarification please let me know.

If you don't have any clarification, you can close the discussion and I request you to rate my answer.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. E Venkata Ramana 21 hours later
Thank you Doctor for the insights. It surely helps in understanding things better. Just to wind up our discussion I would like to know your thoughts on some issues.

FYI, my daughter was born 3.45 kg but soon after had developed jaundice for which she had to be again admitted in hospital with photo therapy and nasal feeding. She lost weight during that time but had recovered from it.

1 - Does this jaundice impair immunity in any way and contributed to her immune systems a bit low and she had these bouts of fever ?

2 - Post this fever, treatment and medicines, my daughter is not eating anything. She is only having mothers milk or eating biscuits or dry bread and doesn't eat anything else after 1-2 bites.
(FYI, she was only on mothers milk till 6 months post which we started semi solid foods like raagi, sabu, cerelac, rice dal veggies, khichdi and other home cooked food along with mother's milk).

Do you have any advice on diet for almost 11 month 20 day baby like her? We have been following our paeds advice of giving her above foods along with fruits like steamed XXXXXXX and non veg like eggs, fish and meat - which also she is not eating.

3 - Can we start giving her cows milk now that she is almost one year? She also doesn't like formula milk. Can we give her pure honey?

4- Is there any food we should avoid or should introduce?

5 - We have conflicting ideas on whether to cover the baby from wind / bathe her fully or do sponge bath any precautions we need to take in a cold place like Bangalore. She throws away blankets, doesn't want to wear socks or caps. Any advice on this will be helpful

I guess I have asked you a lot of generic questions which differ case to case. Still would like to have some of your thoughts.

Once again I would like to thank you for your detailed explanations which helped us a lot during last one week.

Post your response, I will close this discussion and provide ratings.

Answered by Dr. E Venkata Ramana 6 hours later
Brief Answer:
I have adressed your concerns in detailed answer.

Detailed Answer:

Thank you for getting back.

I wrote my insights to your concerns in the serial order.

1. Jaundice at birth doesn't impair immunity in any way and it will not contribute
to low immunity.

And it is not a reason for getting repeated fever later in the life of child.

In fact jaundice in low levels will serve as an antioxidant which protect the infant from oxidative stress.

2.During and after infections, decreased appetite is common in children, appetite will return to normal over time, so nothing to worry and try to feed the child with patience.

You did good thing by feeding exclusively with breast feeds and starting weaning food at right time in addition to breast milk.

At 11 months, I suggest you to give her home made food in soft form without adding spices. This is called family pot feeding.

Try to give one extra meal or snack during this recovery time to XXXXXXX the nutritional deficiencies which occurred during her sickness.

3. I suggest you to start cow's milk after completion of 1 year and there should be no hurry to start cow's milk. Introduce cow's milk after 1 year in a small quantity initially, observe for any allergic problems, and increase its quantity gradually if there is no any problem.

Honey can be given after 1 year, but be careful about purity of it as it is known to cause serious problems in young children if the honey is contaminated. And as such there is no particular benefit in giving honey.

4. You can give home made food which is available locally. But before introducing any new food, give it in small quantity, watch for any allergic reactions and if there are no problems gradually increase over day by day.

5. Cover the baby during cold and wind seasons and while taking out put socks, cap, and protective clothing while going out in a winter, rainy, and cold season.

You can give her full bathing during warm seasons, but use lukewarm water.

During any sickness, just sponging her body with lukewarm water is sufficient instead of giving bath.

You have asked a lot of questions, but they all are very much genuine and its my pleasure to address all your concerns.

Hope I have answered your queries and concerns.

Wish your daughter good health.

Best regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. E Venkata Ramana 17 hours later
Thank you Doctor for patiently answering all our queries. We are really happy with the way you have answered and explained to us over last few days.

Even though I had planned to close the discussion, I remembered something last night which I felt would be better to ask you and take your opinion. Hence could not resist recharging my account in order to be able to ask this follow up question.

My wife had Potts Spine (Tuberculosis) way back in 2007. She had taken the complete course and got cured. Non-pulmonary TB is non-contagious. And there is no chance of spreading from one person to another. Still I was diagnosed with TB - this time Abdominal TB(TB Peritonitis) in July 2011.

I underwent the full course of treatment for 6 months and was declared fit by the doctor in XXXXXXX 2012. Only after he gave the go ahead and assured that there is no problem in planning a baby, we went ahead - long after I had stopped all medicines. We were blessed with a baby girl soon after.

Unfortunately in between 2012 I was diagnosed with signs of relapse at a different body part (chest) but all tests showed negative. There were inconclusive results. Still the doctor had put me on another dose of TB medication for 4 months.

Everything was fine, but again last December 2012 after my child was born I had a lump on throat. I had to undergo surgery of lymph node and tests showed positive and drug resistant TB - this time it happened in another body part (neck). Hence I was put on a 2nd level treatment of drugs and injections (daily) for 3 months which got over last month. Now I am on medicines only which the doctors say will continue for at least 1 year. I have gone for 2nd opinion at AIIMS and it seems I am on correct course of treatment.

I have discussed this issue with all doctors - who have assured that my current treatment and infection has no bearing on my child and we can stay in same house. All the ailments have been Non-Pulmonary or Extra-Pulmonary in nature.

Hence I thought of discussing this with you. What are your thoughts and experience on these kind of scenarios doctor?

Is there any chance my child will get affected because of my ailments/treatments?

Do we need to take any special precautions for her?

Any other advice would be helpful. Thanks once again.

Answered by Dr. E Venkata Ramana 1 hour later
Brief Answer:
No spread from extrapulmonary tuberculosis focus.

Detailed Answer:

Thank you for getting back.

I went through you and your wife medical history.

As you had tuberculosis at extra pulmonary sites, there is no chance of the spread of infection to the kid.

No specific precautions are required.

Hope I have answered your query, if you have any clarifications please let me know.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. E Venkata Ramana 2 days later
Thank you doctor for the reassurance.

Anyways, before parting, wanted to check on one thing. Is it by any chance whatever happened to my daughter was due to some urine infection. We had tested urine earlier too and it was normal. The culture we did after 2 days of injection was also normal. I am asking this as my wife has made her own conclusion that all this was due to urine infection and that Amikacin cured it. Is it by any chance that 2 days of injection will completely cure urine infection and nothing will show up in culture?

I have tried to explain her that everybody has concluded that there was infection and it could have been different infections. But she has become paranoid and keeps checking the baby's diaper for potty time and she thinks she has to wash it immediately, else it will again cause infection.

Do we have to clean the potty/change the diaper almost immediately after her potty or it can wait for sometime - within a reasonable amount of time - and not get any infection.

Warm regards
Answered by Dr. E Venkata Ramana 4 hours later
Brief Answer:
Possibility of urine infection.

Detailed Answer:

Thank you for getting back.

Yes, it could be because of urine infection because there was elevated WBC count.

Girls are more prone for urine infection. But as the investigations didn't show infection in the urine samples it is difficult to confirm.

Elevated WBC count is suggestive of bacterial infection focus such as throat, middle ear or urinary tract.

Urine culture may come negative if urine sample is collected after the start of antibiotic injections.

It is advised to clean the potty immediately after potty to prevent infections and rash.

It is not advisable to wait for cleaning or changing the diaper after she passes stool or urine.

And while cleaning her potty, I suggest you to clean her perineum with water in the direction from front to back to prevent the contact of stool with her genital parts and urethra.

So I suggest you to clean her perineum from front to back direction.

Hope I have answered your query, if you have any clarification please let me know.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Answered by
Dr. E Venkata Ramana


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