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Dr. Ira Shah
M.D, DNB, DCH(Gold Medalist), FCPS

Common bacterial infections seen are:

• Pneumonia
  
• Sepsis
  
• Osteomyelitis and septic arthritis
  
• Meningitis
  
• Abscesses
  
• Otitis media
  

Common organisms are:

• Streptococcus pneumoniae
  
• Hemophilus influenza type b
  
• Staphylococcus aureus
  
• Escherichia Coli
  
• Pneumococcus
  

Others: Gram negative bacteria such as pseudomona aeruginosa, salmonella and E. Coli.

Clinical features: Depends upon the site of infection. HIV infected children with bacterial infections usually have a similar clinical presentation as those without HIV infection. However, the severity of the disease may be more and response to standard duration of antibiotics may be poor.

Diagnosis: The methods of diagnosis essentially remain the same as that of an uninfected child. Isolation of organism by culture is essential.

Treatment: Treatment should be as per the local epidemiologic prevalent strain and sensitivity pattern. If an organism is isolated, then antibiotic susceptibility testing should be performed and therapy based on sensitivity pattern. Longer duration of therapy may be required to cure the infection.

Infection	Empiric recommended drugs
Meningitis or Pneumonia or Bacteremia	Third generation cephalosporin such as ceftriaxone (80-100 mg/kg/day) in 1-2 divided doses (max dose = 4 gm) OR cefotaxime (150-200 mg/kg/day) in 3 to 4 divided doses (max dose – 8-10 gm) OR Cefuroxime (100-150 mg/kg/day) in 3 divided doses (max – 4-6 gm).
Staphylococcus aureus (methicillin resistant)	Vancomycin (40-60 mg/kg/day) in 4 divided doses (max adult dose = 2-4 gm)

Prevention of Bacterial Infections

Primary importance

• Drink boiled and filtered water
• Clean raw fruits and vegetables adequately before consumption
• Proper hand washing
• TMP-SMX given as prophylaxis against PCP pneumonia will also prevent against recurrent bacterial infections

Vaccination:

• Hib and pneumococcal vaccination in HIV infected children less than 5 years of age will be highly recommended.
  
• Administer all the routine bacterial vaccines.
  

Secondary prevention

• TMP-SMX prophylaxis (150 mg TMP/m2/day in 2 divided doses on alternative days) for patients with recurrent bacterial infections. [Recurrent bacterial infections is defined as 2 or more systemic bacterial infections including septicemia, meningitis, pneumonia and osteomyelitis that occur within a two-year period]
  
• Intravenous Immunoglobulin [IVIG] at 400 mg/kg monthly for children with hypogammaglobulinemia if there are recurrent bacterial infections inspite of TMP-SMX prophylaxis.