PENDAHULUAN Pneumonia adalah inflamasi Anak usia 5 tahun , dan pra sekolah o Mycoplasma pneumonia merupakan penyebab terserin

n yan

didapatkan dari lin kun an sekitar! "ebanyak #$ % dari total populasi, &'() % pneumonia pada anak pra sekolah, ()'#( % pneumonia pada anak yan lebih de*asa, dan +$'5$ % pneumonia pada anak yan telah kuliah dan oran di militer! o ,nfeksi Mycoplasma se-alan den an e-alanya yaitu , malaise,

demam yan sedan , sakit kepala dan batuk! .hlamidia pneumonia -u a cukup serin pada umur dan kondisi di atas! Anak sekolah o /acterial pneumonia 0 ($ % 1 palin serin , dan pada anak ini akan terlihat men i il dan terlihat lesu! Lainnya o Pada anak den an pneumonia tuberkulosis, biasanya e-ala akan tampak setelah (') bulan anak tersebut terkena infeksi primer! /ayi dan de*asa muda yan palin tin i resikonya pada penyakit ini! e-ala seperti demam,

Anak 2anak akan memperlihatkan

berkerin at saat malam hari, men i il, batuk dan penurunan berat badan! Pada foto thoraks daerah hillar atau mediastinum tampak limfadenopati, atelektasis, atau konsolidasi pada se men atau lobusnya 0 biasanya lobus atas kanan1 , efusi pleura, lesi ca3itas 0 hanya pada de*asa 1 atau penyakit milier!

o 4ika 5/ tidak diobati pada a*al infeksi, biasanya #5 % pada anak 2anak maka (5 tahun kemudian akan menderita penyakit ekstrapulmonal! o /ordetella pertusis -u a menyebabkan pneumonia, biasanya palin serin pada anak yan tidak tutas dalam pemberian 3aksinasi atau pada anak yan tidak pernah di imunisasi! Perkemban an penyakit bronkhopneumonia akan timbul sebesar (!6'# % pada semua kasus pertusis dan ()'#$ % pada kasus di rumah sakit! Mortalitas rate pada pasien den an komplikasi ini biasanya lebih rendah! Penelitian di in ris menun-ukan bah*a 5& % kematian pertusis

dihubun kan den an adanya pneumonia! 7ambaran klinis yan terlihat antara lain cory8a, malaise, demam, batuk yan paroksismal dan disertai emesis, apnea, tidak mau makan, dan sianosis! o 9iral pneumonia serin terdapat pada umur ini tetapi biasanya

rin an da dapat sembuh sendiri, seperti pada de*asa, akan tetapi, 3iral pneumonia dapat men-adi berat dan berkemban sehin a ter-adi a al nafas, cepat

Pemeriksaan laboratorium ,nformasi menyeluruh o A ent penyebab ineksi merupakan informasi yan berhar a untuk men etahiu komlikasi dari penyakit pneumonia! "ayan nya, etiolo i ini sulit diketahui, maka dari itu, pada kebanyakan kasus

pneumonia yan

didapatkan dari lin kun an sekitar maka

pen obatan empiris didasarkan pada umur pasien dan ambaran klinis! :ultur sputum o :ultur sputum yan adekuat seharusnya berisi #5 sel PMN per lapan dan kuran dari ($ kubik sel per lapan ! o "putum -aran diproduksi oleh anak berumur kuran dari ($ tahun, dan -ika men hasilkan maka sampel biasanya terkontaminasi oleh flora normal mulut! o :uman yan menyebabkan pneumonia umumnya merupakan flora normal mulut oleh karena itu! :ultur sputum tidak ber una pada anak yan menderita pneumonia! /ronchoscopy o /ronchoscopy fiberoptik yan fleksibel biasanya di unakan utuk mendapatkan sekresi pada saluran di unakan untuk kultur atau sitolo i! nafas ba ian ba*ah yan

Aspirasi paru o test ini palin efisient untuk di unakan seba ai kultur! o Penelitian membuktikan den an membandin kan aspirasi darah den an aspirasi paru pada ($$ anak berumur +'56 bulan den an kelainan pneumonia! :ultur darah memperlihatkan sekitar (6 % or anisme pada kultur darah dan 5# % or anisme pada aspirasi paru !

o Aspirsi paru tidak boleh dilakukan pada psien yan men

unakan

3entilator, pasien den an perdarahan diathesis, atau mereka yan suspect terinfeksi pneumocystis! 5horacintesis o 5est ini di unakan untuk dia nostic dan terapi pada anak den a efusi pleura! o 4ika strain ram ne atif atau kultur dari cairan pleura positif atau -ika ;/. lebih dari ($$$! Polymerse chain reaction o 5est ini san at men-an-ikan untuk membantu dia nosa pneumonia oleh karena streptokokus! "kin test o 5est ini di unakan untuk mendia nosa penyakit 5/! 5es mantou< harus diperiksa setelah #'+ hari! o Pada anak kuran dari = tahun tanpa factor resiko, hasil test positif -ika indurasinya (5mm atau lebih! Pada anak, mereka yan memiliki pemaparan terhadap 5/ yan cukup tin yan memilihi factor resiko medis yan i, atau mereka seperti

mendukun

lymphoma, diabetes mellitus, malnutrisi, a al in-al, hasil positif -ika indurasi ($ mm atau lebih,! Pada anak yan an memiliki

uan immunolo is atau imunosupresant atau mereka yan

memiliki ri*ayat kontak den an pasien 5/ , test positif -ika indurasi 5mm atau lebih!

o /ahkan -ika anak telah menerima 3aksin /.7, hasil test mantou< harus di unakan! o >oto thoraks membantu untuk mendia nosa pada anak den an hasil test mantou< positif! 4ika pada foto thoraks positif atau pada anak yan memilki e-ala seperti pada 5/, maka perlu dilakukan isolasi kuman tuberculosis setiap pa i yan berasal dari aspirasi cairan lambun , cairan cerebrospinal, sputum, cairan pleura atau biopsy speciment o Pada anak yan suspect 5/ paru, ! test terbaik ilakukan pada pa i hariden an men aspirasi cairan lambun untuk pemeriksaan A>/ 0 acid'fast bacilli 1, kultur, dan -ika memun kinkan dilakukan pemeriksaan P.?! Aspirasi cairan lambun di simpan di N75 dan harus didiamkan selama #= -am sebelum daimbil sampelnya, dan pen ambilan aspirasi dilakukan sebelum pasien makan atau diterapi ambulasi! Peeriksaan ini dilakukan sebanyak + kali! Hitun sel darah @ test ini harus termasuk pen hitun an ./.! 5otal ;/. dan turunannya mun kin menentukan infeksi disebabkan oleh bakteri atau 3irus, dan disertai den an pemerksaan klinis, foto thoraks, dan E"? dapat membantu memonitorin penyebab dari pneumonia! 7as darah arteri@ test ini diindikasi kan pada semua pasien den an distress respiratorius untuk men etahui dera-at an uan pernafasan

Pen obatan :eputusan untuk memberikan terapi pada anak den an pneumonia disesuaikan den an etiolo i dari infeksi , umur pasien dan keadaan klinik pasien tersebut! :eputusan pemberian antibiotik harus disesuaikan den an or anismenya, umur pasien, ri*ayat tereksposurnya, dan kemun kinan resisten terhadap antibiotik tersebut! Perkusi pada thorak tidak perlu di lakukan pada pasien anak'anak den an pneumonia! Pemeriksaan pada oran de*asa tidak menun-ukan hasil yan memuaskan, ba aimanapun belum ada pemeriksaan yan cukup baik pada pasien anak'anak! :ebanyakan pasien anak'anak tidak memerlukan ekspektoran, karena mereka mampu untuk membersihkan sputum dari paru'paru dan akhirnya tertelan! /ronchodilator tidak boleh di unakan terlalu serin ! /akteri pada traktus respiratorius ba ian ba*ah -aran memicu ter-adinya seran an asma, dan bunyi *hee8in yan terden an pada pasien pneumonia biasanya

disebabkan oleh inflamasi pada sauran nafas dan atau adanya pen umpalan mukus dan ini tidak memerlukan pemberian

bronchodilator! Anak usia sekolah o /anyak yan tidak memerlukan pera*at di rumah sakit dan

biasanya merespon baik terhadap pemberian antibiotic! Antibiotik macrolid ber una pada anak usia ini!

o /iasanya, pasien ini tidak keracunan dan hipoksia sehin terlalu membutuhkan pemberian

a tidak

oksi en! :eculai -ika pasien

muntah, dan tidak bisa diberikan cairan dan antibiotik secara intra3ena!

Anak kuran dari 5 tahun @ pada usia ini anak memerlukan pera*atan di rumah sakit, tetapi keadaan linik, dera-at dehidrasi, dera-at hipoksia, dan perlunya terapi secara intra3ena menentukan keputusan pera*atan!

Pembedahan @ Diet 5idak ada pemberian makanan khuss pada pasien ini ! Draina e efusi parapneumonia den an atau tanpa 8at fibrinolitik

Akti3itas Akti3itas menstimulasi per erakan mukus, batuk ,dan resolusi

perkemban an penyakit! Hal ini perlu disikapi den an bi-ak! Anak'anak bisanya tidak mau beker-a sama -ika pasien sakit, dan pasien malah akan ber erak hanya -ika pasien merasa perlu!

Dru .ate ory@ Macrolide Antibiotics '' 5hese a ents are used for treatment
of pneumonia in school'a ed children because they co3er most common bacteriolo ic and atypical a ents! Drug Name Adult Dose Pediatric Dose A8ithromycin 0Aithroma<1 '' 5reats mild'to'moderate microbial infections! Day (@ 5$$ m PB Days #'5@ #5$ m PB Cd D) months@ Not established

E) months@ Day (@ ($ m Fk PB onceG not to e<ceed 5$$ m Fd Days #'5@ 5 m Fk PB CdG not to e<ceed #5$ m Fd Contraindications Documented hypersensiti3ityG hepatic impairmentG do not administer *ith pimo8ide May increase to<icity of theophylline, *arfarin, and di o<inG effects are reduced *ith coadministration of aluminum andFor ma nesium antacidsG nephroto<icity and neuroto<icity may occur *hen coadministered *ith cyclosporine / ' Usually safe but benefits must out*ei h the risks! /acterial or fun al o3er ro*th may result *ith prolon ed antibiotic useG may increase hepatic en8ymes and cholestatic -aundiceG caution in patients *ith impaired hepatic function, prolon ed H5 inter3als, or pneumoniaG caution in hospitali8ed, elderly, or debilitated patients .larithromycin 0/ia<in1 '' ,nhibits bacterial ro*th, possibly by blockin dissociation of peptidyl t'?NA from ribosomes causin ?NA'dependent protein synthesis to arrest! #5$'5$$ m PB C(#h for I'(= d Administer as in adults 5o<icity increases *ith coadministration of flucona8ole and pimo8ideG clarithromycin effects decrease and 7, ad3erse effects may increase *ith coadministration of rifabutin or rifampinG may increase to<icity of anticoa ulants, cyclosporine, tacrolimus, di o<in, omepra8ole, carbama8epine, er ot alkaloids, tria8olam, HM7'.oA reductase inhibitors Plasma le3els of certain ben8odia8epines may increase, prolon in .N" depressionG arrhythmias and increase in H5c inter3als occur *ith disopyramideG coadministration *ith omepra8ole may increase plasma le3els of both a ents . ' "afety for use durin pre nancy has not been established! .oadministration *ith ranitidine or bismuth citrate is not recommended *ith .r.l D#5 mLFminG i3e half dose or increase dosin inter3al if .r.l D+$ mLFminG diarrhea may be si n of pseudomembranous colitisG superinfections may occur *ith prolon ed or repeated antibiotic therapies Erythromycin 0E!E!"!, E'Mycin, Ery'5ab1 '' ,nhibits bacterial ro*th, possibly by blockin dissociation of peptidyl t'?NA from ribosomes causin ?NA'dependent protein synthesis to arrest! >or treatment of staphylococcal and streptococcal infections!

Interactions Pregnancy

Precautions

Drug Name Adult Dose Pediatric Dose

Contraindications Documented hypersensiti3ityG coadministration of pimo8ide

Interactions

Pregnancy

Precautions

Drug Name

,n children, a e, *ei ht, and se3erity of infection determine proper dosa e! ;hen bid dosin is desired, half'total daily dose may be taken C(#h! >or more se3ere infections, double the dose! Adult Dose #5$ m erythromycin stearateFbase 0or =$$ m ethylsuccinate1 C)h PB ( h ac or 5$$ m C(#h Alternati3ely, +++ m C6hG increase to = Fd dependin on se3erity of infection +$'5$ m Fk Fd 0(5'#5 m FlbFd1 PB di3ided C)'6hG double dose for se3ere infection .oadministration may increase to<icity of theophylline, di o<in, carbama8epine, and cyclosporineG may potentiate anticoa ulant effects of *arfarinG coadministration *ith lo3astatin and sim3astatin, increases risk of rhabdomyolysis / ' Usually safe but benefits must out*ei h the risks! .aution in li3er diseaseG estolate formulation may cause cholestatic -aundiceG 7, ad3erse effects are common 0 i3e doses pc1G discontinue use if nausea, 3omitin , malaise, abdominal colic, or fe3er occur

Pediatric Dose

Contraindications Documented hypersensiti3ityG hepatic impairment Interactions Pregnancy Precautions

Dru .ate ory@ Antibiotics for children younger than 5 years '' 5hese
children are most commonly hospitali8ed, but their clinical status, de ree of hydration, de ree of hypo<ia, and need for intra3enous antibiotic therapy dictate this decision! .eftria<one 0?ocephin1 '' 5hird' eneration cephalosporin *ith broad'spectrum ram'ne ati3e acti3ityG lo*er efficacy a ainst ram'positi3e or anismsG hi her efficacy a ainst resistant or anisms! Arrests bacterial ro*th by bindin to one or more penicillin bindin proteins! ('# ,9 Cd or di3ided bidG not to e<ceed = Fd Neonates EI days@ #5'5$ m Fk Fd ,9F,MG not to e<ceed (#5 m Fd ,nfants and children@ 5$'I5 m Fk Fd ,9F,M di3ided C(#hG not to e<ceed # Fd Probenecid may increase ceftria<one le3elsG coadministration *ith ethacrynic acid, furosemide, and amino lycosides may increase nephroto<icity / ' Usually safe but benefits must out*ei h the risks! Ad-ust dose in renal impairmentG caution in breastfeedin *omen and aller y to penicillin

Drug Name

Adult Dose Pediatric Dose

Contraindications Documented hypersensiti3ity Interactions Pregnancy Precautions

Drug Name

.efota<ime 0.laforan1 '' >or infections caused by susceptible or anisms! Arrests bacterial cell *all synthesis, *hich, in turn, inhibits bacterial ro*th! 5hird' eneration cephalosporin *ith ram'ne ati3e spectrum! Lo*er efficacy a ainst ram' positi3e or anisms! Moderate to se3ere infections@ ('# ,9F,M C)'6h Life threatenin infections@ ('# ,9F,M C=h ,nfants and children@ 5$'(6$ m Fk Fd ,9F,M di3ided C=')h E(# years@ Administer as in adults Probenecid may increase cefota<ime le3elsG coadministration *ith furosemide and amino lycosides may increase nephroto<icity / ' Usually safe but benefits must out*ei h the risks! Ad-ust dose in se3ere renal impairmentG has been associated *ith se3ere colitis Ampicillin 0Marcillin, Bmnipen, Polycillin1 '' /actericidal acti3ity a ainst susceptible or anisms! Alternati3e to amo<icillin *hen unable to take medication orally! #5$'5$$ m PB C)h 5$$ m to (!5 ,M C=')h 5$$ m to + ,9 C=')hG not to e<ceed (# Fd 5$'($$ m Fk Fd PB di3ided C=')h ($$'=$$ m Fk Fd ,MF,9 di3ided C=')h Probenecid and disulfiram ele3ate ampicillin le3elsG allopurinol decreases ampicillin effects and has additi3e effects on ampicillin rashG may decrease effects of oral contracepti3es / ' Usually safe but benefits must out*ei h the risks! Ad-ust dose in renal failureG e3aluate rash and differentiate from hypersensiti3ity reaction .efuro<ime 0Ainacef, .eftin, :efuro<1 '' "econd' eneration cephalosporin maintains ram'positi3e acti3ity that first' eneration cephalosporins ha3eG adds acti3ity a ainst P mirabilis, H influenzae, E coli, K pneumoniae, and M catarrhalis. .ondition of patient, se3erity of infection and susceptibility of microor anism determines proper dose and route of administration! 5$$ m PB bid I5$'(5$$ m ,9 C6h .hildren@ #5$ m PB bidG ($$'(5$ m Fk Fd di3ided C6h

Adult Dose Pediatric Dose

Contraindications Documented hypersensiti3ity Interactions Pregnancy Precautions Drug Name

Adult Dose Pediatric Dose

Contraindications Documented hypersensiti3ity Interactions Pregnancy Precautions

Drug Name

Adult Dose Pediatric Dose

Adolescents@ Administer as in adults Contraindications Documented hypersensiti3ity Disulfiramlike reactions may occur *hen alcohol is consumed *ithin I# h after takin cefuro<imeG may increase hypoprothrombinemic effects of anticoa ulantsG may increase nephroto<icity in patient recei3in potent diuretics 0e , loop diuretics1G coadministration *ith amino lycosides increase nephroto<ic potential . ' "afety for use durin pre nancy has not been established! Administer half dose if .r.l is ($'+$ mLFmin and one'Cuarter dose if less than ($ mLFminG fun al and microor anism o3er ro*th may occur *ith prolon ed therapy

Interactions

Pregnancy Precautions

Dru .ate ory@ Antituberculars '' Use in the treatment of 5/!

Antimycobacterial a ents are a miscellaneous roup of antibiotics *hose spectrum of acti3ity includes Mycobacterium species! Used to treat 5/, leprosy, and other mycobacterial infections! ,sonia8id 0Lania8id, Nydra8id1 '' /est combination of effecti3eness, lo* cost, and minor side effects! >irst'line dru unless patient has kno*n resistance or another contraindication! 5herapeutic re imens of D) months demonstrate unacceptably hi h relapse rate! .oadministration of pyrido<ine is recommended if peripheral neuropathies secondary to isonia8id therapy de3elop! Prophylactic doses of )'5$ m of pyrido<ine daily are recommended! 5 m Fk PB Cd 0usually +$$ m Fd1 and ($ m Fk Cd in ('# di3ided doses in patients *ith disseminated diseaseG not to e<ceed +$$ m Fd Directly obser3ed therapy@ (5 m Fk t*ice *eeklyG not to e<ceed &$$ m Fd ($'#$ m Fk PB CdG not to e<ceed +$$ m Fd Documented hypersensiti3ityG pre3ious isonia8id'associated hepatic in-ury or other se3ere ad3erse reactions Hi her incidence of isonia8id'related hepatitis can occur *ith alcohol in estion on daily basisG aluminum salts may decrease isonia8id serum le3els 0administer ('# h before takin aluminum salts1G may increase anticoa ulants effects *ith coadministrationG may inhibit metabolic clearance of ben8odia8epines .arbama8epine to<icity or isonia8id hepatoto<icity may result from concurrent use 0monitor carbama8epine concentrations and li3er function1G coadministration *ith cycloserine may

Drug Name

Adult Dose

Pediatric Dose Contraindications Interactions

increase .N" side effects 0e , di88iness1G acute beha3ioral and coordination chan es may occur *ith coadministration of disulfiram .oadministration *ith rifampin after halothane anesthesia may result in hepatoto<icity and hepatic encephalopathyG may inhibit hepatic microsomal en8ymes and increase to<icity of hydantoin Pregnancy Precautions . ' "afety for use durin pre nancy has not been established! Monitor patients *ith acti3e chronic li3er disease or se3ere renal dysfunctionG periodic ophthalmolo ic e<aminations durin isonia8id therapy are recommended e3en *hen 3isual symptoms do not occur Ethambutol 0Myambutol1 '' Diffuses into acti3ely ro*in mycobacterial cells, such as tubercle bacilli! ,mpairs cell metabolism by inhibitin synthesis of one or more metabolites, *hich, in turn, causes cell death! No cross' resistance demonstrated! Mycobacterial resistance is freCuent *ith pre3ious therapy! Use in these patients in combination *ith second'line dru s that ha3e not been pre3iously administered! Administer C#=h until permanent bacteriolo ical con3ersion and ma<imal clinical impro3ement obser3ed! Absorption is not si nificantly altered by food! No pre3ious antituberculous therapy@ (5 m Fk 0I m Flb1 PB Cd Pre3ious antituberculous therapy@ #5 m Fk 0(( m Flb1 PB Cd D(+ years@ Not recommended E(+ years@ Administer as in adults Documented hypersensiti3ityG optic neuritis 0unless clinically indicated1 Aluminum salts may delay and reduce absorption 0 i3e se3eral hours before or after ethambutol dose1 / ' Usually safe but benefits must out*ei h the risks! ?educe dose in impaired renal functionG may ha3e re3ersible 3isual ad3erse effects if promptly discontinued ?ifampin 0?ifadin, ?imactane1 '' >or use in combination *ith at least one other antituberculous dru ! ,nhibits ?NA synthesis in bacteria by bindin to beta subunit of DNA' dependent ?NA polymerase, *hich in turn blocks ?NA transcription! 5reat for )'& months or until ) months ha3e elapsed from con3ersion to sputum culture ne ati3ity! )$$ m PBF,9 Cd

Drug Name

Adult Dose Pediatric Dose Contraindications Interactions Pregnancy Precautions

Drug Name

Adult Dose

Pediatric Dose

($'#$ m Fk PBF,9G not to e<ceed )$$ m Fd ,nduces microsomal en8ymes, *hich may decrease effects of acetaminophen, oral anticoa ulants, barbiturates, ben8odia8epines, beta'blockers, chloramphenicol, oral contracepti3es, corticosteroids, me<iletine, cyclosporine, di ito<in, disopyramide, estro ens, hydantoins, methadone, clofibrate, Cuinidine, dapsone, ta8obactam, sulfonylureas, theophyllines, tocainide, and di o<inG blood pressure may increase *ith coadministration of enalaprilG coadministration *ith isonia8id may result in hi her rate of hepatoto<icity than *ith either a ent alone 0discontinue one or both a ents if alterations in L>5s occur1 . ' "afety for use durin pre nancy has not been established! Bbtain ./.s and baseline clinical chemistries before and throu hout therapyG in li3er disease, *ei h benefits a ainst risk of further li3er dama eG interruption of therapy and hi h' dose intermittent therapy are associated *ith thrombocytopenia that is re3ersible if therapy is discontinued as soon as purpura occursG if treatment is continued or resumed after appearance of purpura, cerebral hemorrha e or death may occur Alerts NFA "treptomycin sulfate '' Use in combination *ith other antituberculous dru s 0e , isonia8id, ethambutol, rifampin1! 5otal period of treatment for 5/ is a minimum of ( yG ho*e3er, indications for terminatin streptomycin therapy may occur at any time! ?ecommended *hen less potentially ha8ardous therapeutic a ents are ineffecti3e or contraindicated! ( ,M Cd # timesF*k dosin @ (5 m Fk Fd ,MG not to e<ceed ( Fd + timesF*k dosin @ #5'+$ m Fk Fd ,MG not to e<ceed (!5 Fd # timesF*k dosin @ #$'=$ m Fk Fd ,MG not to e<ceed ( Fd + timesF*k dosin @ #5'+$ m Fk Fd ,MG not to e<ceed (!5 Fd Documented hypersensiti3ityG non2dialysis'dependent renal insufficiency Nephroto<icity may be increased *ith amino lycosides, cephalosporins, penicillins, amphotericin /, and loop diuretics D ' Unsafe in pre nancy Narro* therapeutic inde<G not intended for lon 'term therapyG caution in renal failure not on dialysisG caution *ith myasthenia ra3is, hypocalcemia, and conditions that depress neuromuscular transmission

Contraindications Documented hypersensiti3ity

Interactions

Pregnancy

Precautions

Drug Name

Adult Dose Pediatric Dose Contraindications Interactions Pregnancy Precautions

Drug Name

Pyra8inamide '' Pyra8ine analo of nicotinamide that may be bacteriostatic or bactericidal a ainst Mycobacterium tuberculosis, dependin on concentration of dru attained at site of infectionG mechanism of action is unkno*n! Administer for initial # mo of a )'mo or lon er treatment re imen for dru 'susceptible patients! 5reat dru 'resistant patients *ith indi3iduali8ed re imens! (5'+$ m Fk PB CdG not to e<ceed # Fd ,ndirectly obser3ed therapy@ 5$'I$ m Fk PB # timesF*k, not to e<ceed = FdG alternati3ely, 5$'I$ m Fk + timesF*k, not to e<ceed + Fd Administer as in adults Documented hypersensiti3ityG se3ere hepatic dama e, acute out None reported . ' "afety for use durin pre nancy has not been established! Use only in combination *ith other effecti3e antituberculous a entsG inhibits renal e<cretion of uratesG may result in hyperuricemia 0usually asymptomatic1G perform baseline serum uric acid determinationsG discontinue dru if si ns of hyperuricemia *ith acute outy arthritisG perform baseline L>5s 0closely monitor in li3er disease1G discontinue pyra8inamide if si ns of hepatocellular dama e appearG caution in history of diabetes mellitus

Adult Dose Pediatric Dose Contraindications Interactions Pregnancy

Precautions

Dru .ate ory@ Antiviral agents '' Must be initiated early to adeCuately
inhibit replicatin 3irus! ?iba3irin 09ira8ole1 '' ,nhibits 3iral replication by inhibitin DNA and ?NA synthesis! Anti3iral a ainst ?"9, influen8a 3irus, and herpes simple< 3irus! ?econstitute ) into +$$ mL of sterile *ater to make a concentration of #$ m FmL Administer as continuous aerosol o3er (#'(6 hFd for +'I d Administer as in adults Decreases 8ido3udine effects J ' .ontraindicated in pre nancy Decreases 8ido3udine effects

Drug Name

Adult Dose Pediatric Dose Interactions Pregnancy Precautions

Contraindications Documented hypersensiti3ity