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Prevention of serious bacterial infection in children with nephrotic syndrome
1Department of Immunology and infectious Diseases, Royal Alexandra Hospital for Children, Parramatta, New South Wales, Australia. peterm@nch.edu.au
Insights
Children with nephrotic syndrome face increased bacterial infection risks. Pneumococcal immunization and penicillin prophylaxis show potential benefits, especially for younger children and those with severe disease.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Public Health
Background:
- Nephrotic syndrome increases children's susceptibility to bacterial infections, particularly pneumococcal peritonitis.
- Limited data exist on infection incidence and preventative measure effectiveness in pediatric nephrotic syndrome.
- Pneumococcal disease is a significant concern in this patient population.
Purpose of the Study:
- To review the incidence of invasive bacterial infections in children with nephrotic syndrome.
- To evaluate the evidence for penicillin chemoprophylaxis and pneumococcal immunization effectiveness.
- To identify subgroups of nephrotic syndrome patients who may benefit most from prophylaxis.
Main Methods:
- Systematic review of existing literature on bacterial infections in pediatric nephrotic syndrome.
- Analysis of data on pneumococcal disease patterns and incidence.
- Assessment of evidence for penicillin prophylaxis and pneumococcal vaccination efficacy.
Main Results:
- Pneumococcal immunization is recommended for children over 2 years old due to a favorable risk-benefit profile, despite limited specific data.
- Conjugate pneumococcal vaccines are expected to be more effective, especially in younger children.
- Penicillin prophylaxis may benefit specific subgroups, including those under 2 years, with severe or relapsing disease, or a history of pneumococcal infection.
Conclusions:
- Pneumococcal immunization is advisable for children with nephrotic syndrome over 2 years.
- Penicillin prophylaxis may be beneficial for high-risk subgroups within pediatric nephrotic syndrome.
- Further research is needed to confirm the efficacy of preventative strategies in this population.
Abstract:
Although nephrotic syndrome is well known as a predisposing factor to bacterial infection in children, especially peritonitis due to Streptococcus pneumoniae, data on the incidence of infection and the effectiveness of preventative measures are limited. With particular reference to pneumococcal disease, this review summarises the available data on the pattern and incidence of invasive bacterial infection in children with nephrotic syndrome, and the level of evidence for the use of penicillin chemoprophylaxis and pneumococcal immunisation. Although data on the effectiveness of pneumococcal immunization in children with nephrotic syndrome are limited, the safety profile of this vaccine makes the risk-benefit ratio favourable to use of the current polysaccharide vaccine in those over 2 years of age. Conjugate pneumococcal vaccines are likely to be more effective, particularly in children under 2 years of age and should be available by the year 2000. Although penicillin prophylaxis against pneumococcal infection is not of proven benefit for nephrotic syndrome, it is beneficial in sickle cell disease without appreciable risk. Subgroups of patients with nephrotic syndrome most likely to benefit from twice daily phenoxymethyl penicillin prophylaxis include children under 2 years of age, with unresponsive or frequently relapsing disease, or who have had a previous episode of pneumococcal infection.