Document Detail

Espghan ibd porto group commentary on risk of infection and prevention in pediatric ibd patients.
MedLine Citation:
PMID:  22331017     Owner:  NLM     Status:  Publisher    
ABSTRACT: Combined immunosuppression by immunomodulators and biological therapy has become standard in the medical management of moderate to severe IBD because of clearly demonstrated efficacy. Clinical studies, registries and case reports warn of the increased risk of infections, particularly opportunistic infections. However, already in the steroid mono therapy era patients were at risk since it is accepted that a patient should be considered immunosuppressed when receiving a daily dose of 20 mg prednisone for 2 weeks. Currently, prescriptions increasingly involve azathioprine, methotrexate and various biological agents. The TREAT registry evaluated safety in over 6000 adult patients, half of them treated with infliximab for about 1.9 years. Infliximab treated patients had an increased risk of infections and this was associated with disease severity and concomitant prednisone use. The REACH study, evaluating the efficacy of infliximab in children with moderate to severe Crohn's disease, refractory to immunomodulatory treatment, reports serious infections as the major adverse events and their frequency is higher with shorter treatment intervals. The combination of immunosuppressive medications is a risk factor for opportunistic infections. Exhaustive guidelines on prophylaxis, diagnosis, and management of opportunistic infections in adult IBD patients have been published by an ECCO Working Group, including clear evidence based statements. We have reviewed the literature on infections in pediatric IBD as well as the ECCO guidelines in order to present a commentary on infection prophylaxis for the pediatric age group.
Gigi Veereman-Wauters; Lissy de Ridder; Gábor Veres; Sanja Kolacek; John Fell; Petter Malmborg; Sibylle Koletzko; Jorge Amil Dias; Zrinjka Misak; Jf Rahier; Johanna C Escher;
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-2-10
Journal Detail:
Title:  Journal of pediatric gastroenterology and nutrition     Volume:  -     ISSN:  1536-4801     ISO Abbreviation:  -     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-2-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8211545     Medline TA:  J Pediatr Gastroenterol Nutr     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
*Department of Pediatric Gastroenterology Hepatology & Nutrition, UZ Brussels, Belgium/ Universite Paris Descartes, Paris, France †Department of Pediatric Gastroenterology Hepatology & Nutrition, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands ‡Department of Pediatrics, Semmelweis University, Budapest, Hungary §Children's Hospital Zagreb, University Hospital Centre "Sr milosrdnice", Zagreb, Croatia ||Department of Pediatric Gastroenterology Hepatology & Nutrition, Chelsea and Westminster Hospital, London, UK ¶Department of Women and Child Health, Astrid Lindgren Children's Hospital, Karolinska Hospital, Karolinska Institutet, Stockholm, Sweden #Dr. v. Haunersches Children's Hospital, Ludwig Maximilian University München, Germany **Department of Pediatric Gastroenterology Hepatology & Nutrition, Hospital S. Joao, Porto, Portugal ††Department of Gastroenterology, Cliniques Universitaires UCL Mont Godinne,Yvoir, Belgium.
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