Книги фарма 2 / Bertram G. Katzung-Basic & Clinical Pharmacology(9th Edition)

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Клиническая фармакология

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Infants born to seronegative mothers:

Hepatitis B vaccine (HBV)

Infants born to seronegative mothers:

Administration should begin at birth, with the

second dose administered at least 4 weeks

after the first dose.

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						witho
						ut a
						histor
						y of
						measl
						es or
						live
						virus
						vaccin
						ation
						on or
						after
						their
						first
						birthd
						ay
					2.
						Postex
						posure
						proph
						ylaxis
						in
						unim
						muniz
						ed
						person
						s
Measles-	Live virus	Subcutaneous	See Table I–2	None		For all
mumps-rubella						children
(MMR)
Menningococc	Bacterial	Subcutaneous	One dose	Every 3 to 5		1.
al vaccine	polysaccharid			years if there		Milita
	es of			is continuing		ry
	serotypes			high risk of		recruit
	A/C/Y/W-135			exposure		s
						2.
						Travel
						ers to
						areas
						with
						epide
						mic
						menin
						gococ
						cal
						diseas
						e
						3.
						Indivi
						duals

						with
						asplen
						ia,
						compl
						ement
						deficie
						ncy,
						or
						proper
						din
						deficie
						ncy
					4.
						Contr
						ol of
						outbre
						aks in
						closed
						or
						semi-
						closed
						popula
						tions
					5.
						Colleg
						e
						fresh
						men
						who
						live in
						dormit
						ories
Mumps	Live virus	Subcutaneous	One dose	None		Adults born
						after 1956
						without a
						history of
						mumps or
						live virus
						vaccination
						on or after
						their first
						birthday
Pneumococcal	Bacterial	Intramuscular	One dose	Repeat after		1.
vaccine	polysaccharid	or		5 years in		Adults
	es of 23	subcutaneous		patients at		65
	serotypes			high risk		years
						of age
						2.
						Person
						s at

					increa
					sed
					risk
					for
					pneum
					ococc
					al
					diseas
					e or its
					compl
					ication
					s
Poliovirus	Inactivated	Subcutaneous	See Table I–2 for	One-time	1. For
vaccine,	viruses of all		childhood schedule.	booster dose	all
inactivated	three		Adults: Two doses 4	for adults at	childr
(IPV)	serotypes		to 8 weeks apart,	increased	en
			and a third dose 6 to	risk of	2.
			12 months after the	exposure	Previo
			second		usly
					unvac
					cinate
					d
					adults
					at
					increa
					sed
					risk
					for
					occup
					ational
					or
					travel
					expos
					ure to
					poliov
					iruses
Rabies	Inactivated	Intramuscular	Preexposur	Serologic	1.
	virus	(IM) or	e: Three	testing every	Preex
		intradermal	doses (IM or	6 months to	posur
		(ID)	ID) at days	2 years in	e
			0, 7, and 21	persons at	proph
			or 28	high risk	ylaxis
			Postexposur		in
			e: Five-		person
			doses (IM		s at
			only) at days		risk
			0, 3, 7, 14,		for
			and 28		contac
					t with
					rabies

virus

Poste

xposu

proph

ylaxis

(admi

nister

with

rabies

immu

globul

in)

Rubella

Live virus

Subcutaneous

One or two doses (at

None

Adults born

least 28 days apart)

after 1956

without a

history of

rubella or live

virus

vaccination

on or after

their first

birthday

Tetanus-

Toxoids

Intramuscular

Two doses 4–8

Every 10

1. All

diphtheria (Td

weeks apart, and a

years

adults

or DT)3

third dose 6–12

who

months after the

have

second

not

been

immu

nized

childr

Postex

posure

proph

ylaxis

if > 5

years

has

passed

since

last

dose

Typhoid,

Live bacteria

Oral

Four doses

Risk of

Ty21a oral

administered every

every 5

exposure to

			other day	years
Typhoid, Vi	Bacterial	Intramuscular	One dose	Every 2
capsular	polysaccharid			years
polysaccharide	e
Varicella	Live virus	Subcutaneous	Two doses 4–8	Unknown
			weeks apart in
			persons past their
			13th birthday (see
			Table I–2 for
			childhood schedule)

Yellow Fever	Live virus	Subcutaneous	One dose 10 days to	Every 10
			10 years before	years
			travel

typhoid fever

Risk of exposure to typhoid fever

1. For all childr en

2. Person s (at high risk for expos ure) past their 13th birthd ay witho ut a histor y of varicel la infecti on or immu nizatio n

3. Postex posure proph ylaxis in suscep tible person s

1. Labor atory person nel who may be

expos ed to yellow fever virus 2. Travel ers to areas where yellow fever occurs

1 Dosages for the specific product, including variations for age, are best obtained from the manufacturer's package insert. Does not include all combination products.

2 One dose unless otherwise indicated.

3 Td = Tetanus and diphtheria toxoids for use in persons 7 years of age (contains less diphtheria toxoid than DPT and DT). DT = Tetanus and diphtheria toxoids for use in persons < 7 years of age (contains the same amount of diphtheria toxoid as DPT).

Current recommendations for routine active immunization of children are given in Table I–2.

Table I–2. Recommended Routine Childhood Immunization Schedule.1

Age

Immunization

Comments

Infants born to seropositive mothers:

Should receive the first dose within 12 hours after birth (with hepatitis B immune globulin), the second dose at 1–2 months of age, and the third dose at 6 months of age.

2	Diphtheria and tetanus toxoids and
months	acellular pertussis vaccine (DTaP),
	inactivated poliovirus vaccine (IPV),
	Haemophilus influenzae type b
	conjugate vaccine (Hib)2 pneumococcal
	conjugate vaccine (PCV)


1–4	HBV	The second dose should be given at least 4
months		weeks after the first dose.

4	DTaP, Hib2, IPV, PCV
months

6	DTaP, Hib2, PCV
months

6–18	HBV, IPV	The third dose of HBV should be given at
months		least 16 weeks after the first dose and at least
		8 weeks after the second dose, but not before
		age 6 months.

6–23	Influenza, split virus vaccine	Two doses 1 month apart are recommended
months		for children 9 years who are receiving
		influenza vaccine for the first time.

12–15	Measles-mumps-rubella vaccine
months	(MMR), Hib2, PCV


12–18	DTaP at 15–18 months, varicella	DTaP may be given as early as age 12 months.
months	vaccine	Varicella vaccine is recommended at any visit
		after the first birthday for susceptible children.
		Susceptible children 13 years of age should
		receive two doses given at least 4 weeks apart.

4–6	DTaP IPV, MMR	The second dose of MMR should be routinely
years		administered at 4–6 years of age but may be
		given during any visit if at least 4 weeks have
		elapsed since administration of the first dose.
		The second dose should be given no later than
		age 11–12 years.

11–12	Diphtheria and tetanus toxoids (Td)	Vaccination is recommended if at least 5 years
years		has elapsed since administration of the last
		dose of DTaP. Routine booster doses of Td
		should be given every 10 years thereafter.

1Adapted from MMWR Morb Mortal Wkly Rep 2002;31:31.

2Three Hib conjugate vaccines are available for use: (a) oligosaccharide conjugate Hib vaccine (HbOC), (b) polyribosylribitol phosphate-tetanus toxoid conjugate (PRP-T), and (c) Haemophilus influenzae type b conjugate vaccine (meningococcal protein conjugate) (PRP-OMP). Children immunized with PRP-OMP at 2 and 4 months of age do not require a dose at 6 months of age.

Katzung PHARMACOLOGY, 9e > Section X. Special Topics > Appendix I: Vaccines, Immune Globulins, & Other Complex Biologic Products >

Passive Immunization

Passive immunization consists of transfer of immunity to a host using preformed immunologic products. From a practical standpoint, only immunoglobulins have been utilized for passive immunization, since passive administration of cellular components of the immune system has been technically difficult and associated with graft-versus-host reactions. Products of the cellular immune system (eg, interferons) have also been used in the therapy of a wide variety of hematologic and

infectious diseases (Chapter 56: Immunopharmacology).

Passive immunization with antibodies may be accomplished with either animal or human immunoglobulins in varying degrees of purity. These may contain relatively high titers of antibodies directed against a specific antigen or, as is true for pooled immune globulin, may simply contain antibodies found in most of the population. Passive immunization is useful for (1) individuals unable to form antibodies (eg, congenital agammaglobulinemia); (2) prevention of disease when time does not permit active immunization (eg, postexposure); (3) for treatment of certain diseases normally prevented by immunization (eg, tetanus); and (4) for treatment of conditions for which active immunization is unavailable or impractical (eg, snakebite).

Complications from administration of human immunoglobulins are rare. The injections may be moderately painful and rarely a sterile abscess may occur at the injection site. Transient hypotension and pruritus occasionally occur with the administration of IGIV products, but generally are mild. Individuals with certain immunoglobulin deficiency states (IgA deficiency, etc) may occasionally develop hypersensitivity reactions to immune globulin that may limit therapy. Conventional immune globulin contains aggregates of IgG; it will cause severe reactions if given intravenously. However, if the passively administered antibodies are derived from animal sera, hypersensitivity reactions ranging from anaphylaxis to serum sickness may occur. Highly purified immunoglobulins, especially from rodents or lagomorphs are the least likely to cause reactions. To avoid anaphylactic reactions, tests for hypersensitivity to the animal serum must be performed. If an alternative preparation is not available and administration of the specific antibody is deemed essential, desensitization can be carried out.

Antibodies derived from human serum not only avoid the risk of hypersensitivity reactions but also have a much longer half-life in humans (about 23 days for IgG antibodies) than those from animal sources (5–7 days or less). Consequently, much smaller doses of human antibody can be administered to provide therapeutic concentrations for several weeks. These advantages point to the desirability of using human antibodies for passive protection whenever possible. Materials available for passive immunization are summarized in Table I–3.

Table I–3. Materials Available for Passive Immunization.1

Indication	Product	Dosage	Comments

Black widow	Antivenin	One vial (6000 units) IV or IM.	For persons with
spider bite	(Latrodectus		hypertensive
	mactans), equine		cardiovascular disease or
			age < 16 or > 60 years.

Bone marrow	Immune globulin	500 mg/kg IV on days 7 and 2	Prophylaxis to decrease
transplantation	(intravenous)2	prior to transplantation and	the risk of infection,
		then once weekly through day	interstitial pneumonia, and
		90 after transplantation.	acute graft-versus-host
			disease in adults
			undergoing bone marrow
			transplantation.

Botulism	Botulism	Consult the CDC.3	Treatment and prophylaxis
	antitoxin		of botulism. Available
	(trivalent, types		from the CDC.3 Ten to 20

	A, B, and E),		percent incidence of serum
	equine		reactions.


Chronic	Immune globulin	Initial dose of 400 mg/kg IV	CLL patients with
lymphocytic	(intravenous)3	every 3–4 weeks. Dosage	hypogammaglobulinemia
leukemia (CLL)		should be adjusted upward if	and a history of at least
		bacterial infections occur.	one serious bacterial
			infection.

Cytomegalovirus	Cytomegalovirus	Consult the manufacturer's	Prophylaxis of CMV
(CMV)	immune globulin	dosing recommendations.	infection in bone marrow,
	(intravenous)		kidney, liver, lung,
			pancreas, heart transplant
			recipients.

Diphtheria	Diphtheria	20,000–120,000 units IV or IM	Early treatment of
	antitoxin, equine	depending on the severity and	respiratory diphtheria.
		duration of illness.	Available from the CDC.3
			Anaphylactic reactions in
			7% of adults and serum
			reactions in 5–10% of
			adults.


Hepatitis A	Immune globulin	Preexposure	Preexposure and
	(intramuscular)	prophylaxis: 0.02	postexposure hepatitis A
		mL/kg IM for	prophylaxis. The
		anticipated risk of 3	availability of hepatitis A
		months, 0.06 mL/kg for	vaccine has greatly
		anticipated risk of > 3	reduced the need for
		months, repeated every	preexposure prophylaxis.
		4–6 months for
		continued exposure.
		Postexposure: 0.02
		mL/kg IM as soon as
		possible after exposure
		up to 2 weeks.

Hepatitis B	Hepatitis B	0.06 mL/kg IM as soon as	Postexposure prophylaxis
	immune globulin	possible after exposure up to 1	in nonimmune persons
	(HBIG)	week for percutaneous	following percutaneous,
		exposure or 2 weeks for sexual	mucosal, sexual, or
		exposure. 0.5 mL IM within 12	perinatal exposure.
		hours after birth for perinatal	Hepatitis B vaccine should
		exposure.	also be administered.

HIV-infected	Immune globulin	400 mg/kg IV every 28 days.	HIV-infected children with
children	(intravenous)2		recurrent serious bacterial
			infections or
			hypogammaglobulinemia.

Kawasaki disease	Immune globulin	400 mg/kg IV daily for 4	Effective in the prevention
	(intravenous)2	consecutive days within 4 days	of coronary aneurysms.
		after the onset of illness. A	For use in patients who

		single dose of 2 g/kg IV over	meet strict criteria for
		10 hours is also effective.	Kawasaki disease.

Measles	Immune globulin	Normal hosts: 0.25	Postexposure prophylaxis
	(intramuscular)	mL/kg IM.	(within 6 days after
		Immunocompromised	exposure) in nonimmune
		hosts: 0.5 mL/kg IM	contacts of acute cases.
		(maximum 15 mL for
		all patients).

Idiopathic	Immune globulin	Consult the manufacturer's	Response in children with
thrombocytopenic	(intravenous)2	dosing recommendations for	ITP is greater than in
purpura (ITP)		the specific product being used.	adults. Corticosteroids are
			the treatment of choice in
			adults, except for severe
			pregnancy-associated ITP.

Primary	Immune globulin	Consult the manufacturer's	Primary
immunodeficiency	(intravenous)2	dosing recommendations for	immunodeficiency
disorders		the specific product being used.	disorders include specific
			antibody deficiencies (eg,
			X-linked
			agammaglobulinemia) and
			combined deficiencies (eg,
			severe combined
			immunodeficiencies).

Rabies	Rabies immune	20 IU/kg.The full dose should	Postexposure rabies
	globulin	be infiltrated around the wound	prophylaxis in persons not
		and any remaining volume	previously immunized
		should be given IM at an	with rabies vaccine. Must
		anatomic site distant from	be combined with rabies
		vaccine administration.	vaccine.
Respiratory	Palivizumab	15 mg/kg IM once prior to the	For use in infants and
syncytial virus		beginning of the RSV season	children younger than 24
(RSV)		and once monthly until the end	months with chronic lung
		of the season.	disease or a history of
			premature birth ( 35
			weeks' gestation).

	RSV immune	750 mg/kg IV once prior to the	As for palivizumab.
	globulin	beginning of the RSV season	Palivizumab is preferred
		and once monthly until the end	for selected high-risk
		of the season.	children, but RSV-IGIV
			may be preferred for
			selected high-risk children.

Rubella	Immune globulin	0.55 mL/kg IM.	Nonimmune pregnant
	(intramuscular)		women exposed to rubella
			who will not consider
			therapeutic abortion.
			Administration does not
			prevent rubella in the fetus
			of an exposed mother.

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