Osteogenesis imperfecta

While osteogenesis imperfecta (OI) doesn’t directly change the choice of antibiotics for pneumonia, there are some important drug-related considerations to keep in mind:

1. Avoid Drugs That Impair Bone Health (if long-term used):

• Tetracyclines (e.g., doxycycline) are contraindicated in infants and young children due to risks of:
  • Tooth discoloration
  • Bone growth inhibition
  • Especially in OI, where bones are already fragile, avoid unless absolutely necessary and for a very short duration.

Not usually used in infants anyway—but important to avoid if someone suggests doxy for atypicals.

2. Use Caution with corticosteroids:

• Avoid excessive sodium load or corticosteroids, unless clinically indicated (e.g., if severe inflammation or bronchiolitis component).
• Steroids may worsen bone fragility, especially if used repeatedly or for prolonged durations.

3. Monitor for Nephrotoxicity/Ototoxicity with Aminoglycosides:

• If using aminoglycosides (e.g., gentamicin) as part of pneumonia coverage:
  • OI patients may already have hearing impairment (especially in type I).
  • Minimize use or monitor closely (serum drug levels, hearing assessment if prolonged).

4. Consider Respiratory Support Needs Early:

• If the patient has chest wall deformities or respiratory compromise:
  • Avoid sedatives or respiratory depressants unless strictly needed (e.g., in ICU settings).

5. Vitamin D and Calcium Supplementation:

• If already on bisphosphonates or supplements, be cautious with interactions or calcium balance:
  • Some antibiotics like ceftriaxone can precipitate with calcium if given IV simultaneously.
  • Separate administration if both are IV.