Antibiotics

Adenitis
Bites (animal/human)
Cellulitis
Encephalitis
Endocarditis prophylaxis
Giardiasis
Head lice
Impetigo
Meningitis
Meningococcal prophylaxis
Orbital cellulitis
Osteomyelitis

Otitis media
Periorbital cellulitis
Peritonitis
Pertussis
Pneumonia
Scabies
Septic arthritis
Septicaemia
Tonsillitis
UTI
UTI prophylaxis

Several changes have been made in November 2006. Click here to read the rationale for these changes

Condition	Initial Antibiotics () = maximum dose
CNS / EYE
Encephalitis	Aciclovir 20 mg/kg iv 8H (age <3m ) 500 mg/m² iv 8H (age 3m-12y) Surface area calculator 10 mg/kg iv 8H (age >12y)
Meningitis^{(suspected or proven)} Age < 2 months	Cefotaxime 50 mg/kg (2 g) iv 6H add Benzylpenicillin 60 mg/kg iv 12H (wk 1 of life) 6-8H (wk 2-4 of life) 4H (>wk 4 of life) *and* Gentamicin
Meningococcal prophylaxis	Rifampicin 10 mg/kg (600 mg) po 12H for 2d
Orbital cellulitis	Flucloxacillin 50 mg/kg (2 g) iv 6H *and* Cefotaxime 50 mg/kg (2 g) iv 6H
Periorbital cellulitis Mild: Moderate: Severe, or <5y & not Hib immunised	Amoxycillin/Clavulanate (400/57 mg per 5 mL) 0.3 mL/kg (11 mL) po 12H Flucloxacillin 50 mg/kg (2 g) iv 6H As for orbital cellulitis above
CVS
Endocarditis prophylaxis (dental/upper resp only)	Amoxycillin 50 mg/kg (2 g) po 1 hr before LA, or iv with GA indn
GI TRACT
Peritonitis	Ampicillin 50 mg/kg (2 g) iv 6H *and* Gent 7.5 (6 if >10y) mg/kg (360 mg) iv daily *and* Metronidazole 15 mg/kg (1 g) iv stat, then 7.5 mg/kg (500 mg) iv 8H
Giardiasis	Metronidazole 30 mg/kg (2 g) po daily for 3d
GU TRACT
UTI Sick, or acute pyelonephritis: >6m + not sick:	Benzylpenicillin 60 mg/kg (2 g) iv 6H *and* Gent 7.5 (6 if >10y) mg/kg (360 mg) iv daily Trimethoprim 4 mg/kg (150 mg) tablets po 12H or if syrup necessary then Co-trimoxazole (8/40 mg per mL) 0.5 mL/kg (20 mL) po 12H
UTI prophylaxis	Trimethoprim or Co-trimoxazole at half treatment doses above, once daily
RESPIRATORY
Tonsillitis	Consider no antibiotics (particularly if or Penicillin V 250 (500 if >10y) mg po 12H for 10d
Otitis media	Consider no antibiotics for 48 hrs (especially if >2y old) or Amoxycillin 15 mg/kg (500 mg) po 8H
Pertussis	Ertyromycin 12.5 mg/kg (500 mg) po 6H for 14d Clarithromyci ycin 7.5 mg/kg (500 mg) po 12H for 7d (no syrup available)
Pneumonia Mild: Moderate: Severe or pneumatocoele:	Amoxycillin 15 mg/kg (500 mg) po 8H or Roxithromycin 4 mg/kg (150 mg) po 12H If considering Mycoplasma Benzylpenicillin 60 mg/kg (2 g) iv 6H and Roxithromycin 4 mg/kg (150 mg) po 12H If considering Mycoplasma Flucloxacillin 50 mg/kg (2 g) iv 4H *and* Gent 7.5 (6 if >10y) mg/kg (360 mg) iv daily and Azithromycin 15 mg/kg (500 mg) iv stat then 5mg/kg iv daily If considering Mycoplasma
SKIN / SOFT TISSUE / BONE
Adenitis	Flucloxacillin 50 mg/kg (2 g) iv 6H
Bites (animal/human) Severe:	Amoxycillin/Clavulanate (400/57 mg per 5 mL) 0.3 mL/kg (11 mL) po 12H Ticarcillin/clavulanate 50mg/kg (3g) iv 6H
Cellulitis Mild: Moderate/Severe:	Cephalexin 25mg/kg (500mg) po 6H Flucloxacillin 50 mg/kg (2 g) iv 6H
Impetigo	Mupirocin 2% ointment 8H if localised or Cephalexin 25mg/kg (500mg) po 12H
Head lice	1% Permethrin liquid or cream rinse
Scabies	5% Permethrin cream (treat all family)
Osteomyelitis/Septic arthritis If <5y & not Hib immunised	Flucloxacillin 50 mg/kg (2 g) iv 4-6H add Cefotaxime 50 mg/kg (2 g) iv 6-8H
SEPTICAEMIA
Septicamia (ie sick child) (with normal CSF) If central line in situ or with suspected MRSA	Flucloxacillin 50 mg/kg (2 g) iv 4H *and* Gent 7.5 (6 if >10y) mg/kg (360 mg) iv daily replace Flucloxacillin with Vancomycin 15mg/kg (500mg) iv 6H
Septicaemia (ie sick child) (with unknown CSF) If central line in situ or with suspected MRSA	Flucloxacillin 50 mg/kg (2 g) iv 4H *and* Cefotaxime 50 mg/kg (2 g) iv 6H replace Flucloxacillin with Vancomycin 15mg/kg (500mg) iv 6H

Antibiotics should be changed to narrow spectrum agents once sensitivities are known.

3rd generation cephalosporins may only be used following consultant approval at RCH except for the 1st dose in meningitis

Guidelines do not apply to neonates or immunocompromised patients

These antibiotic guidelines were prepared by Nigel Curtis, Mike Starr, Jim Buttery and Mike South. Sources include the VMPF antibiotic guidelines, RCH acute care guidelines, and consultation with many clinicians. Particular thanks go to Frank Shann. Consensus views have been obtained where possible.

Duration of treatment is not generally given as this may vary with the clinical situation.
Cefotaxime is suggested as the 1st line 3rd generation cephalosporin on the basis of cost. Ceftriaxone should only be used for patients receiving im, or once daily iv, therapy as outpatient therapy.
A laminated credit card version is available from:

Resource Centre for Child Health and Safety (CHAS)
Royal Children's Hospital
Parkville, Vic 3052
Tel 03 9345 6429
Fax 03 9345 6120
chic.bookshop@rch.org.au