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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

     

     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 

    Ceftriaxone 50 mg/kg/dose (2g) iv 12H

    If  age < 2 months: Cefotaxime 50 mg/kg (2g) iv 6H + Benzylpenicillin 60 mg/kg iv 12 H (wk 1 of life) 6-8H 4H (>wk 4 of life)

     

    Meningococcal prophylaxis

    Rifampicin 10 mg/kg (600 mg) po 12H for 2d

    Orbital cellulitis

    Flucloxacillin 50 mg/kg (2 g) iv 6H and
    Ceftriaxone 50 mg/kg/dose (2g) iv 12H

    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

    Clarithromycin 7.5 mg/kg (for child > 1month) up to 500 mg po 12H for 7d
    (No Clarithromycin syrup available at present)

    Azithromycin 10 mg/kg (for infant < 1 month) daily for five days

    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.
    • 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

     

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