Empiric treatment of infectious diseases in Ebola suspect

    • A child that fits the case definition for Ebola may (and is potentially more likely to) have another cause of their illness that needs urgent treatment. 
    • Until Ebola virus infection can be excluded (by a negative Ebola PCR at 72 hours after symptom onset), the routine blood tests that will be available are only those that can be done on an iSTAT machine (blood gas, electrolytes, clotting, Hb).
    • A rapid malaria test may be possible. However, as many African children have asymptomatic parasitaemia, a positive malaria test does not necessarily mean that this is the cause of fever, nor does it exclude the possibility of co-existing Ebola infection.
    • Other routine tests (eg white cell count, blood culture, LFTs, CSF analysis) will not be possible.
    • Therefore, in addition to supportive management, the strategy is to start empiric treatment for other infectious diseases based predominantly on clinical features as follows:

    Empiric treatment for all patients
    All unwell children: start ‘blind’ empiric treatment for:

    Sepsis/meningitisusually Flucloxacillin 50 mg/kg (max 2 g) iv 4H
    and Ceftriaxone 100 mg/kg (max 2 g) iv 24H.
    MalariaMalaria guideline

    Other empiric treatment to consider in selected patients
    Depending on history and clinical features, consider empiric treatment for:

    HSV encephalitis

    Aciclovir 20 mg/kg iv 8H (age <3m);
     500 mg/m2 iv 8H (age 3m-12y);
    10 mg/kg iv 8H (age >12y)

    Influenza

    Oseltamivir:

    Antiviral_drug_doses_in_children_with_influenza

    Kawasaki disease

    IVIG 2 g/kg infusion over 10 hours
    and aspirin 3-5 mg/kg 24H

    Toxic shock syndrome

    Empiric antibiotics as above
    and Clindamycin 10 mg/kg (max 600 mg) iv 8H or
    5-7.5 mg/kg (max 450 mg) po 6-8H
    and IVIG 2 g/kg infusion over 10 hours

    Early liaison and discussion with the on-call Infectious Diseases team is also recommended.

    See also:
    Infection control Ebola resources
    Ebola virus management policy