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Antibiotic guidelines

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					  Antibiotics guidelines for the Paediatric
                   wards

Babies readmitted up to 28 days of age
    Main infecting organisms - Group B Streptococcus
                             - Gram negatives
                             - Staphylococcus aureus
                             - Listeria

    1st Line Antibiotics  PENICILLIN AND GENTAMICIN

    Add FLUCLOXACILLIN if evidence of skin sepsis

    CEFOTAXIME plus AMOXICILLIN if meningitis is suspected
    and/or abnormal CSF results obtained.

    Once microbiology culture and sensitivity results have
    been obtained, antibiotic treatment should be rationalized.

Older babies requiring sepsis screen
    In babies greater than 4 weeks of age, who clinically require a
    full septic screen, it is sensible to commence broad spectrum IV
    antibiotics – such as CEFOTAXIME in those who are clinically
    shocked or who deteriorate or where there is a neutrophilia.

    Intravenous antibiotics may be stopped at 48 hours if all cultures
    are negative – discuss with the consultant of the week. If
    antibiotics need to be continued, change to ceftriaxone, and
    chose a suitable time to give the once daily dose.


Pneumonia
    Main infecting organisms - VIRUSES (commonest cause)
                             - streptococcus pneumoniae
                             - mycoplasma pneumoniae
                             - (haemophilus influenzae)
                             - other gram negative organisms

    For lobar pneumonia the treatment of choice is
    BENZYLPENICILLIN.

    For patch pneumonia with systemic symptoms consider
    ERYTHROMYCIN – if given IV should be by slow infusion.


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    CEFOTAXIME or AUGMENTIN may be used for broader
    cover.
    (CEFTAZIDIME should be reserved for CF patients).

    For extensive CXR changes/suspicion of abscess consider
    adding FLUCLOXACILLIN to cover STAPHYLOCOCCUS
    AUREUS.

    NB: Collapse/consolidation on the chest X-ray of babies with
    bronchiolitis or children with asthma does not always require
    treatment with antibiotics.

Urinary Tract Infection
    See separate guideline on Management of first presentation
    of urinary tract infection in children.


Meningitis :
    See
    Guideline for the management of non-meningococcal
    bacterial meningitis.
    Meningococcal disease



Orbital Celluitis/Lymphadenitis/Skin Sepsis
    Main infecting organisms - staphylococci
                             - streptococci

    Treat either with   PENICILLIN and FLUCLOXACILLIN
                  Or    CEFTRIAXONE and FLUCLOXACILLIN

                        (ERYTHROMYCIN if PENICILLIN allergy)

Osteomyelitis/Septic Arthritis
    Main infecting organisms - staphylococcus aureus
                             - E. coli
                             - streptococci
                             - Haemophilus influenzae

    1st Line antibiotics FLUCLOXACILLIN and CEPHALOSPORIN

    Treatment should be undertaken jointly with the Orthopaedic
    surgeons


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       Treatment may need to continue intravenously for several
       weeks if proven infection.

Infective Endocarditis
       Main infecting organisms - streptococcus viridans (sanguis)
                                - staphylococcus aureus
                                - staphylococcus epidermidis
                                  (often after cardiac surgery)

       Can occur in children with normal hearts. Predisposing factors
       not always identified.



Laboratory diagnosis

       Need six sets of blood cultures before starting treatment (ideally
       4 sets in the first 24 hours followed by 2 sets during the next 24
       hours)

Empirical treatment
      PENCILLIN and GENTAMICIN until blood culture results and
      sensitivities known

Tonsillitis/Otitis Media
       Main infecting organisms - viruses
                                - streptococci
                                - staphylococci
                                - (haemophilus)

       For bacterial tonsillitis the treatment of choice is oral or
       intravenous BENZYLPENICILLIN. For otitis media
       AMOXYCILLIN in usually used. (Erythromycin for patients with
       Penicillin allergy).

       In all cases apart from proven septicaemia, meningitis, bone
       sepsis or endocarditis, the aim is to switch from intravenous to
       oral antibiotics as soon as the clinical situation allows



See separate protocols for oncology patients.



Dr Fiona Thompson
Updated January 2009 – Dr Smith/Dr Minassian


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posted:11/16/2011
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