Antibiotics guidelines for the Paediatric
Babies readmitted up to 28 days of age
Main infecting organisms - Group B Streptococcus
- Gram negatives
- Staphylococcus aureus
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.
Main infecting organisms - VIRUSES (commonest cause)
- streptococcus pneumoniae
- mycoplasma pneumoniae
- (haemophilus influenzae)
- other gram negative organisms
For lobar pneumonia the treatment of choice is
For patch pneumonia with systemic symptoms consider
ERYTHROMYCIN – if given IV should be by slow infusion.
CEFOTAXIME or AUGMENTIN may be used for broader
(CEFTAZIDIME should be reserved for CF patients).
For extensive CXR changes/suspicion of abscess consider
adding FLUCLOXACILLIN to cover STAPHYLOCOCCUS
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.
Guideline for the management of non-meningococcal
Orbital Celluitis/Lymphadenitis/Skin Sepsis
Main infecting organisms - staphylococci
Treat either with PENICILLIN and FLUCLOXACILLIN
Or CEFTRIAXONE and FLUCLOXACILLIN
(ERYTHROMYCIN if PENICILLIN allergy)
Main infecting organisms - staphylococcus aureus
- E. coli
- Haemophilus influenzae
1st Line antibiotics FLUCLOXACILLIN and CEPHALOSPORIN
Treatment should be undertaken jointly with the Orthopaedic
Treatment may need to continue intravenously for several
weeks if proven infection.
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.
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
PENCILLIN and GENTAMICIN until blood culture results and
Main infecting organisms - viruses
For bacterial tonsillitis the treatment of choice is oral or
intravenous BENZYLPENICILLIN. For otitis media
AMOXYCILLIN in usually used. (Erythromycin for patients with
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