Ambulatory care
- Patients with the conditions listed below, who are assessed as being suitable for ambulatory care, can be started on ceftriaxone IV. They will require TWO doses in a hospital setting before community nurses will accept them.
- Before starting antibiotic treatment, take blood cultures and other cultures as appropriate.
- Adjust empirical treatment according to culture results / clinical progress.
- The need for continued intravenous treatment should be reviewed on a daily basis. Switch to oral antibiotics as soon as feasible.
- Patients with known immediate (e.g. urticaria or rash of immediate onset) or severe life threatening penicillin reaction (e.g. anaphylaxis, facial or throat swelling, angio-oedema) should not be treated with cephalosporin or carbapenem antibiotics, please consult Paediatric ID.
- For delayed/non severe reaction to penicillin, ceftriaxone can be administered.
- Gentamicin: modify dose in renal impairment
- Ceftriaxone: dose can be increased to 80mg/kg iv OD in systemic sepsis and to 100mg/kg iv OD if CNS involvement
For further advice: Paediatric Infectious Disease: JR bleep 89-4374 or Paediatrics ID/Micro via switchboard out of hours
Preferred
|
Infection |
Suggested regimen
|
|
Meningitis (after a period of admission) Viral causes excluded Duration: 14-21 days depending on organism
|
ceftriaxone 80mg/kg-100mg/kg (max 4g) iv OD
|
|
Urinary Tract Infection With symptoms of upper UTI Duration: 5-7 days depending on age |
ceftriaxone 50mg/kg (max 2g) iv OD Increase to 80mg/kg (max 4g) iv OD if proven pylonephritis
|
|
Bacterial Sepsis (after a period of admission) Duration: 7-14 days depending on child age and organism
|
ceftriaxone 80mg/kg (max 4g) iv OD |
|
Pneumonia: Severe community- acquired Duration: 5 days
|
ceftriaxone 50mg/kg (max 2g) iv OD
|
|
Peri-orbital cellulitis Duration: 5-7 days (of which 2-4 days of IV antibiotics)
|
ceftriaxone 50mg/kg (max 2g) iv OD |
|
Orbital cellulitis Duration: 5-10 days
|
ceftriaxone 80mg/kg (max 4g) iv OD |
|
Limb Cellulitis, severe Duration: 5-7 days (of which 2-4 days of IV antibiotics)
|
ceftriaxone 80mg/kg (max 4g) iv OD |
|
Lymphadenitis, severe Duration: 5 days |
ceftriaxone 50mg/kg (max 2g) iv OD |
|
Soft tissue injury: Contaminated - Duration: 3 days Established infection - Duration: 5 days |
ceftriaxone 50mg/kg (max 2g) iv OD + metronidazole po: 1 month: 7.5 mg/kg (max 400mg) po BD 2 months-11 years: 7.5 mg/kg (max 400mg) po TDS 12 years and older: 400mg po TDS
|
|
Osteomyelitis/septic arthritis (Paediatric ID decision re duration) |
ceftriaxone 80mg/kg (max 4g) iv OD |
Alternative
Severe penicillin allery: Consult Paediatric ID