Colorectal surgery, complicated by perforation / faecal peritonitis
Give antibiotics for up to 5 days. If a total course of more than 5 days is needed discuss it with Paeds ID
Preferred
co-amoxiclav 30mg/kg (Max 1.2g) iv TDS (BD if 1-2 months old)
If septic add STAT dose gentamicin 7mg/kg iv (Max 560mg)
For MRSA positive patients: Add vancomycin iv. Review once microbiology results available.
Oral step down:
co-amoxiclav po see dosing table below
| Age | co-amoxiclav oral dose |
| 1 month to 11 months | 0.5mL/kg of 125mg/31mg/5mL suspension TDS |
| 1 year to 5 years | 10mLs of 125mg/31mg/5mL suspension TDS |
| 6 years to 17 years |
One 625mg tablet TDS OR 10mLs of 250mg/62mg/5mL suspension TDS if patient cannot take tablets |
Alternatives: Penicillin allergy (non-severe)
For penicillin allergy (non-severe)
ceftriaxone 80mg/kg (Max 4g) iv OD
AND metronidazole iv see dosing table below
If septic add STAT dose gentamicin 7mg/kg iv (Max 560mg)
For MRSA positive patients: Add vancomycin iv.
metronidazole IV dosing information:
|
Age |
metronidazole IV dose |
|
1 month up to 2 months |
Loading dose 15 mg/kg (Max 500mg) iv, then (after 8 hours) 7.5 mg/kg (Max 500mg) iv TDS |
|
2 months to 17 years |
7.5mg/kg (Max 500mg) iv TDS |
Alternatives: Penicillin allergy (severe)
ciprofloxacin* 10mg/kg (Max 400mg) iv TDS
AND metronidazole iv see dosing table below
For MRSA positive patients: ADD vancomycin iv. Review once microbiology results available.
metronidazole IV dosing information:
|
Age |
metronidazole IV dose |
|
1 month up to 2 months |
Loading dose 15 mg/kg (Max 500mg) iv, then (after 8 hours) 7.5 mg/kg (Max 500mg) iv TDS |
|
2 months to 17 years |
7.5mg/kg (Max 500mg) iv TDS |
* Note: Ciprofloxacin may induce convulsions in patients with or without a history of convulsions – use with caution
Also Note: If patient is prescribed cipofloxacin ensure that the patient is given the Fluoroquinolone MHRA patient information leaflet.
For more information about MHRA safety alerts and patient or carer counselling See Fluoroquinolone antibiotics - paediatric position statement
Oral step down in non-severe and severe penicillin allergy
ciprofloxacin* 20mg/kg (max 750mg) po BD
AND 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
* Note: Ciprofloxacin may induce convulsions in patients with or without a history of convulsions – use with caution
Also Note: If patient is prescribed ciprofloxacin ensure that the patient is given the Fluoroquinolone MHRA patient information leaflet.
For more information about MHRA safety alerts and patient or carer counselling See Fluoroquinolone antibiotics - paediatric position statement