Toxic shock syndrome
Consult paediatric ID/micro on call urgently.
Consider need for IVIG.
Preferred
ceftriaxone 100mg/kg (max 4g) iv OD
AND
clindamycin 10mg/kg (max 900mg) iv QDS
Review at 24 hours-36 hours when blood culture result is available AND ceftriaxone to be reviewed and stepped down to the following depending on causative organism identified in cultures and aetiology:
flucloxacillin 50mg/kg (max 2g) iv QDS AND clindamycin 10mg/kg (max 900mg) iv QDS
OR
benzylpenicillin 50mg/kg (max 2.4g) iv QDS (can be increased to every 4 hours for severe infection) AND clindamycin 10mg/kg (max 900mg) iv QDS
Alternative
For penicillin allergy (non-severe and severe) or MRSA positive patients
vancomycin iv
AND
clindamycin 10mg/kg (max 900mg) iv QDS
AND
ciprofloxacin* 10mg/kg (max 400mg) iv TDS
Review at 24 hours-36 hours when blood culture result is available AND tailor therapy to the sensitivities of the causative organism identified in cultures and etiology.
* 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