Cardiac infections

Endocarditis

Benzylpenicillin IV

Neonates: Seek ID specialist advice on dosing in endocarditis.

If more than 1 month of age: 45mg/kg/dose IV every 4 hours (Max 1.8gram/dose)

Plus Flucloxacillin IV

Neonates: Seek ID specialist advice on dosing in endocarditis.

If more than 1 month of age: 50mg/kg/dose IV every 4 hours (Max 2gram/dose)

Plus Gentamicin IV

Neonates: Refer to Gentamicin neonatal dosing section

If more than 1 month and less than 10 years of age: 7.5mg/kg IV once daily (max initial dose of 320mg/day)

If more than 10 years of age: 6mg/kg IV once daily (max initial dose of 560mg/day)

If delayed type hypersensitivity (eg. rash) to penicillins, use Cephazolin IV, Vancomycin IV and Gentamicin IV.

If delayed type hypersensitivity (eg. rash) to penicillins, use Cephazolin IV, Vancomycin IV and Gentamicin IV.

If immediate type hypersensitivity (eg. anaphylaxis) to penicillins/cephalosporins, use Vancomycin IV and Gentamicin IV and seek ID advice.

Comments:
Seek pharmacist/ID advice on appropriate therapeutic drug monitoring (TDM) and appropriate dosing for patients in renal failure
Paediatric Tobramycin/Gentamicin Therapeutic drug monitoring
Paediatric Vancomycin Therapeutic drug monitoring

For more information, refer to CHQ Paediatric Antibiocard: Empirical Antibiotic Guidelines

Endocarditis (prosthetic valve, nosocomial infection or community acquired MRSA is suspected

Vancomycin IV

Neonates: Refer to Vancomycin neonatal dosing section

More than 1 month of age: 15mg/kg (Max 500mg for initial dose) IV every 6 hourly

Plus Flucloxacillin IV

Neonates: Seek ID specialist advice on dosing in endocarditis.

If more than 1 month of age: 50mg/kg/dose IV every 4 hours (Max 2gram/dose)

Plus Gentamicin IV

Neonates: Refer to Gentamicin neonatal dosing section

If more than 1 month and less than 10 years of age: 7.5mg/kg IV once daily (max initial dose of 320mg/day)

If more than 10 years of age: 6mg/kg IV once daily (max initial dose of 560mg/day)

If delayed type hypersensitivity (eg. rash) to penicillins, use Cephazolin IV, Vancomycin IV and Gentamicin IV.

If immediate type hypersensitivity (eg. anaphylaxis) to penicillins/cephalosporins, use Vancomycin IV and Gentamicin IV and seek ID advice.

Comments:
For directed therapy, seek ID specialist advice.

Seek pharmacist/ID advice on appropriate therapeutic drug monitoring (TDM) and appropriate dosing for patients in renal failure
Paediatric Tobramycin/Gentamicin Therapeutic drug monitoring
Paediatric Vancomycin Therapeutic drug monitoring

For more information, refer to CHQ Paediatric Antibiocard: Empirical Antibiotic Guidelines

Suspicion of bacterial infection post cardiac surgery

Postoperative suspicion of bacterial infection without focus:

Culture ‘head-to-toe’

Start Vancomycin IV

Neonates: Refer to Vancomycin neonatal dosing section

More than 1 month of age: 15mg/kg (Max 500mg for initial dose) IV every 6 hourly

Plus Gentamicin IV

Neonates: Refer to Gentamicin neonatal dosing section

If more than 1 month and less than 10 years of age: 7.5mg/kg IV once daily (max initial dose of 320mg/day)

If more than 10 years of age: 6mg/kg IV once daily (max initial dose of 560mg/day)

Cease treatment if cultures are negative after 48hours in consultation with ID team.

Postoperative suspicion of bacterial infection with focus:

Wound and CVL/bloodstream:

Start Vancomycin IV

Neonates: Refer to Vancomycin neonatal dosing section

More than 1 month of age: 15mg/kg (Max 500mg for initial dose) IV every 6 hourly

Plus Gentamicin IV

Neonates: Refer to Gentamicin neonatal dosing section

If more than 1 month and less than 10 years of age: 7.5mg/kg IV once daily (max initial dose of 320mg/day)

If more than 10 years of age: 6mg/kg IV once daily (max initial dose of 560mg/day)

Cease treatment if cultures are negative after 48hours in consultation with ID team.

If life threatening staphylococcal infection suspected:

Add Flucloxacillin IV

Neonates: Refer to Flucloxacillin neonatal dosing section

If more than 1 month of age: 50mg/kg/dose IV every 6 hours (Max 2gram/dose)

Consider replacing CVL; duration of treatment as per ID specialist advice.

Respiratory tract:
Nasopharyngeal swab for respiratory viruses and deep tracheal aspirate for microscopy and culture (MCS)

Piperacillin-tazobactam IV

Neonates: 100mg/kg (Piperacillin component) IV every 8 hourly

If more than 1 month of age: 100mg/kg (max 4gram Piperacillin component) IV every 6 hourly

PLUS Vancomycin IV

Neonates: Refer to Vancomycin neonatal dosing section

More than 1 month of age: 15mg/kg (Max 500mg for initial dose) IV every 6 hourly

Cease Vancomycin after 48hrs if blood cultures negative; duration as per ID consult.

Urinary tract:
Replace indwelling urinary catheter

Ampicillin (or Amoxycillin) IV

Neonates: Refer to Ampicillin/Amoxycillin neonatal dosing section

More than 1 month of age: 50mg/kg (Max 2g) IV every 6 hourly

PLUS Gentamicin IV

Neonates: Refer to Gentamicin neonatal dosing section

If more than 1 month and less than 10 years of age: 7.5mg/kg IV daily (Max initial dose of 320mg/day)

If more than 10 years of age: 6mg/kg IV once daily (max initial dose of 560mg/day)

Comments:
For directed therapy, seek ID specialist advice.Seek pharmacist/ID advice on appropriate therapeutic drug monitoring (TDM) and appropriate dosing for patients in renal failure