Cardiac infections

Endocarditis

Benzylpenicillin 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 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,

Neonates: Seek ID advice.

If more than 1 month of age: Cephazolin IV 50mg/kg/dose every 8 hours (Max 2gram/dose)

PLUS Vancomycin IV 15mg/kg/dose every 6 hours (Max 750mg/dose)

PLUS Gentamicin IV.

If immediate type hypersensitivity (eg. anaphylaxis) to penicillins/cephalosporins,

Neonates: Seek ID advice.

If more than 1 month of age: Vancomycin IV PLUS 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-GDL-01202 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 750mg 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,

Neonates: Seek ID advice.

If more than 1 month of age: Cephazolin IV 50mg/kg/dose every 8 hours (Max 2gram/dose)

PLUS Vancomycin IV 15mg/kg/dose every 6 hours (Max 750mg/dose)

PLUS Gentamicin IV.

If immediate type hypersensitivity (eg. anaphylaxis) to penicillins/cephalosporins,

Neonates: Seek ID advice.

If more than 1 month of age: 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-GDL-01202 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 750mg 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 750mg 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 750mg 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