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)
Paediatric Vancomycin Therapeutic drug monitoring
