Central nervous system infections

Meningitis (neonates and infants less than 2 months of age)

Cefotaxime IV

Neonates: Refer to Cefotaxime neonatal dosing section

If more than 1 month of age: 50mg/kg IV every 6 hourly

PLUS Ampicillin (or Amoxycillin) IV

Neonates: Refer to Ampicilin/Amoxycillin neonatal dosing section

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

If gram negative meningitis/sepsis–Consult ID team for advice.

For immediate type hypersensitivity to penicillins or cephalosporins, seek ID specialist advice for alternative antibiotic choice.

If Encephalitis suspected (neonates and infants less than 2 months of age)

Add Aciclovir IV

Neonates: Refer to Aciclovir neonatal dosing section

If more than 1 month of age: 20mg/kg/dose IV every 8 hourly (for term infants up to 2months of age)

Duration of 3 weeks or till PCR negative.

Comments:

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

Meningitis in infants and children (more than 2 months of age)

Cefotaxime IV 50mg/kg (Max 2g) every 6 hourly

(OR Ceftriaxone IV 50mg/kg (Max 2g) every 12 hourly)

If gram positive cocci in CSF,

Add Vancomycin IV 15mg/kg (Max 500mg for initial dose) every 6 hourly

For immediate type hypersensitivity to cephalosporins, use Ciprofloxacin IV and Vancomycin IV and seek ID specialist advice within 24hours
If more than 3 months of age:
Give Dexamethasone 0.15mg/kg/dose IV every 6 hourly for 4 days if able to start prior to or within 1 hour of antibiotics.
Review if Neisseria meningitidis is confirmed.

Comments:

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

Paediatric Vancomycin Therapeutic drug monitoring

For more information, refer to CHQ Paediatric Antibiocard: Empirical Antibiotic Guidelines and Meningitis: Emergency Management guideline (QH staff only).

If Encephalitis suspected (infants and children more than 2 months of age)

Infants and Children (2 months to 12 years of age):
Aciclovir 500mg/m2/dose IV every 8 hourly. Duration of 3 weeks or till PCR negativ e.

Children (over 12yrs of age):
Aciclovir 10mg/kg/dose IV every 8 hourly. Duration of 3 weeks or till PCR negative.

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

Meningitis (PICU)

If less than 2 months of age
Cefotaxime IV

Neonates: Refer to Cefotaxime neonatal dosing section

If more than 1 month of age: 50mg/kg IV every 6 hourly

PLUS Ampicillin (or Amoxycillin) IV

Neonates: Refer to Ampicilin/Amoxycillin neonatal dosing section

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

If more than 2 months of age
Cefotaxime IV 50mg/kg (max 2gram) every 6 hourly

(OR Ceftriaxone IV 50mg/kg (max 2gram) twice daily)

If more than 3 months of age, give Dexamethasone 0.15mg/kg/dose IV every 6 hourly for 4 days if able to start prior to or within 1 hour of antibiotics. Review if Neisseria meningitidis is confirmed.

If gram positive cocci in CSF or Streptococcus pneumoniae suspected:
Add Vancomycin IV

Neonates: Refer to Vancomycin neonatal dosing section

If more than 1 month of age: 15mg/kg (max 750mg per dose) IV every 6 hourly

If HSV encephalitis suspected:

Add Aciclovir IV
Preterm infants – Refer to Aciclovir neonatal dosing section
Term infants up to 3month of age: 20mg/kg/dose IV every 8 hourly
If more than 3 months of age to 12 years: 500mg/m2/dose IV every 8 hourly
If more than 12 years of age: 10mg/kg/dose IV every 8 hourly

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

Prophylaxis for Neisseria Meningitidis (Meningocccus)

Ciprofloxacin PO

Child younger than 5 years: 30 mg/kg (up to 125 mg) orally as a single dose;

Child 5 to 12 years: 250 mg orally, as a single dose

More than 12 years of age: 500mg orally, as a single dose

or

Rifampicin PO

Neonates (less than 1month of age): 5mg/kg/dose orally twice daily for 2 days

Infants and children older than 1month of age
: 10mg/kg/dose orally twice daily (Max 600mg/dose) for 2 days

Comments:

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

CSF shunt infection

Cefotaxime IV

Neonates: Refer to Cefotaxime neonatal dosing section

If more than 1 month of age: 50mg/kg IV every 6 hourly

PLUS Vancomycin IV

Neonates: Refer to Vancomycin neonatal dosing section

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

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

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