Gastro-intestinal infections

Uncomplicated appendicectomy (no perforation)

Cefoxitin IV 40mg/kg (up to 2g max) as a single dose peri-operatively at induction.

No further antibiotics usually required.

Comments:

For more information, refer to CHQ guideline: Paediatric surgical antibiotic prophylaxis.

Appendicitis – if antibiotics are required post-operatively for treatment

UNCOMPLICATED (e.g. no perforation) and COMPLICATED Appendicitis (e.g perforation, appendiceal collection/ abscess present)

Ampicillin IV ( or Amoxycillin IV)

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

Plus Gentamicin IV

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)

Plus Metronidazole IV

If more than 1 month of age: 7.5mg/kg/dose IV every 8 hours (Max 500mg/dose)

If IV antibiotics required for more than 72 hours, direct treatment based on microbiology results and seek ID advice.

For delayed type hypersensitivity (eg. rash) to penicillins, use Ceftriaxone IV and Metronidazole IV.

For immediate type hypersensitivity (eg. anaphylaxis) to penicillins/cephalosporins, use Gentamicin IV plus Lincomycin IV.

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

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

Necrotising enterocolitis or Peritonitis (Non PICU)

Ampicillin IV ( or Amoxycillin IV)

Neonates: Refer to Ampicillin/Amoxycillin neonatal dosing section

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

Plus Metronidazole IV

Neonates: Refer to Metronidazole neonatal dosing section

If more than 1 month of age: 7.5mg/kg/dose IV every 8 hours (Max 500mg/dose)

Seek ID specialist review if continued for more than 72 hours.

For delayed type hypersensitivity (eg. rash) to penicillins, use Ceftriaxone IV (or Cefotaxime if neonate) and Metronidazole IV.

For immediate type hypersensitivity (eg. anaphylaxis) to penicillins/cephalosporins, seek ID advice on alternative antibiotic choice.

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

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

Abdominal infection or Peritonitis (PICU)

 

Ampicillin IV ( or Amoxycillin IV)

Neonates: Refer to Ampicillin/Amoxycillin neonatal dosing section

If more than 1 month of age: 50mg/kg/dose IV every 6 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: 7mg/kg IV once daily (max initial dose of 640mg/day)

Plus Metronidazole IV

Neonates: Refer to Metronidazole neonatal dosing section

If more than 1 month of age: 7.5mg/kg/dose IV every 8 hours (Max 500mg/dose)

Seek ID specialist review if continued for more than 72 hours.

For immediate type hypersensitivity (eg. anaphylaxis) to penicillins, seek ID advice on alternative antibiotic choice

Comments:

More information, refer to PICU Empirical Antibiotic Guidelines.

Peritonitis in a paediatric peritoneal dialysis patient (CAPD)

Cholangitis

Cefotaxime IV

Neonates: Refer to Cefotaxime neonatal dosing section

If more than one month old: 50mg/kg/dose every 6 hours (Max 2gram/dose)

Plus Metronidazole IV

Neonates: Refer to Metronidazole neonatal dosing section

If more than one month old: 7.5mg/kg/dose IV every 8 hours (Max 500mg/dose)

Seek ID advice within 72hours

OR

If more than one month old:

Ceftriaxone IV 100mg/kg once daily (Max 4gram/day)

Plus Metronidazole IV 7.5mg/kg/dose IV every 8 hours (Max 500mg/dose)

Seek ID advice within 72hours

For immediate type hypersensitivity (eg. anaphylaxis) to penicillins/cephalosporins, seek ID advice on alternative antibiotic choice.

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

Clostridium Difficile infection

Salmonellosis in Children (non-typhoidal)

Pinworms

Infants and Children < 1 year of age: Mebendazole oral 50mg as a single dose

Children >1 year of age: Mebendazole oral 100mg as a single dose

Note: Treat all family members.

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

Giardiasis

Infants and Children: Metronidazole oral 30mg/kg once daily (Max 2gram/dose) for 3 days.

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