Respiratory infections

Bronchiolitis

Community acquired pneumonia in neonates (less than one month of age)

Ampicillin (or Amoxycillin) IV

Neonates: Refer to Ampicilin/Amoxycillin neonatal dosing section

PLUS Gentamicin IV

Neonates: Refer to Gentamicin neonatal dosing section

Consider adding azithromycin if pertussis/ chlamydia likely. Seek ID specialist advice.

Neonatal Azithromycin dosing:

For Pertussis, give Azithromycin PO 10mg/kg once daily for 5 days

For Chlamydia trachomatis and pneumonitis, give Azithromycin PO 20mg/kg once daily for 3 days

For immediate type hypersensitivity to penicillins, seek ID specialist advice for 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-GDL-01202 Paediatric Antibiocard: Empirical Antibiotic Guidelines

Community acquired pneumonia in infants and children (more than one month of age) who are able to tolerate oral therapy

Amoxycillin oral 25mg/kg (Max 1gram/dose) every 8 hourly

Oral antibiotics are sufficient in most children with CAP unless unable to tolerate oral or severe/complicated.

For immediate type hypersensitivity to penicillins, use oral Roxithromycin 4mg/kg/dose twice daily (Max 150mg/dose).

Community acquired pneumonia in infants and children (more than one month of age) who are unable to tolerate oral therapy

Benzylpenicillin IV 60mg/kg (Max 2.4gram/dose) every 6 hourly

For delayed type hypersensitivity (eg. rash) to Benzylpenicillin, use Cefotaxime IV 50mg/kg/dose (Max 2gram/dose) every 6 hourly.

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

Empyema (non PICU)

Benzylpenicillin IV 60mg/kg (Max 2.4gram/dose) every 6 hourly

Plus Lincomycin 15mg/kg (max 1.2g) IV every 8 hourly

Consult respiratory team regarding pleural drainage.

For delayed type hypersensitivity (eg. rash) to penicillins, use Lincomycin IV and Cefotaxime IV 50mg/kg/dose (Max 2gram/dose) every 6 hourly.

Severe community acquired pneumonia (infants and children less than 5 years old) (PICU)

Cefotaxime IV

Neonates: Seek ID advice.

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

Seek ID advice within 48 hours.

If S. aureus (including nmMRSA) pneumonia suspected:

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

PLUS Lincomycin IV 15mg/kg (max 1.2g) every 8 hourly

Seek ID advice within 24 hours.

If life threatening pneumonia OR multi-resistant MRSA suspected:

Cefotaxime IV 50 mg/kg/dose every 6 hours (maximum 2 g/dose)

PLUS Lincomycin IV 15 mg/kg/dose every 6 hours (maximum 1.2 g/dose)

PLUS Vancomycin IV 15 mg/kg/dose IV every 6 hours (maximum initial dose of 750 mg)

PLUS Azithromycin IV 10 mg/kg once daily (maximum 500 mg/day).

Seek ID advice within 24 hours

For immediate type hypersensitivity (eg. anaphylaxis) to cephalosporins, seek ID specialist advice for alternative antibiotic choice.

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-GDL-01202 Paediatric Antibiocard: Empirical Antibiotic Guidelines

Severe community acquired pneumonia (children older than 5 years of age (PICU)

Cefotaxime IV

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

+/- Azithromycin IV 10mg/kg once daily (maximum 500mg/day).

(Swap to oral Roxithromycin 4 mg/kg/dose (maximum 150 mg/dose) twice daily, after 24 hours if possible).

Seek ID advice within 24 hours.

If S. aureus (including nmMRSA) pneumonia suspected:

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

PLUS Lincomycin IV 15mg/kg (max 1.2g) every 8 hourly

Seek ID advice within 24 hours.

If life threatening pneumonia OR multi-resistant MRSA suspected:

Cefotaxime IV 50 mg/kg/dose every 6 hours (maximum 2 g/dose)

PLUS Lincomycin IV 15 mg/kg/dose every 6 hours (maximum 1.2 g/dose)

PLUS Vancomycin IV 15 mg/kg/dose IV every 6 hours (maximum initial dose of 750 mg)

PLUS Azithromycin IV 10 mg/kg once daily (maximum 500 mg/day).

Seek ID advice within 24 hours

For immediate type hypersensitivity (eg. anaphylaxis) to cephalosporins, seek ID specialist advice for alternative antibiotic choice.

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-GDL-01202 Paediatric Antibiocard: Empirical Antibiotic Guidelines

Nosocomial/ventilator associated pneumonia (PICU)

 If less than 5 days in PICU:Cefotaxime 50mg/kg (max 2gram) IV every 6 hours (Neonates: week 1 of life: every 12 hours)

OR Ceftriaxone 100mg/kg (max 4gram) IV once daily (for use in patients >1 month of age)

If more than 5 days in PICU:

Ceftazidime 50mg/kg (max 2gram) IV every 8 hours (neonates week 1 of life: every 12 hours)

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

Comments:
For more information, refer to PICU Empirical Antibiotic Guidelines

Pertussis/ Whooping cough (PICU and Non PICU)

Neonates and infants less than 6 months of age:

Azithromycin oral 10mg/kg (Max 500mg) daily for 5 days

Infants and children older than 6 months of age:

Azithromycin oral 10mg/kg (Max 500mg) on day 1, then 5mg/kg (Max 250mg) daily on days 2 to 5 (total 5 day course)

Tracheitis/ Epiglottitis

Cefotaxime IV

Neonates: Refer to Cefotaxime neonatal dosing section

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

Seek ID specialist advice within 24 hours.

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

Croup

Cystic fibrosis (CF)

Non CF bronchiectasis

Tuberculosis

For advice on the management of tuberculosis, contact the QCH Infection Management Consultant team.

For more information:

Respiratory Syncitial virus (RSV) prophylaxis