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
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.
Comments:
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 unable to tolerate oral therapy
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.
Comments:
For more information, refer to CHQ-GDL-01202 Paediatric Antibiocard: Empirical Antibiotic Guidelines
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.
Comments:
For more information, refer to CHQ-GDL-01202 Paediatric Antibiocard: Empirical Antibiotic Guidelines
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
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
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)
Comments:
For more information, refer to CHQ-GDL-01202 Paediatric Antibiocard: Empirical Antibiotic Guidelines and PICU Empirical Antibiotic Guidelines
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.
Comments:
For more information, refer to CHQ-GDL-01202 Paediatric Antibiocard: Empirical Antibiotic Guidelines
Croup
Cystic fibrosis and non CF bronchiectasis
- CHQ-GDL-01072 Empirical antimicrobial therapy for children with Non-Cystic Fibrosis Bronchiectasis
- CHQ-GDL-01073 Empirical antimicrobial therapy for children with Cystic Fibrosis
- CHQ guideline – Use of Azithromycin in children with non-cystic fibrosis bronchiectasis or chronic suppurative lung disease
Tuberculosis
For advice on the management of tuberculosis, contact the LCCH Infection Management Consultant team.
For more information:
