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 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) 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.

Comments:
For more information, refer to CHQ 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

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

If Mycoplasma suspected:
Add Roxithromycin PO 4mg/kg/dose every 12 hours (Max 150mg/dose)
(If unable to tolerate oral Roxithromycin, seek ID specialist advice for alternative antibiotic choice)
If Staphylococcal Pneumonia suspected:
Add Flucloxacillin IV 50mg/kg/dose IV every 4 hours (Max 2gram/dose) (If delayed or immediate type hypersensitivity to flucloxacillin, use Lincomycin IV)

For delayed type hypersensitivity (eg. rash) to Benzylpenicillin, use Cefotaxime IV.

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

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

Empyema (non PICU)

Benzylpenicillin IV 60mg/kg (Max 2.4gram) 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.

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

Severe community acquired pneumonia (PICU)

In infants and children less than 5 years of age:
Cefotaxime IV

Neonates: Refer to Cefotaxime neonatal dosing section

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


In children older than 5 years of age:
Cefotaxime IV
50mg/kg (max 2g) every 6 hourly
+/- Azithromycin IV
10mg/kg (max 500mg) once daily (swap to Roxithromycin oral 4mg/kg (max 150mg) every 12 hourly, after 24hours if possible)

If empyema or risk factors for non-multiresistant MRSA (previous nmMRSA, history of boils):

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

If life threatening pneumonia or multiresistant MRSA 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


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

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

More information, refer to PICU 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.

Comments:

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

Croup

Cystic fibrosis and non CF bronchiectasis

Tuberculosis

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

For more information:

Respiratory Syncitial virus (RSV) prophylaxis