• Bronchiolitis acute management in infants

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 Paediatric Antibiocard: Empirical Antibiotic Guidelines

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.

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

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)

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

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.

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

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.

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

 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.

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)

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 Paediatric Antibiocard: Empirical Antibiotic Guidelines