• CHQ-GDL-60012 Bronchiolitis – Emergency management in children

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

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 and the CHQ-GDL-00759 Community Acquired Pneumonia – Emergency management in children

Comments:
For more information, refer to CHQ-GDL-01202 Paediatric Antibiocard: Empirical Antibiotic Guidelines and the CHQ-GDL-00759 Community Acquired Pneumonia – Emergency management in children

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 and the CHQ-GDL-00759 Community Acquired Pneumonia – Emergency management in children

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 and the CHQ-GDL-00759 Community Acquired Pneumonia – Emergency management in children

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 and the CHQ-GDL-00759 Community Acquired Pneumonia – Emergency management in children

 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-GDL-01202 Paediatric Antibiocard: Empirical Antibiotic Guidelines