Ampicillin IV (or Amoxicillin IV)
Less than 1 month old: Refer to neonatal dosing section.
1 month or older: 50 mg/kg/dose IV every 6 hours (maximum 2 g/dose).
PLUS
Gentamicin IV** (Dose based on ideal body weight. Perform TDM)
If less than 1 month old: Age dependent – Refer to Gentamicin neonatal dosing section.
If 1 month or older: 7.5 mg/kg IV once daily (maximum 320 mg/day).

If at risk of non multi-resistant MRSA (nmMRSA):

If less than 1 month old: Refer to neonatal dosing section
Ampicillin (or Amoxycillin) IV PLUS Gentamicin IV PLUS Clindamycin IV.

If more than 1 month old:
Ampicillin (or Amoxycillin) IV PLUS Gentamicin IV PLUS Lincomycin IV 15 mg/kg/dose every 8 hours (maximum 1.2 g/dose).

If at risk of multi-resistant MRSA:
If less than 1 month old: Refer to neonatal dosing section.
Ampicillin (or Amoxycillin) IV PLUS Gentamicin IV PLUS Vancomycin IV.

If more than 1 month old:
Ampicillin (or Amoxycillin) IV PLUS Gentamicin IV PLUS Vancomycin IV 15mg/kg/dose every 6 hourly (maximum 750mg/dose).

If immediate type hypersensitivity to penicillins, use Cefotaxime IV
Less than 1 month old: Refer to neonatal dosing section.
1 month or older: 50 mg/kg/dose IV every 6 hours (maximum 2 g/dose).

Note: If Meningitis clinically or by LP treat as stated under MENINGITIS.

Immediate type hypersensitivity

Ciprofloxacin IV 10 mg/kg/dose (Maximum 400mg/dose) every 12 hourly

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

Seek ID advice within 24 hours.

If at risk of non multi-resistant MRSA (nmMRSA):
Cefotaxime IV 50 mg/kg/dose every 6 hours (maximum 2 g/dose)
PLUS Lincomycin IV 15 mg/kg/dose every 8 hourly (maximum 1.2 g/dose).

If at risk of multi-resistant MRSA:
Cefotaxime IV 50 mg/kg/dose every 6 hours (maximum 2 g/dose)
PLUS Vancomycin IV 15 mg/kg every 6 hours (maximum initial Vancomycin dose of 750 mg) (Perform TDM).

In North Queensland during wet season (November to May)
Replace Cefotaxime with Meropenem IV 40 mg/kg/dose every 8 hours (maximum 2 g/dose) to cover Melioidosis.

Paediatric Vancomycin Therapeutic drug monitoring

For more information, refer to CHQ-GDL-01202 Paediatric Antibiocard: Empirical Antibiotic Guidelines

Cefotaxime IV 50 mg/kg/dose every 6 hours (maximum 2 g/dose);
OR Ceftriaxone IV 100 mg/kg once daily (maximum 4 g/day).

Note: If Meningitis clinically or by LP treat as stated under MENINGITIS.

Immediate type hypersensitivity

Ciprofloxacin IV 10 mg/kg/dose (Maximum 400mg/dose) every 12 hourly

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

Seek ID advice within 24 hours.

If at risk of nmMRSA:
Cefotaxime IV 50 mg/kg/dose every 6 hours (maximum 2 g/dose)
PLUS Lincomycin IV 15 mg/kg/dose every 8 hourly (maximum 1.2 g/dose).

If at risk of multi-resistant MRSA:
Cefotaxime IV 50 mg/kg/dose every 6 hours (maximum 2 g/dose)
PLUS Vancomycin IV 15 mg/kg every 6 hours (maximum initial Vancomycin dose of 750 mg) (Perform TDM).

In North Queensland during wet season (November to May)
Replace Cefotaxime with Meropenem IV 40 mg/kg/dose every 8 hours (maximum 2 g/dose) to cover Melioidosis.

Ceftazidime 50mg/kg/dose (Max 2 gram) IV every 8 hours (Neonates: week 1 of life: every 12 hours)

If Central venous Line in-situ:

ADD Vancomycin 15mg/kg (Max 750mg per dose) IV every 6 hours (Neonates: week 1 of life: every 12 hours, week 2-4: IV every 8 hours)

If septic shock:
ADD Vancomycin 15mg/kg (Max 750mg per dose) IV every 6 hours (Neonates: week 1 of life: every 12 hours, week 2-4: IV every 8 hours)

AND ADD Gentamicin 7.5mg/kg IV once daily (max 320mg for initial dose if 10 years old; max initial dose 640mg/day if more than 10 years old; Neonates: week 1 of life: 5mg/kg IV once daily)

If nosocomial sepsis with suspected/proven meningitis, discuss with ID specialist.

Piperacillin-tazobactam IV

Neonates: 100mg/kg (Piperacillin component) IV every 8 hourly

If more than 1 month of age: 100mg/kg (max 4gram Piperacillin component) IV every 6 hourly

PLUS Gentamicin IV

Neonates: Refer to Gentamicin neonatal dosing section

If more than 1 month and less than 10 years of age: 7.5mg/kg IV once daily (max initial dose of 320mg/day)

If more than 10 years of age: 7mg/kg IV once daily (max initial dose of 640mg/day)

PLUS Vancomycin IV

Neonates: Refer to Vancomycin neonatal dosing section

More than 1 month of age: 15mg/kg (Max 750mg per dose) IV every 6 hourly

If nosocomial sepsis with suspected/proven meningitis, discuss with ID specialist.

IF organism unknown:
Cefotaxime IV:
Neonates: Refer to Cefotaxime neonatal dosing section
If more than 1 month of age: 50mg/kg (max 2gram) IV every 6 hourly

PLUS

Vancomycin IV:

Neonates: Refer to Vancomycin neonatal dosing section

More than 1 month of age: 15mg/kg (Max 750mg per dose) IV every 6 hourly

PLUS
Lincomycin 15mg/kg (max 1.2gram) IV every 8 hours

PLUS consider Intragam® 2gram/kg IV once

IF necrotising fasciitis:
Cefotaxime IV :
Neonates: Refer to Cefotaxime neonatal dosing section
If more than 1 month of age: 50mg/kg (max 2gram) IV every 6 hourly

PLUS

Vancomycin IV:

Neonates: Refer to Vancomycin neonatal dosing section

More than 1 month of age: 15mg/kg (Max 750mg per dose) IV every 6 hourly

PLUS
Lincomycin 15mg/kg (max 1.2gram) IV every 8 hours

If external wound/ innoculation associated with necrotising fasciitis,
Replace Cefotaxime with Meropenem IV 40mg/kg/dose (up to 2gram) 8 hourly (neonatal dosing: week 1 and 2 of life: 40mg/kg/dose every 12 hourly, week 3 and 4 of life: 40mg/kg/dose every 8 hourly)

Febrile neutropenia (Acute management):

Febrile neutropenia antibiotic algorithm.

Piperacillin-tazobactam IV

If more than 1 month of age: 100mg/kg (max 4gram Piperacillin component) IV every 6 hourly

If critically ill:

Add Gentamicin IV:

If more than 1 month and less than 10 years of age: 7.5mg/kg IV once daily (max initial dose of 320mg/day)

If more than 10 years of age: 6mg/kg IV once daily (max initial dose of 640mg/day)

AND Vancomycin IV:

More than 1 month of age: 15mg/kg (Max 750mg for initial dose) IV every 6 hourly

If gram positive bacteraemia with resistance to Piperacillin/Tazobactam proven or suspected clinically (i.e. Line or post-surgical):

Add Vancomycin IV:

Neonates: Refer to Vancomycin neonatal dosing section

More than 1 month of age: 15mg/kg (Max 750mg for initial dose) IV every 6 hourly

If delayed type hypersensitivity (eg. rash) to penicillin, use

Ceftazidime IV 50mg/kg/dose every 8 hours (Max 2gram/dose)

Plus Gentamicin IV (single dose then review)

If more than 1 month and less than 10 years of age: 7.5mg/kg IV once daily (max initial dose of 320mg/day)

If more than 10 years of age: 6mg/kg IV once daily (max initial dose of 640mg/day)

If immediate type hypersensitivity (eg. anaphylaxis) to penicillin/cephalosporins, seek ID advice.

If ongoing fevers for more than 96 hours after commencing antibiotics refer to Febrile neutropenia follow-on management algorithm (page 12 of guideline)

Febrile neutropenia follow-on management algorithm.

Febrile NON-neutropenia antibiotic algorithm.

Over 1 month of age: Ceftriaxone IV 100mg/kg (max 4g) once daily and discuss with Paediatric Oncologist

Comments:
For more information, refer to the Febrile non-neutropenia antibiotic algorithm (page 10) of CHQ-GDL-01249 Management of Fever in a Paediatric Oncology Patient- Febrile Neutropaenia and Febrile Non-neutropaenia