Ampicillin (or Amoxycillin) IV

Neonates: Refer to Ampicilin/Amoxycillin neonatal dosing section

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

PLUS Gentamicin IV

Neonates: Refer to Gentamicin neonatal dosing section

If more than 1 month of age: 7.5mg/kg IV once daily (Max 320mg for initial dose if less than 10years old)

If Meningitis suspected treat as stated under MENINGITIS.

If MRSA suspected or life threatening sepsis, see PICU Empirical Antibiotic Guidelines

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

Cefotaxime IV 50mg/kg (max 2g) every 6 hourly

(OR Ceftriaxone IV 100mg/kg (Max 4g) once daily)

If Meningitis suspected treat as stated under meningitis

If less than 2 months of age:

Ampicillin (or Amoxycillin) IV

Neonates: Refer to Ampicillin/Amoxycillin neonatal dosing section

More than 1 month of age: 50mg/kg (Max 2g) 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 daily (Max initial dose of 320mg/day)

If more than 2 months of age:

Cefotaxime 50mg/kg (max 2gram) IV every 6 hourly

(OR Ceftriaxone IV 100mg/kg (Max 4g) once daily)

If risk factors for non-multiresistant MRSA (previous nmMRSA, history of boils):
Add Lincomycin 15mg/kg (max 1.2g) IV every 8 hourly.

If septic shock requiring inotropes:
Add 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

AND 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).

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

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

If critically ill:

Add 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: 6mg/kg IV once daily (max initial dose of 640mg/day)

AND 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 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)

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: 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.

Ceftriaxone IV 100mg/kg (max 4g) once daily and discuss with Paediatric Oncologist

(Neonates: Use Cefotaxime IV – Refer to Cefotaxime neonatal dosing section)

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