Sepsis

Community acquired sepsis in neonates and infants less than 2 months of age (meningitis excluded) (non PICU)

NOTE: If meningitis has not been excluded, treat as stated under MENINGITIS.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).

Comments:
Seek pharmacist/ID advice on appropriate therapeutic drug monitoring (TDM) and appropriate dosing for patients in renal failurePaediatric Tobramycin/Gentamicin Therapeutic drug monitoring

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

Community acquired sepsis in infants and children more than 2 months of age (meningitis excluded) (non PICU)

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 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.

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

Community acquired sepsis (PICU)

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.

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

Nosocomial Sepsis (including CVL sepsis) (PICU)

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.

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
Paediatric Vancomycin Therapeutic drug monitoring

More information, refer to PICU Empirical Antibiotic Guidelines

Sepsis in immunocompromised host with febrile neutropenia (PICU)

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.

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
Paediatric Vancomycin Therapeutic drug monitoring

More information, refer to PICU Empirical Antibiotic Guidelines

Toxic Shock Syndrome (PICU)

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 known Group A Streptococcal infection:
Benzylpenicillin IV:
Neonates: Refer to Benzylpenicillin neonatal dosing section
If more than 1 month of age: 60mg/kg (max 2.4gram) IV every 4 hours

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)

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.

Febrile neutropenia (acute and ongoing management) (Oncology/Haematology)

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.

Comments:
Seek pharmacist/ID advice on appropriate therapeutic drug monitoring (TDM) and appropriate dosing for patients in renal failure

Febrile non-neutropenia (Oncology)

Febrile NON-neutropenia antibiotic algorithm.

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

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

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

Catheter related infections

Sickle cell crisis