Skeletal, soft tissue and skin infections

Surgical wound infection (PICU)

Flucloxacillin IV

Neonates: Refer to Flucloxacillin 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 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)

 

If life threatening suspected staphylococcal wound infection:

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

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

Osteomyelitis, Septic arthritis, Moderate to Severe periorbital cellulitis and Severe cellulitis (all ages and Hib immune)

Flucloxacillin IV

Neonates: Refer to Flucloxacillin neonatal dosing section

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

Previous nmMRSA, at-risk ethnic groups and patients with a personal or family history of boils/furunculosis

Add Lincomycin IV 15mg/kg/dose IV every 8 hours (Max 1.2gram/dose).

For delayed type hypersensitivity (eg. rash) to penicillins, use Cephazolin IV 50mg/kg/dose (Max 2gram/dose) every 8 hourly.

For immediate type hypersensitivity (eg. anaphylaxis) to pencillins, use Lincomycin IV and seek ID advice.

If less than 5 years of age and NOT Hib immune, with Osteomyelitis/Septic arthritis/Moderate to Severe periorbital cellulitis OR orbital cellulitis (all ages)

Cefotaxime IV

Neonates: Refer to Cefotaxime neonatal dosing section

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

Previous nmMRSA, at-risk ethnic groups and patients with a personal or family history of boils/furunculosis

PLUS Lincomycin IV 15mg/kg/dose every 8 hours (Max 1.2gram/dose).

If at risk of multi-resistant MRSA:
Cefotaxime IV
Neonates: Refer to Cefotaxime neonatal dosing section

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

PLUS Vancomycin IV

Neonates: Refer to Vancomycin neonatal dosing section
If more than 1 month of age: 15 mg/kg/dose every 6 hours (maximum initial dose of 750 mg).
For immediate type hypersensitivity (eg. anaphylaxis) to cephalosporins, seek ID advice for alternative antibiotic choice.

Comments:

For more information, refer to CHQ-GDL-01202 Paediatric Antibiocard: Empirical Antibiotic Guidelines and CHQ-GDL-01067 Paediatric Bone and Joint Infection Management.

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

Paediatric Vancomycin Therapeutic drug monitoring

Bone and joint infection management (paediatric)

Compound fractures

For open fractures with no clinical evidence of skin or soft tissue infection or severe tissue damage, give systemic antibiotic prophylaxis:
Cephazolin IV 50mg/kg/dose (max 2gram/dose) every 8 hourly for 24 hours then seek ID advice.

For immediate type hypersensitivity (eg. anaphylaxis) to cephalosporins, use Lincomycin IV 15mg/kg/dose (Max 1.2 gram/dose) every 8 hourly and seek ID advice.

For open fractures with severe tissue damage and severe contamination or clinical evidence of skin or soft tissue infection:
Piperacillin/ Tazobactam IV 100mg/kg/dose IV every 6 hours (Max 4gram/dose Piperacillin component) for 24hours then seek ID advice.

For immediate type hypersensitivity (eg. anaphylaxis) to penicillins,

use Ciprofloxacin IV 10mg/kg/dose (Max 400mg/dose) every 12 hours

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

Seek ID advice within 24 hours.

Impetigo, Cellulitis or Cervical lymphadenitis (Outpatient)

Cephalexin oral 25mg/kg/dose orally four times a day (Max 1000mg/dose) (For children who are unable to swallow capsules)

OR

Flucloxacillin oral 25mg/kg/dose orally four times a day (Max 1000mg/dose) (For children who can swallow capsules)

For immediate type hypersensitivity (eg. anaphylaxis) to penicillins/cephalosporins, use Trimethoprim/Sulfamethoxazole oral 4mg/kg/dose (Max 160mg/dose trimethoprim component) twice daily.

Previous nmMRSA, at-risk ethnic groups and patients with a personal or family history of boils/furunculosis:

Clindamycin oral 7.5mg/kg/dose orally four times a day (Max 450mg/dose) (For children who can swallow capsules)

OR

Trimethoprim/ Sulfamethoxazole oral 4mg/kg/dose orally twice daily (Max 160mg/dose Trimethoprim component) (For children who are unable to swallow capsules)

Note: Seek ID advice for multi-resistant MRSA skin infections.

Suspected necrotising fasciitis

Cefotaxime IV 50 mg/kg/dose every 6 hours (max 2 g/dose)
PLUS Lincomycin IV 15 mg/kg/dose every 8 hours (max 1.2 g/dose)
PLUS Vancomycin IV 15 mg/kg/dose every 6 hours (max initial dose of 750 mg)
Seek ID advice within 24 hours.

For immediate type penicillin/cephalosporin hypersensitivity (eg anaphylaxis), seek ID advice.

If external wound / inoculation associated with necrotising fasciitis:
Meropenem IV 40 mg/kg/dose every 8 hours (max 2 g/dose)
PLUS Lincomycin IV 15 mg/kg/dose every 8 hours (max 1.2 g/dose)
PLUS Vancomycin IV 15 mg/kg/dose every 6 hours (max initial dose of 750 mg)
Seek ID advice within 24 hours.

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

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

Paediatric Vancomycin Therapeutic drug monitoring

Recurrent boils (furunculosis)

Animal bites/wounds

Amoxycillin/Clavulanic acid oral 22.5mg/kg (Max 875mg/dose Amoxycillin component) twice daily

For delayed type OR immediate type hypersensitivity to penicillins,

use Trimethoprim/ Sulfamethoxazole oral 4mg/kg/dose (Max 160mg/dose Trimethoprim component) twice daily

PLUS Metronidazole oral 7.5mg/kg/dose (Max 400mg/dose) every 8 hours

OR

For Severe infection:

IV Amoxicillin-Clavulanic acid

Neonates and Infants (0 to 3 months)

  • If <4kg: 25mg/kg/dose (amoxicillin component) every 12 hours
  • If >4kg: 25mg/kg/dose (amoxicillin component) every 8 hours

Infants and children (>3 months)

Severe infection: 25mg/kg/dose (amoxicillin component) every 6 hourly (Max 1000mg/dose Amoxicillin component)

Adolescents >12 years (and >40kg):

Severe infection: 25mg/kg/dose (amoxicillin component) every 6 hourly (Max 2000mg/dose Amoxicillin component)

If delayed type hypersensitivity to penicillins,
IV Ceftriaxone 100 mg/kg once daily (max 4 g/day)
PLUS Metronidazole orally 7.5 mg/kg/dose every 8 hours (max 400 mg/dose).

Tetanus Prophylaxis in wound management

Water-related wound infections

Deep cardiac surgical wound infection (Mediastinitis suspected) (PICU)

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

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

For more information, refer to PICU Empirical Antibiotic Guidelines.