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.
Paediatric Tobramycin/Gentamicin Therapeutic drug monitoring
Paediatric Vancomycin Therapeutic drug monitoring
For more information, refer to PICU Empirical Antibiotic Guidelines.
Osteomyelitis, Septic arthritis, Moderate to Severe periorbital cellulitis and Severe cellulitis
Flucloxacillin IV
Neonates: Refer to Flucloxacillin neonatal dosing section
If more than 1 month of age: 50mg/kg (Max 2g) 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.
For immediate type hypersensitivity (eg. anaphylaxis) to pencillins, use Lincomycin IV and seek ID advice.
Comments:
For more information, refer to CHQ Paediatric Antibiocard: Empirical Antibiotic Guidelines and LCCH Paediatric Bone and Joint Infection Management Guideline.
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 2g) 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).
Comments:
For more information, refer to CHQ Paediatric Antibiocard: Empirical Antibiotic Guidelines and LCCH Paediatric Bone and Joint Infection Management Guideline.
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 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 8 hours (Max 4gram/dose Piperacillin component) for 24hours then seek ID advice.
For immediate type hypersensitivity (eg. anaphylaxis) to penicillins, use Ciprofloxacin IV and Lincomycin IV and seek ID.
Comments:
For more information, refer to CHQ Paediatric Antibiocard: Empirical Antibiotic Guidelines.
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.
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)
OR
Trimethoprim/ Sulfamethoxazole oral 4mg/kg/dose orally twice daily (Max 160mg/dose Trimethoprim component).
Comments:
For more information, refer to CHQ Paediatric Antibiocard: Empirical Antibiotic Guidelines.
Recurrent boils (furunculosis)
- For more information, refer to CHQ guideline: Recurrent Boils (furunculosis): Guidelines for management and Staphylococcal decolonisation (MRSA and MSSA)
- Information leaflet (see appendix 1 on page 5): Patient and family “Staph” decolonisation
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 oral Trimethoprim/ Sulfamethoxazole and oral Metronidazole)
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)
25mg/kg/dose (amoxicillin component) every 8 hourly (Max 1000mg/dose Amoxicillin component)
Seek ID review within 24 hours.
For delayed type hypersensitivity to penicillins, use IV Ceftriaxone and oral Metronidazole
Comments:
For more information, refer to CHQ Paediatric Antibiocard: Empirical Antibiotic Guidelines.
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.
