PEDIATRIC EMPIRIC ANTIMICROBIAL GUIDE 2016 - Child …

1 PEDIATRIC EMPIRIC ANTIMICROBIAL GUIDE 2016. This GUIDE does NOT apply to NICU or immunocompromised patients. A thorough clinical assessment is required to identify any complicating factors which may necessitate alternative/additional therapy Selection of EMPIRIC regimens may need to be tailored according to current local antibiogram or individual clinical factors. starting anti-microbial therapy, take blood/urine/CSF and/or other relevant samples for culture wherever possible. Obtain appropriate dosage from current Drug Dosage Guidelines . Consider the need for dose adjustments ( renal impairment) and age-related contraindications for antimicrobials.

2 Caution for use in neonates under 44 weeks corrected gestational age. REVIEW DAILY - Adjust treatment according to microbiologic results as soon as they become available. Consult ID and/or relevant subspecialty team(s) if required All drugs IV unless stated Infection Most likely pathogens First choice Penicillin allergy^ Refs**. Sepsis - unknown source Streptococcus agalactiae (GBS). Ampicillin Vancomycin BCCH. Sepsis Escherichia coli + (Gentamicin or Cefotaxime) + (Gentamicin or Cefotaxime) AAP. (<4 weeks) Listeria monocytogenes Acyclovir Acyclovir SSC. Herpes simplex virus (HSV).

3 Neisseria meningitidis Sepsis Streptococcus pneumoniae Cefotaxime Cefotaxime BCCH. ( 4 weeks) Escherichia coli Vancomycin* Vancomycin SSC. Staphylococcus aureus CNS. Streptococcus agalactiae (GBS). Ampicillin Vancomycin Meningitis Escherichia coli AAP. + Cefotaxime + Cefotaxime (<4 weeks) Listeria monocytogenes IDSA. + Acyclovir Acyclovir Herpes simplex virus (HSV). Neisseria meningitidis Cefotaxime Cefotaxime . IDSA. Meningitis Streptococcus pneumoniae + Vancomycin + Vancomycin CPS. ( 4 weeks) Haemophilus influenzae Acyclovir Acyclovir Acyclovir Acyclovir Encephalitis Herpes simplex virus (HSV) + Antibiotics as for + Antibiotics as for IDSA.

4 Meningitis Meningitis . Streptococcus spp. Staphylococcus aureus Cefotaxime Cefotaxime . Cerebral abscess Anaerobic organisms + Vancomycin + Vancomycin FC. or subdural empyema Gram-negative organisms + Metronidazole + Metronidazole Streptococcus pneumoniae Haemophilus influenzae ENT, ocular and dental Cephalexin PO. Penicillin V PO. Streptococcal pharyngitis / or Clindamycin PO IDSA. Streptococcus pyogenes (Group A Strep) or Amoxicillin PO. tonsillitis or Clarithromycin PO RB. or Penicillin G. or Cefazolin Haemophilus influenzae Amoxicillin PO Cefprozil PO CPS.

5 Bacterial acute otitis media Streptococcus pneumoniae or Amoxicillin-clavulanate PO or Clarithromycin PO AAP. Moraxella catarrhalis Streptococcus pneumoniae Cefotaxime Cefotaxime . Mastoiditis Streptococcus pyogenes (Group A Strep) FC. Vancomycin Vancomycin Staphylococcus aureus Haemophilus influenzae Cefprozil PO. Streptococcus pneumoniae Amoxicillin PO or Clarithromycin PO IDSA. Moraxella catarrhalis or Amoxicillin-clavulanate PO or Cefixime PO + Clindamycin PO AAP. Sinusitis Staphylococcus aureus If IV treatment required, BD. Streptococcus pyogenes (Group A Strep) treat as for mastoiditis If IV treatment required, CFM.

6 Anaerobic organisms (older children ) treat as for mastoiditis Cephalexin PO. Clindamycin PO. Staphylococcus aureus or Clindamycin PO* BD. Cervical lymphadenitis or Streptococcus pyogenes (Group A Strep) or FC. Cefazolin Cefazolin Cephalexin PO Cefprozil PO. Streptococcus pneumoniae or Clindamycin PO* or Clindamycin PO* AAP. Preseptal cellulitis Staphylococcus aureus or or Long Cefazolin or Vancomycin* Cefazolin or Vancomycin*. Staphylococcus aureus Streptococcus pneumoniae Cefotaxime Cefotaxime AAP. Orbital cellulitis Other Streptococcus spp. Vancomycin Vancomycin Long Haemophilus influenzae ^Avoid all beta-lactam antibiotics ( cephalosporins, carbapenems) if anaphylaxis to penicillins - consult ID; consider allergy assessment.

7 PEDIATRIC EMPIRIC ANTIMICROBIAL therapy. Version updated September 29, 2016 by the PHSA ANTIMICROBIAL Stewardship Program Approved by: BCCH ID, Micro, All Divisions within UBC Department of Pediatrics Page 1 of 3. Reviewed by the Provincial ANTIMICROBIAL Clinical Expert Group September 2016. All drugs IV unless stated Infection Most likely pathogens First choice Penicillin allergy^ Refs**. Viridans streptococci Peptostreptococcus spp. Amoxicillin-clavulanate PO. Dental abscess with fever Prevotella spp. or BD. Clindamycin PO/IV. and/or extensive spread Porphyromonas melaninogenicus Penicillin G FC.

8 Fusobacterium spp. + Metronidazole PO. Usually polymicrobial Lower respiratory tract . Community-acquired Streptococcus agalactiae (GBS) Cefotaxime Ampicillin BCCH. pneumonia Escherichia coli + Gentamicin + (Gentamicin or Cefotaxime ) BD. (<1 month) Listeria monocytogenes + Vancomycin Streptococcus pneumoniae Community-acquired Streptococcus agalactiae (GBS) Cefotaxime Cefotaxime . BCCH. pneumonia Staphylococcus aureus Vancomycin Vancomycin BD. (1-3 months) Escherichia coli Clarithromycin PO Clarithromycin PO. Chlamydia trachomatis Community-acquired IDSA. pneumonia Amoxicillin PO Cefprozil PO.

9 CPS. (>3 months) - mild Respiratory viruses AAP. Community-acquired Streptococcus pneumoniae Ampicillin Clarithromycin PO Cefotaxime Clarithromycin PO IDSA. pneumonia Haemophilus influenzae Oseltamivir PO Oseltamivir PO CPS. (>3 months) - moderate Staphylococcus aureus BCCH. Mycoplasma pneumoniae Cefotaxime Cefotaxime . Community-acquired Chlamydia pneumoniae IDSA. Vancomycin + Vancomycin pneumonia CPS. Clarithromycin PO Clarithromycin PO. (>3 months) - severe BCCH. Oseltamivir PO Oseltamivir PO. Staphylococcus aureus CPS. Cefotaxime Cefotaxime . Parapneumonic empyema Streptococcus pneumoniae IDSA.

10 Vancomycin Vancomycin Haemophilus influenzae BCCH. Staphylococcus aureus (Cefotaxime or Cefotaxime . hospital -acquired Haemophilus influenzae BCCH. Piperacillin-tazobactam) Vancomycin pneumonia Enterobacter spp. IDSA. Vancomycin* Gentamicin Pseudomonas aeruginosa Staphylococcus aureus Amoxicillin-clavulanate PO Cefotaxime + Clindamycin IV/PO. Haemophilus influenzae or or Aspiration pneumonia Mandell Enterobacter spp. Cefuroxime PO C PO. Oral anaerobes (see dental abscess ) + (Metronidazole or Clindamycin IV/PO) + (Metronidazole or Clindamycin IV/PO). Cardiac Viridans streptococci As guided by blood culture results As guided by blood culture results Infective endocarditis AHA.