RD&E Paediatric Antibiotic Prescribing Guidelines

Paediatric Antibiotic Prescribing Guidelines

Post holder responsible for Guideline:

Paediatric Consultant with responsibility

for Infectious Diseases

Directorate / Department responsible for

Guideline:

Paediatrics

Contact details:

P Oades & Cressida Auckland

Date written:

December 2008

Date revised:

July 2011, Aug 2012, July 2013

Approval route (names of committees):

Antimicrobial subcommittee of D&TC

Date of final approval:

Date due for revision:

July 2015

Controlled Document
This document has been created following the Royal Devon & Exeter NHS Foundation
Trust Policy on the creation of policies, procedures, protocols, guidelines and standards.
It should not be altered in any way without the express permission of the author or their
representative.

Page 1 of 7
Review date: July 2015

Patrick Oades, James Hart

RD&E Paediatric Antibiotic Prescribing Guidelines

Backgrounds and Context

1.1

This guideline provides a framework for antibiotic choice in paediatrics. It is

neither comprehensive nor prescriptive. Treatment decisions must be made on
an individual patient basis, whilst taking these guidelines into account.

1.2

Users should refer to the BNF for Children for antimicrobial dosing schedules.

1.3

Further advice or discussion of individual cases can be obtained by contacting

the on-call microbiologist (bleep 174).

1.4

This guideline should be read in conjunction with the antimicrobial policy, and the
IV to oral switch policy.

Page 2 of 7
Review date: July 2015

Patrick Oades, James Hart

RD&E Paediatric Antibiotic Prescribing Guidelines

RD&E Paediatric Antibiotic Prescribing Guidelines

Refer to BNF for children for drug doses
IV to oral switch refer to Trust guidelines
Length of therapy should be stated on prescription
Condition

Expected pathogens

NICE Feverish Illness in Children

SEPSIS

Early (<48hours age)

neonatal sepsis

Initial Antibiotic Treatment

1.
2.
3.
4.
5.

Group B Streptococci
Coliforms
H. influenzae
Listeria
Other Streptococci

Benzylpenicillin +
Gentamicin

[Mothers genital tract flora]

Late (>48 hours age)

neonatal sepsis

1. Coagulase negative
staphylococci
(line-related)
2. S. aureus
3. Coliforms
4. Group B Streptococci
[Mothers genital tract and
environmental flora]

NNU: Flucloxacillin +
Gentamicin
Other: Amoxicillin +
CefoTAXime

CefTRIaxONE
Infant and child sepsis

Immune compromise
Sepsis

Page 3 of 7
Review date: July 2015

1.
2.
3.
4.
5.

N. meningitidis
S. pneumoniae
Coliforms
S. aureus
Group A Streptococci

Host defense defect specific but

usually include multi-resistant
bacterial species including
pseudomonas, fungi, viruses and
protozoa

Patrick Oades, James Hart

Cefotaxime if calcium infusions being

used. If toxin production (eg Group A
strep, Staph aureus) suspected add
IV clindamycin.

Tazocin

RD&E Paediatric Antibiotic Prescribing Guidelines

SIGN102

CNS

NICE meningitis and meningococcal

Neonatal meningitis and

Infant meningitis < 3
months

Neonatal
1. Group B Streptococci
2. Coliforms
3. Listeria
H. influenzae
Infant 1-3 months
1. H. influenzae
2. Group B streptococci
3. S. pneumoniae
4. N. meningitidis
5. Listeria
6. Coliforms
4. MTB

Older infant and child

meningitis

Suspected encephalitis

1.
2.
3.
4.

N. meningitidis
H. influenzae type b
S. pneumoniae
MTB

1.

Herpes simplex

(+ consider atypical/ unusual

pathogens eg Mycoplasma +
TBM)

Amoxicillin and
CefoTAXime

CefTRIaxONE
Cefotaxime if calcium infusions
being used.

As for meningitis +
Aciclovir

CNS: If recent travel outside UK or exposure to

multiple/prolonged antibiotic courses within past 3 months
add IV vancomycin.
BTS guidelines

RESPIRATORY

Suspected bacterial
pneumonia < 5years

1. S. pneumoniae
2. H. influenzae
3. S. aureus
Call micro if effusion /cavitation

Page 4 of 7
Review date: July 2015

Patrick Oades, James Hart

Amoxicillin oral
(IV co-amoxiclav if severe or
not tolerating oral)

RD&E Paediatric Antibiotic Prescribing Guidelines

Suspected bacterial
pneumonia > 5years

1.
2.
3.
4.

S. pneumoniae
H. influenzae
S. aureus
Mycoplasma spp

Call micro if effusion / cavitation

>3 months
UPPER TRACT SIGNS
fever or loin pain

[+ amoxicillin if Strep
Pneumonia suspected] or IV
co-amoxiclav + PO
azithromycin if severe.
NICE UTI in children

GU
Infant < 3 months

Oral Azithromycin

1. E. coli
2. Klebsiella spp
3. Proteus spp

IV Amoxicillin and
Gentamicin, monitor trough

1. E. coli (inc ESBL)

2. Klebsiella spp
3. Proteus spp

level, should be <1mg/l, and renal

function before second dose.
IV Amoxicillin and
Gentamicin (trough levels
checked, should be <1mg/l, with
renal function prior to second
dose, further doses or changes to
regimen determined by clinical

(Pyelonephritis)

or
Oral Co-amoxiclav.
review and culture results)

Total treatment duration is usually

10 days.

>3 months
LOWER TRACT SIGNS
dysuria and frequency

1.
2.
3.
4.

E. coli
Klebsiella spp
Proteus spp
S. saprophyticus (sexually
active girls)

Trimethoprim oral
(3 day course)

"Well" child UTI

ENT

Uncomplicated otitis
media - infant

Agents can co-exist

1. S. pneumoniae
2. H. influenzae
3. S. aureus
4. M. catarrhalis
5. Coliforms

Consider oral
Amoxicillin.

6. Chlamydia trachomatis
(infants <6 months)

Uncomplicated Otitis
media child

Page 5 of 7
Review date: July 2015

Agents can co-exist

1. S. pneumoniae
2. H. influenzae
3. M. catarrhalis
4. Group A Streptococci
5. S. aureus

Patrick Oades, James Hart

Symptomatic
measures

RD&E Paediatric Antibiotic Prescribing Guidelines

Tonsillitis with exudate

Suspected bacterial
lymphadenitis

1. Group A Streptococci
2. EBV

1.
2.
3.
4.
also
5.
6.
7.
8.

Group A streptococci
S. aureus
Anaerobes
Atypical mycobacteria
EBV, CMV, HIV
Bartonella
Toxoplasmosis
Mycobacterium TB

Oral Penicillin V
Avoid amoxicillin (causes rash in
EBV infection)

Co-amoxiclav (IV if
systemically unwell)
Benefits of specific therapy are
uncertain.
Individual clinical decision
required.

Please exclude seborrhoea, head

lice, Tinea capitis, OM before
initiating more extensive work-up

SKIN AND SOFT

TISSUE

Peri-orbital cellulitis (ie

preseptal)

Orbital cellulitis

Acute soft tissue

infection

1.
2.
3.
4.

H. influenzae type b
S. pneumoniae
Group A streptococci
S. aureus

1. S. aureus
2. Streptococci, incl
S. pneumoniae
3. H.influenzae
4. Anaerobes

1. Group A streptococci
2. S. aureus
If recurrent problems with boils
think PVL-S. aureus

IV Co-amoxiclav

Clindamycin IV and
CefTRIaxONE IV

Flucloxacillin PO
If necrotising infection or toxin
production suspected or systemic

IV flucloxacillin
+ IV clindamycin
Amoxicillin and
Flucloxacillin
signs

S. aureus

Acute bone/joint infection Kingella sp

Group A streptococci
Gram negative bacilli (Newborn)
Group B streptococci (2-4
weeks age)

4-6 weeks for haematogenous

osteomyelitis.
There are other options and treatment
consensus is best achieved after

Page 6 of 7
Review date: July 2015

Patrick Oades, James Hart

RD&E Paediatric Antibiotic Prescribing Guidelines

liaison with orthopaedics and
microbiology.
IV to oral switch as soon as
possible check sensitivities

GIT (surgical abdomen)

Upper and lower GI
infection

E.coli
Enterococci
Anaerobic organisms

IV Amoxicillin +
Metronidazole +
Gentamicin trough

levels
(should be <1mg/l) and renal
function need to be checked prior
to second dose.

In convalescence, and
tolerating oral treatment can be
changed to oral Co-

amoxiclav.

Page 7 of 7
Review date: July 2015

Patrick Oades, James Hart