By John S. Bradley MD, John D. Nelson MD Emeritus
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Additional info for 2010-2011 Nelson's Pocket Book of Pediatric Antimicrobial Therapy
Indd 32 Standard: cephalexin 50–75 mg/kg/day PO div tid OR For topical therapy if mild infection: mupirocin or Bullous impetigo1–3,5–7 (usually S aureus, including cloxacillin 50 mg/kg/day PO div qid OR amox/clav retapamulin ointment CA-MRSA) 45 mg/kg/day PO div tid (CII) CA-MRSA: clindamycin 30 mg/kg/day PO div tid OR TMP/SMX 8 mg/kg/day of TMP PO div bid; x 5–7 d (CIII) Bites, animal and human1,15–17 Amox/clav 45 mg/kg/day PO div tid (amox/clav 7:1, Consider rabies prophylaxis for animal bites (AI); consider Pasteurella multocida (animal), see Chapter 1, Aminopenicillins) x 5–10 d (AII); for tetanus prophylaxis Eikenella corrodens (human), hospitalized children, use ticar/clav 200 mg ticarcillin/ Human bites have a very high rate of infection (do not Staphylococcus spp and kg/day div q6h OR ampicillin and clindamycin (BII) close open wounds) Streptococcus spp S aureus coverage is only fair with amox/clav, ticar/clav, pip/tazo.
Renal, bladder ultrasound for fungus ball. Other triazoles are alternatives; insufficient data on echinocandins for neonatal urinary tract infection. – Coliform bacteria Cefotaxime IV, IM OR, in the absence of renal or perinephric (eg, E coli, Klebsiella, abscess, gentamicin IV, IM x 7–10 d (AII) Enterobacter, Serratia) Ampicillin IV, IM X 7–10 days, add gentamicin until cultures are sterile (AIII); for ampicillin resistance, use vancomycin, add gentamicin until cultures are sterile Ceftazidime IV, IM OR, in the absence of renal or perinephric abscess, tobramycin IV, IM x 10 d (AIII) Amphotericin IV OR fluconazole (if susceptible) (AII) – Enterococcus – P aeruginosa – Candida spp33–36 Investigate for kidney disease and for abnormalities of urinary tract Oral therapy for E coli acceptable once infant asymptomatic and culture sterile.
For serious infections, In children with open fractures secondary to trauma, add infection (usually S aureus, ADD cefazolin to provide better MSSA coverage and ceftazidime for extended aerobic gram-negative activity including CA-MRSA; group add Kingella coverage (CIII) Kingella is often resistant to clindamycin A streptococcus; K kingae) For CA-MRSA: clindamycin 30 mg/kg/day IV div q8h or For MSSA (BI) and Kingella (BIII), follow-up oral therapy vancomycin 40 mg/kg/day IV q8h (BII) with cephalexin 100 mg/kg/day PO div tid For MSSA: oxacillin 150 mg/kg/day IV div q6h OR Oral therapy alternatives for CA-MRSA include cefazolin 100 mg/kg/day IV div q8h (AII) clindamycin and linezolid40 For Kingella: cefazolin, ampicillin or ceftriaxone 50 mg/kg/day IV, IM q24h (BIII) Total therapy (IV plus PO) for 4–6 wks for MSSA.
2010-2011 Nelson's Pocket Book of Pediatric Antimicrobial Therapy by John S. Bradley MD, John D. Nelson MD Emeritus