Paediatric Antibiotic Prescribing Guideline www.oxfdahsn.g/children Magdalen Centre Nth, 1 Robert Robinson Avenue, Oxfd Science Park, OX4 4GA, United Kingdom t: +44(0) 1865 784944 e: info@oxfdahsn.g Follow us @OxfdAHSN Follow us @OxAHSNChild May 2017
Paediatric Antibiotic prescribing guideline Resistance to antibiotics is now recognised as a maj risk to the future health of the wld population. Antimicrobial resistance (AMR) threatens the effective prevention treatment of ever-increasing infections caused by bacteria, parasites, viruses fungi. This threat is now deemed so serious that it is included on the National Risk Register. One method to help reduce antimicrobial resistance is to ensure appropriate prescription administration of empiric antibiotics. The Oxfd AHSN has a geographical footprint that includes five hospitals with paediatric inpatients providing an opptunity f the Children s Netwk to wk with local paediatricians, pharmacists microbiologists to harmonise local prescribing guidelines. We asked the microbiologists to check that there were no local resistance patterns that might preclude harmonisation. Once this was confirmed, we conducted a gap analysis of the five hospitals antibiotic guidelines to identify differences in prescribing practices. We brought together pharmacists, paediatricians microbiologists from each of the five hospitals reached agreement on the optimum prescribing practice f those areas where differences existed. Subsequent min amendments were agreed the revised guideline has now been adopted by each hospital. Start Smart, Then Focus Review all antibiotics after the 1st 48-72 hours accding to microbiology results Sepsis < 1 month admitted from the community (If on neonatal unit refer to neonatal guidelines) 1-3 months > 3 months First line IV Cefotaxime IV Amoxicillin See BNFC f neonatal doses IV Cefotaxime 50mg/kg QDS Consider switching to IV Ceftriaxone if not receiving IV Calcium (max. 4g) Allergy* Severe Penicillin allergy, consider: IV Chlamphenicol 25mg/kg single dose Consider: IV Vancomycin 15mg/kg TDS IV Gentamicin 7mg/kg single dose (max. 560mg) Meningitis 1-3 months IV Cefotaxime 50mg/kg QDS IV Amoxicillin 50mg/kg QDS Non severe IV Cefotaxime 50mg/kg QDS Magdalen Centre Nth, 1 Robert Robinson Avenue, Oxfd Science Park, OX4 4GA, United Kingdom Consider switching to IV Ceftriaxone if not receiving IV Calcium Severe Penicillin allergy consider: IV Chlamphenicol 25mg/kg QDS t: +44(0) 1865 784944 e: info@oxfdahsn.g Follow us @OxfdAHSN Follow us @OxAHSNChild > 3 months F severe Penicillin allergy consider IV Chlamphenicol 25mg/kg QDS www.oxfdahsn.g/children 1 PAEDIATRIC ANTIBIOTIC PRESCRIBING GUIDELINE PAEDIATRIC ANTIBIOTIC PRESCRIBING GUIDELINE 2
Respiraty Bone & Soft Tissue Infections Pneumonia (mild/ moderate) Treat f 5 days Pneumonia (severe) Complicated Pneumonia Empyema associated with septicaemia Urinary Tract Infections Lower UTI/ uncomplicated Treat f 3 days (unless otherwise stated) Upper UTI/ complicated Treat f 7 days First line PO Amoxicillin 1 month 11 months: 125mg TDS 1-4 years: 250mg TDS 5-18 years: 500mg TDS If no improvement atypical pneumonia consider adding 10mg/ f 3 days (max. 500mg OD) IV Amoxicillin 60mg/kg TDS (max. 1g) Consider adding PO Azithromycin 10mg/kg (max. 500mg) OD 3 days IV Clarithromycin 7.5mg/kg BD if an IV agent required child < 6 months 1 month 11 months: (125/31) >3 months 30mg/kg (max. 1.2g) TDS STAT IV Gentamicin 7mg/kg IV OD (max. 560mg) Allergy* PO Clarithromycin 7.5mg/kg BD 10mg/ f 3 days (max. 500mg OD) 1 month 11 years (<50kg) 12-17 years (> 50kg) 2-4 g OD IV Clarithromycin 7.5mg/kg BD PO Cefalexin 1 month 11 months: 125mg BD 1-4 years: 125mg TDS 5-11 years: 250mg TDS 12-18 years: 500mg TDS 2nd line PO Nitrofurantoin 3 months 11 years: 750micrograms/kg QDS 5 days 12-18 years: PO Nitrofurantoin MR 100mg BD F non-severe penicillin allergy: 80mg/ +/- IV Gentamicin 7mg/ (max. 560mg) Severe penicillin allergy: IV Gentamicin 7mg/ (max. 560mg) Septic Arthritis Osteomyelitis Cellulitis (mild/moderate) Severe Cellulitis (without evidence of sepsis) Treat f 7-10 days Toxic shock syndrome Necrotising Fasciitis First line (max. 4g) PO Flucloxacillin 1 month 1 year: 62.5mg - 125mg QDS 2-9 years: 125mg -250mg QDS 10-17 years: 250mg -500mg QDS IV Flucloxacillin 1 month - 18 years: 50mg/kg QDS (max 2g QDS) PO Clindamycin 6mg/kg QDS (Max 450mg QDS) IV Flucloxacillin 50mg/kg QDS (max 2g QDS) IV Benzylpenicillin 50mg/kg QDS (max 2.4g QDS) Allergy* IV Gentamicin 7mg/ (max. 560mg) PO Clarithromycin body weight: < 8 kg: 7.5mg /kg BD 8-11 kg: 62.5mg BD 12-19 kg: 125mg BD 20-29 kg: 187.5mg BD 30-40 kg: 250mg BD 12-17 years 250 mg BD 1 month 11 years (<50kg) PO Clindamycin 6mg/kg QDS (max. 450mg QDS) IV Vancomycin 15mg/kg TDS Severe penicillin allergy: IV Vancomycin 15mg/kg TDS 3 PAEDIATRIC ANTIBIOTIC PRESCRIBING GUIDELINE PAEDIATRIC ANTIBIOTIC PRESCRIBING GUIDELINE 4
Bone & Soft Tissue Infections Upper respiraty Infection First line Allergy* First line Allergy* Peri-bital cellulitis Treat f 7 days 30mg/kg TDS (if< 3 months 30mg/kg BD) Severe Penicillin allergy IV Clarithromycin 7.5mg/kg BD (max 500mg BD) Fever / bleeding following tonsillectomy 1 month - 1 year: (125/31) 6-12 years: (250/62) 5mls TDS 10mg/ Orbital cellulitis Treat f 7 days unless complicated 80mg/ PO Clindamycin 3-6mg/kg QDS (max 450mg QDS) Consider f follow-on therapy/not complicated PO Ciprofloxacin 20mg/kg BD (max 750mg BD) IV Metronidazole 7.5mg/kg TDS (max 500mg TDS) IV Vancomycin 15mg/kg TDS Otitis Media Consider treatment after 24-48 hours Treat f 5 days PO Amoxicillin 1 month 11 months: 125mg TDS 1-4 years 250mg TDS 5-18 years 500mg TDS 10mg/ 3 days Aspiration pneumonia Soft tissue Upper respiraty Infection Epiglottitis Bacterial tracheitis 1 month 11 months: (125/31) 80mg/ 12-17 years (> 50kg) 2-4 g OD PO 80mg/kg Clindamycin OD 3-6mg/kg 12-17 years QDS (> 50kg) (max 2-4 450mg g ODQDS) Consider f follow-on therapy/not complicated IV Metronidazole 7.5mg/kg TDS (max. 500mg TDS) IV Clarithromycin 7.5mg/kg BD IV Chlamphenicol 25mg/kg QDS IV Chlamphenicol 25mg/kg QDS Lymphadenitis Mild: 1 month - 1 year: (125/31) Severe: 10mg/ 3 days Non severe Pharyngitis/Tonsillitis Consider deferring treatment f 48 hours PO Penicillin V 1 month 11 months: 62.5mg QDS 1-5 years: 125mg QDS 6-11 years: 250mg QDS 12-18 years: 500mg QDS IV Benzylpenicillin 50mg/kg (max.2.4g) QDS 10mg/ 5 PAEDIATRIC ANTIBIOTIC PRESCRIBING GUIDELINE PAEDIATRIC ANTIBIOTIC PRESCRIBING GUIDELINE 6
Soft Tissue Abdominal First line Allergy* First line Allergy* Soft tissue injury (Clean) Soft tissue injury (Contaminated) NB Check tetanus vaccination status Animal Bites (including humans) NB Check tetanus vaccination status No antibacterials required 1 month - 11 months: (125/31) +/-PO Metronidazole 1 month 11 months: (125/31) +/- PO Metronidazole 80mg/ PO Metronidazole PO Metronidazole PO Ciprofloxacin 20mg/kg BD (max. 750mg BD) PO Clindamycin 3-6mg/kg QDS (max 450mg QDS) Intra-abdominal infections (including peritonitis) Appendicitis Gastroenteritis Campylobacter enteritis Enteric Fever/Typhoid STAT dose IV Gentamicin 7mg/kg if septic (max. 560mg) No antibiotics required Usually self-limiting. If immunocompromised/severe: PO/IV Clarithromycin 7.5mg/kg BD Switch to al antibiotics once sensitivities known 10mg/ PO Ciprofloxacin 20mg/kg BD (max. 750mg BD) IV Ciprofloxacin 10mg/kg TDS (max 400mg TDS) IV Metronidazole 7.5mg/kg TDS (max.500mg TDS) IV Gentamicin 7mg/ (max 560mg) IV Metronidazole 7.5mg/kg TDS (max.500mg TDS) Consider adding: IV Vancomycin 15mg/kg TDS Clostridium difficile Stop all other antibiotics PO Vancomycin 1 month 4 years: 5mg/kg QDS 5-11 years: 62.5mg QDS 12 18 years: 125 mg QDS f 14 days Doses may be increased if fails to respond Don t treat asymptomatic infants 7 PAEDIATRIC ANTIBIOTIC PRESCRIBING GUIDELINE PAEDIATRIC ANTIBIOTIC PRESCRIBING GUIDELINE 8
Anaphylaxis (Resuscitation Council UK): Anaphylaxis is likely when ALL of the following 3 criteria are met: 1. Sudden onset rapid progression of symptoms 2. Life-threatening Airway / Breathing / Circulation problems 3. Skin / mucosal changes (flushing, urticaria, angioedema) The following suppts the diagnosis: Exposure to a known allergen f the patient Remember: Skin mucosal changes alone are not a sign of an anaphylactic reaction Skin mucosal changes can be subtle absent in up to 20% of reactions (some patients have only a decrease in blood pressure, i.e., a Circulation problem) There can also be gastrointestinal symptoms (e.g. vomiting, abdominal pain, incontinence) 9 PAEDIATRIC ANTIBIOTIC PRESCRIBING GUIDELINE PAEDIATRIC ANTIBIOTIC PRESCRIBING GUIDELINE 10