Antibiotics By Diagnosis (Peds) - Revision history

Rossdonaldson1: Redirected page to Pediatric antibiotics

2015-05-25T18:41:57Z

Redirected page to Pediatric antibiotics

Rossdonaldson1 at 18:39, 25 May 2015

2015-05-25T18:39:18Z

← Older revision		Revision as of 18:39, 25 May 2015
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	== Neonatal Infections~~<br>~~ ==
			== Neonatal Infections==

	NOTE: All doses listed below are for patients >2 kg and at least 7 days of age<br>		NOTE: All doses listed below are for patients >2 kg and at least 7 days of age<br>
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	<br>		<br>

	== Febrile Syndromes/Bloodstream Infections~~<br>~~ ==


			== Febrile Syndromes/Bloodstream Infections ==


	{\| cellspacing="0" cellpadding="2" border="1" align="left"		{\| cellspacing="0" cellpadding="2" border="1" align="left"

Rossdonaldson1: /* See Also */

2014-11-18T14:55:50Z

Rossdonaldson1: /* A Note On Ceftriaxone */

2014-03-03T07:49:54Z

A Note On Ceftriaxone

← Older revision		Revision as of 07:49, 3 March 2014
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	*[[Pediatric Fever]]		*[[Pediatric Fever]]

	== A Note On Ceftriaxone==		== A Note On [[Ceftriaxone]]==
	CAUTION: Ceftriaxone (Rocephin) should NOT be administered to any patient who is less that 28 days of age. If a 3rd generation cephalosporin is required, ~~please~~ consider using Cefotaxime instead~~. <br>~~		CAUTION: [[Ceftriaxone]] (Rocephin) should NOT be administered to any patient who is less that 28 days of age. If a 3rd generation cephalosporin is required, consider using Cefotaxime instead

	== Source==		== Source==

Rossdonaldson1: /* Orthopedic Infections */

2014-03-03T07:49:14Z

Orthopedic Infections

← Older revision		Revision as of 07:49, 3 March 2014
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	{\| cellspacing="0" cellpadding="2" border="1" align="left"		{\| cellspacing="0" cellpadding="2" border="1" align="left"
	\|-		\|-
	\| Osteomyelitis		\| [[Osteomyelitis]]
	\| Outside neonatal period: ''S. aureus, GAS, ''rarely coliforms		\| Outside neonatal period: ''S. aureus, GAS, ''rarely coliforms
	\|		\|
	#Nafcillin 200 mg/kg/day IV div Q6 OR Cefazolin 100 mg/kg/day div Q8 x4-6 weeks or longer. If open fracture with trauma, consider adding anti-Pseudomonal coverage pending negative cultures for GNs. If nonresponsive to above therapy or very ill, consider ~~Vancomycin~~ or Clindamycin if MRSA present.		#Nafcillin 200 mg/kg/day IV div Q6 OR Cefazolin 100 mg/kg/day div Q8 x4-6 weeks or longer. If open fracture with trauma, consider adding anti-Pseudomonal coverage pending negative cultures for GNs. If nonresponsive to above therapy or very ill, consider [[[vancomycin]] or Clindamycin if MRSA present.

	\|-		\|-
	\| Septic ~~arthritis~~		\| [[Septic Arthritis]]
	\| Outside neonatal period: ''S. aureus, GAS ''(''S. pneumo ''and ''Hib ''unlikely if fully immunized). ''Kingella ''if <5 yo. ''Gonococcus'' in adolescents.		\| Outside neonatal period: ''S. aureus, GAS ''(''S. pneumo ''and ''Hib ''unlikely if fully immunized). ''Kingella ''if <5 yo. ''Gonococcus'' in adolescents.
	\|		\|
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	If unimmunized again ''Hib'': Cefuroxime OR [Cefotaxime AND [Nafcillin OR Cefazolin]] x21 days.		If unimmunized again ''Hib'': Cefuroxime OR [Cefotaxime AND [Nafcillin OR Cefazolin]] x21 days.

	If ''Gonococcus'' suspected or isolated, ~~Ceftriaxone~~ 50 mg/kg/day IV/IM daily OR Penicillin G IV (if susceptible) x7-10 days.		If ''[[Gonococcus]]'' suspected or isolated, [[ceftriaxone]] 50 mg/kg/day IV/IM daily OR Penicillin G IV (if susceptible) x7-10 days.

	\|}		\|}
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	<br>		<br>

	<br>		<br>

	==See Also==		==See Also==

Rossdonaldson1: /* Skin & Soft Tissue Infections */

2014-03-03T07:45:02Z

Skin & Soft Tissue Infections

← Older revision		Revision as of 07:45, 3 March 2014
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	\|		\|
	#OSSA/MSSA - [[Cephalexin]] 50-75 mg/kg/day PO div TID OR Augmentin 80-90 mg/kg/day PO div BID x5-7 days. '''I&D when indicated.'''<br>		#OSSA/MSSA - [[Cephalexin]] 50-75 mg/kg/day PO div TID OR Augmentin 80-90 mg/kg/day PO div BID x5-7 days. '''I&D when indicated.'''<br>
	#If MRSA prevalent or if recurrent abscess, send specimen for culture and sensitivity. Treat with Clindamycin 40 mg/kg/day IV div Q6 or TMP-SMX (Bactrim) 5 mg/kg/dose TMP Q6-8. If toxic-appearing, use ~~Vancomycin~~.~~<br>~~		#If MRSA prevalent or if recurrent abscess, send specimen for culture and sensitivity. Treat with Clindamycin 40 mg/kg/day IV div Q6 or [[TMP-SMX]] (Bactrim) 5 mg/kg/dose TMP Q6-8. If toxic-appearing, use [[vancomycin]].

	\|-		\|-
	\| Breast abscess~~<br>~~		\| Breast abscess
	\| colspan="2" \|		\| colspan="2" \|
	#Neonate: Gram stain and culture expressed material/colostrum. Treat with IV abx to minimize damage to breast tissue. Empiric treatment with Nafcillin or ~~Vancomycin~~ (if contacts with MRSA).~~<br>~~		#Neonate: Gram stain and culture expressed material/colostrum. Treat with IV abx to minimize damage to breast tissue. Empiric treatment with Nafcillin or [[vancomycin]] (if contacts with MRSA).
	#Non-neonate: Nafcillin 200 mg/kg/day IV div Q6 x5-7 days; Cefotaxime if GNR found on Gram stain		#Non-neonate: Nafcillin 200 mg/kg/day IV div Q6 x5-7 days; Cefotaxime if GNR found on Gram stain

	\|-		\|-
	\| Cellulitis (unknown etiology)~~<br>~~		\| [[Cellulitis]] (unknown etiology)
	\| ''GAS, S. aureus''<br>		\| ''GAS, S. aureus''<br>
	\|		\|
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	\| Penicillin G IV, then transition to Pencicillin V or Amoxicillin PO x10 days.<br>		\| Penicillin G IV, then transition to Pencicillin V or Amoxicillin PO x10 days.<br>
	\|-		\|-
	\| Impetigo~~<br>~~		\| [[Impetigo]]
	\| Mixed ''Strep ''and ''Staph sp. ''Bullous impetigo more likely ''Staphylococcal.''<br>		\| Mixed ''Strep ''and ''Staph sp. ''Bullous impetigo more likely ''Staphylococcal.''<br>
	\| Mupirocin topical to lesions TID, cleanse with soap and water. Bathe daily. If extensive, treat with [[Cephalexin]] PO or Amoxicillin-Clavunate x5-7 days.~~<br>~~		\| Mupirocin topical to lesions TID, cleanse with soap and water. Bathe daily. If extensive, treat with [[Cephalexin]] PO or Amoxicillin-Clavunate x5-7 days.
	\|-		\|-
	\| Omphalitis/Funisitis~~<br>~~		\| Omphalitis/Funisitis
	\| Coliform bacteria, ''S. aureus'' and anaerobes ''(Clostridia)''<br>		\| Coliform bacteria, ''S. aureus'' and anaerobes ''(Clostridia)''<br>
	\|		\|
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	\|-		\|-
	\| Paronychia~~<br>~~		\| [[Paronychia]]
	\| ''S. aureus, ''anaerobes~~<br>~~		\| ''S. aureus, ''anaerobes
	\| Local wound care and I&D unless signs of spreading infection, then consider Augmentin or Clindamycin.<br>		\| Local wound care and I&D unless signs of spreading infection, then consider Augmentin or Clindamycin.<br>
	\|-		\|-
	\| Scabies~~<br>~~		\| [[Scabies]]
	\| ''Sarcoptes scabeii''~~<br>~~		\| ''[[Sarcoptes scabeii]]''
	\|		\|
	#Topical 5% Permethrin cream, apply to neck down, wash off in 8-14 hours.<br>		#Topical 5% Permethrin cream, apply to neck down, wash off in 8-14 hours.<br>
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	Differentiate from TENs (drug induced). Corticosteroids contraindicated. Culture skin.		Differentiate from TENs (drug induced). Corticosteroids contraindicated. Culture skin.

	#Nafcillin 200 mg/kg/day IV div Q6 OR Cefazolin IV x5-7 days. Consider ~~Vancomycin~~.		#Nafcillin 200 mg/kg/day IV div Q6 OR Cefazolin IV x5-7 days. Consider [[vancomycin]].

	Avoid TMP-SMX.		Avoid TMP-SMX.

	\|-		\|-
	\| Tinea corporis~~<br>~~		\| [[Tinea corporis]]
	\| colspan="2" \| May use one of many topical antifungal agents: Terbinafine 1% cream or gel BID to affected areas; Clotrimazole 1% cream, lotion or solution; others include Econazole, Sulconazole, Oxiconazole, Naftifine, Cicloprox, Ketoconazole, Sertaconazle, Moconazole and Tolnaftate. Treat for 14 days. Keep affected areas dry.<br>		\| colspan="2" \| May use one of many topical antifungal agents: Terbinafine 1% cream or gel BID to affected areas; Clotrimazole 1% cream, lotion or solution; others include Econazole, Sulconazole, Oxiconazole, Naftifine, Cicloprox, Ketoconazole, Sertaconazle, Moconazole and Tolnaftate. Treat for 14 days. Keep affected areas dry.<br>
	\|-		\|-
	\| Tinea capitis~~<br>~~		\| [[Tinea capitis]]
	\| ''Trichophyton tonsurans''~~<br>~~		\| ''[[Trichophyton tonsurans]]''
	\| [Griseofulvin Microsize 10-20 mg/kg/day div Q12-24 (max 1000 mg/day) OR Griseofulfin Ultramicrosize >2 years 5-10 mg/kg/day div Q12-24 x6 weeks] AND Selenium sulfide shampoo twice weekly x1 week as directed.<br>		\| [Griseofulvin Microsize 10-20 mg/kg/day div Q12-24 (max 1000 mg/day) OR Griseofulfin Ultramicrosize >2 years 5-10 mg/kg/day div Q12-24 x6 weeks] AND Selenium sulfide shampoo twice weekly x1 week as directed.<br>
	\|-		\|-
	\| Necrotizing ~~fasciitis<br>~~		\| [[Necrotizing Fasciitis]]
	\| ''Strep (A, C ''or ''G), Clostridia ''or polymicrobial<br>		\| ''Strep (A, C ''or ''G), Clostridia ''or polymicrobial<br>
	\|		\|
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	\| '''Rabies prone: BATS''', feral cats, raccoon, skunk, foxes, coyotes, most carnivores, woodchucks and livestock in certain areas<br>		\| '''Rabies prone: BATS''', feral cats, raccoon, skunk, foxes, coyotes, most carnivores, woodchucks and livestock in certain areas<br>
	\|		\|
	Treat all bat and feral cat exposures with both HRIG and Rabies vaccine as below. Otherwise, treat with vaccine and contact public health officials or infection control for advice on whether to treat with HRIG. Monitor animal for 10 days.		Treat all bat and feral cat exposures with both HRIG and [[Rabies]] vaccine as below. Otherwise, treat with vaccine and contact public health officials or infection control for advice on whether to treat with HRIG. Monitor animal for 10 days.

	#Rabies vaccine 1 mL IM into deltoid days 0, 3, 7, 14 and 28.		#[[Rabies]] vaccine 1 mL IM into deltoid days 0, 3, 7, 14 and 28.
	#HRIG 20 IU/kg around wound and begin vaccination series with HDCV or RVA vaccine days 0, 3, 7, 14 and 28.		#HRIG 20 IU/kg around wound and begin vaccination series with HDCV or RVA vaccine days 0, 3, 7, 14 and 28.
	#Consider treating with Augmentin as below.		#Consider treating with Augmentin as below.
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	\| Cat: ''Pasteurella multocida, S. aureus''<br>		\| Cat: ''Pasteurella multocida, S. aureus''<br>
	\|		\|
	#Augmentin 45 mg/kg/day div Q8-12 x5-7 days. For PCN allergic patients, ''Pasteurella ''is covered by Doxycycline or Ciprofloxacin. Add another drug for ''Strep ''or ''Staph sp.''~~<br>~~		#Augmentin 45 mg/kg/day div Q8-12 x5-7 days. For PCN allergic patients, ''Pasteurella ''is covered by Doxycycline or Ciprofloxacin. Add another drug for ''Strep ''or ''Staph sp.''
	#Rabies: See above if feral cat. Check tetanus status.		#Rabies: See above if feral cat. Check tetanus status.

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	MSSA: Augmentin 90 mg/kg/day PO div BID OR [[Cephalexin]] 100 mg/kg/day PO div QID x10 days. If IV needed, Cefazolin 100 mg/kg/day IV div Q8.		MSSA: Augmentin 90 mg/kg/day PO div BID OR [[Cephalexin]] 100 mg/kg/day PO div QID x10 days. If IV needed, Cefazolin 100 mg/kg/day IV div Q8.

	MRSA: Clindamycin OR TMP-SMX OR Linezolid. If IV needed, Clindamycin 40 mg/kg/day IV div Q6 OR ~~Vancomycin~~ (age based dosing) x7-10 days total.		MRSA: Clindamycin OR TMP-SMX OR Linezolid. If IV needed, Clindamycin 40 mg/kg/day IV div Q6 OR [[vancomycin]] (age based dosing) x7-10 days total.

	\|-		\|-
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	#Azithromycin 10 mg/kg/day PO Q24 x5 days.		#Azithromycin 10 mg/kg/day PO Q24 x5 days.

	May also use Bactrim, Rifampin and Ciprofloxacin. Duration of therapy is uncertain.		May also use [[Bactrim]], Rifampin and Ciprofloxacin. Duration of therapy is uncertain.

	\|}		\|}
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	<br>		<br>



	== Orthopedic Infections ==		== Orthopedic Infections ==

Rossdonaldson1: /* Gastroenterologic Infections */

2014-03-03T07:40:33Z

Gastroenterologic Infections

← Older revision		Revision as of 07:40, 3 March 2014
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	{\| cellspacing="0" cellpadding="2" border="1" align="left"		{\| cellspacing="0" cellpadding="2" border="1" align="left"
	\|-		\|-
	\| rowspan="7" \| Diarrhea~~<br>~~		\| rowspan="7" \| [[Diarrhea]]
	\| colspan="2" \|		\| colspan="2" \|
	'''Initial Workup:''' If blood diarrhea or >6 stools/day and febrile then consider stool cultures, fecal leukocytes, electrolytes.		'''Initial Workup:''' If blood diarrhea or >6 stools/day and febrile then consider stool cultures, fecal leukocytes, electrolytes.
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	\|-		\|-
	\| ''C. difficile''~~<br>~~		\| ''[[C. difficile]]''
	\|		\|
	Suspect if blood diarrhea, cramping develop with recent antibiotic exposure.		Suspect if blood diarrhea, cramping develop with recent antibiotic exposure.

	#Metronidazole 30 mg/kg/day PO/IV div QID x10 days.		#Metronidazole 30 mg/kg/day PO/IV div QID x10 days.
	#Vancomycin 40 mg/kg/day PO div QID x10 days ONLY for Metronidazole failures.		#[[Vancomycin]] 40 mg/kg/day PO div QID x10 days ONLY for Metronidazole failures.

	\|-		\|-
	\| ''C. jejuni''~~<br>~~		\| ''C. jejuni''
	\|		\|
	Suspect if prominent abdominal pain. Young infants may only have bloody diarrhea. Can have immunoreactive complications such as AIDP, reactive arthritis, Reiter syndrome or erythema nodosum.		Suspect if prominent abdominal pain. Young infants may only have bloody diarrhea. Can have immunoreactive complications such as AIDP, reactive arthritis, Reiter syndrome or erythema nodosum.
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	Suspect if fever, cramps, tenesmus, abdominal pain. Complications include seizures, bacteremia, Reiter Syndrome, HUS (''S. dystenteriae ''type 1), toxic megacolon and toxic encephalopathy (ekiri syndrome).		Suspect if fever, cramps, tenesmus, abdominal pain. Complications include seizures, bacteremia, Reiter Syndrome, HUS (''S. dystenteriae ''type 1), toxic megacolon and toxic encephalopathy (ekiri syndrome).

	#Cefixime 8 mg/kg/day PO div BID or TMP-SMX (Bactrim) 8 mg/kg/day TMP PO div TID x5-7 days. Illness usually self-limited (48-72 hours), but treatment is always indicated to decrease duration of shedding, which is important for public health measures.<br>		#Cefixime 8 mg/kg/day PO div BID or [[TMP-SMX]] (Bactrim) 8 mg/kg/day TMP PO div TID x5-7 days. Illness usually self-limited (48-72 hours), but treatment is always indicated to decrease duration of shedding, which is important for public health measures.<br>

	\|-		\|-
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	\| Causes mesenteric adenitis, mimics appendicitis. Predisposed by iron overload states (chronic transfusions). Antimicrobial therapies not indicated in normal hosts.<br>		\| Causes mesenteric adenitis, mimics appendicitis. Predisposed by iron overload states (chronic transfusions). Antimicrobial therapies not indicated in normal hosts.<br>
	\|-		\|-
	\| Necrotizing Enterocolitis (NEC)~~<br>~~		\| [[Necrotizing Enterocolitis]] (NEC)
	\| Multifactorial disease, including bacterial invasion (debated). ''E. coli, Klebsiella, Pseudomonas, Clostridial sp., S. aureus, B. fragilis.''<br>		\| Multifactorial disease, including bacterial invasion (debated). ''E. coli, Klebsiella, Pseudomonas, Clostridial sp., S. aureus, B. fragilis.''<br>
	\|		\|
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	#Ampicillin AND Gentamicin x10 or more days<br>		#Ampicillin AND Gentamicin x10 or more days<br>

	Consider adding Cefotaxime if CNS involvement cannot be exclused. Consider replacing Ampicillin with ~~Vancomycin~~ if MRSA/CONS. Consider adding Clindamycin if perforation cannot be excluded.<br>		Consider adding Cefotaxime if CNS involvement cannot be exclused. Consider replacing Ampicillin with [[vancomycin]] if MRSA/CONS. Consider adding Clindamycin if perforation cannot be excluded.<br>

	\|-		\|-
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	<br>		<br>

	<br>		<br>

	== Genitourinary Infections<br> ==		== Genitourinary Infections<br> ==

Rossdonaldson1: /* Cardiovascular Infections */

2014-03-03T07:38:39Z

Cardiovascular Infections

← Older revision		Revision as of 07:38, 3 March 2014
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	{\| cellspacing="0" cellpadding="2" border="1" align="left"		{\| cellspacing="0" cellpadding="2" border="1" align="left"
	\|-		\|-
	\| rowspan="3" \| Endocarditis		\| rowspan="3" \| [[Endocarditis]]
	\| '''Prophylaxis indications'''		\| '''Prophylaxis indications'''
	\| rowspan="1" \|		\| rowspan="1" \|
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	\| rowspan="1" \|		\| rowspan="1" \|
	#Amoxicillin 50 mg/kg PO x1 OR Ampicillin 50 mg/kg IV x1, 30-60 minutes prior to the procedure.		#Amoxicillin 50 mg/kg PO x1 OR Ampicillin 50 mg/kg IV x1, 30-60 minutes prior to the procedure.
	#Allergic patients: Clindamycin 20 mg/kg PO/IV x1 OR [[~~Cephalexin~~]] 50 mg/kg PO x1 OR Azithromycin 15 mg/kg PO x1.		#Allergic patients: Clindamycin 20 mg/kg PO/IV x1 OR [[cephalexin]] 50 mg/kg PO x1 OR Azithromycin 15 mg/kg PO x1.

	\|-		\|-
	\| '''Empiric therapy, '''native valves: ''S. viridnas, Enterococci, Staphylococci''		\| '''Empiric therapy, '''native valves: ''S. viridnas, Enterococci, Staphylococci''
	\| rowspan="1" \| By definition includes multiple positive blood cultures, new murmur of valvular insufficiency, emboli and echo evidence of vegetations. Send cultures and target therapy based on results. Vancomycin and Gentamicin pending culture results.		\| rowspan="1" \| By definition includes multiple positive [[blood cultures]], new murmur of valvular insufficiency, emboli and echo evidence of vegetations. Send cultures and target therapy based on results. [[Vancomycin]] and Gentamicin pending culture results.
	\|}		\|}

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	<br>		<br>

	<br>		<br>

	== Gastroenterologic Infections ==		== Gastroenterologic Infections ==

Rossdonaldson1: /* Respiratory Tract Infections */

2014-03-03T07:37:05Z

Respiratory Tract Infections

← Older revision		Revision as of 07:37, 3 March 2014
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	{\| cellspacing="0" cellpadding="2" border="1" align="left"		{\| cellspacing="0" cellpadding="2" border="1" align="left"
	\|-		\|-
	\| Bronchiolitis		\| [[Bronchiolitis]]
	\| RSV (50%), parainfluenza (25%), other viruses (20%)		\| RSV (50%), parainfluenza (25%), other viruses (20%)
	\|		\|
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	Supportive care. Contact Infection Control if suspect ''M. Tb.''		Supportive care. Contact Infection Control if suspect ''M. Tb.''

	'''Inpatient: '''Cefuroxime 150 mg/kg/day IV/IM div Q8 OR ~~Ceftriaxone~~ 50 mg/kg/day IV/IM Q24 OR Cefotaxime 150 mg/kg/day IV div Q8 x10-14 days. If persistently ill, consider addition of Clindamycin 40 mg/kg/day IV div Q6 OR ~~Vancomycin~~. Rule-out parapneumonic effusion.		'''Inpatient: '''Cefuroxime 150 mg/kg/day IV/IM div Q8 OR [[ceftriaxone]] 50 mg/kg/day IV/IM Q24 OR Cefotaxime 150 mg/kg/day IV div Q8 x10-14 days. If persistently ill, consider addition of Clindamycin 40 mg/kg/day IV div Q6 OR [[vancomycin]]. Rule-out parapneumonic effusion.

	'''Outpatient: '''Amoxicillin PO 90 mg/kg/day PO div BID x10-14 days with atypical coverage as indicated.		'''Outpatient: '''Amoxicillin PO 90 mg/kg/day PO div BID x10-14 days with atypical coverage as indicated.
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	<br>		<br>



	== Cardiovascular Infections ==		== Cardiovascular Infections ==

Rossdonaldson1: /* Head, Eyes, Ears, Nose & Throat Infections */

2014-03-03T07:33:47Z

Head, Eyes, Ears, Nose & Throat Infections

← Older revision		Revision as of 07:33, 3 March 2014
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	{\| cellspacing="0" cellpadding="2" border="1" align="left"		{\| cellspacing="0" cellpadding="2" border="1" align="left"
	\|-		\|-
	\| Head: Mastoiditis, acute		\| Head: [[Mastoiditis]], acute
	\| ''S. pneumo ''(22%), ''S. pyogenes ''(16%), ''S. aureus ''(7%), ''H. flu, P. aeruginosa''		\| ''S. pneumo ''(22%), ''S. pyogenes ''(16%), ''S. aureus ''(7%), ''H. flu, P. aeruginosa''
	\| R/O meningitis. Surgical debridement as indicated. Transition to PO once clinically improved. Ampicillin-Sulbactam (Unasyn) 300 mg/kg/dau IV div Q6 OR Cefotaxime 150 mg/kg/day div Q8 OR ~~Ceftriaxone~~ 50 mg/kg/day Q24 +/- Nafcillin 200mg/kg/day IV div Q6 OR Clindamycin 40 mg/kg/day IV div Q6 or ~~Vancomycin~~ x21 days.		\| R/O [[meningitis]]. Surgical debridement as indicated. Transition to PO once clinically improved. Ampicillin-Sulbactam (Unasyn) 300 mg/kg/dau IV div Q6 OR Cefotaxime 150 mg/kg/day div Q8 OR [[ceftriaxone]] 50 mg/kg/day Q24 +/- Nafcillin 200mg/kg/day IV div Q6 OR Clindamycin 40 mg/kg/day IV div Q6 or [[vancomycin]] x21 days.
	\|-		\|-
	\| Head: Sinusitis, acute		\| Head: [[Sinusitis]], acute
	\| ''S. pneumo ''(31%), ''H. flu'' (21%), ''M. catarrhalis ''(2%), ''GAS, anaerobes ''(6%), viruses (15%), ''S. aureus ''(4%)		\| ''S. pneumo ''(31%), ''H. flu'' (21%), ''M. catarrhalis ''(2%), ''GAS, anaerobes ''(6%), viruses (15%), ''S. aureus ''(4%)
	\|		\|
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	\| AKA pink eye. No treatment needed. Highly contagious. Cold artificial tears may help. NEVER treat with steroids except by an ophthalmologist!		\| AKA pink eye. No treatment needed. Highly contagious. Cold artificial tears may help. NEVER treat with steroids except by an ophthalmologist!
	\|-		\|-
	\| HSV types 1-2		\| [[HSV]] types 1-2
	\|		\|
	Can be sight-threatening. Refer to ophthalmologist immediately! 30-50% recurrence in 2 years.		Can be sight-threatening. Refer to ophthalmologist immediately! 30-50% recurrence in 2 years.
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	\| Polymixin/trimethoprim ophthalmic solution 1 drop Q3 OR polymixin.bacitracin/Neosporin ophthalmic solution 1 drop Q3 x7-10 days.		\| Polymixin/trimethoprim ophthalmic solution 1 drop Q3 OR polymixin.bacitracin/Neosporin ophthalmic solution 1 drop Q3 x7-10 days.
	\|-		\|-
	\| Eyes: Dacryocystitis		\| Eyes: [[Dacryocystitis ]]
	\| colspan="2" \| Warm compresses and tear duct massage. No antimicrobial therapy usually needed. Oral antimicrobial therapy for more symptomatic infections.~~<br>~~		\| colspan="2" \| Warm compresses and tear duct massage. No antimicrobial therapy usually needed. Oral antimicrobial therapy for more symptomatic infections.
	\|-		\|-
	\| Eyes: Orbital ~~cellulitis~~		\| Eyes: [[Orbital Cellulitis]]
	\|		\|
	''S. pneumo'''', H. flu, M. catarrhalis, S. aureus, anaerobes, ''''GAS.''		''S. pneumo'''', H. flu, M. catarrhalis, S. aureus, anaerobes, ''''GAS.''

	Post-trauma: ''GN-bacilli''		Post-trauma: ''[[Gram-Negative]] bacilli''

	\|		\|
	Proptosis, limited EOM, chemosis, eyelid edema, pain. Complication of sinusitic. If pus present on CT, in orbit or subperiosteum, surgical drainage indicated.		Proptosis, limited EOM, chemosis, eyelid edema, pain. Complication of sinusitic. If pus present on CT, in orbit or subperiosteum, surgical drainage indicated.

	Ampicillin-Sulbactam (Unasyn) 300 mg/kg/day IV div Q6 OR Cefotaxime 150 mg/kg/day div Q8 OR ~~Ceftriaxone~~ 50 mg/kg/day Q24 AND Nafcillin 200 mg/kg/day IV div Q6. If any MRSA isolated locally, add Clindamycin 40 mg/kg/day IV div Q6 OR ~~Vancomycin~~ x10-14 days.		Ampicillin-Sulbactam (Unasyn) 300 mg/kg/day IV div Q6 OR Cefotaxime 150 mg/kg/day div Q8 OR [[ceftriaxone]] 50 mg/kg/day Q24 AND Nafcillin 200 mg/kg/day IV div Q6. If any MRSA isolated locally, add Clindamycin 40 mg/kg/day IV div Q6 OR [[vancomycin]] x10-14 days.

	\|-		\|-
	\| Eyes: Periorbital (preseptal) ~~cellulitis~~		\| Eyes: [[Periorbital Cellulitis\|Periorbital (preseptal) Cellulitis]]
	\| ''S. pneumo, S. aureus, coagulase-negative Staph (CONS), anaerobes; H. flu ''now uncommon unless unvaccinated		\| ''S. pneumo, S. aureus, coagulase-negative Staph (CONS), anaerobes; H. flu ''now uncommon unless unvaccinated
	\|		\|
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	#If known entry site: Nafcillin 200 mg/kg/day IV div Q6 OR Cefazolin 100 mg/kg/day IV Q8 x7-10 days. If MRSA suspected, Vancomycin OR Clindamycin 40 mg/kg/day IV div Q6. Oral antistaphylococcal antibiotics for less severe infections.		#If known entry site: Nafcillin 200 mg/kg/day IV div Q6 OR Cefazolin 100 mg/kg/day IV Q8 x7-10 days. If MRSA suspected, Vancomycin OR Clindamycin 40 mg/kg/day IV div Q6. Oral antistaphylococcal antibiotics for less severe infections.
	#Periorbital swelling without cellulitis (often associated with sinusitis): Ceftriaxone 50 mg/kg/day IV Q24 OR Cefotaxime 150 mg/kg/day IV div Q8. ADD Clindamycin 40 mg/kg/day IV div Q6 for more severe infections of suspicion of MRSA. See 'Head: Sinusitis' for oral therapy options.		#Periorbital swelling without cellulitis (often associated with sinusitis): [[Ceftriaxone]] 50 mg/kg/day IV Q24 OR Cefotaxime 150 mg/kg/day IV div Q8. ADD Clindamycin 40 mg/kg/day IV div Q6 for more severe infections of suspicion of MRSA. See 'Head: Sinusitis' for oral therapy options.

	\|-		\|-
	\| Ears: Otitis ~~externa~~		\| Ears: [[Otitis Externa]]
	\| ''Pseudomonas, Enterobacteriae, Proteus.''		\| ''Pseudomonas, Enterobacteriae, Proteus.''
	\|		\|
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	\|-		\|-
	\| Ears: Otitis ~~media~~		\| Ears: [[Otitis Media]]
	\| ''S. pneumo ''(50%), ''H. flu ''(20%), ''M. catarrhalis'' (15%), non-bacterial origin (33%).		\| ''S. pneumo ''(50%), ''H. flu ''(20%), ''M. catarrhalis'' (15%), non-bacterial origin (33%).
	\|		\|
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	\|-		\|-
	\| Mouth: Ludwig's ~~angina~~		\| Mouth: [[Ludwig's Angina]]
	\| colspan="2" \|		\| colspan="2" \|
	High risk of respiratory tract obstruction due to inflammatory edema.		High risk of respiratory tract obstruction due to inflammatory edema.

	#Penicillin G 200,000 U/kg/day div Q6 AND Clindamycin 40 mg/kg/day IV vid Q6.		#Penicillin G 200,000 U/kg/day div Q6 AND Clindamycin 40 mg/kg/day IV vid Q6.
	#Consider Meropenem, Piperacillin-Tazobactam (Zosyn) OR ~~Ceftriaxone~~ if GNR suspected.		#Consider Meropenem, Piperacillin-Tazobactam (Zosyn) OR [[ceftriaxone]] if [[GNR]] suspected.

	\|-		\|-
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	Polymicrobial oral flora.		Polymicrobial oral flora.

	Can progress to Ludwig's ~~angina~~.		Can progress to [[Ludwig's Angina]].

	\|		\|
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	\| ''S. aureus (MRSA), GAS, S. pneumo, H. flu.''		\| ''S. aureus (MRSA), GAS, S. pneumo, H. flu.''
	\|		\|
	#[Vancomycin OR Clindamycin 40 mg/kg/day div Q6] AND [Cefotaxime 150 mg/kg/day div Q8 OR ~~Ceftriaxone~~ 50 mg/kg/day Q24]. Tailor to cultures.		#([[Vancomycin OR Clindamycin 40 mg/kg/day div Q6) AND (Cefotaxime 150 mg/kg/day div Q8 OR [[ceftriaxone]] 50 mg/kg/day Q24). Tailor to cultures.
	#Cefuroxime 100-150 mg/kg/day div Q8.		#Cefuroxime 100-150 mg/kg/day div Q8.

	\|-		\|-
	\| Throat: Epiglottitis		\| Throat: [[Epiglottitis]]
	\| ''GAS, S. pneumo, S. aureus, H. flu ''(rare unless unvaccinated).		\| ''GAS, S. pneumo, S. aureus, H. flu ''(rare unless unvaccinated).
	\|		\|
	Provide airway support in OR or ICU setting in consultation with airway specialist.		Provide airway support in OR or ICU setting in consultation with airway specialist.

	Cefotaxime 150 mg/kg/day div Q8 OR ~~Ceftriaxone~~ 50 mg/kg/day Q24. ADD Clindamycin 40 mg/kg/day IV div Q6 OR ~~Vancomycin~~ if Staph suspected.		Cefotaxime 150 mg/kg/day div Q8 OR [[ceftriaxone]] 50 mg/kg/day Q24. ADD Clindamycin 40 mg/kg/day IV div Q6 OR [[vancomycin]] if Staph suspected.

	\|-		\|-
	\| rowspan="2" \| Throat: Pharyngitis		\| rowspan="2" \| Throat: [[Pharyngitis]]
	\| Viral etiology most common. Group A, C, G Strep also. Infectious mononucleosis.		\| Viral etiology most common. Group A, C, G Strep also. Infectious mononucleosis.
	\| rowspan="1" \|		\| rowspan="1" \|
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	\|-		\|-
	\| ''N. gonorrhea''		\| ''[[N. gonorrhea]]''
	\| rowspan="1" \| Consider in adolescents. Ceftriaxone 125 mg IM x1 and Azithromycin 1 gram PO x1.		\| rowspan="1" \| Consider in adolescents. [[Ceftriaxone]] 125 mg IM x1 and Azithromycin 1 gram PO x1.
	\|-		\|-
	\| Throat: Retropharyngeal abscess		\| Throat: Retropharyngeal abscess
	\| Polymicrobial: ''Streptococcal sp., anaerobes, Eikenella''		\| Polymicrobial: ''Streptococcal sp., anaerobes, Eikenella''
	\| Airway films in extension show increased prevertebral space. Consider CT to r/o abscess. Possible airway compromise or mediastinitis. Ampicillin-Sulbactam (Unasyn) 300 mg/kg/day IV div Q6 OR [Cefotaxime 150 mg/kg/day div Q8 OR ~~Ceftriaxone~~ 50 mg/kg/day Q24] AND Clindamycin 40 mg/kg/day IV div Q6.		\| Airway films in extension show increased prevertebral space. Consider CT to r/o abscess. Possible airway compromise or mediastinitis. Ampicillin-Sulbactam (Unasyn) 300 mg/kg/day IV div Q6 OR (Cefotaxime 150 mg/kg/day div Q8 OR [[ceftriaxone]] 50 mg/kg/day Q24) AND Clindamycin 40 mg/kg/day IV div Q6.
	\|}		\|}

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	<br>		<br>



	== Respiratory Tract Infections ==		== Respiratory Tract Infections ==

← Older revision		Revision as of 14:55, 18 November 2014
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	*[[Antibiotics (Main)]]		*[[Antibiotics (Main)]]
	*[[Pediatric Fever]]		*[[Pediatric Fever]]
			*[[Antimicrobial Dosing (Peds)]]

	== A Note On [[Ceftriaxone]]==		== A Note On [[Ceftriaxone]]==