By John S. Bradley MD, John D. Nelson MD Emeritus
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Extra resources for 2010-2011 Nelson's Pocket Book of Pediatric Antimicrobial Therapy
Consider adding amox/clav or clindamycin for severe disease with oral flora superinfection. indd 43 Larger dosages may lead to tissue invasion by Aspergillus. 5 mg/kg every other day aspergillosis – Primary, putrid (ie, foul- Clindamycin 40 mg/kg/day IV div q8h OR meropenem Alternatives: imipenem IV, or pip/tazo IV, or ticar/ smelling; polymicrobial 60 mg/kg/day IV div q8h x 10 d or longer (AIII) clav IV (BIII) infection with oral aerobes and anaerobes)101 Abscess, lung – Primary (severe, necrotizing Empiric therapy with ceftriaxone 50–75 mg/kg/day For severe CA-MRSA infections, see Chapter 4.
AIII) 21 d. CT scan to confirm cure. 5 mg/kg/day IM, IV, or amikacin 15–20 mg/kg/ alternatives (no clinical data). Very poor outcomes. day IM, IV div q8h x 10–14 d (AIII) Ceftriaxone 50 mg/kg q24h IV, IM (AIII) Treatment course x 10–14 d – Staphylococcal Vancomycin 40 mg/kg/day IV div q8h pending susceptibility testing; oxacillin 150 mg/kg/day IV div q6h if susceptible (AIII) – Empiric therapy following Vancomycin 40 mg/kg/day IV div q8h AND ceftazidime open globe injury 150 mg/kg/day IV div q8h (AIII) Endophthalmitis56,57 NOTE: Subconjunctival/subtenon antibiotics usually needed; steroids commonly used; Refer to ophthalmologist; vitrectomy may be necessary for requires anterior chamber or vitreous tap for microbiological diagnosis advanced endophthalmitis Dacryocystitis No antibiotic usually needed; oral therapy for more Warm compresses; may require surgical probing of symptomatic infection, based on Gram stain and nasolacrimal duct culture of pus; topical therapy as for conjunctivitis may be helpful Conjunctivitis, herpetic54,55 Trifluridine 1% ophth soln OR acyclovir 3% ophth Refer to ophthalmologist.
Indd 42 Pharyngitis Amoxicillin 50–75 mg/kg/day PO, either once daily, bid Amoxicillin displays better gastrointestinal absorption (group A streptococcus) or tid x 10 d OR penicillin V 50–75 mg/kg/day PO div than oral phenoxymethyl penicillin; the suspension is 7,91–93 tonsillopharyngitis bid or tid, OR benzathine penicillin 600,000 units IM better tolerated. 2 million units IM if >27 kg, as a by the increased spectrum of activity that is not needed. single dose (AII) Once daily amoxicillin dosage: for children >3 years of For penicillin-allergic children: erythromycin (estolate at age and <40 kg: 750 mg once daily; for those >40 kg, 20–40 mg/kg/day PO div bid to qid; or ethylsuccinate 1,000 mg once daily.
2010-2011 Nelson's Pocket Book of Pediatric Antimicrobial Therapy by John S. Bradley MD, John D. Nelson MD Emeritus