GUIDELINES FOR TREATMENT OF INFECTIONS IN CHILDREN

A. RESPIRATORY TRACT INFECTIONS

UPPER RESPIRATORY TRACT INFECTIONS

Infection/Condition/likely

organism

Suggested treatment Comment

Preferred Alternative

Acute tonsillo-pharyngitis

Group A β hemolytic

streptococci

Amoxicillin:

Child<30Kg-

20mg/kg/dose

BIDx10days

Child>30Kg- 250mg

TIDx10days

Inj Crystalline

Penicillin

50,000U/Kg i.v. 4-

6hrly (if child cannot

swallow)

Oral Penicillin

V

<27 kg:

250mg tid

; ≥27 kg: 1

500mg tid x

10days

Erythromycin

10mg/Kg/dose

PO 3-4 times

x10 days

Azithromycin

12mg/Kg

ODx5days

(IAP Drug

Formulary Pg97)

Cephalexin:

20mg/kg/dose

BID

OR

Cepadroxyl:

15mg/kg/dose

BID

Acute otitis media

Streptococcus pneumoniae

Haemophilus influenza

Moraxella catarrhalis

Amoxicillin:

40mg/Kg/dose BID x

10days

Amoxicillin-

clavulanate

(40

mg/kg/dose of

amoxicillin,

with 6.4 mg/kg

per day of

clavulanate

[amoxicillin to

clavulanate

ratio, 14:1] in

2

divided doses)

Cefuroxime

(15

mg/kg/dose

12hrly)

10 day therapy is

recommended for

younger children

and children with

severe disease

For children >6yrs

with mild to

moderate disease

5-7days therapy

recommended.

If no response-

Ceftriaxone

50mg/Kg OD x

3days

Acute sinusitis

Streptococcus pneumoniae

Haemophilus influenzae

Moraxella catarrhalis

Amoxicillin- 80-

20mg/Kg/dose BID x

10-14days

Amoxicillin-

clavulanate

(40

mg/kg/dose of

amoxicillin,

with 6.4 mg/kg

per day of

clavulanate

* If S.pneumoniae

prevalence

>10%,start high

dose Amoxicillin

40mg/Kg/dose

12rly

[amoxicillin to

clavulanate

ratio, 14:1] in

2

divided doses)

Cefuroxime

(15

mg/kg/dose

12hrly x 10-

14days

LOWER RESPIRATORY TRACT INFECTIONS

Community acquired

pneumonia (Outpatient)

<5 years old (preschool)

>5 years old

Amoxicillin (40

mg/kg/dose PO

12hrly)

Amoxicillin (40

mg/kg/dose PO

12hrly (maximum

of 4 g/day)

Oral

Amox +

Clauv- (Amox

component

40mg/Kg/dose

12hrly

Oral

Amoxicillin +

Clavulanate

(amoxicillin

component, 40

mg/kg/dose

12rly to

maximum

dose of 4000

mg/day,

eg, one 2000-

mg tablet

twice daily

For children

with presumed

bacterial

CAP who do not

have clinical,

laboratory, or

radiographic

evidence that

distinguishes

bacterial CAP

from

atypical CAP, a

macrolide

can be added to a

b-lactam

antibiotic for

empiric therapy

Community acquired

pneumonia (Inpatient)

Fully immunized with

conjugate vaccines for

Haemophilus influenzae

type b and Streptococcus

Ampicillin

50mg/Kg/dose IV 6th

hourly

Ceftriaxone

50mg/kg/dose

12hrly*

Or

*Add

Vancomycin

15mg/Kg/dose

6hrly or

Clindamycin

10mg/Kg/dose

6hrly for

pneumoniae; local

penicillin resistance in

invasive strains of

pneumococcus is minimal

Not fully immunized for

H. Influenzae type B and

S. pneumoniae; local

penicillin resistance in

invasive strains of

pneumococcus is

significant

Ampicillin

50mg/Kg/dose IV

6hrly

Amox-

40mg/Kg/dose 12hrly

OR

Cefuroxime

50mg/Kg/dose

8th hourly

Ceftriaxone

50mg/kg/dose

12hrly*

Or

Cefuroxime

50mg/Kg/dose

8th hourly

suspected CA-

MRSA

Atypical pneumonia Azithromycin oral

(10 mg/kg on

day 1, followed by 5

mg/kg/day

once daily on days 2–

5)

Oral

Clarithromycin

(7.5

mg/kg/dose

12hrly

for 7-14 days)

or oral

Erythromycin

(10

mg/kg/dose

QID)

Bronchiolitis

RSV,Parainfluenza virus,

adenovirus

None* *If infiltrates are

present on chest

Xray treat as

pneumonia

B. CARDIOVASCULAR INFECTIONS

Infection/Condition/likely

organism

Suggested treatment Comment

Preferred Alternative

Infective endocarditis

empirical/due to

Penicillin-

Susceptible

Streptococcus

viridans

Inj. Crystalline

penicillin 50,000

U/Kg/dose i.v every

4-6hrly (Max

18million Units/day)

x 4weeks

Plus

Inj. Gentamicin 3

mg/kg 24hrly x

2weeks

Inj.

Ceftriaxone

100

mg/kg/dose

24hrly (Max

2gm)

Plus

Inj.

Gentamicin 3

mg/kg 24hrly

Treatment

duration is 4weeks

when Ceftriaxone

or Crystalline

Penicillin is used

alone and 2weeks

when combined

with Gentamicin.

2week regimen

not indicated in

Cardiac and Extra

OR

Vancomycin

15mg/kg/dose

8hrly x

4weeks

cardiac abscess.

Vancomycin

regimen

recommended

only for patients

unable to tolerate

Ceftriaxone or

Cryatalline

Penicillin

Infective endocarditis due

to Enterococcus sp.

S. viridans

resistant to penicillin

Inj Crystalline

Penicillin 50,000

U/Kg/dose 4hrly OR

as continuous

infusion

Plus

Inj Gentamicin

3mg/Kg 24hrly x

6weeks

Inj.

Vancomycin

15 mg/kg/dose

8hrly

Vancomycin

regimen

recommended

only for patients

unable to tolerate

Crystalline

Penicillin or

Ceftriaxone

Culture negative

Inj Ceftriaxone

100mg/Kg dose (Max

2gm) 24hrly

Plus

Inj Gentamicin

3mg/Kg/dose 24hrly

Treatment

duration is 6

weeks for

endocarditis of

prosthetic valves

Infective

endocarditis

MSSA

MRSA

Inj. Cloxacillin 50

mg/kg/dose 6hrly

with optimal addition

of Inj Gentamicin

3mg/kg 24hrly x 3-

5days

Inj. Vancomycin

15mg/kg/dose 8hrly

Inj Cefazolin

35mg/Kg/dose

8hrly x

6weeks with

optimal

addition of

Inj

Gentamicin

3mg/Kg

24hrly x 3-

5days

Treatment

duration is 6

weeks

C.GASTROINTESTINAL INFECTIONS

Infection/Conditi

on/likely

organism

Suggested treatment Comment

Preferred Alternative

Acute

gastroenteritis

(Usually viral eg.

Rotavirus)

Antibiotics not

recommended

Zinc- 20 mg/day

in children > 6

Ciprofloxacin15mg/kg/dose

Oral

rehydration is

the

cornerstone of

treatment

Non typhoidal

Salmonella

months; 10mg <6

months; for 14

days

No antibiotic

required except

in severely

malnourished

child, neonate or

if sepsis

suspected

Ceftriaxone

50mg/Kg 24hrly

IV

12hrly x 5days (not required)

Oral

rehydration

and zinc are

the

cornerstones

of treatment;

continue

breast feeds

and normal

diet

Bacillary

dysentery

( Shigella spp)

Most mild

infections

resolved

spontaneously

without

antibiotics

Children

<2years-

Trimethoprim/Su

lphamethoxazole

(TMP:

4mg/kg/dose BID

x 5-7 days

OR

Tab Cefixime 4 mg/kg/dose 12hrly x 7days

If sick:

Ceftriaxone 50

mg/kg/24h

for 5days

Inj Cefotaxime 30mg/Kg/dose

8hrly x 5days

Inj Ciprofloxacin

15mg/Kg/dose 12hrly x 3days

(WHO recommendation)

Continue

feeding and

add zinc

Supplementati

on

Zinc-

<6months:

10mg

>6months:

20mg x

14days

Cholera Ciprofloxacin

single dose

30mg/ kg

maximum 1 g

Doxycycline

(adults and older

children):

Above 8 years, doxycycline 5

mg/kg to be preferred

Erythromycin 12.5

mg/kg/dose 4 times a day × 3

days (up to

250 mg 4 times a day × 3

days)

Prompt

rehydration

essential,

antibiotic

therapy is only

adjunct to

rehydration

300 mg given as

a single dose

or

Tetracycline 12.5

mg/kg/dose 4

times/day

× 3 days (up to

500 mg per dose

× 3days)

Azithromycin, Trimethoprim-

sulfamethoxazole and

ciprofloxacin, are also

effective

Cephalosporin

s and

aminoglycosid

es should not

be used, even

if in vitro

tests show

strains to be

sensitive.

Zinc should be

given as soon

as vomiting

stops

Giardiasis Metronidazole 5

mg/kg/dose 8hrly

x 5days

Tinidazole >3 yr:

50 mg/kg single

dose

Nitazoxanide 1-

4yr: 100 mg (5

mL) bid for 3

days

4-12yr: 200 mg

(10 mL) bid for 3

days

>12 yr: 500 mg

bid for 3 days

Metronidazole

15 mg/kg/day in

3 divided doses

for 5-7 days

Albendazole 400mg PO X

5days

Nitazoxanide 1-4yrs- 100mg

bd x 3days 4-12yrs- 200mg bd

x 3days Adol- 500mg bd x

3days

Albendazole

>6 yr: 400 mg once a day for

5 days

Furazolidone

6 mg/kg/day in 4 divided

doses for 10 days

Quinacrine

6 mg/kg/day in 3 divided doses for 5 days

Liver abscess

(amoebic)

Entamoeba

histolytica

Metronidazole

10mg/kg/dose

8hrly x 10-14

days

Amoebic

abscess tend to

be solitary

lesion.

Consider

surgical

drainage if

needed

Liver abscess

(pyogenic)

Gram-ve,

Anaerobic, S.

Ampicillin

50mg/kg/dose

6hrly

PLUS

Inj Cefotaxime 50mg/kg/dose

6hrly

PLUS

Inj Metronidazole

Initially broad

spectrum

antibiotics;

should

aureus Gentamicin

5mg/kg 24hrly

PLUS

Metronidazole

10mg/kg/dose

8hrly

Empirical initial

antibiotic

regimens include

Ampicillin/

Sulbactam or

Piperacillin/Tazo

bactam

10mg/kg/dose 8hrly then be

narrowed,

based on the

culture results

of the abscess;

IV for 2-3

weeks

followed

by oral

therapy to

complete a 4-6

week course

Surgical

drainage is

needed in

most

cases

Acute cholangitis

(Gram negative,

anaerobes, gram

positive)

Ampicillin

50mg/kg/dose

6hrly

PLUS

Gentamicin

7.5mg/Kg IV o.d

PLUS

Metronidazole

10mg/kg/dose

8hrly for 7 days

Cefotaxime 50mg/kg/dose

6hrly

PLUS

Metronidazole 10mg/kg/dose

8hrly

If Cholangitis

due to gall

stones:

consider

clearance of

obstruction by

ERCP

Peritonitis

(Primary)

Strep.

Pneumoniae,

gram-neg

organisms

Ampicillin

50mg/kg/dose

6hrly

PLUS

Gentamicin

7.5mg/Kg IV o.d

x 7days

Cefotaxime 50mg/kg/dose

8hrly

D.SEPSIS SYNDROMES

Infection/Conditi

on/likely

organism

Suggested treatment Comment

Preferred Alternative

Enteric fever Ampicillin/Amox

ycillin

50mg/kg/dose

6hrly PO x 10-

14 days

Or

[Trimethoprim/S

ulphamethoxazol

e 4/20

mg/kg/dose BID]

Cholorampenicol

25mg/Kg/dose 6-

8hrly

Oral- Tab. Cefixime

10mg/kg/dose 12hrly

(max.400mg/day) x 10-14

days

Or

Parenteral- I.V. Ceftriaxone

25-35mg/kg/dose 12hrly x 10-

14 days

Or

*Ciprofloxacin 10mg/kg/dose

PO BID

*Quinolones

need to be

used with

caution in

children due to

possible

arthropathy

and rapid

development

of

resistance.

Community

acquired sepsis

Ceftriaxone 50

mg/kg/dose

12hrly x 14 days

Cefotaxime 50mg/kg/dose IV

4-6hrly X 14days

Intravenous

catheter related

sepsis

Cloxacillin

100mg/Kg/day

IV in 4 bdivided

doses +

Gentamicin

5mg/Kg IV o.d

Gentamicin

7.5mg/Kg IV o.d

Vancomycin 30mg/kg/day IV

in 3 divided doses +

Gentamicin 5mg/kg IV o.d

Modify

therapy based

on

susceptibility

report;

consider line

removal for

persistent

positive

cultures,

fungal

infection or

gram negative

infection

E. CENTRAL NERVOUS SYSTEM INFECTIONS

Infection/Conditi

on/likely

organism

Suggested treatment Comment

Preferred Alternative

Acute bacterial

meningitis

Ceftriaxone 50

mg/kg/dose

12hrly x 7-

14days

Cefotaxime 50mg/kg/dose IV

6hrly X 7-14 days

In neonatal and resistant

bacterial meningitis other

antibiotics to be advised.

If culture

grows

Streptococcus

pneumoniae,

susceptible to

penicillin,treat

Need for Vancomycin as add

on in primary empirical drug

also to be discussed

ment may be

modified to IV

Crystalline

penicillin(2-

4lac

units/kg/day

every 4-6 hrs

for 10-14days

Herpes Simplex

encephalitis

Acyclovir:

12 weeks-12

years old:

500mg/m2 q8h

If > 12 years

olds: 10mg/kg IV

q8h

Duration: for 14-

21 days

Brain Abscess Ceftriaxone 50

mg/kg/dose

12hrly

And

Metronidazole

15mg/kg IV stat

then

7.5mg/kg IV q8h

If there is history of

Neursurgery, trauma or

sinusitis terapy should include

Ceftazidime 50mg/Kg/dose

8hrly, Vancomycin

15mg/Kg/dose 6hrly and

Metronidazole 7.5mg/Kg

8hrly

Duration of

antibiotic

would depends

on response by

neuroimaging;

4-8

weeks may be

needed)

F. SKIN AND SOFT TISSUE INFECTIONS

Infection/Conditi

on/likely

organism

Suggested treatment Comment

Preferred Alternative

Cephalexin

10mg/Kg/dose

6hrly

Amox+Clauv

25mg/Kg/dose

12hrly

Erythromycin 10mg/Kg/dose

6hrly

G. URINARY TRACT INFECTION

Cephalexin

25mg/Kg/dose

8hrly

Amox+Clav

25mg/Kg/dose

12hrly

Cefixime

5mg/Kg/dose

12hrly

Inj Cefotaxime 50mg/Kg/dose

8hrly

OR

Inj Amikacin 15mg/Kg od

<3months with

complicated

UTI- Admit

and treat

For Infants

treat for 10-

14days and

others 7-

10days

H. NEONATAL INFECTIONS

*Reference NEOFAX 2011 Thomson Reuters’ 24th Edition

NECROTISING ENTEROCOLITIS

AMPICILLIN

DOSE & ADMINISTRATION: 25 TO 50mg/kg per dose by slow push

100mg/kg/dose when treating meningitis & severe group B streptococcal sepsis

PMA (WEEKS) POSTNATAL (DAYS) INTERVAL (HOURS)

< 29 0-28

>28

12

8

30-36 0-14

>14

12

8

37-44 0-7

>7

12

8

≥ 45 ALL 6

GENTAMICIN

PMA (WEEKS) POSTNATAL

(DAYS)

DOSE (mg/kg) INTERVAL

(HOURS)

≤ 29* 0-7

8-28

≥29

5

4

4

48

36

24

30 to 34 0-7

≥8

4.5

4

36

24

≥ 35 ALL 4 24 *or significant asphyxia, PDA, or treatment with indomethacin

METRONIDAZOLE

PMA (WEEKS) POSTNATAL (DAYS) INTERVAL (HOURS)

≤29 0-28

>28

48

24

30-36 0-14

>14

24

12

37-44 0-7

>7

24

12

≥45 ALL 8

Loading dose : 15 mg/kg PO or IV infusion by syringe pump over 60 minutes

Maintenance dose: 7.5 mg/kg PO or IV infusion over 60 minutes

HERPES SIMPLEX

ACYCLOVIR

20 mg/kg per dose Q8 hrs IV infusion over 1 hr

Increase dosing interval in premature infants <34 weeks PMA or patients with significant renal

impairment/ hepatic failure

EARLY ONSET SEPSIS

BENZYL PENCILLIN

Meningitis : 75,000 to 100,000 units/kg per dose IV infusion over 30 minutes

Bacteremia : 25,000 to 50,000 units/kg per dose IV infusion over 15 minutes

PMA (WEEKS) POSTNATAL (DAYS) INTERVAL (HOURS)

≤29 0-28

>28

12

8

30-36 0-14

>14

12

8

37-44 0-7

>7

12

8

≥45 ALL 6

CEFOTAXIME

50 mg/kg per dose iv infusion by syringe pump over 30 minutes ,or IM

PMA (WEEKS) POSTNATAL (DAYS) INTERVAL (HOURS)

≤29 0-28

>28

12

8

30-36 0-14

>14

12

8

37-44 0-7

>7

12

8

≥45 ALL 6

CONGENITAL SYPHILLIS

BENZYL PENCILLIN

PMA (WEEKS) POSTNATAL (DAYS) INTERVAL (HOURS)

≤29 0-28

>28

12

8

30-36 0-14

>14

12

8

37-44 0-7

>7

12

8

≥45 ALL 6

Meningitis : 75,000 to 100,000 units/kg per dose IV infusion over 30 minutes

Bacteremia : 25,000 to 50,000 units/kg per dose IV infusion over 15 minutes

GENTAMICIN

PMA (WEEKS) POSTNATAL

(DAYS)

DOSE (mg/kg) INTERVAL

(HOURS)

≤ 29* 0-7

8-28

≥29

5

4

4

48

36

24

30 to 34 0-7

≥8

4.5

4

36

24

≥ 35 ALL 4 24 *or significant asphyxia, PDA, or treatment with indomethacin

LATE ONSET SEPSIS

CEFOTAXIME

50 mg/kg per dose iv infusion by syringe pump over 30 minutes ,or IM

PMA (WEEKS) POSTNATAL (DAYS) INTERVAL (HOURS)

≤29 0-28

>28

12

8

30-36 0-14

>14

12

8

37-44 0-7

>7

12

8

≥45 ALL 6

** REFERENCE: Neonatal Formulary : Drug Use in Pregnancy and First Year of Life 5thEdn BMJ

books.

CONGENITAL TOXOPLASMOSIS

IN INFANCY : give an oral loading dose of 1mg/kg of pyrimethamine twice a day for 2 days

followed by maintanence treatment with 1 mg/kg once a day for 8 weeks ,if there is evidence of

congenital infection.treatment with 50 mg/kg of oral sulfadiazine once every 12 hours should be

started at the same time.check weekly for possible thrombocytopenia,leucopenia and

megaloblastic anemia