By John S. Bradley MD, John D. Nelson MD Emeritus
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Additional resources for 2010-2011 Nelson's Pocket Book of Pediatric Antimicrobial Therapy
BII) PO qd Adenitis, nontuberculous Excision usually curative (BII); azithromycin PO OR Antibiotic susceptibility patterns are quite variable; (atypical) mycobacterial8–11 clarithromycin PO x 6–12 wks (with or without cultures should guide therapy; medical therapy rifampin) if susceptible (BII) 60%–70% effective. Adenitis, acute bacterial1–7 Empiric IV therapy: May need surgical drainage (S aureus, including CA-MRSA, Standard: oxacillin 150 mg/kg/day IV div q6h OR For oral therapy for MSSA: cephalexin OR cloxacillin; for or group A streptococcus) cefazolin 100 mg/kg/day IV div q8h (AI) CA-MRSA: clindamycin, TMP/SMX, or linezolid CA-MRSA: clindamycin 30 mg/kg/day For group A strep: amoxicillin IV div q8h or vancomycin 40 mg/kg/day IV q8h (BII) Total IV plus PO therapy x 7–10 d Clinical Diagnosis NOTE: CA-MRSA (see Chapter 4 on CA-MRSA) is now prevalent in many areas of the world.
38,39 See Chapter 5. indd 35 – Other bacteria See Chapter 7 for preferred antibiotics. – Gonococcal arthritis or Ceftriaxone 50 mg/kg IV, IM q24h (BII); OR (if susceptible) PO cefixime 8 mg/kg/day (CII) as a single daily dose for tenosynovitis41,42 penicillin G 100,000 U/kg/day IV div q6h (AII); x 7 d penicillin-resistant strains. Quinolone resistance is increasing. – Infants (S aureus, including Empiric therapy: clindamycin (to cover CA-MRSA). For Oral therapy options: CA-MRSA; group A serious infections, ADD cefazolin to provide better For CA-MRSA: clindamycin OR linezolid40 streptococcus; Kingella MSSA coverage and add Kingella coverage For MSSA: cephalexin OR dicloxacillin kingae; in unimmunized or For CA-MRSA: clindamycin 30 mg/kg/day IV div q8h or For Kingella, most penicillins or cephalosporins (but not immune-compromised vancomycin 40 mg/kg/day IV q8h clindamycin) children: pneumococcus, For MSSA: oxacillin 150 mg/kg/day IV div q6h OR H influenzae type b) cefazolin 100 mg/kg/day IV div q8h Total therapy (IV plus PO) for 3 wks with normal ESR; – Children (S aureus, including For Kingella: cefazolin, ampicillin, or ceftriaxone 50 mg/ low-risk, non-hip arthritis may respond to a 10-day CA-MRSA; group A kg/day IV, IM q24h course.
100,111–114 40–60 mg/kg/day div q8h for S aureus (AIII) Consider H influenzae type b For suspect Mycoplasma/atypical pneumonia agents, pneumococcus: no need to add empiric vancomycin in the unimmunized child. particularly in school-aged children, ADD azithromycin for this reason (CIII) M pneumoniae may cause 10 mg/kg IV, PO x 1, then decrease dose to 5 mg/kg Oral therapy for pneumococcus and Haemophilus may lobar pneumonia. once daily for days 2–5 of treatment (AII) also be successful with: amox/clav, cefdinir, cefpodoxime Empiric oral outpatient therapy for less severe illness: or cefuroxime high dosage amoxicillin 80–100 mg/kg/day PO div q8h Levofloxacin is an alternative (BI)115 but due to cartilage (NOTq12h); for Mycoplasma, ADD a macrolide as toxicity concerns, should not be first-line therapy.
2010-2011 Nelson's Pocket Book of Pediatric Antimicrobial Therapy by John S. Bradley MD, John D. Nelson MD Emeritus