Cefotaxime 200-300mg/kg/day IV in 4 divided doses (max. 2g/dose)

OR 

Ceftriaxone 100mg/kg/day IV in 2 divided doses 

(max. 2g/dose; 4g/day)

--

For children below 3 months of age:

Cefotaxime is the preferred third generation cephalosporin since less drug-drug interactions (in terms of interaction with calcium-containing infusion & bilirubin displacement).

Given the commonality of GBS in this age group, adding IV C Penicillin (Benzylpenicillin) to Cefotaxime while awaiting culture results can be considered.

Once organism is known, please refer below to adjust antibiotics and duration.

Benzylpenicillin 300,000-400,000 units/kg/day IV in 4-6 divided doses (max. 24 million units/day) 

--

Duration: 14 days 

Cefotaxime 200-300mg/kg/day IV in 4 divided doses (max. 2g/dose)

OR

Ceftriaxone 100mg/kg/day IV in 1 or 2 divided doses (max. 2g/dose; 4g/day)

Ampicillin 300mg/kg/day q6h (max. 12g/day)

(if MIC <1mcg/mL) 

Duration: 10 days 

Benzylpenicillin 300,000-400,000 units/kg/day; max. 12 million units/day) IV in 4-6 divided doses

OR

Ceftriaxone 100mg/kg/day IV in 2 divided doses (max. 2g/dose; 4g/day) 

--

Duration: 7 days

Prophylaxis for all household contacts & health care workers involved in unprotected contact during intubation & suctioning of airway/mouth-to-mouth resuscitation.

Benzylpenicillin 300,000-400,000 units/kg/day in 4-6 divided doses (max. 24 million units/day)

Penicillin-resistant (MIC≥0.12 mcg/ml) & cefotaxime/ ceftriaxone- sensitive (MIC ≤0.5 mcg/mL):

Cefotaxime 200-300mg/kg/day IV in 4 divided doses (max. 2g/dose)

OR

Ceftriaxone 100mg/kg/day IV in 2 divided doses (max. 2g/dose; 4g/day)

*Penicillin & cefotaxime/ceftriaxone-nonsusceptible (MIC ≥1.0 mcg/ml) (drug-resistant Streptococcus pneumoniae, DRSP):

High dose cefotaxime 300mg/kg/day IV in 4 divided doses (max. 12g/day) or ceftriaxone 100mg/kg/day IV in 1 or 2 divided doses (max. 2g/dose; 4g/day)

PLUS

Vancomycin 60mg/kg/day in 3 divided doses (max. 2g/day unless unable to achieve therapeutic level). Target AUC24 of 400-600 mg*hour/L

--

Duration: 14 days 

*Treat in consultation with ID specialist.

Induction Therapy:

Amphotericin B 1.0mg/kg/day IV q24h

MAY ADD 5-flucytosine 25mg/kg/dose (max. 2g/dose) PO q6h for 2-4 weeks

Consolidation Therapy:

Fluconazole 6-12mg/kg/dose (max. 400mg/dose) IV/PO q24h for 8 weeks

--

Duration of induction with 5-flucytosine (5-FU) is at least 2 weeks & until CSF repeat culture is NEGATIVE. 

Pediatric herpes CNS disease:  

> 4month to 12 years old

Acyclovir 30-45mg/kg/day IV in 3 divided doses

> 12 years old

Acyclovir 30mg/kg/day IV in 3 divided doses

Neonatal herpes CNS disease:

IV Acyclovir 60mg/kg/day in 3 divided doses

--

Duration: 21 days minimum.

Dosing exceeding 500mg/m2 can be associated with acute kidney injury. 

Cefotaxime 200-300mg/kg/day IV in 4 divided doses (max. 2g/dose)

OR

Ceftriaxone 100mg/kg/day IV in 2 divided doses (max. 2g/dose; 4g/day)

PLUS

Metronidazole 15mg/kg IV stat then 7.5mg/kg IV q8h (max. 4g/day)

If secondary to trauma:

PLUS

Cloxacillin 200-300mg/kg/day in 4-6 divided doses (max. 12g/day)

(Add to third generation cephalosporin)

Surgical drainage may be indicated if appropriate.

Duration: 6-8 weeks, depending on response based on neuroimaging & clinical presentations.