By John S. Bradley MD, John D. Nelson MD Emeritus
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Extra info for 2010-2011 Nelson's Pocket Book of Pediatric Antimicrobial Therapy
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.
CIII) For CA-MRSA: clindamycin or linezolid (CIII) Watch for beta-lactam–associated neutropenia with high-dose, long-term therapy, and neutropenia/ thrombocytopenia with long-term linezolid – Acute, other organisms – Infants and children, acute Empiric therapy: clindamycin. For serious infections, In children with open fractures secondary to trauma, add infection (usually S aureus, ADD cefazolin to provide better MSSA coverage and ceftazidime for extended aerobic gram-negative activity including CA-MRSA; group add Kingella coverage (CIII) Kingella is often resistant to clindamycin A streptococcus; K kingae) For CA-MRSA: clindamycin 30 mg/kg/day IV div q8h or For MSSA (BI) and Kingella (BIII), follow-up oral therapy vancomycin 40 mg/kg/day IV q8h (BII) with cephalexin 100 mg/kg/day PO div tid For MSSA: oxacillin 150 mg/kg/day IV div q6h OR Oral therapy alternatives for CA-MRSA include cefazolin 100 mg/kg/day IV div q8h (AII) clindamycin and linezolid40 For Kingella: cefazolin, ampicillin or ceftriaxone 50 mg/kg/day IV, IM q24h (BIII) Total therapy (IV plus PO) for 4–6 wks for MSSA.
Consult the index for the alphabetized listing of diseases and Chapters 7 through 10 for the alphabetized listing of pathogens and for uncommon organisms not included in this chapter. • Abbreviations: ADH, antidiuretic hormone; AFB, acid-fast bacilli; amox/clav, amoxicillin/clavulanate; amp/sulbactam, ampicillin/ sulbactam; bid, twice daily; AOM, acute otitis media; CA-MRSA, community-associated methicillin-resistant Staphylococcus aureus; CMV, cytomegalovirus; CNS, central nervous system; CSF, cerebrospinal fluid; CT, computed tomography; div, divided; EBV, Epstein-Barr virus; ESBL, extended spectrum beta-lactamase; ESR, erythrocyte sedimentation rate; FDA, US Food and Drug Administration; HAP/VAP, hospital-acquired pneumonia/ventilator-acquired pneumonia; HIV, human immunodeficiency virus; HSV, herpes simplex virus; HUS, hemolytic uremic syndrome; I&D, incision and drainage; IM, intramuscular; inh, inhaled; IV, intravenous; IVIG, intravenous immune globulin; LP, lumbar puncture; MAC, Mycobacterium avium complex; MSSA, methicillin-susceptible S aureus; MSSE, methicillin-sensitive Staphylococcus epidermidis; MRSE, methicillin-resistant S epidermidis; ophth, ophthalmic; pen-R, penicillin-resistant; pen-S, penicillin-susceptible; pip/tazo, piperacillin/tazobactam; PO, orally; PPD, purified protein derivative; qd, once daily; qid, 4 times daily; RSV, respiratory syncytial virus; SPAG-2, small particle aerosol generator-2; STI, sexually transmitted infection; soln, solution; ticar/clav, ticarcillin/clavulanate; tid, 3 times daily; TB, tuberculosis; TMP/SMX, trimethoprim/ sulfamethoxazole; VDRL, Venereal Disease Research Laboratories; WBC, white blood cell.
2010-2011 Nelson's Pocket Book of Pediatric Antimicrobial Therapy by John S. Bradley MD, John D. Nelson MD Emeritus