Professional Documents
Culture Documents
In: Paediatrics
This guideline has been approved by the Trust's Clinical Guidelines Assessment Panel as an aid to the diagnosis and
management of relevant patients and clinical circumstances. Not every patient or situation fits neatly into a standard guideline
scenario and the guideline must be interpreted and applied in practice in the light of prevailing clinical circumstances, the
diagnostic and treatment options available and the professional judgement, knowledge and expertise of relevant clinicians. It is
advised that the rationale for any departure from relevant guidance should be documented in the patient's case notes.
The Trust's guidelines are made publicly available as part of the collective endeavour to continuously improve the quality of
healthcare through sharing medical experience and knowledge. The Trust accepts no responsibility for any misunderstanding
or misapplication of this document.
Author/s: Dr Caroline Kavanagh, Caroline Hallam, Dr Nandu Thalange, Dr Catherine Tremlett, Dr Bron Hennebry Date of issue: March 2015
Valid until: March 2018 Guideline Ref No (CA5084) v 2.1
Document: Trust Antibiotic Policy for the Management of Common Infections in Paediatrics
Copy of complete document available from: Trust Intranet Page 1 of 16
Trust Antibiotic Policy for the Empirical Management of Common Infections in
Paediatrics
Page
Contents
Introduction 3
ENT Infections 9
Endocarditis 13
Eye Infections 15
Author/s: Dr Caroline Kavanagh, Caroline Hallam, Dr Nandu Thalange, Dr Catherine Tremlett, Dr Bron Hennebry Date of issue: March 2015
Valid until: March 2018 Guideline Ref No (CA5084) v 2.1
Document: Trust Antibiotic Policy for the Management of Common Infections in Paediatrics
Copy of complete document available from: Trust Intranet Page 2 of 16
Trust Antibiotic Policy for the Empirical Management of Common Infections in
Paediatrics
Introduction:
The objective of this guideline is to ensure the appropriate selection of antimicrobials for the
empirical treatment of common infections in children (age 1 month to 16 years).
History of recent infections and organisms isolated should be considered when deciding
which antibiotic to use.
Only use antibiotics when infection has been recognised or when there is a high degree of
suspicion of infection.
Remember to take appropriate diagnostic samples before starting antibiotics whenever
possible
The indication for prescribing should be written below the antibiotic on the DRUG
CHART for all prescriptions.
Keep all courses of antibiotics as short as possible. Five days treatment is sufficient for many
infections.
Specify a stop date for the antibiotic if possible, if not specify a review date.
Change from the IV to oral route as soon as is possible (see IV to oral conversion guidelines
CA 1091)
Review antibiotics on a DAILY BASIS
Notifiable infections/diseases are indicated with a red flag
Some Drugs for uncommon indications may not be approved for use in the hospital.
Named patient approval must be sought from the Chair of the Drug, Therapeutics &
Medicines Management (DTMM) Committee.
Dose: Consult the BNF for children for the correct dose.
Author/s: Dr Caroline Kavanagh, Caroline Hallam, Dr Nandu Thalange, Dr Catherine Tremlett, Dr Bron Hennebry Date of issue: March 2015
Valid until: March 2018 Guideline Ref No (CA5084) v 2.1
Document: Trust Antibiotic Policy for the Management of Common Infections in Paediatrics
Copy of complete document available from: Trust Intranet Page 3 of 16
Trust Antibiotic Policy for the Empirical Management of Common Infections in
Paediatrics
Vancomycin For information on vancomycin prescribing and monitoring consult the BNF
for Children.
Author/s: Dr Caroline Kavanagh, Caroline Hallam, Dr Nandu Thalange, Dr Catherine Tremlett, Dr Bron Hennebry Date of issue: March 2015
Valid until: March 2018 Guideline Ref No (CA5084) v 2.1
Document: Trust Antibiotic Policy for the Management of Common Infections in Paediatrics
Copy of complete document available from: Trust Intranet Page 4 of 16
Trust Antibiotic Policy for the Empirical Management of Common Infections in Paediatrics
Genito-Urinary Infection
Common Penicillin Allergy
Infection First Line Notes
Organisms (Also See guidance notes)
Co-Amoxiclav PO Cefradine capsules/Cefalexin elixir PO
OR OR See also NICE Clinical Guideline 54.
Cefradine capsules/Cefalexin elixir PO Nitrofurantoin PO
Uncomplicated UTI Gram negative Bacilli
3 days 3 days oral therapy recommended.
PO Review if still unwell at 24-48 hours.
If history of penicillin anaphylaxis
3 days Nitrofurantoin PO 3 days
Co-Amoxiclav PO/IV Cefotaxime IV Gentamicin IV Consider switching to oral antibiotics at 48-96
OR If history of penicillin anaphylaxis hours if not commenced on oral therapy.
Gram negative Bacilli Cefotaxime IV Gentamicin IV NICE defines Atypical UTI as:
Ciprofloxacin IV/PO
Seriously ill
7-10 days 7-10 days Poor urine flow
Atypical UTI including
Abdominal or bladder mass
Pyelonephritis Ciprofloxacin PO (IV if not absorbing) Cefotaxime IV Gentamicin IV
Raised creatinine
OR If history of penicillin anaphylaxis Septicaemia
Pseudomonas Ceftazidime IV Gentamicin IV Ciprofloxacin IV/PO Failure to respond to treatment with
7-10 days 7-10 days suitable antibiotics within 48 hours
Infection with non-E. coli organisms
Nitrofurantoin PO
Nitrofurantoin PO UTI prophylaxis not recommended. If used,
OR
OR be guided by culture sensitivities.
Trimethoprim PO
UTI prophylaxis Gram negative Bacilli Cefalexin elixir PO
OR
OR High rates of resistance to amoxicillin and
Cefalexin elixir PO (if no history of trimethoprim locally.
Trimethoprim PO
penicillin anaphylaxis)
Doxycycline (>12y) Doxycycline (>12y)
OR OR
Syphilis Treponema pallidum Erythromycin Erythromycin Consider Safeguarding issues.
Early infection 14 days Early infection 14 days
Late/latent infection 28 days Late/latent infection 28 days
Ceftriaxone IV/IM <12y
Ceftriaxone IV/IM <12y OR
OR Ciprofloxacin PO
Gonorrhoea Neisseria gonorrhoeae Ciprofloxacin PO Consider Safeguarding issues.
If history of penicillin anaphylaxis
Single dose Ciprofloxacin PO
Single dose
Chlamydia trachomatis
Chlamydia/ Erythromycin PO <12y for 12 days Erythromycin PO <12y for 12 days
Non-Gonococcal Ureaplasma urealyticum, OR OR Consider Safeguarding issues.
Haemophilus vaginalis, Doxycycline PO >12y for 7 days Doxycycline PO >12y for 7 days
Urethritis Mycoplasma genitalium
Author/s: Dr Caroline Kavanagh, Caroline Hallam, Dr Nandu Thalange, Dr Catherine Tremlett, Dr Bron Hennebry Date of issue: March 2015
Valid until: March 2018 Guideline Ref No (CA5084) v 2.1
Document: Trust Antibiotic Policy for the Management of Common Infections in Paediatrics
Copy of complete document available from: Trust Intranet Page 5 of 16
Trust Antibiotic Policy for the Empirical Management of Common Infections in Paediatrics
Author/s: Dr Caroline Kavanagh, Caroline Hallam, Dr Nandu Thalange, Dr Catherine Tremlett, Dr Bron Hennebry Date of issue: March 2015
Valid until: March 2018 Guideline Ref No (CA5084) v 2.1
Document: Trust Antibiotic Policy for the Management of Common Infections in Paediatrics
Copy of complete document available from: Trust Intranet Page 6 of 16
Trust Antibiotic Policy for the Empirical Management of Common Infections in Paediatrics
Respiratory Tract Infections (In known or suspected immunodeficiency, obtain expert advice)
Common Penicillin Allergy
Infection First Line Notes
Organisms (Also See guidance notes)
Author/s: Dr Caroline Kavanagh, Caroline Hallam, Dr Nandu Thalange, Dr Catherine Tremlett, Dr Bron Hennebry Date of issue: March 2015
Valid until: March 2018 Guideline Ref No (CA5084) v 2.1
Document: Trust Antibiotic Policy for the Management of Common Infections in Paediatrics
Copy of complete document available from: Trust Intranet Page 7 of 16
Trust Antibiotic Policy for the Empirical Management of Common Infections in Paediatrics
Author/s: Dr Caroline Kavanagh, Caroline Hallam, Dr Nandu Thalange, Dr Catherine Tremlett, Dr Bron Hennebry Date of issue: March 2015
Valid until: March 2018 Guideline Ref No (CA5084) v 2.1
Document: Trust Antibiotic Policy for the Management of Common Infections in Paediatrics
Copy of complete document available from: Trust Intranet Page 8 of 16
Trust Antibiotic Policy for the Empirical Management of Common Infections in Paediatrics
ENT Infections
Common Penicillin Allergy
Infection First Line Notes
Organisms (Also See guidance notes)
Bacteroides spp
Peptostreptococcus spp Ceftriaxone IV + Involve anaesthetic and ENT teams
Fusobacterium spp Metronidazole IV promptly if clinical suspicion of
alpha- and gamma- Ceftriaxone IV +
Metronidazole IV retropharyngeal abscess.
Retropharyngeal abscess haemolytic streptococci, If history of penicillin anaphylaxis
Staphylococcus aureus
Haemophilus spp
5-7 days Meropenem IV invasive Group A streptococcal
5-7 days disease is a Notifiable Disease.
Group A Streptococci
Most uncomplicated cases resolve without
Pharyngitis/ Tonsillitis Amoxicillin PO antibiotics, which should NOT routinely be
Scarlet Fever is a Group A Streptococcus OR
Cefradine capsules/Cefalexin elixir PO PO
Clarithromycin PO
10 days
used.
Notifiable disease 10 days DO NOT USE amoxicillin in suspected
glandular fever due to risk of rash.
Amoxicillin PO
Streptococcus pneumoniae Most uncomplicated cases resolve without
Switch to
Haemophilus influenzae Clarithromycin PO
Acute otitis media Moraxella catarrhalis Co-Amoxiclav PO where no clinical 5 days
antibiotics, which should NOT routinely be
Group A Streptococcus response after 48 hours used.
5 days
Clarithromycin PO
(IV if oral route not tolerated)
Streptococcus pneumoniae OR
Haemophilus influenzae Co-Amoxiclav PO/IV Clindamycin PO if anaerobic cover
Sinusitis Moraxella catarrhalis required (IV if oral route not tolerated)
Gram negative bacilli 7-10 days
OR
Anaerobes Cefuroxime IV + Metronidazole PO (if no
history of penicillin anaphylaxis)
7-10 days
Author/s: Dr Caroline Kavanagh, Caroline Hallam, Dr Nandu Thalange, Dr Catherine Tremlett, Dr Bron Hennebry Date of issue: March 2015
Valid until: March 2018 Guideline Ref No (CA5084) v 2.1
Document: Trust Antibiotic Policy for the Management of Common Infections in Paediatrics
Copy of complete document available from: Trust Intranet Page 9 of 16
Trust Antibiotic Policy for the Empirical Management of Common Infections in Paediatrics
Author/s: Dr Caroline Kavanagh, Caroline Hallam, Dr Nandu Thalange, Dr Catherine Tremlett, Dr Bron Hennebry Date of issue: March 2015
Valid until: March 2018 Guideline Ref No (CA5084) v 2.1
Document: Trust Antibiotic Policy for the Management of Common Infections in Paediatrics
Copy of complete document available from: Trust Intranet Page 10 of 16
Trust Antibiotic Policy for the Empirical Management of Common Infections in Paediatrics
Gastrointestinal/Abdominal Infections
Common Penicillin Allergy
Infection First Line Notes
Organisms (Also See guidance notes)
Discuss all cases with infection control/
microbiology.
Pseudomembranous/ Metronidazole PO Metronidazole PO rd
OR OR Use Vancomycin only if 3 or subsequent
Antibiotic Associated Clostridium difficile episode of infection, for severe infection,
Vancomycin PO Vancomycin PO
Colitis 7-10 days 7-10 days for infection not responding to
Metronidazole, or in children intolerant of
Metronidazole.
E. Coli 0157 infection Escherichia coli Antibiotics not recommended Antibiotics not recommended Haemolytic Uraemic Syndrome is a
Notifiable Disease
Usually settles without treatment.
Erythromycin PO Erythromycin PO Treat severe infection. Prolonged course
Campylobacter enteritis of antibiotics may be required.
Campylobacter Spp OR OR
Ciprofloxacin PO Ciprofloxacin PO Infectious Bloody Diarrhoea is a
Notifiable Disease
Ciprofloxacin PO/IV
OR Approval from DTMM Chair (or deputy)
Ciprofloxacin PO
Invasive Samonellosis/ Azithromycin required for this indication.
OR
Salmonella spp OR
Typhoid fever Azithromycin PO
Cefotaxime IV (if no history of penicillin Enteric fever and Infectious Bloody
Discuss duration with microbiology anaphylaxis) Diarrhoea are Notifiable Diseases
Discuss duration with microbiology
Ciprofloxacin PO Ciprofloxacin PO Treat severe infection.
Dysentery Shigella spp OR OR Infectious Bloody Diarrhoea is a
Cefotaxime IV Cefotaxime IV Notifiable Disease
Amoebiasis Increase duration of therapy if extra-
Metronidazole PO Metronidazole PO
Infectious bloody Entamoeba histolytica
5 days 5 days
intestinal infection present (e.g. liver
diarrhoea is notifiable abscess).
Metronidazole PO Metronidazole PO
Giardiasis Giardia lamblia
5 days 5 days
Amoxicillin PO + Metronidazole PO +
Clarithromycin OR Metronidazole+ Clarithromycin+
Helicobacter Helicobacter pylori Proton Pump inhibitor (e.g. Omeprazole) Proton Pump Inhibitor (e.g. Omeprazole) High rates of resistance to Clarithromycin.
10-14 days 10-14 days
Author/s: Dr Caroline Kavanagh, Caroline Hallam, Dr Nandu Thalange, Dr Catherine Tremlett, Dr Bron Hennebry Date of issue: March 2015
Valid until: March 2018 Guideline Ref No (CA5084) v 2.1
Document: Trust Antibiotic Policy for the Management of Common Infections in Paediatrics
Copy of complete document available from: Trust Intranet Page 11 of 16
Trust Antibiotic Policy for the Empirical Management of Common Infections in Paediatrics
Author/s: Dr Caroline Kavanagh, Caroline Hallam, Dr Nandu Thalange, Dr Catherine Tremlett, Dr Bron Hennebry Date of issue: March 2015
Valid until: March 2018 Guideline Ref No (CA5084) v 2.1
Document: Trust Antibiotic Policy for the Management of Common Infections in Paediatrics
Copy of complete document available from: Trust Intranet Page 13 of 16
Trust Antibiotic Policy for the Empirical Management of Common Infections in Paediatrics
Author/s: Dr Caroline Kavanagh, Caroline Hallam, Dr Nandu Thalange, Dr Catherine Tremlett, Dr Bron Hennebry Date of issue: March 2015
Valid until: March 2018 Guideline Ref No (CA5084) v 2.1
Document: Trust Antibiotic Policy for the Management of Common Infections in Paediatrics
Copy of complete document available from: Trust Intranet Page 14 of 16
Trust Antibiotic Policy for the Empirical Management of Common Infections in Paediatrics
Eye Infections
Common Penicillin Allergy
Infection First Line Notes
Organisms (Also See guidance notes)
Ofloxacin 0.3% eye drops 2 hourly + Ofloxacin 0.3% eye drops 2 hourly + Ophthalmia Neonatorum is a
Neisseria gonorrhoea: Neisseria gonorrhoea: Notifiable Disease
Cefotaxime IV Cefotaxime IV Treatment depends on results of gram
Opthalmia neonatorum Neisseria gonorrhoeae
Chlamydia: Chlamydia: stain: If N. gonorrhoea suspected treat
Chlamydia
Herpes Erythromycin PO 14 days Erythromycin PO 14 days promptly before results of gram stain are
back. Otherwise treat empirically as
Herpes Simplex: Herpes Simplex: Chlamydia.
Aciclovir IV and acyclovir eye ointment Aciclovir IV tds and acyclovir eye Specific swabs are available for
5 x day for 5 days ointment 5 x day for 5 days Chlamydia and viral culture.
Staphylococcus aureus, Chloramphenicol eye drops 0.5% 2 Chloramphenicol eye drops 0.5% 2
Haemophilus influenzae, hourly OR hourly OR
Acute Purulent Streptococcus pneumoniae Fucithalmic eye drops 1% bd Fucithalmic eye drops 1% bd
Conjunctivitis Ofloxacin 0.3% eye drops OR Ofloxacin 0.3% eye drops OR
Pseudomonas aeruginosa
Levofloxacin 0.5% eye drops Levofloxacin 0.5% eye drops
Author/s: Dr Caroline Kavanagh, Caroline Hallam, Dr Nandu Thalange, Dr Catherine Tremlett, Dr Bron Hennebry Date of issue: March 2015
Valid until: March 2018 Guideline Ref No (CA5084) v 2.1
Document: Trust Antibiotic Policy for the Management of Common Infections in Paediatrics
Copy of complete document available from: Trust Intranet Page 15 of 16
Trust Antibiotic Policy for the Empirical Management of Common Infections in Paediatrics
Author/s: Dr Caroline Kavanagh, Caroline Hallam, Dr Nandu Thalange, Dr Catherine Tremlett, Dr Bron Hennebry Date of issue: March 2015
Valid until: March 2018 Guideline Ref No (CA5084) v 2.1
Document: Trust Antibiotic Policy for the Management of Common Infections in Paediatrics
Copy of complete document available from: Trust Intranet Page 16 of 16