Drug of choice 
 
 
URTI
 
 
Acute follicular tonsilitis
•                     < 3 Years old ( viruses - H. influ) Augmentn - Zinnat x Sdays
•                     >3 Years old ( Group A strept) Zithromax - Klacid - Velosef x Sdays
•                     IV penicillin G
 
Acute otitis media ( pneumococci, H influ.. Moraxella )
•                     Augmentin - Zinnat
 
Acute Epiglottitis^ H influ. )
•                     Ceftriaxome / cefotaxime x 10 days
 
Bacterial Trachietis (Staph, auerus)
•                     Flucloxacillin iv
 
 
 
 
Pneumonia
 
 
Neonatal pneumonia (GBS.Ecoli, listeria) 
 Ampicillin + Amikacin
 
lmo - 1 year (Pneumococci. H influ. staph.)
Seriously ill     IV Zinnat + Ooxacilhn
Not Seriously ill           Zinnat IV/PO 
 
lyear - 5vears (pneumococci. occousionllv H influ. .mycoplasma).
Seriously ill    Zinnat IV 
Not Seriously ill          Augmentin or Erythromycin
 
Age > 5 years ( Pneumococci. mycoplasma ) 
Seriously ill   IV penicillin< Ampiciiun) if no response within 48 hrs change to Erythromycin
Not Seriously ill  Erythromycin / Augmentin
 
 
 
Skin and soft tissue infections
 
 
Erysipelas (spreading cellulitis ): strep G A, staph, H. influ
•        IV Zinnat
 
Facial cellulitis :H. influ <2 years
•        IV Zinnat
 
Orbital and periorbital cellulitis: (H influ, pneumcocd, staph, streptGA).
•                       Ceftriaxone /cefotaxime (if no wound)
•                       above +flucloxacelhn (if any wound)
 
Bullous Impetigo in neonates
•                       IV flucloxacelUn
 
Impetigo contagiosa (staph, streptGA)
•         fucidin oint. x 7 day
 
 
 
Bones and Joints infections
 
Neonates( staph aureus, GBS)
•         flucloxacilllin + Amoxicillin .
lmo - 5years (staph. H influ)
•                     flucloxacillin +Cefotaxime / Zinnat
>5 yrs (staph, GA streptGA)
•                     Flucloxacillin +Ampicillin
 
Patient with sickle cell anemia (staph. salmonella)
•                     Flucloxacillin +Ceftriaxone /cefotaxime
 
Osteomylitis dt puncture wound (staph - pseudomonas )
•                     Flucloxacillin + fortum/pipracillin.
 
Nosocomial infection (MRSA)
•                     Vancomycin +cefotaxime
 
Duration of therapy for uncomplicated cases are 6 wks
 
 
 
Septic arthritis
 
•Neonates (staph aureus. GBS)
•lmo - 5yrs (H. influ. staph aureus)
•>5vrs (staph aureus - pneumococci. strept GA
•Emperical therapy for all ages: Flucloxacillin + 3rd generation cephalosporins
Duration for uncomplicated staph is 6 wks-other organisms are 3 wks Surgical consultation is mandatory
 
 
UTI
 
Organisms : Ecoli (75%). klebsiella , proteus.
 
Acutely ill children &neonates:
•                     Send for blood & urine c/s
•                     Ampicillin /cefotaxime + Amikacin x 10 -15 days.
 
Not ill children:
•                     Send for urine c/s
•                     Septrin/Augmentin /oral Cephalosporins x 7 days
 
prophylactic therapy:
septrin 12 mg /kg /day (OD) for
•                     Children <3 yrs till investigation is completed
•                     Recurrent UTI till 6 mo is reached.
•                     VUR till improvement or up to 7 yrs.
 
 
 
Septicemia
 
 
Neonates (GBS, Ecoli. listeria)
•                     Ampicillin + Amikacin (sepsis )
•                     Ampicillin + cefotaxime (sepsis with meningitis)
Infant & children (pneumococci, H influ, miningoccoci)
•                     Ampicillin + cefotaxime .
Nosocomial sepsis (MRSA)
•         Vancomycin + cefotaxime
 
Typhoid fever
 
Ceftriaxone 100 mg /kg /day ( bid )or ( cefoperzone) forlO -14 days
Ciprofloxacin 10 mg /kg/day( bid )Iv for 10-14 days ??
Ciprofloxacin 15 mg /kg/day (bid )PO for 10-14 days??
 

 

TB

Initially start with : INH +RIF+PZA +STP ( OD)

•                     STP x 3wks (20 -40 mg /kg /dayX max. 1 gm)

•                     PZA x 2 mo (20 -40 mg /kg/day) (max. 2gm)

•         INH(5mg /kg/day)+RIF(l0mg/kg/day)x6mo(double the dose In meningitis)
In cases of milliary TB,TB meningitis ,TB bones& joints continue for 9-12mo

 

 
ACUTE GASTROENRERITIS

Indication for antibiotics:

Toxic, ill, highly febrile child (signs of systemic invasion )

Less than 3mo.

Immunodefecient child  

Bloody diarhea _ high fever (shigellosis)

Leukocytosis, +ve blood/stool

c/s

Ampicillin /Rocephin  ±} flagyl

Salmonella _ Systemic invasion ---- Ceftriaxone/cefoperazone/cefotaxime

Shigella ±} systemic invasion------ Ceftriaxone/cefoperazone/cefotaxime

E coli  ------------------------------------ septrin

Amebiasis-------------------------------  Furazol (>2yrs)

Giardiasis -----------------------------Flagyl

Campylobacter-----------------------Erythromycin

 

 

 

CNS  INFECTION

Neonates (GBS,Ecoli,Listeria):ceftriaxone/claforan+ampicillin x3wks

1mo.-5yrs(H influ./pnemococci): ceftiraxone/claforan+ampicillin x2wks

5yrs-10yrs(pnemococci / H influ ): ceftiraxone/claforan+ampicillin/vancomycin x2wks

10yrs-12yrs (Meningococci/pneumococci):PenicillinG+Chloramphenicol x 10days

Meningoencephalitis (viruses):Acyclovir+Antibiotics of bacterial meningitis until diagnosis is confirmed

 

Dr.Kamel Hassan

Best Regards

 

 

 
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