Drug of choice 
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
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
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.
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??



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



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


Ampicillin /Rocephin  ±} flagyl

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

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

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

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

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






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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