Empirical therapy guidance for common infections in children in the acute sector
- IV to Oral Switch Therapy (IVOST)
- Penicillin Allergy
- Gentamicin and vancomycin
This guidance should be used to determine the choice of initial empirical antibiotic therapy for paediatric patients in acute hospitals in NHS Grampian. This guidance does not cover the choice of empirical antibiotic therapy for all infections and does not replace the need for taking samples to determine the specific causative organism to further direct therapy. Specialist advice will be required for some infections.
The document should not be used to guide therapy if the organism is known and there are specific microbiological sensitivities or if there are other reasons that determine specific antimicrobial therapy, e.g. previous sensitivity testing. The document does not cover the treatment of infections in patients with some chronic disorders or apply in all cases, for example, patients who are immunosuppressed.
Doses have not been included for most infections in order to keep this policy brief and easy to read. Where a dose is recommended it applies to children with normal renal and hepatic function and may require adjustment for individual patients according to clinical judgement. Prescribers should refer to the BNF for Children http://bnfc.org/ or the manufacturers' summary of product characteristics (www.medicines.org.uk) for information on doses.
The reason for prescribing an antimicrobial must be clearly documented in the patient's medical notes together with any relevant signs and symptoms, assessment of severity, microbiology samples taken and results obtained and details of the antimicrobials prescribed. A duration, stop or review date must be clearly documented on the drug kardex for each antimicrobial prescription. For further details please refer to the NHS Grampian Antimicrobial Documentation Policy.
Recommendations for intravenous (IV) to oral switches are included in the guidance. Exercise caution when considering a switch to oral in neonates and infants because of the relatively high incidence of bacteraemia and the possibility of variable oral absorption.
Options for patients with penicillin allergy are included in the guidance - for further information refer to the Guidance for NHS Grampian Staff on Antibiotic Choice for Patients with Penicillin Hypersensitivity.
Tetracyclines should not be given to children under 12 years as deposition of tetracyclines in growing bone and teeth (by binding to calcium) causes staining and occasionally dental hypoplasia.
Quinolones cause arthropathy in the weight-bearing joints of immature animals and are therefore generally not recommended in children and growing adolescents. However, the significance of this effect in humans is uncertain and in some specific circumstances, e.g. to treat pyelonephritis in penicillin allergic patients, short-term use of a quinolone in children is justified.
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Further advice about antimicrobials is available from the on-call Medical Microbiologist, Consultant Paediatrician, Ward Pharmacist, Specialist Antimicrobial Pharmacist. Information about who to contact to obtain further specialist advice regarding the treatment of specific infections is given in the relevant section.