Pediatric ID

• In hospitalized children:
• -IV Ampicillin/Sulbactam (UNASYN) OR
• -IV Clindamycin

• RATIONALE:
• Beta-lactamase production among oral anaerobes, particularly pigmented Prevotella spp and Fusobacterium spp, is increasingly recognized, and treatment failure with penicillin alone has been well documented. Thus, penicillin monotherapy is no longer recommended. Ampicillin-sulbactam provides extended coverage against oral anaerobes, including those that produce beta-lactamases, and is the treatment of choice. An alternative is penicillin G in combination with metronidazole (500 mg IV or orally every eight hours). Although metronidazole is highly active against anaerobic gram-negative bacilli and spirochetes, it is only moderately active against anaerobic cocci and is not active against aerobes, including streptococci . As a result, it should not be used as a single agent in odontogenic infections except in acute necrotizing gingivitis and advanced periodontitis. Penicillin-allergic patients should be treated with clindamycin (600 mg IV every eight hours). Erythromycin and tetracycline are not recommended because of increasing resistance among some strains of streptococci and their lack of optimal anaerobic activity. In the compromised host, such as the patient with leukemia and severe neutropenia after chemotherapy, it is prudent to cover for facultative gram-negative bacilli (including Pseudomonas spp) as well, and agents with broad-spectrum activity against both aerobes and anaerobes are desirable.

• Penicillin VK
• -<27kg (60lbs): 250mg 2-3 times daily x10 days
• ->27kg (60lbs): 500mg 2-3 times daily x10 days

Amoxicillin-50mg/kg once daily (1g max.)x10 days

• Cephalexin (don't use if Type I allergy to PCN)
• -Child: 25-100mg/kg/day divq6-12h x10days
• -Adult: 500mg BID-TIDx10days

Clindamycin-20mg/kg/day divided in 3 doses (1.8g/day max) x10days

Azithromycin-12mg/kg once daily (500mg max)x5days

"A negative result is especially unreliable in infants <3 months" -RedBook 2009

• Adults: 300mg daily
• Children: 10-15mg/kg/daily

Routine determination of serum transaminase concentrations during the 9 months of therapy for LTBI is not indicated except for children and adolescents who: (1) have concurrent or recent liver or biliary disease; (2) are pregnant or in the first 12 weeks postpartum; (3) are having clinical evidence of hepatotoxic effects; or (4) concurrently are taking other hepatotoxic drugs (eg, anticonvulsant or HIV agents)

• Patients with conditions that can predispose to neuropathy (including diabetes, uremia, alcoholism, malnutrition, and HIV infection)
• Pregnant women
• Seizure disorders.
• Infants of breastfeeding mothers receiving INH

• Infants and Children: 1 mg/kg/day; 50 mg/day MAX
• Adolescents and adults: 25 to 50 mg per day

• Rifampin:
• -Adults: 600mg daily x 4 months
• -Children: 10-20mg/kg/daily x 6 months

• Polytrim drops-1-2 drops to affected eye(s) every 4 hours for 7 days
• Erythromycin ophthalmic ointment-apply thin ribbon to affected eye(s) every 4 hours for 7 days.

In children with a fulminant presentation of IE, Staphylococcus aureus is the most common cause. Therefore, prompt initiation of antimicrobial therapy with a bactericidal agent such as vancomycin is warranted.