BNF for Children 2011-2012

BNFC 2011–2012 5.1 Antibacterial drugs 247Respiratory systemHaemophilus influenzae epiglottitisCefotaxime 1If history of immediate hypersensitivity reaction to penicillin or to cephalosporins, chloramphenicolPneumonia: uncomplicated community-acquiredNeonate and child under 6 months, treat as for severe community-acquired pneumonia ofunknown aetiologyChild 6 months–18 years, oral amoxicillin 2Pneumococci with decreased penicillin sensitivity being isolated, but not yet common in UK.If staphylococci suspected (e.g. in influenza or measles), add flucloxacillin.Suggested duration of treatment 7 days (14–21 days for infections caused by staphylococci)Child 6 months–18 years, if penicillin-allergic or if atypical pathogens suspected, oralclarithromycin 3Suggested duration of treatment 7 days (14–21 days for infections caused by staphylococci)Pneumonia: severe community-acquired of unknown aetiologyNeonate, benzylpenicillin + gentamicinChild 1 month–18 years, co-amoxiclav or cefuroximeSuggested duration of treatment 7–10 days (may extend treatment to 14–21 days in some cases e.g. ifstaphylococci or Gram-negative enteric bacilli suspected)Child 1 month–18 years, if atypical pathogens such as mycoplasma (more common inchildren over 5 years) or chlamydia suspected, or if penicillin-allergic, clarithromycin 3Suggested duration of treatment 7–10 days (may extend treatment to 14–21 days in some cases e.g. ifstaphylococci or Gram-negative enteric bacilli suspected)Pneumonia possibly caused by atypical pathogensClarithromycin 3Suggested duration of treatment 14 daysAlternative for chlamydial or mycoplasma infections in children over 12 years, doxycyclineSuggested duration of treatment 14 daysPneumonia: hospital-acquiredEarly-onset infection (less than 5 days after admission to hospital), treat as for severecommunity-acquired pneumonia of unknown aetiology; if life-threatening infection, or ifrecent history of antibacterial treatment, or if resistant organisms suspected, treat as for lateonsethospital-acquired pneumoniaLate-onset infection (more than 5 days after admission to hospital), an antipseudomonalpenicillin (e.g. piperacillin with tazobactam) or another antipseudomonal beta-lactamIf meticillin-resistant Staphylococcus aureus suspected, add vancomycin.If severe illness caused by Pseudomonas aeruginosa, add an aminoglycoside.Suggested duration of treatment 7 days (longer if Pseudomonas aeruginosa confirmed)5 InfectionsCystic fibrosisStaphylococcal lung infection in cystic fibrosisFlucloxacillinIf child already taking flucloxacillin prophylaxis or if severe exacerbation, add sodium fusidate orrifampicin; use flucloxacillin at treatment doseIf penicillin-allergic and if micro-organism sensitive, clarithromycin 3Alternative if penicillin-allergic, clindamycinHaemophilus influenzae lung infection in cystic fibrosisAmoxicillin or a broad-spectrum cephalosporinIn severe exacerbation use a third-generation cephalosporin (e.g. cefotaxime)Pseudomonal lung infection in cystic fibrosisCiprofloxacin + nebulised colistimethate sodiumFor severe exacerbation, an antipseudomonal beta-lactam antibacterial + parenteral tobramycin1. Where cefotaxime is suggested ceftriaxone may be used2. Where amoxicillin is suggested ampicillin may be used3. Where clarithromycin is suggested azithromycin or erythromycin may be used