BNF for Children 2011-2012

248 5.1 Antibacterial drugs BNFC 2011–2012Central nervous systemMeningitis: initial empirical therapy. Transfer patient to hospital urgently.. If meningococcal disease (meningitis with non-blanching rash or meningococcal septicaemia) suspected,benzylpenicillin (see p. 258 for dose) should be given before transfer to hospital, so long as this does not delaythe transfer. If a patient with suspected bacterial meningitis without non-blanching rash cannot be transferred tohospital urgently, benzylpenicillin (see p. 258 for dose) should be given before the transfer. Cefotaxime (section5.1.2) may be an alternative in penicillin allergy; chloramphenicol (section 5.1.7) may be used if history ofimmediate hypersensitivity reaction to penicillins or to cephalosporins.. In hospital, consider adjunctive treatment with dexamethasone (section 6.3.2), preferably starting before or withfirst dose of antibacterial, but no later than 12 hours after starting antibacterial; avoid dexamethasone in septicshock, meningococcal septicaemia, or if immunocompromised, or in meningitis following surgery.. In hospital, if aetiology unknown:Neonate and child 1–3 months, cefotaxime 1 + amoxicillin 2Consider adding vancomycin if prolonged or multiple use of other antibacterials in the last 3 months, or iftravelled, in the last 3 months, to areas outside the UK with highly penicillin- and cephalosporin-resistantpneumococciSuggested duration of treatment at least 14 daysChild 3 months–18 years, cefotaxime 1Consider adding vancomycin if prolonged or multiple use of other antibacterials in the last 3 months, or iftravelled, in the last 3 months, to areas outside the UK with highly penicillin- and cephalosporin-resistantpneumococciSuggested duration of treatment at least 10 days5 InfectionsMeningitis caused by group B streptococcusBenzylpenicillin + gentamicin or cefotaxime 1 aloneSuggested duration of treatment at least 14 daysMeningitis caused by meningococciBenzylpenicillin or cefotaxime 1Suggested duration of treatment 7 days.To eliminate nasopharyngeal carriage in patients treated with benzylpenicillin or cefotaxime see Table 2,section 5.1If history of immediate hypersensitivity reaction to penicillin or to cephalosporins, chloramphenicolSuggested duration of treatment 7 days.To eliminate nasopharyngeal carriage see Table 2, section 5.1Meningitis caused by pneumococciCefotaxime 1Consider adjunctive treatment with dexamethasone (section 6.3.2), preferably starting before or with firstdose of antibacterial, but no later than 12 hours after starting antibacterial (may reduce penetration ofvancomycin into cerebrospinal fluid).If micro-organism penicillin-sensitive, replace cefotaxime with benzylpenicillin.If micro-organism highly penicillin- and cephalosporin-resistant, add vancomycin and if necessary rifampicin.Suggested duration of antibacterial treatment 14 daysMeningitis caused by Haemophilus influenzaeCefotaxime 1Consider adjunctive treatment with dexamethasone (section 6.3.2), preferably starting before or with firstdose of antibacterial, but no later than 12 hours after starting antibacterial.Suggested duration of antibacterial treatment 10 days.For H. influenzae type b give rifampicin for 4 days before hospital discharge (see Table 2, section 5.1)If history of immediate hypersensitivity reaction to penicillin or to cephalosporins, or if microorganismresistant to cefotaxime, chloramphenicolConsider adjunctive treatment with dexamethasone (section 6.3.2), preferably starting before or with firstdose of antibacterial, but no later than 12 hours after starting antibacterial.Suggested duration of antibacterial treatment 10 days.For H. influenzae type b give rifampicin for 4 days before hospital discharge (see Table 2, section 5.1)Meningitis caused by ListeriaAmoxicillin 2 + gentamicinSuggested duration of treatment 21 days.Consider stopping gentamicin after 7 daysIf history of immediate hypersensitivity reaction to penicillin, co-trimoxazoleSuggested duration of treatment 21 days1. Where cefotaxime is suggested ceftriaxone may be used2. Where amoxicillin is suggested ampicillin may be used