BNF for Children 2011-2012

250 5.1 Antibacterial drugs BNFC 2011–2012Uncomplicated genital chlamydial infection, non-gonococcal urethritis and non-specificgenital infectionContact tracing recommended.Child under 12 years, erythromycinSuggested duration of treatment 14 daysChild 12–18 years, azithromycin or doxycyclineSuggested duration of treatment azithromycin as a single dose or doxycycline for 7 daysChild 12–18 years, alternative, erythromycinSuggested duration of treatment 14 daysPelvic inflammatory diseaseContact tracing recommendedChild 2–12 years, erythromycin + metronidazole + i/m ceftriaxoneSuggested duration of treatment 14 days (use i/m ceftriaxone as a single dose)Child 12–18 years, doxycycline + metronidazole + i/m ceftriaxoneIf severely ill, seek specialist advice.Suggested duration of treatment 14 days (use i/m ceftriaxone as a single dose)5 InfectionsBloodSepticaemiaNeonate less than 48 hours old, benzylpenicillin + gentamicin or amoxicillin 1 + cefotaximeNeonate more than 48 hours old, flucloxacillin + gentamicin or amoxicillin 1 + cefotaximeChild 1 month–18 years with community-acquired septicaemia, aminoglycoside +amoxicillin 1 or cefotaxime 2 aloneIf pseudomonas suspected, use a broad-spectrum antipseudomonal beta-lactam antibacterial.If anaerobic infection suspected, add metronidazole.If Gram-positive infection suspected, add flucloxacillin or vancomycin 3 .Child 1 month–18 years with hospital-acquired septicaemia, a broad-spectrum antipseudomonalbeta-lactam antibacterial (e.g. piperacillin with tazobactam, ticarcillin with clavulanicacid, imipenem with cilastatin, or meropenem)If pseudomonas suspected, or if multiple-resistant organisms suspected, or if severe sepsis, add aminoglycoside.If meticillin-resistant Staphylococcus aureus suspected, add vancomycin 3 .If anaerobic infection suspected, add metronidazole to a broad-spectrum cephalosporinSepticaemia related to vascular catheterVancomycin 3If Gram-negative sepsis suspected, especially in the immunocompromised, add a broad-spectrum antipseudomonalbeta-lactam.Consider removing vascular catheter, particularly if infection caused by Staphylococcus aureus, pseudomonas,or candidaMeningococcal septicaemiaIf meningococcal disease suspected, a single dose of benzylpenicillin (see p. 258 for dose) should be given beforeurgent transfer to hospital, so long as this does not delay the transfer; cefotaxime (section 5.1.2) may be analternative in penicillin allergy; chloramphenicol may be used if history of immediate hypersensitivity reaction topenicillin or to cephalosporins.Benzylpenicillin or cefotaxime 2To 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, chloramphenicolTo eliminate nasopharyngeal carriage see Table 2, section 5.11. Where amoxicillin is suggested ampicillin may be used2. Where cefotaxime is suggested ceftriaxone may be used3. Where vancomycin is suggested teicoplanin may be used