Learning objectives:

  • Choosing appropriate antibiotics for common infections in Paediatrics
  • Know common infective organisms for common sites of infections

Consider the common organisms:

 

Early (<48hours age) neonatal sepsis

Group B Streptococci, Coliforms, H. influenza, Listeria, Other Streptococci

Late (>48 hours age) neonatal sepsis

Coagulase negative staphylococci (line-related), S. aureus, Coliforms, Group B Streptococci 

Infant and child sepsis

N. meningitides, S. pneumonia, Coliforms, S. aureus, Group A Streptococci

Immune compromise Sepsis

Prone to multi-resistant bacterial species including pseudomonas, fungi, viruses and protozoa

Neonatal meningitis

Group B Streptococci, Coliforms, Listeria, H. influenzae

Infant meningitis < 3 months

H. influenza, Group B streptococci, S. pneumonia, N. meningitides, Listeria, Coliforms, MTB

Older infant and child meningitis

N. meningitides, H. influenzae type B, S. pneumonia, MTB

Suspected encephalitis

Herpes simplex  (also consider atypical/ unusual pathogens eg Mycoplasma + TBM)

Suspected bacterial pneumonia < 5years

S. pneumonia, H. influenza, S. aureus

Suspected bacterial pneumonia > 5years

S. pneumonia, H. influenza, S. aureus, Mycoplasma spp

Pyelonephritis (=fever or loin pain)

E. coli, Klebsiella spp, Proteus spp

Uncomplicated otitis media infant

S. Pneumonia, H. influenza, S. aureus, M. catarrhalis, Group A Streptococci (Agents can co-exist )

Tonsillitis with exudate

Group A Streptococci, EBV

Epiglottitis

H Influenza B, S aureua, Streptococci, Pneumococcus

Suspected bacterial lymphadenitis

Group A streptococci, S. aureus, Anaerobes, Atypical mycobacteria,

also

EBV, CMV, HIV, Bartonella, Toxoplasmosis, Mycobacterium TB

Peri-orbital cellulitis (ie preseptal)

S. Pneumonia, H. influenza, S. aureus, , Group A Streptococci

Orbital cellulitis

S. aureus, Streptococci, incl S. pneumonia, H.influenzae and Anaerobes

Acute soft tissue infection

Group A streptococci, S. aureus

If recurrent problems with boils – think PVL-Staph or MRSA

Acute bone/joint infection

S. aureus, Kingella sp, Group A streptococci, Gram negative bacilli (Newborn), Group B streptococci (2-4 weeks age)

 

Notes:

  • These are only guidelines- treat on individual patient basis
  • All doses as per BNFC
  • Always think of which bacteria you are trying to cover
  • Send appropriate samples before commencing antibiotics & track results once available.
  • Consider switching to oral antibiotics & discontinuing when appropriate
  • Liaise early with Microbiologist for advise in unusual/ severe/ non responding cases or if unsure
  • Review antibiotics with culture results or upon discussion with Microbiologists if indicated