Antimicrobial prescribing: NHS Grampian, Orkney & Shetland
Important: Therapy
Chemical inflammation / irritation of airways, no antibiotic required
Aspiration Pneumonia
Warning
What's new / Latest updates
Routine anaerobic cover no longer recommended.
Duration: 5 days
Updated treatment choices dependent on severity, with no antibiotics required if mild.
Oral antibiotics recommended first line in most cases.
Micro Organisms
Mouth flora – streptococci and coliforms
Less common: anaerobes – routine cover not required
Duration
If no signs of infection at 72 hours STOP antibiotics
Standard duration of treatment: 5 days
Seek advice from paediatric infectious diseases consultant or microbiology if no improvement after 48 hours or known resistance.
If slow response, treatment can be extended up to a total of 10 days.
Important: Therapy
Oral Amoxicillin
Notes:
IV amoxicillin may be used if the oral route is compromised.
Important: Therapy
Oral Clindamycin (6mg/kg per dose, maximum 450mg per dose)
Notes:
If oral route is compromised, use IV clindamycin.
Important: Therapy
Oral Co-amoxiclav
Notes:
IV Co-amoxiclav may be used if the oral route is compromised.
Important: Therapy
Non-anaphylactic reaction to penicillin:
IV Ceftriaxone* or IV Cefotaxime
* Contraindications to ceftriaxone:
- Concomitant treatment with intravenous calcium (including total parenteral nutrition containing calcium) in premature and full-term neonates
- Full-term neonates with jaundice, hypoalbuminaemia, acidosis, unconjugated hyperbilirubinaemia (bilirubin greater than or equal to 200 umol/L), or impaired bilirubin binding
- 41 weeks or less corrected gestational age
Notes: If ceftriaxone is contra-indicated give IV Cefotaxime.
For oral switch, seek advice from paediatric infectious diseases consultant or microbiology.
Anaphylactic reaction to penicillin:
Oral Clindamycin (6mg/kg per dose, maximum 450mg per dose)
+ oral Ciprofloxacin#
# check important safety information in BNFC and provide Medicines for Children: Ciprofloxacin information for parents and carers.
Notes:
IV clindamycin and ciprofloxacin may be used if the oral route is compromised.
Important: Notes
Assessment of severity should be based on clinical judgement. Markers of severity include:
- Significant tachypnoea*
- Significant tachycardia*
- Severe respiratory distress (significant recession (age < 12 months), nasal flaring, grunting)
- Apnoeas (ages < 12 months)
- Hypoxia (sustained O2 sats ≤ 92% in room air)
- Cyanosis
- Signs of severe dehydration
- Capillary Refill Time > 2 seconds
If features of sepsis, for urgent senior input.
*Parameters for significant tachycardia / tachypnoea:
Age < 12 months: RR > 70, HR > 170,
Age 1 year to < 3 years: RR > 50, HR > 150,
Age 3-5 years: RR >50, HR > 140,
Age 5 to 14 years: RR > 40, HR > 120,
Age 14-17 years: RR >30, HR > 100