Antimicrobial prescribing: NHS Grampian, Orkney & Shetland
Important: Therapy
Oral Co-amoxiclav
Notes:
IV co-amoxiclav may be used if the oral route is compromised.
Healthcare associated pneumonia (HAP)
Warning
What's new / Latest updates
New section added to guidance.
Duration: 5 days
Recommendations on antibiotic choices added, with oral therapy first line except in severe infection.
Micro Organisms
Coliforms, Staphylococcus aureus, Pseudomonas spp (rare)
Review previous microbiology results prior to prescribing. Tailored antibiotic regime may be required.
Duration
5 days
If slow response, treatment can be extended up to a total of 10 days.
Review IV therapy after 24- 48 hours.
Seek advice from paediatric infectious diseases consultant or microbiology if no improvement after 48 hours.
Important: Therapy
Oral Clarithromycin
Notes:
IV clarithromycin may be used if the oral route is compromised.
Important: Therapy
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.
In the absence of microbiology results use Co-amoxiclav for oral switch.
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:
IV Ciprofloxacin#
+ IV Teicoplanin
# check important safety information in BNFC and provide Medicines for Children: Ciprofloxacin information for parents and carers.
Notes:
For oral switch, seek advice from paediatric infectious diseases consultant or microbiology.
Important: Notes
If less than 5 days since admission to hospital and no additional risk factors (e.g. immunosuppression, neurodisability, home non-invasive ventilation (NIV), recent influenza infection, recent broad spectrum antibiotic use or frequent healthcare contact) then treat as Community-acquired pneumonia.
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