By John S. Bradley MD, John D. Nelson MD Emeritus
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Additional info for 2010-2011 Nelson's Pocket Book of Pediatric Antimicrobial Therapy
6. indd 32 Standard: cephalexin 50–75 mg/kg/day PO div tid OR For topical therapy if mild infection: mupirocin or Bullous impetigo1–3,5–7 (usually S aureus, including cloxacillin 50 mg/kg/day PO div qid OR amox/clav retapamulin ointment CA-MRSA) 45 mg/kg/day PO div tid (CII) CA-MRSA: clindamycin 30 mg/kg/day PO div tid OR TMP/SMX 8 mg/kg/day of TMP PO div bid; x 5–7 d (CIII) Bites, animal and human1,15–17 Amox/clav 45 mg/kg/day PO div tid (amox/clav 7:1, Consider rabies prophylaxis for animal bites (AI); consider Pasteurella multocida (animal), see Chapter 1, Aminopenicillins) x 5–10 d (AII); for tetanus prophylaxis Eikenella corrodens (human), hospitalized children, use ticar/clav 200 mg ticarcillin/ Human bites have a very high rate of infection (do not Staphylococcus spp and kg/day div q6h OR ampicillin and clindamycin (BII) close open wounds) Streptococcus spp S aureus coverage is only fair with amox/clav, ticar/clav, pip/tazo.
Topical steroids for keratitis while using Acyclovir PO (60–80 mg/kg/day div qid) has been topical antiviral solution. effective in limited studies (BIII) Long-term prophylaxis for suppression of recurrent infection with oral acyclovir 20–25 mg/kg/dose (max 400 mg) PO bid (little long-term safety data in children). Assess for neutropenia on long-term therapy; potential risks must balance potential benefits to vision. 5 mg/kg/day IM (AIII) effective: cefepime IV, meropenem IV or imipenem IV, pip/tazo Otitis externa – Bacterial (swimmer’s ear) Topical antibiotics: fluoroquinolone (ciprofloxacin or Wick moistened with Burow solution used for marked (P aeruginosa, S aureus, ofloxacin) with steroid, OR neomycin/polymyxin B/ swelling of canal; to prevent swimmer’s ear, 2% acetic 61,62 including CA-MRSA) hydrocortisone (BII) acid to canal after water exposure will restore acid pH Irrigation and cleaning canal of detritus important Bullous myringitis (see Otitis media, acute) D.
See Chapter 14 for information on patients with impaired renal function. Higher dosages may also be necessary if the antibiotic does not penetrate well into the infected tissue, or if the child is immunecompromised. • Duration of treatment should be individualized. Those recommended are based on the literature, common practice, and general experience. Critical evaluations of duration of therapy have been carried out in very few diseases. In general, a longer duration of therapy should be used (1) for tissues in which antibiotic concentrations may be relatively low (eg, abscess, bone), (2) when the organisms are less susceptible, (3) when a relapse of infection is unacceptable (eg, CNS infections), or (4) when the host is immune-compromised in some way.