| Condition | Major Pathogens | First-choice Therapy | Alternative Therapy | Comments |
|---|---|---|---|---|
|
Intracranial abscess or empyema (epidural, subdural, brain) > 3 months old, community-onset Includes intracranial extension of sinus, orbital or ear infections |
Streptococci (aerobic & anaerobic) Anaerobic oral and sinus flora Other organisms depending on source |
Ceftriaxone AND Metronidazole AND Vancomycin |
Penicillin or cephalosporin allergy with higher risk for allergic reaction: Vancomycin AND Aztreonam AND Metronidazole |
Neurosurgery and ID consults recommended Treatment is modified based on cultures, with vancomycin discontinued if MRSA is not identified Duration: Variable, guided by extent of drainage and response to therapy in follow-up assessments, usual range 4-8 weeks |
| CNS infection in immunocompromised patient, or hospital-acquired, or following neurosurgical intervention, or following trauma | Variable based on risk factors | Consult ID for recommendations | Neurosurgery and ID consults recommended |
Pediatric Empiric Antimicrobial Therapy Guidelines
This is a subsection of the UCSF Benioff Children’s Hospitals Empiric Antimicrobial Therapy Guidelines, developed by the Pediatric Antimicrobial Stewardship Programs at each campus to inform initial selection of empiric antimicrobial therapy for children at the UCSF Benioff Children’s Hospitals and affiliated outpatient sites.
These are guidelines only and not intended to replace clinical judgment. Modification of therapy may be indicated based on patient comorbidities, previous antibiotic therapy or infection history. Doses provided are usual doses but may require modification based on patient age or comorbid conditions. Refer to Pediatric Antimicrobial Dosing Guideline for further guidance on dosing in children, and Neonatal Dosing Guideline for infants < 1 month of age. Consult a pediatric pharmacist for individualized renal or hepatic dose adjustment. Durations provided are usual recommendations for patients who are responding appropriately to therapy. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP) at the campus where your patient is receiving care.
For questions or feedback about these guidelines, please email primary content owners, Rachel Wattier, Pediatric ASP Medical Director at BCH SF and Prachi Singh, Pediatric ASP Medical Director at BCH OAK.
The content of these guidelines was updated in July 2021. See Summary and Rationale for Changes (password login to Box needed) for detailed explanations of the content changes.