Condition | Major Pathogens | First Choice Therapy | Alternative Therapy | Comments |
Brain abscess > 3 months old, community-onset Or intracranial extension of sinus, orbital or ear infections |
Streptococci (aerobic & anaerobic) Anaerobic oral and sinus flora Other organisms depending on source |
Ceftriaxone 50mg/kg/dose IV q12h (max 2g/dose) AND Metronidazole 10mg/kg/dose IV q8h (max 500mg/dose) AND Vancomycin: Age 3mo-<12yo: 17.5mg/kg/dose IV q6h (initial max 1g/dose) Age >=12 yo: 15mg/kg/dose IV q6h (initial max 1g/dose) |
Severe beta lactam allergy: Vancomycin: Age 3mo-<12yo: 17.5mg/kg/dose IV q6h (initial max 1g/dose) Age >=12 yo: 15mg/kg/dose IV q6h (initial max 1g/dose) AND Aztreonam 30mg/kg/dose IV q6h (max 2g/dose) AND Metronidazole 10mg/kg/dose IV q8h (max 500mg/dose) |
ID consult recommended |
CNS infection, hospital-acquired or following neurosurgical intervention, or following trauma |
Variable based on risk factors |
Consult ID for recommendations |
ID consult recommended | |
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. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP). |