Pediatric Guidelines: Severe Sepsis - Previously Healthy Infant or Child

These guidelines are intended for patients who meet criteria for severe sepsis i.e. probable or documented infection with systemic inflammatory response criteria and specific evidence of hypo-perfusion or organ dysfunction not explained by an alternative process; these guidelines are not intended for "rule out" scenarios in clinically stable patients. 
Condition Major Pathogens First Choice Therapy Alternative Therapy Comments

Severe sepsis, < 28 days old, communit-onset, previously healthy (admitted from home)

Click here for guidelines on empiric therapy for hospitalized neonates with severe sepsis

Enteric Gram negatives

Group B streptococcus


Less Common: 

Staphylococcus aureus

Listeria monocytogenes

Herpes simplex virus




REPLACE Ampicillin with Vancomycin if suspected skin, soft tissue, bone or joint source

ADD Acyclovir if infant has cutaneous vesicles, seizure, focal neurologic signs, CSF pleocytosis, thrombocytopenia or hepatitis


Refer to Neonatal Dosing Guideline for antibiotic doses and intervals

ID consult recommended

Refer to Fever Without a Source section if patient is well-appearing without severe sepsis.

Severe sepsis, > 28 days old, community-onset, no preexisting comorbidities or recent healthcare exposure

Staphylococcus aureus

Streptococcus pneumoniae

Group A streptococcus

Neisseria meningitidis

Enteric Gram negatives

Ceftriaxone 50mg/kg/dose IV q24h (max 2g/dose)



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)  

ADD Metronidazole 10mg/kg/dose IV q8h (max 500mg/dose) for suspected intra-abdominal infection

Severe beta lactam allergy:

Aztreonam 30mg/kg/dose IV q8h (max 2g/dose) in place of Ceftriaxone

ID consult recommended

Refer to Meningitis section if meningitis is suspected

Corrected gestational age < 44 weeks:

Cefotaxime per Neonatal Dosing Guideline

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).