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max 2 gm erythromycin/day
[susp per 5 mL: Erythromycin 200 mg, sulfisoxazole
600 mg] OR
-Amoxicillin/clavulanate (Augmentin) 40 mg/kg/day of
amoxicillin PO tid, max 500 mg/dose
[elixir 125 mg/5 mL, 250 mg/5 mL; tabs: 250, 500
mg; tabs, chew: 125, 250 mg] OR
-Amoxicillin/clavulanate (Augmentin Bid)
40 mg/kg/day PO bid, max 875 mg (amoxicillin)/dose
[susp: 200 mg/5 mL, 400 mg/5 mL; tab: 875 mg;
tabs, chew: 200, 400 mg] OR
-Cefuroxime axetil (Ceftin)
3 months-12 years: suspension 30 mg/kg/day PO
bid (max 1 gm/day) or tablet 250 mg PO bid
12 years: suspension 500 mg PO bid or tablet 250
500 mg PO bid
[susp: 125 mg/5 mL, 250 mg/5mL; tabs 125, 250,
500 mg]
Labs: Sinus X-rays, CT scan, MRI scan.
Suspected Sepsis
1. Admit to:
2. Diagnosis: Suspected sepsis.
3. Condition:
4. Vital signs: Call MD if:
5. Activity:
6. Nursing: Inputs and outputs, daily weights, cooling
measures prn temp 38°C; consent for lumbar
puncture.
7. Diet:
8. IV fluids: Correct hypovolemia if present; NS 10-20
mL/kg IV bolus, then IV fluids at 1-1.5 times
maintenance.
9. Special medications:
Term newborns 1 month old (Group B strep, E coli,
Group D s t r e p , g ra m n e g a t i ve s , L is t eria
monocytogenes): Ampicillin and gentamicin or
cefotaxime.
-Ampicillin IV/IM: 0-7days: 150 mg/kg/day q8h; 7d:
200 mg/kg/day q6h AND EITHER
-Cefotaxime (Claforan) IV/IM: 0-7 days: 100 mg/kg/day
q12h; 7 days: 150 mg/kg/day q8h OR
-Gentamicin (Garamycin) IV/IM: 5 mg/kg/day q12h.
-Also see page 129.
Infant 1-2 months old (H. flu, strep pneumonia, N.
meningitidis, Group B strep):
-Ampicillin 100 mg/kg/day IV/IM q6h AND EITHER
-Cefotaxime (Claforan) 100 mg/kg/day IV/IM q6h OR
-Ceftriaxone (Rocephin) 50-75 mg/kg/day IV/IM q12
24h OR
-Gentamicin (Garamycin) 5 mg/kg/day IV/IM q12h
Children 2 months-18 years old (S pneumonia, H.
influenzae, N. meningitidis):
-Cefotaxime (Claforan) 100 mg/kg/day IV/IM q6h, max
12 gm/day OR
-Ceftriaxone (Rocephin) 50-75 mg/kg/day IV/IM q 12
24h, max 4 gm/day.
Immunocompromised Patients (Gram-negative bacilli,
Pseudomonas, Staph, Strep viridans):
-Ticarcillin (Ticar) 200-300 mg/kg/day IV/IM q6h, max
24 gm/day OR
-Ticarcillin/clavulanate (Timentin) 200-300 mg/kg/day
of ticarcillin IV/IM q6-8h, max 24gm/day OR
-Piperacillin/tazobactam (Zosyn) 240 mg/kg/day of
piperacillin IV/IM q6-8h, max 12 gm/day OR
-Ceftazidime (Fortaz) 100-150 mg/kg/day IV/IM q8h,
max 12 gm/day AND
-Tobramycin (Nebcin) or Gentamicin (Garamycin);
(normal renal function):
5 years (except neonates): 7.5 mg/kg/day IV/IM
q8h.
5-10 years: 6.0 mg/kg/day IV/IM q8h.
10 years: 5.0 mg/kg/day IV/IM q8h AND (if gram
positive infection strongly suspected or signs of
central line infection present)
-Vancomycin (Vancocin) 40-60 mg/kg/day IV q6-8h,
max 4 gm/day
10. Symptomatic Medications:
-Acetaminophen (Tylenol) 10-15 mg/kg PO/PR q4-6h
prn temp 38°C or pain.
11. Extras and X-rays: Chest X-ray.
12. Labs: CBC, SMA 7. Blood culture and sensitivity x 2.
UA, urine culture and sensitivity; antibiotic levels.
Stool for Wright stain if diarrhea present.
Nasopharyngeal washings for direct fluorescent
antibody (RSV, chlamydia).
CSF Tube 1 - Gram stain, culture and sensitivity for
bacteria, antigen screen (1-2 mL).
CSF Tube 2 - Glucose, protein (1-2 mL).
CSF Tube 3 - Cell count and differential (1-2 mL).
Varicella Zoster Infections
I. Immunocompetent Patient
A. Therapy with oral acyclovir is not recommended
routinely for the treatment of uncomplicated
varicella in the otherwise healthy child 12 years of
age.
B. Oral acyclovir may be given within 24 hours of the
onset of rash. Administration results in a modest
decrease in the duration and magnitude of fever
and a decrease in the number and duration of skin
lesions.
C. Acyclovir (Zovirax) 80 mg/kg/day PO q6h for five
days, max 3200 mg/day [cap: 200 mg; susp: 200
mg/5 mL; tabs: 400, 800 mg].
II. Immunocompromised Patient
A. Intravenous acyclovir should be initiated early in the
course of the illness. Therapy within 24 hours of
rash onset maximizes efficacy. Oral acyclovir
should not be used because of unreliable oral
bioavailability.
Dose: 500 mg/m2/dose IV q8h x 7-10 days.
B. Varicella zoster immune globulin (VZIG) may be
given shortly after exposure to prevent or modify the
course of the disease. It is not effective once
disease is established.
Dose: 125 U per 10 kg body weight, round up to
nearest vial size to max of 625 U [vial: 125
U/1.25ml]. Must be administered IM.
Ventriculoperitoneal Shunt Infection
1. Admit to:
2. Diagnosis: VP Shunt Infection
3. Condition: Guarded.
4. Vital signs: Call MD if:
5. Activity:
6. Nursing: Inputs and outputs, daily weights; cooling
measures prn temp 38°C.
7. Diet:
8. IV fluids: Isotonic fluids at maintenance rate.
9. Special medications:
-Vancomycin 40-60 mg/kg/day IV q6-8h, max 4 gm/day
OR
-Nafcillin (Nafcil) or oxacillin (Bactocill, Prostaphlin)
150-200 mg/kg/day IV/IM q6h, max 12 gm/day
10. Symptomatic Medications:
-Ibuprofen 5-10 mg/kg/dose PO q6-8h prn OR
-Acetaminophen 15 mg/kg PO/PR q4h prn temp 38°C
or pain.
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