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Sepsis PAEDIATRIC First Dose Empirical Parenteral Antibiotic Guideline v2.1 Table 3: Antibiotics that treat common infecting organisms
Susceptible organism
Herpes simplex type 1, herpes simplex type 2 and varicella zoster viruses Group A streptococcus (Streptococcus pyogenes), penicillin SENSITIVE Staphylococcus aureus, E coli, Proteus mirabilis. NOT Klebsiella species. Chlamydia trachomatis Group A streptococcus (Streptococcus pyogenes), Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus), methicillin SENSITIVE Staphylococcus aureus, E coli, Klebsiella, Proteus mirabilis. Note: Good central nervous system penetration. Group A streptococcus (Streptococcus pyogenes), Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus), methicillin SENSITIVE Staphylococcus aureus, E coli, Klebsiella, Proteus mirabilis. Note: Good central nervous system penetration. Enterobacteriaceae (e.g. E. coli Klebsiella, Proteus, Enterobacter, Serratia, Citrobacter species), Pseudomonas aeruginosa, Staphylococcus aureus. Staphylococcus aureus*, Group A streptococcus* (Streptococcus pyogenes)* Streptococcus pneumoniae* (pneumococcus) and anaerobes Methicillin SENSITIVE Staphylococcus aureus, group A streptococcus (Streptococcus pyogenes). Enterobacteriaceae (e.g. E coli, Klebsiella, Proteus, Enterobacter, Serratia, Morganella, Hafnia species) and Pseudomonas aeruginosa. Note: Poor central nervous system penetration. Staphylococcus aureus*, Group A streptococcus* (Streptococcus pyogenes)* Streptococcus pneumoniae* (pneumococcus) and anaerobes (Streptococcus pyogenes)* and anaerobes Anaerobic gram negative bacteria including Bacteroides fragilis. Streptococcus pneumoniae (pneumococcus), Staphylococcus aureus, Group A streptococcus (Streptococcus pyogenes), Neisseria, Haemophilus and Moraxella species, Enterobacteriaceae, many anaerobes. Methicillin RESISTANT Staphylococcus aureus, group A streptococci (Streptococcus pyogenes), cefotaxime RESISTANT Streptococcus pneumoniae (pneumococcus) in central nervous system infections.
* = if sensitive
Footnote: This table provides information about common infecting bacteria and their probable sensitivities.
This is not an exhaustive list further information can be obtained from a microbiologist or infectious diseases
physician. Final sensitivities are dependent on laboratory testing.
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Clinical Excellence Commission 2013 Updated September 2013 SHPN (CEC) 130094 Sepsis PAEDIATRIC First Dose Empirical Parenteral Antibiotic Guideline v2.1 Table 4: PAEDIATRIC antibiotic administration
 Administer the antibiotic which takes the least time to inject or infuse, in the order provided.  Reconstitute antibiotics with sterile water for injection (WFI) unless stated otherwise.  If further dilution is required for IV injection or infusion, use sterile sodium chloride 0.9% or sterile glucose 5% unless stated otherwise.  To avoid drug incompatibility without delaying fluid administration, flush the IV line with sterile sodium chloride 0.9% before and after the antibiotic injection or infusion.  When injecting antibiotics directly into an IV injection port which has resuscitation fluid running: o clamp the infusion fluid line and flush with 20mL sterile sodium chloride 0.9% o administer antibiotic over the required time o flush the line with 20mL sterile sodium chloride 0.9% and recommence resuscitation fluid Antibiotic
Intramuscular (IM)
volume / fluid for
intravenous (IV) or
intraosseous (IO)
Dose interval adjusted if renal aciclovir
Do NOT give intramuscularly Reconstitute with WFI Penicillin class antibiotic. ampicillin
100mg/mL 5 minutes 500mg vial with 1.7mL WFI 1g vial with 1.3mL WFI
azithromycin
Do NOT give intramuscularly Rare reports of prolonged QT interval. Reconstitute with WFI or Cephalosporin class antibiotic. It is inadvisable to give more than 4mL by the cefotaxime
500 mg vial with 2mL IM route. If IM injection is required, ceftriaxone is the preferable agent. 1g vial with 3mL Page 2 of 4
Clinical Excellence Commission 2013 Updated September 2013 SHPN (CEC) 130094 Sepsis PAEDIATRIC First Dose Empirical Parenteral Antibiotic Guideline v2.1
Table 4: PAEDIATRIC antibiotic administration (cont.)
Antibiotic
Intramuscular (IM)
volume / fluid for
intravenous (IV) or
intraosseous (IO)
Reconstitute with lignocaine 1% Avoid in premature infants or in first 6 weeks of life due to bilirubin displacement. 1g vials with 3.5mL lignocaine Ceftriaxone and IV calcium-containing ceftriaxone
solutions must not be administered within 48 IM injection without lignocaine hours of each other in newborn infants. May induce seizures in epileptics. Local site reactions are more frequent when shorter infusion times are used. Do NOT give intramuscularly 100mg/50mL 200mg/100mL 400mg/200mL Inject undiluted FRIDGE ITEM: kept at 2-8oC
Check product is clear of any crystals clindamycin
A single dose greater than prior to administration. 600mg at a single site is not recommended Reconstitute with WFI Penicillin class antibiotic. 500mg vial with 2mL 1g vial with 2.5mL IV gentamicin is inactivated by IV cephalosporins and penicillins. Flush line gentamicin
Inject undiluted well before giving gentamicin to prevent inactivation. Monitoring required for ongoing dosing. Severe cardiopulmonary reactions have occurred when administering at a higher lincomycin
Inject undiluted concentration or rate than recommended. Page 3 of 4
Clinical Excellence Commission 2013 Updated September 2013 SHPN (CEC) 130094 Sepsis PAEDIATRIC First Dose Empirical Parenteral Antibiotic Guideline v2.1 Table 4: PAEDIATRIC antibiotic administration (cont.)
Antibiotic
Intramuscular (IM)
volume / fluid for
intravenous (IV) or
intraosseous (IO)
Do NOT give intramuscularly Not TGA approved for paediatric use. May prolong QT interval and lead to Do NOT give intramuscularly ventricular arrhythmias. May induce seizures in epileptics. Infusion related effects are common, may flush with red "red man syndrome". In this instance decrease vancomycin
Do NOT give intramuscularly infusion rate, check dosing and monitor closely. Serum Levels required for ongoing dosing References
1. MIMS (2011)2. Antibiotic Expert GroupMelbourne: Therapeutic Guidelines Limited; 2010. Accessed through eTG complete (via CIAP). 3. Burridge N (ed The Society of Hospital Pharmacists Australia; 2008. 4. Rossi S (edChapter 5. Adelaide: Australian Medicines Handbook; 2011. 5. Paediatric Sepsis Reference Group, Clinical Excellence Commission. 6. [revised Oct 2010]. In: eTG complete [Internet]. Melbourne: Therapeutic Guidelines Limited; Nov 2012. 7. [revised Jun 2010]. In: eTG complete [Internet]. Melbourne: Therapeutic Guidelines Limited; Nov 2012. 8. Loewenthal MR, Dobson PM. Tobramycin and gentamicin can safely be given by slow push. J Antimicrob Chemother. 2010 Sep;65(9):2049-50 9. Robinson RF. Nahata MC. Safety of Intravenous Bolus Administration of Gentamicin in Pediatric Patients. Annals of Pharmacotherapy. 35(11): 1327-31, 2001 Nov. 10. Bromiker R. Adelman C. Ared I. Shapiro M. Levi H. Safety of Gentamicin Administered by Intravenous Bolus in the Nursery. Clinical Pediatrics. 433-435, 1999 Jul. 11. Department P (ed). Pediatric Injectables Guidelines. 4th ed. Melbourne: The Royal Children's Hospital Melbourne; 2011. The Children's Hospital at Westmead Antimicrobial Stewardship Recommendations may also be useful for further information - drug doses based on MIMS (2011).

Acknowledgments
With kind thanks to The Children's Hospital at Westmead for use of their Antibiotic Guidelines which form the basis of Tables 1 and 2. The Antibiotic Guidelines are based
on MMS (2011).
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Clinical Excellence Commission 2013 Updated September 2013 SHPN (CEC) 130094

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