Antibiotics

Starting Antibiotics for common paediatric infections

In the UK, starting empirical antibiotics for common paediatric infections follows a structured approach based on the most likely causative organisms and the severity of the illness. This guidance is crucial for paediatric trainees to ensure the correct treatment is initiated promptly while awaiting culture results.

The information below has been updated to reflect current UK practices.

 

Sepsis and Meningitis

  • Sepsis/Meningitis (<3 months): The common organisms are Group B Streptococci and E. coli. The recommended antibiotic is a combination of amoxicillin and cefotaxime.

  • Sepsis/Meningitis (>3 months): The most likely organisms are N. meningitidis and S. pneumoniae. The antibiotic of choice is ceftriaxone. Dexamethasone should also be considered in meningitis for children over 3 months.

  • Encephalitis: If viral encephalitis is suspected, the initial empirical treatment is ceftriaxone, along with aciclovir and clarithromycin. Atypical pathogens like Mycoplasma and tuberculosis should also be considered.

 

Respiratory Tract Infections

  • Tonsillitis/Pharyngitis: The most common bacterial cause is Group A Streptococcus. The first-line antibiotic is penicillin V (oral) or benzylpenicillin (IV).

  • Pneumonia (<5 years): The common pathogens are S. pneumoniae, H. influenzae, and S. aureus. The recommended antibiotics are amoxicillin (oral) or co-amoxiclav (oral/IV).

  • Pneumonia (>5 years): Mycoplasma becomes a more common cause in older children.

  • Acute Epiglottitis: This is a medical emergency. The primary pathogens are H. influenzae type B, S. aureus, and Streptococci. The recommended antibiotic is ceftriaxone.

 

Other Common Infections

 

  • Urinary Tract Infection (UTI):

    • Uncomplicated Lower UTI: The most common organism is E. coli. The first-line treatment is cefalexin or trimethoprim (if local resistance rates are low).

    • Pyelonephritis: The most likely pathogens are E. coli and Klebsiella species. The antibiotic is ceftriaxone (IV).

  • Skin, Soft Tissue, and Joint Infections:

    • Periorbital Cellulitis: Caused by S. pneumoniae, H. influenzae, and S. aureus. Mild cases can be managed with co-amoxiclav (oral).

    • Orbital Cellulitis: This is a serious infection requiring a combination of co-amoxiclav and metronidazole (IV).

    • Acute Soft Tissue Infection: The common organisms are Group A Streptococcus and S. aureus. Treatment is flucloxacillin (oral/IV).

  • Osteomyelitis/Septic Arthritis: The most common organism is S. aureus. Management is with flucloxacillin (IV), and a microbiologist should be consulted.

 

Important Considerations

  • Dosing: All antibiotic doses must be calculated according to the child’s weight, as per the British National Formulary for Children (BNFC).

  • Cultures: Always send appropriate samples for culture and sensitivity before starting antibiotics.

  • Review: Review the antibiotics and consider switching to a more narrow-spectrum agent once culture results are available. Liaise with a microbiologist for severe or unusual cases.