Handbook of Pediatric Drug Therapy and Immunization RK Suneja
INDEX
Page numbers followed by f refer to figure, fc refer to flowchart, and t refer to table
A
Abacavir 324t
Acellular pertussis 216
Acetaminophen 399, 472
poisoning 249
Acetazolamide 389, 473
Acetone 248
Acetylcysteine 439
Acidosis
correction of 166
metabolic 102
severe 462
Acquired immunodeficiency syndrome, management of 93t
Activated partial thromboplastin time 423
Acyclovir 318, 472
Adenosine 157, 350
Adrenaline 334, 337, 370, 373
injection subcutaneous 114
tartrate 374
Adrenergic
agonist 132, 335, 339
blocking agents 138
Adrenocorticotropic hormone 356, 421
aqueous 356, 421
gel 356, 421
Airway, breathing and circulation 153, 174, 188
Alanine aminotransferase 293
Albendazole 309
Albumin 439
Alcohol 248
Aldosterone antagonists 130
Alfacalcidol 431
Allergy, symptomatic relief of 411
Allopurinol 440
Alprazolam 402
Aluminum hydroxide 381
Amantadine hydrochloride 320
Amantrel 320
Amebiasis 88, 314, 318
metastatic 88, 314
severe intestinal 318
Amebicidal drug 313
Amikacin 48, 469, 470
sulfate 265
Aminoglycoside 48, 67, 284, 295, 300, 470, 486
antibiotic 265, 283, 288, 289, 297
Aminopenicillin 266268
Aminophylline 114, 370
preparations 381
Amiodarone 156, 157, 350
Amitriptyline 261, 402
Amlodipine 138, 341
Amoxicillin 25, 39, 40, 266, 486
Amphotericin B 313, 472, 486
deoxycholate 329
lipid complex 96, 330
Ampicillin 39, 40, 267, 268, 467, 471
Amrinone 133, 166, 335
Amyl nitrite 252
Anaerobic infection 33, 314
Analgesia 188, 397
Analgesics 393, 395, 399, 477
Anaphylactic reaction, emergency treatment of 411
Anaphylaxis 374, 375
Ancylostoma braziliense 86
Anemia
chronic 196
pernicious 434
Anesthesia induction 368
Angiotensin-converting enzyme 141, 142
inhibitor 129, 130, 137, 340t, 342, 344, 346
Angiotensin-receptor blocker 129, 130, 137, 340t, 343, 346, 348, 350
Anidulafungin 330
Anorexia 369
Antiallergic agent 373
Antiarrhythmic 260, 355, 366
agent 350, 352, 353, 474
Antibacterial 477
chemoprophylaxis 70
drugs 265
Antibiotic 39, 40, 168, 289, 486, 491
choice of 31
fluoroquinolone group 285
initial choice of 10
role of 17
therapy 31
duration of 30, 34
treatment 7
Anti-cancer drugs 491
Anticholinergic 383
bronchodilator 376
poisoning 249
Anticoagulant 452, 466
overdose of 436
Anticonvulsant 359, 362, 366, 406, 408, 473, 491
drug 356
therapy 117
Antidepressant 402
tricyclic 259, 261, 407, 458
Antidote 249, 251259
Antiemetic 416, 417
therapy 362, 406
Antiepileptic drugs 115t
Antifibrinolytic agent 465
Antiflatulent 389
Antifungal 333, 472
agent 333
drugs 329
Antihelminthics 309
Antihemophilic factor 440
Antihistamines 249, 414, 417, 419
Antihistaminic 404, 409, 410, 413
Antihypertensive 390, 473
agent 346
drug 137, 141, 141t, 340
contraindications of 142t
Anti-immunoglobulin E 108, 111
Anti-inflammatory 421, 422, 425, 428, 429
agents 393, 464
controller drugs, long-term 107
Antileprosy drugs 303
Antimalarial 260, 477, 491
drugs 304, 305
therapy 81, 82
Antimicrobial 485
agents 467
dosages of 467t, 469t
therapy, guidelines for 3
Antimycobacterial drug 299, 304
Antineoplastic 397
Antiparasitic drugs 313
Antiprotozoal 313
drug 305
Antipseudomonal penicillins 40
Antipsychotic 261
drug 403, 410
Antipyretics 393
Antiretroviral drug 9294, 327
therapy, principle of 94
Antispasmodics 249, 384, 385, 387
Antistaphylococcal penicillin 40, 290
Antithyroid agent 428
Antithyroid drug 430
Antitoxins 239
Antituberculosis drugs 75t, 295, 300, 301
dosages of 77t
first line 298
second-line 284, 301303
Antituberculous agents 472
Antiulcer agent 389
Antivenin serum polyvalent 441
amount of 441t
Antiviral 472
agent 321
drugs 318
Anuria 392, 455
Anxiety 362, 404, 406
Anxiolytic 362, 404, 406, 413
agent 402
Apnea, neonatal 370
Arrhythmias 347, 349, 354
digoxin-induced 366
life-threatening 349, 354
Arsenic poisoning 250, 459
mild 250
moderate 250
Artemether 83, 304
Artemisinin combination therapy 81
Arterial vasodilator 347
Artesunate 82, 304
Arthritis 20, 397
Arthropod infestations 89
Ascariasis 86, 311
Ascorbic acid 431, 434
Aspartate aminotransferase 293
Aspergillosis 96
allergic bronchopulmonary 96
invasive pulmonary 96
Aspirin 393
Asplenia 205
Astemizole 410
Asthma 370, 371, 458
acute 429
attack of 377, 378, 455
bronchial 371, 372, 374, 377
chronic 378
bronchial 371, 378
drugs for 370
exacerbation, severe 113
exercise induced 379
intermittent 108, 109
management of 107
mild persistent 108, 109
moderate persistent 108, 109
nocturnal 371
severe persistent 108, 109
severity of 107
stepwise treatment of 109
various categories of 108t
Ataxia 369
Atenolol 139, 342, 473
poisoning 251
Atomoxetine 442
Atorvastatin calcium 443
Atovaquone 84, 307
Atresia, biliary 466
Atrial fibrillation 148, 352, 355
Atrial flutter 148, 352, 355
Atrioventricular block, third-degree 149
Atropine 157, 257
sulfate 443
Attack
acute 370
termination of 147
Attention-deficit hyperactivity disorder 457
selective treatment of 442
Auranofin 394
Azatadine maleate 411
Azathioprine 444
Azithromycin 25, 49, 268
Azlocillin 40
Aztreonam 52, 269, 467
B
Bacillus calmette-guérin 204
vaccine 79, 204, 205, 207
Baclofen 444
Bacteremia 24
Bacteroides fragilis 58
meningitis 33
Balantidiasis 88
Balantidium coli infection 88
Bambuterol hydrochloride 371
Barbiturate 365, 408
Basic life support 151
Beclomethasone dipropionate 371
Beef tapeworm 87
Benadryl 258
Benazepril 137
Benzathine 468
Benzodiazepine 362, 406
poisoning 251
Benztropine 258
Beriberi 432
Beta-lactamase inhibitor 41, 266, 268, 272, 294
Betamethasone 421
Beta-nonselective adrenergic blocker 345
Bethanechol 382
Bisacodyl 382
Bisoprolol 131, 342
Bites 4
animal 238t
Bleeding tendency 396
Blood 168
component therapy 196
loss, acute 196
pressure 161
diastolic 135, 136
levels 135, 136
systolic 135, 136, 174
urea nitrogen 256
Body surface area nomogram and equation 504
Bone marrow
suppression 320
transplant 448
Bordetella pertussis 58
Brain abscess 17
Breast abscess 35
Bretylium 157, 474
British anti-Lewisite 250, 255, 256, 444
Broad spectrum 278, 368
antibiotic 284
Bronchitis, acute 9
Bronchodilator 370, 376, 380
inhalation 185
inhaled short-acting 113
Brugia malayi 86
Brugia timori 86
Budesonide 371
Bumetanide 390
C
Caffeine citrate 444
Calcitriol 431
Calcium
channel blocker 138, 251, 260, 341, 341t, 345, 348, 355, 451
chloride 157, 251, 445
disodium
ethylenediaminetetraacetic acid 255, 256
gluconate 251, 445
leucovorin 317
salts 251
supplements 446
Campylobacter jejuni 58
Candesartan 137, 343
Candidiasis 96
neonatal 97
oral 96, 333
systemic 97
Capreomycin 301
Captopril 130, 342, 473
Carbamazepine 356, 473
Carbapenem 51, 66
resistant enterobacteriaceae, treatment of 69
Carbenicillin 269, 471
Carbimazole 422
Carbon monoxide poisoning 252
Carbonate 446
Carbonic anhydrase inhibitor 389
Carboxyhemoglobin 252
Carboxypenicillin 269
Cardiac arrest 445, 446, 463
Cardiac arrhythmias
drugs for 350
management of 147
Cardiovascular system 120, 145
Carnitine 446
Carvedilol 131, 343
Caspofungin 96, 331
Catecholamine refractory
shock 466
vasodilatory septic shock 431
Cefaclor 42, 270
Cefadroxil 41, 270
Cefazolin 41, 270, 467, 471
Cefdinir 271
Cefepime 46
hydrochloride 271
Cefixime 25, 44, 272
Cefoperazone 46, 272
Cefotaxime 26, 43, 273, 467, 471
Cefotetan 42
disodium 273
Cefoxitin 42, 471
sodium 273
Cefpirome 46, 274
Cefpodoxime 43
proxetil 274
Cefprozil 42, 274
Ceftaroline 275
fosamil 275
Ceftazidime 4, 45, 275, 467, 471
Ceftibuten 44, 276
Ceftizoxime 45, 276
Ceftriaxone 26, 43, 467, 471
sodium 276
Cefuroxime 42, 277, 471
axetil 42
Cellulitis 3, 4, 35
retropharyngeal 6
Central nervous system 87, 119, 143, 161
infections of 13, 98
Central venous pressure 161, 163
Cephalexin 41, 277
Cephalosporin 41, 471, 486
fifth-generation 275
first-generation 270, 277
fourth-generation 271, 274
second-generation 270, 273, 274, 277
third-generation 271276
Cephalothin 471
Cerebral
edema 187, 368, 392, 424, 455
perfusion pressure 187
Cerebrospinal fluid 187
Cervical adenitis 5
Cetirizine 411
Chancroid 22
Chelation, drugs for 250
Chemoprophylaxis
against malaria 84
antimicrobial 70
antiviral 72
indications for 78
Chemotherapy 420
prevention of 418
Chlamydia trachomatis 23, 34, 58
Chloral hydrate 402
Chloramphenicol 25, 50, 278, 468, 472, 486
Chloroquine 80, 84, 260, 305, 313, 474
resistant Plasmodium falciparum malaria 304, 306
Chlorpheniramine maleate 411
Chlorpromazine 258, 261, 403, 416
Chlorpropamide 260
Chlorthalidone 390
Chlorzoxazone 447
Cholecalciferol 434
Cholera 18
vaccine 232
Cholestasis 466
Cholestyramine resin 447
Cholinergic agent 382, 457
Cholinesterase inhibitor 457, 462
insecticides 257
Chorea 416
Chorionic gonadotropin 422
Chorioretinitis 36
Ciclesonide 372
Cilastatin 66, 284
Cimetidine 383, 474
Ciprofloxacin 26, 47, 278, 472, 486
Citrate solutions 447
Clarithromycin 49, 279, 487
Clavulanate 40, 41, 296, 471
Clavulanic acid 266
Clemastine 412
Clindamycin 4, 51, 279, 468, 472, 487
Clobazam 357
Clofazimine 303
Clofazine 303
Clonazepam 357
Clonidine 139, 344
Clostridium difficile 59
Clostridium tetani 59
Clotrimazole 331
Cloxacillin 40, 280
Coccidioidomycosis 97
Codeine 260, 394, 472
Colistimethate 54
sodium 280
Colistin 54, 67, 69, 280
Colitis 88, 318
amebic 314
pseudomembranous 314
Common poisoning, antidote for 249
Community-acquired
infection 24
pneumonia 9
Complete heart block 149
Complex partial seizures, adjunctive therapy for 368
Congenital syphilis, asymptomatic 292
Congestive heart failure 127, 141, 142, 351t
management of 128
pathophysiology of 127
pharmacotherapy in 127
Conjunctivitis, gonococcal 23
Conscious sedation 363
Constipation, chronic 385
Continuous ambulatory peritoneal dialysis 67
Corticosteroid 205, 371, 375, 425, 430
administration 185
adrenal 424
inhaled 107, 110
role of 189
systemic 112, 113
therapy, daily inhaled 110
Cortisone acetate 422
Corynebacterium diphtheriae 59
Cosmetics 247
Cotrimoxazole 281
Cough 372
Cromolyn 373
Cryoprecipitate 199
Cryptococcosis 98
Cryptorchidism, prepubertal 422
Cryptosporidiosis 88, 315
Cutaneous larva migrans 86
Cyanide poisoning 252
Cyanocobalamin 434
Cyanotic spell 349
management of 397
severe 463
Cyclizine 447
Cyclophosphamide 448
Cycloserine 302
Cyproheptadine 412
Cystic fibrosis 466
Cysticercosis 86, 87
Cystitis, acute 21
Cytomegalovirus 90, 320
D
Dapsone 303
Daptomycin 52, 53, 282
Datura 249
Deep sedation 188
Deferiprone 255, 449
Deferoxamine 255, 449
mesylate 253, 254
Dehydration 99, 100
assessment of 99
grade of 100
hypotonic 103
prevention of 178
prompt treatment of 178
severe 102
status, assessment of 100t
Dehydroemetine hydrochloride 313
Demeclocycline 282
Dengue
management of 171
mild 171
moderate 171, 172fc
severe 173
shock syndrome 170
Depression 405, 458
Desmopressin acetate 423
Dexamethasone 423
Dextran 449
Dextromethorphan 449
Diabetes
insipidus 423, 431, 466
mellitus 144, 219, 227, 346, 392
Diabetic ketoacidosis 179, 426
diagnostic features of 181
management of 181
Diaper dermatitis 96
Diarrhea 99
acute 386
chronic 386
secretory 458
Diazepam 121, 358, 403, 473
intravenous 120
Diclofenac sodium 394
Dicloxacillin 40
Dicyclomine hydrochloride 383
Didanosine 325
Dietary deficiency 433
Diethylcarbamazine 310
Digitalis 131
poisoning 252
Digoxin 131, 335, 351, 473
Diloxanide furoate 313
Diltiazem 260, 473
Dimenhydrinate 417
Dimercaptosuccinic acid 250, 255, 449
Dimethindene maleate 413
Diphenhydramine 258, 413
Diphtheria 6, 70, 233
antitoxin 239
pertussis and tetanus 233
vaccine 212, 213
tetanus
and acellular pertussis 204
and pertussis combined vaccines 216
and whole-cell pertussis 204
toxoid vaccine 214
toxoid 214
Diphyllobothrium latum 87
Directly observed treatment short-course strategy 74
Disopyramide 260, 352
Disseminated intravascular coagulation 198
Diuretics 129, 138, 389, 473
Dizziness 369
Dobutamine 132, 157, 165, 336
Docusate 383
Domperidone 417
Dopamine 132, 157, 165, 336
Doxapram hydrochloride 449
Doxycycline 4, 49, 84, 282
D-penicillamine 256
Drug
guidelines for choice of 86
hematologic adverse effects of 480
regimen 75
therapy 1, 74, 80, 115, 136, 142, 164, 184
principles of 108
Dysentery 18
Dysplasia, bronchopulmonary 424
Dyspnea 253
Dystonic reaction, acute 258
E
Echinococcosis 86
Echinococcus granulosus, intermediate stage infection of 87
Ectopic tachycardia, postoperative junctional 148
Edema 393
Efavirenz 325
Eikenella corrodens 59
Electrocardiogram 106, 153, 156
monitor 104
Electrocardiography 161
Electroencephalogram 115
Electrolytes 99
Emergency drugs 156t
Emesis, chemotherapy-induced 418
Emetic 453
Empyema 12
Enalapril 130, 137, 344, 473
maleate 344
Enalaprilat 137, 344
Encephalitis 17
Encephalopathy, hepatic 385
Endocarditis 27
bacterial 72
gonococcal 23
prosthetic value 67
Endocrine disorders, drugs for 421
Enteric fever, uncomplicated 25
Enterobius vermicularis 86, 87
Enteroviral infections 33
Enuresis 404
nocturnal 407, 423, 458
Envenomation, severity of 441
Eosinophilia, tropical pulmonary 86, 310
Epididymitis 22
Epiglottitis 8
Epilepsy 115
partial 369
Epinephrine 132, 156, 165, 185, 337, 373
Epistaxis 372
Eplerenone 138
Epsilon aminocaproic acid 450
Eptoin 367
Equine rabies immunoglobulin 242
Ergotamine 450
Ertapenem 66
Erysipelas 3
Erythromycin 49, 282, 468, 487
Erythropoietin 436
Escherichia coli 31, 59
Esmolol 344
Esomeprazole 384
Ethacrynic acid 391
Ethambutol 76, 77, 301, 472
Ethanol 451
Ethionamide 302
Ethosuximide 359
Ethylene glycol poisoning 252
Ethylenediaminetetraacetic acid 256, 450
Etrapenem 51
Extended-spectrum penicillin 293, 296
F
Fab antibodies, digoxin-specific 252
Famotidine 384
Fatal hepatic failure 369
Fatigue 369
Febrile seizure 124, 363
types of 124t
Felbamate 359
Felodipine 138
Fentanyl 395, 473
Fever 320
acute rheumatic 393
severe enteric 26
Fexofenadine 413
Filariasis 86
lymphatic 310
Fixed drug combination 75
Flecainide 474
acetate 352
Fluconazole 331, 472
Flucytosine 332
Fludrocortisone acetate 424
Fluid 99
choice of 163
overload 173
therapy 162, 166
Flumazenil 251, 451
Flunarizine 451
Fluoroquinolone 47, 278
Fluoxetine hydrochloride 403
Fluticasone propionate 374
Folate deficiency anemia, treatment of 437, 437t
Folic acid 437
Fomepizole 252, 256
Foot-puncture wound, osteomyelitis of 20
Formoterol fumarate 374
Foscarnet 320
Fosfomycin 54
Fosinopril 137
Fosphenytoin
intravenous 121
sodium 359
Fulminant intestinal disease 88
Fungal infections 29
serious systemic 329
severe 329
Furazolidone 283, 314
Furosemide 158, 391, 473
Fusidic acid 55
Fusion inhibitor 94
G
Gabapentin 360, 473
Ganciclovir 321
Gastric acid
proton pump inhibitor 386
secretion inhibitor 386
Gastric ulcer 388
Gastritis 19, 19t
Gastroenteritis, acute 17, 99
Gastroesophageal reflux 382, 417
disease 384, 386
Gastrointestinal infections 17
Gastrointestinal tract 258
Gatifloxacin 48
Genitourinary infections 21
Genotropin 425
Gentamicin 48, 283, 469, 471
Giardiasis 88, 314, 315, 318
Gingivostomatitis 6
Glaucoma 384, 390
Glibenclamide 260
Glipizide 260
Glubionate 446
Glucagon 251, 452
Glucose
6-phosphate dehydrogenase deficiency 80
infusion 426
Glucostix 123
Glycopeptide 51
antibiotic 297
Glycopyrrolate 452
Glycosides, cardiac 473
Glycylcycline 53
Goiter, nontoxic 427
Gonococcal infection, disseminated 23
Gonorrhea 23
Gram-negative enteric bacteria 33
Granisetron 417
Granulocyte colony-stimulating factor 437, 451
Griseofulvin 332
Group A streptococcal infection, treatment of 292
Growth hormone deficiency 425
H
Haemophilus ducreyi 22, 60
Haemophilus influenzae 3, 60, 125
type B 204, 216, 218
vaccine 217, 218
Hallucinations 258
Haloperidol 403
Havrix vaccine 222
Heart
disease, congenital 128, 461
rate 152, 153, 156
Helicobacter pylori 19, 19t, 60
Helminthic infection 86
treatment of 86
Hemarthrosis 440
Hematinics 436
Hematocrit 172
Hematoma, significant subcutaneous 440
Hematuria 441
Hemochromatosis, primary 254
Hemophilia
A 191193, 423, 440
bleeding in 440
management of 191
mild 191
moderate 191
severe 191
Hemorrhage
iliopsoas 441
life-threatening 440
variceal 431, 466
Hemorrhagic disease 436
Heparin
poisoning 253
sodium 452
Hepatic disease 485
Hepatitis
A 204, 236
pre-exposure prophylaxis 237t
vaccine 206, 222, 223
virus 222
B 204, 206, 218, 236
chronic 90, 321
immunization 209
immunoglobulin 204, 240
vaccine 204, 209, 210, 217, 223
virus 209
C, chronic 90
active 321, 322
Heroin 257
Herpes meningoencephalitis 33
Herpes simplex 90, 318, 320
infection 24
virus 17, 318
infection 318
Herpes zoster 319
Histamine-2 receptor antagonist 185, 383, 384, 388
Histoplasmosis 98
mildly symptomatic acute pulmonary 98
Hookworm 87, 309, 311, 312
Hormones 421, 491
Hospital-acquired pneumonia 12
Human bovine pentavalent rotavirus live vaccine RV5 211
Human growth hormone 425
Human immunodeficiency virus 10, 92
drug 324, 328
antiretroviral 326
immunization of 205
infection 327
antiviral drug for 326
treatment of 328
management of 93t
treatment
guidelines for 92
NACO guidelines for 92
Human monovalent rotavirus live vaccine RV1 211
Human normal immunoglobulin 241
Human papillomavirus 204
vaccine 207, 225
Human rabies immunoglobulin 229, 242
Humatrope 425
Hydatid cyst 309
Hydatid disease 87
Hydralazine 345, 473
Hydration status 100
Hydrochlorothiazide 391
Hydrocortisone sodium succinate 375, 425
Hydroquinone 248
Hydroxyzine 413
hydrochloride 404
Hymenolepis nana 87
Hyoscine butylbromide 385
Hyperbilirubinemia 366
Hypercalcemia 256
Hypercyanotic attacks, management of 177, 177t
Hyperkalemia 446
acute 104
correction of 463
mild-to-moderate 104
severe 104, 426
Hypernatremia 103
Hypersensitivity 253
Hypertension 134, 135, 141, 141t, 343, 347349, 393
choice of drugs in 140
chronic 348
classification of 134
intracranial 187
pharmacotherapy in 134
portal 431, 466
stages of 134, 135
Hypertensive crisis, preoperative management of 348
Hypertensive emergency 134, 142, 143, 348
drugs for 144t
Hypertensive urgency 142, 146
Hyperthyroidism 422
Hypertonic saline 189
Hypnotics 402
Hypocalcemia 166, 431, 445
neonatal 426, 445
prevention of 434
Hypoglycemia 123, 179
Hypoglycemic
agent 456
oral 260
Hypogonadism, hypogonadotropic 422
Hypokalemia 102, 105
acute 104
asymptomatic 106
management of 106
Hypomagnesemia
severe 454
symptomatic 454
Hyposplenia 205
anatomic 217
functional 217
Hypotension 253, 339
orthostatic 258
severe 362
Hypothyroidism 427
congenital 427
Hypovolemia 439
I
Ibuprofen 395
Idiopathic thrombocytopenic purpura 240
Imipenem 51, 66, 284, 469, 472
Imipramine 261, 404
Immunization
active 203
regime, primary 212
schedule 203, 215
Immunoglobulin 239
intravenous 240
Impetigo 35
Indian Academy of Pediatrics Immunization Schedule 204t
Indinavir 326
Infantile spasms 356, 421
Influenza 72
A 91
B 91
vaccine 227
inactivated 206, 227
Inorganic mercury poisoning 250
Insulin 252, 426, 474
therapy, alternative regimens of 180
types of 180t
Integrase strand transfer inhibitors 94
Intensive care unit 114, 132, 145
Intestinal disease, mild-to-moderate 318
Intestinal infection, adult 87
Intestinal luminal amebiasis, asymptomatic 88
Intestinal nematodes 312
Intracranial pressure 187
Invasive intestinal disease, mild-to-moderate 88
Iodine 428
Ipecac syrup 453
Ipratropium 113
bromide 376
inhalation 114
Iron 438
deficiency, total replacement of 438
oral 178
overload, chronic 254
poisoning 253
Isoniazid 77, 298, 472, 487
poisoning 255
antidote for 433
Isoprinosine 321
Isoproterenol 132, 158, 166, 338
Isradipine 138, 345
Itraconazole 96, 332, 472
J
Japanese encephalitis 231
vaccine 231
inactivated vero cell-derived 231
K
Kanamac 303
Kanamycin 284, 302, 469, 471
Kawasaki disease 241, 393
Ketamine 405
Ketoconazole 333, 472
Ketolide 56
Ketorolac 396
Ketotifen 376, 454
L
Labetalol 345
Lactase 454
Lactate salts 446
Lactulose 385
Lamivudine 326
Lamotrigine 360
Lansoprazole 386
Lead
intoxication 459
poisoning 255
Leishmaniasis 88, 329
Lennox-Gastaut syndrome 357
Leprosy 303
Leukotriene receptor antagonist 108, 110, 377, 381
Levalbuterol nebulized 113
Levetiracetam 124, 361
Levocetirizine 414
Levofloxacin 48, 285
Levosalbutamol 112, 376
Levothyroxine sodium 430
Lice 89
Lidocaine 124, 156, 353, 474
Lincomycin 285
Lincosamide 51
antibiotic 279, 285
Linezolid 52, 53, 66, 286, 487
Liothyronine 427
Lipoglycopeptide 51
Lipopeptide 52
Lisinopril 137, 346
Listeria monocytogenes 33, 61
Lithium 405
Liver abscess 314
amebic 88, 318
Löffler pneumonia 310
Long QT syndrome 149, 349
Loop diuretics 130, 138, 390, 391
Loperamide 386
Lopinavir 326
Loratadine 414
Lorazepam 120, 124, 362, 406, 473
intravenous 120
Losartan 137, 346
Low dose infusion 336
Loxapine 261
Ludwig's angina 5
Lugol's solution 428
Lung abscess 13
M
Macrolide 49
antibiotic 268, 279, 282
Magnesium sulfate 114, 377, 454
Malaria 70, 80, 89, 305
chemoprophylaxis 80
treatment 80
complicated 307
severe 307
uncomplicated 304
Malarone 84
Mania, acute 405
Mantoux test 78
Mast cell stabilizer 373
Mastoiditis, acute 8
Measles 206, 233
mumps, and rubella 204
vaccine 220
prophylaxis 241
vaccine 220
Mebendazole 311
Meclizine 455
Mediastinal disease, mild 98
Mefenamic acid 397, 456
Mefloquine 84, 306, 487
Meningitis 31, 70, 468
bacterial 13, 15t, 424
gonococcal 23
neonatal 17, 32, 34, 292
Meningococcal vaccines 227
Meperidine 400, 473
Mercury poisoning 250, 256
Meropenem 51, 66, 286, 469, 487
Metformin 456
Methanol poisoning 252, 256
Methdilazine hydrochloride 414
Methemoglobinemia 256
Methicillin-resistant staphylococcus
aureus 56, 66, 67
infection 32
treatment of 68
epidermidis 66
Methocarbamol 456
Methotrexate 397
Methyldopa 139, 473
Methylene blue 256, 457
Methylphenidate 457
Methylprednisolone sodium succinate 428
Metoclopra 474
Metoclopramide 417
toxicity 258
Metolazone 392
Metoprolol 131, 139, 347
Metronidazole 52, 314, 469, 472, 487
Mezlocillin 40
sodium 287
Micafungin 96
Miconazole 333
Micronutrients 436
Midazolam 121, 124, 362, 406, 473, 474
infusion 122
intravenous 120
Migraine 450
headache, intractable 419, 460
prophylaxis 349
Milrinone 133, 338
Miltefosine 315
Minimal potential fatal dose 260
Minocycline 49, 287
Minoxidil 347
Monobactam 52
antibiotic inhibitor 269
Moraxella catarrhalis 61
Morphine 257, 397, 473
Motion sickness 417, 420
Mouth bleeding 440
Moxifloxacin 48
Multidrug-resistant
bacterial pathogens, treatment of 68
tuberculosis, second-line drug in 302
Muscle 440
relaxant 444
Myasthenia gravis 462
treatment 457
Mycoplasma pneumoniae 61
N
N-acetylcysteine 249
Nafcillin 40, 468, 471
sodium 287
Nalidixic acid 288, 487
Naloxone 158, 257, 457
Naproxen 398
Narcotics 260, 395, 472
analgesics 497
overdose poisoning 257
Nasal irritation 372
National AIDS Control Organisation 92
Nausea 416, 420
Necrotizing funisitis 35
Neisseria gonorrhoeae 61
Neisseria meningitidis 62
Nelfinavir 327
Neomycin 288
Neonatal intensive care unit 31
Neonatal seizures 115, 363, 408
management of 122
Neonatal sepsis
early-onset 32
late-onset 32
Neostigmine 457
Nephrotic syndrome 429, 448
Nephrotoxicity 320
Nervousness 258
Netilmicin 48, 289, 469
Neuritis, drug induced 433
Neurocysticercosis 309
Neuromuscular blocking agent 464
Neurosyphilis 24
Neutral protamine Hagedorn 180
Neutropenia, reduces duration of 437
Nevirapine 327
Nicardipine 138
Nifedipine 138, 251, 260, 348, 473
Nimesulide 398
Nitazoxanide 315
Nitrazepam 363
Nitrofurantoin 55, 289
Nitroprusside 473
Nondigitalis inotropic agents 132
Non-nucleoside reverse transcriptase inhibitor 94, 325327
Nonselective beta-adrenergic blocker 349, 354
Nonsteroidal anti-inflammatory
agents 108
drug 111, 171, 394398, 400, 401
Norditropin 425
Norepinephrine 165, 339
reuptake inhibitor 442
Norfloxacin 47, 289
Nortriptyline hydrochloride 407, 458
Nucleoside reverse transcriptase inhibitor 93, 324, 328
Nystatin 333
O
Octreotide 458
Ofloxacin 26, 47, 290
Oliguria 392, 455
Olmesartan 137, 348
Omalizumab 111
Omeprazole 386
Omphalitis 35
Ondansetron 418
Oral corticosteroids
systemic 108
use of 112
Oral poliovirus vaccine 204
Oral rehydration solution, administration of 99
Orbital cellulitis 8
Organophosphate poisoning 257
Oropharyngeal candidiasis 97
Oseltamivir 322
Osteomyelitis 20, 35
acute 20
chronic 20
Otitis media 7, 35
Oxacillin 40, 290, 468
Oxazolidinone 52
antibiotic 286
Oxcarbazepine 363
Oxybutynin 387
Oxygen administration 113, 162
Oxyphenonium bromide 387
Oxytetracycline 291
P
Packed red blood cell
transfusion 196
volume of 196
Pain
moderate acute 396
severe acute 396
Pancuronium 458
Pantoprazole 387
Para-aminosalicylic acid 303
Paracetamol 399
Paraldehyde 364, 408
Parasitic infection, treatment of 86
Parenteral therapy 26, 250
Parkland fluid replacement formula 502
Paromomycin 315
Pasteurella multocida 4, 62
Pediatric
advanced life support 150
antiretroviral therapy 95
basic life support 151fc
bradycardia advanced life support 153fc
drug formulary 265
life support 150
pulseless cardiac arrest advanced life support 154fc
tachycardia advanced life support 155fc
Pediculosis 89
Pefloxacin 47, 291
Peginterferon 322
Penicillamine 255, 459
Penicillin 4, 39, 40, 296, 468, 471
allergy 72
G 39, 468, 471
aqueous 291
benzathine 292
procaine 292
penicillinase resistant 280, 287
V 39
potassium 293
Pentamidine isothionate 316
Pentazocine 257, 399
Pentobarbital 365, 408
coma 408
Peptic ulcer 384, 388
Pericarditis
purulent 28
tuberculous 28
Perinephric abscess 22
Perirectal abscess 19
Peritonitis 27
acute
primary 27
secondary 27
Pertussis 13, 70, 234
antimicrobial prophylaxis of 235t
Pethidine 257, 400
Pharmacotherapy 123
guidelines for 107
Pharyngitis 5, 372
Phenazopyridine 400, 459
Pheniramine maleate 414
Phenobarbital 473
Phenobarbitone 365, 408
high dose 122
Phenothiazine 258, 409, 415, 419
derivative 409
group 419, 460
Phentolamine mesylate 348
Phenylephrine 166, 353
hydrochloride 339
Phenytoin 353, 366, 474
intravenous 121
Pheochromocytoma 347
diagnosis 348
surgery 348
Phosphodiesterase inhibitors 133
Physostigmine 249, 459
Phytonadione 259, 436
Pinworm 87, 309, 312
Pipenzolate methyl bromide 388
Piperacillin 4, 40, 294
sodium 293
Piperazine 488
citrate 311
Piracetam 460
Pirbuterol 112
Piroxicam 400
Plasma
transfusion 198
volume expander 449
Plasmodium falciparum 81
malaria, uncomplicated 81
chloroquine resistant 308
Plasmodium ovale malaria 306
Plasmodium vivax malaria 306
uncomplicated 80
Platelet
rate of transfusion of 198
transfusion 197
role of 173
Pneumococcal conjugate vaccine 204, 218
Pneumococcal polysaccharide vaccine 219
Pneumococcal vaccine 206, 218
Pneumocystis carinii 89
Pneumocystis jirovecii pneumonia 89
Pneumonia 9, 34
diffuse 97
necrotizing 13
neonatal 34
nosocomial 34
severe 10
Polio vaccine 203, 206, 207
Poliovirus vaccine, inactivated 204
Pork tapeworm 87
Posaconazole 96
Potassium
chloride 106, 460
iodide 428
level, serum 104
removing resin 463
sparing diuretic 138, 392, 393
Pralidoxime 257, 460
Praziquantel 312
Prednisolone 114, 429
intramuscular 113
intravenous 113
oral 113
Prednisone 429
Prehypertension 134
Prematurity
anemia of 436
apnea of 370, 444
Primaquine 306
Primidone 367
Procainamide 156, 157, 260, 353, 474
Procaine 468
Prochlorperazine 258, 419, 460
Proguanil 84, 307
Promethazine 258
hydrochloride 409, 415, 419
preparations 415
theoclate 420, 461
Propafenone 355
Propantheline bromide 388
Propofol 367
infusion 122
Propranolol 349, 354, 473
oral 178
poisoning 251
Propylthiouracil 430
Prostigmine 457
Protamine sulfate 253, 461
Protease inhibitor 94, 326, 327
Proteus mirabilis 62
Proton pump inhibitor 384, 387
Protozoal infection 88
treatment of 86
Pruritus 404
Pseudoephedrine 461
Pseudomonas 20, 31, 33, 34
aeruginosa 3, 62, 66
infection 36
Pseudotumor cerebri 390
Pulseless electrical activity 154
Pyelonephritis, acute 21
Pyoderma 5
Pyrantel pamoate 312
Pyrazinamide 76, 77, 300, 472
Pyrexia 397
Pyridostigmine 462
Pyridoxine 124, 255, 433
dependent persistent neonatal seizures 433
Pyrimethamine 309, 316
Pyritinol 462
Q
Quinapril 137
Quinidine 260, 474
phenylethyl-barbiturate 355
sulfate 355
Quinine 260, 488
dihydrochloride 307
intramuscular 83
intravenous 83
sulfate 308
Quinolone 486
antibiotic 290
first-generation 288
group antibiotic 291, 294
R
Rabies 237
exposure, categories of 230t
immunoglobulin 242
vaccine 229
Radiation 420
Raised intracranial pressure 390
Ramipril 137
Ranitidine 388, 474
Rapid diagnostic test 81
Rash 320
Rat-bite fever 5
Red blood cell 172, 174
Renal abscess 22
Renal disease 391
Renal failure 396, 432, 470
acute 254, 462
chronic 437
Respiratory syncytial virus 34, 91
monoclonal antibody against 242
Respiratory tract infections, lower 8
Resuscitation
cardiopulmonary 151, 154
neonatal 152fc
Retinitis 320
Revised National Tuberculosis Control Program 74, 77, 77t
Rheumatic fever 71
prophylaxis 292, 293
Rheumatoid arthritis 393, 396, 459
juvenile 394, 397
Rhinitis, allergic 372
Ribavirin 323
Riboflavin 433
Ribonucleic acid 92
Rickets
prevention of 434
treatment of 435
Rickettsial infection 29
Rifampicin 67, 76, 77, 299, 303, 304
Rifampin 52, 472
Rimantadine 323
Ritonavir 326
Rotavirus vaccine 206, 211
Roundworm 87, 309
Roxithromycin 49, 294
S
Salbutamol 112, 113, 378
nebulization 114
Salicylates 258
Salmeterol 378
Salmonella gastroenteritis 18
Scabies 89, 310
Schistosomiasis 87
Scurvy 434
Sedation 358, 362, 363, 368, 406, 408, 420
preoperative 363, 404
Sedatives 402
Seizures
multiple types of 363
myoclonic 363
partial 359, 363, 366
persistent 121
refractory 390
termination of 120
types of 115, 116, 124
Selective serotonin re-uptake inhibitor 403
Semisynthetic macrolide antibiotic 294
Senna 389
Sennosides 389
Sepsis 24, 30
neonatal 31, 34
nosocomial 24
Septic shock 28, 166, 167fc
syndrome 28, 168
Sexually transmitted infections 21
Shigella infection 18
Shock 159, 169, 375, 426, 439, 449
anaphylactic 169
cardiogenic 169
cardiovascular drugs for 165t
compensated 174fc
early recognition of 162
hypotensive decompensated 175fc
impending 449
management of 159
stages of 162t
types of 160t
Short stature, idiopathic 425
Sick sinus syndrome 149
Sickle cell disease 71, 217
Simethiconet 389
Sinus rhythm 147
Sinusitis, acute 7
Skeletal muscle relaxant 456, 458
Skin
and soft tissue infections 3, 35
lighteners 248
pinch 100
Sodium
bicarbonate 258, 462
administration 183
cromoglycate 373
nitrite 252
polystyrene sulfonate 463
stibogluconate 317
thiosulfate 252
valproate 368
Somatropin 425
Sparfloxacin 48, 294
Spinal cord injury, acute 428
Spiramycin 317
Spironolactone 138, 392, 473
Staphylococcal scalded skin syndrome 5
Staphylococcus
aureus 3, 28, 31, 33, 63, 66
epidermidis 63, 66
saprophyticus 63
Status asthmaticus 113, 375, 425, 428
Status epilepticus 119, 358, 362, 364, 366, 368, 406, 408
management of 119
seizures 367
Stavudine 327
Steroids 168
role of 76
Streptococcal pharyngitis, acute group 293
Streptococcus
pneumoniae 64, 168
pyogenes 4, 64
Streptomycin 76, 77
sulfate 295, 300
Strongyloidiasis 87, 312
Succinylcholine 464
Sucralfate 389
Sulbactam 40, 268, 272
Sulfadiazine 295, 317
Sulfadoxine 309
Sulfamethoxazole 25, 50, 281, 295, 472
Sulfasalazine 464
Sulfonamides 488
Synthetic human growth hormone 425
Syphilis 23
congenital 36
T
Tachyarrhythmia, supraventricular 351t
Tachycardia 258
atrial 355
functional ectopic 350
supraventricular 147, 350, 352, 355
ventricular 148, 350, 355
Taenia saginata 87, 311, 312
Taenia solium 87
intermediate stage infection of 87
Tapeworm infections 87
Tazobactam 4, 294, 471
Teicoplanin 51, 68
Telavancin 51
Telithromycin 56
Tenofovir 328
Terbinafine 334
Terbutaline 112, 114
sulfate 379
Terfenadine 416
Tetanus 28, 36, 236
antitoxin 28
immunoglobulin 28, 242
neonatal 416
prevention of 236t
prophylaxis 216t
toxoid 214, 215
treatment of 243
Tetracycline 49, 295, 488
derivative antibiotic 282
group antibiotic 282
Tetralogy of Fallot 177, 177t, 349, 397
management 177
prevention 177
Theophylline 111, 260, 380
salt 380
combination preparations 381
Thiabendazole 312
Thiamine 432
Thiazide 130, 138
diuretic 390, 391
Thiopental sodium 368, 465
Thioridazine 261, 409
Thrombocytopenic purpura 429
Thrombosis 452
Thymidine analogues 93
Thyroidectomy, preoperative 428
Thyrotoxic crisis 428
Thyrotoxicosis 349, 422, 428
neonatal 428
Thyroxine sodium 430
Tiagabine 368
Ticarcillin 40, 41, 296, 468, 471
disodium 296
Tigecycline 53, 69
Tinidazole 318
Tobramycin 48, 297, 469, 471
Tolmetin sodium 401
Tonic clonic seizures, generalized 366
Tonsillopharyngitis 5
Tooth extraction 440
Topiramate 124, 368
Toxicity 249
Toxocara, larval infection of 88
Toxocariasis 87
Toxoplasmosis 89
acquired 316
congenital 36, 316
Tracheitis bacterial 9
Tramadol 401
Tranexamic acid 465
Tranquilizers 402
Triamcinolone 430
Triamterene 393
Trichinella spiralis 87
Trichinellosis 87
Trichomonas vaginalis 89
Trichomoniasis 22, 89, 314, 318
Trichuriasis 88
Triclofos sodium 410
Trifluoperazine 258, 410
Triflupromazine 420
Trimethoprim 25, 50, 281, 295, 472
Trovafloxacin 48
Tuberculosis 13, 71, 74, 78
childhood 74
infection 14
pulmonary 78
Typhoid
conjugate vaccine 222
fever 25
vaccines 222
Ulcerative colitis 464
Universal Immunization Programme 231
U
Upper respiratory tract infections 5
Ureaplasma urealyticum 34
Uric acid lowering agent 440
Urinary acidification 434
Urinary retention, nonobstructive 382
Urinary tract
infection 36
recurrent 71
obstruction 21
Ursodeoxycholic acid 466
Ursodiol 466
V
Vaccination, dose and schedule of 226
Vaccines 205
Vaginal infections 22
Vaginosis, bacterial 22
Valganciclovir 324
Valparin 369
Valproic acid 368
Valsartan 137, 350
Vancomycin 4, 51, 67, 297, 468, 472
resistant enterococcus, treatment of 69
Varicella 234
vaccine 207, 223
zoster
immunoglobulin 243
virus 91
Vasodilator 139, 341t, 345
Vasopressin 339, 431, 466
analog 423
Ventriculoperitoneal shunt infection 14
Verapamil 251, 260, 355, 473
Vertigo 417
Vibrio cholerae 64
Vigabatrin 369
Viral infection 90
treatment of 90t
types of 90, 91
Viral load 92
Visceral larva migrans 88, 310
Visceral leishmaniasis 315
Vitamin 431
A 432
B1 432
B12 434
deficiency 434
B2 433
B6 433
C 434, 436
D 434
analog 431
preparation 431
D3 434
E 435
K deficiency 436
K1 259, 436
Vomiting 416, 418420, 460
radiotherapy-induced 418
Voriconazole 96, 334
Vulvovaginal candidiasis 22, 96
W
Wernicke encephalopathy 433
Whipworm 88, 311
Whole-cell pertussis 216218
Wilson disease 459
Wound management 216t
Wuchereria bancrofti 86
X
Xerophthalmia 432
Y
Yersinia enterocolitica 65
Z
Zalcitabine 328
Zanamivir 324
Zidovudine 328
Zinc supplements 439
Zonisamide 369
×
Chapter Notes

Save Clear


1Drug Therapy2

Guidelines for Antimicrobial TherapyCHAPTER 1

It is crucial that antibiotics should be prescribed only when they are necessary for treatment following a clear diagnosis and that these be administered for the desirable, precise duration.
While choosing an antibiotic, the age of the child, his hepatic and renal status, history of allergy, comorbid condition; antibiotic sensitivity or resistance pattern of organisms in the local community or institution, culture sensitivity findings in the patients sample (if available) and the known effectiveness, limitations and potential adverse effects of the proposed antibiotic should be duly taken into account. As far as possible, a first-line simple antibiotic, which would suffice, should be chosen for treatment instead of the strong second-line one. In the event of hypersensitivity to the first-line antibiotic or lack of proper clinical response, suitable alternative second-line antibiotic may be employed.
Taking into consideration different important factors and the recommendations of various national and international regulatory bodies, guidelines for antimicrobial therapy in children have been described in this and following sections.
Note:For dosage, mode of use and other information regarding recommended drugs, see under the individual drug in “Pediatric Drug Formulary”.
 
SKIN AND SOFT TISSUE INFECTIONS
 
Cellulitis and Erysipelas (Nonpurulent)
(Mainly Group A Streptococcus, Staphylococcus aureus; in immunocompromised—Pseudomonas aeruginosa, Haemophilus influenzae type b, and others).4
 
Mild
Clindamycin or cephalosporin or cloxacillin per oral (PO).
 
Moderate
Ceftriaxone or cefazolin or clindamycin intravenous (IV).
 
Severe
Empirical: Vancomycin + piperacillin − tazobactam IV
Subsequently as per culture findings:
  • Monomicrobial Streptococcus pyogenes; or clostridia species:
    • Penicillin + clindamycin
  • Vibrio vulnificus
    • Doxycycline + ceftazidime
  • Polymicrobial
    • Vancomycin + piperacillin − tazobactam.
Duration of treatment: 10 days
 
Cellulitis, Buccal
H. influenzae type b, Pneumococcus:
  • Initial: Cefotaxime or ceftriaxone or cefuroxime IV/intramuscular (IM)
  • Alternative: Chloramphenicol IV
  • Later: Amoxicillin-clavulanate PO or a second or third generation cephalosporin PO
  • Duration of treatment: 7–10 days.
 
BITES
 
Dog, Cat, Other Animals, and Human
[Streptococci, S. aureus, S. epidermidis, Pasteurella multocida and canis (in animal bites), and Eikenella corrodens (in human bites)]
Amoxicillin-clavulanate PO
For severe infection: Ampicillin-sulbactam or ticarcillin-clavulanate IV.5
Alternative: Ampicillin + clindamycin IV.
For penicillin allergic patients: clindamycin + sulfamethoxazole.
 
Ludwig's Angina (Bilateral Submandibular Space Infection)
(Streptococcus species, anaerobes, Eikenella corrodens, and others)
  • Clindamycin or ticarcillin-clavulanate IV or
  • Piperacillin-tazobactam IV.
 
Pyoderma, Cervical Adenitis
(Streptococcal, Staph. aureus)
Cephalexin or cloxacillin PO × 5–10 days.
For serious infection: Cloxacillin or clindamycin IV.
 
Rat-bite Fever
(Streptobacillus moniliformis and Spirillum minus)
Penicillin G IV or procaine penicillin IM × 7–10 days, alternatives: Tetracycline, doxycycline, gentamicin, or streptomycin (in penicillin allergic patients).
 
Staphylococcal Scalded Skin Syndrome
  • Initial: Cloxacillin or nafcillin; vancomycin [if methicillin-resistant Staphylococcus aureus (MRSA)] PO/IV
  • Later: Add clindamycin.
 
OROPHARYNGEAL, NOSE, EAR, EYE, AND UPPER RESPIRATORY TRACT INFECTIONS
 
Pharyngitis, Tonsillopharyngitis
[(Group A β-hemolytic Streptococcus (GABHS)]
  • For patients who are not allergic to penicillin:
    • Amoxicillin 50 mg/kg/day (max 1 g) div q 8–12 h PO × 10 days6
    • Penicillin V (i) wt <27 kg: 250 mg q BD; weight >27 kg: 500 mg div. in BD PO × 10 days.
    • Benzathine penicillin (i) wt <27 kg: 600,000 units; >27 kg: 1.2 million units in single dose
  • For penicillin allergic patients:
    • Erythromycin ethylsuccinate 40 mg/kg/day (max 1 g) div. in BID × 10 days PO
    • Azithromycin (12 mg/kg/day × 1 day; then 6 mg/kg/day div. in OD × 4 days PO
    • Clarithromycin 15 mg/kg/day (max 500 mg/day) div. in BID × 10 days PO.
  • For those with only type 1 allergy to patients:
    • Cefaclor 20−40 mg/kg/day (max 1.8 g/day) div. in TID × 10 days PO
    • Cephalexin: 50 mg/kg/day div in q 6–8 hr PO × 10 days.
  • For recurrent GABHS culture positive pharyngitis and streptococcal carriers:
    • Clindamycin 20 mg/kg/day div in TID PO × 10 days; (adults—150−450 mg/dose q TID PO)
    • Alternative: Amoxicillin-clavulanate @ amoxicillin 40 mg/kg/day up to 2000 mg/day div in TID × 10 days.
 
Retropharyngeal Cellulitis or Abscess
(Group A Streptococcus, oral anaerobes, staphylococci, H. influenzae, and Klebsiella)
Clindamycin or ampicillin-sulbactam + cefotaxime or ceftriaxone IV × several days; when improved PO (clindamycin + cefdinir or cefpodoxime).
 
Gingivostomatitis
(Herpetic)
Acyclovir × 7 days; for mild infection—PO; for severe cases—IV.
 
Diphtheria
  • Erythromycin 40–50 mg/kg/day div. in q 6 h PO (max 2 g/day) × 14 days7
  • Or Procaine penicillin: <10 kg: 300,000 units/dose OD IM × 14 days
    >10 kg: 600,000 units/dose OD 1M × 14 days
  • Or Aqueous crystalline penicillin 100,000–150,000 U/kg/day. div q 6 hr IV/IM × 14 days.
PLUS diphtheria antitoxin (see under “immunoglobulins and antitoxins” for dosage). Antitoxin is the mainstay of therapy.
Note:Parenteral penicillin is recommended till the patient is unable to swallow. It is followed by oral erythromycin (total duration 14 days).
 
Otitis Media (Acute)
 
Initial Treatment
  • Amoxicillin 40–90 mg/kg/day div q BID × 7–10 days
  • or amoxicillin clavulanate (amoxicillin 40–90 mg/kg/day) div q BID × 7–10 days
  • or ceftriaxone 50 mg/kg IM/IV × 3 doses on alternate days
If patient allergic to penicillin:
  • Cefdinir 14 mg/kg/day div in OD/BID × 7–10 days
  • Or cefuroxime 30 mg/kg/day div in BID × 7–10 days
  • Or cefpodoxime 10 mg/kg/day div in BID × 7–10 days
  • Or ceftriaxone 50 mg/kg IM/IV × 3 doses on alternate days.
 
Antibiotic Treatment after 48–72 hours of Failure of Initial Treatment
Clindamycin 30–40 mg/kg/day div. in TID + cefuroxime or cefdinir.
 
Sinusitis (Acute)
(Pneumococcus, H. influenzae, Moraxella catarrhalis, streptococci)
  • Uncomplicated mild/moderate acute bacterial sinusitis
    • Initial: Amoxicillin 45 mg/kg/day div in BID8
      • For penicillin allergic cases: Cefdinir or cefuroxime axetil or cefpodoxime or cefixime or levofloxacin (in an older child).
  • Severe sinusitis; no response to initial 3 days treatment; children age <2 years:
    • Amoxicillin clavulanate high dose 80–90 mg/kg/day div in BID
    • Or ceftriaxone 75 mg/kg/day IV/IM initial followed by oral cefdinir or cefuroxime
    • Duration of treatment: Minimum 10 days or 7 days after resolution of symptoms
Note: Azithromycin and cotrimoxazole are not recommended (high microbial resistance)
 
Mastoiditis (Acute)
(Pneumococcus, group A Streptococcus, nontypable H. influenzae, Pseudomonas aeruginosa)
Obtain cultures and treat accordingly:
  • Initial: Ceftriaxone 75 mg/kg/day + cloxacillin 75 mg/kg/day
  • Later: As per culture and sensitivity findings.
 
Orbital Cellulitis
(H. influenzae, S. aureus, MRSA, S. pneumoniae, streptococci)
  • Vancomycin + cefotaxime or ceftriaxone
  • Add metronidazole if anaerobes suspected
  • If no improvement, sinus drainage.
 
LOWER RESPIRATORY TRACT INFECTIONS
 
Epiglottitis
(H. influenzae type b in nonvaccinated children; streptococci, nontypable H. influenzae, S. aureus)
  • Initial: Ceftriaxone or cefotaxime or meropenem IV × 10 days
  • Later as per culture and sensitivity findings.9
 
Tracheitis Bacterial
(S. aureus, S. pneumoniae, S. pyogenes, Moraxella catarrhalis, H. influenzae, anaerobes)
  • Cloxacillin or clindamycin + cefotaxime or ceftriaxone IV
  • If MRSA infection—use vancomycin in place of cloxacillin or clindamycin.
 
Bronchitis (Acute)
(Bacterial)
Same drugs as for acute otitis media.
 
Pneumonia
 
Community-acquired Pneumonia
  • Common causative organisms:
    • Bacteria: Strep. pneumoniae, H. influenzae, S. aureus, Group A Streptococcus, Klebsiella, and Escherichia coli
    • Viruses: Respiratory syncytial virus (RSV), parainfluenza, rhinoviruses and adenoviruses
    • Nonviral pathogens: Mycoplasma pneumoniae, Chlamydia pneumoniae, and Chlamydia trachomatis
  • Age incidence: Viral infections are common below 5 years of age; S. pneumoniae, M. pneumoniae, and C. pneumoniae are more common in above 5 year olds; gram-negative organisms (esp. Klebsiella, E. coli, and C. trachomatis) are common between 3 weeks and 3 months of age.
  • Guide to antibiotic therapy: In view of the uncertain differentiation on clinical, radiologic, or laboratory findings between pneumonia caused by various bacterial, viral, and nonviral pathogens, antibiotic treatment is largely empirical. The choice of drugs is initially guided by the child's age and the likelihood of causative organisms in that age group, type of infection then prevalent in the community and its antibiotic sensitivity pattern, the child's immunity and nutritional status, the type of infection likely to be present in association with the underlying illness* (Table 1.1) (if any) and the severity of illness.10
  • Outpatient treatment for mild illness:
    Initial: (i) Amoxicillin 40–50 mg/kg/day PO div q 8 h PO × 5 days
    • If poor response to (i) or if high incidence of penicillin-resistant pneumococci in the community: Amoxicillin high dose (80–90 mg/kg/day) PO
    • Alternative: Cefuroxime axetil or amoxicillin-clavulanate or cefdinir or cefpodoxime.
    • Children >5 years, suspected M. pneumoniae, or C. pneumoniae infection:
      • A macrolide (azithromycin 10 mg/kg/day OD × 5 days or clarithromycin 15 mg/kg/day div q BID × 10 days)
      • Alternative in adolescents: Levofloxacin or moxifloxacin.
  • Initial choice of antibiotics in severe pneumonia:
    • Under 2 months of age:
      • Cefotaxime or ceftriaxone IV + gentamicin IV × 10 days
    • Above 2 months of age:
      • Ampicillin 200 mg/kg/day div q 6 h IV + gentamicin 7.5 mg/kg/day IV/IM OD × 7–10 days
      • If no response in 2 days, assess for complications, such as empyema;
        Table 1.1   Illness and susceptibility to infection.
        * Underlying illness
        Susceptibility to infection
        Nephrotic syndrome, and hemoglobinopathies
        Pneumococcal infection
        Cystic fibrosis
        Staphylococcus, Haemophilus influenzae, and Pseudomonas
        HIV infection
        Tuberculosis, gram-negative bacilli, Pneumocystis carinii, and fungi
        HIV: Human immunodeficiency virus
        11
      • If none: Change ampicillin to cefotaxime 200 mg/kg/day div q 6 h IV or ceftriaxone 75–100 mg/kg/day div q 12 h IV + continue gentamicin.
    • Above 5 years of age:
      • Cefuroxime or ceftriaxone or cefotaxime IV + macrolide (macrolide to cover against Mycoplasma and C. pneumoniae infection instead of aminoglycoside)
    • Suspected S. aureus infection
      • Add cloxacillin or clindamycin to initial regime of cefotaxime or ceftriaxone + gentamicin
      • If suspected methicillin resistance, add vancomycin or teicoplanin or linezolid to initial regime
        • Vancomycin 25–30 mg/kg IV loading dose, followed by 15–20 mg/kg/day div q 8–12 h IV
        • or teicoplanin 10 mg/kg/dose q 12 h × 3 doses then 10 mg/kg/day IM or IV (bolus or slow infusion)
        • or linezolid 20 mg/kg/day div q 12 h IV
        • Total duration of treatment 3–4 weeks
    • Multidrug resistant S. pneumoniae
      • Vancomycin and linezolid
    • Klebsiella pneumoniae
      • Cefotaxime or ceftriaxone IV
  • Mode and duration of drug administration: In patients with severe pneumonia, antibiotics should be given intravenously for first 7 days or so. Once the child improves, is stable and can take orally, treatment can be switched over to oral amoxicillin-clavulanate (in cases of infection by organisms sensitive to it). While some authorities consider this drug to be preferable to oral cephalosporins cefdinir, cefpodoxime, and cefuroxime-axetil, others consider them to be equally good. Alternatively, ceftriaxone IM can be given as a follow-up drug.
In general, antibiotics are administered for 10–14 days or till 5 days after subsidence of fever. Patients with pneumonia caused by staphylococci, gram-negative bacilli and M. pneumoniae and some cases of severe pneumonia of undiagnosed etiology need treatment for 2–3 weeks, while those due to C. pneumoniae need treatment for up to 6 weeks.12
 
Hospital-acquired Pneumonia
Empirical therapy:
According to prevalence and sensitivity of causative organisms in hospital/ICU:
  • Potential pathogens: Pseudomonas aeruginosa, Klebsiella pneumoniae (ESBL) or Acinetobacter species
    Antibiotics: Piperacillin-tazobactam PLUS
    1. Aminoglycoside (amikacin, gentamicin or tobramycin) or
    2. Antipseudomonal fluoroquinolone (ciprofloxacin or levofloxacin)
  • Methicillin resistant staphylococci
    First-line antibiotics: Vancomycin or linezolid
    Second line: Daptomycin
  • Anaerobes
    Antibiotic: Metronidazole or clindamycin
  • Cytomegalovirus
    Antibiotic: Ganciclovir IV (+ IV immunoglobulin)
  • Pneumocystis carinii
    Antibiotic: Trimethoprim–sulfamethoxazole
  • Legionella
    Antibiotic: Erythromycin
  • Herpes simplex
    Antibiotic: Acyclovir and foscarnet IV
  • Respiratory syncytial virus
    Antibiotic: Ribavirin by aerosol.
 
Empyema
  • Initial: Cloxacillin + cefotaxime or ceftriaxone
  • Suspected staphylococcal infection: Vancomycin + cefotaxime or ceftriaxone
  • Suspected anaerobic infection: IV clindamycin
  • Nosocomial empyema: IV piperacillin-tazobactam or meropenem + vancomycin or linezolid13
  • Subsequently: As per in vitro sensitivity of the organisms grown on pus culture.
 
Lung Abscess or Necrotizing Pneumonia
Ceftriaxone or cefotaxime + cloxacillin or clindamycin.
 
Pertussis
  • Erythromycin: 40–50 mg/kg div q 6 h × 14 days
  • Age above 2 months: Alternatives—clarithromycin × 7 days or azithromycin × 5 days.
 
Tuberculosis
See in separate section on “Tuberculosis”.
 
INFECTIONS OF CENTRAL NERVOUS SYSTEM
 
Meningitis (Bacterial)
0–2 months (>2 kg)
Initial empiric therapy
  • First-line therapy
    1. Inj. cefotaxime 50 mg/kg/dose IV–age < 7 days: q 12 hr; age > 7 days: q 8 hr; for 2–3 weeks
      PLUS
    2. Inj. gentamicin 5 mg/kg/dose IV age <7 days q 24 hr; × 2–3 weeks, age >7 days: 2.5 mg/kg/dose q 8 hr × 2–3 weeks
  • Second-line therapy
    1. Meropenem 20 mg/kg/dose; age <7 days: 12 hrly; age > 7 days: 8 hrly × 2–3 weeks
      PLUS
    2. Vancomycin 15 mg/kg/dose; age <7 days: 12 hrly and >7 days: 8 hrly × 2–3 weeks
Duration of treatment for gram–ve bacilli or Staph sp × at least 21 days
For 2 month and above
  • First-line therapy
Inj ceftriaxone 100 mg/kg/day div. q 12 hr × 10–14 days14
Note: If ceftriaxone not available, inj cefotaxime 200 mg/kg/day IV div q 8 hr/6 hr × 10–14 days
If clinically suspected staphylococcal infection, add inj. vancomycin; continue treatment for minimum 3 weeks
  • Second-line therapy
    1. Inj. meropenem 120 mg/kg/day div q 8 hr × 10–14 days
      PLUS
    2. Inj. vancomycin 60 mg/kg/day div q 6 hr × 10–14 days
  • Subsequent drug therapy after isolation of organisms as per their antibiotic sensitivity.
  • Meningococcal meningitis: Ceftriaxone × 7 days
  • Haemophilus influenzae type b (Hib) meningitis: Ceftriaxone × 10 days
  • Streptococcus pneumoniae type b meningitis: Ceftriaxone × 14 days.
  • Other organisms: See Table 1.2.
 
Suspected Tuberculosis Infection
See under section “Drug Treatment of Childhood Tuberculosis”.
 
Ventriculoperitoneal Shunt Infection
  • Initial: Vancomycin + ceftriaxone or cefotaxime + metronidazole
  • Subsequently: As per organisms grown on culture:
    • For coagulase negative Staphylococcus: Vancomycin + rifampicin 10–14 days
    • For E. coli: Cefotaxime or ceftriaxone × 21 days + gentamicin × 10 days or till cerebrospinal fluid (CSF) becomes sterile.15
Table 1.2   Bacterial meningitis: (treatment continued) subsequent therapy after isolation of organisms (age 2 months–12 years).
Pathogen
Drugs of choice
Alternative drugs
Duration of therapy
Streptococcus pneumoniae
  • Penicillin sensitive
Crystalline penicillin or ampicillin
Ceftriaxone and cefotaxime
14 days
  • Intermediate resistance to penicillin
Vancomycin + ceftriaxone or cefotaxime
Meropenem
14 days
  • Highly resistant
Add rifampicin
Fluoroquinolone (moxi)
14 days
Haemophilus influenzae type b
Ceftriaxone (+ dexamethasone for first 2–4 days)
Chloramphenicol, aztreonam, ciprofloxacin
10 days
Neisseria meningitidis
Cefotaxime or ceftriaxone
Chloramphenicol, meropenem, fluoroquinolone (Moxifloxacin)
7–10 days
Staphylococcus aureus
Vancomycin
Linezolid (if methicillin resistant)
3 weeks
Pseudomonas
Ceftazidime + aminoglycoside or
Cefepime + genta
Meropenem + aminoglycoside; Aztreonam + genta
3 weeks16
Gram-negative (E. coli, other Enterobacteriaceae)
Ceftazidime or cefepime + gentamicin
Meropenem + cipro
3 weeks or at last 2 weeks after CSF sterilization
Staphylococcus epidermidis
Vancomycin
Linezolid
2–3 weeks
Enterococcus
  • Ampicillin susceptible
  • Ampicillin resistant
  • Ampicillin and vancomycin resistant
  • Ampicillin + gentamicin
  • Vancomycin + gentamicin
  • Linezolid
17
 
Brain Abscess
 
Infants and Children
  • Initial: Vancomycin + cefotaxime or ceftriaxone + metronidazole IV
  • Alternative: Meropenem IV + vancomycin
  • Subsequently as per pus culture sensitivity:
    • Duration of antibiotic therapy: 4–6 weeks.
 
Neonatal Meningitis with Brain Abscess
  • Initial: Meropenem + aminoglycoside IV
  • Subsequently: As per aspirated pus culture and sensitivity.
 
Encephalitis
(Herpes simplex virus)
See section “Viral infections”.
 
GASTROINTESTINAL INFECTIONS
 
Acute Gastroenteritis
Rotavirus and enterotoxigenic E. coli are responsible for nearly half, cholera for about 5–10% and Salmonella for about 3–7% cases of acute diarrhea in Indian children. Giardia lamblia is an uncommon cause. Several other bacteria; viruses and parasites also induce acute diarrhea.
Dysentery is caused largely by Shigella intestinal infection. Other causes for it are infection by Entamoeba histolytica, enteroinvasive and enterohemorrhagic E. coli, Salmonella, and Campylobacter jejuni.
 
Role of Antibiotic in Therapy
Antimicrobial agents have no role in treatment of diarrhea caused by Rotavirus and other viral intestinal infections. Antimicrobial therapy is chiefly indicated for cases of acute bloody diarrhea (caused mostly by Shigella infection), suspected cases of cholera and for infrequent cases of diarrhea due to protozoal (E. histolytica and Giardia) infection.18
 
Dysentery due to Shigella Infection
In view of widespread increasing resistance of Shigella organisms to different antibiotics, the preferred agents are now considered to be as follows:
  • Ciprofloxacin 30 mg/kg/day div in BD PO × 3 days; watch clinical response closely for 48 hours
  • In case of failure of response to ciprofloxacin, in moderately ill cases, switch to cefixime 8–10 mg/kg/day div in BD PO
  • In a sick child, better initiate treatment with IV
    Ceftriaxone instead of ciprofloxacin. Ceftrioxone 50–100 mg/kg/day div in BD IV × 3–5 days.
 
Cholera
  • Antibiotics are recommended in children having moderate-to-severe dehydration
  • Tetracycline 12.5 mg/kg/dose (max 500 mg/dose) four times a day PO × 3 days
  • Or erythromycin 12.5 mg/kg/dose (max 250 mg) × four times a day × 3 days PO
  • Or azithromycin 20 mg/kg (max 1 g) as a single dose PO
  • Or doxycycline 2–4 mg/kg single dose PO
  • Or ciprofloxacin 20 mg/kg (max 1g) as a single dose PO.
 
Salmonella Gastroenteritis (Nontypical Species)
Antibiotics are not indicated routinely in uncomplicated cases.
Indications for use: Infants (≤3 months of age) and other children who are at an increased risk of a disseminated disease, such as, children on immunosuppressive and corticosteroid therapy, patients suffering from acquired immunodeficiency syndrome (AIDS), malignancies, malaria, and malnutrition.
Treatment: As described earlier under Dysentery.19
 
Helicobacter pylori Gastritis
At least two antibiotics + one potent proton pump inhibitor (Table 1.3).
 
Perirectal Abscess
Clindamycin + gentamicin or cefotaxime or ceftriaxone.
Table 1.3   First-line options for Helicobacter pylori gastritis.
Drug
Dosage
Duration
i. Amoxicillin
50 mg/kg/day
(max 1 g/dose BID)
14 days
+ Clarithromycin
15 mg/kg/day
(max 500 mg/dose BID)
14 days
+ Omeprazole*
1 mg/kg/day
(max 20 mg/dose BID)
1 month
ii. Amoxicillin
50 mg/kg/day
(max 1 g/dose/BID)
14 days
+ Metronidazole
20 mg/kg/day
(max 500 mg/dose BID)
14 days
+ Omeprazole*
1 mg/kg/day
(max 20 mg/dose BID)
1 month
iii. Clarithromycin
15 mg/kg/day
(max 500 mg/dose BID)
14 days
+ Metronidazole
20 mg/kg/day
(max 500 mg/dose BID)
× 14 days
+ Omeprazole*
1 mg/kg/day
(max 20 mg/dose BID)
1 month
*Omeprazole or lansoprazole or any other proton pump inhibitor
20
 
Skeletal Infections
 
Arthritis (Septic)
  • Infants <3 months (S. aureus, Enterobacteriaceae, Group B Strep)
    Oxacillin or nafcillin + cefotaxime or ceftriaxone IM/IV
    • If MRSA: Vancomycin + cefotaxime or ceftriaxone IM/IV.
  • Children (3 months–14 years) (S. aureus, Hib, S. pyogenes S. pneumoniae, gram-negative bacilli, and others)
    • Vancomycin + cefotaxime or ceftriaxone or ceftizoxime.
 
Osteomyelitis (Acute)
  • Neonate: See section “Neonatal Infections”
  • Children <5 years: (S. aureus, Streptococcus, Hib) Cloxacillin or clindamycin + cefotaxime or ceftriaxone
  • Children >5 years: (Staph, Strep) Cloxacillin or nafcillin or cefazolin IV
  • Duration of treatment: 4–6 weeks or more
  • If MRSA: Vancomycin or clindamycin instead of cloxacillin.
 
Osteomyelitis (Chronic)
Staphylococcal:
  • Initial: Cloxacillin or nafcillin IV
  • For MRSA: Vancomycin or clindamycin IV
  • Later: Cloxacillin or first generation cephalosporin PO (cephalexin, cefadroxil, and cefazolin).
 
Osteomyelitis of the Foot-puncture Wound
Pseudomonas:
  • Ceftazidime IV/IM or ticarcillin IV plus tobramycin or amikacin IV × 10 days
  • Alternative: Meropenem or cefepime IV OR ticarcillin-clavulanate.21
 
GENITOURINARY AND SEXUALLY TRANSMITTED INFECTIONS
Acute cystitis (uncomplicated lower UTI without urinary tract obstruction) (E. coli, Klebsiella, Proteus species, Enterobacter)
  • Initial (before results of urine culture): Cotrimoxazole/ trimethoprim @ 8–10 mg/kg/day PO × 3–5 days
  • After results of culture:
    • If organisms on culture sensitive to it, continue cotrimoxazole × 7–10 days
  • Or nitrofurantoin 5–7 mg/kg/div in TID/QID × 7–10 days
  • Or amoxicillin 50 mg/kg/day div in TID/QID × 7–10 days
  • Or cefixime 8–10 mg/kg/day div in BD × 7–10 days
  • Or amoxicillin–clavulanate (30–50 mg of amoxicillin/kg/day) div in BD × 7–10 days.
Since it is difficult to distinguish between cystitis and pyelonephritis in infants and children below the age of 5 years, all cases of urinary tract infection (UTI) in this age group should be treated for 14 days.
 
Acute Pyelonephritis
(E. coli, Proteus, Klebsiella species, Staphylococcus saprophyticus, Enterococcus, and others)
It is advisable to choose the initial drug (on empirical basis before receipt of urine culture report) on the basis of known drug sensitivity of the likely source of infection:
Uropathogenic E. coli, the most common causative pathogen, in the community, or
That of locally prevalent flora in the institution or pediatric intensive care unit (PICU)
Initial (common choice): Ceftriaxone or cefotaxime IV or ampicillin + gentamicin IV
Later: As per antibiotic sensitivity of the organisms grown on culture
  • Oral cefixime for gram-negative organisms almost as good as parenteral ceftriaxone (except against Pseudomonas)
  • Ciprofloxacin—a good alternative agent for Pseudomonas. Levofloxacin is a good alternative quinolone22
  • Do not use nitrofurantoin in a child with febrile UTI (inadequate renal tissue concentration).
Second line treatment for complicated UTI:
  • Piperacillin tazobactam 90 mg/kg/dose q 6 h IV or IM or Meropenem 20–40 mg/kg/dose q 8 h × 10–14 days.
  • Suspected urosepsis, child vomiting, infant <1 month: Parenteral drugs IV/IM × 10–14 days
    • Older children: Initially parenteral, may give PO following improvement, total of 10–14 days.
 
Renal or Perinephric Abscess
Cloxacillin or nafcillin + gentamicin or ceftriaxone/ cefotaxime.
 
Epididymitis
(Young children—E. coli and S. aureus; older children—gonorrhea and Chlamydia)
Cefuroxime or cefotaxime or ceftriaxone × 7–10 days.
Add cloxacillin if suspected S. aureus infection. If C. trachomatis infection is suspected in sexually active adolescents or adults, add azithromycin or erythromycin or doxycycline
 
Vaginal Infections
  • Bacterial vaginosis: Metronidazole × 7 days or single large dose
  • Group A strep. infection: Penicillin V × 10 days PO
  • Vulvovaginal candidiasis: See section “Fungal infections”.
 
Trichomoniasis
See section “Protozoal and other parasitic infections”.
 
Chancroid
(Haemophilus ducreyi)
Ceftriaxone 250 mg IM, single dose or azithromycin 1 g PO, single dose.23
 
Chlamydia trachomatis
  • Erythromycin (or in >7 years old—doxycycline) × 7 days
  • Alternative (in adults): Azithromycin 1 g PO, single dose
 
Gonorrhea
  • Uncomplicated urogenital, anorectal, and pharyngeal infection
    1. Ceftriaxone 250 mg IM single dose + azithromycin 1 g PO once or
    2. Cefixime 400 mg PO once + azithromycin 1 g PO once or
    3. Ceftriaxone 250 mg IM single dose + doxycycline 100 mg BD PO × 7 days
      • Alternative to ceftriaxone: Cefotaxime 500 mg IM; or ceftizoxime 500 mg IM
  • Disseminated gonococcal infection:
    • Ceftriaxone 1 g/day IM × 7–14 days + azithromycin 1g PO single dose
  • Gonococcal conjunctivitis: Ceftriaxone 1 g IM single dose
  • Gonococcal meningitis: Ceftriaxone 1–2 g IV q 12 hr × 10–14 days
  • Gonococcal endocarditis: Ceftriaxone 1–2 g IV q 12 hr × 4 weeks or more.
Note: Concurrent therapy in these patients must be done for Chlamydia infection.
 
Syphilis
  • Congenital: See section “Neonatal infections”
  • Early: Primary, secondary, or latent <1 year
    • Benzathine penicillin single dose IM (50,000 U/kg, max 2.4 million units)
    • Alternative: For nonpregnant penicillin allergic patients—tetracycline 500 mg dose QID PO or doxycycline 100 mg BID × PO × 14 days24
  • Syphilis >1 year duration:
    • Benzathine penicillin IM once weekly × 3 doses (50,000 U/kg, max 2.4 million units, divided over two injection sites)
    • Alternative: For penicillin allergic patients—doxycycline PO × 4 weeks (4 mg/kg/day, max. 200 mg/day div in BID)
 
Neurosyphilis
Penicillin G IV (2.5 lac U/kg/day, max 24 million U/day div Q 6 hr) × 10–14 days.
 
MISCELLANEOUS SYSTEMIC INFECTIONS
 
Bacteremia or Sepsis
  • Neonate: See section “Neonatal infections”
  • Infants <3 months:
    • Community-acquired pathogens: Pneumococcus, Hib, N. meningitides, Salmonella, E. coli, S. aureus, and other late-onset neonatal sepsis organisms, such as Group B Streptococcus and Listeria.
      1. Initial empiric treatment: Ceftriaxone or cefotaxime + ampicillin IV
      2. (If meningitis suspected, add vancomycin IV) to treatment as given above
      3. Suspected S. aureus infection: Cefotaxime + cloxacillin or nafcillin or clindamycin
      4. Herpes simplex infection: Acyclovir IV.
  • Sepsis in older infants and children:
    • Community-acquired infection: S. pneumoniae, N. meningitides, Salmonella, Hib in children age <5 years
      • Initial: Ceftriaxone or cefotaxime
      • Later: As per blood culture and sensitivity findings
    • Nosocomial sepsis
      • Initial: Ceftriaxone or cefotaxime or piperacillin-tazobactam + aminoglycoside25
      • Add vancomycin, if coagulase-ve staphylococcal or penicillin-resistant pneumococcal infection is suspected.
 
Typhoid Fever
While planning treatment for typhoid fever watch for multidrug resistant S. typhi infection. Many S. typhi organisms are now resistant to chloramphenicol, cotrimoxazole, ampicillin, and amoxicillin. As such, these drugs are not recommended today for initial use on empirical basis. These may be considered later, if the organisms are found fully susceptible on culture.
If S. typhi organisms are found to be resistant to nalidixic acid on culture, nalidixic acid resistant S. typhi (NARST), it suggests that fluoroquinolone drugs (ciprofloxacin and ofloxacin) would not be clinically effective even if the organisms exhibit in vitro sensitivity to them.
Nalidixic acid and norfloxacin do not achieve adequate blood concentration after oral administration and should not be used. Ciprofloxacin and ofloxacin* are effective in some cases but their use has not been approved by the Drug Controller General of India for patient under 18 years of age except when the child is resistant to all other recommended drugs and is suffering from life-threatening infection.
  • For cases of uncomplicated enteric fever (OPD cases):
    • Cefixime: 15–20 mg/kg/day div q 12 h PO × 14 days (first-line drug)
    • Azithromycin: 10–20 mg/kg/day (max 1 g/day) OD PO × 7–14 days. To continue till one week post-fever defervescence
    • Amoxicillin: 75–100 mg/kg day div q 6 h PO × 14 days (if organisms sensitive)
    • Trimethoprim-sulfamethoxazole (TMP-SMX): 8 mg, TMP, 40 mg SMX/kg/day div q 12 h PO × 14 days (if organisms sensitive)
    • Chloramphenicol:* 50–75 mg/kg/day div q 6 h PO × 14 days (if organisms sensitive)
  • For cases of severe enteric fever (requiring parenteral therapy):
    • First line:
      Ceftriaxone: 75–100 mg/kg/day div q 24 h/12 h IV/IM × 14 days
      or Cefotaxime: 100 mg/kg/day div q 6 h IV/IM × 14 days
      (On resolution of fever following IV use of ceftriaxone or cefotaxime, these may be replaced by oral cefixime 20 mg/kg/day—continue till one week after subsidence of fever)
      or Ciprofloxacin: 15–20 mg/kg/day div q 12 h IV × 10–14 days (max 800 mg/day)
      or Ofloxacin: 15–20 mg/kg/day div q 12 h IV × 10–14 days; continue for 1 week post-fever defervescence)
    • If organisms sensitive; may use:
      • Chloramphenicol: 50–75 mg/kg/day × 14 days, or
      • Ampicillin: 100 mg/kg/day × 14 days or
      • Trimethoprim-SMX: 8 TMP, 40 SMX mg/kg/day × 14 days.
    • Second line:
  • Some authorities recommend that in severe cases requiring hospitalization, a third generation cephalosporin (ceftriaxone or cefixime) may be used in combination with a quinolone (ciprofloxacin or ofloxacin) or with azithromycin.
  • For non-responders, serious cases (may use):
    • Aztreonam: 90–120 mg/kg/day div q 6–8 h IV/IM × 14 days
Adjunctive use of dexamethasone initially 3 mg/kg followed by 1 mg/kg every 6 hours for 48 hr and then gradual reduction of dose over next 3 days has been found useful in severe cases of typhoid fever, presenting with delirium, obtundation, stupor, coma or shock, alongwith other supportive treatment.
Shorter duration of therapy with some antibiotics has been found to be equally effective by some workers. It is generally recommended that antibiotic therapy should be continued for 5–7 days after the child becomes afebrile.27
 
Peritonitis
  • Acute primary peritonitis (without a demonstrable intra-abdominal source) (usually monomicrobial) common: pneumococci, group A streptococci, staphylococci, gram–ve enteric bacteria.
    Treatment
    Initial: Cefotaxime IV
    Later: As per culture sensitivity findings
    For resistant pneumococci: Vancomycin
    Duration of treatment: 10–14 days
  • Acute secondary peritonitis (due to entry of enteric bacteria into the peritoneal cavity through a necrotic defect in wall of the intestines/other viscus) (usually polymicrobial infection)
    Treatment
    Initial choice of antibiotic:
    • For lower GIT perforation cases.
      Ampicillin, gentamicin + clindamycin or metronidazole
    • For peritoneal catheter-related peritonitis
      Intraperitoneal cefepime or cefazolin + ceftazidime
Later: As per antibiotic sensitivity of peritoneal fluid isolate.
 
Endocarditis
  • Unknown organisms (no prosthetic valve); empirical therapy:
    • Initial: Vancomycin + gentamicin (4–6 weeks)
    • Later: As per antibiotic sensitivity of cultured organisms
  • Strep. viridans and Streptococcus bovis:
    • Penicillin G or ceftriaxone + gentamicin IV
    • If penicillin allergy: Vancomycin + gentamicin IV
  • Staphylococcus aureus and S. epidermidis:
    Cloxacillin or nafcillin + gentamicin
    Or vancomycin + gentamicin (if MRSA).28
 
Pericarditis (Purulent)
  • Empiric (S. aureus, Hib, Strep pneumoniae, Group A streptococci and gram-negative organisms)
    • Initial: Vanco + cefepime
    • Later: As per pericardial fluid cultured organism's antibiotic sensitivity.
  • Staphylococcus aureus
    • Cloxacillin or cefazolin IV; vancomycin (if methicillin-resistant) IV × 3–4 weeks
    • Alternative: Imipenem.
 
Pericarditis (Tuberculous)
See section “Treatment of tuberculosis”.
 
Tetanus
  • Penicillin G IV (200,000 U/kg/day div q 6 h) × 10–14 days or metronidazole IV (30 mg/kg/day div q 8 h) × 10–14 days
  • Tetanus immunoglobulin (TIG) or tetanus antitoxin (TA): For details see under section on “Vaccines and immunoglobulins”.
 
Septic Shock Syndrome
 
Critically Ill Child with Severe Sepsis and Septic Shock
Guiding principles for initial presumptive therapy:
  • Provide coverage for MRSA
  • If suspected GIT source (e.g. burst appendicitis) or genitourinary infection—cover for enteric organisms
  • Immunocompromised child—cover for Pseudomonas infection
  • Modify later depending upon culture reports and patient's response.
 
Immunocompetent Children >28 Days of Age
  • Ceftriaxone or cefotaxime + vancomycin or teicoplanin29
  • If suspected genitourinary source → Add aminoglycoside (genta or amika)
  • If suspected GIT source → Add piperacillin-tazobactam or clindamycin or metronidazole.
 
Immunosuppressed >28 Days of Age or Risk of Pseudomonas Species Infection
  • Ceftazidime or cefepime + vancomycin or teicoplanin
  • If extended-spectrum β-lactamases (ESBL) resistant organisms present → add aminoglycoside or carbapenem. Carbapenem addition preferable, if any broad spectrum antibiotic received within 2 weeks, such as third generation cephalosporin, aminoglycoside, or fluoroquinolone.
 
Allergic to Penicillin or Recently Received Broad-Spectrum Antibiotic
  • Vancomycin or teicoplanin + meropenem
  • Alternative to meropenem: (i) aztreonam or (ii) ciprofloxacin + clindamycin.
 
Patient at Increased Risk of Fungal Infections
  • Immunocompromised with persistent fever on broad-spectrum antibiotics or
  • With an identified fungal source
Add the following antifungals to the antimicrobial regimen:
  • Liposomal amphotericin B or
  • Caspofungin or micafungin or anidulafungin.
 
Patients with Risk Factors for Rickettsial Infection (Travel to or Reside in an Endemic Region)
  • Add doxycycline or tetracycline to the antibiotic regimen
  • Besides use of appropriate antibiotic, treat or control source of infection, e.g. by drainage of pus, removal of infected viscus or catheter.30
 
Duration of Antibiotic Therapy for Sepsis
  • If no complication: 7–10 days
  • Longer course recommended: If slow clinical response; undrainable foci of infection; S. aureus bacteremia; some fungal and viral infections; or immunologic deficiency.
If MRSA infection suspected: Empirical therapy recommended with vancomycin; If minimum inhibitory concentration (MIC) value for MRSA isolates 12 mg/mL—use daptomycin. Linezolid should not be used for empirical therapy.