Ver el código de «Pediatric antibiotics»

==Neonatal Infections==
*All doses are for patients >2 kg and at least 7 days of age
*Always treat for meningitis until you are sure it is not

===[[Pediatric fever of uncertain source]]===
===Neonatal (0-28 days)===
{{Pediatric fever antibiotics 0-28)}}

{{Pediatric fever acyclovir indications}}

===Neonatal (28-90 days)===
{{Pediatric fever antibiotics 28-90}}

{{Pediatric fever acyclovir indications}}

==[[Meningitis (peds)|Meningitis]]==
{{Neonatal meningitis antibiotics}}

{{Neonatal HSV antivirals}}

==[[Pneumonia (peds)]]==
{{Pediatric pneumonia treatment}}

==[[Osteomyelitis]]==
*Empiric treatment: [[Nafcillin]] 200mg/kg/day IV div Q6 AND [[cefotaxime]] 150mg/kg/day IV div Q8 for >21 days.

==[[UTI (peds)]]==
*<2 weeks: [[Ampicillin]] 100mg/kg/day IV div Q6 (or Q12 if <7 days) AND [[gentamicin]] 3mg/kg/day IV Q24 OR [[cefotaxime]] 150mg/kg/day IV div Q8
*2 weeks - 2 months: [[Ampicillin]] 100mg/kg/day IV div Q6 AND [[cefotaxime]] 150mg/kg/day div Q8

==[[Neonatal conjunctivitis]]==
{{Neonatal conjunctivitis treatment}}

= Febrile Syndromes/Bloodstream Infections =
==[[Pediatric fever of uncertain source]] (90 days - 36 months)==
{{Pediatric fever antibiotics 90dy-36mo}}


{| cellspacing="0" cellpadding="2" border="1" align="left"
|-
| rowspan="2" | Septic shock syndromes 
| [[Bacteremia]]: ''[[S. pneumo]], [[N. meningitidis]], [[H. influenzae]]'' (if not immunized) 
| rowspan="1" | Replete intravascular volume, maximize delivery of oxygen to tissues. Blood cultures. [[Ceftriaxone]] 50mg/kg/day IV/IM Q24 or [[Cefotaxime]] 150mg/kg/day IV div Q8 until afebrile x24 hours.
|-
| [[Toxic shock syndrome]]: ''Staphylococcal ''(less often associated with deep tissue disease), ''Streptococcal'' 
| rowspan="1" | 
'''Empiric therapy should include [[clindamycin]] and [[beta-lactam]] until etiology is isolated.''' 

'''[[Staphylococcal]]: '''Most often associated with toxin-producing organism at a mucosal site, may involved disease at a deeper site. Associated with tampon use, wound infection or burns. 5-15% case fatality rate. Rx: [[Nafcillin]] AND [[clindamycin]] initially. Substitute [[cefazolin]] or [[vancomycin]] for nafcillin if MRSA suspected. [[IVIG]] 1 g/kg may bind toxins, but should be reserved for life-threatening infections. 

'''[[Streptococcal]]: '''Invasive disease at a deep site is the rule; deep site infection should be sought aggressively and treated. Defined as isolation of ''GAS'', hypotension, renal impairment, coagulopathy, ARDS and soft tissue necrosis. Associated with erysipelas, [[Necrotizing Fascitis]], secondary infection of varicella. Rx: Once streptococcus is identified, change therapy to [[penicillin]] or other [[ß-lactam]] antibiotic PLUS Clindamycin. 

|-
| rowspan="2" | [[Central line]] infection 
| ''Coagulase-negative Staph (CONS), [[S. aureus]], GN-bacilli, [[Candida]] spp.'' 
| rowspan="1" | 
''Coagulase-negative Staph (CONS)'': can try to salvage catheter with 10-14 days of therapy ([[vancomycin]]), 80% cure rate for exit site infections, 25% if deeper. 

If ''[[S. aureus]]'', ''[[Gram-Negative]] bacilli'' or ''[[Candida]]'': always remove the catheter if possible. ''S. aureus ''has a 10% exit site cure rate and 0% deeper infection cure rate if catheter left in. 

If septic thrombophlebitis, [[endocarditis]], [[osteomyelitis]] or repeated positive cultures, ALWAYS remove catheter. 

|-
| TPN/Intralipids: as above and ''Malassezia furfur'' 
| rowspan="1" | Remove catheter and discontinue antimicrobials if possible. If ''[[Candida albicans]]'', treat with [[Fluconazole]] 6-12mg/kg/day IV Q24 (if >14 days old) x 28 days OR conventional [[Amphotericin B]] 1mg/kg/day IV div Q24. If ''[[Staph epidermidis]]'', treat with [[vancomycin]] and discontinue intralipids. If ''M. furfur'', treat with conventional [[Amphotericin B]].
|-
| [[Fever and Neutropenia]]
| ''Aerobic GNR, [[Strep viridans]], MRSA''
| 
[[Piperacillin-tazobactam]] 400mg/kg/day IV div Q6 OR [[Ceftzidime]] 150mg/kg/day IV div Q8 OR [[Meropenem]] 60mg/kg/day IV div Q8. Consider adding [[gentamicin]] if persistently ill-appearing. Consider adding [[vancomycin]] if MRSA or coagulase-negative Staph suspected. 

Consider adding [[amphotericin B]] 1mg/kg/day IV Q24 if persistently febrile >5 days on antibiotics. Consider [[meropenem]] alone or addition of [[metronidazole]] if [[typhlitis]] suspected. 

|-
| [[Lyme Disease]]
| ''[[Borrelia burgdorferi]]'' 
| 
Early rash (erythema migrans), carditic, facial nerve palsy, [[meningitis]]/[[encephalitis]], [[arthritis]]. 

*Early localized/disseminated disease: [[doxycycline]] 4mg/kg/day PO div BID (if >7 yo) OR [[amoxicillin]] 50mg/kg/day PO (max 1.5 g/day) div TID x14-21 days. Alternative [[erythromycin]] 30mg/kg/day IV div Q8. 
*Arthritis (no CNS disease): As above x28 days.<br> 
*[[Bell's Palsy]]: As above x21-28 days.<br> 
*Neuroborreliosis (CNS): [[ceftriaxone]] 75-100mg/kg/day IV Q24 OR [[penicillin G]] 300,000 U/kg/day IV div Q4 x14-21 days.<br>

|-
| [[Rocky Mountain Spotted Fever]]
| ''[[Rickettsia ricketsii]]''
| 
Suspect if fever, rash (95%), petechiae spreading from distal to central. Confirm with antibody titers. Ticks most often in Mid-Atlantic states. Treat empirically and aggressively, can be fatal. 

#[[Doxycycline]] 4mg/kg/day PO div BID x7-10 days (recommend for all age groups).<br>

|-
| [[Ehrlichiosis]]
| ''Ehrlichia chaffensis ''or ''phagocytophilum''<br> 
| 
Suspect if febrile, flu-like illness with rash in April-Sept. Leukopenia and thrombocytopenia common. 80% have positive blood smear (HGE only). Dx HME with PCR. Confirm with DFA. Commonly co-infected with ''B. burgdorferi<u></u>''. 

#[[Doxycycline]] 4mg/kg/day PO div BID x7 days.<br>

|}

<br>

= CNS Infections =
==[[Meningitis (peds)]]==
''Treatment guidelines based on van de Beek et al''<ref>van de Beek D. et al. Advances in treatment of bacterial meningitis. Lancet. Nov 10 2012;380(9854):1693-702</ref>
===Neonates (up to 1 month of age)===
{{Neonatal meningitis antibiotics}}

===> 1 month old===
{{Pediatric meningitis antibiotics}}

==[[VP shunt infections]]==
{{Pediatric VP shunt infections}}

= Head, Eyes, Ears, Nose & Throat Infections=
==[[Mastoiditis]], acute==
''S. pneumo ''(22%), ''S. pyogenes ''(16%), ''S. aureus ''(7%), ''H. flu, P. aeruginosa'' 
R/O [[meningitis]]. Surgical debridement as indicated. Transition to PO once clinically improved. [[Ampicillin-sulbactam]] 300mg/kg/dau IV div Q6 OR [[cefotaxime]] 150mg/kg/day div Q8 OR [[ceftriaxone]] 50mg/kg/day Q24 +/- [[nafcillin]] 200mg/kg/day IV div Q6 OR [[clindamycin]] 40mg/kg/day IV div Q6 or [[vancomycin]] x21 days.

==[[Sinusitis]], acute==
#[[Amoxicillin]] 90mg/kg/day x14-21 days.<br> 
#[[Augmentin]], [[cefuroxime]] or [[cefdinir]] if recent antibiotics or chronic sinusitis.

==[[Conjunctivitis]]==
*[[Adenovirus]] (types 3, 7) 
**AKA pink eye. No treatment needed. Highly contagious. Cold artificial tears may help. NEVER treat with steroids except by an ophthalmologist!
*[[HSV]] types 1-2 
**Can be sight-threatening. Refer to ophthalmologist immediately! 30-50% recurrence in 2 years. 
**Trifluridine OR idoxuridine ophthalmic solution 1 drop Q2-3 while awake x7-14 days. 
**Vidarbine ophthalmic ointment Q3 until 1 weeks after healthing.
*''S. pneumo, H. flu'' 
**Polymyxin/trimethoprim ophthalmic solution 1 drop Q3 OR polymixin.bacitracin/Neosporin ophthalmic solution 1 drop Q3 x7-10 days.

==[[Dacryocystitis ]]==
*Warm compresses and tear duct massage. No antimicrobial therapy usually needed. Oral antimicrobial therapy for more symptomatic infections

==[[Orbital Cellulitis]]==
*[[Ampicillin-sulbactam]] 300mg/kg/day IV div Q6 OR [[cefotaxime]] 150mg/kg/day div Q8 OR [[ceftriaxone]] 50mg/kg/day Q24 AND [[nafcillin]] 200mg/kg/day IV div Q6. If any MRSA isolated locally, add [[clindamycin]] 40mg/kg/day IV div Q6 OR [[vancomycin]] x10-14 days.

==[[Periorbital Cellulitis|Periorbital (preseptal) Cellulitis]]==
#If known entry site: [[nafcillin]] 200mg/kg/day IV div Q6 OR [[cefazolin]] 100mg/kg/day IV Q8 x7-10 days. If MRSA suspected, [[Vancomycin]] OR [[clindamycin]] 40mg/kg/day IV div Q6. Oral antistaphylococcal antibiotics for less severe infections. 
#Periorbital swelling without cellulitis (often associated with sinusitis): [[Ceftriaxone]] 50mg/kg/day IV Q24 OR [[cefotaxime]] 150mg/kg/day IV div Q8. ADD [[clindamycin]] 40mg/kg/day IV div Q6 for more severe infections of suspicion of MRSA. See 'Head: Sinusitis' for oral therapy options.

==[[Otitis Externa]]==
*Clean canal often. 
*[[Hydrocortisone/neomycin/polymyxin|Neomycin/Polymixin B +/- hydrocortisone]] otic drops. Alternate: [[Ofloxacin]] or [[ciprofloxacin]] solution. For 'swimmers ear' use VoSol (2% acetic acid) to canal. 
*Candidal: [[Fluconazole]] 5-10mg/kg/day PO Q24 x5-7 days. 

==[[Otitis Media]]==
'''Note: '''If >2 years, afebrile, no otalgia, borderline exam → consider symptomatic treatment or safety net antibiotic prescription (SNAP). 

#[[Amoxicillin]] 80-90mg/kg/day div BID or TID x10 days (<2 years) or x5 days (>2 years). 
#[[Augmentin]] 90mg/kg/day amoxicillin component div BID. 
#[[Cefdinir]], [[cefpodoxime]], [[cefprozil]], [[cefuroxime]]. [[Azithromycin]] (up to 40% resistance in PRSP).

==[[Ludwig's Angina]]==
High risk of respiratory tract obstruction due to inflammatory edema. 

#[[Penicillin G]] 200,000 U/kg/day div Q6 AND [[clindamycin]] 40mg/kg/day IV vid Q6. 
#Consider 
[[meropenem]], [[piperacillin-tazobactam]] OR [[ceftriaxone]] if [[GNR]] suspected.

==[[Dental abscess]]==
#[[Clindamycin]] 40mg/kg/day PO/IV/IM div Q6 or [[Penicillin G]] 100,000-200,000 U/kg/day IV div Q6.

==[[Gingivostomatitis]]==
*[[Acyclovir]] PO 80mg/kg/day div Q6 x7 days. For severe disease can use Acyclovir 30mg/kg/day IV div Q8.

==[[Bacterial tracheitis]]==
#([[Vancomycin]] OR [[clindamycin]] 40mg/kg/day div Q6) AND ([[Cefotaxime]] 150mg/kg/day div Q8 OR [[ceftriaxone]] 50mg/kg/day Q24). Tailor to cultures. 
#[[Cefuroxime]] 100-150mg/kg/day div Q8.

==[[Epiglottitis]]==
*[[Cefotaxime]] 150mg/kg/day div Q8 OR [[ceftriaxone]] 50mg/kg/day Q24. ADD Clindamycin 40mg/kg/day IV div Q6 OR [[vancomycin]] if Staph suspected.

==[[Pharyngitis]]==
*Throat: Culture before treating. ''GAS'' uncommon in children <3 years. Treatment decrease rheumatic fever 2.8 to 0.2%. Rx as below also for scarlet fever. 

#[[Penicillin]] V 25-50mg/kg/day PO div TID-QID OR [[amoxicillin]] 50-75mg/kg/day div BID-TID x10 days. 
#[[Penicillin G]] Benzathine 600,000 U IM (<27 kg), 1.2 million U (>27 kg) x1. 
#[[Erythromycin]] or [[clindamycin]] for PCN-allergic patients.

= Respiratory Tract Infections  =
==Pneumonia==
{{Pediatric pneumonia treatment}}

==[[Whooping cough]]==
#[[Erythromycin]] ethyl succinate 40mg/kg/day PO div QID x14 days (max 2000mg/day). Note: Do not use erythromycin base, which causes excessive GI symptoms. 
#[[Azithromycin]] (<6 months): 10mg/kg once daily x5 days (max 500mg). Note: Preferred agent for patients <1 month. 

==Cardiovascular Infections==
===[[Endocarditis]]===
'''Prophylaxis indications''' 
Prosthetic cardiac valve or prosthetic material used for cardiac valve repair. 

Previous infectious endocarditis. 

[[Congenital heart disease]] (CHD) - except for the conditions listed below, antibiotic prophylaxis is no longer recommended for any other form of CHD. 

*Unrepaired cyanotic CHD, including palliative shunts and conduits. 
*Completely repaired CHD with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first 6 months after the procedure. 
*Repaired CHD with residual defects at the site or adjacent to the site or a prosthetic patch or prosthetic device (which inhibit endothelialization).

Cardiac transplantation recipients who develop cardiac valvulopathy. 

'''Prophylaxis for oral, dental, respiratory tract or high risk patients with chronic GI/GU infections '''
#[[Amoxicillin]] 50mg/kg PO x1 OR Ampicillin 50mg/kg IV x1, 30-60 minutes prior to the procedure. 
#Allergic patients: [[Clindamycin]] 20mg/kg PO/IV x1 OR [[cephalexin]] 50mg/kg PO x1 OR [[azithromycin]] 15mg/kg PO x1.

'''Empiric therapy, native valves: S. viridans, Enterococci, Staphylococci'''

By definition includes multiple positive [[blood cultures]], new murmur of valvular insufficiency, emboli and echo evidence of vegetations. Send cultures and target therapy based on results. [[Vancomycin]] and Gentamicin pending culture results.

==Gastroenterologic Infections==

{| cellspacing="0" cellpadding="2" border="1" align="left"
|-
| rowspan="7" | [[Diarrhea]]
| colspan="2" | 
'''Initial Workup:''' If blood diarrhea or >6 stools/day and febrile then consider stool cultures, fecal leukocytes, electrolytes. 

'''Isolation:''' Contact precautions for diapered or incontinent children. 

|-
| ''[[C. difficile]]''
| 
Suspect if blood diarrhea, cramping develop with recent antibiotic exposure. 

#[[Metronidazole]] 30mg/kg/day PO/IV div QID x10 days. 
#[[Vancomycin]] 40mg/kg/day PO;div QID x10 days ONLY for Metronidazole failures.

|-
| ''C. jejuni''
| 
Suspect if prominent abdominal pain. Young infants may only have bloody diarrhea. Can have immunoreactive complications such as AIDP, reactive arthritis, Reiter syndrome or erythema nodosum. 

#[[Erythromycin]] 40mg/kg/day PO div QID x5 days. Shortens duration of illness and prevents relapse if given early. 

|-
| 
''[[E. coli]] O157:H7'' 

''(Enterotoxin producing, ETEC)'' 

| Suspect if bloody diarrhea, >6 unformed stools/day and afebrile. Causes 36% of bloody diarrhea. Consider CBC and blood smear. If no hemolysis, azotemia or thrombocytopenia after 3 days of illness, risk of developing HUS is low. Antimicrobial therapy may precipitate an adverse reaction.<br>
|-
| ''[[Salmonella]]''<br> 
| 
May cause asymptomatic disease, gastroenteritis, bacteremia, osteomyelitis or meningitis. Exposures to lizards and other reptiles may result in unusual species of ''Salmonella''. 

#Antimicrobial therapy increases duration of illness in most carriers.<br> 
#Therapy recommended if invasive or focal disease, if <3 months old, chronic GI disease, oncology patients, hemoglobinopathies, or HIV+. May treat with [[amoxicillin]] or [[TMP-SMX]]; [[Ceftriaxone]] for neonates (not receiving calcium containing fluids) or septic clinical state.<br>

|-
| ''[[Shigella]]''<br> 
| 
Suspect if fever, cramps, tenesmus, abdominal pain. Complications include seizures, bacteremia, Reiter Syndrome, HUS (''S. dystenteriae;''type 1), toxic megacolon and toxic encephalopathy (ekiri syndrome). 

#[[Cefixime]] 8mg/kg/day PO div BID or [[TMP-SMX]] 8mg/kg/day TMP PO div TID x5-7 days. Illness usually self-limited (48-72 hours), but treatment is always indicated to decrease duration of shedding, which is important for public health measures.<br>

|-
| ''[[Yersinia enterocolitica]]''<br> 
| Causes mesenteric adenitis, mimics appendicitis. Predisposed by iron overload states (chronic transfusions). Antimicrobial therapies not indicated in normal hosts.<br>
|-
| [[Necrotizing Enterocolitis]] (NEC) 
| Multifactorial disease, including bacterial invasion (debated). ''E. coli, Klebsiella, Pseudomonas, Clostridial sp., S. aureus, B. fragilis.''<br> 
| 
Bacteremia in 30-50% of cases. Definitive antimicrobial therapy based on culture results. ''B. fragilis ''invades gut after several days of age. 

#[[Ampicillin]] AND [[gentamicin]] x10 or more days<br>

Consider adding [[cefotaxime]] if CNS involvement cannot be excluded. Consider replacing [[ampicillin]] with [[vancomycin]] if MRSA/CONS. Consider adding [[clindamycin]] if perforation cannot be excluded.<br> 

|-
| Peritonitis (bowel perforation or appendicitis)<br> 
| ''Enteric GNR, Bacteroides sp., Enterococcus sp.''<br> 
| 
#[[Meropenem]] 60mg/kg/day IV div Q8 OR [[piperacillin-tazobactam]] 400mg/kg/day IV div Q6 x7-10 days.<br> 
#[[Ampicillin]] 150mg/kg/day IV div Q8 AND [[gentamicin]] (dose per age) IV div Q8 AND [[clindamycin]] 40mg/kg/day IV Q6 OR [[metronidazole]] 30mg/kg/day IV div Q6] x7-10 days.<br>

|-
| Peritonitis (peritoneal dialysis)<br> 
| ''Staphylococci, GNs, ''yeast<br> 
| Antibiotic added to dialysate in concentrations approximating those attained in serum for systemic disease [[gentamicin]] 8mg/L, [[Vancomycin]] 50mg/L).<br>
|}

==Genitourinary Infections==
===[[Pyelonephritis]]===
Inpatient: [[Ceftriaxone]] 50mg/kg/day IV/IM Q24 OR [[gentamicin]] (age based dosing) OR [[TMP/SMX] 8mg/kg/day IV div BID x14 days. Treat IV until defervesces and clinically improved, then transition to PO.

Outpatient: [[TMP-SMX]] OR [[cefixime]] OR [[ciprofloxacin]] (in adolescents); see doses under UTI

===[[UTI]]===
'''Inpatient: '''>2 months: [[cefotaxime]] or [[ceftriaxone]] until taking PO, well appearing → transition to outpatient therapy. 

'''Outpatient: '''(Infants and Children): [[TMP-SMX]] 6-10mg/kg/day TMP component div BID OR [[cefixime]] 16mg/kg/day x1 day, then 8mg/kg/day Q24 (max 400mg/dose) OR [[cephalexin]] 25mg/kg/dose QID (max 1000mg/dose) x7-14 days. Alternatives: [[nitrofurantoin]], [[ciprofloxacin]], [[ceftriaxone]]. <br>

==Skin &amp; Soft Tissue Infections<br>==
===Skin [[abscess]]===
*OSSA/MSSA - [[Cephalexin]] 50-75mg/kg/day PO div TID OR [[Augmentin]] 80-90mg/kg/day PO div BID x5-7 days. '''I&amp;D when indicated.'''<br> 
*If MRSA prevalent or if recurrent abscess, send specimen for culture and sensitivity. Treat with [[clindamycin]] 40mg/kg/day IV div Q6 or [[TMP-SMX]] 5mg/kg/dose TMP Q6-8. If toxic-appearing, use [[vancomycin]].

===[[Cellulitis]]===
*Start IV: [[Clindamycin]] 40mg/kg/day IV div Q6 if high community incidence of MRSA. May use [[nafcillin]] 200mg/kg/day IV div Q6 OR [[cefazolin]] 100mg/kg/day IV div Q8 if low incidence of MRSA. Transition to PO when stable. If no improvement, change to [[vancomycin]] (dose by age). 

*PO: [[Cephalexin]] 50-75mg/kg/day divided TID OR [[dicloxacillin]] 50mg/kg/day PO div Q6. Total duration of treatment 7-10 days.

===[[Erysipelas]]===
*[[Penicillin G]] IV, then transition to [[penicillin]] V or [[amoxicillin]] PO;x10 days.<br>

===[[Impetigo]]===
*[[Mupirocin]] topical to lesions TID, cleanse with soap and water. Bathe daily. If extensive, treat with [[cephalexin]] PO or [[amoxicillin-clavulanate]] x5-7 days.

===Omphalitis/Funisitis===
*Empiric: [[Cefotaxime]] AND [[clindamycin]] x10 or more days. 

*Funisitis (local infection of cord): cord care, topical antimicrobials.

===[[Paronychia]]===
*Local wound care and I&D unless signs of spreading infection, then consider [[Augmentin]] or [[clindamycin]].

===[[Scabies]]===
#Topical 5% [[permethrin]] cream, apply to neck down, wash off in 8-14 hours.<br> 
#Topical Lindane 1%- ''Avoid unless treatment failure to permethrin due to risk of neurotoxicity. Many contraindications/precautions!''

===[[Staphylococcal scalded skin syndrome]]===
#[[Nafcillin]] 200mg/kg/day IV div Q6 OR Cefazolin IV x5-7 days. Consider [[vancomycin]].
Avoid TMP-SMX. 

===[[Tinea corporis]]===
*May use one of many topical antifungal agents: [[Terbinafine]] 1% cream or gel BID to affected areas; [[clotrimazole]] 1% cream, lotion or solution; others include Econazole, Sulconazole, Oxiconazole, Naftifine, Cicloprox, Ketoconazole, Sertaconazle, Moconazole and Tolnaftate. Treat for 14 days. Keep affected areas dry.<br>

===[[Tinea capitis]]===
*[[Griseofulvin]] Microsize 10-20mg/kg/day div Q12-24 (max 1000mg/day) OR [[Griseofulvin]] Ultramicrosize >2 years 5-10mg/kg/day div Q12-24 x6 weeks] AND [[Selenium sulfide]] shampoo twice weekly x1 week as directed.

===[[Necrotizing Fasciitis]]===
#Prompt surgical debridement and cultures. Send for cultures and sensitivities.<br> 
#Treat with [[clindamycin]] AND [[Zosyn]] OR [[cefotaxime]]. For proven streptococcal disease, [[penicillin]] and [[clindamycin]] suffice.



{| cellspacing="0" cellpadding="2" border="1" align="left"
|-
| rowspan="6" | Animal bites
| '''Rabies prone: BATS''', feral cats, raccoon, skunk, foxes, coyotes, most carnivores, woodchucks and livestock in certain areas<br> 
| 
Treat all bat and feral cat exposures with both HRIG and [[Rabies]] vaccine as below. Otherwise, treat with vaccine and contact public health officials or infection control for advice on whether to treat with HRIG. Monitor animal for 10 days. 

#[[Rabies]] vaccine 1 mL;IM into deltoid days 0, 3, 7, 14 and 28. 
#HRIG 20 IU/kg around wound and begin vaccination series with HDCV or;RVA vaccine days 0, 3, 7, 14 and 28. 
#Consider treating with Augmentin as below.

|-
| colspan="2" | '''Non Rabies-prone: '''Rodents, rabbits, hares, squirrels, hamsters, guinea pigs, gerbils, rats, chipmunks and mice usually do not require anti-rabies therapy. Consult public health officials with concerns. Check tetanus status. Consider Augmentin as below.<br>
|-
| Cat: ''Pasteurella multocida, S. aureus''<br> 
| 
#[[Augmentin]] 45mg/kg/day div Q8-12 x5-7 days. For penicillin allergic patients, ''Pasteurella ''is covered by [[doxycycline]] or [[ciprofloxacin]]. Add another drug for ''Strep;''or ''Staph sp.''
#Rabies: See above if feral cat. Check tetanus status.

|-
| Dog: ''Pasteurella multocida, S. aureu''''s, Bacteroides, Fusobacterium, Capnophaga'''''<b><br></b> 
| 
#[[Augmentin]] 45mg/kg/day PO div Q8-12 x5-7 days<br> 
#Rabies: see above. Check tetanus status.

|-
| Human: ''Strep viridans;''(100%), ''Staph epinephrine ''(53%), ''Cornybacterium ''(41%), ''S. aureus ''(29%), ''Eikenella, Bacteroides, Peptostrep''<br> 
| 
High rates of infection. '''Do not close open wounds!''' 

#Early (no signs of infection): [[Augmentin]] 45mg/kg/day PO div Q8-12 x5-7 days. 
#Late (signs of infection): [[Ampicillin-sulbactam]] IV. Can use [[clindamycin]] AND [[ampicillin]]. 
#Check tetanus status.

|-
| Rat or pig (polymicrobial, ''Sprillum minus'', ''Streptobacillus'')<br> 
| 
#[[Augmentin]] 45mg/kg/day PO div Q8-12 x5-7 days<br> 
#Rabies: see above. Check tetanus status.

|-
| rowspan="2" | Lymphadenitis<br> 
| Localized infection: ''GAS, S. aureus (MRSA)...less likely anaerobes, M. Tb ''(scrofula), ''Toxoplasmosis, Tularemia, Sporotrichosis,;''atypical mycobacterial (consider the latter if nonresponsive to antimicrobials)<br> 
| 
MSSA: [[Augmentin]] 90mg/kg/day PO div BID OR [[Cephalexin]] 100mg/kg/day PO div QID x10 days. If IV needed, [[cefazolin]] 100mg/kg/day IV div Q8. 

MRSA: [[Clindamycin]] OR [[TMP-SMX]] OR [[linezolid]] OR [[vancomycin]] (age based dosing) x7-10 days total. 

|-
| Cat-scratch disease: ''Bartonella henslae''<br> 
| 
Lymphadenitis common in axillary/epitrochlear nodes (46%), neck (26%), inguinal (17%). Treat for immunocompromised host of signs of systemic illness;(HSM). 

#[[Azithromycin]] 10mg/kg/day PO Q24 x5 days.

May also use [[Bactrim]], [[rifampin]] and [[ciprofloxacin]]. Duration of therapy is uncertain. 

|}

==Orthopedic Infections==
===[[Osteomyelitis]]===
{{Osteomyelitis Antibiotics}}

===[[Septic Arthritis]]===
*If immunized against ''Hib'': [[Nafcillin]] 200mg/kg/day IV div Q6 OR [[cefazolin]] 100mg/kg/day div Q8 x21 days. 
*If unimmunized again ''Hib'': [[Cefuroxime]] OR [[cefotaxime]] AND [[nafcillin]] OR [[cefazolin]] x21 days. 
*If ''[[Gonococcus]]'' suspected or isolated, [[ceftriaxone]] 50mg/kg/day IV/IM daily OR [[penicillin G]] IV (if susceptible) x7-10 days.

==See Also==
{{Antibiotics by diagnosis navigation}}

==References==
<references/>
[[Category:ID]] [[Category:Pharmacology]] [[Category:Pediatrics]]