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Paediatric Antibiotic
Prescribing Guideline

www.oxfordahsn.org/children

Magdalen Centre North,

1 Robert Robinson Avenue, Oxford Science Park, OX4 4GA, United Kingdom

F T May 2017

t: +44(0) 1865 784944 e: info@oxfordahsn.org

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Follow us @OxfordAHSN
Follow us @OxAHSNChild
 Paediatric Antibiotic prescribing guideline Start Smart, Then Focus
Resistance to antibiotics is now recognised as a major risk to the future health Review all antibiotics after the 1st 48-72 hours according to microbiology results
of the world population. Antimicrobial resistance (AMR) threatens the effective
Sepsis
prevention and treatment of ever-increasing infections caused by bacteria, parasites,
First line Allergy*
viruses and fungi. This threat is now deemed so serious that it is included on the
< 1 month admitted from the IV Cefotaxime
National Risk Register. community (If on neonatal unit refer and
to neonatal guidelines) IV Amoxicillin
One method to help reduce antimicrobial resistance is to ensure appropriate See BNFC for neonatal doses

prescription and administration of empiric antibiotics. The Oxford AHSN has a IV Cefotaxime 50mg/kg QDS
geographical footprint that includes five hospitals with paediatric inpatients providing 1-3 months Consider switching to IV
an opportunity for the Children’s Network to work with local paediatricians, Ceftriaxone 80mg/kg OD if not
receiving IV Calcium
pharmacists and microbiologists to harmonise local prescribing guidelines.
Severe Penicillin
We asked the microbiologists to check that there were no local resistance patterns allergy, consider:
IV Chloramphenicol
that might preclude harmonisation. Once this was confirmed, we conducted a gap 25mg/kg single dose

analysis of the five hospitals’ antibiotic guidelines to identify differences in prescribing IV Ceftriaxone Consider:
practices. We brought together pharmacists, paediatricians and microbiologists > 3 months 1 month – 11 years (<50kg) IV Vancomycin
80mg/kg OD (max. 4g) 15mg/kg TDS
from each of the five hospitals and reached agreement on the optimum prescribing 12-17 years (> 50kg) 2-4 g OD (max. daily dose 2g)

practice for those areas where differences existed. Subsequent minor amendments and IV Gentamicin
were agreed and the revised guideline has now been adopted by each hospital. 7mg/kg single dose
(max. 560mg)

Meningitis
Non severe Penicillin allergy:
IV Cefotaxime 50mg/kg QDS
IV Cefotaxime
1-3 months and
50mg/kg QDS
IV Amoxicillin 50mg/kg QDS
Severe Penicillin allergy consider:
Consider switching to IV
Magdalen Centre North, Ceftriaxone 80mg/kg OD if not
IV Chloramphenicol
1 Robert Robinson Avenue, Oxford Science Park, OX4 4GA, United Kingdom receiving IV Calcium
25mg/kg QDS

t: +44(0) 1865 784944 e: info@oxfordahsn.org IV Ceftriaxone For severe Penicillin allergy consider
1 month – 11 years (<50kg) IV Chloramphenicol 25mg/kg QDS
Follow us @OxfordAHSN > 3 months
80mg/kg OD
Follow us @OxAHSNChild 12-17 years (> 50kg) 2-4 g OD

www.oxfordahsn.org/children
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1 PAEDIATRIC ANTIBIOTIC PRESCRIBING GUIDELINE
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PAEDIATRIC ANTIBIOTIC PRESCRIBING GUIDELINE 2
 Respiratory
Pneumonia
(mild/ moderate)
Treat for 5 days
Pneumonia (severe)
Complicated Pneumonia
Empyema associated
with septicaemia
Urinary Tract Infections
Lower UTI/ uncomplicated
Treat for 3 days
(unless otherwise stated)
Upper UTI/ complicated
Treat for 7 days
3 PAEDIATRIC ANTIBIOTIC PRESCRIBING GUIDELINE
First line Allergy*
PO Amoxicillin
1 month – 11 months: 125mg TDS
1-4 years: 250mg TDS
5 -18 years: 500mg TDS
If no improvement or atypical
pneumonia consider adding
<6 months:
PO Clarithromycin 7.5mg/kg BD
(max. 500mg BD)
>6 months:
PO Azithromycin
10mg/kg OD for 3 days
(max. 500mg OD)
IV Amoxicillin 60mg/kg TDS
(max. 1g)
Consider adding PO
Azithromycin 10mg/kg (max.
500mg) OD 3 days
or
IV Clarithromycin 7.5mg/kg BD
(max. 500mg) if an IV agent
required or child < 6 months
PO Co-Amoxiclav
1 month – 11 months: (125/31)
0.25ml/kg TDS
1-5 years: (125/31) 5mls TDS
6-11 years: (250/62) 5mls TDS
12-18 years: (250/125) 1 tablet TDS
IV Co-Amoxiclav
<3 months 30mg/kg BD
>3 months 30mg/kg (max. 1.2g) TDS
and
STAT IV Gentamicin 7mg/kg IV
OD (max. 560mg)
Bone & Soft Tissue Infections
First line Allergy*
Penicillin allergy:
<6 months: Severe Penicillin allergy:
PO Clarithromycin IV Clindamycin 6.25mg/kg QDS
IV Ceftriaxone
7.5mg/kg BD (max. 1.2g QDS)
Septic Arthritis and 1 month – 11 years (<50kg)
(max. 500mg BD) Osteomyelitis 80mg/kg OD (max. 4g)
and
12-17 years (> 50kg) 2-4 g OD
>6 months: IV Gentamicin 7mg/kg OD
PO Azithromycin (max. 560mg)
10mg/kg OD for 3 days
(max. 500mg OD) Penicillin allergy:
PO Clarithromycin
PO Flucloxacillin body weight:
1 month – 1 year: < 8 kg: 7.5mg /kg BD
Cellulitis
62.5mg - 125mg QDS 8-11 kg: 62.5mg BD
(mild/moderate)
2-9 years: 125mg -250mg QDS 12-19 kg: 125mg BD
10-17 years: 250mg -500mg QDS 20-29 kg: 187.5mg BD
Non-severe Penicillin allergy: 30-40 kg: 250mg BD
IV Ceftriaxone 12-17 years 250 mg BD
1 month – 11 years
Non-severe Penicillin allergy:
(<50kg) 80mg/kg OD
IV Ceftriaxone
12-17 years (> 50kg)
1 month – 11 years
2-4 g OD IV Flucloxacillin
(<50kg) 80mg/kg OD
1 month - 18 years:
Severe Cellulitis 12-17 years (> 50kg) 2-4 g OD
Severe Penicillin allergy: 50mg/kg QDS (max 2g QDS)
(without evidence of sepsis)
IV Clarithromycin and
Treat for 7-10 days Severe Penicillin allergy:
7.5mg/kg BD (max. 500mg BD) PO Clindamycin 6mg/kg QDS
PO Clindamycin 6mg/kg QDS
(Max 450mg QDS)
(max. 450mg QDS)
IV Clindamycin 6.25mg/kg QDS
(max. 1.2g QDS)
Non-severe Penicillin allergy:
PO Cefalexin IV Clindamycin 6.25mg/kg QDS
1 month – 11 months: 125mg BD IV Flucloxacillin 50mg/kg QDS
(max. 1.2g QDS)
1-4 years: 125mg TDS (max 2g QDS)
and
5-11 years: 250mg TDS Toxic shock syndrome and
IV Vancomycin
12-18 years: 500mg TDS IV Clindamycin 6.25mg/kg QDS
15mg/kg TDS
(max. 1.2g QDS)
(max. daily dose 2g)
Severe Penicillin allergy:
2nd line PO Nitrofurantoin
Non-severe Penicillin allergy:
3 months – 11 years:
750micrograms/kg QDS 5 days IV Ceftriaxone
12- 18 years: 1 month – 11 years (<50kg)
PO Nitrofurantoin MR 100mg BD 80mg/kg OD
12-17 years (> 50kg) 2-4 g OD
For non-severe penicillin allergy: IV Benzylpenicillin 50mg/kg QDS and
IV Ceftriaxone (max 2.4g QDS) IV Clindamycin 6.25mg/kg QDS
1 month – 11 years (<50kg) 80mg/ Necrotising Fasciitis and (max. 1.2g QDS)
T T
IV Clindamycin 6.25mg/kg QDS
kg OD
F F
12-17 years (> 50kg) 2-4 g OD (max. 1.2g QDS) Severe penicillin allergy:
IV Vancomycin 15mg/kg TDS
+/-
A A
IV Gentamicin (max. daily dose 2g)
and
7mg/kg OD (max. 560mg)
R R
IV Clindamycin 6.25mg/kg QDS
Severe penicillin allergy: (max. 1.2g QDS)
D D
IV Gentamicin
7mg/kg OD (max. 560mg)
PAEDIATRIC ANTIBIOTIC PRESCRIBING GUIDELINE 4
 Bone & Soft Tissue Infections Upper respiratory Infection
First line Allergy* First line Allergy*

Non-severe Penicillin allergy:

<6 months:
IV Ceftriaxone
PO Co-Amoxiclav PO Clarithromycin 7.5mg/kg BD
1 month – 11 years (<50kg)
IV Co-Amoxiclav 30mg/kg TDS 1 month - 1 year: (125/31) (max. 500mg BD)
80mg/kg OD
Peri-orbital cellulitis (if< 3 months 30mg/kg BD) Fever / bleeding following 0.25ml/kg TDS
12-17 years (> 50kg) 2-4 g OD
Treat for 7 days (max. 1.2g TDS) tonsillectomy 1-5 years: (125/31) 5mls TDS >6 months:
6-12 years: (250/62) 5mls TDS PO Azithromycin
Severe Penicillin allergy
12-18 years: (250/125) 1 tablet TDS 10mg/kg OD
IV Clarithromycin 7.5mg/kg BD
(max. 500mg)
(max 500mg BD)

IV Ceftriaxone Severe Penicillin allergy: Penicillin allergy:

1 month – 11 years (<50kg) 80mg/ PO Ciprofloxacin 20mg/kg BD <6 months:
kg OD (max 750mg BD) PO Clarithromycin 7.5mg/kg BD
PO Amoxicillin
12-17 years (> 50kg) 2-4 g OD and Otitis Media (max. 500mg BD)
Orbital cellulitis 1 month – 11 months: 125mg TDS
and IV Metronidazole Consider treatment after 24-48 hours
Treat for 7 days unless complicated 1-4 years 250mg TDS
PO Clindamycin 7.5mg/kg TDS (max 500mg TDS) Treat for 5 days >6 months:
5-18 years 500mg TDS
3-6mg/kg QDS (max 450mg QDS) and PO Azithromycin
Consider PO Co-Amoxiclav for IV Vancomycin 10mg/kg OD 3 days
follow-on therapy/not complicated 15mg/kg TDS (max. daily dose 2g) (max. 500mg)

Aspiration pneumonia Soft tissue

PO Co-Amoxiclav Severe Penicillin allergy: Penicillin allergy:
1 month – 11 months: (125/31) IV Metronidazole <6 months:
0.25ml/kg TDS 7.5mg/kg TDS (max. 500mg TDS) PO Clarithromycin 7.5mg/kg BD
1-5 years: (125/31) 5mls TDS and Mild: (max. 500mg BD)
6-11 years: (250/62) 5mls TDS IV Clarithromycin 7.5mg/kg BD PO Co-Amoxiclav
12-18 years: (250/125) 1 tablet TDS (max. 500mg BD) >6 months:
1 month - 1 year: (125/31)
IV Ceftriaxone 0.25ml/kg TDS PO Azithromycin
Upper respiratory Infection 1 month – 11 years (<50kg) 80mg/ 1-5 years: (125/31) 5mls TDS 10mg/kg OD 3 days
kg OD 6-11 years: (250/62) 5mls TDS (max. 500mg)
12-17 years (> 50kg) 2-4 g OD
IV Ceftriaxone 12-18 years: (250/125) 1 tablet TDS
Severe Penicillin allergy: Lymphadenitis
and
1 month – 11 years (<50kg) Non severe Penicillin allergy:
Epiglottitis IV Chloramphenicol
PO Clindamycin
80mg/kg OD Severe: IV Ceftriaxone
25mg/kg QDS
3-6mg/kg
12-17 yearsQDS (max 2-4
(> 50kg) 450mg QDS)
g OD IV Co-Amoxiclav 1 month – 11 years (<50kg)
Consider PO Co-Amoxiclav for <3 months 30mg/kg BD 80mg/kg OD
follow-on therapy/not complicated >3 months 30mg/kg TDS 12-17 years (> 50kg) 2-4 g OD
Non-severe Penicillin allergy:
(max. 1.2g TDS)
IV Ceftriaxone
Severe Penicillin allergy:
IV Co-Amoxiclav 1 month – 11 years (<50kg)
IV Clindamycin 6.25mg/kg QDS
<3 months 30mg/kg BD 80mg/kg OD
Bacterial tracheitis (max. 1.2g QDS)
>3 months 30mg/kg TDS 12-17 years (> 50kg) 2-4 g OD
(max. 1.2g TDS)
Severe Penicillin allergy:
IV Chloramphenicol 25mg/kg QDS

T T
PO Penicillin V Penicillin allergy:

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1 month – 11 months: 62.5mg QDS <6 months:
1-5 years: 125mg QDS PO Clarithromycin 7.5mg/kg BD

A A
Pharyngitis/Tonsillitis
6-11 years: 250mg QDS (max. 500mg BD)
Consider deferring treatment for

R R
12-18 years: 500mg QDS >6 months:
48 hours
or PO Azithromycin

D D
IV Benzylpenicillin 50mg/kg 10mg/kg OD
(max.2.4g) QDS (max. 500mg)

5 PAEDIATRIC ANTIBIOTIC PRESCRIBING GUIDELINE PAEDIATRIC ANTIBIOTIC PRESCRIBING GUIDELINE 6

 Soft Tissue
First line Allergy*
Soft tissue injury
No antibacterials required
(Clean)
PO Co-Amoxiclav
1 month - 11 months: (125/31)
0.25ml/kg TDS
1-5 years: (125/31) 5mls TDS
Soft tissue injury
6-11 years: (250/62) 5mls TDS
(Contaminated)
12-18 years: (250/125) 1 tablet TDS
NB Check tetanus vaccination status
+/-PO Metronidazole
1 – 2 months: 7.5mg/kg BD
> 2 months: 7.5mg/kg TDS
(max. 400mg TDS)
PO Co-Amoxiclav
1 month – 11 months: (125/31)
0.25ml/kg TDS
1-5 years: (125/31) 5mls TDS
Animal Bites 6-11 years: (250/62) 5mls TDS
(including humans) 12-18 years: (250/125) 1 tablet TDS
NB Check tetanus vaccination status
+/- PO Metronidazole
1 – 2 months: 7.5mg/kg BD
> 2 months: 7.5mg/kg TDS
(max. 400mg TDS)
7 PAEDIATRIC ANTIBIOTIC PRESCRIBING GUIDELINE
Non-severe Penicillin allergy:
IV Ceftriaxone
1 month – 11 years (<50kg) 80mg/
kg OD
12-17 years (> 50kg) 2-4 g OD
and
PO Metronidazole
1 – 2 months: 7.5mg/kg BD
> 2 months: 7.5mg/kg TDS
(max. 400mg TDS)
Severe Penicillin allergy:
IV Clindamycin 6.25mg/kg QDS
(max. 1.2g QDS)
Non-severe Penicillin allergy:
IV Ceftriaxone
1 month – 11 years (<50kg)
80mg/kg OD
12-17 years (> 50kg) 2-4 g OD
and
PO Metronidazole
1 – 2 months: 7.5mg/kg BD
> 2 months: 7.5mg/kg TDS
(max. 400mg TDS)
Severe Penicillin allergy:
PO Ciprofloxacin 20mg/kg BD
(max. 750mg BD)
and
PO Clindamycin
3-6mg/kg QDS (max 450mg QDS)
T T
F F
A A
R R
D D
Abdominal
First line Allergy*
IV Co-Amoxiclav
<3 months 30mg/kg BD Severe Penicillin allergy:
>3 months 30mg/kg TDS IV Ciprofloxacin
Intra-abdominal infections
(max. 1.2g TDS) 10mg/kg TDS (max 400mg TDS)
(including peritonitis)
and
STAT dose IV Gentamicin 7mg/kg if
IV Metronidazole 7.5mg/kg TDS
septic (max. 560mg)
(max.500mg TDS)
or
IV Gentamicin 7mg/kg OD
(max 560mg)
IV Co-Amoxiclav and
<3 months 30mg/kg BD IV Metronidazole 7.5mg/kg TDS
Appendicitis
>3 months 30mg/kg TDS (max.500mg TDS)
(max. 1.2g TDS)
Consider adding: IV Vancomycin
15mg/kg TDS
(max. daily dose 2g)
Gastroenteritis No antibiotics required
Usually self-limiting.
If immunocompromised/severe:
Campylobacter enteritis
PO/IV Clarithromycin 7.5mg/kg
BD (max. 500mg BD)
IV Ceftriaxone
1 month – 11 years (<50kg)
80mg/kg OD
12-17 years (> 50kg) 2-4 g OD
Switch to oral antibiotics once
Enteric Fever/Typhoid
sensitivities known
PO Azithromycin 10mg/kg OD
(max. 500mg)
or
PO Ciprofloxacin 20mg/kg BD
(max. 750mg BD)
Stop all other antibiotics
PO Vancomycin
1 month – 4 years: 5mg/kg QDS
5-11 years: 62.5mg QDS
Clostridium difficile 12 – 18 years: 125 mg QDS
for 14 days
Doses may be increased if fails to
respond
Don’t treat asymptomatic infants
PAEDIATRIC ANTIBIOTIC PRESCRIBING GUIDELINE 8
 Anaphylaxis (Resuscitation Council UK):
Anaphylaxis is likely when ALL of the following 3 criteria are met:
1. Sudden onset and rapid progression of symptoms
2. Life-threatening Airway and/or Breathing and/or Circulation problems
3. Skin and/or mucosal changes (flushing, urticaria, angioedema)

The following supports the diagnosis:

• Exposure to a known allergen for the patient

Remember:
• Skin or mucosal changes alone are not a sign of an anaphylactic reaction
• Skin and mucosal changes can be subtle or absent in up to 20% of reactions (some patients
have only a decrease in blood pressure, i.e., a Circulation problem)
• There can also be gastrointestinal symptoms (e.g. vomiting, abdominal pain, incontinence)

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