Approach to empiric antimicrobial therapy for outpatient treatment of uncomplicated ABRS in children with contraindications to penicillin antibiotics

This algorithm is intended for use with UpToDate content on ABRS in children. Inpatient therapy is indicated for patients who have toxic-appearance (eg, lethargy, poor perfusion, cardiorespiratory compromise) and complications or suspected complications, with the possible exception of mild preseptal cellulitis in children older than 1 year. If a pathogen is identified, antimicrobial therapy should be adjusted according to susceptibilities. Refer to relevant UpToDate content for additional information (eg, adverse drug reactions to penicillins, cephalosporin allergy, evaluation for complications, empiric treatment of ABRS in children without contraindications to penicillin).

ABRS: acute bacterial rhinosinusitis; SJS, Stevens-Johnson syndrome; TEN: toxic epidermal necrolysis; IV: intravenously; ID: infectious diseases; ORL: otorhinolaryngology; IM: intramuscular.

* If vomiting precludes administration of oral antibiotics, admit for parenteral therapy until vomiting resolves.

¶ If vomiting precludes administration of oral antibiotics, can administer ceftriaxone 50 mg/kg IM for one dose (maximum dose 1 g), followed by cefpodoxime or cefdinir 24 hours later.

Δ For those who failed treatment with levofloxacin at 10 mg/kg per day orally, it is reasonable to try levofloxacin at 20 mg/kg per day IV. For those who failed treatment with oral levofloxacin 20 mg/kg per day, meropenem is appropriate.

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خرید پکیج

Approach to empiric antimicrobial therapy for outpatient treatment of uncomplicated ABRS in children with contraindications to penicillin antibiotics