BNF for Children (BNFC) 2018-2019

▶Consider adjunctive treatment with dexamethasone,

preferably starting before or withfirst dose of

antibacterial, but no later than 12 hours after starting

antibacterial (may reduce penetration of vancomycin into

cerebrospinalfluid).

▶If micro-organism penicillin-sensitive, replace cefotaxime

with benzylpenicillin sodium.

▶If micro-organism highly penicillin- and cephalosporin-

resistant, add vancomycin and if necessary rifampicin

p. 364.

▶Suggested duration of antibacterial treatment 14 days.

Meningitis caused byHaemophilus influenzae

.Cefotaxime (orceftriaxone)

▶Consider adjunctive treatment with dexamethasone,

preferably starting before or withfirst dose of

antibacterial, but no later than 12 hours after starting

antibacterial.

▶Suggested duration of antibacterial treatment 10 days.

▶ForH. influenzaetype b give rifampicin for 4 days before

hospital discharge to those under 10 years of age or to

those in contact with vulnerable household contacts

.If history of immediate hypersensitivity reaction to penicillin

or to cephalosporins, or if micro-organism resistant to

cefotaxime, chloramphenicol

▶Consider adjunctive treatment with dexamethasone,

preferably starting before or withfirst dose of

antibacterial, but no later than 12 hours after starting

antibacterial.

▶Suggested duration of antibacterial treatment 10 days.

▶ForH. influenzaetype b give rifampicin for 4 days before

hospital discharge to those under 10 years of age or to

those in contact with vulnerable household contacts

Meningitis caused by Listeria

.Amoxicillin (orampicillin) + gentamicin

▶Suggested duration of treatment 21 days.

▶Consider stopping gentamicin after 7 days

.If history of immediate hypersensitivity reaction to penicillin,

co-trimoxazole p. 350

▶Suggested duration of treatment 21 days.

Ear infections, antibacterial therapy

Otitis externa

.For topical treatments, considerOtitis externa, under Ear

p. 688.

Consider systemic antibacterial if spreading cellulitis or

patient systemically unwell.

.Flucloxacillin p. 345

▶If penicillin-allergic, clarithromycin p. 330 (orazithromycin

p. 329 orerythromycin p. 331 )

▶If pseudomonas suspected, ciprofloxacin p. 348 (oran

aminoglycoside)

Otitis media

.Many infections are caused by viruses. Most

uncomplicated cases resolve without antibacterial

treatment. In children without systemic features,

antibacterial treatment may be started after 72 hours if no

improvement. Consider earlier treatment if deterioration,

if systemically unwell, if at high risk of serious

complications (e.g. in immunosuppression, cysticfibrosis),

if mastoiditis present, or in children under 2 years of age

with bilateral otitis media.

.Amoxicillin p. 339 (orampicillin p. 341 )

▶Consider co-amoxiclav p. 343 if no improvement after

48 hours.

▶In severe infection, initial parenteral therapy with co-

amoxiclav or cefuroxime p. 319.

▶Suggested duration of treatment 5 days (longer if severely

ill).

.If penicillin-allergic, clarithromycin (orazithromycinor

erythromycin)

▶Suggested duration of treatment 5 days (longer if severely

ill)

Eye infections, antibacterial therapy

Purulent conjuctivitis

.Chloramphenicol p. 677 eye drops.

Congenital chlamydial conjuctivitis

▶Erythromycin p. 331 (by mouth)

.Suggested duration of treatment 14 days

Congenital gonococcal conjunctivitis

▶Cefotaxime p. 320 (orceftriaxone p. 322 )

.Suggested duration of treatmentsingle dose.

Gastro-intestinal system infections,

antibacterial therapy

Gastro-enteritis

.Frequently self-limiting and may not be bacterial.

.Antibacterial not usually indicated.

Campylobacter enteritis

.Frequently self-limiting; treat if immunocompromised or

if severe infection.

.Clarithromycin p. 330 (orazithromycin p. 329 or

erythromycin p. 331 )

▶Alternative, ciprofloxacin p. 348

▶Strains with decreased sensitivity to ciprofloxacin isolated

frequently

Salmonella (non-typhoid)

▶Treat invasive or severe infection. Do not treat less severe

infection unless there is a risk of developing invasive

infection (e.g. immunocompromised children, those with

haemoglobinopathy, or children under 6 months of age).

.Ciprofloxacinorcefotaxime p. 320

Shigellosis

▶Antibacterial not indicated for mild cases.

.Azithromycinorciprofloxacin

▶Alternatives if micro-organism sensitive, amoxicillin p. 339

ortrimethoprim p. 359

Typhoid fever

▶Infections from Middle-East, South Asia, and South-East

Asia may be multiple-antibacterial-resistant and

sensitivity should be tested.

.Cefotaxime (orceftriaxone p. 322 )

▶azithromycin may be an alternative in mild or moderate

disease caused by multiple-antibacterial-resistant micro-

organisms

.Alternative if micro-organism sensitive, ciprofloxacinor

chloramphenicol p. 354

Clostridium difficile infection

▶Clostridium difficileinfection is caused by colonisation of

the colon withClostridium difficileand production of toxin.

306 Bacterial infection BNFC 2018 – 2019

Infection

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