BNF for Children (BNFC) 2018-2019

Endocarditis caused by staphylococci

.Flucloxacillin
▶Add rifampicin for at least 2 weeks in prosthetic valve
endocarditis
▶Suggested duration of treatmentat least 4 weeks (at least
6 weeks for prosthetic valve endocarditis)

.If penicillin-allergic or if meticillin-resistant Staphylococcus
aureus, vancomycin + rifampicin

▶Suggested duration of treatmentat least 4 weeks (at least
6 weeks for prosthetic valve endocarditis)

Endocarditis (native valve) caused by fully-sensitive

streptococci e.g. viridans streptococci

.Benzylpenicillin sodium

▶Suggested duration of treatment 4 weeks
▶Alternative if a large vegetation, intracardial abscess, or
infected emboli are absent, benzylpenicillin sodium +
gentamicin
▶Suggested duration of treatment 2 weeks

.If penicillin-allergic, vancomycin

▶Suggested duration of treatment 4 weeks

Endocarditis (native valve) caused by less-sensitive

streptococci

.Benzylpenicillin sodium + gentamicin

▶Suggested duration of treatment 4 – 6 weeks (stop
gentamicin after 2 weeks for micro-organisms moderately
sensitive to penicillin)
▶If aminoglycoside cannot be used and if streptococci
moderately sensitive to penicillin, benzylpenicillin sodium
▶Suggested duration of treatment 4 weeks

.If penicillin-allergic or highly penicillin-resistant,
vancomycin (orteicoplanin p. 325 ) + gentamicin

▶Suggested duration of treatment 4 – 6 weeks (stop
gentamicin after 2 weeks for micro-organisms moderately
sensitive to penicillin)

Endocarditis (prosthetic valve) caused by

streptococci

.Benzylpenicillin sodium + gentamicin

▶Suggested duration of treatmentat least 6 weeks (stop
gentamicin after 2 weeks if micro-organisms fully sensitive
to penicillin)

.If penicillin-allergic or highly penicillin-resistant,
vancomycin (orteicoplanin) + gentamicin

▶Suggested duration of treatmentat least 6 weeks (stop
gentamicin after 2 weeks if micro-organisms fully sensitive
to penicillin)

Endocarditis caused by enterococci (e.g.

Enterococcus faecalis)

.Amoxicillin p. 339 (orampicillin p. 341 ) + gentamicin

▶If gentamicin-resistant, substitute gentamicin with
streptomycin p. 313
▶Suggested duration of treatmentat least 4 weeks (at least
6 weeks for prosthetic valve endocarditis)

.If penicillin-allergic or penicillin-resistant, vancomycin (or
teicoplanin) + gentamicin

.If gentamicin-resistant, substitute gentamicin with
streptomycin

▶Suggested duration of treatmentat least 4 weeks (at least
6 weeks for prosthetic valve endocarditis)

Endocarditis caused byHaemophilus,Actinobacillus,

Cardiobacterium,Eikenella,andKingellaspecies

(’HACEK’micro-organisms)

.Amoxicillin (orampicillin) + gentamicin

▶Suggested duration of treatment 4 weeks ( 6 weeks for

prosthetic valve endocarditis); stop gentamicin after

2 weeks

.If amoxicillin-resistant, ceftriaxone p. 322 + gentamicin

▶Suggested duration of treatment 4 weeks ( 6 weeks for

prosthetic valve endocarditis); stop gentamicin after

2 weeks

Central nervous system infections,

antibacterial therapy

Meningitis: initial empirical therapy

.Transfer patient to hospital urgently.

.Ifmeningococcal disease(meningitis with non-blanching

rash or meningococcal septicaemia) suspected,

benzylpenicillin sodium p. 338 should be given before

transfer to hospital, so long as this does not delay the

transfer. If a patient with suspected bacterial meningitis

without non-blanching rash cannot be transferred to

hospital urgently, benzylpenicillin sodium should be given

before the transfer. Cefotaxime p. 320 may be an

alternative in penicillin allergy; chloramphenicol p. 354

may be used if history of immediate hypersensitivity

reaction to penicillin or to cephalosporins.

.In hospital, consider adjunctive treatment with

dexamethasone p. 439 , preferably starting before or with

first dose of antibacterial, but no later than 12 hours after

starting antibacterial; avoid dexamethasone in septic

shock, meningococcal septicaemia, or if

immunocompromised, or in meningitis following surgery.

In hospital, if aetiology unknown:

.Neonate and child 1 – 3 months, cefotaxime (orceftriaxone

p. 322 ) + amoxicillin p. 339 (orampicillin p. 341 )

▶Consider adding vancomycin p. 325 if prolonged or

multiple use of other antibacterials in the last 3 months, or

if travelled, in the last 3 months, to areas outside the UK

with highly penicillin- and cephalosporin-resistant

pneumococci

▶Suggested duration of treatmentat least 14 days

.Child 3 months– 18 yearscefotaxime (orceftriaxone)

▶Consider adding vancomycin if prolonged or multiple use

of other antibacterials in the last 3 months, or if travelled,

in the last 3 months, to areas outside the UK with highly

penicillin- and cephalosporin-resistant pneumococci

▶Suggested duration of treatmentat least 10 days

Meningitis caused by group B streptococcus

.Benzylpenicillin sodium + gentamicin p. 312 orcefotaxime

(orceftriaxone) alone

▶Suggested duration of treatmentat least 14 days; stop

gentamicin after 5 days

Meningitis caused by meningococci

.Benzylpenicillin sodiumorcefotaxime (orceftriaxone)

▶Suggested duration of treatment 7 days.

.If history of immediate hypersensitivity reaction to penicillin

or to cephalosporins, chloramphenicol

▶Suggested duration of treatment 7 days.

Meningitis caused by pneumococci

.Cefotaxime (orceftriaxone)

BNFC 2018 – 2019 Bacterial infection 305

Infection

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