Intravenous empirical therapy for bronchiectasis exacerbations in children

For children with a bronchiectasis exacerbation who require empirical intravenous therapy, use:

1ceftriaxone (child 1 month or older) 50 mg/kg up to 2 g intravenously, daily; see advice on modification and duration of therapy ceftriaxone

OR

1cefotaxime 50 mg/kg up to 2 g intravenously, 8-hourly; see advice on modification and duration of therapy cefotaxime

OR

1amoxicillin+clavulanate intravenously; see advice on modification and duration of therapy amoxicillin + clavulanate

1+0.2 g formulation

child younger than 3 months and less than 4 kg: 25+5 mg/kg 12-hourly

child younger than 3 months and 4 kg or more: 25+5 mg/kg 8-hourly

child 3 months or older and less than 40 kg: 25+5 mg/kg up to 1+0.2 g 8-hourly

child 40 kg or more: 1+0.2 g 6-hourly

OR

2+0.2 g formulation

child 40 kg or more: 2+0.2 g 8-hourly.

For children with a bronchiectasis exacerbation who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin, use ceftriaxone or cefotaxime at the dosages above.

For children with a bronchiectasis exacerbation who have had a severe immediate1 hypersensitivity reaction to a penicillin, ceftriaxone or cefotaxime (at the dosage above) can be considered if a beta-lactam antibiotic is strongly preferred (for considerations, see Severe immediate hypersensitivity: Implications of cross-reactivity between penicillins and cephalosporins).

For children with a bronchiectasis exacerbation who have had a severe immediate1 hypersensitivity reaction to a penicillin in whom ceftriaxone or cefotaxime is not used, or for children who have had a severe delayed2 hypersensitivity reaction to a penicillin, use:

moxifloxacin 10 mg/kg up to 400 mg intravenously, daily3; see advice on modification and duration of therapy. moxifloxacin

1 Severe immediate hypersensitivity reactions include anaphylaxis, compromised airway, airway angioedema, hypotension and collapse.Return
2 Severe delayed hypersensitivity reactions include cutaneous adverse drug reactions (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome/toxic epidermal necrolysis [SJS/TEN], severe blistering or desquamative rash), and significant internal organ involvement (eg acute interstitial nephritis).Return
3 Moxifloxacin is not licensed for use in children on the basis of animal studies that showed an adverse effect on cartilage development with quinolone use; however, clinical trial data suggest that adverse musculoskeletal events are usually mild and short term, similar to those observed in adults. Moxifloxacin can be used in children when it is the drug of choice.Return