Standard intramuscular regimen for community-acquired septic shock in children 2 months or older
For children 2 months or older with community-acquired septic shock of unknown source, if intravenous (or intraosseous) access cannot be rapidly established (eg within 15 minutes), the initial antibiotic doses can be administered intramuscularly. As a 2-drug regimen, use:
1cefotaxime 50 mg/kg up to 2 g intramuscularly, as a single dose while establishing intravenous (or intraosseous) access1 cefotaxime
OR
1ceftriaxone 50 mg/kg up to 2 g intramuscularly, as a single dose while establishing intravenous (or intraosseous) access2 ceftriaxone
PLUS with either of the above regimens
1gentamicin 7 mg/kg intramuscularly as an initial dose3; see Principles of aminoglycoside use for prescribing considerations and subsequent dosing gentamicin
OR
1tobramycin 7 mg/kg intramuscularly as an initial dose3; see Principles of aminoglycoside use for prescribing considerations and subsequent dosing. tobramycin
Vancomycin and aciclovir cannot be administered intramuscularly. If methicillin-resistant Staphylococcus aureus (MRSA) infection or herpes simplex encephalitis is suspected, seek expert advice.
Establish intravenous (or intraosseous) access before the next scheduled antibiotic dose. There are few data on absorption and distribution of intramuscular antimicrobials in sepsis or septic shock.