Standard intravenous regimen for community-acquired sepsis in children 2 months or older
For children 2 months or older with community-acquired sepsis of unknown source without septic shock (whether or not meningitis has been excluded), use:
1cefotaxime 50 mg/kg up to 2 g intravenously, 6-hourly1 cefotaxime
OR
1ceftriaxone 50 mg/kg up to 2 g intravenously, 12-hourly2 ceftriaxone
PLUS with either of the above regimens if the child is at increased risk of MRSA infection
vancomycin intravenously; for initial dosing, see Intermittent vancomycin dosing for young infants and children. vancomycin
If vancomycin is required, prioritise administration of cefotaxime or ceftriaxone, because vancomycin requires slow infusion.
If meningitis is suspected, add to the above regimens:
dexamethasone 0.15 mg/kg up to 10 mg intravenously, preferably starting before the first dose of antibiotic, then 6-hourly3. For duration of therapy, see Overview of empirical therapy for adults and children 2 months or older with meningitis. dexamethasone
If herpes simplex encephalitis is suspected, add to the above regimens:
aciclovir intravenously, 8-hourly45 aciclovir
child younger than 5 years: 20 mg/kg or 500 mg/m2
child 5 years to 12 years: 15 mg/kg or 500 mg/m2
child older than 12 years: 10 mg/kg.
If herpes simplex encephalitis is confirmed, seek expert advice. See also Herpes simplex encephalitis for subsequent management.
These empirical regimens are intended for initial therapy only (up to 48 hours). Modify therapy as soon as additional information is available (eg source of infection, results of Gram stain, culture and susceptibility testing). Evaluate the appropriateness of antimicrobial therapy daily, with consideration given to the patient’s clinical status and the principles of antimicrobial stewardship.