Standard intramuscular 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, if intravenous (or intraosseous) access cannot be rapidly established (eg within 15 minutes), the initial antibiotic dose can be administered intramuscularly. Use:

1cefotaxime 50 mg/kg up to 2 g intramuscularly, as a single dose while establishing intravenous (or intraosseous) access¹ cefotaxime

1ceftriaxone 50 mg/kg up to 2 g intramuscularly, as a single dose while establishing intravenous (or intraosseous) access². ceftriaxone

Vancomycin and aciclovir cannot be administered intramuscularly. If 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.

¹ Intramuscular injection of cefotaxime is painful; consider reconstituting with lidocaine 0.5%. Split large intramuscular doses into 2 injections.Return

² Intramuscular injection of ceftriaxone is painful; consider reconstituting with lidocaine 1%. Split large intramuscular doses into 2 injections.Return