Standard regimen for hospital-acquired sepsis or septic shock in children 2 months or older
For children 2 months or older with hospital-acquired sepsis or septic shock of unknown source, in the absence of local protocols or expert advice, useAbdul-Aziz, 2024Dulhunty, 2024:
child without septic shock and not requiring intensive care support: 100+12.5 mg/kg up to 4+0.5 g, 6-hourly
child with septic shock or requiring intensive care support: 100+12.5 mg/kg up to 4+0.5 g administered as a loading dose over 30 minutes. After 3 hours, start a continuous infusion of 400+50 mg/kg up to 16+2 g administered over 24 hours12
PLUS if the child has septic shock, suspected line-related sepsis or other risk factors for MRSA infection
vancomycin intravenously; for initial dosing, see Intermittent vancomycin dosing for young infants and children.
For children 2 months or older in whom toxic shock syndrome is suspected3, add to the above regimen:
clindamycin 15 mg/kg up to 600 mg intravenously, 8-hourly for a minimum of 72 hours and until organ function has significantly improved4 clindamycin
PLUS
intravenous immunoglobulin (IVIg) 2 g/kg intravenously, as a single dose as soon as possible but not later than 72 hours. It is reasonable to give the dose in divided doses if it is not possible to give a single dose.
For children at risk of invasive Candida infection, consider the addition of an empirical antifungal.
This empirical regimen is 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.