Hospital-acquired sepsis or septic shock in neonates and children younger than 2 months who may have meningitis
For term and preterm neonates with late onset sepsis or septic shock (occurring after 72 hours of birth) who have been in hospital since birth and may have meningitis (ie not excluded by lumbar puncture), or children younger than 2 months who have hospital-acquired sepsis or septic shock and may have meningitis, as a 2-drug regimen, use:
1cefotaxime 50 mg/kg intravenously; for dosing frequency, see Cefotaxime intravenous dosing for neonates and children younger than 2 months with sepsis or septic shock cefotaxime
OR
1ceftriaxone (child 1 month or older) 50 mg/kg intravenously, 12-hourly1 ceftriaxone
PLUS with either of the above regimens
vancomycin intravenously; for initial dosing, see Intermittent vancomycin dosing in young infants. vancomycin
|
cefotaxime intravenous dose = 50 mg/kg | ||
|
postmenstrual age [NB1] | postnatal age | dosing frequency |
|
younger than 30 weeks |
28 days or younger |
12-hourly |
|
29 days or older |
8-hourly | |
|
30 to younger than 37 weeks |
14 days or younger |
12-hourly |
|
15 days or older |
8-hourly | |
|
37 weeks and older | 7 days or younger |
8-hourly |
| 8 days or older |
6-hourly | |
|
child 1 month to younger than 2 months | - |
6-hourly |
|
Note:
NB1: postmenstrual age = gestational age + postnatal age | ||
In neonates and children younger than 2 months suspected to have HSV infection, or neonates whose birthing parent had active genital HSV infection at birth, add aciclovir to the above regimens. Use:
If HSV infection is confirmed, see Neonatal herpes simplex infection for subsequent management.
For more information on the management of neonates suspected to have HSV infection, or whose birthing parent had active genital HSV infection at birth, see the Australasian Society for Infectious Diseases (ASID) Management of Perinatal Infections guidelines.
If intravenous (or intraosseous) access cannot be rapidly established (eg within 15 minutes), the initial dose of antimicrobial therapy can be administered intramuscularly. Ceftriaxone is preferred over cefotaxime when administered intramuscularly due to its long half-life. Cefotaxime should be given rather than ceftriaxone for neonates and children younger than 2 months receiving intravenous calcium solutions (including parenteral nutrition, compound sodium lactate [Hartmann solution], lactated Ringer solution), or those with jaundice, hypoalbuminaemia, acidosis, unconjugated hyperbilirubinaemia or impaired bilirubin binding. For more information, see Practical information on using beta lactams: cephalosporins.
If intravenous (or intraosseous) access cannot be rapidly established in term and preterm neonates, and children younger than 2 months, use:
1ceftriaxone 50 mg/kg intramuscularly, as a single dose while establishing intravenous (or intraosseous) access ceftriaxone
OR
2cefotaxime 50 mg/kg intramuscularly, as a single dose while establishing intravenous (or intraosseous) access. cefotaxime
Vancomycin and aciclovir cannot be administered intramuscularly. If the neonate or child younger than 2 months is at increased risk of MRSA infection (eg exposed to a caregiver colonised with MRSA) or if HSV infection is suspected, seek expert advice.
Establish intravenous (or intraosseous) access before the next scheduled antimicrobial dose. There are few data on absorption and distribution of intramuscular antimicrobials in sepsis or septic shock. If switching from intramuscular ceftriaxone to intravenous cefotaxime, administer the first cefotaxime dose 12 hours after the intramuscular ceftriaxone dose.