Community-acquired sepsis or septic shock in neonates and children younger than 2 months who do not have meningitis
For term and preterm neonates with late onset community-acquired sepsis or septic shock (occurring after 72 hours of birth) who do not have meningitis (ie excluded by lumbar puncture), and children younger than 2 months who have community-acquired sepsis or septic shock who do not have meningitis, as a 2-drug regimen, use:
1gentamicin intravenously; see Principles of aminoglycoside use for prescribing considerations and subsequent dosing gentamicin
child 1 to 2 months: 7 mg/kg for initial dose
OR
1tobramycin intravenously; see Principles of aminoglycoside use for prescribing considerations and subsequent dosing tobramycin
child 1 to 2 months: 7 mg/kg for initial dose
PLUS EITHER
1amoxicillin 50 mg/kg intravenously amoxicillin
neonate less than 7 days: 12-hourly
neonate 7 days or older: 8-hourly
child 1 to 2 months: 6-hourly
OR
1ampicillin 50 mg/kg intravenously ampicillin
neonate less than 7 days: 12-hourly
neonate 7 days or older: 8-hourly
child 1 to 2 months: 6-hourly.
In neonates and children suspected to have HSV infection, or neonates whose birthing parent had active genital HSV infection at birth, add aciclovir to the above regimens. Use:Australasian Society for Infections Diseases (ASID) 2022
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 HSV infection is confirmed, see Neonatal herpes simplex infection for subsequent management.
For neonates and children at increased risk of MRSA infection (eg exposed to a caregiver colonised with MRSA), add vancomycin to the above regimens. Use:
vancomycin intravenously; for initial dosing, see Intermittent vancomycin dosing in young infants. vancomycin
If intravenous (or intraosseous) access cannot be rapidly established (eg within 15 minutes), the initial dose of antimicrobial therapy can be administered intramuscularly. For neonates and children who do not have meningitis (ie excluded by lumbar puncture), as a 2-drug regimen, use:
1gentamicin intramuscularly; see Principles of aminoglycoside use for prescribing considerations and subsequent dosing gentamicin
child 1 to 2 months: 7 mg/kg for initial dose
OR
1tobramycin intramuscularly; see Principles of aminoglycoside use for prescribing considerations and subsequent dosing tobramycin
child 1 to 2 months: 7 mg/kg for initial dose
PLUS EITHER
1amoxicillin 50 mg/kg intramuscularly, as a single dose while establishing intravenous (or intraosseous) access amoxicillin
OR
1ampicillin 50 mg/kg intramuscularly, as a single dose while establishing intravenous (or intraosseous) access. ampicillin
Vancomycin and aciclovir cannot be administered intramuscularly. If the neonate or child 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.