Hospital-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 sepsis or septic shock (occurring after 72 hours of birth) who have been in hospital since birth and do not have meningitis (ie excluded by lumbar puncture), and children younger than 2 months who have hospital-acquired sepsis or septic shock and 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
1flucloxacillin 50 mg/kg intravenously flucloxacillin
neonate 7 days or younger: 12-hourly
neonate 8 days to younger than 21 days: 8-hourly
neonate 21 days to younger than 1 month: 6-hourly
child 1 to 2 months: 6-hourly
OR if the neonate or child is at increased risk of MRSA infection
1vancomycin intravenously; for initial dosing, see Intermittent vancomycin dosing in young infants. vancomycin
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.
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 with either of the above regimens
flucloxacillin 50 mg/kg intramuscularly as a single dose while establishing intravenous (or intraosseous) access. flucloxacillin
Vancomycin and aciclovir cannot be given 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.