Standard regimen for septic jugular thrombophlebitis in children

For initial management of children with septic jugular thrombophlebitis (including those with associated lung abscess), while awaiting the results of culture and susceptibility testing, as a 2-drug regimen, use:

metronidazole 12.5 mg/kg up to 500 mg intravenously, 12-hourly. See advice on modification and duration of therapy metronidazole

PLUS EITHER

1ceftriaxone (child 1 month or older) 50 mg/kg up to 2 g intravenously, daily. For children with septic shock or requiring intensive care support, use ceftriaxone (child 1 month or older) 50 mg/kg up to 1 g intravenously, 12-hourly. See advice on modification and duration of therapy ceftriaxone

OR

1cefotaxime 50 mg/kg up to 2 g intravenously, 8-hourly. For children with septic shock or requiring intensive care support, use cefotaxime 50 mg/kg up to 2 g intravenously, 6-hourly. See advice on modification and duration of therapy. cefotaxime

For children with septic shock, add to the above regimen:

vancomycin intravenously; for initial dosing, see Intermittent vancomycin dosing for young infants and children. See advice on modification and duration of therapy. vancomycin

Pharmacokinetics may be altered in children who are critically ill (eg because of enhanced kidney clearance or changes in volume of distribution). To ensure adequate drug exposure in children with septic jugular thrombophlebitis who have septic shock or require intensive care support, modified dosages of ceftriaxone and cefotaxime are recommended. Once the critical illness has resolved, consider switching to the standard dosage.