Spinal epidural abscess in children who are not at increased risk of infection with MRSA or gram-negative organisms

In children with spinal epidural abscess, take blood for culture before starting antibiotic therapy.

Start empirical therapy for spinal epidural abscess as soon as possible. Do not delay for surgery. For children who are not at increased risk of infection with MRSA or gram-negative organisms, while awaiting susceptibility results, use:

flucloxacillin 50 mg/kg up to 2 g intravenously, 6-hourly. For critically ill children, use a 4-hourly dosing interval (ie 50 mg/kg up to 2 g intravenously, 4-hourly)¹. See advice on modification and duration of therapy. flucloxacillin

For children who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin, while awaiting susceptibility results, use:

cefazolin 50 mg/kg up to 2 g intravenously, 8-hourly. See advice on modification and duration of therapy. cefazolin

For children who have had a severe immediate² hypersensitivity reaction to a penicillin, cefazolin (at the dosage above) can be considered if a beta-lactam antibiotic is strongly preferred (for considerations, see Severe immediate hypersensitivity: Implications of cross-reactivity between penicillins and cephalosporins).

For children who have had a severe immediate² hypersensitivity reaction to a penicillin in whom cefazolin is not used, or for patients who have had a severe delayed³ hypersensitivity reaction to a penicillin, while awaiting susceptibility results, use:

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

¹ Some children with spinal epidural abscess will be critically ill. To ensure adequate drug exposure in these patients, a modified dosage of flucloxacillin is recommended. This is because pharmacokinetics may be altered in critical illness (eg because of enhanced kidney clearance or changes in volume of distribution). Once the critical illness has resolved, consider switching to the standard dosage.Return

² Severe immediate hypersensitivity reactions include anaphylaxis, compromised airway, airway angioedema, hypotension and collapse.Return

³ Severe delayed hypersensitivity reactions include cutaneous adverse drug reactions (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome/toxic epidermal necrolysis [SJS/TEN], severe blistering or desquamative rash), and significant internal organ involvement (eg acute interstitial nephritis).Return