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Adults and children over 5 years The usual organisms involved are Staphylococcus aureus and Streptococcus spp. Empiric treatment: Cloxacillin 100 - 200 mg/kg/day up to 12 g/day IV divided 6 hourly OR Cefazolin100 mg/kg/day up to 4 g/day IV divided 6 hourly In patients allergic to beta-lactams: Vancomycin 1 g IV 12 hourly (40 mg/kg/day in children) OR Clindamycin 16 mg/kg/day up to 1200 mg/day IV divided 6 hourly OR Fusidic acid 30 mg/kg/day up to 1500 mg/day IV divided 8 hourly. It is ideal to combine clindamycin or fusidicacid with a second antistaphylococcal agent such as rifampicin.

The standard recommendations for the empiric treatment of bacterial meningitis have undergone some significant changes in the last decade. The emergence of beta-lactamase-producing strains of Haemophilus influenzae, which now account for approximately 10% of community-acquired strains, has dictated against the use of ampicillin alone as empiric therapy for meningitis in infants and children less than 5 years old. In addition, there is an increasing prevalence of Streptococcus pneumoniae strains which are either highly- or intermediately-resistant to penicillin.

The first dose of dexamethasone MUST be given 30 minutes before the first dose of antibiotic. Note: It must not be given after the onset of antibiotic therapy. Page 54 B r ai n a bs c e s s Usual pathogens include Streptococcus milleri, Enterobacteriaceae, Staphylococcus aureus and anaerobes (often polymicrobic). 5 - 50 mg/kg SMX 12 hourly Amikacin 15mg/kg IV or IM daily Staphylococcus aureus Dose: Pseudomonas Cloxacillin for 3 - 6 weeks 2 g 6 hourly (adults), 200 mg/kg/day (children) Ceftazidime PLUS amikacin for 4 - 16 weeks OR Piperacillin PLUS amikacin for 4 - 16 weeks Dose: Ceftazidime 2 g 8 hourly (adults) Amikacin 15 mg/kg daily (adults) Piperacillin 4 g 8 hourly (adults) Page 55 Causative Organism and / Drug of Choice or Illness type Acute bacterial meningitis: Neonates Children 2 months - 5 years Adult Dose Dose in Children Alternative Cefotaxime OR Ceftriaxone PLUS Ampicillin 100 - 200 mg/kg/ day IV 100 mg/kg day IV 100 - 200 mg/ kg/day IV Ceftriaxone OR Cefotaxime 100 mg/kg/day Ampicillin OR IV 150 - 200 mg/kg/ Chloramphenicol day IV 100 mg/kg/day IV 150 - 200 mg/ kg/day IV Adults and children > 5 years Ceftriaxone OR Cefotaxime 100 mg/kg/day IV 150 - 200 mg/kg/ day IV Meningococcal meningitis 250000 U/kg/day Ampicillin Penicillin G OR 250000 U/kg/ Chloramphenicol day IV in 4 - 6 divided doses (up to 20 - 24 million U/day) Pneumococcal meningitis Penicillin G 250 000 U/kg/ 250000 U/kg/ day day IV in 4 - 6 divided doses (up to 20 - 24 million U/day) Haemophilus influenzae meningitis Ceftriaxone OR Cefotaxime 100 mg/kg/ day IV 150 - 200 mg/ kg/day IV in 2 - 4 divided doses Brain abscess Penicillin G PLUS Ceftriaxone PLUS Metronidazole 5 mU 4 hrly 100 mg/kg/ day IV 150 - 200 mg/ kg/day IV Cefotaxime OR Ceftriaxone - if not fully sensitive to penicillin PLUS Vancomycin and/ or rifampicin if not fully sensi- tive to third generation cephalosporins Ampicillin 200 mg/ kg/day IV in 4 divided doses OR Amoxycillin (same dose as ampicillin) only if sensitive OR Chloramphenicol 1 - 2 g 12 – 24 hrly 750 mg 8 hrly Page 56 Ch apte r 1 1 : E ar , N o s e an d T h r o at I n fe c ti o n s Oti ti s m e di a Acute suppurative otitis media Usual pathogens: Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis.

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