Antibiotic Treatment of Infectious Diseases in Pediatrics
The first-line antibiotic treatment for pediatric infectious diseases should be selected based on the specific infection site, patient age, and likely pathogens, with narrow-spectrum antibiotics preferred whenever possible to prevent antimicrobial resistance. 1
Common Antibiotics by Infection Site
Respiratory Tract Infections
Upper Respiratory Tract (Ear, Nose, Throat)
- First-line: Amoxicillin 90 mg/kg/day divided in 2 doses 1, 2
- Alternatives:
- Amoxicillin-clavulanate (for beta-lactamase producing organisms)
- Macrolides (for atypical pathogens or penicillin allergy)
Lower Respiratory Tract (Pneumonia)
Outpatient treatment:
- Children <5 years: Amoxicillin 90 mg/kg/day in 2 doses
- Children ≥5 years: Amoxicillin 90 mg/kg/day in 2 doses (max 4g/day)
- Consider macrolides for atypical pneumonia
Inpatient treatment:
- Ampicillin 150-200 mg/kg/day divided every 6 hours
- Alternatives: Cefotaxime (150 mg/kg/day every 8 hours) or Ceftriaxone (50-100 mg/kg/day every 12-24 hours) 1
Neonatal Infections
Neonatal Sepsis and Pneumonia
- First-line: Ampicillin plus Gentamicin 1
- Ampicillin dosing by age and weight:
Postnatal Age Weight Recommended Dose ≤7 days ≤2000 g 50 mg/kg/day every 12 hours ≤7 days >2000 g 75 mg/kg/day every 8 hours >7 days <1200 g 50 mg/kg/day every 12 hours >7 days 1200-2000 g 75 mg/kg/day every 8 hours >7 days >2000 g 100 mg/kg/day every 6 hours
- Ampicillin dosing by age and weight:
Skin and Soft Tissue Infections
- Mild-moderate: Cephalexin or Clindamycin (if MRSA suspected)
- Severe: Vancomycin or Clindamycin plus a beta-lactam 1
Genitourinary Tract Infections
- First-line: Amoxicillin for susceptible organisms 2
- Alternatives:
- Trimethoprim-sulfamethoxazole
- Cephalosporins (cefixime, ceftriaxone)
- Nitrofurantoin for lower UTIs
Bone and Joint Infections
- First-line: Cefotaxime plus anti-staphylococcal coverage 3
- Alternatives: Based on culture results and local resistance patterns
Age-Specific Considerations
Neonates (0-28 days)
- Special considerations:
Infants and Young Children
- Common pathogens:
- Respiratory: S. pneumoniae, H. influenzae, S. pyogenes
- UTI: E. coli, other Enterobacteriaceae
- Skin: S. aureus, S. pyogenes
Older Children and Adolescents
- Dosing: Approaches adult dosing based on weight
- Considerations: Increased compliance issues, different pathogen distribution
Antibiotic Stewardship Principles
- Narrow-spectrum first: Use the narrowest spectrum antibiotic effective against the suspected pathogen 1
- Appropriate duration: Avoid unnecessarily prolonged courses
- Culture when possible: Guide therapy based on susceptibility results
- Monitor for improvement: Assess clinical response within 48-72 hours 1
Special Situations
Antimicrobial Resistance Concerns
- MRSA: Consider local prevalence when selecting empiric therapy
- Drug-resistant S. pneumoniae: May require higher amoxicillin doses (90 mg/kg/day)
- Beta-lactamase producers: Use beta-lactamase inhibitor combinations
H. pylori Infection (Adolescents)
- Triple therapy: Amoxicillin 1g twice daily + clarithromycin 500mg twice daily + lansoprazole 30mg twice daily for 14 days
- Dual therapy: Amoxicillin 1g three times daily + lansoprazole 30mg three times daily for 14 days 2
Monitoring and Safety
- Renal function: Adjust doses for aminoglycosides and certain beta-lactams in renal impairment
- Drug levels: Monitor aminoglycoside levels to prevent toxicity
- Adverse effects: Watch for diarrhea (including C. difficile), rash, and allergic reactions 1, 2
Pitfalls to Avoid
- Overuse of broad-spectrum antibiotics: Increases resistance and adverse effects
- Inadequate dosing: Particularly in rapidly growing children
- Failure to adjust therapy: When culture results become available
- Overlooking supportive care: Ensure adequate hydration, oxygenation, and nutrition alongside antibiotic therapy 1
Remember that local resistance patterns may necessitate adjustments to these recommendations, and clinical judgment should guide therapy decisions in individual cases.