What is the recommended treatment for bacterial infections in children?

Treatment of Bacterial Infections in Children

The recommended treatment for bacterial infections in children depends on the specific type of infection, with first-line therapy typically being amoxicillin for respiratory infections, cephalosporins for skin infections, and targeted antibiotics based on suspected pathogens for other infections. 1

General Principles of Antibiotic Selection

• Selection of antibiotics should be based on the origin of infection (community vs. healthcare-acquired), severity of illness, and safety of antimicrobial agents in specific pediatric age groups 1
• Empiric therapy should target the most likely pathogens based on the site of infection, with consideration for local resistance patterns 1
• Dosing should be optimized to ensure adequate tissue penetration while minimizing adverse effects 1

Treatment by Infection Type

Respiratory Tract Infections

Community-Acquired Pneumonia

• First-line treatment: Amoxicillin 90 mg/kg/day divided in 2 doses for 5-7 days 1
• For children with penicillin allergy: Clindamycin (30-40 mg/kg/day in 3-4 doses) 1
• For atypical pathogens (Mycoplasma, Chlamydia): Add azithromycin (10 mg/kg on day 1, followed by 5 mg/kg/day for days 2-5) 2
• For hospitalized patients with severe pneumonia: Ceftriaxone (50-100 mg/kg/day) or ampicillin (200 mg/kg/day) 1

Acute Otitis Media

• First-line treatment: Amoxicillin 40-50 mg/kg/day divided in 2 doses for 5 days 3, 4
• For recent antibiotic exposure or high-resistance areas: High-dose amoxicillin-clavulanate (90/6.4 mg/kg/day in 2 doses) 3, 4

Sinusitis

• First-line treatment: Amoxicillin 45 mg/kg/day in 2 doses for 5-8 days 3
• For treatment failure: Amoxicillin-clavulanate (90 mg/kg/day of amoxicillin component) 1, 3

Skin and Soft Tissue Infections

Impetigo, Cellulitis, Erysipelas

• First-line treatment: Oral cephalexin (75-100 mg/kg/day in 3-4 doses) for mild infections 1, 5
• For methicillin-susceptible S. aureus: Flucloxacillin or dicloxacillin 5
• For methicillin-resistant S. aureus (MRSA): Oral clindamycin (30-40 mg/kg/day in 3-4 doses) 1
• For severe infections: IV vancomycin (40-60 mg/kg/day) or clindamycin (40 mg/kg/day) 1

Intra-abdominal Infections

• First-line treatment: Combination therapy with ampicillin (200 mg/kg/day), gentamicin (5-7.5 mg/kg/day), and metronidazole (30-40 mg/kg/day) 1
• Alternative regimens: Piperacillin-tazobactam (200-300 mg/kg/day of piperacillin component) or a carbapenem (meropenem 60 mg/kg/day) 1
• For mild-moderate infections: Amoxicillin-clavulanate or ceftriaxone plus metronidazole 1

Pleural Infections (Empyema)

• First-line treatment: Cefuroxime, co-amoxiclav, or penicillin plus flucloxacillin 1
• For penicillin-allergic patients: Clindamycin alone 1
• Duration: Continue IV antibiotics until afebrile or chest drain removed, then oral antibiotics for 1-4 weeks 1

Special Considerations

Neonatal Infections

• For early-onset sepsis: Ampicillin (150-200 mg/kg/day) plus gentamicin (5 mg/kg/day) 1, 6
• For late-onset sepsis: Consider broader coverage with cefotaxime (150 mg/kg/day) plus ampicillin 1

Treatment Failure

• For children who fail first-line amoxicillin: Switch to amoxicillin-clavulanate (80-90 mg/kg/day of amoxicillin component) 1
• For children over 3 years with persistent symptoms: Consider adding a macrolide (erythromycin 50 mg/kg in four divided doses) 1

Duration of Therapy

• Community-acquired pneumonia: 5-7 days 1, 7
• Otitis media: 5 days for uncomplicated cases 3
• Skin infections: 7-10 days depending on severity 5
• Intra-abdominal infections: 7-10 days, guided by clinical response 1

Common Pitfalls to Avoid

• Avoid fluoroquinolones in children due to potential adverse effects on developing cartilage 1, 3
• Avoid antibiotics for viral infections; most respiratory infections in young children are viral 1, 3
• Avoid underdosing antibiotics, particularly for S. pneumoniae infections in high-resistance areas 1, 4
• Ensure adequate dosing based on weight and age; neonates and young infants may require different dosing schedules due to immature renal function 6
• Monitor for adverse effects, particularly diarrhea with amoxicillin-clavulanate, which occurs less frequently with twice-daily dosing compared to three-times-daily dosing 4