Neonatal sepsis (Infection of blood stream)

When a pathogenic organism access into blood stream, they may case  on overwhelming infection without much localization.

Common organism

1. E-coli
2. Staphylococcus aureus
3. klebsiella  
4. H influenza
5. Pseudomonas 

Types of Neonatal sepsis

1. Early onset neonatal sepsis  <72hrs
2. Late onset neonatal sepsis >72 hrs

1. Early onset neonatal sepsis  <72hrs

Infection caused by organism prevalent in the maternal genital tract or in the delivery area.

Predisposing factors <72hrs 

1. Prolonged rupture of membrane
2. Foul smelling liquor
3. Multiple per vaginal examination
4. Maternal fever 
5. Prolonged labor
6. LBW

1. Late onset neonatal sepsis >72 hrs

Infection caused by external environment of the home or the hospital eg. The infection transmitted through the hands of the care provides

Predisposing factors >72hrs 

1. LBW
2. Lack  of breast feeding
3. Poor core care
4. Superficial infection

Causative organism

1. Enterobacter (Mainly in surgical pattern)

Clinical feature  

1. Lethargic
2. Poor cry
3. Fever
4. Poor feeding 
5. Hypothermia
6. Abdominal distension
7. Vomiting 
8. Fast breathing

Note:

1. Most causes of meningitis don't have any distinct  clinical feature of meningeal sign in all cases suspected sepsis 
2. Seizure
3. Bulging anterior fontanel are suggestive of meningitis
4. Shock
5. Tachycardia

Investigation

1. Tc
2. Dc
3. ESR
4. Hb%
5. Platelates 
6. CSF

Treatment 

1.Antibiotics therapy

1. Ampicillin:50mg/kg/day*QID
2. Amikacin:15mg/kg/day* OD
3. Cefetaxime:50mg/kg/dose*TDS

In meningitis 

1. Ceftriaxone : 50mg/kg/dose*BD*10dys
2. Amikacin :15mg/kg/OD

2.Symptomatic Treatment

Ampicillin

Dosing & Uses

Pediatric

Dosing Forms & Strengths

General Dosing Guidelines

100-400 mg/kg/day IV/IM divided q6hr

50-100 mg/kg/day PO divided q6hr

Severe infection: 200-400 mg/kg/day IV/IM divided q6hr

Neonates (<28 Days Old)

<7 days old

• <2 kg: 50-100 mg/kg/day divided q12hr IV/IM
• >2 kg: 75-150 mg/kg/day divided q8hr IV/IM

>7 days old

• <1.2 kg: 50-100 mg/kg/day divided q12hr IV/IM
• 1.2-2 kg: 75-150 mg/kg/day divided q8hr IV/IM
• >2 kg: 100-200 mg/kg/day divided q6hr IV/IM

Endocarditis Prophylaxis

50 mg/kg (+/- gentamicin 1.5 mg/kg for GI/GU) IV/IM within 30 minutes before procedure 

Recent AHA Guidelines recommend only for high risk patients

Genitourinary Tract Infections

<20 kg: 50-100 mg/kg/day IV divided q6hr

>20 kg: 500 mg IV q6hr

GI Tract Infections

<20 kg: 50-100 mg/kg/day IV divided q6hr

>20 kg: 500 mg IV q6hr

Gonorrhea

<20 kg: Safety & efficacy not established

>20 kg: 3.5 g IV administered once simultaneously with 1 g of probenecid

Respiratory Tract Infections

<20 kg: 50 mg/kg/day IV divided q6-8hr

>20 kg: 250 mg IV q6hr

Cholera

50 mg/kg/day PO divided q6hr for 3 days; not to exceed 2 g/day

Other Information

Potential toxic dose <6 years old: 300 mg/kg

Take on empty stomach

Dosing & Uses

Adult

Dosing Forms & Strengths

General Dosing Guidelines

PO: 250-500 mg q6hr

IV/IM: 1-2 g q4-6hr

Endocarditis Prophylaxis

2 g IV/IM (±gentamicin 1.5 mg/kg for GI/GU) within 30 minutes before procedure

Recent AHA Guidelines recommend only for high risk patients

Genitourinary Tract Infections (Excluding Gonorrhea)

500 - 2000 mg IV q6hr

GI Tract Infections

500 mg IV q6hr

Gonorrhea

3.5 g IV administered once simultaneously with 1 g of probenecid

Respiratory Tract Infections

250 mg IV q6hr

Renal Impairment

CrCl <10 mL/min: use q12-16hr

Amikacin

Dosing & Uses

Pediatric

Dosing Forms & Strengths

General Dosing

15-22.5 mg/kg/day IV/IM divided q8hr  

Neonates

≤7 Days Old

• <29 weeks gestational age: 18 mg/kg IV/IM q48hr 
• 30-33 weeks gestational age: 18 mg/kg IV/IM q36hr
• >34 weeks gestational age: 15 mg/kg IV/IM q24hr

>7 Days Old

• 30-33 weeks gestational age: 15 mg/kg IV/IM q24hr
• >34 weeks gestational age: 15 mg/kg IV/IM q12-18hr

8-28 Days Old & <29 Weeks Gestational Age

15 mg/kg IV/IM q36hr 

Significant Asphyxia, indomethacin for PDA, poor cardiac output, Renal Impairment: dose as <29 weeks gestational age

>28 Days Old & <29 Weeks Gestational Age

15 mg/kg IV/IM q24hr 

Dosing & Uses

Adult

Dosing Forms & Strengths

General Dosing

15 mg/kg/day divided IV/IM q8-12hr 

Urinary Tract Infection

250 mg IV/IM q12hr

Extended Interval Dosing (q24 Hours)

First dose: 15 mg/kg IV based on lean body weight 

Subsequent doses: consult pharmacist

Hospital Acquired Pneumonia

20 mg/kg/day IV; may administer with antipseudomonal beta-lactam or carbapenem 

Meningitis (Gram-Negative Organisms)

5 mg/kg IV q8hr with another bactericidal antibiotic 

Ceftriaxone

Dosing & Uses

Pediatric

Dosing Forms & Strengths

Acute Bacterial Otitis Media

<12 years: 50 mg/kg IM in single dose; not to exceed 1 g 

>12 years: 1-2 g/day IV/IM in single daily dose or divided q12hr for 4-14 days, depending on type and severity of infection

Meningitis

<12 years: 100 mg/kg/day IV/IM in single daily dose or divided q12hr for 7-14 days; not to exceed 4 g/day 

>12 years: 1-2 g/day IV/IM in single daily dose or divided q12hr for 4-14 days, depending on type and severity of infection

Serious Infections Other Than Meningitis

<12 years: 50-75 mg/kg/day IV/IM divided q12hr for 4-14 days 

>12 years: 1-2 g/day IV/IM in single daily dose or divided q12hr for 4-14 days, depending on type and severity of infection

Skin/Skin Structure Infections

<12 years: 50-75 mg/kg/day IV/IM in single daily dose or divided q12hr 

>12 years: 1-2 g/day IV/IM in single daily dose or divided q12hr for 4-14 days, depending on type and severity of infection

Gonococcal Infections

Neonates

• Ophthalmia neonatorum: 25-50 mg/kg IV/IM once; not to exceed 125 mg 
• Disseminated gonococcal infections and gonococcal scalp abscesses: 25-50 mg/kg/day IV/IM in single daily dose for 7 days; if meningitis is documented, treat for 10-14 days
• Prophylaxis for infants of mothers with gonococcal infection: 25-50 mg/kg IV/IM once; not to exceed 125 mg

Children

• <45 kg with uncomplicated gonococcal vulvovaginitis, cervicitis, urethritis, pharyngitis, or proctitis: 125 mg IM once
• <45 kg with bacteremia or arthritis: 50 mg/kg/day IM/IV in single daily dose for 7 days; daily dose not to exceed 1 g
• >45 kg with bacteremia or arthritis: 50 mg/kg/day IM/IV in single daily dose for 7 days
• >45 kg: 1-2 g IV q12hr

• Dosing & Uses

  Adult

  Dosing Forms & Strengths

  Intra-abdominal Infections

  1-2 g/day IV/IM in single daily dose or divided q12hr for 4-14 days, depending on type and severity of infection

  Acute Bacterial Otitis Media

  1-2 g/day IV/IM in single daily dose or divided q12hr for 4-14 days, depending on type and severity of infection

  Pelvic Inflammatory Disease

  1-2 g/day IV/IM in single daily dose or divided q12hr for 4-14 days, depending on type and severity of infection

  Bacterial Septicemia

  1-2 g/day IV/IM in single daily dose or divided q12hr for 4-14 days, depending on type and severity of infection

  Bone & Joint Infections

  1-2 g/day IV/IM in single daily dose or divided q12hr for 4-14 days, depending on type and severity of infection

  Lower Respiratory Tract Infections

  1-2 g/day IV/IM in single daily dose or divided q12hr for 4-14 days, depending on type and severity of infection

  Skin/Skin Structure Infections

  1-2 g/day IV/IM in single daily dose or divided q12hr for 4-14 days, depending on type and severity of infection

  Meningitis

  1-2 g/day IV/IM in single daily dose or divided q12hr for 4-14 days, depending on type and severity of infection

  Urinary Tract Infections

  1-2 g/day IV/IM in single daily dose or divided q12hr for 4-14 days, depending on type and severity of infection

  Uncomplicated Gonococcal Infections

  250 mg IM once

  Infection of pharynx, cervix, urethra, or rectum: 250 mg IM once plus azithromycin or doxycycline

  Sexual assault

  • Prophylaxis of sexually transmitted diseases (STDs) such as gonorrhea after sexual assault
  • 250 mg IM once as part of 3-drug regimen that includes either ceftriaxone or cefixime plus metronidazole plus either azithromycin or doxycycline (per Centers for Disease Control and Prevention guidelines)

  Preparation for Surgery

  Prophylaxis of surgical infection

  1 g IV 0.5-2 hours before procedure

  Other Gonococcal Infections (Off-label)

  Gonococcal conjunctivitis: 1 g IM once

  Disseminated gonococcal infection: 1 g/day IV/IM; continued for at least 24-48 hours after improvement is observed, then continued with cefixime 400 mg PO q12hr to complete at least 1 week of therapy

  Gonococcal endocarditis:1-2 g IV q12hr for 4 weeks

  Gonococcal meningitis: 1-2 g IV q12hr for 10-14 days

• Adverse Effects
• Warnings
• Pregnancy
• Pharmacology
• Administration
• Images
• Patient Handout
• Cefotaxime

Dosing & Uses

Pediatric

Dosing Forms & Strengths

Susceptible Infections

<12 years old or < 50 kg: 50-200 mg/kg/day IV/IM divided q6-8hr 

>12 years old or >50 kg: As in adults

Epiglotitis

<12 years old or < 50 kg: 150-200 mg/kg/day IV/IM divided QID with clindamycin for 7-10 days 

>12 years old or >50 kg: As in adults

Meningitis

<12 years old or < 50 kg: 200 mg/kg/day IV/IM divided q6hr 

>12 years old or >50 kg: As in adults

Pneumonia

<12 years old or < 50 kg: 200 mg/kg/day IV divided q8hr 

>12 years old or >50 kg: As in adults

Sepsis

<12 years old or < 50 kg: 150 mg/kg/day IV divided q8hr 

>12 years old or >50 kg: As in adults

Typhoid Fever

<12 years old or < 50 kg: 150-200 mg/kg/day IV/IM divided TID/QID; 12 g/day maximum 

Fluoroquinolone resistant: 80 mg/kg/day IV/IM divided TID/QID; 12 g/day maximum

>12 years old or >50 kg: As in adults

General Cefotaxime Dosing

0-1 week: 50 mg/kg IV q12hr 

1-4 weeks: 50 mg/kg IV q8hr

1 month old to 12 years old or <50 kg: 50-180 mg/kg/day IV divided q4-6hr

Meningitis: 200 mg/kg/day divided q6hr IV/IM

Dosing & Uses

AdultPediatric

Dosing Forms & Strengths

Gonococcal Urethritis/Cervicitis

0.5 g IM (single dose)

Gonorrhea, Rectal (Men)

1 g IM (single dose)

Gonorrhea, Rectal (Women)

0.5 g IM (single dose)

Moderate to Severe Infections

1 to 2 g IV/IM q8hr

More Severe Infections (Septicemia)

2 g IV q6-8hr

Life-Threatening Infections

2 g IV q4hr up to 12 g/day

Perioperative Prophylaxis

Single 1 g IM or IV dose administered 30 to 90 minutes prior to start of surgery

Uncomplicated Infections

1 g IV/IM q12hr

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