Table 14 CQ18–2: How should empirical antibacterial drugs be selected for pediatric sepsis when the source of infection is difficult to identify?

Community-acquired

Cefotaxime (ceftriaxone)

[Less than 1 month old with high possibility of meningitis]

Add ampicillin in consideration of Listeria monocytogenes

[More than 1 month old with high possibility of meningitis]

Add vancomycin

[High risk of ESBL-producing bacteria]

Switch to meropenem

Streptococcus pneumoniae,

Haemophilus influenzae,

Staphylococcus aureus,

E. coli, etc.

Consider underlying diseases, immune function, history of local endemics, etc.

Hospital-acquired

Cefotaxime (ceftriaxone)

or cefepime

or piperacillin tazobactam

or meropenem

(+vancomycin)

(+antifungal drugs)

Enterobacteriaceae,

non-glucose fermenting bacteria such as Pseudomonas aeruginosa,

Staphylococcus aureus including MRSA,

fungi, etc.

Consider underlying diseases, treatment history, immune function, previous detection of resistant bacteria, in-hospital antibiograms, etc.

Add vancomycin or antifungal drugs according to risk

Dosage　 Cefotaxime　

200 mg/kg/day, every 6 h (meningitis; 300 mg/kg/day, every 6 h)　 maximum of 12 g/day

Ampicillin

200 mg/kg/day, every 6 h (meningitis; 400 mg/kg/day, every 6 h)　 maximum of 12 g/day

Cefepime

150 mg/kg/day, every 8 h

maximum of 6 g/day)

Piperacillin tazobactam

337.5 mg/kg/day, every 8 h

maximum of 18 g/day

Meropenem

120 mg/kg/day, every 8 h

maximum of 6 g/day

Vancomycin

60 mg/kg/day, every 6 h