Skip to main content

Febrile Infant: Antibacterial Therapy and Empiric HSV Therapy

Initial Empirical Antibacterial Therapy for Well-Appearing Infants 7 to 60 Days Old

(These are INITIAL antimicrobial recommendations and should be re-evaluated for appropriateness at 48 hours after initiation)

Suspected Source for Infection

8-21 Days Old

22-28 Days Old

29-60 Days Old

No Focus Identified

(low concern for bacterial meningitis)
  •  Ampicillin 50 mg/kg IV or IM every 8 h and either

PLUS

  • Ceftazidime 50 mg/kg IV or IM every 8 h  OR Gentamicin2 4 mg/kg IV or IM every 24 h
  • Ceftriaxone1 50 mg/kg IV or IM every 24 h
  • Ceftriaxone 50 mg/kg IV or IM every 24 h

UTI
  • Ampicillin 50 mg/kg IV or IM every 8 h and either

PLUS

  • Ceftazidime 50 mg/kg IV or IM every 8 h OR Gentamicin2 4 mg/kg IV or IM every 24 h
  • Ceftriaxone1 50 mg/kg IV or IM every 24 h
  • Ceftriaxone 50 mg/kg IV or IM every 24 h
  • Oral medications for infants older than 28 d Cephalexin 25 - 30 mg/kg PO q 8h OR Cefixime 8 mg/kg PO q 24h

 

Bacterial Meningitis3
  • Ampicillin 75 mg/kg IV or IM every 6 h

PLUS

  • Ceftazidime 50 mg/kg IV or IM every 8 h
  • Ampicillin 75 mg/kg IV or IM every 6 h

PLUS

  • Ceftazidime 50 mg/kg IV or IM every 8 h
  • Ceftriaxone IV (100 mg/kg/DAY given once daily or divided every 12 h)

PLUS

  • Vancomycin 20 mg/kg IV every 8 h

Empiric HSV Treatment
  • Acyclovir 20 mg/kg IV every 8 h
  • Acyclovir 20 mg/kg IV every 8 h
  • Acyclovir 20 mg/kg IV every 8 h

 

1Alternative antibiotic (e.g. ceftazidime +/- ampicillin) must be used in neonates < 28 days old receiving concurrent calcium-containing fluids (e.g. parenteral nutrition) or known hyperbilirubinemia or jaundice.

2Gentamicin is generally not preferred at Children’s Mercy; choices should be made based on clinical factors and local susceptibility patterns.

3On the basis of CSF analysis results. Some experts will add gentamicin or another aminoglycoside to this regimen, particularly if the CSF Gram stain reveals Gram-negative organisms.

These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.

Evidence Based Practice Menu
Children's Mercy Kansas City   /    Health Care Providers   /    Evidence Based Practice / Clinical Pathways    /    Clinical Practice Guidelines, Care Process Models, and Enhanced Recovery After Surgery Pathways   /    Febrile Infant   /   Febrile Infant: Antibacterial Therapy and Empiric HSV Therapy