Oseltamivir (the choice of antiviral agent in severely Children with risk factors should be 5 days immunocompromised patients depends on the predominant treated with antivirals (as per PHE circulating strain ie H3N2 versus H1N1 (higher risk of guidance) if admitted to hospital with oseltamivir resistance with H1N1). confirmed or presumed influenza infection (during periods that Where indicated, treatment should be initiated as soon as influenza is known to be circulating possible (ideally within the first 48 hours of symptoms). locally). Only treat children without risk Influenza factors who are admitted to PHDU / PICU with confirmed or presumed influenza infection. For Community acquired organisms most If <5 days since admission, ceftriaxone IV. If already on Review with BAL results. Ventilator ceftriaxone at the time of respiratory deterioration, switch to likely if early-onset VAP (See above) associated piperacillin/tazobactam IV. Enterobacter cloacae, Pseudomonas If confirmed VAP, 5-7 days. If non-lactose pneumonia aeruginosa, Acinetobacter species, fermenting Gram -ve (Pseudomonas spp., (for patients on Stenotrophomonas maltophilia If >5 days since admission, piperacillin/tazobactam IV. Acinetobacter), minimum 10 day course. NICU, see neonatal Staph. aureus (including MRSA) section) If VAP unlikely, stop Abs after 48 hours. Ceftriaxone IV. Strep. pneumoniae Usually 2 weeks minimum. Consider IV to Add clindamycin if any evidence of toxin mediated disease oral switch (co-amoxiclav) once fever Staph. aureus (haemodynamic instability, mucosal erythema, rash, resolving and CRP normalising. Non-typeable H. influenzae diarrhoea etc). Pleural empyema [azithromycin PO if penicillin allergy]
Influenza Children with risk factors should be treated with antivirals (as per PHE guidance) if admitted to hospital with confirmed or presumed influenza infection (during periods that influenza is known to be circulating locally). Only treat children without risk factors who are admitted to PHDU / PICU with confirmed or presumed influenza infection. For Oseltamivir (the choice of antiviral agent in severely immunocompromised patients depends on the predominant circulating strain ie H3N2 versus H1N1 (higher risk of oseltamivir resistance with H1N1). Where indicated, treatment should be initiated as soon as possible (ideally within the first 48 hours of symptoms). 5 days Ventilator associated pneumonia (for patients on NICU, see neonatal section) Community acquired organisms most likely if early-onset VAP (See above) Enterobacter cloacae, Pseudomonas aeruginosa, Acinetobacter species, Stenotrophomonas maltophilia Staph. aureus (including MRSA) If <5 days since admission, ceftriaxone IV. If already on ceftriaxone at the time of respiratory deterioration, switch to piperacillin/tazobactam IV. If >5 days since admission, piperacillin/tazobactam IV. Review with BAL results. If confirmed VAP, 5-7 days. If non-lactose fermenting Gram -ve (Pseudomonas spp., Acinetobacter), minimum 10 day course. If VAP unlikely, stop Abs after 48 hours. Pleural empyema Strep. pneumoniae Staph. aureus Non-typeable H. influenzae Ceftriaxone IV. Add clindamycin if any evidence of toxin mediated disease (haemodynamic instability, mucosal erythema, rash, diarrhoea etc). Usually 2 weeks minimum. Consider IV to oral switch (co-amoxiclav) once fever resolving and CRP normalising. [azithromycin PO if penicillin allergy]
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