Pediatric emergency medicine trisk 2269 2269
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TABLE 94.7
EMPIRIC ANTIBIOTIC THERAPY FOR SUSPECTED ACUTE BACTERIAL MENINGITIS
Age
Most common pathogens
Empiric antibiotics
<1 mo
Group B streptococcus (S. agalactiae), E. coli,
Listeria monocytogenes, Klebsiella species
Ampicillin (50 mg/kg every 8 hrs in the first week
of life; 50 mg/kg every 6 hrs on days 8–28)
and
Cefotaxime (50 mg/kg every 8 hrs in the first
week of life; 50 mg/kg every 6 hrs on days 8–
28)
1–23 mo
S. pneumoniae, N. meningitidis, group B
streptococcus, E. coli, H. influenzae type b
Vancomycin (15 mg/kg every 6 hrs)
and
Cefotaxime (75 mg/kg every 6 hrs, maximum 2
g/dose) or ceftriaxone (50 mg/kg every 12 hrs,
maximum 2 g/dose)
≥24 mo
N. meningitidis, S. pneumoniae
Vancomycin (15 mg/kg every 6 hrs)
and
Cefotaxime (75 mg/kg every 6 hrs, maximum 2
g/dose) or ceftriaxone (50 mg/kg every 12 hrs,
maximum 2 g/dose)
From Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 2004;39:1267–1284, by
permission of the Oxford University Press.
TABLE 94.8
MANIFESTATIONS OF NEONATAL HERPES SIMPLEX VIRUS INFECTION a
Goals of Treatment
The goal of treatment of neonatal HSV is the rapid recognition and initiation of acyclovir promptly. Clinical
outcomes include time to antiviral therapy and neurologic sequelae.
Clinical Considerations
Clinical recognition: There are three manifestations of HSV in the neonatal period: SEM disease, seen in
approximately 45% of cases; CNS disease, seen in 30%; and disseminated disease, seen in 25%. The most
common clinical and laboratory presentations are described in Table 94.8 . There is substantial overlap between
the three most common disease entities, as many children with vesicles have more invasive disease, and many
children with disseminated disease have CNS involvement. Children with isolated SEM disease have the best
prognosis, with few reported cases of death or neurologic sequelae. While the mortality rate for CNS disease is
low, most children have neurologic sequelae. In contrast to older patients, in whom HSV has a tropism for the
temporal lobes, neonatal CNS HSV infection often involves multiple portions of the brain. Children with
disseminated disease present septic, and require multiorgan system support, as they often have severe synthetic
hepatic dysfunction resulting in coagulopathy and can develop HSV pneumonitis, which is often hemorrhagic.
Adrenal involvement is common; as such, the provider should consider hydrocortisone for children with suspected
