Antimicrobials in children
also: benzylpenicillin strep · amoxicillin paeds · cefotaxime neonate · paediatric antibiotics
Overview
The antibiotics/antivirals for common childhood infections, in context — same agents as adults but with the crucial paediatric/neonatal age rules (full class mechanisms live in the Antimicrobials section).
Mechanism
Pathogen-directed antimicrobials. The paediatric distinctives are: weight-based dosing, the neonatal cautions (ceftriaxone displaces bilirubin → use cefotaxime), the need for Listeria cover under 3 months, and the age contraindications (tetracyclines, chloramphenicol grey-baby).
Indications
- Common paediatric infections (ENT, chest, meningitis, neonatal sepsis, UTI, viral)
The agents
PO / IM
Strep throat & scarlet fever (penicillin V 10 days); IM benzylpenicillin pre-hospital for suspected meningococcal sepsis.
PO/IV
First-line acute otitis media (if antibiotic indicated) and community pneumonia; add to meningitis regimen <3mo for Listeria.
IV
Bacterial meningitis: cefotaxime if <3 months (ceftriaxone displaces bilirubin → kernicterus + Ca-incompatibility); ceftriaxone if ≥3 months.
IV
Neonatal sepsis = IV benzylpenicillin + gentamicin (NICE).
PO
Penicillin allergy, atypical pneumonia, and whooping cough (pertussis).
IV/PO
Neonatal HSV, HSV encephalitis, and severe/immunocompromised chickenpox; VZIG for post-exposure prophylaxis.
PO
Childhood UTI (avoid nitrofurantoin <3 months / at term).
Adverse effects
Not a true penicillin allergy — common paeds pitfall.
Use cefotaxime under 3 months.
Cautions & contraindications
Kernicterus; use cefotaxime.
Teeth/bone.
Grey baby syndrome.
Cephalosporins don't cover Listeria — add amoxicillin/ampicillin.
Interactions
- As per individual agents (see Antimicrobials section)
Monitoring & kinetics
Weight-based dosing; gentamicin levels; response
Weight-based; route per severity. See the Antimicrobials section for full class pharmacology.
Source: NICE NG143/NG240 — Fever / sepsis in under 5s · BNF for Children — Antibacterials