Ambulatory care

1. Patients with the conditions listed below, who are assessed as being suitable for ambulatory care, can be started on ceftriaxone IV. They will require the FIRST dose in a hospital setting before referral to the community nursing service.
2. Before starting antibiotic treatment, take blood cultures and other cultures as appropriate.
3. Adjust empirical treatment according to culture results / clinical progress.
4. The need for continued intravenous treatment should be reviewed on a daily basis. Switch to oral antibiotics as soon as feasible.
5. Patients with known immediate (e.g. urticaria or rash of immediate onset) or severe life threatening penicillin reaction (e.g. anaphylaxis, facial or throat swelling, angio-oedema) should not be treated with cephalosporin or carbapenem antibiotics, please consult Paediatric ID.
6. For delayed/non severe reaction to penicillin, ceftriaxone can be administered.
7. Gentamicin: modify dose in renal impairment
8. Ceftriaxone: dose can be increased to 100mg/kg (max 4g) iv OD if CNS involvement
9. For uncomplicated bone and joint infection oral treatment with cefalexin is preferred. Use ceftriaxone if patient unable to tolerate oral therapy.
10. Do round up or down dose as appropriate to ease measurement and administration of drugs.

For further advice: Paediatric Infectious Disease: JR bleep 89-4374 or Paediatric ID/Micro via switchboard out of hours.

Refer to the quick reference guide for the referral to CCN H@H here.