Guideline

Paediatric Antibiocard:
Empirical Antibiotic Guidelines
Document ID CHQ-GDL-01202

Version No. 10.0 Standard 4

Medication Safety
Risk Rating Very high

Primary Document
Custodian Director, Infection Management and Prevention Approval date 27/09/2024
Services Medical Lead, Antimicrobial Stewardship

Accountable Executive Director Medical Services Effective date 11/10/2024

Officer
Applicable to All Children’s Health Queensland staff Review date 27/09/2025

HUMAN RIGHTS
This governance document has been human rights compatibility assessed. No limitations were identified
indicating reasonable confidence that, when adhered to, there are no implications arising under the Human
Rights Act 2019.

PURPOSE
The recommendations of this guideline are for the initial treatment of presumptive infections in patients
cared for by Children’s Health Queensland (CHQ). These guidelines are to be used only before the results
of microbiological investigations are available or finalised.

SCOPE
This guideline provides information for all Queensland Health employees (permanent, temporary and
casual) and all organisations and individuals acting as its agents (including Visiting Medical Officers and
other partners, contractors, consultants and volunteers).

1
GUIDELINE

Introduction
Standards of Antimicrobial Stewardship in Children’s Health Queensland
• Take cultures before starting antibiotics. In children commenced on empiric MRSA coverage, please do
MRO screening swabs for MRSA to guide ongoing management/oral stepdown.
• Cease antibiotics if cultures negative at 48 hours except if:
– the child has signs of severe sepsis.
– cultures were taken after antibiotic treatment was started, discuss with Infectious Diseases (ID) team.
– ongoing infection is likely.
• Change to narrow spectrum antibiotics once sensitivities are known.
• Consult Infection specialist.
– if patient has a previous (or new onset) severe antimicrobial hypersensitivity reaction (include the
following information: type of antimicrobial, type of reaction and severity, onset of reaction in relation to
commencing antimicrobial, treatment required to treat symptoms).
– for recommendations for treatment duration in confirmed infections.
• Document indication, Infectious Diseases (ID) approval number (where applicable) and planned
duration/review date on the electronic Medication order in the integrated electronic medical record (ieMR)
or the Paediatric National Inpatient Medication Chart (P-NIMC) when prescribing antimicrobials.
• Daily review of antibiotic plan (stop/continue antibiotics) should occur during ward round, review is to
include:
– Consideration of Early Intravenous (IV) to Oral Switch Therapy - Patients should be reviewed at 24 to
48 hours to consider whether early IV to oral switch would be appropriate. Refer to CHQ-GDL-01057
Antimicrobial treatment: Antibiotic duration and timing of the switch from intravenous to oral for common
bacterial infections in children for further information. Exercise caution when considering a switch to oral
in neonates and infants because of the relatively high incidence of bacteremia and the possibility of
variable oral absorption.
– Review of pathology results and appropriate antimicrobial dosing and choice based on these results.
• Seek Pharmacist / ID advice on appropriate therapeutic drug monitoring (TDM) and appropriate dosing for
patients in renal failure
– Paediatric Aminoglycoside (Tobramycin/Gentamicin/Amikacin) Guideline
– Paediatric Vancomycin Therapeutic Drug Monitoring
• Patients labelled with an antibiotic allergy have longer hospital stays and increased exposure to
suboptimal antibiotics. Take a comprehensive antimicrobial allergy history and assess the risk as per the
CHQ-GDL-01076 Paediatric antibiotic allergy assessment, testing and de-labelling
• For ID consults:
– Normal business hours (Monday to Friday) – contact QCH ID registrar
• For Queensland Children’s hospital, please also order a “Consult to Infectious Diseases” via iEMR
– Afterhours – page QCH Paediatric infection specialist (ID SMO) on call via QCH switchboard

CHQ-GDL-01202 Paediatric Antibiocard: Empirical Antibiotic Guidelines V10.0

INFECTION FIRST CHOICE ANTIMICROBIAL Alternative antibiotic in the event
(* IV Lincomycin and IV Clindamycin can be used interchangeably for indications of immediate type (e.g.
as specified in guideline in infants and children >1 month of age. Please confirm anaphylaxis) or delayed type (e.g.
supply availability at your local hospital) rash) hypersensitivity to 1st line
antimicrobial

SEPSIS (Oncology / Haematology)

Febrile neutropenia Refer to CHQ-GDL-01249 Management of Fever in a Paediatric Oncology Patient (Febrile Neutropenia and Febrile
(Oncology / Haematology) Non-neutropoenia). Review at 48 to 72 hours
Febrile non-neutropenia Refer to CHQ-GDL-01249 Management of Fever in a Paediatric Oncology Patient (Febrile Neutropenia and Febrile
(Oncology) Non-neutropenia) Review at 48 to 72 hours

SEPSIS
Cefotaxime IV 50 mg/kg/dose every 6 hours (maximum 2 g/dose); Immediate type hypersensitivity
COMMUNITY ACQUIRED OR Ceftriaxone IV 100 mg/kg once daily (maximum 4 g/day).
Ciprofloxacin IV 10 mg/kg/dose
SEPSIS (non PICU) Note: If Meningitis clinically or by LP treat as below under MENINGITIS.
8-hourly
Review antibiotics at 48 hours.
(maximum 400 mg/dose)
Less than 1 month old: Refer to neonatal dosing section.
Cefotaxime IV PLUS Ampicillin IV (or Amoxicillin IV) PLUS
If at risk of nmMRSA: Vancomycin IV
Cefotaxime IV PLUS Lincomycin* IV 15 mg/kg/dose every 8 hourly Seek ID advice within 24 hours.
(maximum 1.2 g/dose).
Less than 1 month old: Refer to neonatal dosing section.
Cefotaxime IV PLUS Ampicillin IV (or Amoxicillin IV) PLUS Clindamycin IV
If at risk of multi-resistant MRSA
Cefotaxime IV PLUS Vancomycin IV 15 mg/kg every 6 hours
(maximum initial Vancomycin dose of 750 mg) (Perform TDM).

Less than 1 month old: Refer to neonatal dosing section

Cefotaxime IV PLUS Ampicillin IV (or Amoxicillin IV) PLUS Vancomycin IV

CHQ-GDL-01202 Paediatric Antibiocard: Empirical Antibiotic Guidelines V10.0

INFECTION FIRST CHOICE ANTIMICROBIAL Alternative antibiotic in the event
(* IV Lincomycin and IV Clindamycin can be used interchangeably for indications of immediate type (e.g.
as specified in guideline in infants and children >1 month of age. Please confirm anaphylaxis) or delayed type (e.g.
supply availability at your local hospital) rash) hypersensitivity to 1st line
antimicrobial

CARDIAC
Endocarditis Benzylpenicillin IV 50 mg/kg/dose every 4 hours (maximum 1.8 g/dose) Delayed type hypersensitivity
(Note: For directed therapy, PLUS Flucloxacillin IV 50 mg/kg/dose every 4 hours (maximum 2 g/dose) Cefazolin IV
seek ID advice) PLUS Gentamicin IV (Dose based on adjusted body weight. Perform TDM). 50 mg/kg every 8 hours
• If more than 1 month and less than 10 years old: (maximum 2 g/dose)
7.5 mg/kg once daily (maximum 320 mg/day). PLUS Gentamicin IV
• If more than 10 years old: 6 mg/kg once daily (maximum 560 mg/day). PLUS Vancomycin IV and seek ID
Note: If less than 1 month old, refer to neonatal dosing section. ID review advice within 24 hours.
required within 24 hours
Endocarditis (prosthetic Vancomycin IV (Perform TDM)
valve, nosocomial infection • If more than 1 month old: 15 mg/kg/dose IV every 6 hours Immediate type hypersensitivity,
(maximum initial dose of 750 mg). Gentamicin IV
or community acquired PLUS Vancomycin IV
MRSA is suspected) PLUS Flucloxacillin IV and seek ID advice within 24 hours.
(Note: For directed therapy, • If more than 1 month old: 50 mg/kg/dose IV every 4 hours
seek ID advice) (maximum 2 g/dose)
PLUS Gentamicin IV (Dose based on adjusted body weight. Perform TDM)
• If more than 1 month and less than 10 years old:
7.5 mg/kg once daily (maximum 320 mg/day)
• If more than 10 years old: 6 mg/kg once daily (maximum 560 mg/day)
ID review required within 24 hours. If Pseudomonas aeruginosa cultured,
seek ID advice on appropriate directed therapy.
Note: If less than 1 month old, refer to neonatal dosing section.
Perform TDM for Gentamicin and Vancomycin.
If Pseudomonas aeruginosa cultured, seek ID advice on appropriate
directed therapy.

CHQ-GDL-01202 Paediatric Antibiocard: Empirical Antibiotic Guidelines V10.0

INFECTION FIRST CHOICE ANTIMICROBIAL Alternative antibiotic in the event
(* IV Lincomycin and IV Clindamycin can be used interchangeably for indications of immediate type (e.g.
as specified in guideline in infants and children >1 month of age. Please confirm anaphylaxis) or delayed type (e.g.
supply availability at your local hospital) rash) hypersensitivity to 1st line
antimicrobial

CENTRAL NERVOUS SYSTEM

Meningitis More than one month old: Immediate type hypersensitivity,
Cefotaxime IV 50 mg/kg/dose IV every 6 hours (maximum 2 g/dose) Ciprofloxacin IV 10 mg/kg/dose
OR Ceftriaxone IV 100 mg/kg/dose (maximum 2 g/dose) daily. 8-hourly (maximum 400 mg/dose)
Discuss with ID within 24 to 48 hours with cerebrospinal fluid (CSF) culture and PLUS Vancomycin IV
susceptibility results. and seek ID advice within 24 hours.
PLUS
If more than 2 months old:
Dexamethasone IV 0.15 mg/kg/dose (maximum 10 mg) every 6 hourly for 4 days.
Start before or with first dose of antibiotics (ideally administered within 4 hours
after starting IV antibiotic) but not beyond 12 hours.

Less than one month old: Refer to neonatal dosing section

Cefotaxime IV Plus Ampicillin IV (or Amoxicillin IV)
Review antibiotics at 48 hours. For Gram negative meningitis/sepsis, consult ID
If Gram positive cocci in CSF:
Add Vancomycin IV (see TDM section) and discuss with ID.
If more than 1 month old: 15 mg/kg/dose IV every 6 hours
(maximum 750 mg/dose starting dose). Perform TDM.
If Encephalitis suspected Add Aciclovir IV
Less than one month old: Refer to neonatal dosing section
If more than 2 months old or less than 12 years old:
500 mg/m2/dose IV every 8 hours (maximum 1000 mg/dose).
If more than 12 years old:
10 mg/kg/dose IV every 8 hours (maximum 1000 mg/dose).
If less than 2 months old:
20 mg/kg/dose IV every 8 hours
Review at 24 to 48 hours.

CHQ-GDL-01202 Paediatric Antibiocard: Empirical Antibiotic Guidelines V10.0

INFECTION FIRST CHOICE ANTIMICROBIAL Alternative antibiotic in the event
(* IV Lincomycin and IV Clindamycin can be used interchangeably for indications of immediate type (e.g.
as specified in guideline in infants and children >1 month of age. Please confirm anaphylaxis) or delayed type (e.g.
supply availability at your local hospital) rash) hypersensitivity to 1st line
antimicrobial
Prophylaxis for Ciprofloxacin oral: Seek ID advice.
N. meningitidis
Infant or Child 3 months to 5 years old: 30 mg/kg (up to 125 mg) orally as a
single dose.

Child 5 to 12 years old: 250 mg orally, as a single dose.

Adolescents more than 12 years old: 500 mg orally, as a single dose.

OR Rifampicin oral:

Less than 1 month old: 5 mg/kg/dose orally twice daily for 2 days.

More than 1 month old: 10 mg/kg/dose orally twice daily

(maximum 600 mg/dose) for 2 days.

Public Health Fact sheet Meningococcal disease - antibiotics for close contacts of a person with meningococcal infection: ciprofloxacin, rifampicin
| Health and wellbeing | Queensland Government (www.qld.gov.au)

CSF shunt infection Neonates: Seek ID advice. Immediate type hypersensitivity,

seek ID advice.
If more than 1 month old:
Cefotaxime IV 50 mg/kg/dose IV every 6 hours (Maximum 2 g/dose)
AND Vancomycin IV (Perform TDM )
15 mg/kg/dose IV every 6 hours (maximum initial dose of 750 mg)
Discuss with ID within 48 hours.

CHQ-GDL-01202 Paediatric Antibiocard: Empirical Antibiotic Guidelines V10.0

INFECTION FIRST CHOICE ANTIMICROBIAL Alternative antibiotic in the event
(* IV Lincomycin and IV Clindamycin can be used interchangeably for indications of immediate type (e.g.
as specified in guideline in infants and children >1 month of age. Please confirm anaphylaxis) or delayed type (e.g.
supply availability at your local hospital) rash) hypersensitivity to 1st line
antimicrobial

RESPIRATORY
Community acquired Ampicillin IV (or Amoxicillin IV) PLUS Gentamicin IV Immediate type hypersensitivity,
Pneumonia Age dependent dosing - Refer to neonatal dosing section. seek ID advice.
Neonate Use adjusted body weight for dosing Gentamicin and perform TDM.
(less than or equal to Review antibiotics at 24 to 48 hours.
1 month old)
(Comment: Consider adding oral azithromycin if pertussis, chlamydia trachomatis
likely. Discuss with ID within 24 hours)

Community acquired Amoxicillin orally 30 mg/kg/dose every 8 hours (maximum 1 g/dose). Immediate type hypersensitivity,
Pneumonia (CAP) Azithromycin orally
(more than 1 month old) Comment: Oral antibiotics are sufficient in most children with CAP unless unable 10 mg/kg/dose once daily
to tolerate oral or severe/complicated disease. (maximum 500 mg/dose)

Community acquired Benzylpenicillin IV 60 mg/kg/dose every 6 hours (maximum 2.4 g/dose). Delayed type hypersensitivity,
Pneumonia Review antibiotics at 24 to 48 hours. Cefazolin IV 50 mg/kg/dose
(more than 1 month old) (maximum 2 g/dose) 8 hourly.
(unable to tolerate oral) Immediate type hypersensitivity,
seek ID advice within 24 hours.

Empyema Benzylpenicillin IV 60 mg/kg/dose every 6 hours (maximum 2.4 g/dose) Delayed type hypersensitivity,
(more than 1 month old) PLUS, Lincomycin IV 15 mg/kg/dose every 8 hours (maximum 1.2 g/dose) Cefazolin IV plus Lincomycin IV
and seek ID advice within
Neonates – seek ID advice If < 5 years AND not fully vaccinated for HiB, use Cefotaxime 50 mg/kg/dose 24 hours
(maximum 2 g/dose) 6 hourly PLUS Lincomycin IV

Seek ID advice within 48 hours. Consult respiratory team regarding pleural Immediate type hypersensitivity,
drainage. seek ID advice.

CHQ-GDL-01202 Paediatric Antibiocard: Empirical Antibiotic Guidelines V10.0

INFECTION FIRST CHOICE ANTIMICROBIAL Alternative antibiotic in the event
(* IV Lincomycin and IV Clindamycin can be used interchangeably for indications of immediate type (e.g.
as specified in guideline in infants and children >1 month of age. Please confirm anaphylaxis) or delayed type (e.g.
supply availability at your local hospital) rash) hypersensitivity to 1st line
antimicrobial
Severe Pneumonia Cefotaxime IV 50 mg/kg/dose every 6 hours (maximum 2 g/dose). Immediate type hypersensitivity,
(Paediatric intensive care PLUS, Lincomycin IV 15 mg/kg/dose every 8 hours (maximum 1.2 g/dose) seek ID advice.
(PICU))
(more than 1 month old) Discuss with ID within 48 hours.

Neonates – seek ID advice If life threatening pneumonia OR multi-resistant MRSA suspected:

Cefotaxime IV 50 mg/kg/dose every 6 hours (maximum 2 g/dose)

PLUS Lincomycin IV 15 mg/kg/dose every 6 hours (maximum 1.2 g/dose)
PLUS Vancomycin IV 15 mg/kg/dose IV every 6 hours (maximum initial dose of
750 mg) (Perform therapeutic drug monitoring for Vancomycin.)
PLUS if M. pneumoniae suspected, add Azithromycin IV 10 mg/kg once daily
(maximum 500 mg/day). Switch to oral Azithromycin after 24 hours.

Seek ID advice within 24 hours. Consult respiratory team regarding pleural

drainage if applicable.

Tracheitis/Epiglottitis Cefotaxime IV 50 mg/kg/dose IV every 6 hours (maximum 2 g/dose) and seek ID Immediate type hypersensitivity,
review within 24 hours. seek ID advice.

Pertussis Azithromycin oral Immediate type hypersensitivity,

Less than or equal to 6 months old: 10 mg/kg orally once daily seek ID advice.
(maximum 500 mg/day) for 5 days.
More than 6 months old: 10 mg/kg orally once daily on Day 1 (maximum
500 mg), then 5 mg/kg daily on Day 2 to 5 (maximum 250 mg/day).

Notifiable disease - Pertussis | Disease control guidance (health.qld.gov.au)

CHQ-GDL-01202 Paediatric Antibiocard: Empirical Antibiotic Guidelines V10.0

INFECTION FIRST CHOICE ANTIMICROBIAL Alternative antibiotic in the event
(* IV Lincomycin and IV Clindamycin can be used interchangeably for indications of immediate type (e.g.
as specified in guideline in infants and children >1 month of age. Please confirm anaphylaxis) or delayed type (e.g.
supply availability at your local hospital) rash) hypersensitivity to 1st line
antimicrobial

EAR, NOSE AND THROAT (ENT)

Tonsillitis Phenoxymethylpenicillin Delayed type hypersensitivity
15 mg/kg/dose orally twice daily (maximum 500 mg/dose) for 10 days. Azithromycin 10mg/kg orally once
daily for 5 days.
Acute Otitis Media Amoxicillin 30 mg/kg/dose orally every 8 hours (maximum 1 g/dose) for 5 days. Delayed type hypersensitivity,
Cephalexin orally
For further information, refer to CHQ-GDL-6000 Acute otitis media - Emergency 30 mg/kg/dose every 8 hourly
management in children. (maximum 1 g/dose).

Otitis externa Refer to CHQ-GDL-00720 Otitis Externa: Emergency Management in Children for guidance.

Mastoiditis Cefotaxime IV 50 mg/kg/dose every 6 hours (maximum 2 g/dose) and seek ID Immediate type hypersensitivity,
review within 72 hours. seek ID advice

Retropharyngeal abscess IV Amoxicillin-Clavulanic acid Delayed type hypersensitivity,

Neonates and Infants (0 to 3 months old): Cefotaxime IV.
If less than or equal to 4 kg: 25 mg/kg/dose (amoxicillin component) every 12
hours.
If more than 4 kg: 25 mg/kg/dose (amoxicillin component) every 8 hours.

Infants and children (more than 3 months old):

Severe infection: 25 mg/kg/dose (amoxicillin component) every 6 hourly
(maximum 1 g/dose Amoxicillin component).

Adolescents older than 12 years old (and more than 40 kg):

Severe infection: 25 mg/kg/dose (amoxicillin component) every 6 hourly
(maximum 1 g/dose Amoxicillin component; maximum 200 mg/dose clavulanate
component). Seek ID review within 24 hours.

CHQ-GDL-01202 Paediatric Antibiocard: Empirical Antibiotic Guidelines V10.0

INFECTION FIRST CHOICE ANTIMICROBIAL Alternative antibiotic in the event
(* IV Lincomycin and IV Clindamycin can be used interchangeably for indications of immediate type (e.g.
as specified in guideline in infants and children >1 month of age. Please confirm anaphylaxis) or delayed type (e.g.
supply availability at your local hospital) rash) hypersensitivity to 1st line
antimicrobial

GASTRO-INTESTINAL

Appendicitis For patients transferring to theatre for appendicectomy, refer to CHQ-GDL-01064 CHQ Paediatric surgical antibiotic
SURGICAL PROPHYLAXIS prophylaxis guidelines for guidance on peri-operative antibiotic prophylaxis.
Note: To achieve optimal cover, per-operative prophylaxis should be administered at time of induction (knife to skin).
Appendicitis IV antibiotics are not usually required for postoperative treatment of Immediate type hypersensitivity,
UNCOMPLICATED uncomplicated appendicitis.
Gentamicin IV (dose based on
(e.g. no perforation)
adjusted body weight)
If operative intervention will be significantly delayed (> 6 hours) preoperative
PLUS Lincomycin IV
antibiotics below may be started.
If post operative antibiotics are requested a short course (e.g. <72 hours) is 15 mg/kg/dose every 8 hours
usually sufficient: Seek ID advice within 72 hours. (maximum 1.2 g/dose).
Seek ID advice within 48 hours.
Amoxicillin-Clavulanic acid IV
Neonates and Infants (0 to 3 months old):
If less than or equal to 4 kg:
25 mg/kg/dose (amoxicillin component) every 12 hours.
If more than 4 kg:
25 mg/kg/dose (amoxicillin component) every 8 hours.

Infants and children (more than 3 months old):

Severe infection:
25 mg/kg/dose (amoxicillin component) every 6 hours (maximum 1 g/dose Amoxicillin
component).

Adolescents older than 12 years (and more than 40kg):

Severe infection:
25 mg/kg/dose (amoxicillin component) every 6 hours (maximum 1 g/dose Amoxicillin
component; maximum 200 mg/dose clavulanate component).

CHQ-GDL-01202 Paediatric Antibiocard: Empirical Antibiotic Guidelines V10.0

INFECTION FIRST CHOICE ANTIMICROBIAL Alternative antibiotic in the event
(* IV Lincomycin and IV Clindamycin can be used interchangeably for indications of immediate type (e.g.
as specified in guideline in infants and children >1 month of age. Please confirm anaphylaxis) or delayed type (e.g.
supply availability at your local hospital) rash) hypersensitivity to 1st line
antimicrobial
Appendicitis COMPLICATED EMPIRICAL ANTIBIOTICS FOR FIRST 72 HOURS, CHOOSE EITHER: Seek ID advice within 48 hours.
(e.g. perforation, Ampicillin IV (or Amoxicillin IV) Piperacillin/
appendiceal collection / If more than 1 month old: 50 mg/kg/dose every 6 hours Tazobactam Delayed type hypersensitivity,
abscess) (maximum 2 g/dose) 100mg/kg/dose Ceftriaxone IV 50 mg/kg once daily
PLUS Metronidazole IV 7.5 mg/kg/dose every 8 hours (Maximum IV (Maximum 2 g/day)
500 mg/dose) every 6 hours PLUS Metronidazole IV.
Peritonitis PLUS Gentamicin IV (Dose based on Adjusted body weight. (maximum
Perform TDM) 4 g/dose If associated sepsis, give
If more than 1 month and less than (or equal to) 10 years old: Piperacillin
7.5 mg/kg once daily (maximum 320 mg/day). Ceftriaxone IV 100 mg/kg once daily
component).
NEC (for neonates - Age If more than 10 years old: 6mg/kg once daily (Maximum 4 g/day)
dependent dosing - Refer to (maximum 560 mg/day). PLUS Metronidazole IV.
Seek ID advice within 72 hours. Due to risk of toxicity, consider
Ampicillin/Amoxicillin, switching to non-aminoglycoside containing regimen. Immediate type hypersensitivity,
Metronidazole and Gentamicin
IF ANTIBIOTICS REQUIRED BEYOND 72 HOURS, CHANGE TO EITHER: Gentamicin IV
neonatal section).
Amoxicillin-Clavulanic acid IV (for up to 4 days) Piperacillin/ PLUS Lincomycin IV
Neonates and Infants (0 to 3 months old): Tazobactam 15 mg/kg/dose every 8 hours
If less than or equal to 4 kg: 100mg/kg/dose (maximum of 1.2 g/dose).
Note: If Pseudomonas
25 mg/kg/dose (amoxicillin) every 12 hours. IV
aeruginosa cultured, seek ID If more than 4 kg: 25 mg/kg/dose (amoxicillin) every 8 hours.
advice on directed therapy. every 6 hours
Infants and children (more than 3 months old): (maximum
Severe infection: 25 mg/kg/dose (amoxicillin) every 6 hours
(maximum 1 g/dose Amoxicillin component).
4 g/dose
Adolescents older than 12 years (and more than 40kg): Piperacillin
Severe infection: 25 mg/kg/dose (amoxicillin) every 6 hours component)
(maximum 1 g/dose Amoxicillin component; (for up to
maximum 200 mg/dose clavulanate component). 4 days).
Oral option to complete course: Amoxicillin/ Clavulanic acid Immediate type hypersensitivity,
22.5 mg/kg/dose orally twice daily (maximum 875 mg/dose Amoxicillin
seek ID advice.
component). Early oral switch can take place if patient clinically improving.
If poor clinical response, antibiotic regimens may be modified based upon the results of cultures of blood, peritoneal
fluid, or surgical specimens - seek ID advice. Antibiotic therapy is generally required for total 4 to 7 days, the duration
may need to be further prolonged if there are deep undrained collections. Seek ID advice for treatment beyond 7 days.

CHQ-GDL-01202 Paediatric Antibiocard: Empirical Antibiotic Guidelines V10.0

INFECTION FIRST CHOICE ANTIMICROBIAL Alternative antibiotic in the event
(* IV Lincomycin and IV Clindamycin can be used interchangeably for indications of immediate type (e.g.
as specified in guideline in infants and children >1 month of age. Please confirm anaphylaxis) or delayed type (e.g.
supply availability at your local hospital) rash) hypersensitivity to 1st line
antimicrobial
GASTRO-INTESTINAL
Cholangitis Cefotaxime IV 50 mg/kg/dose every 6 hours (maximum 2 g/dose) Immediate type hypersensitivity
(OR if more than one month old: Ceftriaxone IV 50 mg/kg once daily seek ID advice
(maximum 2 g/day))
PLUS Metronidazole IV 7.5 mg/kg/dose every 8 hours (maximum 500 mg/dose).
Seek ID advice within 72 hours.

If associated sepsis,
Give Ceftriaxone IV 100 mg/kg once daily (maximum 4 g/day)
PLUS
Metronidazole IV 7.5 mg/kg/dose every 8 hours (maximum 500 mg/dose).
Seek ID advice within 72 hours.

Giardiasis Metronidazole 30 mg/kg/dose orally once daily (maximum 2 g/dose) for 3 days.

Clostridium Difficile Refer to CHQ-GDL-01058 Paediatric Clostridium (Clostridioides) Difficile Infection - Treatment Guidelines for guidance.

Suspected salmonella (non Refer to CHQ-GDL-63001 Management Guideline for Non-typhoidal Salmonellosis in Children for guidance.,
typhoidal) infection

Pinworms Mebendazole:
(Treat all family members) If less than or equal to 1 year old: 50 mg orally as a single dose.
If more than 1 year old: 100 mg orally as a single dose.

CHQ-GDL-01202 Paediatric Antibiocard: Empirical Antibiotic Guidelines V10.0

INFECTION FIRST CHOICE ANTIMICROBIAL Alternative antibiotic in the event
(* IV Lincomycin and IV Clindamycin can be used interchangeably for indications of immediate type (e.g.
as specified in guideline in infants and children >1 month of age. Please confirm anaphylaxis) or delayed type (e.g.
supply availability at your local hospital) rash) hypersensitivity to 1st line
antimicrobial
URINARY TRACT
Uncomplicated Urinary UTI and less than 3 months old - Treat as for Pyelonephritis.
Tract Infection (UTI)
Infants and children more than 3 months old:

Trimethoprim/ Sulfamethoxazole 4 mg/kg/dose orally twice daily (maximum

160 mg/dose Trimethoprim component) for 5 days.

OR Cefalexin 30 mg/kg/dose orally every 8 hours (maximum 1 g/dose)

Pyelonephritis If more than 1 month old: Immediate or delayed

Ampicillin IV (or Amoxicillin IV) hypersensitivity penicillin,
50 mg/kg/dose IV every 6 hours (maximum 2 g/dose) use Gentamicin IV as single agent
PLUS initially then seek ID advice within
Gentamicin IV (Dose based on adjusted body weight. See TDM section) 48 hours.
If more than 1 month old and less than (or equal to) 10 years old:
7.5 mg/kg once daily (maximum 320 mg/day).
If more than 10 years old: 6 mg/kg IV once daily (maximum 560 mg/day).
Seek ID advice within 48 hours. Perform TDM.

Less than 1 month old: Refer to neonatal dosing section.

CHQ-GDL-01202 Paediatric Antibiocard: Empirical Antibiotic Guidelines V10.0

INFECTION FIRST CHOICE ANTIMICROBIAL Alternative antibiotic in the event
(* IV Lincomycin and IV Clindamycin can be used interchangeably for indications of immediate type (e.g.
as specified in guideline in infants and children >1 month of age. Please confirm anaphylaxis) or delayed type (e.g.
supply availability at your local hospital) rash) hypersensitivity to 1st line
antimicrobial

SKELETAL / SOFT TISSUE / SKIN

Mild Cellulitis Cefalexin 30 mg/kg/dose orally every 8 hours (maximum 1 g/dose) Immediate type hypersensitivity to
OR penicillin or cephalosporin, give
Mild Periorbital cellulitis
Flucloxacillin 25 mg/kg/dose orally four times a day (maximum 1 g/dose)
Impetigo Trimethoprim / Sulfamethoxazole
(For children who can swallow capsules).
Cervical lymphadenitis orally.
(Outpatient) If at risk of nmMRSA or if family/personal history of boils
(Previous nmMRSA, History of boils or Aboriginal or Pacific islander descent)

Trimethoprim/ Sulfamethoxazole 4 mg/kg/dose orally twice daily

(maximum 160 mg/dose Trimethoprim component).
OR
Clindamycin 10 mg/kg/dose orally three times a day (maximum 600 mg/dose)
(For children who can swallow capsules whole)

Duration: Refer to CHQ GDL 01057 Antimicrobial treatment: Antibiotic duration

and timing of the switch from intravenous to oral for common bacterial infections
in children - Paediatric Guideline

Severe cellulitis Flucloxacillin 50 mg/kg/dose IV 6 hourly (maximum 2 g/dose) Immediate type hypersensitivity to
Severe preseptal cellulitis For patients who are likely to require >72 hours of IV therapy, to conserve penicillin, give
Severe cervical peripheral intravenous cannula, suggest Cefazolin switching to 50mg/kg/dose IV Lincomycin IV 15mg/kg 8 hourly
lymphadenitis 8 hourly (maximum 2 g/dose) (maximum 1.2 g/dose)
(Inpatient)
If at risk of nmMRSA or if family/personal history of boils
(Previous nmMRSA, History of boils or Aboriginal or Pacific islander descent)
Lincomycin IV 15 mg/kg/dose every 8 hours (maximum 1.2 g/dose).

Review antibiotics with ID within 48 hours

CHQ-GDL-01202 Paediatric Antibiocard: Empirical Antibiotic Guidelines V10.0

INFECTION FIRST CHOICE ANTIMICROBIAL Alternative antibiotic in the event
(* IV Lincomycin and IV Clindamycin can be used interchangeably for indications of immediate type (e.g.
as specified in guideline in infants and children >1 month of age. Please confirm anaphylaxis) or delayed type (e.g.
supply availability at your local hospital) rash) hypersensitivity to 1st line
antimicrobial
Osteomyelitis Under 5 years of age (risk of Kingella infections): Delayed type hypersensitivity to
Septic Arthritis Cefazolin IV 50 mg/kg/dose (maximum 2 g/dose) every 8 hours flucloxacillin, give Cefazolin IV.

Under 5 years AND not immunised against HiB (ie. No HiB containing Immediate type hypersensitivity to
vaccines received): penicillins or cephalosporins,
Cefotaxime IV 50 mg/kg/dose (maximum 2 g/dose) every 6 hours
Lincomycin IV and seek ID advice.
Over 5 years of age:
Flucloxacillin IV 50 mg/kg/dose every 6 hours (maximum 2 g/dose).
For patients who are likely to require >48-72 hours of IV therapy AND have no
long line, to conserve peripheral IV cannula, suggest Cefazolin 50 mg/kg/dose IV
8 hourly (maximum 2 g/dose)
Refer to CHQ-GDL-01067 Paediatric Bone and Joint Infection Management for
further information.
If at risk of nmMRSA or if family/personal history of boils (Previous
nmMRSA, History of boils or Aboriginal or Pacific islander descent)
ADD Lincomycin IV 15 mg/kg/dose every 8 hours (maximum 1.2 g/dose).
Review antibiotics with ID within 48 hours
Moderate to Severe Cefotaxime IV 50 mg/kg/dose every 6 hours (maximum 2 g/dose) Immediate type hypersensitivity,
Periorbital cellulitis (under 5 If peri-orbital or orbital cellulitis suspected, refer to CHQ-GDL-00723 Peri-Orbital
seek ID advice.
years and not immunised and Orbital Cellulitis: Emergency Management in Children
against HiB) Review antibiotics with ID within 48 hours
OR If at risk of nmMRSA:
Cefotaxime IV 50 mg/kg/dose every 6 hours (maximum 2 g/dose).
Orbital Cellulitis (ALL ages)
PLUS Lincomycin IV 15 mg/kg/dose every 8 hours (maximum 1.2 g/dose)
Review antibiotics with ID within 48 hours
If at risk of multi-resistant MRSA:
Cefotaxime IV 50 mg/kg/dose every 6 hours (maximum 2 g/dose)
PLUS Vancomycin IV 15 mg/kg/dose every 6 hours
(maximum initial dose of 750 mg). (Perform TDM for Vancomycin).
Review antibiotics with ID within 48 hours

CHQ-GDL-01202 Paediatric Antibiocard: Empirical Antibiotic Guidelines V10.0

INFECTION FIRST CHOICE ANTIMICROBIAL Alternative antibiotic in the event
(* IV Lincomycin and IV Clindamycin can be used interchangeably for indications of immediate type (e.g.
as specified in guideline in infants and children >1 month of age. Please confirm anaphylaxis) or delayed type (e.g.
supply availability at your local hospital) rash) hypersensitivity to 1st line
antimicrobial

SKELETAL / SOFT TISSUE / SKIN

Suspected necrotising Cefotaxime IV 50 mg/kg/dose every 6 hours (maximum 2 g/dose). Immediate type hypersensitivity
fasciitis PLUS Lincomycin IV 15 mg/kg/dose every 8 hours (maximum 1.2 g/dose) seek ID advice.
PLUS Vancomycin IV 15 mg/kg/dose every 6 hours
(maximum initial dose of 750 mg). (Perform therapeutic drug monitoring for
Vancomycin).
Seek ID advice within 24 hours.

If external wound / inoculation associated with necrotising fasciitis:

Meropenem IV 40 mg/kg/dose every 8 hours (maximum 2 g/dose)
PLUS Lincomycin IV 15 mg/kg/dose every 8 hours (maximum 1.2 g/dose)
PLUS Vancomycin IV 15 mg/kg/dose every 6 hours
(maximum initial dose of 750 mg). (Perform therapeutic drug monitoring for
Vancomycin).
Seek ID advice within 24 hours.

Compound fractures For open fractures with no clinical evidence of skin or soft tissue infection Immediate type hypersensitivity
or severe tissue damage, give systemic antibiotic prophylaxis: Lincomycin IV and seek ID advice.
Cefazolin IV 50 mg/kg/dose (maximum 2 g/dose) every 8 hourly and seek ID
advice within 24 hours.

For open fractures with severe tissue damage or clinical evidence of skin or Immediate type hypersensitivity
soft tissue infection: Ciprofloxacin IV
Piperacillin - Tazobactam IV 100 mg/kg/dose every 6 hours (10 mg/kg/dose 12-hourly (maximum
(maximum 4 g/dose Piperacillin component) and seek ID advice within 400 mg/dose)
24 hours. PLUS Lincomycin IV
and seek ID advice within 24 hours.

CHQ-GDL-01202 Paediatric Antibiocard: Empirical Antibiotic Guidelines V10.0

INFECTION FIRST CHOICE ANTIMICROBIAL Alternative antibiotic in the event
(* IV Lincomycin and IV Clindamycin can be used interchangeably for indications of immediate type (e.g.
as specified in guideline in infants and children >1 month of age. Please confirm anaphylaxis) or delayed type (e.g.
supply availability at your local hospital) rash) hypersensitivity to 1st line
antimicrobial

SKELETAL / SOFT TISSUE / SKIN

Animal Bites with Amoxicillin/ Clavulanic acid 22.5 mg/kg/dose orally twice daily Delayed type OR immediate type
established infection (maximum 875 mg/dose Amoxycillin component). hypersensitivity,
Duration: 5 to 7 days Trimethoprim/ Sulfamethoxazole
Prophylaxis for animal bites orally 4 mg/kg/dose twice daily
is not indicated for small (maximum 160 mg/dose
wounds not involving trimethoprim component)
deeper tissues that present PLUS
within 8 hours and can be Metronidazole orally
adequately debrided and 7.5 mg/kg/dose every 8 hours
irrigated (maximum 400 mg/dose).

Always check Tetanus For Severe infection: Delayed type hypersensitivity,

immunisation status
Amoxicillin-Clavulanic acid IV (seek ID advice within 48 hours) IV Ceftriaxone 100 mg/kg once
Neonates and Infants (0 to 3 months old): daily (maximum 4 g/day)
If less than or equal to 4 kg: PLUS
25 mg/kg/dose (amoxicillin component) every 12 hours. Metronidazole orally
If more than 4 kg: 7.5 mg/kg/dose every 8 hours
25 mg/kg/dose (amoxicillin component) every 8 hours. (maximum 400 mg/dose).
Infants and children (more than 3 months old):
Severe infection:
25 mg/kg/dose (amoxicillin component) every 6 hourly (maximum 1 g/dose
amoxicillin component).
Adolescents older than 12 years old (and more than 40kg):
Severe infection: 25 mg/kg/dose (amoxicillin component) every 6 hourly
(maximum 1 g/dose amoxicillin component; note: maximum 200 mg/dose
clavulanate component).

CHQ-GDL-01202 Paediatric Antibiocard: Empirical Antibiotic Guidelines V10.0

INFECTION FIRST CHOICE ANTIMICROBIAL Alternative antibiotic in the event
(* IV Lincomycin and IV Clindamycin can be used interchangeably for indications of immediate type (e.g.
as specified in guideline in infants and children >1 month of age. Please confirm anaphylaxis) or delayed type (e.g.
supply availability at your local hospital) rash) hypersensitivity to 1st line
antimicrobial
SKELETAL / SOFT TISSUE / SKIN
Antibiotic prophylaxis for Antibiotic prophylaxis is not routinely required for traumatic wounds that do not Delayed type OR immediate type
wounds require surgical management and are not significantly contaminated. hypersensitivity, seek ID advice.
(excluding fractures, If concerned about infection, send swabs from base of wound for M/C/S.
wounds sustained in water
and animal bites) Severe wounds
Cefazolin IV 50 mg/kg/dose (maximum 2 g/dose) every 8 hourly
Always check Tetanus PLUS
immunisation status Metronidazole IV 7.5 mg/kg/dose (maximum 500 mg/dose) every 8 hourly
For severe wounds contaminated with vegetative matter (soil, grass etc) use
piperacillin-tazobactam IV 100 mg/kg/dose (maximum 4g/dose) every 6 hourly.

Discontinue at wound closure (Maximum 24 hours IV antibiotics).

If severe seek ID advice (may require continuation 24 hours after definitive
wound closure – ID approval required).

Less severe wounds

Flucloxacillin orally 25 mg/kg (Maximum 500mg/dose) 6-hourly for 24 hours.
OR Cefalexin orally 30 mg/kg (Maximum 1 g/dose) 8-hourly for 24 hours.
Maximum duration 72 hours. Seek ID advice.
Wounds sustained in water Refer to CHQ-GDL-63000 Management of Water-immersed Wound Infections in Children for guidance. Seek ID advice
within 24 hours.
Always check Tetanus
immunisation status
Bat (Lyssavirus) exposure Refer to CHQ-GDL-00719
Management of children presenting with potential Lyssavirus (rabies) exposures - Emergency Management in Children
for guidance. Notify Public Health and CHQ ID service.

CHQ-GDL-01202 Paediatric Antibiocard: Empirical Antibiotic Guidelines V10.0

SPECIFIC NEONATAL ANTIMICROBIAL DOSING - AUSTRALASIAN NEONATAL MEDICINES FORMULARY (ANMF) and NEOMEDQ
Antimicrobial Australasian Neonatal Medicines Formulary (ANMF) NeoMedQ
Aciclovir IV ANMF – Aciclovir NeomedQ – Aciclovir
Amikacin IV ANMF – Amikacin -
Amoxicillin IV ANMF – Amoxicillin NeomedQ - Amoxicillin
Amoxicillin/clavulanate ANMF – Amoxicillin-clavulanate -
Ampicillin IV ANMF – Ampicillin NeomedQ - Ampicillin
Azithromycin ANMF – Azithromycin NeomedQ - Azithromycin
Benzylpenicillin IV ANMF – Benzylpenicillin NeomedQ - Benzylpenicillin
Cefalexin PO ANMF – Cefalexin
Cefazolin IV ANMF – Cefazolin NeomedQ - Cefazolin
Cefepime IV ANMF - Cefepime NeomedQ - Cefepime
Cefotaxime IV ANMF – Cefotaxime NeomedQ - Cefotaxime
Ceftazidime IV ANMF – Ceftazidime -
Clindamycin IV ANMF - Clindamycin -
Comment: Does not provide CNS cover – seek ID advice
Flucloxacillin IV ANMF – Flucloxacillin NeomedQ - Flucloxacillin
Comment: Higher oral mg/kg doses may be required in neonates – see
AMH CDC for dosing recommendations
Gentamicin IV ANMF – Gentamicin NeomedQ - Gentamicin
Comment: TDM required. Seek AMS/ Pharmacist advice.
Meropenem IV ANMF – Meropenem NeomedQ - Meropenem
Metronidazole IV ANMF – Metronidazole NeomedQ - Metronidazole
Piperacillin/Tazobactam IV ANMF – Piperacillin/Tazobactam -
Comment: Does not provide CNS cover – seek ID advice
ANMF – Tobramycin -
Tobramycin IV
Comment: TDM required. Seek AMS/ Pharmacist advice.

Trimethoprim/ sulfamethoxazole PO ANMF – Trimethoprim/sulfamethoxazole NeomedQ –

Caution: Kernicterus risk in neonates – seek ID advice Trimethoprim/sulfamethoxazole
Vancomycin IV ANMF – Vancomycin NeomedQ - Vancomycin
Comment: TDM required. Seek AMS/ Pharmacist advice.

CHQ-GDL-01202 Paediatric Antibiocard: Empirical Antibiotic Guidelines V10.0

SUPPORTING DOCUMENTS
• CHQ-PROC-01036 Antimicrobial: Prescribing and Management
• CHQ-GDL-01057 Antimicrobial treatment: Antibiotic duration and timing of the switch from intravenous to
oral for common bacterial infections in children
• CHQ Antimicrobial restrictions
• CHQ-GDL-01076 Paediatric antibiotic allergy assessment, testing and de-labelling
• Pathology Queensland – Queensland Children’s Hospital Antibiograms
• Pathology Queensland – All children at Queensland Public Hospitals Antibiograms
• Queensland Paediatric Statewide Sepsis Pathway

CONSULTATION
Key stakeholders who reviewed this version:

• Service Group Director - Infection • Paediatric Infection Specialist Consultant,

Management and Prevention service, Gold Coast University Hospital Clinical
Rheumatology and Immunology Pharmacist Lead - Antimicrobial Stewardship
• Paediatric Surgeon • Medicines Advisory Committee (CHQ) –
endorsed 20/10/2022
• Paediatric Infection Specialist Consultant
and Fellow Team (CHQ)

CHQ-GDL-01202 Paediatric Antibiocard: Empirical Antibiotic Guidelines V10.0

DEFINITIONS

Term Definition

ABW Actual body weight

AMS Antimicrobial stewardship

CHQ Children’s Health Queensland

CNS Central nervous system

CSF Cerebral spinal fluid

IBW Ideal body weight

iEMR Integrated electronic medical record

ID Infectious diseases team

IV Intravenous

LP Lumbar puncture

MRSA Multi-resistant staphylococcus aureus

nmMRSA Non multi-resistant staphylococcus aureus

QCH Queensland Children’s hospital

TDM Therapeutic drug monitoring

REFERENCES

No. Reference

1 Antibiotic Therapeutic Guidelines (14th Edition) Therapeutic Guidelines Committee, North Melbourne, Victoria
(2021).

2 Taketomo CK eds. Pediatric Dosage Handbook International – available online:

https://uptodate.chq.health.qld.gov.au/ [Accessed 25 August 2024]

3 The Australasian Neonatal Medicines Formulary Steering group. https://www.anmfonline.org/clinical-

resources/ [ Accessed 25 August 2024]

4 Bijleveld YA et al. Population Pharmacokinetics and Dosing Considerations for Gentamicin in Newborns with
Suspected or Proven Sepsis Caused by Gram-Negative Bacteria. Antimicrobial Agents and Chemotherapy.
2017; 61 (1): e01304-16.

CHQ-GDL-01202 Paediatric Antibiocard: Empirical Antibiotic Guidelines V10.0

GUIDELINE REVISION AND APPROVAL HISTORY

Version Modified by Amendments Approved by Comments

No. authorised by
2.0 Infectious Diseases Medicines Advisory General Manager
Consultant- Committee (CHQ) Operations
Antimicrobial
Stewardship
(Infection
Management and
Prevention Service)

3.0 Infectious Diseases Medicines Advisory General Manager

(04/08/2016) Consultants (Infection Committee (CHQ) Operations
Management and Infectious Diseases
Prevention Service) Consultant team and
Antimicrobial Medical Lead -
Stewardship Antimicrobial
Pharmacist (CHQ) Stewardship
(Infection
Management and
Prevention Service)

4.0 Infectious Diseases Medicines Advisory Executive Director

(30/11/2016) Consultants (Infection Committee (CHQ) Hospital Services
Management and Infectious Diseases
Prevention Service) Consultant team and
Antimicrobial Medical Lead -
Stewardship Antimicrobial
Pharmacist (CHQ) Stewardship
(Infection
Management and
Prevention Service)

5.0 Infectious Diseases Medicines Advisory Executive Director

(11/10/2017) Consultants (Infection Committee (CHQ) Hospital Services
Management and Infectious Diseases
Prevention Service) Consultant team and
Antimicrobial Medical Lead -
Stewardship Antimicrobial
Pharmacist (CHQ) Stewardship
(Infection
Management and
Prevention Service)

6.0 Infectious Diseases Medicines Advisory Executive Director

(12/03/2019) Consultants (Infection Committee (CHQ) Clinical Services (QCH)
Management and
Prevention Service)

CHQ-GDL-01202 Paediatric Antibiocard: Empirical Antibiotic Guidelines V10.0

 Antimicrobial
Stewardship
Pharmacist (CHQ)

7.0 Director, Infection Medicines Advisory Executive Director

(20/06/2019) Management and Committee (CHQ) Clinical Services (QCH)
Prevention Services
Medical Lead,
Antimicrobial
Stewardship (QCH)

8.0 Director, Infection Medicines Advisory Executive Director

(10/06/2021) Management and Committee (CHQ) Clinical Services (QCH)
Prevention Services
Clinical Pharmacist
Lead, Antimicrobial
Stewardship (QCH)

8.1 Medical Lead, Medicines Advisory Executive Director

(21/09/2021) Paediatric Sepsis Committee (CHQ) Clinical Services (QCH)
program
Clinical Pharmacist
Lead, Antimicrobial
Stewardship (QCH)

9.0 Clinical Pharmacist Director, Infection Divisional Director

(18/10/2022) Lead, Antimicrobial Management and Medicine
Stewardship (QCH) Prevention Services

10.0 Pharmacist Advanced Director, Infection Executive Director Scheduled review

27/09/2024 – Antimicrobial Management and Medical Services
Stewardship Prevention Services

CHQ-GDL-01202 Paediatric Antibiocard: Empirical Antibiotic Guidelines V10.0

 Key words Paediatric antibiocard, empirical, antimicrobial stewardship, sepsis, pneumonia,
empyema, meningitis, CSF shunt infection, febrile neutropenia, non-neutropenia,
community acquired, meningitis, encephalitis, pertussis, cholangitis, uncomplicated
appendicitis, complicated appendicitis, necrotising enterocolitis, NEC, peritonitis,
endocarditis, mastoiditis, retropharyngeal abscess, otitis media, tonsillitis, tracheitis,
epiglottitis, compound fracture osteomyelitis, septic arthritis, cellulitis, periorbital
cellulitis, orbital cellulitis, animal bites, wounds, UTI, urinary tract infection,
pyelonephritis, giardiasis, pinworms, neonatal antibiotic dosing, therapeutic drug
monitoring, ampicillin, amoxicillin, azithromycin, benzylpenicillin, gentamicin,
cefotaxime, cefazolin, ceftriaxone, ciprofloxacin, clindamycin, vancomycin,
gentamicin , flucloxacillin, mebendazole, cefalexin, clindamycin, trimethoprim/
sulfamethoxazole, metronidazole, meropenem, piperacillin-tazobactam, lincomycin,
amoxicillin/ clavulanic acid, therapeutic drug monitoring, TDM, area under the curve,
AUC, nmMRSA, mrMRSA, ANMF, NeoMedQ, 01202
Accreditation National Safety and Quality Health Service Standards (1-8):
references • Standard 3 Preventing and Controlling Healthcare-Associated Infection,
• Standard 4 Medication Safety

CHQ-GDL-01202 Paediatric Antibiocard: Empirical Antibiotic Guidelines V10.0