Ceftriaxone (50-100mg/kg/dose) AND
Consider vancomycin (15mg/kg)^^^^

Empiric therapy should include clindamycin and beta-lactam until etiology is isolated.
Staphylococcal: Most often associated with toxin-producing organism at a mucosal site, may involved disease at a deeper site. Associated with tampon use, wound infection or burns. 5-15% case fatality rate. Rx: Nafcillin AND clindamycin initially. Substitute cefazolin or vancomycin for nafcillin if MRSA suspected. IVIG 1 g/kg may bind toxins, but should be reserved for life-threatening infections.
Streptococcal: Invasive disease at a deep site is the rule; deep site infection should be sought aggressively and treated. Defined as isolation of GAS, hypotension, renal impairment, coagulopathy, ARDS and soft tissue necrosis. Associated with erysipelas, Necrotizing Fascitis, secondary infection of varicella. Rx: Once streptococcus is identified, change therapy to penicillin or other ß-lactam antibiotic PLUS Clindamycin.
Coagulase-negative Staph (CONS): can try to salvage catheter with 10-14 days of therapy (vancomycin), 80% cure rate for exit site infections, 25% if deeper.
If S. aureus, Gram-Negative bacilli or Candida: always remove the catheter if possible. S. aureus has a 10% exit site cure rate and 0% deeper infection cure rate if catheter left in.
If septic thrombophlebitis, endocarditis, osteomyelitis or repeated positive cultures, ALWAYS remove catheter.
Piperacillin-tazobactam 400mg/kg/day IV div Q6 OR Ceftzidime 150mg/kg/day IV div Q8 OR Meropenem 60mg/kg/day IV div Q8. Consider adding gentamicin if persistently ill-appearing. Consider adding vancomycin if MRSA or coagulase-negative Staph suspected.
Consider adding amphotericin B 1mg/kg/day IV Q24 if persistently febrile >5 days on antibiotics. Consider meropenem alone or addition of metronidazole if typhlitis suspected.
Early rash (erythema migrans), carditic, facial nerve palsy, meningitis/encephalitis, arthritis.
Early localized/disseminated disease: doxycycline 4mg/kg/day PO div BID (if >7 yo) OR amoxicillin 50mg/kg/day PO (max 1.5 g/day) div TID x14-21 days. Alternative erythromycin 30mg/kg/day IV div Q8.
Arthritis (no CNS disease): As above x28 days.
Bell's Palsy: As above x21-28 days.
Neuroborreliosis (CNS): ceftriaxone 75-100mg/kg/day IV Q24 OR penicillin G 300,000 U/kg/day IV div Q4 x14-21 days.
Suspect if fever, rash (95%), petechiae spreading from distal to central. Confirm with antibody titers. Ticks most often in Mid-Atlantic states. Treat empirically and aggressively, can be fatal.
Suspect if febrile, flu-like illness with rash in April-Sept. Leukopenia and thrombocytopenia common. 80% have positive blood smear (HGE only). Dx HME with PCR. Confirm with DFA. Commonly co-infected with B. burgdorferi.
Pediatric antibiotics
OB/GYN antibiotics
Skin and soft tissue antibiotics
Newborn resuscitation
Post exposure prophylaxis antibiotics
Baby feeding and nutrition
Sepsis antibiotics
Neuro antibiotics