WebbCalc Pediatric Antibiotic & Sepsis Calculator

Note for Neonatal Sepsis (IV Empiric Therapy):

Prompt evaluation and empiric intravenous (IV) antibiotics are critical in suspected neonatal sepsis. Management should always be guided by current neonatal sepsis protocols and consultation with neonatology and/or infectious disease specialists.

A common first-line empiric regimen includes Ampicillin PLUS either Gentamicin or Cefotaxime. Specific dosing for these agents, which varies by postnatal age, weight, and gestation, can be found using the calculator.

• The choice between Gentamicin and Cefotaxime (to combine with Ampicillin) often depends on various clinical factors, including suspected source of infection (e.g., risk of meningitis where Cefotaxime might be preferred), renal function, and local antimicrobial susceptibility patterns.

If Herpes Simplex Virus (HSV) infection is a clinical concern, empiric Acyclovir should also be strongly considered. Refer to the calculator for Acyclovir dosing guidance.

Penicillin Allergy: While true, documented penicillin allergy is rare in neonates, if there's a significant concern (e.g., based on maternal history of severe immediate hypersensitivity), this complex situation requires immediate specialist consultation for appropriate alternative regimens.

It is crucial to obtain blood cultures and other relevant microbiological specimens (e.g., CSF, urine if indicated) *before* administering antibiotics, provided this does not cause a clinically significant delay in treatment.

Note for Pneumonia:

First-line therapy for presumed bacterial pneumonia is typically Amoxicillin (e.g., 90 mg/kg/day) or Amoxicillin-Clavulanate.

For suspected atypical pneumonia (e.g., Mycoplasma pneumoniae), Azithromycin is often recommended, especially for children ≥ 5 years. Doxycycline is an alternative for older children and adolescents (e.g., >7-8 years) requiring atypical coverage.

If penicillin-allergic, alternatives include Azithromycin, Doxycycline (for older children, as mentioned for atypical coverage), or a suitable respiratory cephalosporin (e.g., Cefdinir, Cefuroxime), depending on the allergy's nature and suspected pathogen(s).

Always consult current pediatric infectious disease guidelines and consider local antimicrobial resistance patterns when selecting an antibiotic.

Note for Otitis Externa (Swimmer's Ear):

Otitis Externa (OE), commonly known as "swimmer's ear," is an inflammation or infection of the external auditory canal. Key symptoms include ear pain (otalgia), which is often severe and characteristically worsened by pressure on the tragus or by pulling the pinna (outer ear). Other common symptoms are itching (pruritus), ear discharge (otorrhea), and a sensation of ear fullness or muffled hearing.

Effective management typically involves meticulous cleaning of the ear canal (aural toilet, if significant debris is present and TM is intact or visualized), pain control, and topical therapy. Topical agents are the mainstay for uncomplicated OE and include:

• Acidifying solutions (e.g., acetic acid, as in the calculator) to restore the canal's natural pH.
• Topical antibiotic drops, often combined with a corticosteroid to reduce inflammation and pain (e.g., Ciprofloxacin with Dexamethasone, as in the calculator). Fluoroquinolone-based drops are generally safe if tympanic membrane perforation is suspected or confirmed.

Systemic (oral) antibiotics are generally NOT indicated for uncomplicated, localized OE. They may be considered if there is significant cellulitis extending beyond the ear canal, severe disease, in immunocompromised patients, or if the infection does not respond to appropriate topical therapy. To help prevent OE, advise keeping ears as dry as possible (e.g., after swimming/bathing) and avoiding insertion of objects (like cotton swabs) into the ear canal.

Note for Open Fracture Management in Pediatrics:

Open fractures in children require prompt and meticulous management to minimize infection risk and optimize healing outcomes. Initial critical steps include thorough irrigation and debridement of the wound, administration of tetanus prophylaxis if indicated based on immunization history and wound characteristics, and early initiation of intravenous (IV) antibiotic therapy—ideally within one hour of injury.

For Type I and Type II open fractures (Gustilo-Anderson classification), a first-generation cephalosporin (e.g., cefazolin) is commonly recommended. Type III open fractures typically necessitate broader antimicrobial coverage, often involving the addition of an aminoglycoside (e.g., gentamicin) to the first-generation cephalosporin. If there is significant concern for soil or farm-related contamination, additional coverage for Clostridium species with penicillin or metronidazole should be strongly considered.

Urgent orthopedic consultation is mandatory for operative irrigation, debridement, and appropriate fracture stabilization. While early surgical intervention (traditionally cited as within 6 hours) is considered ideal, the timely administration of antibiotics is paramount in preventing infection. Antibiotics are typically continued for 24–72 hours postoperatively or until definitive wound closure; longer courses may be necessary for heavily contaminated wounds or more severe fracture types.

Close follow-up is essential to monitor for potential complications such as infection (osteomyelitis, cellulitis), delayed healing or nonunion, and compartment syndrome. Multidisciplinary care involving orthopedics, infectious disease specialists, and rehabilitation services may be required for complex cases or those with complications.

Note for Pediatric Sepsis Antibiotics (Beyond Neonatal Period):

Pediatric sepsis is a life-threatening emergency requiring prompt recognition and immediate administration of broad-spectrum intravenous (IV) antibiotics, ideally after blood cultures are obtained (if this does not significantly delay treatment). The initial empiric antibiotic choice is critical and depends on the child's age (this note excludes neonates, who have specific protocols), immune status, suspected source of infection, and local antimicrobial resistance patterns.

For children beyond the neonatal period with community-acquired sepsis of unknown origin, a common empiric regimen includes a third-generation cephalosporin (e.g., Ceftriaxone or Cefotaxime) for broad Gram-negative and typical Gram-positive coverage, PLUS Vancomycin for coverage of Methicillin-Resistant Staphylococcus aureus (MRSA). (Dosing for these agents is available in the calculator).

In specific circumstances, broader Gram-negative coverage, including for Pseudomonas aeruginosa, should be strongly considered. This includes patients with neutropenia (see also Febrile Neutropenia indication), healthcare-associated infections, severe burns, known prior colonization, or if a pseudomonal source is suspected (e.g., certain types of pneumonia, hot tub folliculitis). In such cases, an anti-pseudomonal agent like Cefepime (available in the calculator for this indication) is often used, typically in combination with Vancomycin. Other agents like Piperacillin-Tazobactam or a carbapenem may also be indicated depending on severity and risk factors.

Antibiotic therapy should be re-evaluated daily, narrowed, or adjusted once a pathogen is identified and susceptibilities are known. The duration of therapy depends on the source and severity of infection, causative organism, and clinical response. Always consult current pediatric sepsis guidelines and consider involving infectious disease specialists, especially for complex cases.

Note for Otitis Media (AOM):

First-line treatment is typically High-Dose Amoxicillin (80-90 mg/kg/day). Consider Amoxicillin-Clavulanate (Augmentin) if the child has received Amoxicillin in the past 30 days, has concurrent purulent conjunctivitis, a history of recurrent AOM unresponsive to Amoxicillin, or for initial treatment failure.

If penicillin-allergic: For non-type I (non-anaphylactic) hypersensitivity, a cephalosporin (e.g., Cefdinir, Cefuroxime, Cefpodoxime) is often an alternative. For type I hypersensitivity to penicillin, Clindamycin may be considered (sometimes with a third-generation cephalosporin if broader coverage is needed and allergy allows, or as monotherapy depending on local resistance).

Duration of therapy: Usually 10 days for children <2 years or those with severe symptoms/perforated TM; 5-7 days may be considered for children ≥2 years with mild-to-moderate, non-severe AOM.

Effective pain management (e.g., acetaminophen, ibuprofen) is a key component of AOM care. Observation without initial antibiotics may be an option for select children (e.g., ≥2 years with non-severe unilateral AOM) based on shared decision-making.

Note for Pediatric Sepsis IV Pressors:

Vasopressor therapy should be initiated promptly in children with septic shock who remain hypotensive or show persistent signs of poor perfusion despite adequate intravenous (IV) fluid resuscitation (typically after 40-60 mL/kg of isotonic crystalloids). The primary goal is to restore adequate mean arterial pressure (MAP) and improve tissue oxygen delivery.

The initial choice of vasopressor is often guided by the patient's clinical presentation and presumed hemodynamic profile:

• For "cold shock" (common in children, characterized by cool extremities, weak peripheral pulses, delayed capillary refill, and often low cardiac output with high systemic vascular resistance): Epinephrine is generally considered the first-line agent due to its potent inotropic (improves heart contractility) and vasopressor effects.
• For "warm shock" (less common in children, characterized by warm extremities, bounding pulses, flash capillary refill, and low systemic vascular resistance with preserved or increased cardiac output): Norepinephrine is often the preferred first-line agent due to its strong vasoconstrictive properties.

(Dosing for Epinephrine and Norepinephrine infusions are available in the calculator).

Vasopressin (dosing in calculator) can be considered as an adjunctive therapy in cases of catecholamine-resistant shock (i.e., shock persisting despite high doses of epinephrine or norepinephrine), particularly if profound vasodilation is suspected. It is generally not recommended as a sole initial vasopressor.

Vasopressors are potent medications requiring continuous hemodynamic monitoring (including intra-arterial blood pressure monitoring if possible). They should ideally be administered via a central venous line to minimize the risk of tissue injury from peripheral extravasation, though emergent peripheral administration may be necessary while establishing central access. Doses must be carefully titrated to achieve specific hemodynamic targets (e.g., target MAP for age, improved perfusion markers). Management in a pediatric intensive care unit (PICU) or equivalent setting is essential.

Note for Orbital Cellulitis:

Orbital cellulitis is a serious infection located posterior to the orbital septum. It is an ophthalmologic emergency due to the risk of vision loss and intracranial complications (e.g., abscess, meningitis). It must be carefully distinguished from preseptal (periorbital) cellulitis.

Key signs suggesting orbital (postseptal) involvement, as opposed to preseptal, include: proptosis (bulging eye), ophthalmoplegia (restricted or painful eye movements), and/or decreased visual acuity. Fever and leukocytosis are common.

Management typically requires prompt hospital admission for parenteral (IV) broad-spectrum antibiotics. Urgent consultation with Ophthalmology is essential, and ENT consultation may also be warranted. A CT scan of the orbits and sinuses (with contrast) is usually indicated to confirm the diagnosis, assess for an orbital abscess, and evaluate sinus involvement (sinusitis is a common predisposing factor).

Empiric IV antibiotic therapy (examples in calculator below) should cover common pathogens including Staphylococcus aureus (including MRSA), Streptococcus pneumoniae, other Streptococci, and Gram-negative bacteria such as Haemophilus influenzae (especially in unimmunized children). Anaerobic coverage may also be considered.

Surgical drainage may be necessary if a significant orbital abscess is present, if there's no clinical improvement after 24-48 hours of IV antibiotics, or if vision is compromised.

Note for Pharyngitis (Strep Throat):

This note primarily addresses Group A Streptococcal (GAS) pharyngitis, as most sore throats are viral and do not require antibiotics. Diagnosis of GAS pharyngitis should ideally be confirmed with a Rapid Antigen Detection Test (RADT) and/or throat culture, because clinical features alone can be unreliable.

First-line antibiotic treatment for confirmed GAS pharyngitis is typically Penicillin or Amoxicillin (e.g., Amoxicillin 50 mg/kg once daily, max 1000mg, as an option in the calculator). Treatment aims to prevent acute rheumatic fever, shorten symptom duration, reduce spread, and prevent suppurative complications.

If penicillin-allergic: For non-type I (non-anaphylactic) hypersensitivity, a first-generation cephalosporin (e.g., Cephalexin - not currently in this calculator section for Pharyngitis) or Cefdinir are common alternatives. For patients with type I hypersensitivity to penicillins, Clindamycin or a macrolide like Azithromycin (not currently in this calculator section for Pharyngitis) may be considered, keeping in mind local macrolide resistance patterns. (Dosing for Amoxicillin, Cefdinir, and Clindamycin can be found in the calculator for Pharyngitis).

The standard duration of treatment for GAS pharyngitis with penicillins or cephalosporins is 10 days. Patients are generally considered non-contagious after 12-24 hours of appropriate antibiotic therapy.

Note for Skin/Soft-Tissue Infections (SSTI):

For non-purulent cellulitis (suspect Streptococcus spp. or MSSA), Cephalexin is a common first-line choice. For purulent SSTIs (e.g., abscesses), Incision & Drainage (I&D) is primary; antibiotics are adjunctive when there are systemic signs, extensive cellulitis, or immunocompromise.

If MRSA coverage is needed—especially in purulent or severe non-purulent cases—empiric options include:

• Clindamycin (covers MRSA & Streptococci)
• Trimethoprim–Sulfamethoxazole (TMP–SMX)
• Doxycycline (for children ≥ 8 years)

(Dosing for all agents is available in the calculator below.)

Typical antibiotic duration is 5–10 days. Always consider local resistance patterns and patient-specific factors.

Note for Uncomplicated UTI (Cystitis):

An uncomplicated Urinary Tract Infection (UTI), or cystitis, involves infection confined to the bladder, typically presenting with symptoms like dysuria (painful urination), urinary frequency/urgency, new-onset incontinence, or suprapubic pain, without fever or flank pain (which would suggest pyelonephritis). Diagnosis is supported by urinalysis and confirmed by urine culture, especially for a first documented UTI, recurrent infections, or if the diagnosis is uncertain.

Prompt treatment with effective oral antibiotics is indicated. First-line empiric choices often include a cephalosporin (e.g., Cephalexin) or Trimethoprim-Sulfamethoxazole (TMP-SMX), depending on local antimicrobial resistance patterns. Nitrofurantoin is another effective option specifically for cystitis (ensure patient is >1 month old, has adequate renal function, and no G6PD deficiency). If penicillin-allergic, TMP-SMX and Nitrofurantoin are generally suitable alternatives. (Specific dosing is available in the calculator).

The typical duration of antibiotic therapy for uncomplicated cystitis in children is 3-7 days. Encouraging adequate fluid intake and proper voiding hygiene can help prevent recurrences.

Note for Animal Bite Prophylaxis:

Thorough wound irrigation and debridement (if needed) are critical first steps in managing animal bites. Prophylactic antibiotics are generally recommended for bites considered high-risk for infection. This includes: all cat bites (due to common puncture nature and risk of Pasteurella multocida), deep dog puncture wounds, any bites involving hands, feet, face, or genital areas, bites over joints or prosthetic material, and bites in immunocompromised hosts.

The first-line choice for antibiotic prophylaxis is Amoxicillin-Clavulanate (Augmentin), given its broad-spectrum coverage against common oral flora of animals, including Pasteurella spp., Staphylococci, Streptococci, and anaerobes. The typical duration for prophylaxis is 3-5 days. (See calculator for Augmentin dosing).

If penicillin-allergic: A common alternative regimen is the combination of Clindamycin (for Gram-positive and anaerobic coverage) PLUS Trimethoprim-Sulfamethoxazole (TMP-SMX) (for many Gram-negative organisms and potential MRSA coverage). (Dosing for Clindamycin and TMP-SMX is also available in the calculator).

Regardless of antibiotic prophylaxis, always assess and update Tetanus immunization status as appropriate. Rabies prophylaxis should be considered based on the type of animal, its vaccination status (if known), the nature of the exposure, and local public health guidance; this is a separate critical assessment.

Note for Conjunctivitis (Pink Eye):

Conjunctivitis ("pink eye") inflammation can be viral, bacterial, or allergic. Treatment depends on the cause:

• Viral: Most common cause overall. Typically presents with watery discharge, redness, gritty sensation, and often accompanies cold symptoms. Usually self-limiting over 1-2 weeks. Supportive care (cool compresses, artificial tears) is primary.
• Bacterial: Characterized by purulent (thick, yellow/green) discharge, eyelids matted shut upon waking, and redness. Topical antibiotics (see calculator for examples like Polymyxin B/Trimethoprim or Erythromycin) are often prescribed to shorten the clinical course, reduce transmission, and facilitate earlier return to school/daycare.
• Allergic: Itching is the hallmark symptom, along with redness, watery or stringy mucoid discharge, and often other allergic symptoms (e.g., rhinitis). Avoidance of allergens and topical antihistamine/mast cell stabilizer eye drops are key.

Red Flags: Any conjunctivitis associated with significant eye pain (not just irritation), photophobia (light sensitivity), reduced visual acuity, corneal opacity, suspected herpetic lesions (vesicles on eyelid), or in a neonate (<1 month old), requires urgent ophthalmologic evaluation.

Good hand hygiene is crucial to prevent the spread of infectious conjunctivitis.

Note for Preseptal Cellulitis (Periorbital Cellulitis):

Preseptal cellulitis is an infection of tissues anterior to the orbital septum. It is critical to distinguish from orbital cellulitis by the ABSENCE of proptosis (bulging eye), painful or restricted eye movements, or changes in visual acuity. If these "orbital signs" are present, urgent evaluation for orbital cellulitis (often including imaging) is required. Common causes include local skin trauma or spread from sinusitis/URI.

Most uncomplicated preseptal cellulitis cases can be managed outpatient with oral antibiotics. Amoxicillin-Clavulanate (Augmentin) is a common first-line choice. If penicillin-allergic or with significant MRSA concern, Clindamycin is a good alternative (dosing for these agents is in the calculator). Typical duration is 7-10 days. Consider admission for IV antibiotics for very young infants, severe cases, inability to tolerate oral medication, or if orbital cellulitis cannot be confidently ruled out.

Note for Pyelonephritis (Kidney Infection):

Pyelonephritis is a serious bacterial infection of the kidney requiring prompt evaluation and treatment to prevent renal damage. Suspect in patients with fever, flank/abdominal pain, vomiting, or other UTI symptoms; infants may present with nonspecific signs (e.g., fever, poor feeding). Diagnosis relies on urinalysis and urine culture. Imaging (e.g., renal ultrasound) is often indicated, especially for young children, first febrile UTI, or severe illness.

Initial empiric antibiotic therapy should be started promptly after obtaining cultures. Parenteral (IV) antibiotics (e.g., Ceftriaxone) are often necessary for infants, ill-appearing children, or those unable to tolerate oral medications, typically requiring hospital admission. Stable, older children may sometimes be managed with appropriate oral antibiotics outpatient. Transition from IV to oral therapy (e.g., TMP-SMX, Cephalexin) is guided by clinical improvement and culture sensitivities. (The calculator provides common dosing examples).

Total duration of antibiotic treatment (IV followed by oral, or oral alone) is typically 7-14 days. Follow-up and consideration for further urologic evaluation (e.g., VCUG) should be based on current pediatric guidelines, patient age, and imaging results.

Note for Appendicitis:

Appendicitis, an inflammation of the appendix, is one of the most common pediatric surgical emergencies and requires prompt evaluation. Classic symptoms include periumbilical pain migrating to the right lower quadrant (RLQ), anorexia, nausea, vomiting, and low-grade fever. However, presentations can vary significantly, especially in younger children.

Diagnosis is primarily clinical, often supported by laboratory findings and scoring systems (e.g., Pediatric Appendicitis Score). Imaging studies such as ultrasound (often first-line) or CT scan (for equivocal cases or suspected complications) are frequently used to aid diagnosis. Early surgical consultation is essential if appendicitis is suspected.

The standard treatment for acute appendicitis is appendectomy. Preoperative intravenous (IV) antibiotics are crucial to reduce postoperative infectious complications (e.g., wound infection, intra-abdominal abscess). Antibiotic regimens should cover common enteric Gram-negative bacilli and anaerobic bacteria (examples like Ceftriaxone plus Metronidazole are provided in the calculator). The duration and type of postoperative antibiotics will vary based on operative findings (e.g., uncomplicated, gangrenous, or perforated appendicitis) and institutional protocols.

Note for Antipyretic Dosing:
Acetaminophen for all ages.
Ibuprofen is only recommended for children ≥ 6 months of age.

Note for Acute Bacterial Sinusitis:

First-line treatment options for acute bacterial sinusitis include standard-dose Amoxicillin (if low resistance risk) or high-dose Amoxicillin-Clavulanate (Augmentin). High-dose Amoxicillin (90 mg/kg/day) or Amoxicillin-Clavulanate (90 mg/kg/day of amoxicillin component) is recommended in regions with high rates of penicillin-resistant S. pneumoniae or if the child has risk factors.

Amoxicillin-Clavulanate is generally preferred over Amoxicillin alone if the child has received antibiotics in the preceding 30 days, attends daycare, is younger than 2 years, has moderate-to-severe illness, or has concurrent purulent conjunctivitis (which may suggest H. influenzae).

If penicillin-allergic (non-type I, e.g., rash): An oral cephalosporin such as Cefdinir, Cefuroxime, or Cefpodoxime may be considered.

If penicillin-allergic (type I, e.g., anaphylaxis): Clindamycin is an alternative. If coverage for H. influenzae is also a concern (as Clindamycin has limited activity), combination with Cefixime or Ceftriaxone might be considered if the cephalosporin is deemed safe despite the severe penicillin allergy (requires careful assessment and specialist consultation).

Macrolides (e.g., Azithromycin, Clarithromycin) and Trimethoprim-Sulfamethoxazole (TMP-SMX) are generally NOT recommended for empiric treatment due to high rates of resistance among common sinusitis pathogens like Streptococcus pneumoniae and Haemophilus influenzae.

Note for Impetigo:

For localized and mild cases of impetigo, topical treatment with Mupirocin ointment is generally the first-line approach.

If the impetigo is extensive, non-responsive to topical therapy, or if there are multiple lesions, oral antibiotics (such as Cephalexin) are typically required.

Coverage for Methicillin-Resistant Staphylococcus aureus (MRSA) with an agent like Clindamycin should be considered if there are specific risk factors for MRSA or if the local prevalence is high.

If the patient has a penicillin allergy: Clindamycin or another appropriate alternative antibiotic should be selected, considering the nature of the allergy and local resistance patterns.

Note for Balanoposthitis:

Initial management for non-infectious or mild cases includes sitz baths, maintaining good hygiene, and potentially topical corticosteroids.

If a bacterial infection is suspected, treatment options include topical Mupirocin or an oral antibiotic like Cephalexin.

If the patient has a penicillin allergy or if MRSA is a concern: Clindamycin may be considered as an alternative.

Note for Dental Infection (Odontogenic):

Effective management of odontogenic infections typically requires dental source control (e.g., extraction, pulpectomy, incision and drainage) as the primary intervention, with antibiotics serving an adjunctive role.

The choice of antibiotic should cover common oral flora (including aerobes and anaerobes), and is guided by the severity of the infection. For mild infections in otherwise healthy patients, oral antibiotics are recommended. The following options may be considered:

• Amoxicillin: A first-line option for mild to moderate infections.
• Penicillin VK: Another option for mild cases, especially if the infection is localized and uncomplicated.
• Clindamycin: Recommended for patients with a penicillin allergy or in cases of severe infection where anaerobic coverage is needed.

For severe infections, deep space involvement, immunocompromised patients, or those who cannot tolerate oral medications, intravenous (IV) antibiotics may be necessary. The following IV antibiotics may be indicated:

• Ampicillin-Sulbactam: Provides broad-spectrum coverage, including both aerobic and anaerobic organisms, and is often used in more severe or complicated cases.

Duration of antibiotic therapy is typically 5-7 days for uncomplicated cases, guided by clinical response and the definitive dental procedure. Always consult specific dental or oral surgery guidelines for comprehensive management.

Note for Epididymitis (Prepubertal/Non-STI):

In prepubertal individuals, epididymitis is often related to a urinary tract infection (UTI), structural abnormalities, or post-viral inflammation. It is crucial that testicular torsion is definitively ruled out, as this is a surgical emergency.

Management typically involves supportive care (e.g., analgesia, rest). If a bacterial infection is suspected (often secondary to UTI), antibiotics such as Cephalexin or TMP-SMX may be prescribed for a duration of 7-14 days. Consultation with pediatric urology should be considered, especially for recurrent episodes or if structural anomalies are suspected.

Note for Epididymitis (Sexually Active/STI suspected):

In sexually active individuals, epididymitis is most commonly caused by Neisseria gonorrhoeae (GC) and/or Chlamydia trachomatis (CT). It is critical to rule out testicular torsion, which is a surgical emergency. Comprehensive STI testing should be performed.

According to CDC guidelines, a recommended empiric treatment regimen is Ceftriaxone 500 mg intramuscularly (IM) as a single dose (if patient weight is ≥150 kg, use 1 gram IM) PLUS Doxycycline 100 mg orally twice daily for 10 days.

If infection with enteric organisms is also suspected (e.g., in patients who engage in anal intercourse), consider empiric treatment with Ceftriaxone (as above) PLUS Levofloxacin 500 mg orally once daily for 10 days.

Additional management includes treating all sexual partners from the preceding 60 days, advising abstinence from sexual intercourse until completion of therapy and resolution of symptoms for both the patient and partners, and providing supportive care (such as analgesia and scrotal support).

Note for Bacterial Vaginosis (BV):

BV is common in postmenarchal/sexually active adolescents; rare in prepubertal girls without sexual activity/abuse. Symptoms include vaginal discharge (often thin, gray/white, fishy odor), itching, or burning. Proper diagnosis (e.g., Amsel criteria, microscopy) is important.

Treatment is recommended for symptomatic individuals. Typical antibiotics include Metronidazole and Clindamycin.

Some treatments (e.g., clindamycin cream/ovules) are oil-based and may weaken latex condoms.

Note for Vulvovaginal Candidiasis (Yeast Infection):

Vulvovaginal candidiasis, commonly known as a yeast infection, is most frequently caused by Candida albicans, although other Candida species can sometimes be involved. Characteristic symptoms include vulvar and/or vaginal itching (pruritus), soreness, and irritation. A thick, white, odorless, curd-like (cottage cheese-like) vaginal discharge may also be present, but discharge can vary. While yeast infections can affect females of any age, in prepubertal girls, a definitive diagnosis (e.g., via KOH microscopy of vaginal secretions to identify yeast forms) is particularly important, as symptoms can overlap significantly with nonspecific vulvovaginitis, which is more prevalent in this age group.

Several risk factors can predispose individuals to vulvovaginal candidiasis, including recent antibiotic use, diabetes mellitus, immunosuppression, and the use of oral contraceptives (OCPs) or other estrogen-containing hormonal therapies. Effective treatment options, many of which are available over-the-counter (OTC), include topical antifungal creams or suppositories (such as products containing Clotrimazole or Miconazole) and oral antifungal agents (like Fluconazole). Dosing regimens for these medications can be found using the calculator. If symptoms are severe, persist despite appropriate OTC treatment, or if infections are recurrent (typically defined as four or more episodes in a year), a medical evaluation is necessary to confirm the diagnosis, rule out other conditions, and guide appropriate management, which may involve different or prescription-strength therapies, or longer treatment courses.

Note for Gonorrhea/Chlamydia (Uncomplicated Urogenital/Rectal):

These guidelines primarily address uncomplicated gonococcal and chlamydial infections of the cervix, urethra, or rectum. Pharyngeal infections often require different treatment regimens; consult an infectious disease specialist or current CDC guidelines for these specific scenarios.

Gonorrhea Treatment: The recommended regimen for uncomplicated gonorrhea is Ceftriaxone 500 mg intramuscularly (IM) as a single dose. For individuals weighing 150 kg (330 lbs) or more, a 1-gram IM dose of Ceftriaxone should be administered.

Chlamydia Co-treatment: If chlamydial infection has not been ruled out, patients treated for gonorrhea should also receive empiric treatment for chlamydia. The preferred regimen is Doxycycline 100 mg orally twice daily for 7 days. An alternative is Azithromycin 1 gram orally as a single dose. Note that Doxycycline is generally favored over Azithromycin for chlamydial infections due to efficacy and resistance concerns.

Important Considerations: Patients should be tested for other sexually transmitted infections (STIs), including HIV and syphilis. All sexual partners within the preceding 60 days should be evaluated and treated. Patients should be advised to abstain from sexual intercourse until they and their partner(s) have completed their full course of treatment and any symptoms have resolved. Due to high rates of reinfection, re-screening for gonorrhea and chlamydia approximately 3 months after treatment is recommended.

In prepubertal children, a diagnosis of gonorrhea or chlamydia is a strong indicator of sexual abuse. Such cases require mandatory reporting to child protective services and a specialized evaluation as per local regulations and protocols.

Note for Peritonsillar Abscess (PTA):

A peritonsillar abscess (PTA), also known as quinsy, is a collection of pus that forms in the space between the tonsillar capsule and the pharyngeal constrictor muscle, often developing as a complication of acute tonsillitis. PTA requires prompt evaluation and active management, which crucially includes drainage of the abscess. Drainage procedures can include needle aspiration, incision and drainage, or, in certain situations, an acute tonsillectomy (quinsy tonsillectomy). These procedures are typically performed by an experienced clinician, such as an ENT (Otolaryngology) specialist.

Antibiotics are an essential adjunctive therapy to drainage. Initial antibiotic treatment may be administered parenterally (IV), especially for patients presenting with severe symptoms, inability to tolerate oral medications, significant trismus (difficulty opening the mouth), or any concerns regarding airway patency. Common intravenous antibiotic choices include Clindamycin or Ampicillin-Sulbactam. Another effective IV regimen is Penicillin G combined with Metronidazole to ensure adequate anaerobic coverage.

Oral antibiotics are appropriate for step-down therapy once a patient shows clinical improvement on IV treatment, or for managing milder cases of PTA immediately following successful drainage. Oral antibiotic selections should provide coverage for common pathogens including Group A Streptococcus, Staphylococcus aureus (with consideration for MRSA depending on local prevalence and patient risk factors), and oropharyngeal anaerobes.

The total recommended duration of antibiotic therapy for PTA is typically 10-14 days. Comprehensive supportive care, including effective pain management and maintenance of hydration, is also a key component of treatment. Close monitoring of the airway is critical, particularly in patients with severe presentations or if there is any suspicion of airway compromise.

Note for Lyme Disease (Early Localized or Early Disseminated - e.g., Erythema Migrans, Isolated Facial Nerve Palsy):

This guidance covers early manifestations of Lyme disease, such as a single or multiple Erythema Migrans (EM) rash(es), or isolated seventh cranial nerve (facial) palsy (Bell's palsy). For Erythema Migrans, the diagnosis is typically made clinically. For other early manifestations, serologic testing can be supportive, though it may be negative in the very early stages of infection.

Treatment Choice Considerations: For most manifestations of early Lyme disease, Doxycycline is recommended by the Infectious Diseases Society of America (IDSA) and the American Academy of Pediatrics (AAP) for patients of all ages. Effective alternative oral antibiotics include Amoxicillin or Cefuroxime Axetil.

Typical Durations: For Erythema Migrans, the usual treatment duration is 10 to 14 days; Doxycycline is often prescribed for 10 days, while Amoxicillin or Cefuroxime are typically given for 14 days. For isolated facial nerve palsy attributable to Lyme disease, a course of 14 to 21 days is common.

Important Considerations: More severe disseminated Lyme disease (e.g., carditis with significant AV block, meningitis, or other neurologic conditions like radiculoneuropathy) or late Lyme disease manifestations (such as Lyme arthritis) often necessitate different treatment regimens, potentially including intravenous antibiotics (e.g., Ceftriaxone), and may require longer durations of therapy. Always consult the most current IDSA/AAP guidelines and consider consultation with an infectious disease specialist for these more complex presentations. Note that tick-bite prophylaxis is a separate indication with a distinct antibiotic regimen and specific criteria for use.

Note for Tick Bite Prophylaxis (Lyme Disease Prevention):
Antibiotic prophylaxis is ONLY recommended if ALL the following criteria are met:

1. The attached tick is reliably identified as an adult or nymphal Ixodes scapularis (deer tick).
2. The tick is estimated to have been attached for ≥36 hours (e.g., based on tick engorgement or certainty of exposure time).
3. Prophylaxis can be started within 72 hours of tick removal.
4. The local rate of tick infection with Borrelia burgdorferi is ≥20% (this applies to Long Island and many parts of NYS and the Northeast/Mid-Atlantic/Upper Midwest).
5. Doxycycline is not contraindicated (e.g., true allergy; pregnancy is a relative contraindication - consult OB). IDSA guidelines state age is not a contraindication for a single prophylactic dose.

If all criteria are met, a single dose of Doxycycline is recommended: Adults: 200mg. Children: 4.4 mg/kg, up to a max of 200mg.
If Doxycycline is contraindicated, no alternative antibiotic prophylaxis is routinely recommended; observe for symptoms.
Always remove attached ticks promptly and correctly. Monitor for signs/symptoms of Lyme disease (e.g., rash, fever, fatigue, joint pain, facial palsy) for 30 days after any tick bite, regardless of whether prophylaxis was given, and seek medical attention if they develop. General tick prevention measures are crucial.

Note for Febrile Neutropenia (Initial IV Empiric Treatment):

Febrile neutropenia (defined as Fever + Absolute Neutrophil Count (ANC) <500/µL, or <1000/µL and predicted to drop to <500/µL) is a medical emergency, particularly in oncology patients. Prompt evaluation, including blood cultures (ideally obtained before antibiotics, if this does not cause significant delay), and the administration of empiric broad-spectrum intravenous (IV) antibiotics are critical.

Initial Empiric IV Monotherapy should provide antipseudomonal coverage. Common first-line options include agents such as Cefepime, Piperacillin-Tazobactam, or a Carbapenem (e.g., Meropenem).

Consider adding Vancomycin (or other specific Gram-positive coverage) initially ONLY if certain clinical criteria are met, including (but not limited to): hemodynamic instability or severe sepsis, suspected catheter-related infection, known prior colonization with MRSA, documented pneumonia, or a significant skin/soft tissue infection.

This calculator provides common initial empiric IV antibiotic dosages. However, the definitive antibiotic choice should always be guided by local antimicrobial resistance patterns, patient-specific factors like prior infections or colonizations, and any known drug allergies. The duration of antibiotic therapy and any subsequent modifications will be guided by the patient's clinical course, culture results, ANC recovery, and ongoing consultation with specialists (such as Hematology/Oncology and Infectious Diseases). Patient risk stratification (e.g., MASCC score for low-risk vs. high-risk) also plays a crucial role in overall management decisions.

Note for Septic Arthritis (Initial IV Empiric Treatment):

Septic arthritis is an orthopedic emergency requiring prompt evaluation and management to prevent irreversible joint damage. Diagnostic evaluation typically includes joint aspiration for synovial fluid analysis (including cell count with differential, Gram stain, and culture) and blood cultures. Immediate empiric intravenous (IV) antibiotic therapy should be initiated after appropriate cultures are obtained, provided this does not significantly delay treatment. Surgical drainage or arthroscopic washout of the affected joint may also be necessary for source control.

Initial Empiric IV Antibiotic Choices (these vary significantly by patient age, suspected pathogens, and local antimicrobial resistance patterns): For neonates (younger than 2 months), specific antibiotic regimens are required (e.g., a combination like Ampicillin plus Cefotaxime or an aminoglycoside such as Gentamicin), and care should be guided by neonatal specialists. In children older than 2 months, empiric therapy is often designed to cover common pathogens such as Staphylococcus aureus (including MRSA), Streptococcal species, and, particularly in younger children, Kingella kingae. Common empiric regimens frequently include Vancomycin (for MRSA coverage) PLUS a third-generation cephalosporin (e.g., Ceftriaxone). In sexually active adolescents, empiric coverage for Neisseria gonorrhoeae is crucial, with Ceftriaxone being a cornerstone of therapy.

The definitive antibiotic choice is ultimately tailored based on Gram stain results (if informative), patient age, local resistance data, and, most importantly, the culture and susceptibility results from synovial fluid or blood. The duration of antibiotic therapy for septic arthritis is typically 3-4 weeks, often initiated with IV therapy and followed by a transition to oral antibiotics, as guided by clinical response and consultation with specialists (such as Orthopedics and Infectious Diseases).

Note for Mastoiditis (Initial IV Empiric Treatment):

Acute mastoiditis is a serious bacterial infection of the mastoid air cells, typically developing as a complication of acute otitis media. This condition requires prompt evaluation, which often includes CT imaging of the temporal bones, and usually necessitates hospital admission for intravenous (IV) antibiotics. Consultation with an ENT (Otolaryngology) specialist is essential for management.

Empiric IV antibiotic therapy should be broad-spectrum, providing coverage for common acute otitis media pathogens (such as Streptococcus pneumoniae, Haemophilus influenzae, and Streptococcus pyogenes), as well as Staphylococcus aureus (including consideration for MRSA). In certain cases, such as those involving chronic ear disease or recent broad-spectrum antibiotic use, coverage for Pseudomonas aeruginosa may also be warranted.

Common empiric IV regimens often involve combination therapy. A frequently used approach includes Vancomycin (primarily for MRSA and resistant pneumococcal coverage) administered concurrently with a broad-spectrum beta-lactam antibiotic. Options for the beta-lactam component include Ceftriaxone, Cefepime (which also offers Pseudomonas coverage), or Piperacillin-Tazobactam.

Surgical intervention, commonly myringotomy with or without the placement of a tympanostomy tube, is often performed to obtain material for culture and to facilitate drainage. More extensive surgical procedures, like mastoidectomy, may be necessary for patients with complications (e.g., subperiosteal abscess, intracranial extension) or for those who do not show significant improvement with appropriate medical therapy.

The duration of initial IV antibiotic therapy is typically at least 7-10 days, or until there is clear evidence of significant clinical improvement. This is generally followed by a course of oral antibiotics to complete a total treatment duration of approximately 2-4 weeks, with the specific duration guided by clinical response, culture results, and recommendations from specialists.

Note for Retropharyngeal Abscess (RPA) (Initial IV Empiric Treatment):

A retropharyngeal abscess (RPA) represents a serious deep neck space infection, which can be potentially life-threatening due to the risk of acute airway compromise. This condition requires urgent evaluation by an ENT (Otolaryngology) specialist or another clinician experienced in managing deep neck infections, alongside a thorough airway assessment. Hospital admission is typically indicated, and diagnostic imaging, most commonly a CT scan with contrast of the neck, is usually necessary to confirm the diagnosis and define the extent of the abscess.

Prompt initiation of empiric intravenous (IV) antibiotics is crucial once RPA is suspected, ideally after obtaining blood cultures (and pus cultures if surgical drainage is performed, if this does not delay antibiotic administration). Empiric antibiotic coverage should target common causative pathogens, including Group A Streptococcus, Staphylococcus aureus (with consideration for MRSA based on local epidemiology and patient risk factors), and various respiratory anaerobes.

Common empiric IV antibiotic regimens include: Clindamycin (which provides good coverage for many Gram-positive organisms and anaerobes), Ampicillin-Sulbactam. Alternatively, a combination such as Vancomycin (for MRSA) PLUS a third-generation cephalosporin (e.g., Ceftriaxone) can be used. Metronidazole may be added to certain regimens (like those based on Penicillin or a cephalosporin) to ensure more robust anaerobic coverage, especially if Clindamycin or Ampicillin-Sulbactam (which have intrinsic anaerobic activity) are not chosen.

Surgical drainage of the abscess is frequently required, particularly for larger or more discrete abscess collections, or if there are any signs of impending or actual airway compromise. Antibiotic therapy is typically continued for a total duration of 10-14 days, although longer courses (e.g., 2-3 weeks) may be warranted depending on the clinical severity and response. A transition from IV to oral antibiotics is usually guided by clinical improvement and under the direction of the treating specialist.

Note for Osteomyelitis (Initial IV Empiric Treatment):

Osteomyelitis is a serious infection of the bone requiring prompt and thorough medical evaluation. Key diagnostic steps include appropriate imaging (MRI is often preferred for early detection and delineating the extent of infection), blood cultures, and frequently, bone aspiration or biopsy to obtain material for culture and sensitivity testing (ideally before antibiotics are started, if clinically feasible). Hospital admission for initial intravenous (IV) antibiotic therapy is standard. Consultation with Orthopedic and/or Infectious Diseases specialists is crucial for optimal management.

Empiric IV Antibiotic Choices (vary significantly by age, suspected pathogens, and local resistance patterns; this calculator focuses on children >2 months): Neonates (<2 months) require specific antibiotic regimens and immediate specialist/neonatology consultation. For infants and children older than 2 months, initial empiric therapy must provide robust coverage for Staphylococcus aureus, including Methicillin-Resistant Staphylococcus aureus (MRSA). A common empiric regimen involves Vancomycin PLUS a third-generation cephalosporin (such as Ceftriaxone or Cefotaxime). Alternative agents like Clindamycin, or Nafcillin/Oxacillin (if MRSA risk is low and the isolate is expected to be susceptible), can be considered in specific clinical scenarios. In patients with sickle cell disease, empiric coverage for Salmonella species is also essential.

Surgical debridement of infected or necrotic bone may be necessary, particularly for chronic osteomyelitis or if there is a poor response to medical therapy. Antibiotic treatment for osteomyelitis is typically prolonged, often for 4-6 weeks or longer, usually initiated with IV therapy followed by a transition to oral antibiotics. The specific choice and duration of antibiotics are guided by the identified pathogen(s), their susceptibility patterns, the patient's clinical response, and the trend of inflammatory markers (e.g., CRP, ESR).

Note for Pertussis (Whooping Cough) - Treatment & Postexposure Prophylaxis (PEP):

Pertussis, also known as whooping cough, is a highly contagious bacterial respiratory illness. Antibiotics are recommended for treatment to lessen symptom severity and reduce transmission (most effective if initiated early, ideally within 3 weeks of cough onset). Antibiotics are also indicated for postexposure prophylaxis (PEP) for close contacts of an infectious case, ideally started within 21 days of exposure.

Preferred Antibiotics (Macrolides): Azithromycin is generally the preferred macrolide for all age groups. Specific dosing for Azithromycin is as follows: For infants younger than 1 month: 10 mg/kg/day orally once daily for 5 days (important: monitor for infantile hypertrophic pyloric stenosis - IHPS). For infants aged 1-5 months: 10 mg/kg/day orally once daily for 5 days (maximum dose of 500 mg/day). For children 6 months and older: 10 mg/kg (maximum 500 mg) orally on Day 1, followed by 5 mg/kg/day (maximum 250 mg/day) orally on Days 2 through 5. Clarithromycin is an alternative macrolide for infants aged 1 month and older, typically dosed at 7.5 mg/kg/dose orally twice daily for 7 days (maximum 500 mg/dose).

Alternative (if macrolide allergy or intolerance, for patients ≥2 months old): Trimethoprim-Sulfamethoxazole (TMP-SMX) may be used. The dosage is 8 mg/kg/day based on the trimethoprim component, administered orally in two divided doses, for a duration of 14 days (maximum 160 mg of trimethoprim per dose).

Pertussis is a nationally notifiable disease; report suspected cases to local public health authorities. Infected individuals should typically be excluded from school, childcare facilities, and other group settings until they have completed 5 days of appropriate antibiotic therapy to minimize transmission.

Note for Diaper Dermatitis (Diaper Rash):

Diaper dermatitis is common. Management focuses on the "ABCDs": Air exposure, Barrier creams, gentle Cleansing, and frequent Diaper changes.

Irritant Dermatitis: Redness on convex surfaces, spares folds. Treat with barrier creams (e.g., Zinc Oxide, Petrolatum) applied thickly with each diaper change.

Candidal (Yeast) Dermatitis: Beefy red rash, often in skin folds, with satellite lesions. Treat with topical antifungal creams (e.g., Nystatin, Clotrimazole, Miconazole) BID-QID until clear + few days after.

Inflammation: For significant inflammation with irritant dermatitis (not primarily yeast), a short course (3-7 days) of low-potency topical Hydrocortisone (0.5% or 1%) cream can be applied sparingly BID. Use with caution and avoid prolonged use. If yeast is suspected, use with an antifungal.

Seek medical advice if rash is severe (blisters, ulcers), doesn't improve in 2-3 days, spreads, or shows signs of bacterial infection (pus, crusts).

Note for Tinea Capitis (Scalp Ringworm):

Tinea capitis is a dermatophyte fungal infection of the scalp hair follicles. Effective treatment requires systemic oral antifungal therapy, as topical treatments alone are generally insufficient to eradicate the infection. Diagnosis should be confirmed whenever possible, for example, by potassium hydroxide (KOH) preparation and fungal culture of plucked hairs or scalp scrapings. Common causative fungi include species of Trichophyton and Microsporum.

First-line systemic antifungal agents typically include Griseofulvin and Terbinafine. Griseofulvin (microsize or ultramicrosize) should be administered with a fatty meal to enhance absorption, with a treatment duration commonly lasting 6-8 weeks or longer, until clinical and mycological cure. Terbinafine is another effective first-line option, with treatment durations often ranging from 4 to 8 weeks, which can vary depending on the specific fungal species identified. Fluconazole may be considered an alternative agent. Adjunctive therapy with antifungal shampoos (such as ketoconazole 2% or selenium sulfide 2.5%), used 2-3 times per week, can help to reduce spore shedding and decrease the risk of transmission to others. Screening and, if indicated, treatment of close household contacts are also important components of management.

Note for Tinea (Skin - Body/Groin/Feet - Tinea Corporis, Cruris, Pedis):

For localized, uncomplicated tinea infections affecting the skin (such as tinea corporis/ringworm of the body, tinea cruris/jock itch, or tinea pedis/athlete's foot), topical antifungal therapy is the first-line treatment. Common options include "azole" antifungal creams (e.g., Clotrimazole, Miconazole, Ketoconazole), which are typically applied twice daily (BID), or allylamine creams such as Terbinafine, often applied once or twice daily (QD-BID). The topical medication should be applied to the affected area and also cover 1-2 cm of normal-appearing skin beyond the visible border of the rash. Treatment should generally be continued for at least one week after the rash has clinically cleared, with total treatment durations usually ranging from 2 to 4 weeks. Keeping the affected area clean and dry is an important adjunctive measure.

Systemic oral antifungal therapy may be indicated for tinea infections that are particularly extensive, severe, recurrent, unresponsive to appropriate topical therapy, or if the patient is immunocompromised. Such cases warrant a thorough medical evaluation to determine the most appropriate management strategy.

Pediatric Sepsis IV Fluids

Rapid and aggressive fluid resuscitation is a critical early intervention in pediatric septic shock to restore intravascular volume and improve end-organ perfusion.

For suspected septic shock, administer an initial bolus of 20 mL/kg of isotonic crystalloid (e.g., Normal Saline 0.9% or Lactated Ringer's) intravenously. This bolus should be given rapidly, typically over 5-20 minutes (or as a push if the patient is in severe shock and an appropriate IV access is available).

Further boluses of 20 mL/kg can be administered, potentially reaching a total of 40-60 mL/kg (or more in some cases) within the first hour, guided by frequent and careful reassessment after each bolus. Monitor clinical signs of perfusion (heart rate, blood pressure, capillary refill time, mental status, urine output) and assess for signs of fluid overload (e.g., new or worsening rales, hepatomegaly, jugular venous distension).

If shock persists despite 40-60 mL/kg of fluid resuscitation, vasopressor therapy should be initiated promptly, and further fluid administration should be guided by dynamic assessments of fluid responsiveness.

Note: Use caution with fluid administration in children with known severe cardiac dysfunction or in specific conditions like DKA where different fluid management protocols apply. This guidance is for septic shock.