Spectrum: Local Antimicrobial Stewardship, for UCLA Health

Moderately Ill

Criteria

  • Increased WOB (grunting, retracting, tachypnea)

  • Hypoxia (< 90% SpO2 on room air)

Admit Patient

Inpatient Floor

First Line Therapy

Ampicillin (High Dose)
150-200mg/kg/day IV divided every 6 hours
Max dose: 4g per day

Hib/PCV Immunizations Not up to Date

Ceftriaxone 50mg/kg/day IV in once daily dosing.
Consider 100mg/kg/day IV divided daily or BID for severe infection
Max dose: 2g per day

Definitions of Fully Immunized

Pneumococcal

  • < 4 months: 1 dose

  • 4-6 months: 2 doses

  • 6-12 months: 3 doses

  • > 12 months: 4 doses of vaccine (primary series plus one booster dose at 12-15 months)

Hib

  • < 4 months: 1 dose

  • 4-6 months: 2 doses

  • 6-12 months: 3 doses

  • > 12 months: 4 doses of vaccine (primary series plus one booster dose at 12-15 months)

Beta-lactam Allergy

Clindamycin 30-40mg/kg/day PO divided every 6-8 hours
Max dose: 1800mg per day

OR

Clindamycin 40mg/kg/day IV divided every 6-8 hours
Max dose: 1800mg per day

Additional Recommendations

Transition to oral equivalent when improving

O₂ to keep SpO₂ > 90%

IVF as needed

No repeat CBC/CXR needed unless not improving

Recommendations for Atypical Pneumonia

Recommendations for Influenza

Recommendations for MRSA

Concern for parapneumonic effusion on CXR?

Chest US (CT is second line): ID consult recommended