Antibiotic Regimens (SDCEP)
If antibiotic prophylaxis is required, an appropriate oral regimen is:
| Amoxicillin, 3 g Oral Powder Sachet | Dose for children |
|---|---|
| Give: 3 g (1 sachet) 60 minutes before procedure | Amoxicillin Oral Suspension*, 250 mg/5 ml or 3 g Oral Powder Sachet* |
| (3 g prophylactic dose) | 6 months – 17 years: 50 mg/kg; maximum dose 3 g (prophylactic dose) |
NB:
- Amoxicillin, like other penicillins, can cause hypersensitivity reactions, including rashes and anaphylaxis, and may lead to antibiotic-associated colitis, which can be fatal. Avoid in patients with a history of anaphylaxis, urticaria, or rash following penicillin administration.
- Amoxicillin can alter the anticoagulant effect of warfarin; INR should be monitored in warfarin users.
- Sugar-free preparation is available.
In patients who are allergic to penicillin, an appropriate oral regimen is:
| Clindamycin Capsules, 300 mg | Dose for children |
|---|---|
| Give: 600 mg (2 capsules) 60 minutes before procedure | 6 months – 17 years: 20 mg/kg; maximum dose 600 mg (prophylactic dose) |
NB:
- Advise patients to swallow capsules with a glass of water.
- Do not prescribe clindamycin to patients with diarrheal conditions.
- Be aware of the risk of antibiotic-associated colitis, which can be fatal.
- Clindamycin is unavailable as an oral suspension. Azithromycin oral suspension may be a suitable alternative for children unable to take capsules.
In patients who are allergic to penicillin and unable to swallow capsules, an appropriate oral regimen is:
| Azithromycin Oral Suspension 200 mg/5 ml | Dose for children |
|---|---|
| Give: 500 mg (12.5 ml) 60 minutes before procedure | 6 months – 11 years: 12 mg/kg; maximum dose 500 mg |
| (500 mg prophylactic dose) | 12–17 years: 500 mg (prophylactic dose) |
NB:
- Azithromycin can cause abdominal discomfort, diarrhoea, nausea, and vomiting.
For patients who require intravenous prophylaxis, an appropriate regimen is:
| Amoxicillin | Dose for children |
|---|---|
| Give: 1 g i.v. just before the procedure or at induction of anaesthesia | 6 months – 17 years: 50 mg/kg; maximum dose 1 g |
NB:
- Amoxicillin, like other penicillins, can cause hypersensitivity reactions and antibiotic-associated colitis. Avoid in patients with penicillin hypersensitivity.
- Amoxicillin can alter the anticoagulant effect of warfarin; monitor INR in warfarin users.
For patients who require intravenous prophylaxis and are allergic to penicillin, an appropriate regimen is:
| Clindamycin | Dose for children |
|---|---|
| Give: 300 mg i.v. just before the procedure or at induction of anaesthesia | 6 months – 17 years: 20 mg/kg; maximum dose 300 mg |
NB:
- Avoid prescribing clindamycin to patients with diarrheal conditions.
- Monitor for antibiotic-associated colitis, which can be fatal.