x

Remember to check allergy status

x

Paediatric Treatment - Upper Respiratory Tract Infections

1

Scarlet fever (GAS)

Prompt treatment with appropriate antibiotics significantly reduces the risk of complications.[1D] Observe immunocompromised individuals (diabetes; chickenpox) as they are at increased risk of developing invasive infection.[1D]

Medicine Calendar

First line (mild): analgesia

Phenoxymethylpenicillin

see BNFc

10 days

Penicillin allergy: clarithromycin

see BNFc

5 days

Influenza

Annual vaccination is essential for all those “at risk” of influenza.[1D]

First line treatment for “at risk” patients: five days oseltamivir,[1D] when influenza is circulating in the community, and ideally within 48 hours of onset.

Or if severe immunosuppression or oseltamivir resistance: use zanamivir for up to 10 days and seek advice.[4D]

See PHE Influenza guidance for treatment.

See NICE Influenza for prophylaxis

Medicine Calendar

At risk: children under six months; chronic respiratory disease (including COPD and asthma); significant cardiovascular disease (not hypertension); severe immunosuppression; diabetes mellitus; chronic neurological, renal or liver disease; morbid obesity (BMI>40).[4D]

Oseltamivir (oral)

see PHE guidelines

5 days

Zanamivir (ideally within 36 hours of onset)

see PHE guidelines

5-10 days

Acute otitis externa

CKS OE

First line: analgesia for pain relief,[1D,2D] and apply localised heat (eg a warm flannel).[2D]

Second line: topical acetic acid or topical antibiotic +/- corticosteroid: similar cure at 7 days.[2D,3A+,4B-]

If cellulitis or disease extends outside ear canal, or systemic signs of infection, start oral flucloxacillin and refer to exclude malignant otitis externa.[1D]

Medicine Calendar

First line:
analgesia and apply localised heat

Second line
topical acetic acid 2%

Over 12 years: 1 spray TDS

7 days

OR topical neomycin sulphate with corticosteroid

3 drops TDS

7 days minimum to 14 days maximum1A+

If cellulitis: flucloxacillin

see BNFc

7 days

Acute otitis media

NICE-CKS OM
NICE-Fever in children

Optimise analgesia and target antibiotics 2,3B- AOM resolves in 60% in 24hrs without antibiotics, which only reduce pain at 2 days (NNT15) and does not prevent deafness 4 A+

Consider 2 or 3-day delayed antibiotics1 A+, or immediate antibiotics for pain relief if: <2 years AND bilateral AOM (NNT4)5-7A+ or bulging membrane or symptom score >8 for:

  • fever
  • tugging ears
  • crying
  • irritability
  • difficulty sleeping
  • less playful
  • eating less (0 = no symptoms; 1 = a little; 2= a lot)

All ages with otorrhoea NNT3 8 A+
Antibiotics to prevent mastoiditis NNT >4000 9 B-

Medicine Calendar

amoxicillin 10 A+

Neonate 7-28 days 30mg/kg TDS (max. per dose 125 mg).
1 -11 months: 125mg TDS.
1-4 years: 250mg TDS.
5-18 years: 500mg TDS

5 days 13 A+

Penicillin Allergy:
erythromycin 11 D

< 2yrs: 125mg QDS
2-7yrs: 250mg QDS
8-17yrs: 250-500mg QDS

5 days 13 A+

OR clarithromycin

1 month - 11 years: 7.5mg/kg BD (max 250mg BD)

12-17 years: 250mg BD

5 days

Sinusitis (acute)

NICE-CKS RS

Symptoms <10 days:[1A+] do not offer antibiotics as most resolve in 14 days without,[2A+] and antibiotics only offer marginal benefit after 7 days (NNT15).[3A+]
Symptoms >10 days:[1A+] no antibiotic, or back-up antibiotic[4D] if several of: purulent nasal discharge;[1A+] severe localised unilateral pain; fever; marked deterioration after initial milder phase.[1A+]
Systemically very unwell, or more serious signs and symptoms:[1A+] immediate antibiotic.[1A+,5A-]Suspected complications: eg sepsis, intraorbital or intracranial, refer to secondary care.[1A+]
Self-care: paracetamol/ibuprofen for pain/fever.6D Consider high-dose nasal steroid if >12 years.[1A+] Nasal decongestants or saline may help some.[1A+]

Medicine Calendar

No antibiotics: self-care

First line for delayed: phenoxymethylpenicillin

see BNFc

5 days

Penicillin allergy or intolerance: clarithromycin

see BNFc

5 days

Very unwell or worsening: co-amoxiclav

see BNFc

5 days

Acute Sore Throat

NICE-CKS

Avoid antibiotics as 82% resolve in 7 days 1 A+, and pain is only reduced by 16 hours 2 A+.

Use FeverPAIN Score: Fever in last 24h, Purulence, Attend rapidly under 3 days, severely Inflamed tonsils, No cough or coryza.3 B+ 4 B+

Score 0-1: 13-18% streptococci, use NO antibiotic strategy
Score 2-3: 34-40% streptococci, use 3 day delayed/back-up antibiotic
Score 4 or more: 62-65% streptococci, use immediate antibiotic if severe, or 48hr short delayed/back-up prescription.5 A-

Advise paracetamol, self-care, and safety net.

Complications are rare: antibiotics to prevent quinsy NNT >4000 4 B-, otitis media NNT 200 2 A+

RCT in <18yr olds shows 10 days penicillin had lower relapse vs 5 days 8

Medicine Calendar

Fever pain 0-1: self-care

Fever pain 2-3: 3-day delayed/back up prescription of phenoxymethylpenicillin 5 B-

See BNFc

5-10 days

Fever pain 4 or more: phenoxymethylpenicillin (if severe) or 48hr delayed/back-up prescription

See BNFc

5-10 days

If Penicillin Allergic:
Clarithromycin

See BNFc

5 days

The POCAST project is funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London and by the Imperial College Healthcare Charity (Grant Ref No:7006/P36U).