Review previous microbiology results: If resistant target organisms previously isolated (e.g. MRSA, ESBL, known resistance to empirical antibiotic choices), discuss antibiotic choice with Paediatric and/or Microbiology Consultant.

User guide: for further advice regarding antimicrobial prescribing good practice, oral switch, penicillin allergy, dosing, and safety considerations: HERE

Tonsillitis (including Streptococcal sore throat and scarlet fever)

Antibiotics are not required in all cases. Refer to local paediatric guidelines.

First line

PO penicillin V

If unable to swallow: IV benzylpenicillin, with switch to PO penicillin V

Total duration (IV + PO)

Acute sore throat (includes Group A/C/G streptococci): 5 days; consider up to 10 days if severely unwell / associated sepsis
Recurrent acute sore throat <2 weeks from previously treated infection: 10 days
Scarlet fever: 10 days

Penicillin allergy

PO azithromycin

Total duration

Acute sore throat (includes Group A/C/G streptococci): 3 days
Scarlet fever: 5 days

or

IV/PO clarithromycin

Total duration (IV + PO)

Acute sore throat (includes Group A/C/G streptococci): 5 days
Scarlet fever: 10 days

Epiglottitis / Tracheitis

First line

IV cefTRIAXone

Oral switch (no penicillin allergy): co-amoxiclav
Oral switch (mild penicillin allergy): clindamycin and ciprofloxacin

Penicillin allergy (severe)

IV clindamycin 
and IV ciprofloxacin

Oral switch: clindamycin and ciprofloxacin

Total duration (IV + PO)
  • 5 days

Otitis media

Children with acute otitis media do not usually require antibiotics, which typically shorten symptoms by 24 hours only.
Consider delayed antibiotic treatment.
Refer to BSAC Paediatric Pathways for further guidance.

First line

PO/IV amoxicillin

TOTAL duration  5 days
Penicillin allergy

PO azithromycin

TOTAL duration  3 days

or

PO/IV clarithromycin

TOTAL duration (IV + PO)  5 days

Acute mastoiditis

First line 

IV cefTRIAXone
and IV/PO metronidazole

Oral switch: co-amoxiclav

Penicillin allergy
No intra-cranial involvement

IV clindamycin
and IV gentamicin

Oral switch: clindamycin

Penicillin allergy  
intra-cranial involvement

IV vancomycin
and IV/PO ciprofloxacin 
and IV/PO metronidazole  

Total duration (IV + PO)
  • No intracranial involvement: 14 days
  • Intracranial involvement: 28 days

Lymphadenitis

A well child with few systemic symptoms or generalised lymphadenopathy does not require antibiotics.
Antibiotics should be reserved for systemically unwell children (i.e. those more likely to have an acute bacterial cause).

First line - Systemically unwell

PO/IV co-amoxiclav

Total duration (IV + PO)  7 days
Penicillin allergy - SYstemically unwell

PO azithromycin

TOTAL duration  3 days

or

IV/PO clarithromycin

TOTAL duration (IV + PO)  7 days

Pertussis

First line

PO azithromycin

TOTAL duration  3 days

or

IV/PO clarithromycin 

Preferred option for children ≤1 month 

TOTAL duration (IV + PO)  7 days
Second LINE

IV/PO co-trimoxazole

Not licensed for infants below 6 weeks

TOTAL duration (IV + PO)  7 days
Comments
  • Public Health Notification
    Suspected or confirmed Pertussis infection requires notification to Public Health Scotland, via the local Health Protection Team (HPT).
  • UKHSA Pertussis guidelines are available: HERE

Editorial Information

Last reviewed: 20/02/2024

Next review date: 20/02/2026

Author(s): Dr Jon van Aartsen (Consultant Microbiologist), Dr Jed Bamber (Consultant Paediatrician).

Version: v1.0

Approved By: AMT (20.02.2024) and ADTC (28.02.2024)

Reviewer name(s): Dr Jed Bamber (Consultant Paediatrician), AMS Team.