Template:Ludwig's Antibiotics

• Must cover typical polymicrobial oral flora and tailored based on patient's immune status
• Most commonly a 3rd generation cehpalosporin + (clindamycin or metronidazole)
• If the patient is immuncompromised, the antibiotics need to also cover MRSA and gram-negative rods

Immunocompetent Host

• Ampicillin/Sulbactam 3g (50mg/kg) IV q6 hrs OR
• Penicillin G 2-4 million units IV q6 hrs + Metronidazole 500 mg IV q6 hrs OR
• Clindamycin 600 mg IV q6 hrs (option for those allergic to penicillin)

Pediatric Immunocompetent

• Ampicillin/Sulbactam 50mg/kg IV q6hrs (max 3g/dose) OR
• Penicillin G 50,000 units/kg IV q6hrs (max 4 million units) + Metronidazole 7.5mg/kg IV q6hrs (max 500mg) OR
• Clindamycin 10-13mg/kg IV q8hrs (max 900mg/dose)

Immunocompromised

• Cefepime 2 g IV q12 hrs + Metronidazole 500 mg IV q6 hrs OR
• Meropenem 1 g IV q8 hrs OR
• Imipenem/Cilastatin 500mg (20mg/kg) IV q6 hours
• Piperacillin/Tazobactam 4.5g (80mg/kg) IV q6 hours
• Add Vancomycin 15-20 mg/kg IV q8 hrs (max 2 g per dose) if concern for MRSA risk factors

Pediatric Immunocompromised

• Cefepime 50mg/kg IV q8hrs (max 2g) + Metronidazole 7.5mg/kg IV q6hrs (max 500mg) OR
• Meropenem 20mg/kg IV q8hrs (max 1g) OR
• Piperacillin/Tazobactam 80-100mg/kg IV q6-8hrs (max 4.5g)
• Add Vancomycin 15mg/kg IV q6hrs if concern for MRSA