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2. Choosing Among Antifungal Agents: Polyenes, Azoles, and Echinocandins3. How Antibiotic Dosages Are Determined Using Susceptibility Data, Pharmacodynamics, and Treatment Outcomes4. Approach to Antibiotic Therapy of Drug-Resistant Gram-negative Bacilli and Methicillin-ResistantStaphylococcus aureus5. Antimicrobial Therapy for Newborns6. Antimicrobial Therapy According to Clinical Syndromes7. Preferred Therapy for Specific Bacterial and Mycobacterial Pathogens8. Preferred Therapy for Specific Fungal Pathogens9. Preferred Therapy for Specific Viral Pathogens10. Preferred Therapy for Specific Parasitic Pathogens11. Alphabetic Listing of Antimicrobials13. Sequential Parenteral-Oral Antibiotic Therapy (Oral Step-down Therapy) for Serious Infections14. Antimicrobial Prophylaxis/Prevention of Symptomatic InfectionReferencesBradleyNelsonAppendix: Nomogram for Determining Body Surface Area25th Edition12. Antibiotic Therapy for Children Who Are Obese2019 Nelson’s Pediatric Antimicrobial Therapy1. Choosing Among Antibiotics Within a Class: Beta-lactams and Beta-lactamase Inhibitors, Macrolides,Aminoglycosides, and Fluoroquinolones2019Nelson’s PediatricAntimicrobial TherapyJohn S. Bradley, MDEditor in ChiefJohn D. Nelson, MDEmeritus25THEDITIONElizabeth D. Barnett, MDJoseph B. Cantey, MDDavid W. Kimberlin, MDPaul E. Palumbo, MDJason Sauberan, PharmDJ. Howard Smart, MDWilliam J. Steinbach, MDContributing EditorsIndexAAPNELSON PEDIATRIC SPREAD 2019 FINAL.indd All Pages11/13/18 2:39 PM

2019Nelson’s PediatricAntimicrobial TherapyJohn S. Bradley, MD25th EditionEditor in ChiefJohn D. Nelson, MDEmeritusElizabeth D. Barnett, MDJoseph B. Cantey, MDDavid W. Kimberlin, MDPaul E. Palumbo, MDJason Sauberan, PharmDJ. Howard Smart, MDWilliam J. Steinbach, MDContributing Editorsch00-Nelson-2019 FM i-xii.indd 111/12/18 2:51 PM

American Academy of Pediatrics Publishing StaffMary Lou White, Chief Product and Services Officer/SVP, Membership, Marketing, and PublishingMark Grimes, Vice President, PublishingPeter Lynch, Senior Manager, Digital Strategy and Product DevelopmentMary Kelly, Senior Editor, Professional and Clinical PublishingShannan Martin, Production Manager, Consumer PublicationsJason Crase, Manager, Editorial ServicesLinda Smessaert, MSIMC, Senior Marketing Manager, Professional ResourcesMary Louise Carr, MBA, Marketing Manager, Clinical PublicationsPublished by the American Academy of Pediatrics345 Park BlvdItasca, IL 60143Telephone: 630/626-6000Facsimile: 847/434-8000www.aap.orgThe American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medicalsubspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of infants,children, adolescents, and young adults.The recommendations in this publication do not indicate an exclusive course of treatment or serve as astandard of medical care. Variations, taking into account individual circumstances, may be appropriate.Statements and opinions expressed are those of the authors and not necessarily those of theAmerican Academy of Pediatrics.Products and Web sites are mentioned for informational purposes only and do not imply an endorsement bythe American Academy of Pediatrics. Web site addresses are as current as possible but may change at any time.Brand names are furnished for identifying purposes only. No endorsement of the manufacturers orproducts listed is implied.The publishers have made every effort to trace the copyright holders for borrowed materials.If they have inadvertently overlooked any, they will be pleased to make the necessaryarrangements at the first opportunity.This publication has been developed by the American Academy of Pediatrics. The authors, editors, andcontributors are expert authorities in the field of pediatrics. No commercial involvement of any kind hasbeen solicited or accepted in the development of the content of this publication. Disclosures: Dr Kimberlindisclosed a consulting relationship with Slack Incorporated. Dr Palumbo disclosed a safety monitoringboard relationship with Janssen Pharmaceutical Companies. Dr Steinbach disclosed an advisory boardrelationship with Merck & Company and Astellas Pharma, Inc.Every effort has been made to ensure that the drug selection and dosages set forth in this text are inaccordance with current recommendations and practice at the time of publication. It is the responsibility ofthe health care professional to check the package insert of each drug for any change in indications ordosage and for added warnings and precautions, and to review newly published, peer-reviewed data inthe medical literature for current data on safety and efficacy.Special discounts are available for bulk purchases of this publication.E-mail Special Sales at aapsales@aap.org for more information. 2019 John S. Bradley and John D. NelsonPublishing rights, American Academy of Pediatrics. All rights reserved. No part of this publication may bereproduced, stored in a retrieval system, or transmitted in any form or by any means—electronic, mechanical,photocopying, recording, or otherwise—without prior permission from the authors.First edition published in 1975.Printed in the United States of America.1 2 3 4 5 6 7 8 9 10MA0881ISSN: 2164-9278 (print)ISSN: 2164-9286 (electronic)ISBN: 978-1-61002-210-19-422/1218ch00-Nelson-2019 FM i-xii.indd 211/12/18 2:51 PM

iiiEditor in ChiefEmeritusJohn S. Bradley, MDProfessor of PediatricsChief, Division of Infectious Diseases,Department of PediatricsUniversity of California, San Diego,School of MedicineDirector, Division of Infectious Diseases,Rady Children’s Hospital San DiegoSan Diego, CAJohn D. Nelson, MDProfessor Emeritus of PediatricsThe University of TexasSouthwestern Medical Center at DallasSouthwestern Medical SchoolDallas, TXContributing EditorsElizabeth D. Barnett, MDProfessor of PediatricsBoston University School of MedicineDirector, International Clinic and RefugeeHealth Assessment Program,Boston Medical CenterGeoSentinel Surveillance Network,Boston Medical CenterBoston, MAJoseph B. Cantey, MDAssistant Professor of PediatricsDivisions of Pediatric Infectious Diseases andNeonatology/Perinatal MedicineUniversity of Texas Health Science Center atSan AntonioSan Antonio, TXDavid W. Kimberlin, MDEditor, Red Book: 2018–2021 Report of theCommittee on Infectious Diseases,31st EditionProfessor of PediatricsCodirector, Division of PediatricInfectious DiseasesSergio Stagno Endowed Chair inPediatric Infectious DiseasesUniversity of Alabama at BirminghamBirmingham, ALch00-Nelson-2019 FM i-xii.indd 3Paul E. Palumbo, MDProfessor of Pediatrics and MedicineGeisel School of Medicine at DartmouthDirector, International Pediatric HIV ProgramDartmouth-Hitchcock Medical CenterLebanon, NHJason Sauberan, PharmDAssistant Clinical ProfessorUniversity of California, San Diego,Skaggs School of Pharmacy andPharmaceutical SciencesRady Children’s Hospital San DiegoSan Diego, CAJ. Howard Smart, MDChairman, Department of PediatricsSharp Rees-Stealy Medical GroupAssistant Clinical Professor of PediatricsUniversity of California, San DiegoSchool of MedicineSan Diego, CAWilliam J. Steinbach, MDProfessor of PediatricsProfessor in Molecular Geneticsand MicrobiologyChief, Division of Pediatric Infectious DiseasesDirector, Duke PediatricImmunocompromised Host ProgramDirector, International Pediatric FungalNetworkDuke University School of MedicineDurham, NC11/12/18 2:51 PM

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