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NH22021 Nelson’s Pediatric Antimicrobial Therapy2. Antimicrobial Therapy for Neonates3. Preferred Therapy for Bacterial & Mycobacterial Pathogens4. Choosing Among Antibiotics Within a Class5. Preferred Therapy for Fungal Pathogens6. Choosing Among Antifungal Agents7. Preferred Therapy for Viral Pathogens8. Choosing Among Antiviral Agents9. Preferred Therapy for Parasitic Pathogens10. Choosing Among Antiparasitic Agents11. How Antibiotic Dosages Are Determined12. Approach to Antibiotic Therapy of Drug-Resistant Gram-negative Bacilli & MRSA14. Sequential Parenteral-Oral Antibiotic Therapy for Serious Infections15. Antimicrobial Prophylaxis/Prevention of Symptomatic Infection17. Antibiotic StewardshipBradleyNelson16. Approach to Antibiotic Allergies27th Edition13. Antibiotic Therapy for Children Who Are Obese2021 Nelson’s Pediatric Antimicrobial Therapy1. Antimicrobial Therapy According to Clinical Syndromes18. Alphabetic Listing of AntimicrobialsOHN2021NNNHOONOOP OOHONelson’s PediatricAntimicrobial Therapy27th EditionJohn S. Bradley, MDEditor in ChiefJohn D. Nelson, MDEmeritusElizabeth D. Barnett, MDJoseph B. Cantey, MDDavid W. Kimberlin, MDPaul E. Palumbo, MDJason Sauberan, PharmDJ. Howard Smart, MDWilliam J. Steinbach, MDUpdatesavailable atwww.aap.org/NelsonsContributing EditorsAppendixReferencesIndexNELSON-2021 CoverSpread.indd 1AAP12/1/20 9:45 AM
Your go-to reference for treatingneonatal infections.This handy reference providesevidence-based recommendationsfrom leading experts inantimicrobial therapy for thetreatment of infectious diseasesin neonates.Get expert advice on Dosing for neonates, includinglow-birth-weight newborns Drug selection for bacterial,fungal, viral, and parasiticpathogens Drug stewardship And more.HHHH4-Star Review“This handbook will be an invaluable assetfor clinicians practicing in the NICU. It goesbeyond the standard treatment tables found inmost general textbooks and the drug-by-drugapproach of NeoFax.”Jay P. Goldsmith, MDTulane University School of Medicine—Doody’s Book Reviews 0995 AAP ADINS934 Nelson Ad.F112420.indd 1NELSON-2021 CoverSpread.indd 2Paperback, 2019—85 pagesMA0923Book ISBN 978-1-61002-318-4eBook ISBN 978-1-61002-319-1Price: 24.95 Member Price: 19.95Visit shop.aap.org/books11/24/20 4:49 PM12/1/20 9:45 AM
NH2OHN2021NNNHOONOOP OOHONelson’s PediatricAntimicrobial Therapy27th EditionJohn S. Bradley, MDEditor 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-2021 FM i-xii.indd 111/24/20 9:51 AM
American Academy of Pediatrics Publishing StaffMary Lou White, Chief Product and Services Officer/SVP, Membership, Marketing, and PublishingMark Grimes, Vice President, PublishingCheryl Firestone, Senior Manager, Digital PublishingMary Kelly, Senior Editor, Professional and Clinical PublishingJason Crase, Senior Manager, Production and Editorial ServicesShannan Martin, Production Manager, Consumer PublicationsLinda 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 all infants,children, adolescents, and young adults.While every effort has been made to ensure the accuracy of this publication, the American Academy ofPediatrics does not guarantee that it is accurate, complete, or without error.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.Any websites, brand names, products, or manufacturers are mentioned for informational and identificationpurposes only and do not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is notresponsible for the content of external resources. Information was current at the time of publication.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.Please visit www.aap.org/errata for an up-to-date list of any applicable errata for this publication.Special discounts are available for bulk purchases of this publication.Email Special Sales at nationalaccounts@aap.org for more information. 2021 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.9-466/1220 1 2 3 4 5 6 7 8 9 10MA0987ISSN: 2164-9278 (print)ISSN: 2164-9286 (electronic)ISBN: 978-1-61002-444-0eBook: 978-1-61002-445-7ch00-Nelson-2021 FM i-xii.indd 211/24/20 9:51 AM
iiiEditor in ChiefEmeritusJohn S. Bradley, MD, FAAPJohn D. Nelson, MDDistinguished Professor of PediatricsDivision of Infectious Diseases, Department ofPediatricsUniversity of California, San Diego,School of MedicineDirector, Division of Infectious Diseases,Rady Children’s Hospital San DiegoSan Diego, CAChapters 1, 3, 4, 11, 12, 14, 15, and 17Professor Emeritus of PediatricsThe University of TexasSouthwestern Medical Center at DallasSouthwestern Medical SchoolDallas, TXContributing EditorsElizabeth D. Barnett, MD, FAAPDavid W. Kimberlin, MD, FAAPProfessor of PediatricsBoston University School of MedicineDirector, International Clinic and Refugee HealthAssessment Program, Boston Medical CenterGeoSentinel Surveillance Network,Boston Medical CenterBoston, MAChapters 9 and 10Editor, Red Book: 2018–2021 Report of the Committeeon Infectious Diseases, 31st EditionProfessor of PediatricsCo-Director, Division of Pediatric Infectious DiseasesSergio Stagno Endowed Chair inPediatric Infectious DiseasesUniversity of Alabama at BirminghamBirmingham, ALChapters 7 and 8Joseph B. Cantey, MD, FAAPPaul E. Palumbo, MDAssistant Professor of PediatricsDivisions of Pediatric Infectious Diseases andNeonatology/Perinatal MedicineUniversity of Texas Health Science Center atSan AntonioSan Antonio, TXChapters 2 and 17Professor of Pediatrics and MedicineGeisel School of Medicine at DartmouthDirector, International Pediatric HIV ProgramDartmouth-Hitchcock Medical CenterLebanon, NHHIV treatmentch00-Nelson-2021 FM i-xii.indd 311/24/20 9:51 AM
ivContributing Editors (continued)Jason Sauberan, PharmDWilliam J. Steinbach, MD, FAAPNeonatal Research InstituteSharp Mary Birch Hospital for Women & NewbornsRady Children’s Hospital San DiegoSan Diego, CAChapters 2, 3, and 18Samuel L. Katz Distinguished Professor of PediatricsProfessor in Molecular Genetics and MicrobiologyChief, Division of Pediatric Infectious DiseasesDirector, Duke Pediatric Immunocompromised HostProgramDirector, International Pediatric Fungal NetworkDuke University School of MedicineDurham, NCChapters 5 and 6J. Howard Smart, MD, FAAPChairman, Department of PediatricsSharp Rees-Stealy Medical GroupAssistant Clinical Professor of PediatricsUniversity of California, San Diego,School of MedicineSan Diego, CAApp developmentAdditional ContributorChristopher R. Cannavino, MDDivisions of Infectious Diseases and HospitalMedicineUniversity of California, San Diego (UCSD)Rady Children’s Hospital San DiegoAssociate Professor of Clinical PediatricsDirector, UCSD Pediatric Infectious DiseaseFellowship ProgramAssociate Director, UCSD Pediatric ResidencyProgramDirector, Pediatric Medical Student Education, UCSDSchool of MedicineSan Diego, CAChapter 16ch00-Nelson-2021 FM i-xii.indd 411/24/20 9:51 AM
vContentsIntroduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viiNotable Changes to 2021 Nelson’s Pediatric Antimicrobial Therapy,27th Edition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi1.Antimicrobial Therapy According to Clinical Syndromes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1A. Skin and Soft Tissue Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4B. Skeletal Infections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10C. Eye Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13D. Ear and Sinus Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17E. Oropharyngeal Infections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20F. Lower Respiratory Tract Infections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23G. Cardiovascular Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36H. Gastrointestinal Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44I. Genital and Sexually Transmitted Infections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50J. Central Nervous System Infections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55K. Urinary Tract Infections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60L. Miscellaneous Systemic Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 622.Antimicrobial Therapy for Neonates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71A. Recommended Therapy for Selected Neonatal Conditions . . . . . . . . . . . . . . . . . . . . . . . . 74B. Antimicrobial Dosages for Neonates. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95C. Aminoglycosides. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99D. Vancomycin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .100E. Use of Antimicrobials During Pregnancy or Breastfeeding . . . . . . . . . . . . . . . . . . . . . . 1003.Preferred Therapy for Specific Bacterial and Mycobacterial Pathogens. . . . . . . . .103A. Common Bacterial Pathogens and Usual Pattern of Susceptibility toAntibiotics (Gram Positive). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104B. Common Bacterial Pathogens and Usual Pattern of Susceptibility toAntibiotics (Gram Negative). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106C. Common Bacterial Pathogens and Usual Pattern of Susceptibility toAntibiotics (Anaerobes) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .108D. Preferred Therapy for Specific Bacterial and Mycobacterial Pathogens. . . . . . . . 1104.Choosing Among Antibiotics Within a Class: Beta-lactams and Beta-lactamaseInhibitors, Macrolides, Aminoglycosides, and Fluoroquinolones . . . . . . . . . . . . . . . .1315.Preferred Therapy for Specific Fungal Pathogens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139A. Overview of More Common Fungal Pathogens and Their Usual Patternof Antifungal Susceptibilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140B. Systemic Infections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
NELSON-2021_CoverSpread.indd 2 12/1/20 9:45 AM. Elizabeth D. Barnett, MD Joseph B. Cantey, MD David W. Kimberlin, MD Paul E. Palumbo, MD Jason Sauberan, PharmD J. Howard Smart, MD William J. Steinbach, MD Contributing Editors John S. Bradley, MD Editor in Chief John D. Nelson, MD Emeritus 2021 Nelson’s Pediatric Antimicrobial Therapy 27th Edition O O O O O O HO OH HN NH 2 N N N N P
