Next Best Antibiotic Options After Augmentin Failure in a 7-Year-Old with Impaired Renal Function
Evaluation of Treatment Failure
- The American Academy of Pediatrics recommends assessing for clinical improvement within 48-72 hours of starting therapy, as deterioration or lack of improvement indicates treatment failure 1, 2
- Treatment failure may be due to resistant organisms, inadequate dosing, poor compliance, or other underlying conditions, according to the Infectious Diseases Society of America 3
- For children who fail amoxicillin-clavulanate, a change in antibiotic is necessary, as stated by the American Academy of Pediatrics 4
Next Best Antibiotic Options (Based on Age and Renal Function)
- Ceftriaxone or cefotaxime is the most appropriate next choice for a 7-year-old with impaired renal function who has failed Augmentin, with a recommended dose of 50 mg/kg/day IM or IV for ceftriaxone, as recommended by the Infectious Diseases Society of America 1, 2, 5
- Cefotaxime dosing should be adjusted based on the degree of renal impairment, according to the Clinical Infectious Diseases guidelines 6
Special Considerations for Renal Impairment
- Ceftriaxone has dual elimination (renal and biliary) making it safer in renal impairment, as noted by the Clinical Infectious Diseases guidelines 6
- Consult with a pediatric infectious disease specialist for dosing adjustments based on the degree of renal impairment, as recommended by the American Academy of Pediatrics 4
Approach Based on Suspected Pathogen
- For presumed bacterial pneumonia, ceftriaxone or cefotaxime with dose adjustment for renal function is recommended, according to the Infectious Diseases Society of America 1, 5
- For atypical pneumonia, consider adding azithromycin with dose adjustment for renal function, as recommended by the Clinical Infectious Diseases guidelines 5