Managing paediatric sepsis is difficult. Children require different drugs and doses and the typical pathogens vary across age groups. The team at the BMJ have put together a review of the management and treatment options for children, including neonates.

Antibiotics are the only treatment of proven value in paediatric sepsis. Progression to organ failure and shock can be rapid so early recognition and institution of the correct treatment is extremely important.

Early administration of broad spectrum antibiotics is proven to save lives in sepsis.

The choice of antibiotic is complex and should be based on the clinical syndrome, underlying disease, drug intolerances, and local pathogen susceptibility. Treatment should be initiated with broad spectrum antibiotic cover appropriate for the prevalent organisms for each age group and geographical area. This should be changed to an appropriate narrow spectrum antibiotic regimen once a causative pathogen is identified.

It is good practice to review antibiotic therapy on a daily basis for clinical effect and de-escalate when appropriate. A 5-7 day course of intravenous antibiotics would suffice in most uncomplicated infections. In deep seated or disseminated infections, or infections in immunocompromised patients, prolonged courses of antimicrobials may be required.

The BMJ review is available here. There are also a number of resources available from the Clinical Excellence Commission to improve management of both adult and paediatric septic patients.