Antibiotic Protocol for Pediatric Cardiac Cases

Antibiotics are used for 2 purposes

  1. Curative purpose ( Table 1)
  2. Prophylactic purpose ( Table 2 )

Table 1: Protocol for curative purpose

1. Empirical use 1st line drugs
  1. Phenoxymethyl penicillin
  2. Benzylpenicillin
  3. Amoxicillin
  4. 1st generation cephalosoprines (e.g Cephradine)
  5. Erythromycin
  6. Cotrimoxazol
  7. Gentamicin
2nd line drugs
  1. 2nd generation cephalosporine (e.g Cefuroxime )
  2. 3rd generation oral cephalosporine e.g
    • cefixime
    • cefpodoxime
  1. Cloxacillin, flucloxacillin
  2. Azithromycin
  3. Clarithromycin
  4. Amikacin
  5. Quinolones ( e.g. Ciprofloxacin)
  6. Linezolid
3rd line drugs a.3rd generation parenteral cephalosporine e.g

a.       Ceftriaxone

b.      Cefotaxime

c.       Ceftazidime

II.            Vancomycin

4th line drugs
  1. Meropenem, Imepenem
  2. 4th generation cephalosporine ( Cefepime)
  3. Piperacillin+ Tazobactam
2. Definite use Based on diagnosis along with culture sensitivity report (eg- Nitrofurantoin)

Table 2: Protocol for prophylactic purpose

2rd generation parenteral cephalosporin & 3rd generation parenteral cephalosporin (ceftriaxone) as prophylactic antibiotics before any interventional procedure (angiogram/ percutaneous device closure).


  1. 1st line antibiotics can be prescribed by medical officer with acknowledgement of concerned specialist in-charge.
  2. 2nd line antibiotics can be prescribed by junior consultant with acknowledgement of concerned specialist in-charge
  3. 3rd& 4th line antibiotics will be prescribed by concerned specialist in-charge only.
  4. Fresh order of ICU should be updated daily
  5. Antifungal, antiviral, antiprotozoal, antimalarial, anti-tubercular are not included.
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