Oral antibiotic prophylaxis and empiric emergency antibiotics in asplenic and hyposplenic children

	Preferred agents	Alternative agents
Daily prophylaxis^*	Penicillin V <3 years: 125 mg twice daily ≥3 years: 250 mg twice daily Amoxicillin 10 mg/kg twice daily (maximum 250 mg per dose)	Cephalexin 25 mg/kg twice daily (maximum 250 mg per dose)^¶ Azithromycin 5 mg/kg once daily (maximum 250 mg per dose)
Emergency antibiotics (for fever)^Δ	Amoxicillin-clavulanate (14:1 formulation) 45 mg/kg (amoxicillin component) twice daily (maximum 875 mg per dose)	Cefdinir 7 mg/kg twice daily (maximum 300 mg per dose)^¶ Levofloxacin 10 mg/kg twice daily (maximum 375 mg per dose)

This table should be used in conjunction with the UpToDate topic on prevention of infection in patients with impaired splenic function. The doses in this table are intended for children with normal renal function. The doses of many of these agents must be adjusted in the setting of renal insufficiency; refer to the drug-specific monographs included within UpToDate for renal dose adjustments.

* The need for daily antibiotic prophylaxis and its duration is typically determined individually based on patient age, immune status, history of infection, potential for adverse drug reactions, and other factors.

¶ For patients with mild non-immunoglobulin (Ig)E-mediated reactions to penicillins or for patients with IgE-mediated reactions to penicillins in whom cephalosporins are deemed to be safe based on allergy consultation.

Δ All asplenic or hyposplenic patients should be given an emergency supply of antibiotics to be kept on hand and taken for the development of fever along with instruction to present to the nearest medical facility immediately after taking the first dose.

Graphic 119183 Version 4.0

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Oral antibiotic prophylaxis and empiric emergency antibiotics in asplenic and hyposplenic children