Selection of antimicrobial agents for initial treatment of suspected septicemia in infants and children.

Septicemia is relatively common in infants and children, and empiric antimicrobial therapy is frequently necessary. In immunocompetent children the most likely causative agents are Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, and Salmonella species. Effective empiric therapy is often the combination of ampicillin and chloramphenicol. In immunocompromised children the etiologic possibilities in septicemia include a large number of opportunistic pathogens, the most common of which are Escherichia coli and other enteric bacilli, Pseudomonas species and other hospital-related bacilli, and Staphylococcus aureus. Empiric therapy often consists of an aminoglycoside, a penicillinase-resistant penicillin or cephalosporin, and carbenicillin or ticarcillin. The third-generation cephalosporins offer considerable promise in the empiric treatment of septicemia in children.