Choice of antibiotics in severely malnourished

All HIV positive children	Preventive ABx = Co-trimoxazole 120 mg if < 5 kg BD PO, 240 mg if > 5 kg BD PO
All Moyo patients	1st Line AB treatment Benzylpenicillin 50.000IU/kg QDS IV/IM for 2 days then oral Amoxicillin 25-40mg/kg TDS PO for 5 days (Amoxicillin: infants <3 kg: 15 mg/kg/dose every 12 hours) AND Gentamicin 7.5 mg/kg OD IV/IM for 7 days
Failure to respond or clinical deterioration (if child fails to lose oedema, remains anorexic, or clinically septic/ sick)	2nd Line AB treatment Ceftriaxone 100 mg/kg OD IV/IM for 5 to 7 days

Conditions needing special antibiotic treatment

Extensive/infected skin lesions Cloxacillin 25-50mg/kg/day QDS PO or Flucloxacillin 25 mg/kg QDS PO
Infected skin lesions or Kwashiorkor dermatitis (open sores): GV paint or a skin barrier spray.
Distended abdomen suspect bacterial overgrowth of the small gut. Metronidazole 7.5-10 mg/kg PO TDS for 7 days.
Persistent Diarrhoea with suspected protozoan infections of the gut. Metronidazole 10 mg/kg TDS for 7 days. Consider high dose Co-trimoxazole (60 mg/kg BD) if HIV infection.
Candida infection of the perineum: removing diapers to dry the area and apply GV paint. Nystatin ointment if available (ask LEPRA skin clinic if o/s in pharmacy).
If gram-negative sepsis suspected then give Ciprofloxacin 15-20 mg/kg PO BD for 7 days (in NTS sepsis for 14 days)
Oral Candidiasis. 1) GV-paint, 2) oral Nystatin, 3) Fluconazole 3-6 mg/kg OD PO in oesophageal/systemic Candidiasis