// ============================================================
// bedside/antimicrobials.js
// ANTIMICROBIALS (empiric, by age + infection type).
// ============================================================
import { S } from './shared.js';
var REG = {
neonate: {
sepsis: { first: 'Ampicillin + gentamicin', alt: 'Add cefotaxime if meningitis suspected or gram-neg concern', duration: '7-10 days; 21 days if confirmed meningitis', notes: 'Cover GBS, E. coli, Listeria. Add acyclovir if HSV risk (maternal lesions, vesicles, seizures).' },
meningitis: { first: 'Ampicillin + cefotaxime (or gentamicin) + acyclovir', alt: 'Add vancomycin if gram-positive cocci', duration: '14-21 days depending on organism', notes: 'HSV coverage essential. LP + HSV PCR.' },
pna: { first: 'Ampicillin + gentamicin', alt: 'Add cefotaxime for gram-neg', duration: '7-10 days', notes: 'Same as sepsis coverage.' },
uti: { first: 'Ampicillin + gentamicin', alt: 'Cefotaxime if sensitivities known', duration: '10-14 days', notes: 'Evaluate for sepsis. Renal US and VCUG workup.' },
skin: { first: 'Ampicillin + gentamicin', alt: 'Add vancomycin if MRSA risk', duration: '7-10 days', notes: 'Omphalitis, mastitis — broad coverage.' },
ent: { first: 'Discuss with infectious diseases', alt: '—', duration: '—', notes: 'Rare in neonates. Any ear/throat infection warrants sepsis eval.' },
neutropenic: { first: 'Cefepime or piperacillin-tazobactam', alt: 'Add vancomycin if indwelling line, severe mucositis, or MRSA', duration: 'Until ANC recovery + afebrile ≥48h', notes: 'Oncology/ID consult.' },
ic: { first: 'Ampicillin + gentamicin + metronidazole', alt: 'Or piperacillin-tazobactam', duration: '7-14 days', notes: 'NEC: add metronidazole/clindamycin for anaerobes.' },
bone: { first: 'Ampicillin + gentamicin', alt: 'Vancomycin if MRSA risk', duration: '3-6 weeks (IV then PO)', notes: 'Usually hematogenous. S. aureus, GBS, E. coli.' }
},
infant: {
sepsis: { first: 'Ampicillin + ceftriaxone (or gentamicin)', alt: '+ vancomycin if MRSA / severe', duration: '7-10 days', notes: 'Add acyclovir if HSV suspected (<6 wks). Fever in <90 days requires workup.' },
meningitis: { first: 'Ceftriaxone + vancomycin (± ampicillin if <6 wks for Listeria)', alt: '+ acyclovir if HSV', duration: '10-14 days (longer for Listeria/gram-neg)', notes: 'Dexamethasone if H. influenzae suspected.' },
pna: { first: 'Ampicillin (or ceftriaxone)', alt: 'Add azithromycin if atypical', duration: '7-10 days', notes: 'S. pneumoniae most common. RSV/viral often primary.' },
uti: { first: 'Ceftriaxone or cefotaxime', alt: 'Ampicillin + gentamicin', duration: '10-14 days', notes: 'US kidney/bladder if first febrile UTI.' },
skin: { first: 'Cefazolin or clindamycin', alt: 'Vancomycin if MRSA risk', duration: '7-10 days', notes: 'Consider MRSA if purulent or local resistance >10%.' },
ent: { first: 'Amoxicillin (90 mg/kg/day) for AOM', alt: 'Amox-clav if recent abx/treatment failure', duration: 'AOM 10 days <2 yr; 7 days ≥2 yr', notes: 'Observe mild AOM if >6 mo and no severe features.' },
neutropenic: { first: 'Cefepime or piperacillin-tazobactam', alt: '+ vancomycin for severe/mucositis/line', duration: 'Until ANC recovery + afebrile', notes: 'Oncology/ID consult.' },
ic: { first: 'Ceftriaxone + metronidazole', alt: 'Piperacillin-tazobactam', duration: '5-7 days (uncomplicated), longer for complicated', notes: 'Appendicitis — surgical consult.' },
bone: { first: 'Cefazolin ± vancomycin', alt: 'Clindamycin', duration: '3-4 weeks (IV then PO transition)', notes: 'S. aureus most common. Kingella in <4 yr.' }
},
child: {
sepsis: { first: 'Ceftriaxone + vancomycin', alt: 'Piperacillin-tazobactam if intra-abdominal', duration: '7-14 days', notes: 'Expand if specific source. Add antifungal if prolonged neutropenia.' },
meningitis: { first: 'Ceftriaxone + vancomycin', alt: '+ dexamethasone (Hib coverage)', duration: '10-14 days', notes: 'Lumbar puncture. Dexamethasone 0.15 mg/kg q6h x 4 days.' },
pna: { first: 'Ampicillin OR amoxicillin (high dose)', alt: 'Ceftriaxone if hospitalized; add azithromycin for atypical', duration: '5-7 days (uncomplicated)', notes: 'Mycoplasma if >5 yr. Consider viral causes.' },
uti: { first: 'Cephalexin or TMP-SMX (PO)', alt: 'Ceftriaxone if ill', duration: '7-10 days (10-14 if pyelo)', notes: 'Culture-guided de-escalation.' },
skin: { first: 'Cephalexin or clindamycin', alt: 'TMP-SMX or doxycycline if MRSA', duration: '5-10 days', notes: 'Abscess — incision & drainage primary tx.' },
ent: { first: 'Amoxicillin 90 mg/kg/day (AOM); Penicillin V for strep pharyngitis', alt: 'Amox-clav; cephalexin if non-anaphylactic PCN allergy', duration: 'AOM 5-10 days; strep 10 days', notes: 'Strep pharyngitis dose: PCN V 250 mg BID-TID (<27 kg) or 500 mg BID (≥27 kg).' },
neutropenic: { first: 'Cefepime OR piperacillin-tazobactam', alt: '+ vancomycin', duration: 'Until ANC recovery + afebrile', notes: 'Add empiric antifungal if fever >4-7 days.' },
ic: { first: 'Ceftriaxone + metronidazole', alt: 'Piperacillin-tazobactam', duration: '5-7 days (uncomplicated appendicitis)', notes: 'Surgical consult.' },
bone: { first: 'Cefazolin ± vancomycin', alt: 'Clindamycin', duration: '3-4 weeks total', notes: 'S. aureus, group A strep. Consider MRSA if severe.' }
}
};
function lookupAbx() {
var age = document.getElementById('abx-age').value;
var inf = document.getElementById('abx-infection').value;
var el = document.getElementById('abx-result');
var r = REG[age] && REG[age][inf];
if (!r) { el.innerHTML = 'No regimen found.
'; return; }
var ageLbl = { neonate: 'Neonate (0-28 d)', infant: 'Infant (1-3 mo)', child: 'Child (>3 mo)' }[age];
var infLbl = document.querySelector('#abx-infection option[value="' + inf + '"]').textContent;
var html = '' + ageLbl + ' — ' + infLbl + '
';
html += 'First-line: ' + r.first + '
';
html += 'Alternative / add: ' + r.alt + '
';
html += 'Duration: ' + r.duration + '
';
html += 'Notes: ' + r.notes + '
';
html += S.ref('AAP Red Book, IDSA guidelines, Harriet Lane. Always tailor to local resistance patterns and culture results.');
el.innerHTML = html;
}
export function init() {
document.addEventListener('click', function(e) {
if (e.target.id === 'btn-abx-lookup' || e.target.closest('#btn-abx-lookup')) lookupAbx();
});
}