pediatric-ai-scribe-v3/public/js/bedside/antimicrobials.js

// ============================================================
// 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 &lt;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 &lt;2 yr; 7 days ≥2 yr', notes: 'Observe mild AOM if &gt;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 &lt;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 &gt;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 &amp; 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 (&lt;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 &gt;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 = '<p style="color:var(--red);font-size:13px;">No regimen found.</p>'; 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 = '<div style="padding:10px 14px;border-radius:8px;background:var(--blue-light);border:1.5px solid var(--blue);margin-bottom:10px;"><strong style="color:var(--blue-dark);">' + ageLbl + ' — ' + infLbl + '</strong></div>';
  html += '<div style="padding:12px;background:#d1fae5;border-radius:6px;margin-bottom:10px;"><strong style="color:#065f46;">First-line:</strong> ' + r.first + '</div>';
  html += '<div style="padding:12px;background:var(--g50);border-radius:6px;margin-bottom:10px;"><strong>Alternative / add:</strong> ' + r.alt + '</div>';
  html += '<div style="padding:12px;background:var(--g50);border-radius:6px;margin-bottom:10px;"><strong>Duration:</strong> ' + r.duration + '</div>';
  html += '<div style="padding:10px;background:#fef3c7;border-radius:6px;font-size:12px;color:#92400e;"><strong>Notes:</strong> ' + r.notes + '</div>';
  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();
  });
}