›Immunocompromised
›Severe disease
›Older adolescents within 24 hours of rash onset
›Acyclovir dosing
›Acyclovir PO 20 mg/kg per dose four times daily
›Maximum 800 mg per dose
›Typical course 5 days
›Acyclovir IV 10 mg/kg every 8 hours for severe disease
›Renal dosing adjustment
›Adequate IV hydration
Emergency therapies for dangerous mimics
›Sepsis and meningococcemia pathway
›If shock, fluid resuscitation 20 ml/kg isotonic crystalloid
›Reassess after each bolus
›Early vasopressors if fluid refractory
›Empiric antibiotics for suspected meningococcemia
›Ceftriaxone IV 50 mg/kg
›Maximum 2 g
›Alternative cefotaxime per local formulary
›Airway and ventilation support
›Escalate to critical care team
›Early intubation if worsening mental status
›Anaphylaxis pathway if urticaria with respiratory or cardiovascular compromise
›Epinephrine IM 0.01 mg/kg of 1 mg/ml
›Maximum 0.5 mg per dose
›Repeat every 5 to 15 minutes as needed
›Adjuncts
›H1 antihistamine
›Inhaled bronchodilator for wheeze
›SJS TEN supportive pathway
›Stop suspected culprit drug immediately
›Antibiotics high risk
›Anticonvulsants high risk
›Pain control
›Multimodal regimen
›Avoid NSAIDs if renal risk
›Transfer planning
›ICU level monitoring
›Burn unit consideration
Evidence and guideline notes
›Evidence levels
›Routine labs not indicated for well appearing classic viral exanthem
›ACEP Level C consensus style approach
›Pediatric practice standard
›Measles suspected, airborne isolation and public health notification
›CDC guidance
›Infection control standard
›Meningococcemia suspected, antibiotics without delay
›Class I recommendation based on expert consensus for time critical sepsis care
›Pediatric sepsis bundles