Foreign Body Ingestion — Empiric Antibiotic Therapy for Button Battery Ingestion — Clinical Pathway: Emergency, ICU and Inpatient

Foreign Body Ingestion Clinical Pathway — Emergency Department, ICU, and Inpatient

Empiric Antibiotic Therapy for Children with Button Battery Ingestion

General Principles

  • Antibiotic prophylaxis is unnecessary for most children who ingest foreign bodies, including button batteries.
  • Consider antibiotics for children with:
    • Severe esophageal injury
    • Esophageal perforation
    • Fever
  • The purpose of antibiotic prophylaxis is to prevent severe complications, such as mediastinitis, in children with severe esophageal injury.
  • For most children, the total duration of antibiotic prophylaxis should not exceed 3 days. For children with severe esophageal injury and ongoing concern for infection, infectious diseases consultation is recommended to guide therapy.

Target Pathogens

  • Streptococcus spp.
  • Staphylococcus spp.
  • Oropharyngeal anaerobes (Prevotella, Peptostreptococcus, Fusobacterium)
  • Haemophilus influenzae

Antibiotic Recommendations

Antibiotics are generally not recommended for most patients with button battery ingestions. Only patients with severe esophageal injury, esophageal perforation, or fever should receive antibiotic prophylaxis.

Empiric Antibiotic Recommendations for Severe Esophageal Injury Following Button Battery Ingestion

First-Line Therapy Allergy to First-Line β-Lactam
Assess Need for Alternative
  • Ampicillin/sulbactam, IV
  • 50 mg/kg/dose every 6 hours
  • Max: 2,000 mg/dose
  • or
  • Amoxicillin/clavulanate, PO
  • 45 mg/kg/day of amoxicillin in 2 divided doses
  • Max: 1,750 mg amoxicillin/day
  • Clindamycin, IV
  • 10 mg/kg/dose every 8 hours
  • Max: 900 mg/dose
  • or
  • Clindamycin, PO
  • 10 mg/kg/dose every 8 hours
  • Max: 600 mg/dose

CHOP Formulary for complete drug information.