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PEDIATRIC (AGE > 1 MO) DOSE SERIOUS INFECTIONS ORAL PARENTERAL DOSE IN RENAL FAILUREa (CrCl < 10 mL/min)
ORAL
PARENTERAL
Amikacin
N/A
Gentamicin
N/A
For synergy with N/A a cell wallactive antibiotic to treat enterococcal endocarditis caused by strains susceptible to gentamicin
N/A
1.52.5 mg/kg IV q 2448 h 0.340.51 mg/kg IV q 2448 h Infectious disease consultation required for dosage Dosage adjusted to achieve peak serum concentration of 34 g/mL and trough concentration of < 1 g/mL N/A
N/A
N/A
For streptococcal or 1 mg/kg IV q 8 h N/A Staphylococcus auor reus endocarditis 3 mg/kg IV once/day Neomycin For preoperative 1 g for 3 doses N/A N/A gut antisepsis (eg, at 1, 2, and (with erythromy11 pm on the cin and mechaniday before cal cleansing) surgery)
N/A
N/A
13 g qid
N/A
N/A
N/A
N/A
N/A
For synergy with a cell wallactive antibiotic to treat enterococcal endocarditis Tobramycin
N/A
15 mg/kg IM q 24 h N/A (maximum: 1.0 g/ day) initially, then 1.0 g 23 times/wk 7.5 mg/kg IM q 12 h N/A
N/A
N/A
N/A
N/A 13 g IV q 12 h 1 g IV q 8 h to 2 g IV q 4 h
N/A 2040 mg/kg IV q 12 h 2733 mg/kg IV q 8 h or, for severe infections, 2540 mg/kg q6h N/A
Cefprozil Cefuroxime
For meningitis
-Lactams: Cephalosporins (3rd generation)
1015 mg/kg suspension 2550 mg/kg IV 0.250.5 g po q 24 h q 12 h q8h or For older children: 0.75 g IV q 24 h 125250 mg tablets q 12 h 5060 mg/kg IV q 6 h N/A N/A 25100 mg/kg IV Same as adult dose q 12 h 8.333.3 mg/kg IV 12 g IV q 24 h q4h or 16.666.6 mg/kg q 6 h
Table continues on the following page.
Cefoperazone Cefotaxime
PEDIATRIC (AGE > 1 MO) DOSE SERIOUS INFECTIONS ORAL PARENTERAL DOSE IN RENAL FAILUREa (CrCl < 10 mL/min)
PARENTERAL
0.10.4 g q 12 h N/A N/A 1 g IV q 12 h to 2 g q8h 0.4 g q 24 h N/A N/A 0.5 g IV q 12 h to 4 g IV q 8 h N/A 12 g IV q 24 h N/A 2 g IV q 12 h
N/A 2 g IV q 8 h N/A 4 g IV q 8 h 2 g IV q 24 h 2 g IV q 12 h
N/A 2550 mg/kg IV q8h N/A 50 mg/kg IV q 68 h 5075 mg/kg IV q 24 h or 2537.5 mg/kg q 12 h 50 mg/kg IV q 12 h or 100 mg/kg q 24 h (not to exceed 4 g/day) Possibly a loading dose of 100 mg/kg IV (not to exceed 4 g) at the start of therapy
N/A
12 g IV q 812 h
N/A 12.525 mg/kg q 12 h or 713 mg/kg q 8 h 50 mg/kg 1 h before procedure If > 40 kg: Adult dose
50 mg/kg IV q 812 h 0.251 g IV q 24 h N/A N/A N/A 0.250.5 g po q 24 h 2 g po for 1 dose 0.250.5 g po q 24 h
-Lactams: Penicillins
N/A N/A
N/A N/A
N/A N/A
N/A N/A
0.52.0 g IV q 46 h 2 g IV q 4 h 2 g IV q 4 h 2 g IV q 4 h 3 g IV q 6 h
Ampicillin/ N/A 1.53.0 g IV q 6 h sulbactam (3 g = 2 g ampicillin + 1 g sulbactam) 0.1250.5 g q 6 h N/A Dicloxacillinb Nafcillin Rarely used 12 g IV q 4 h
2550 mg/kg IV q 6 h 0.52.0 g IV q 1224 h 2 g IV q 12 h 50100 mg/kg IV q6h 2550 mg/kg IV q 6 h 1.53.0 g IV q 24 h
N/A 2 g IV q 4 h
Oxacillin
Rarely used
12 g IV q 4 h
2 g IV q 4 h
Penicillin Gb
3.1256.25 mg/kg q 6 h N/A N/A 12.525 mg/kg IV q6h or 8.333.3 mg/kg q 4 h N/A 12.525 mg/kg IV q6h or 8.333.3 mg/kg IV q4h Penicillin VK 6,250100,000 units/ 6.2512.5 mg/kg kg IV q 6 h q8h or 4,166.666,666 units/kg IV q 4 h
0.1250.5 g po q 6 h 12 g IV q 4 h
12 g IV q 4 h
N/A
Prophylaxis for rheumatic fever For early syphilis For late syphilis (excluding neurosyphilis) Penicillin G procaine (IM only) Piperacillin (1.9 mEq Na/g)
1.2 million units IM N/A q 34 wk 2.4 million units IM N/A for 1 dose 2.4 million units N/A IM/wk for 3 wk 0.30.6 million units N/A IM q 12 h
25,00050,000 units/ kg IM as a single dose or If < 27 kg: 300,000 600,000 units as a single dose or If 27 kg: 0.9 million units as a single dose 25,00050,000 units/ kg IM q 34 wk 50,000 units/kg IM for 1 dose 50,000 units/kg IM in 3 doses 1 wk apart
1.2 million units IM q 34 wk 2.4 million units IM for 1 dose 2.4 million units IM for 1 dose
N/A
3 g IV q 46 h
3 g IV q 4 h
N/A
25,00050,000 units/ 0.3 to 0.6 million units kg IM q 24 h IM q 12 h or 12,50025,000 units/ kg IM q 12 h 5075 mg/kg IV q 6 h 34 g IV q 12 h or 33.350 mg/kg IV q4h
Table continues on the following page.
Piperacillin/tazo- N/A bactam (2.25 g = 2.0 g piperacillin + 0.25 g tazobactam) Ticarcillin N/A (5.2 mEq Na/g) Ticarcillin/clavu- N/A lanate (3.1 g = 3 g ticarcillin + 0.1 g clavulanic acid)
Other -lactams
3.375 g IV q 46 h
3.375 g IV q 4 h
N/A
80 mg/kg IV q 8 h
2.25 g IV q 8 h to 4.5 g IV q 12 h
3 g IV q 46 h 3.1 g IV q 46 h
3 g IV q 4 h 3.1 g IV q 4 h
N/A N/A
If < 60 kg: 50 mg/kg 12 g IV q 12 h IV q 46 h If < 60 kg: 50 mg/kg 2 g IV q 12 h IV (based on ticarcillin component) q 46 h 3040 mg/kg IV q 68 h N/A For infants 4 wk to 3 mo: 25 mg/kg IV q6h For children > 3 mo: 1525 mg/kg IV q6h 2040 mg/kg IV q 8 h 1015 mg/kg IV q 12 h (in select circumstances) 0.5 g IV q 8 h 0.5 g IV q 24 h 0.1250.25 g IV q 12 h (may increase risk of seizures)
12 g IV q 612 h 1 g IV q 24 h 0.51.0 g IV q 6 h
2 g IV q 6 h 1 g IV q 24 h 1 g IV q 6 h
N/A 0.50.75 g q 12 h
Ciprofloxacin
Extended-release 0.5 g q 24 h for for uncomplicated 3 days cystitis Gemifloxacin 320 mg q 24 h Levofloxacin 0.250.75 g q 24 h Moxifloxacin 0.4 g q 24 h Norfloxacinb 0.4 g q 12 h Ofloxacin 0.20.4 g q 12 h
Macrolides
N/A 160 mg po q 24 h 0.250.5 g po or IV q 48 h 0.4 g q 24 h po or IV 0.4 g po q 24 h 0.10.2 g po or IV q 24 h 0.5 g on day 1, then 0.25 g po q 24 h for 4 days or 0.5 g IV q 24 h N/A N/A N/A N/A
0.5 g on day 1, 0.5 g IV q 24 h then 0.25 g q 24 h for 4 days For nongonococcal 1 g for 1 dose N/A cervicitis and urethritis For travelers 1 g for 1 dose N/A diarrhea For tonsillitis or N/A N/A pharyngitis For otitis media N/A N/A or communityacquired pneumonia
Azithromycin
0.250.5 g q 12 h N/A Extended-release: 1 g q 24 h 0.5 g q 24 h N/A 0.250.5 g N/A q6h N/A N/A 0.51 g IV q 6 h 0.51 g IV q 6 h N/A N/A
7.5 mg/kg q 12 h N/A 1016.6 mg/kg q 8 h or 7.512.5 mg/kg q 6 h N/A N/A 20 mg/kg for 3 doses N/A 3037.5 mg/kg q 6 h or 2025 mg/kg q 4 h 7.511.25 mg/kg q 6 h 2530 mg/kg q 12 h 2 mg/kg q 12 h for 10 days for UTI 36 mg TMP/kg q 12 h
N/A N/A N/A 3.755.0 mg/kg IV q6h 3.755.0 mg/kg IV q6h N/A N/A N/A N/A N/A N/A 36 mg TMP/kg IV q 12 h
0.250.5 g po q 24 h 0.5 g po q 24 h 0.25 g po q 6 h 0.5 g IV q 6 h 0.5 g IV q 6 h N/A 800 mg po q 24 h 1 g po q 1224 h N/A 1 g po q 24 h 0.1 g po q 24 h (Not recommended if other alternatives are available)
25 mg/kg IV q 6 h (not N/A available in US) N/A N/A N/A 35 mg TMP/kg IV q 68 h N/A N/A N/A 5 mg TMP/kg IV q6h
For Pneumocystis 0.32/1.6 g q 8 h 5 mg TMP/kg IV jirovecii pneumo- for 21 days q 8 h for 21 days niae
5 mg TMP/kg IV q 68 h
56.6 mg TMP/kg q 8 h 56.6 mg TMP/kg IV If essential, 5 mg q8h TMP/kg IV q 24 h or or 3.755 mg TMP/kg q 6 h or 3.755 mg TMP/kg 1.25 mg TMP/kg IV IV q 6 h q6h Age > 8 yr: 24 mg/kg q 24 h or 12 mg/kg q 12 h N/A Age > 8 yr: 6.2512.5 mg/kg q 6 h N/A Age > 8 yr: 24 mg/ 0.1 g IV or po q 12 h kg IV q 24 h or 12 mg/kg IV q 12 h N/A 0.1 g IV or po q 12 h N/A Doxycycline used instead N/A Same as adult dose
Tetracyclines
Doxycycline
0.1 g q 12 h
0.1 g IV q 12 h
0.1 mg IV q 12 h
0.1 g IV q 12 h N/A 100 mg, then 50 mg (25 mg for severe hepatic dysfunction) IV q 12 hr
Others
Clindamycin
12.5 mg/kg q 6 h 12.5 mg/kg IV (maximum: 4 g/day) q 6 h (maximum: 4 g/day) 4 mg/kg IV q 24 h 4 mg/kg IV q 24 h
6.613.2 mg/kg IV q8h or 510 mg/kg IV q 6 h 12.518.75 mg/kg IV q 6 h 18.7525 mg/kg IV q6h N/A
0.6 g q 12 h
0.6 g IV q 12 h
For Clostridium difficileinduced diarrhea (pseudomembranous colitis) For amebiasis 0.50.75 g q 8 h for 10 days followed by paromomycin po 0.5 g q 8 h for 7 days For giardiasis 0.25 g q 68 h for 57 days Nitrofurantoin 50100 mg macrocrystals q6h Nitrofurantoin 100 mg q 12 h monohydrate/ macrocrystals
7.5 mg/kg q 6 h 7.5 mg/kg IV (not to exceed q 6 h (not to 4 g/day) exceed 4 g/day) 2 g for 1 dose N/A or 0.5 g q 12 h for 7 days 0.5 g q 68 h for 500 mg IV q 68 h 1014 days
500 mg IV q 6 h
7.5 mg/kg q 8 h
7.5 mg/kg IV q 6 h
250 mg po or IV q 8 h
0.75 g IV q 8 h for 10 days followed by paromomycin po 0.5 g q 8 h for 7 days N/A N/A N/A
0.75 g IV q 8 h 11.616.6 mg/kg for 10 days q 8 h for 710 days followed by paromomycin po 0.5 g q 8 h for 7 days N/A N/A N/A 5 mg/kg q 68 h for 5 days 1.251.75 mg/kg q6h N/A
N/A
Quinupristin/ dalfopristin
N/A
7.5 mg/kg IV q 8 h
N/A
7.5 mg/kg IV q 12 h 7.5 mg/kg IV q 812 h for complicated skin or skin structure infection or 7.5 mg/kg q 8 h for serious infections 1020 mg/kg IV q 24 h N/A 0.30.6 g IV or po q 24 h 0.6 g po q 12 h for 4 doses
Rifampinb For TB
0.6 g q 24 h
0.6 g IV q 24 h
N/A N/A
20 mg/kg q 24 h N/A for 4 days (not to exceed 600 mg q 24 h) For staphylococcal 0.3 g q 8 h 0.3 g IV q 8 h infections (used or or with a penicillin, 0.60.9 g q 24 h 0.60.9 g IV q 24 h cephalosporin, or vancomycin) Spectinomycin N/A 2 g IM for 1 dose
N/A
510 mg/kg q 12 h or 1020 mg/kg q 24 h Age 1 mo: 10 mg/kg q 12 h for 2 days Age < 1 mo: 5 mg/kg q 12 h for 2 days 20 mg/kg q 24 h for 4 days Age < 1 mo: 10 mg/kg q 24 h for 4 days
N/A
20 mg/kg q 24 h for 4 days (not to exceed 600 mg q 24 h) 0.3 g IV or po q 8 h or 0.60.9 g IV or po q 24 h 2 g IM for 1 dose
N/A
N/A
Vancomycin
For meningitis
125 mg q 6 h 15 mg/kg q 12 h (only effective (often 1 g q 12) for C. difficile induced diarrhea N/A 1 g IV q 8 h or 1.5 g IV q 12 hf
15 mg/kg IV q 12 h N/A
0.51.0 g IV q wk
1 g IV q 8 h or 1.5 g IV q 12 h
N/A
15 mg/kg IV q wk
aInitial loading dose should be equivalent to the usual dose for patients with normal renal function, followed by a dose adjusted for renal failure. Dosing adjustments of aminoglycosides should be assisted by measuring peak (drawn 1 h after the start of a 30-min IV infusion) and trough (drawn 30 min before next dose) serum levels. b Rate or extent of absorption is decreased when the drug is taken with food. cDosage should not exceed that for adults. d These drugs are generally avoided in children. eDose is based on TMP. fIn addition, intrathecal or intraventricular vancomycin 1020 mg/day may be necessary, and dose may need to be adjusted to achieve trough CSF levels of 1020 g/mL. N/A = not applicable; TMP = trimethoprim.
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