Acyclovir 20 mg / kg / dose q 8 hr IV Administer over 1 hour Herpes Simplex and Varicella. Increase dosing interval with 34 wk gestation or with significant renal / hepatic failure. Amikacin Give IV or IM PMA (weeks) Postnatal (days) dose (mg / kg) interval (hrs)
Acyclovir 20 mg / kg / dose q 8 hr IV Administer over 1 hour Herpes Simplex and Varicella. Increase dosing interval with 34 wk gestation or with significant renal / hepatic failure. Amikacin Give IV or IM PMA (weeks) Postnatal (days) dose (mg / kg) interval (hrs)
Acyclovir 20 mg / kg / dose q 8 hr IV Administer over 1 hour Herpes Simplex and Varicella. Increase dosing interval with 34 wk gestation or with significant renal / hepatic failure. Amikacin Give IV or IM PMA (weeks) Postnatal (days) dose (mg / kg) interval (hrs)
Drug Dosage Major Indications / Remarks Acyclovir 20 mg/kg/dose q 8 hr IV Administer over 1 hour Herpes Simplex & Varicella. Increase dosing interval with <34 wk gestation or with significant renal / hepatic failure Treat localized infections for 14 days; disseminated or CNS infections for 21 days. Amikacin* Give IV or IM PMA (weeks) Postnatal (days) Dose (mg/kg) Interval (hrs) !29 0 to 7 8 to 28 "29 18 15 15 48 36 24 30 to 34 0 to 7 "8 18 15 36 24 "35 ALL 15 24 Administer over 30 minutes Gram negative enteric bacteria peak 20-30, trough 2-5 mcg/ml Usually used in combination with a beta- lactam antibiotic. Amoxicillin 20 mg/kg/dose q HS PO UTI prophylaxis Amphotericin B test dose: 0.1 mg/kg IV initial dose: 0.25 mg/kg IV increment : 0.125 - 0.25 gm/kg/d IV maintenance dose: 1 mg/kg/d qd or 1.5 mg/kg/d qod IV Administer over 2-6 hours Most systemic fungal infections & severe superficial mycoses. Decreases renal blood flow / GFR; Monitor renal / hepatic status closely. total dose: 15-30 mg/kg Ampicillin
Mild/Moderate infection: 100 mg/kg/dose IV Meningitis:400 mg/kg/d q 8-12 hr IV See Table 2 for dosing interval Administer by IV push over 3-5 minutes Group B streptococcus, enterococcus, E coli, Listeria monocytogenes Aztreonam 30 mg/kg/dose IV or IM Administer slow IV push over 5-10 minutes See Table 2 for dosing interval Gram negative organisms. Generally used in combination with ampicillin (empirical treatment of sepsis) or an aminoglycoside (for synergism against Pseudomonas and Enterobacteriaceae). Check serum glucose 1 hour after administration. Aztreonam contains L- arginine so adequate amounts of glucose must be provided to prevent hypoglycemia. Caspofungin 25 mg/m 2 (or approximately 2 mg/kg) IV per dose q24 hours Administer over 1 hour Antifungal agent for refractory Candida or invasive Aspergillosis refractory or intolerant to other therapies. Max concentration 0.5 mg/ml diluted in an NS product; not dextrose Cefazolin 25 mg/kg/dose IV slow push or IM See Table 2 for dosing interval 1 st generation cephalosporin. Gram + cocci ; may cause false positive urine reducing substance. Poor CNS penetration. Cefepime !28 days: 30 mg/kg/dose q 12 hr IV or IM >28 days: 50 mg/kg/dose q 12 hr IV or IM Meningitis and severe infections: 50 mg/kg/dose q 8 hr IV or IM Administer IV over 30 minutes 4 th -generation cephalosporin for serious gram-positive and gram-negative infections, especially Pseudomonas aeruginosa. Drug distributes widely in body tissues and fluids. Cefotaxime 50 mg/kg dose IV or IM See Table 2 for dosing interval Administer IV over 30 minutes 3 rd -generation cephalosporin. Treatment of gram-negative enteric bacteria. Penetrates well across BBB and good for use in meningitis Cefoxitin 30 mg/kg/dose IV or IM See Table 2 for dosing interval Administer IV over 30 minutes 2 nd -generation cephalosporin with enhanced activity against anaerobic bacteria. Poor CNS penetration. Treatment usually limited to skin, intra- abdominal, and urinary tract infections. Ceftazidime Sepsis 0-4 weeks: 30 mg/kg/dose IV Meningitis: 50 mg/kg/dose IV See Table 2 for dosing interval Administer IV over 30 minutes 3 rd -generation cephalosporin for gram- negative esp. Pseudomonas: Consider two antibiotics with positive Pseudomonas cultures. Synergistic with aminoglycosides. Ceftriaxone Sepsis/Disseminated gonococcal infections: 50 mg/kg q 24 hours IV or IM Meningitis: 100 mg/kg loading dose than 80 mg/kg q 24 hours IV or IM. Uncomplicated gonococcal ophthalmia: 50 mg/kg (max 125 mg) once IV or IM. Administer IV over 30 minutes 3 rd -generation cephalosporin for gram- negative bacteria and gonococcal infection. Widely distributes. Not recommended for use in neonates with hyperbilirubinemia. Concurrent administration with calcium-containing products in neonates is contraindicated. Cefuroxime 15 mg/kg/dose qHS PO UTI Prophylaxis Cephalexin 10-20 mg/kg/dose qHS PO UTI Prophylaxis Can alternate with or change to Bactrim at 2 months of life Clindamycin 5 to 7.5 mg/kg/dose IV, IM, or PO See Table 2 for dosing interval Administer IV over 30 minutes
Gram-positive cocci and bacteroides. Widely distributes to most tissues, esp the lungs. Poor CSF penetration. Psuedomembranous colitis most serious adverse effect bloody diarrhea, fever Erythromycin 10-15 mg/kg q 6-12 hr PO Do NOT administer IM Chlamydia and Mycoplasma Risk of hypertrophic pyloric stenosis is increased 10-fold in neonates < 2 weeks who receive oral erythromycin for pertussis prophylaxis. Fluconazole Treatment: 12 mg/kg loading dose, then 6 mg/kg IV or PO Prophylaxis: 3 mg/kg/dose 2x/wk IV or PO Thrush: 6 mg/kg LD, then 3 mg/kg/dose qd PO Gest Age (weeks) PostNatal (days) Interval (hours) !29 0 to 14 >14 48 24 >30 0 to 7 >7 48 24 Administer IV over 60 minutes Antifungal for Candida species. Monitor renal and hepatic function. Extended dosing interval when SCr >1.3. PO/IV both well-absorbed and distributes widely, incl. CSF. May increase levels of phenytoin and rifampin. Use with Cisapride contraindicated. Flucytosine 12.5 to 37.5 mg/kg/dose q 6 hours PO Increase dosing interval if renal dysfunction is present. Antifungal for Candida, Cryptococcus. Must be used in combination with amphotericin B of fluconazole due to development of resistance. Toxicities include impaired renal function, fatal bone marrow depression, hepatitis, severe diarrhea, rash. Ganciclovir 6 mg/kg/dose q12 hours IV Treat for a minimum of 6 weeks if possible Decrease dose by # for neutropenia (<500 cells/mm 3 ). Discontinue therapy if neutropenia does not resolve after dose reduction. Administer over 60 minutes Prevention of progressive hearing loss and lessening of developmental delays in symptomatic congenital CMV. Gentamicin* Give IV or IM PMA (weeks) Postnatal (days) Dose (mg/kg) Interval (hrs) !29 0 to 7 8 to 28 "29 5 4 4 48 36 24 30 to 34 0 to 7 "8 4.5 4 36 24 "35 ALL 4 24 Administer IV over 30 minutes
Gram negative aerobic bacilli; Usually used in combination with a beta- lactam antibiotic. Administer as a separate infusion from penicillin- containing compounds. Ototoxic effects synergistic with lasix. Need to monitor serum levels: Trough: < 2, ideal 0.5 to 1.0; Peak: 5- 12 mg/L For high trough levels, increasing dosing interval to next higher level is usually sufficient - always recheck levels again after adjusting dosage/interval Imipenem/Cilastatin 20-25 mg/kg/dose q12 hrs IV Administer over 30 minutes Non-CNS infections caused by Enterobacteriaceae and anaerobes resistant to other antibiotics. Seizures common with meningitis and severe renal dysfunction. Isoniazid Treatment: 10-15 mg/kg/day PO qd or divided BID Prophylaxis: 10 mg/kg PO qd Mycobacteria Lamivudine 2 mg/kg/dose q 12 hours PO for 1 week following birth Used in combination with zidovudine. Prevention of mother-to-child HIV transmission when no other therapy during pregnancy. Linezolid 10 mg/kg/dose q8 hours PO or IV Preterm and < 1 week give q12 hours. Administer IV over 30 minutes. Gram-positive organisms, incl. MRSA, refractory to vancomycin and other antibiotics. Not used for empiric therapy. Meropenem Sepsis: 20 mg/kg/dose IV Gest Age (weeks) Postnatal (days) Interval (hours) !32 0 to 14 >14 12 8 >32 0 to 7 >7 12 8 Meningitis/Pseudomonas: 40 mg/kg/dose q8 hr Administer IV over 30 minutes Multidrug-resistant gram-negative, gram-positive, and anaerobic organisms. Methicillin
25 - 50 mg/kg/dose IV or IM < 2 kg: < 7 d: q12 h; > 7 d: q 8 h > 2 kg: < 7 d: q 8 h; > 7 d: q 6 h Penicillinase-producing Staphylococcus aureus. Use the higher doses for meningitis Metronidazole Loading dose: 15 mg/kg IV/PO Maintenance dose: 7.5 mg/kg IV/PO PMA (weeks) Postnatal (days) Interval (hours) !29 0 to 28 >28 48 24 30 to 36 0 to 14 >14 24 12 37 to 44 0 to 7 >7 24 12 "44 ALL 8 Administer IV over 60 minutes Anaerobic infections; begin maintenance dose 48 h after load in preterm infants & after 24 h in term infants. Mezlocillin 50 - 100 mg/kg/dose IV / IM See Methicillin for dosing schedule Pseudomonas, Group B Strep, most Klebsiella pneumoniae and Serratia marcescens Mupirocin Apply small amount topically to affected area q8 hours for 5-14 days. MRSA topical infections. Do not apply to the eye. May cover with gauze. Nafcillin Usual: 25 mg/kg/dose IV Meningitis: 50 mg/kg/dose IV See Table 3 for dosing interval Administer IV over 15 minutes Penicillinase-producing Staphylococcus aureus. Use nafcillin for renal dysfunction pts. Nevirapine 2 mg/kg PO once at 48 to 72 hours of age. If mother did not receive intrapartum single-dose nevirapine, administer 2 mg/kg as soon as possible after birth. Used ONLY in combination with zidovudine in treatment of neonates born to HIV-infected women who had no therapy during pregnancy. Nystatin Preterm: 0.5 mL PO q6 hours Mucocutaneous candida infections. Term: 1 mL PO q6 hours Apply topically with swap to each side of mouth. Use for length of antibiotic therapy and continue for 24 hours after discontinuation of antibiotic therapy, especially in infants <1500 grams. Prophylaxis against invasive fungal infections in VLBW infants. Do not need if using fluconazole. Oxacillin 25 mg/kg/dose IV or IM Meningitis: 50 mg/kg/dose IV or IM See Table 3 for dosing interval Administer IV over 10 minutes Penicillinase-producing Staphylococcus Aureus. Interstitial nephritis. Penicillins See Table 3 for dosing interval Non-producing Penicillinase organisms ! Pen G: Meningitis 75,000 - 100,000 IU/kg/dose IV or IM Administer IV over 30 minutes See Methicillin for dosing schedule ! Pen G: Sepsis 25,000 - 50,000 IU/kg/dose IV or IM Administer IV over 15 minutes
For Group B Strep sepsis: 200,000 IU/kg/d in divided doses and 400,000 IU/kg/d in divided doses with meningitis
Treatment of susceptible organisms: streptococci , cong. syphilis, gonococci
! Benzathine 50,000 units/kg one dose, IM only 50,000 U/kg IM q wk x 3 doses Syphilis (No clinical findings and only if follow-up cannot be ensured) Syphilis > 1 yr. in mother ! Procaine 50,000 units/kg q day, IM only Syphilis Piperacillin 50 to 100 mg/kg/dose IV or IM See Table 3 for dosing interval Administer IV over 30 minutes Gram-positive, gram-negative, anaerobic incl. Pseudomonas and Group B Strep. Piperacillin-Tazobactam (Zosyn) 50 to 100 mg/kg/dose IV or IM See Table 3 for dosing interval Administer IV over 30 minutes Gram-positive, gram-negative, anaerobic incl. Pseudomonas and Group B Strep. Non-CNS infections. Ribavirin Dilute 6 gm in 300 ml sterile water. Administer by aerosol over 12 - 18 hr daily for 3 - 7 days Respiratory syncytial virus (severe herpes). Most effective if begun early in course of illness. May worsen respiratory distress. Should be administered in a well-ventilated room. Women of child- bearing age should not administer. Rifampin PO: 10 -20 mg/kg q24 hr. IV: 5 - 10 mg/kg q 12 hr Administer IV over 30 minutes Mycobacteria; causes red discoloration of body secretions. Must be used in combination with vancomycin or aminoglycosides for persistent staphylococcal infections. Causes orange/red discoloration of body secretions. Potent inducer of P450. Ticarcillin -Clavulanate 75-100 mg/kg/dose IV See Table 3 for dosing interval Administer IV over 30 minutes
Pseudomonas may cause decreased platelet aggregation, bleeding diathesis, hypernatremia, hypocalcemia, increased AST Tobramycin* See Gentamicin for dosing schedule Administer IV over 30 minutes Aerobic gram-negative bacilli (e.g., E coli, Pseudomonas, Klebsiella) Need to monitor levels Trough: < 2 mg/L, ideal 0.5 -1.0. Peak: 5 - 12 mg/L Trimethoprim- Sulfamethoxazole (Bactrim) Prophylaxis: 2 mg/kg qHS PO Treatment: 4 mg/kg q12 hours PO UTI caused by E.coli, Klebsiella, Enterobacter, Proteus Contraindicated < 2 months Valganciclovir 16 mg/kg/dose PO q12 hours. Treat for a minimum of 6 weeks. Prodrug of ganciclovir. Neutropenia common. If ANC<500 hold until >750 If ANC<750, reduce dose by 50% If ANC<500 again, discontinue. Vancomycin* 10-15 mg/kg/dose IV PMA (weeks) Postnatal (days) Interval (hours) !29 0 to 14 >14 18 12 30 to 36 0 to 14 >14 12 8 37 to 44 0 to 7 >7 12 8 "45 ALL 6 Administer IV over 90 minutes Methicillin-resistant staphylococci (e.g., S aureus and S epidermidis) and penicillin-resistant pneumococci. Note: Red man syndrome results from rapid IV infusion. Need to monitor serum levels Trough: 5-10 mg/L; Peak: 25 - 40 mg/L Give 15 mg/kg/dose if CNS infection Zidovudine IV: 1.5 mg/kg/dose over 60 minutes PO: 2 mg/kg/dose. Do not give IM Begin treatment 6-12 hours after birth and continue for 6 weeks. Treatment of HIV infection in combination with other antiretroviral agents. Initiation of therapy after age 2 days is not likely to be effective. * Serum drug level monitoring recommended. See document Use of Drug Monitoring Levels in the NICU for appropriate procedures.
Table 2: Dosing Interval Chart Gest. age Postnatal age Interval (q) < 29 wk 0 to 28 d 12 hr > 28 d 8 hr 30 to 36 wk 0 to 14 d 12 hr > 14 d 8 hr "37 wk 0 to 7 d 12 hr > 7 d 8 hr
Table 3: Dosing Interval Chart PMA (weeks) Postnatal (days) Interval (hours) !29 0 to 28 >28 12 8 30 to 36 0 to 14 >14 12 8 37 to 44 0 to 7 >7 12 8 "45 ALL 6
Table 4: Usual Therapeutic Range PEAK (g/ml) TROUGH (g/ml) Gentamicin 5-12 0.5-1.0 Tobramycin 5-12 0.5-1.0 Kanamycin 20-25 5-10 Amikacin 20-30 2-5 Vancomycin 25-40 5-10 These data represent usual starting and maintenance doses for seriously compromised infants or LBW weight premature infants (< 2 kg or <34 wk. gestation) and full-term infants. Monitoring of serum drug levels will assist in optimizing dosage adjustments, particularly with changing organ function as the newborn matures or recovers from the initial illness. Optimum time to obtain levels is 30 min. prior to next dose for trough levels, and 30 minutes after completion of IV infusion for peak levels. With high serum levels, usually an increase in interval of administration is warranted rather than lowering of individual dose, although both may be necessary in some neonates.
References 1. Young TE, Mangum B. Neofax A manual of drugs used in neonatal care. 23rd edition, Columbus, Ohio; Ross Laboratories, 2010.. 2. Johnson KB. The Harriet Lane Handbook. 13th edition. Mosby - Year Book, Inc., St Louis, MO, 1993 Brown & Campoli-Richards, 1989; (4) Beretz & Tato, 1988; and (5) Remington & Klein, 1990. 3. MICROMEDEX. Accessed online 2012. Updated annually. 4. Taketomo CK, Hodding JH, Kraus DM. Lexi-Comp:Pediatric Dosage Handbook. Accessed online 2012. Updated annually.