Drug

Dosage

Major Indications / Remarks

Acyclovir

30 mg/kg/d divided q 8 hr IV

administer over 1 hr

Herpes Simplex & Varicella.

increase dosing interval with <34 wk gest or with significant renal / hepatic failure

Amikacin*

7.5 - 10 mg/kg per dose IV / IM

see Gentamicin for dosing schedule

Gram negative enteric bacteria

peak 20-30, trough 5-10 mcg/ml

Amphotericin B

test dose: 0.1 mg/kg

initial dose: 0.25 mg/kg

increment : 0.125 - 0.25 gm/kg/d

maintenance dose: 1 mg/kg/d qd or 1.5 mg/kg/d qod

Most systemic fungal infections & severe superficial mycoses; Give over 4 to 6 hr. Decreases renal blood flow / GFR; Monitor renal / hepatic status closely.

total dose: 15-30 mg/kg

Ampicillin

Mild - Moderate infection

Meningitis

200 mg/kg/d ÷ q 12 hr

IV or IM, q 8 hr ³ 1 week age

400 mg/kg/d ÷ q 8-12 hr

Group B streptococcus, enterococcus,

E coli, Listeria monocytogenes

Cephalothin

20 mg/kg q 6-8 hr IV / IM

Gram + cocci

Cefazolin

< 7 days: 20 mg/kg q 12 hr IV / IM

> 7 days: 20 mg/kg q 8 hr

Gram + cocci ; may cause false positive urine reducing substance

Cefotaxime & Ceftazidime

50 mg/kg dose IV over 30 min.

Cefotaxime:

Gram - enteric bacteria

penetrates well across BBB and good for use in meningitis

Ceftazidime:

Gram - , esp. Pseudomonas ; Consider two antibiotics with positive Pseudomns. cultures

Ceftriaxone

50 - 75 mg/kg/dose IV/IM

<1.2 kg: <28 d:q 24 h; >28 d: q12 h

>1.2 kg: < 7 d: q 24 h; > 7 d: q12 h

Gram - bacteria and

gonococcal infection

Clindamycin

Preterm <1mo: 5 mg/kg q 8 h IV

Preterm >1mo: 5 mg/kg q 6 h

Full term: 5 - 10 mg/kg q 6 h

Gram + cocci and bacteroides

Psuedomembranous colitis most serious adverse effect Æ bloody diarrhea, fever

Erythromycin

10-15 mg/kg q 8-12 hr. PO

Chlamydia and Mycoplasma

Gentamicin*

2.5 mg/kg/dose

Gram negative aerobic bacilli;

Ototoxic effects synergistic with lasix. Need to monitor serum levels:

Trough: < 2; Peak: 4 - 8 mg/L

For high trough levels, increasing dosing interval to next higher level is usually sufficient - always recheck levels again after adjusting dosage/interval

Isoniazid

10 mg/kg PO q d

Mycobacteria

Methicillin

&

Nafcillin

25 - 50 mg/kg/dose IV / 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 Nafcillin for renal dysfunction pts. Use the higher doses for meningitis

Metronidazole

Loading dose: 15 mg/kg IV

Maintenance dose: 7.5 mg/kg IV q12 h

anaerobic infections; begin maintenance dose 48 h after load in preterm infants & after 24 h in term infants

Oxacillin

25 mg/kg/dose IV / IM

< 7d: q 12 hr. > 7 d: q 6-8 hr

Penicillinase-producing Staphylococcus Aureus

Mezlocillin & Piperacillin

50 - 100 mg/kg/dose IV / IM

See Methicillin for dosing schedule

Pseudomonas, Gr B Strep, most Klebsiella pneumoniae and Serratia marcescens

Penicillins

Non-producing Penicillinase organisms

Pen G: Meningitis

75,000 - 100,000 IU/kg/dose IV

See Methicillin for dosing schedule

Pen G: Sepsis

25,000 - 50,000 IU/kg/dose

See Methicillin for dosing schedule

Treatment of susceptible organisms:

streptococci , cong. syphilis, gonococci

For group B strep sepsis: 200,000 IU/kg/d and 400,000 IU/kg/d with meningitis

Benzathine

50,000 units/kg one dose IM

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

Syphilis

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

Rifampin

Children:

5 - 10 mg/kg PO/IV q 12 hr

Mycobacteria; causes red discoloration of body secretions.

Ticarcillin

75 mg/kg/dose IV

< 1.2 kg: 0-4 wk: q 12 hr

< 2 kg: < 7 d q 12 h; > 7 d q 8 h

> 2 kg: < 7 d q 8 h; > 7 d q 6 h

Pseudomonas

may cause decreased platelet aggregation, bleeding diathesis, hypernatremia, hypocalcemia, increased AST

Tobramycin*

2.5 mg/kg dose

See Gentamicin for dosing schedule

Aerobic gram-negative bacilli (e.g., E coli, Pseudomonas, Klebsiella)

Need to monitor levels

Trough: < 2 mg/L. Peak: 5 - 10 mg/L

Vancomycin*

10 mg/kg per dose IV, give

by syringe pump over 60 min.

< 1 kg: < 7 d: q 24 h; > 7 d: q 18 h

1-2 kg: < 7 d: q 18 h; > 7 d: q 12 h

>2 kg: <7 d: q 12 h; > 7 d: q 8 h

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

5-8

1 - 2

5-8

1 - 2

20-25

5 - 10

20-25

5 - 10

25-40

5 - 10