Determining Antibiotic Dosing in Neonates Based on Age

For all antibiotics other than aminoglycosides, the dosing charts in Neofax® refer to postmenstrual age (as
opposed to the previously used postconceptional age) and postnatal age as the primary dose determinants.
Postmenstrual Age is defined as gestational age (calculated from the date of last menses, not date of
estimated conception) plus postnatal age and is expressed in weeks.

Please follow the steps below to determine appropriate dosing intervals for antibiotics other than gentamicin:
1. Determine patient’s gestational age (defined as age in weeks from last menses to date of birth)
2. Calculate postmenstrual age (adding gestational age plus postnatal age)
3. Determine appropriate dose/interval by first finding postmenstrual age, then the appropriate subset within
that age group that corresponds to the patient’s postnatal age.

For example, an infant born at 27 weeks gestation who is now 30 days old would receive ampicillin 25-100
mg/kg every 8 hours since his/her postmenstrual age is now 31 weeks (between 30-36 weeks) and postnatal
age is 30 days (> 14 days).

These dosing regimens should be followed except under circumstances in which renal function or other
factors suggest a more conservative regimen.

Aminoglycosides

Gentamicin and tobramycin should be prescribed according to the attached algorithm, which is a YNHH
adaptation of the guidelines that appear in Neofax. Dose and dosing interval are stratified by gestational age
during the first 7 days of life; subsequently postnatal age, postmenstrual age and renal function are
considered when initiating therapy.

Peak gentamicin/tobramycin levels are no longer needed, except under rare circumstances in which extended
interval dosing is NOT used (i.e. q 8-12 h dosing).

(Revised Feb 03)

Guidelines for Gentamicin* Therapy in the NBSCU
Initial therapy for Patients 0-7 days of life
PMA ≤ 29 weeks PMA 30-33 wks PMA 34-37 wks PMA ≥ 38 wks
5mg/kg q48h 4.5mg/kg q48h 4mg/kg q36h 4mg/kg q24h
If therapy exceeds 48 hours, draw level 4 hours before next dose.

Initial therapy for ALL patients >7 days of life

PMA < 34 weeks PMA ≥ 34 weeks and PMA ≥ 34 weeks and
Serum Cr < 1.0mg/dL Serum Cr ≥ 1.0mg/dL
4mg/kg x1 dose 4mg/kg q24h up to 2 4mg/kg q36h for up to 2
doses doses
Check level 20 hours later:
If < 1.5 mcg/mL: If therapy continues beyond 48 hours,
Order 4 mg/kg q24h draw level 4 hours before 3rd dose.
If 1.6-2 mcg/mL:
Order 4 mg/kg q36h
If > 2, repeat level in 12
hours (will most
likely need q48h)

Therapy changes based on appropriately timed levels

≤ 1.5 mcg/mL 1.6 – 2 mcg/mL > 2 mcg/mL
Continue therapy at Extend dosing interval by Hold dose. Repeat level in
present dose and 12 hrs (e.g. q24h to q36h, 12 hours. If second level is
interval. q36h to q48h). For ≤ 1.5 mcg/mL, extend
therapies with initial dosing interval by 12 hrs
dosing intervals of q48h, and repeat dose. Recheck
give single dose and repeat level 4 hrs before next
level 44 hrs later. scheduled dose.
Recheck a level if therapy exceeds 7 days from last level or if renal function
changes occur.
* Tobramycin therapies should follow the same dosing and monitoring guidelines.
Original Nov99; REVISED FEB03