You are on page 1of 12

NORTH SHORE – LONG ISLAND JEWISH HEALTH SYSTEM SCHNEIDER CHILDREN’S HOSPITAL PHARMACY AND THERAPEUTICS Guideline Title

: ANTIMICROBIAL DOSING - PEDIATRICS: COMBINED APPROVED, RESTRICTED, (Includes CYSTIC FIBROSIS)
Prepared by: Mark Kurot RN, NNP Director Nursing Standards and Budgets

Effective Date: 6 / 28 / 09

Total Pages: 12

General Statement of Purpose: 1. To standardize antimicrobial dosing for pediatric patients admitted to Schneider Children’s Hospital. 2. To establish a process for the use of restricted antimicrobials for pediatric patients admitted to Schneider Children’s Hospital. Guideline Statement: These guidelines have been established to assist the physician in selecting a dosing regimen for antimicrobials to be administered to pediatric patients. Doses may have been modified from the references listed based on past hospital practice and / or attaining therapeutic levels. Doses of antimicrobials given in the Harriet Lane Handbook or other sources may differ significantly from these guidelines or a range may be specified rather than a specific dose –use these guidelines or discuss dosing with the Infectious Diseases service. At Schneider Children’s Hospital, restricted antimicrobials require approval by the Pediatric Infectious Diseases service before they can be prescribed. Certain restricted antimicrobials are pre-approved for certain indications as described below. To avoid the need to call the Pediatric Infectious Diseases service for approval, the pre-approved indication / diagnosis must be specified on the order sheet - e.g., cefotaxime 1,000 mg IV q 8 hours (225 mg / kg / day; diagnosis: meningitis). Pharmacy will not dispense a restricted antimicrobial if the diagnosis is not designated on the order sheet. Scope: This policy applies to all members of the Schneider Children’s Hospital interdisciplinary health care team which includes but is not limited to: Physicians, Nurse Practitioners, Physician Assistants, Nurses, and Pharmacists performing work for or at Schneider Children’s Hospital. Notes: *For use of antimicrobials indicated with an asterisk (*) in patients younger than 30 days AND less than or equal to 44 6/7 weeks corrected gestational age, refer to SCH Antibiotic Dosing: Neonatal for antibiotic dosing guidelines. Assumes normal renal function Cystic fibrosis: If different (higher) doses of a particular antimicrobial are indicated for cystic fibrosis patients, the recommended dose is described. Restricted antimicrobials prescribed by Pulmonary Medicine for cystic fibrosis patients do not need ID approval.

This document is intended as a general guideline. The healthcare professional must use the appropriate judgment dependent on the particular clinical situation. Antimicrobial Dosing - Pediatrics: Combined Approved, Restricted, (Includes Cystic Fibrosis), June 28, 2009 (Total pages 12)

1

Note: Therapeutic monitoring for amikacin (and other aminoglycosides) should be performed on all patients receiving therapy for greater than 48 hours.5 mg / kg / day divided q 8 hours Infants and children younger than 5 years: 22. Amikacin IV (or IM): RESTRICTED ANTIMICROBIAL Age less than or equal to 7 days: 10 mg / kg loading dose. 2009 (Total pages 12) 2 .Acyclovir: Intravenous: Infants less than 6 weeks of age with suspected neonatal Herpes simplex infection: 60 mg / kg / day divided q 8 hours (20 mg / kg / dose).5 gm / day may be exceeded based on results of therapeutic monitoring. At minimum. Peak is obtained 30 minutes after completion of a 30 minute infusion. For patients receiving once daily amikacin. Oral: For varicella or zoster: 80 mg / kg / day divided q 6 hours (maximum 800 mg / dose) For Herpes simplex: 60 mg / kg / day divided q 6 hours (maximum 400 mg / dose) Oral acyclovir should not be used for HSV encephalitis. Antimicrobial Dosing . June 28. Note: For extremely obese children. Maximum dose of 1. Adjusted body weight = ideal body weight + 0. recent antimicrobial therapy. check trough concentration only and value should be less than 2.5 mg / kg / day divided q 8 hours Children 5 years and older. then 22. trough 5 to 10 micrograms / mL. use adjusted body weight in dose calculation. For ideal body weight. The healthcare professional must use the appropriate judgment dependent on the particular clinical situation. maximum: 2 gm q 12 hours (4 gm per day) 1 gm once daily for streptococcal pharyngitis This document is intended as a general guideline.Pediatrics: Combined Approved. Monitoring: Peak 20 to 30 micrograms / mL.4 (actual body weight – ideal body weight). a trough concentration should be obtained to ensure the concentration is not excessive.5 micrograms / mL.. then 15 mg / kg / day divided q 12 hours Age 8 to 28 days: 10 mg / kg loading dose. Restricted. day care center attendance). Older infants and children (dosage for obese patients should be based on ideal body weight) • for Herpes simplex encephalitis: 30 mg / kg / day divided q 8 hours (10 mg / kg / dose) • for non-CNS Herpes simplex infection: 15 mg / kg / day divided q 8 hours (5 mg / kg / dose) • for varicella-zoster infection: 1500 mg / M2 / day divided q 8 hours (500 mg / M2 / dose) • ensure adequate hydration for patients on IV acyclovir to minimize risk of renal dysfunction due to drug crystallization in the kidneys. * Amoxicillin Oral: Infants and children: 45 mg / kg / day PO divided bid 90 mg / kg / day PO divided bid: for patients with severe infections or suspicion of infection with penicillin-resistant pneumococci (e. 50 mg / kg once daily (maximum 1 gm) for streptococcal pharyngitis Adults: 500 to 875 mg every 12 hours.5 mg / kg / day divided q 8 hours Cystic fibrosis patient (does not need ID approval) Higher than standard dose: 30 mg / kg / day (10 mg / kg / dose) divided q 8 hours.5 gm / day) Oncology patients of all ages with fever and neutropenia: 22. (Includes Cystic Fibrosis). use 50 percentile for age and sex.g. and adults: 15 mg / kg / day once daily (maximum initial daily dose: 1. adolescents.

3. maximum dose: 12 gm/day This document is intended as a general guideline. maximum: 2 gm q 4 hours (12 gm per day) Ampicillin / sulbactam (Unasyn®) . May increase to maximum dose of 1 mg / kg / dose on subsequent days Notes: 1. K+. June 28. Causes renal wasting of Na+. and Ca++ concentrations. Liposomal (Ambisome®) IV: RESTRICTED ANTIMICROBIAL Neonate: 5 mg / kg over 1 hour once daily Other than neonate: Empiric therapy for febrile neutropenia or candidiasis: 3 mg / kg over 1 hour once daily Suspected aspergillosis infection: 5 mg / kg over 1 hour once daily Note: Pretreatment with acetaminophen and diphenhydramine is generally unnecessary. K+.5 mg / kg / dose over 1 to 3 hours on day 1. 2.* Amphotericin B Deoxycholate (conventional amphotericin B) IV Initial daily dose (all ages): 0. 2009 (Total pages 12) 3 . Monitor Na+. Restricted.Pediatrics: Combined Approved. The healthcare professional must use the appropriate judgment dependent on the particular clinical situation. Pretreat (other than neonate) with acetaminophen and diphenhydramine (Benadryl) to decrease infusion related adverse events. and Ca++. Amphotericin B. *Ampicillin IV: Infants and Children (Age greater than 7 days): 150 mg / kg / day divided q 6 hours (meningitis not present). maximum 8 gm / day (2 gm q 6 hours) Cystic fibrosis patient (does not need ID approval) . Consider pretreatment with 10 ml/kg normal saline bolus to decrease nephrotoxicity. (Includes Cystic Fibrosis). Consider increasing daily doses of Na+. K+.IV: RESTRICTED ANTIMICROBIAL dosing based on ampicillin content Infants and Children (Age greater than 7 days): 200 mg ampicillin component / kg / day divided q 6 hours Adults: 2 gm ampicillin component q 6 hours. 300 mg / kg / day divided q 6 hours (meningitis) Adults: 2 gm q 6 hours. Antimicrobial Dosing . and Ca++ in anticipation of increased renal losses. maximum: 2 gm ampicillin component q 4 hours (12 gm per day) Azithromycin RESTRICTED ANTIMICROBIAL For pneumonia: PO: 10 mg / kg q day (Maximum dose 500mg) x 5 – 10 days IV: 10 mg / kg q day (Maximum dose 500 mg) x 5 – 10 days Adults: 500 mg IV or PO once daily Pre-approved indications for azithromycin: pneumonia Aztreonam RESTRICTED ANTIMICROBIAL: Age less than or equal to 7 days: 90 mg / kg / day divided q 8 hours Age 7 – 30 days: 120 mg / kg / day divided q 8 hours Infants and children: 120 mg / kg / day divided q 8 hours Adults: 2 gm q 8 hours.Higher than standard dose: 150 mg / kg / day IV divided in four doses daily (every 6 hours).

4. maximum 12 gm / day Note: The meningitis dose should be prescribed for an infant less than 2 months of age with suspected sepsis pending culture results. Restricted.) This document is intended as a general guideline. Fever and neutropenia in an oncology patient 2. June 28. and imipenem / cilastatin [Primaxin®]. HIV infection D. Kefzol®) – IV Infants and children: 100 mg / kg / day divided q 8 hours Adults: 2 gm q 8 hours.Pediatrics: Combined Approved. Pneumonia: After completion of IV antimicrobial. Asplenia C. 7. The healthcare professional must use the appropriate judgment dependent on the particular clinical situation. 3. ticarcillin / clavulanate [Timentin®]. Antimicrobial Dosing . meropenem. maximum 12 gm / day Cefepime (Maxipime®) IV: RESTRICTED ANTIMICROBIAL Fever and neutropenia oncology patient: 150 mg / kg / day divided q 8 hours. 2009 (Total pages 12) 4 . the most active of oral beta-lactam antimicrobials against pneumococcus. (Includes Cystic Fibrosis). 8. Neonate (outside of NICU) B. the usual oral antimicrobial is amoxicillin. Fever / suspected sepsis in the following situations: A. maximum dose: 2 gm q 8 hours Other than fever / neutropenia: 100 mg / kg / day divided q 12 hours Adults: 2 gm q 8 hours (fever / neutropenia). Empiric therapy of nosocomial pneumonia (including ventilator-associated pneumonia) *Cefotaxime IV: RESTRICTED ANTIMICROBIAL Infants and children (Age greater than 30 days): 225 mg / kg / day divided q 8 hours – proven or suspected meningitis 150 mg / kg / day divided q 8 hours – sepsis Adults: 2 gm q 8 hours. 2 gm q 12 hours (other uses) Pre-approved indications for cefepime: 1. Pre-approved indications for ceftriaxone / cefotaxime: 1.Caspofungin IV: RESTRICTED ANTIMICROBIAL Age 3 months and older: Loading dose: 70 mg / M2 / dose (maximum dose: 70mg / day) Maintenance dose: 50mg / M2 / dose (maximum dose: 50mg / day) *Cefazolin (Ancef®. Sickle cell disease 2. 5. 6. Meningitis (with or without vancomycin) Epiglottitis Gonococcal infection Lyme disease Periorbital or orbital cellulitis (alone or in combination with nafcillin or clindamycin) Pyelonephritis (alone or in combination with ampicillin for enterococci) (*Ceftazidime IV: [150 mg / kg / day divided q 8 hours] should no longer be routinely prescribed due to possible induction of antimicrobial resistance to gram-negative bacilli via extended spectrum beta-lactamases to a greater extent than other antimicrobials such as cefepime. piperacillin / tazobactam [Zosyn®].

The healthcare professional must use the appropriate judgment dependent on the particular clinical situation. 3. Sickle cell disease 2. the most active of oral beta-lactam antimicrobials against pneumococcus. Previously. Fever / suspected sepsis in the following situations: A. Please contact the Infectious Disease service to discuss the usage and dosage recommendations Infants and children (Age greater than or equal to 30 days): Meningitis: 100 mg / kg / day q 24 hours (maximum 2 gm per dose. maximum dose: 4 gm / day Other than meningitis: 75 mg / kg / day q 24 hours. 6. (Includes Cystic Fibrosis). In there is evidence of hemolysis. Pneumonia. the usual oral antimicrobial is amoxicillin. maximum 2 gm Otitis media: 50 mg / kg / day q 24 hours x 1 to 3 days Adults: Meningitis: 2 gm q 12 hours. June 28. Asplenia C. maximum: 2 gm q 24 hours Lyme meningitis: 2 gm q 24 hours Note: Generally. the meningitis dose should be prescribed for an infant less than 2 months of age with suspected sepsis pending culture results. the FDA recommended against using ceftriaxone in patients receiving intravenous or oral calcium supplementation. 7. all cases with an adverse event associated with ceftriaxone and calcium supplementation have occurred in patients younger than 1 month of age. Pre-approved indications for ceftriaxone / cefotaxime: 1. then divide dose q 12 hours). often with a fatal outcome. the ceftriaxone should be discontinued. Age less than 30 days: Not generally recommended Age 7 to 30 days: Use of ceftriaxone can be considered if the patient does not have indirect hyperbilirubinemia and is not receiving intravenous or oral calcium supplementation.Ceftriaxone IV / IM: RESTRICTED ANTIMICROBIAL CAUTION: As of 4 / 14 / 09 the FDA has indicated that ceftriaxone and calcium-containing products may be used concomitantly in patients greater than 28 days of age. 4. tachycardia. HIV infection D. However. 5. the transfusion of blood. 2009 (Total pages 12) 5 . Patients receiving ceftriaxone who develop signs of acute hemolysis (dark urine. Neonate (outside of NICU) B. In rare cases. If dose exceeds 2 grams. 8. and if necessary. Antimicrobial Dosing . After completion of IV antimicrobial.Pediatrics: Combined Approved. ceftriaxone has been associated with massive intravascular hemolysis. Restricted. anemia) should be appropriately evaluated (CBC and examination of blood smear for evidence of hemolysis). maximum dose: 2 gm q 12 hours Other than meningitis: 1 to 2 gm q 24 hours. Essentially all of these cases have occurred in patients receiving more than course of ceftriaxone and many of the cases have occurred in pediatric patients with a sickle cell disease. Meningitis (with or without vancomycin) Epiglottitis Gonococcal infection Lyme disease Periorbital or orbital cellulitis (alone or in combination with nafcillin or clindamycin) Pyelonephritis (alone or in combination with ampicillin for enterococci) This document is intended as a general guideline. and consideration should be given to the administration of corticosteroids.

(Includes Cystic Fibrosis).8 gm / day) PO: Infants and children: 25 mg / kg / day divided q 8 hours Adults: 300-600 mg PO q 8 hours (maximum 1.2 gm / day). children: Systemic candidiasis in children: 12 mg/kg/day once daily (maximum dose.5 gm / day) IV: 30 mg / kg / day divided q 8 hours. then 100 mg once daily. *Clindamycin: IV: Infants and children (older than 30 days): 40 mg / kg / day divided q 8 hours (maximum 900 mg q 8 hours) Adults: 900 mg IV q 8 hours (maximum 4. 800 mg / day) Urinary Tract Infection.2 gm / day Note: Maximum dose for children is higher than adult maximum due to more rapid clearance in children.5 gm / day IV: 400 mg q 12 hours. maximum 1. coli urinary tract infections due to antimicrobial – resistant bacteria. Restricted. Adults: PO: 500 mg q 12 hours.Ciprofloxacin (Cipro®): RESTRICTED ANTIMICROBIAL Not FDA-approved for age less than 18 years old except for: children with complicated E. infants. June 28. maximum 800 mg / day. Oropharyngeal Candidiasis. Esophageal Candidiasis: 6 mg / kg / day (maximum dose. Infants and children less than 18 years of age: PO: 30 mg / kg / day divided q 12 hours (PO maximum 1. for severe or complicated infections: 400 mg q 8 hours Maximum 1.8 gm / day) Ertapenem (Invanz®): – RESTRICTED ANTIMICROBIAL Age less than 3 months: not recommended Age 3 months to 12 years: 30 mg / kg / day divided q 12 hours (maximum 1 gm per day) Adults: 1 gm IV q 24 hours (maximum 1 gm / day) *Fluconazole: Age greater than 30 days. invasive infection: 400 to 800 mg once daily This document is intended as a general guideline.Pediatrics: Combined Approved. The healthcare professional must use the appropriate judgment dependent on the particular clinical situation. 2009 (Total pages 12) 6 . 400 mg) Adults: 200 mg once. published data supports usage in special clinical situations. (IV maximum 1. Antimicrobial Dosing .

trough 0. Adjusted body weight = ideal body weight + 0. For patients receiving once daily gentamicin. 450 mg daily Note: For extremely obese children. June 28. sinusitis). (Includes Cystic Fibrosis). 2009 (Total pages 12) 7 . Note: Therapeutic monitoring for gentamicin (and other aminoglycosides) should be performed on all patients receiving therapy for greater than 48 hours. NON-FORMULARY IV and PO are bioequivalent: Not approved for age less than 18 years. adolescents. Peak is obtained 30 minutes after completion of a 30 minute infusion. Restricted. and adults: 6 mg / kg / day once daily (maximum initial daily dose: 450 mg / day) Cystic fibrosis patient: Higher than standard dose: Age less than 5 years: 10 mg / kg/ day in 3 doses every 8 hours Age greater than or equal to 5 years: 7. a peak concentration should be obtained. Infants and children greater than 6 months to 4 years of age: 20 mg / kg / day divided q 12 hours IV or PO (maximum dosing: 500 mg / day). (Pseudomonas aeruginosa pneumonia: 750 mg / day) Linezolid (Zyvox®) – RESTRICTED ANTIMICROBIAL IV and PO are bioequivalent. Antimicrobial Dosing .5 mg / kg / day once daily. maximum initial dose. use adjusted body weight in dose calculation. Monitoring: peak 5 to 10 micrograms / mL. a trough concentration should be obtained to ensure the concentration is not excessive.5 mg / kg / day divided q 8 hours Children 5 years and older. For ideal body weight. Children 5 years of age and older: 10 mg / kg once daily (maximum dose 500 mg) Adult: 500 mg q 24 hours (pneumonia. *Imipenem / cilastatin (Primaxin®) IV: RESTRICTED ANTIMICROBIAL Age 1 month to 3 years: 100 mg / kg / day divided q 6 hours Age greater than 3 years: 60 mg / kg / day divided q 6 hours Adult: 500 mg q 6 hours (maximum 4 gm / day) Levofloxacin (Levaquin®): RESTRICTED ANTIMICROBIAL. At minimum. If the infection is not clinically resolving.5 to 2 micrograms / mL.Pediatrics: Combined Approved. published data supports usage in special clinical situations.4 (actual body weight – ideal body weight). The healthcare professional must use the appropriate judgment dependent on the particular clinical situation. check trough concentration only and value should be less than 0. maximum dose 600 mg per dose Adult: 600 mg q 12 hours This document is intended as a general guideline.5 micrograms / mL. PO route preferred Age less than 12 years: 30 mg / kg / day divided q 8 hours Age greater than or equal to 12 years: 20 mg / kg / day divided q 12 hours.*Gentamicin IV / IM: (for patients with normal renal function) Infants and children: 31 days through 4 years of age and all oncology patients with fever and neutropenia: 7. use 50th percentile for age and sex.

PO route preferred Not FDA approved for age less than 18 year of age. then 30 mg / kg / day divided q 6 hours Adult: 500 mg q 8 hours Metronidazole oral (Flagyl®) for C. 2009 (Total pages 12) 8 . difficile colitis: Infant and children: 30 mg / kg / day PO divided q 8 hours Adult: 125 to 500 mg PO tid. Restricted. Adolescents and adults: 400 mg q 24 hours *Nafcillin IV: Infants and children: 150 mg / kg / day divided q 6 hours (other than meningitis) 200 mg / kg / day divided q 6 hours (meningitis) Adults: 2 gm q 6 hours (maximum: 12 gm / day) Oseltamivir: Treatment of influenza: twice daily for 5 days Age less 3 months: 12 mg twice daily Age 3 through 5 months: 20 mg twice daily Age 6 through 11 months: 25 mg twice daily Body weight less than or equal to 15 kg. June 28.Meropenem (Merrem®) IV: RESTRICTED ANTIMICROBIAL Age less than or equal to 60 days: generally use meningitis dose. (Includes Cystic Fibrosis).Pediatrics: Combined Approved. age 12 months or greater: 30 mg once daily Body weight greater than 15 to 23 kg: 45 mg once daily Body weight greater than 23 to 40 kg: 60 mg once daily Body weight greater than 40 kg and adults: 75 mg once daily This document is intended as a general guideline.30 days: 60 mg / kg / day divided q 8 hours] Infants and children greater than or equal to 3 months: 60 mg / kg / day divided q 8 hours (no meningitis) 120 mg / kg / day divided q 8 hours (meningitis) Adult: 1 gm q 8 hours (maximum dose: 6 gm per day) Metronidazole IV (Flagyl®): Age less than 7 days: 15 mg / kg day divided q 12 hours Age 7 to 30 days: 30 mg / kg / day divided q 12 hours Infants and children: 15 mg / kg loading dose. age 12 months or greater: 30 mg twice daily Body weight greater than 15 to 23 kg: 45 mg twice daily Body weight greater than 23 to 40 kg: 60 mg twice daily Body weight greater than 40 kg and adults: 75 mg twice daily Prophylaxis of influenza: once daily for 10 days Age less 3 months: generally not recommended Age 3 through 5 months: 20 mg once daily Age 6 through 11 months: 25 mg once daily Body weight less than or equal to 15 kg. Antimicrobial Dosing . The healthcare professional must use the appropriate judgment dependent on the particular clinical situation. maximum dosing: 4 gm / day Moxifloxacin (Avelox®): RESTRICTED ANTIMICROBIAL IV and PO are bioequivalent. 120 mg / kg / day divided q 8 hours [Meningitis excluded: Age less than or equal to 7 days: 40 mg / kg / day divided q 12 hours] [Meningitis excluded: Age 7 .

IV – RESTRICTED ANTIMICROBIAL Age less than 6 months: 240 mg of piperacillin component / kg / day divided q 8 hours Infants and children age greater than or equal to 6 months: 320 mg of piperacillin component / kg / day divided q 6 hours Adult: 3. For meningococcal prophylaxis/eradication: 20 mg / kg / day (maximum. 600 mg / dose) for 4 days Meningococcal prophylaxis/eradication: 10 mg / kg / day q 12 hours for 4 doses Haemophilus influenzae type b prophylaxis/eradication: 10 mg / kg once daily for 4 days Adults: 600 mg in one or 2 doses (maximum adult dose. Oropharyngeal candidiasis: 100 mg PO bid x 1 day. (Includes Cystic Fibrosis). Empiric therapy of nosocomial pneumonia including ventilator-associated pneumonia 3. 18 gm as piperacillin per day).375 gm tazobactam) q 6 hours (q 4 hours for pneumonia due to Pseudomonas aeruginosa) Cystic fibrosis patient: (does not need ID approval).375 gm (3 gm piperacillin / 0. 2009 (Total pages 12) 9 . 1. maximum adult dose. e. Restricted. Give as 3 doses of approximately 2 grams per dose via nebulizer for 2 hours on. Fever and neutropenia in an oncology patient 2. 600 mg / dose) q 12 hours for 4 doses For Haemophilus influenzae type b prophylaxis/eradication: 20 mg / kg once daily (maximum. NON-FORMULARY 13 years and above Indications: 1. June 28. followed by 100 mg PO once daily x 13 days 2.200 mg).Pediatrics: Combined Approved. Oropharyngeal candidiasis refractory to fluconazole or itraconazole: 400 mg PO bid Ribavirin Inhalation: RESTRICTED ANTIMICROBIAL Preparation: 6 grams in 100 mL sterile water. The healthcare professional must use the appropriate judgment dependent on the particular clinical situation. appendicitis Posaconazole – oral suspension only – RESTRICTED ANTIMICROBIAL. Rifampin PO or IV. 600 mg.000 units / kg / day divided q 6 hours (other than meningitis) 300.000 units / kg / day divided q 6 hours (meningitis) Adult: 2 million units q 4 to 6 hours (maximum: 24 million units per day) *Piperacillin / Tazobactam (Zosyn®) . Pre-approved indications for piperacillin/tazobactam: 1. For meningococcal prophylaxis/eradication: 600 mg q 12 hours for 4 doses For Haemophilus influenzae type b prophylaxis/eradication: 600 mg once daily for 4 days This document is intended as a general guideline.200 mg). Antimicrobial Dosing . Higher than standard dose: 400 mg of piperacillin component / kg / day IV divided every 6 hours (as inpatient) and every 8 hours at home (maximum dose. 1. 6 hours off and repeat 2 more cycles within 24 hours using a SPAG aerosol generator.*Penicillin G IV aqueous (available as penicillin G potassium or penicillin G sodium): Infants and children: 200..g. PO preferred if tolerated Infants and children: 15 mg / kg / day in one or two doses (usual adult maximum dose. Empiric therapy of intra-abdominal sepsis.

1 gm q 4 hours for very severe infection. June 28. a trough concentration should be obtained to ensure the concentration is not excessive. maximum initial dose. and all oncology patients with fever and neutropenia: 7. Adjusted body weight = ideal body weight + 0. At minimum. Peak is obtained 30 minutes after completion of a 30 minute infusion. For ideal body weight.Ticarcillin / Clavulanate (Timentin®): RESTRICTED ANTIMICROBIAL Infants and children: 250 mg ticarcillin component / kg day divided q 6 hours (300 mg ticarcillin component / kg / day divided q 4 hours for very severe infections) Adult: 3.Pediatrics: Combined Approved. PO or IV Age less than 28 days: generally not used (displaces bilirubin binding to albumin) Infants and children: Non-CNS infection: 10 mg / kg / day divided q 12 hours Pneumocystis pneumonia. (Includes Cystic Fibrosis). serious infection: 20 mg / kg / day divided q 6 hours This document is intended as a general guideline. The healthcare professional must use the appropriate judgment dependent on the particular clinical situation. Monitoring: peak 5 to 10 micrograms / mL.5 to 2 micrograms / mL.1 gm (3 gm ticarcillin / 0. Note: Dosing and monitoring is identical to gentamicin Trimethoprim-sulfamethoxazole (Bactrim.4 (actual body weight – ideal body weight). dosing based on trimethoprim content. 1: sulfamethoxazole. use 50 percentile for age and sex. use adjusted body weight in dose calculation.600 mg sulfa (two double strength tablets) PO q 12 hours Pneumocystis pneumonia. check trough concentration only and value should be less than 0. Timentin® (see Ticarcillin / Clavulanate) *Tobramycin: RESTRICTED ANTIMICROBIAL (for patients with normal renal function) Infants. Septra) trimethopim. maximum 24 gm / day) Cystic fibrosis patient .(does not need ID approval). If once daily therapy is used (for large adolescent/adult). adolescents. 24 gm per day). 5 fixed ratio. Antimicrobial Dosing . If the infection is not clinically resolving. Note: Therapeutic monitoring for gentamicin (and other aminoglycosides) should be performed on all patients receiving therapy for greater than 48 hours.5 mg / kg / day divided q 8 hours Children 5 years and older. children younger than 5 years.5 micrograms / mL.5 mg / kg / day once daily. Restricted.1 gm clavulanic acid) q 6 hours (3. and adults: 6 mg / kg / day once daily maximum initial daily dose: 450 mg / day Cystic fibrosis patient(does not need ID approval): Age less than 5 years: 10 mg / kg/ day in 3 doses every 8 hours Age greater than or equal to 5 years: 7. a peak concentration should be obtained. 450 mg daily Note: For extremely obese children. trough 0. 2009 (Total pages 12) 10 . serious infection: 20 mg / kg / day divided q 6 hours Adolescents and adults: Non-CNS infection: Body weight 70 kg or less: 160 mg TMP / 800 mg sulfa (double strength tablet) PO q 12 hours Body weight over 70 kg: 320 mg TMP / 1. Higher than standard dose: 400 mg of ticarcillin component / kg / day IV divided every 6 hours (as inpatient) and every 8 hours at home (maximum dose.

Pre-approved indications for intravenous vancomycin: 1.*Vancomycin IV: RESTRICTED ANTIMICROBIAL: Infants and children: 45 mg / kg / day divided q 8 hours (non-CNS infection) 60 mg / kg / day divided q 6 hours (meningitis / CNS infection) Adolescents and adults: 45 mg / kg / day divided q 8 hours (CNS or non-CNS infection. Empiric therapy of sepsis syndrome or septic shock. Oral: Less than 40 kg: 200 mg PO q12 hours x 2 doses Greater than or equal to 40 kg: 400 mg PO q12 hour x 2 doses Maintenance dose: Oral dosing (preferred): Less than 40 kg: 100 mg orally every 12 hours Greater than 40 kg: 200 mg orally every 12 hours IV: 4mg / kg / dose every 12 hours *Zosyn®: (see Piperacillin / Tazobactam) This document is intended as a general guideline. for obese patients use actual body weight) Note: It is unnecessary to routinely obtain vancomycin levels in patients with normal renal function who are responding to treatment.C. and adults: 125 mg PO 4 times a day. target trough concentration range is 15 to 20 micrograms / mL.Pediatrics: Combined Approved. or Staphylococcus aureus pneumonia. difficile colitis is rare: 45 mg / kg / day divided q 6 hours Children weighing 10 kg or more. difficile colitis: RESTRICTED ANTIMICROBIAL: PO: Children weighing less than 10 kg . adolescents. Antimicrobial Dosing . maximum 500 mg / day for 7 to 10 days Voriconazole: RESTRICTED ANTIMICROBIAL Children 2 through 11 years: 7 mg / kg / dose every 12 hours (14 mg / kg / day) 12 years and above: Loading dose: IV (preferred): 6mg / kg / dose IV every 12 hours for 2 doses. central nervous system infection including meningitis. Obtain trough levels in patients with: endocarditis. 3. June 28. (Includes Cystic Fibrosis). Empiric therapy of suspected bacterial meningitis: pre-approved for 48 hours only 2. target trough concentration range is 10 to 20 micrograms / mL. In patients treated with vancomycin for endocarditis. abnormal renal function. The healthcare professional must use the appropriate judgment dependent on the particular clinical situation. central nervous system infection. Late onset sepsis in NICU: pre-approved for 48 hours only 4. Suspected vascular catheter related infection: approved for 48 hours only Vancomycin oral for C. In other patients. Restricted. or with proven infection but an inadequate or incomplete response to vancomycin. 2009 (Total pages 12) 11 .

MD By: Chairman Signature on File Pharmacy and Therapeutics Committee Schneider Children’s Hospital Signature James Abberton. 14201452 Steinbach WJ. 2008. (Includes Cystic Fibrosis). 2009 (Total pages 12) 12 . (Includes Cystic Fibrosis) Date Created by: Pharmacy and Therapeutics Committee 6 / 2000 History: Implemented: 6 / 2000. and the Interdisciplinary Council on Quality of Care and Outcomes Research. Dvorak CC. Baltimore RS.Guideline: Antimicrobial Dosing .Pediatrics: Combined Approved. Endocarditis.Ph Director Pharmacy Services Signature on File Long Island Jewish Medical Center General References: Lexi-Comp’s Pediatric Dosage Handbook. Revised 2 / 2008.S.. Rotschafer J. 15th edition. 3rd ed. A Scientific Statement From the American Heart Association Rheumatic Fever.119:15411551 This document is intended as a general guideline. Principles and Practice of Pediatric Infectious Diseases. 2008. Lomaestro B. Antimicrobial Dosing . Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis. PA: Churchill Livingstone. 2008-2009. Implemented 3 / 2008.Pediatrics: Combined Approved. R. In: Long S. Antimicrobial Agents. et al. Eaton CB. Bradley JS. Circulation 2009. the Infectious Diseases Society of America. Philadelphia. Pickering LK. Therapeutic monitoring of vancomycin in adult patients: A consensus review of the American Society of Health-System Pharmacists. Antifungal agents. Restricted. Sauberan J. PA: Churchill Livingstone. The healthcare professional must use the appropriate judgment dependent on the particular clinical situation. 3rd ed. Revised 6 / 2006. Principles and Practice of Pediatric Infectious Diseases. In: Long S. M. Restricted. Et al. June 28. 66 (1):8298 Gerber MA. Prober CG. the Interdisciplinary Council on Functional Genomics and Translational Biology. and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young. Revised 1 / 2007. eds. Revised 12 / 2008: Revised 6 / 2009 Signature Approved Lorry Rubin. Pickering LK. 14521460 Rybak M. and the Society of Infectious Diseases Pharmacists. Revised 7 / 2003. Am J Health Syst Pharm 2009. eds. Philadelphia. Prober CG.