Pediatric drug doses

BY DR. Mohammad Taqi Asif

 This is a simple summary of drugs that include the common pediatric drugs used in emergency to

simplify and facilitate the way of retrieving these drug doses also you need to apply them in order to

save them

 In front of each drugs there is its corresponding volume as vial or ampoule or suspension , I tried to put

the correct volume as the common drugs available in our hospitals but some drugs volume may differ

from hospital to another one so you should notice these changes before calculate the dose

 For administration and dilution you should review the BNF

 Some drug doses are different according to indication (not all indication is written in this summary

especially the antibiotics)

 Some of antibiotics come with powder vial so you should add fluid into it for administration , the

amount of fluid that you add determine the corresponding volume and how much mg in this volume for

example: Ceftriaxone vial (1 gram) if you add 10 cc of distilled water into it the result is 1cc=100 mg,if

the dose is 50 mg/kg and patient’s weight is 10 kg so the dose is 5cc/day divided twice so 2.5 cc/12

hour should be diluted and administered slowly

 You can determine a child’s expected weight in kilograms, based on his/her age, using the following

formulas:

– Child’s weight at 3–12 months = (age in months + 9)/2

– Child’s weight at 1–6 years = 2(age in years) + 8

– Child’s weight at 7–12 years = (7 × age in years – 5)/2

1
Fluid Doses
Whole blood 10-20 cc/kg(20cc is the usual dose used in our hospitals)
Packed RBCs 10–15 cc/kg (usually 10cc is used in our hospitals)
Fresh Frozen Plasma 10–15 cc/kg (usually 15cc is used in our hospitals)
Platelet concentrate 1 unit/10 kg or 10 cc/kg
Cryoprecipitate 1 unit/5 kg
Mannitol 20% (500ml=100gram) 1.25 cc-7.5 cc/kg initially then 1.25 cc-2.5 cc/kg q4-6 hrs IV
Albumin 50mg/ml (5%) 10 to 20 cc/kg/dose(0.5 to 1 g/kg/dose)IV infused over 1 hr; may infuse more rapidly for hypovolemic shock

Albumin 200mg/ml (20%) 2.5cc-5cc/kg/dose(0.5 to 1 g/kg/dose)IV slow infusion

(10% dextrose) Initial bolus :2-4 cc/kg of 10% dextrose IV
(500mL contain 50 gram of After the initial bolus, an infusion of IV glucose should be given:
glucose,1ml=100mg) 0.08-0.12cc/kg/min for infants , 0.06-0.08cc/kg/min for children(8 to 12 mg/kg/min in infants, 6 to 8
mg/kg/min in children)
Note: in our hospital the dextrose that available is 5% dextrose not 10% so we should add 50 cc of ( 50%
dextrose) into 1 pint of 5% dextrose so the result is approximately 10% dextrose
(25% dextrose) Infants < 6 months
1-2 cc/kg/dose of 25% solution IV
Infants > 6 months and Children
2-4 cc/kg/dose of 25% solution IV
Note:Dilute before IV administration, may give more concentrated solution peripherally in emergency (ie,
12.5-25%)

Plasil 5mg/ml ≈ 0.25cc/10kg/dose(0.1mg[0.02cc]/kg up to 4 times a day) IV slow infusion

Zofran 2mg/ml 0.75cc/10kg/dose(0.15mg[0.075cc]/kg/dose 4 times a day) IV slow infusion
Allermin (diphenhydramine) Infants, Children, and Adolescents: 0.5cc/kg/day(5 mg/kg/day)in divided q 6 to 8 hr) IM, IV, Oral
10mg/ml
Chlorpheniramine IV
10mg/ml Child 1–5 months: 0.025cc/kg(0.25mg/kg) (max. per dose 2.5 mg), repeated if necessary; maximum 4 doses
per day
Child 6 months–5 years: 0.25cc/dose(2.5 mg), repeated if necessary; maximum 4 doses per day
Child 6–11 years: 0.5cc/dose(5mg) repeated if necessary; maximum 4 doses per day
Child 12–17 years: 1cc/dose(10 mg) repeated if necessary;maximum 4 doses per day
Decadron IV
4mg/ml Meningitis:0.0375cc/kg/dose(0.15mg/kg every 6 hours)
Croup:0.15cc/kg(0.6 mg/kg/IV/IM once)
Suppression of inflammatory and allergic disorders
Child 1 month–11 years: ≈ 0.02cc-0.083cc/kg/day(0.083–0.333mg/kg) in 1–2 doses
Life-threatening cerebral oedema
-Child (body-weight up to 35 kg): Initially 16.7 mg, then 3.3 mg every 3 hours for 3 days
-Child (body-weight 35 kg and above): Initially 20.8 mg, then 3.3 mg every 2 hours for 3 days
Hydrocortisone Vial 50mg/ml Inflamation:0.02-0.1cc/kg/day(1-5 mg/kg/day IM/IV divided q12-24hr)
Asthma:0.02-0.04cc/kg/dose (1-2 mg/kg IV q6hr for 24 hr)

Valium 5mg/ml Status epilepticus

Phenytoin
50mg/ml
Phenobarbital(luminal) 40mg/ml
Note:Other Amp contain 200 mg/ml
Age<11 yrs :0.06-0.08cc/kg/dose (0.3-0.4mg/kg/dose,repeat once after 5-10 minutes)IV
Age>12 yrs : 10 mg/dose , repeat after 5-10 minutes
Status epilepticus
Age:neonate-12 years IV
Loading dose:0.4cc/kg (20 mg/kg) in single or divided dose if necessary may administer additional dose of 5-
10 mg/kg 10 min after loading dose
Maintenance: 0.08-0.16cc/kg/day(4-8mg/kg/day) divided twice daily
(Maintenance doses should be started within 12 to 24 hours of the loading dose)
Status epilepticus
Age:neonate-12 years IV
Loading dose:0.5cc/kg (20 mg/kg/dose) then additional doses of 5-10 mg/kg can be given until a cumulative
dose of 40 mg/kg is reached
Maintenance :0.075-0.15cc/kg/day (3-6 mg/kg/day) divided twice daily
(Maintenance doses should be started within 12 to 24 hours of the loading dose)
Note:if the amp contain 200 mg/ml so the the dose in cc is different.

Antipyrexia/NSAID
Paracetamol 10mg/ml
Ibuprofen
Diclofenac potassium
Doses
1-1.5cc/kg/dose (10-15mg/kg) IV q 4–6 hours , in neonate the low dose is preferable
The oral dose is same as IV in infants and children
5-10 mg/kg/dose PO q 6-8hr
≥3 years: 2-3 mg/kg/day PO for up to 4 weeks

2
Vitamin K(phytomenadione) Neonatal prophylaxis of vitamin-K deficiency bleeding
10mg/ml BY IM INJECTION
Preterm neonate: 0.04cc/kg(0.4mg/kg , max. per dose 1 mg) for 1 dose
Neonate: 0.1cc/dose (1 mg for 1 dose, to be given at birth)

Neonatal hypoprothrombin aemia | Vitamin-K deficiency bleeding

BY IV INJECTION
Neonate:0.1cc (1 mg every 8 hours if required)
Vitamin A In measles Vitamin A should be administered once daily for 2 days at doses of:
Age<6 mo=50,000 IU PO
Age 6-11mo=100,000 IU PO
Age>11mo=200,000 IU PO

Calcium chloride (10%) Hypocalcemia: 0.027-0.05cc/kg/dose (2.7 to 5 mg/kg/dose) every 4 to 6 hours IV

1ml=100 mg ,1.36 meq/ml
Calcium gluconate (10%) Hypocalcemia: Infants, Children, and Adolescents:2-5cc/kg/day (200 to 500 mg/kg/day) as a continuous
1ml=100 mg infusion or in 4 divided doses IV

Symptomatic(severe tetany or seizures resulting from hypocalcemia):

1 to 2 cc/kg/dose(100-200mg/kg) IV
In hypocalcemia due to exchange transfusion:
give 1cc calcium for each 100 ml of blood during Exchange transfusion
Potassium chloride 15% In DKA:Potassium replacement should be given as 50% potassium chloride and 50% potassium phosphate at
1.5 gram in 10 ml a concentration of 20 to 40 mEq/L(10-20cc /L)=1-2cc of Kcl/100ml of fluid
1ml=2mmol , 1 meq=1 mmol
Na bicarbonate 8.4% Renal hyperkalaemia , Persistent cyanotic spell in a child with congenital heart disease despite optimal
1 ml=1 mmol use of 100% oxygen and propranolol
1 meq=1 mmol 1cc/kg (1 mmol/kg/day)
For IV administration to infants, use the 0.5 mEq/mL solution or dilute the 1 mEq/mL solution 1:1 with sterile
water , for direct IV infusion in emergencies, administer slowly (maximum rate in infants: 10 mEq/minute);
for infusion, dilute to a maximum concentration of 0.5 mEq/mL in dextrose solution and infuse over 2 hours
(maximum rate of administration: 1 mEq/kg/hour).
Note:the direct iv is used in hyperkalemia over 5–10 min
Aminophylline Bronchospasm
1ml=25 mg Loading dose
0.2cc/kg(5mg/kg)infused over 20-30 minutes IV
Maintenance dose
Child 1 month–11 years:0.04cc/kg(1mg/kg/hour)
Child 12–17 years:0.02-0.028cc/kg (0.5-0.7 mg/kg/hour)
Lasix 1mL=10mg Oedema in heart failure, renal disease, and hepatic disease | Pulmonary oedema
Neonate: 0.05-0.1cc/kg(0.5–1 mg/kg every 12–24 hours) IV
Child 1 month–11 years: 0.05-0.1cc/kg (0.5–1 mg/kg every 8 hours) (max.per dose 40 mg every 8 hours)
Child 12–17 years: 2-4cc(20–40 mg every 8 hours as required )
Atropine 1ml=0.6 mg Sinus bradycardia
0.033cc/kg(0.02 mg/kg IV/IO q5min for 2-3 doses)
Treatment of poisoning by organophosphorus insecticide or nerve agent (in combination with
pralidoxime chloride)
0.033cc/kg (0.02 mg/kg every 5–10 minutes)
Adrenaline 1ml=1mg Asystole and symptomatic bradycardia
1:1000 solution 1:10,000 solution:0.1cc/kg (0.01 mg/kg IO/IV)
Note:9cc of fluid should be added in 1cc of adrenaline so the result is 10 cc of 1:10000 Solution(1cc=0.1mg)
Croup
BY INHALATION OF NEBULISED SOLUTION
Child 1 month–11 years: 0.4cc/kg(0.4 mg/kg) dose to be repeated after 30 minutes if necessary
Emergency treatment of acute anaphylaxis (under expert supervision) | Angioedema
BY IM INJECTION
Child 1 month–5 years: 0.15mg, doses may be repeated several times if necessary at 5 minute intervals
Child 6–11 years: 0.3mg, doses may be repeated several times if necessary at 5 minute intervals
Child 12–17 years: 0.5mg,doses may be repeated several times if necessary at 5 minute intervals
Dopamine hydrochloride To correct the haemodynamic imbalance due to acute hypotension, shock, cardiac failure, adjunct
40 mg/ ml following cardiac surgery
80 mg/ml BY CONTINUOUS INTRAVENOUS INFUSION
160 mg/ml ▶ Neonate: Initially 3 micrograms/kg/minute (max. per dose 20 micrograms/kg/minute), adjusted according
to response.
▶ Child: Initially 5 micrograms/kg/minute (max. per dose 20 micrograms/kg/minute), adjusted according to
response
Dobutamine Inotropic support in low cardiac output states, after cardiac surgery, cardiomyopathies, shock
12.5mg/ml BY CONTINUOUS INTRAVENOUS INFUSION
5mg/ml Neonate: Initially 5 micrograms/kg/minute, then adjusted according to response to 2–20
micrograms/kg/minute
Child: Initially 5 micrograms/kg/minute, then adjusted according to response to 2–20 micrograms/kg/minute

3
Noradrenaline
1mg/1ml
Amoxicillin
(500-mg or 1gram dry powder
vials)
Ampicillin (500-mg dry powder
vials)
Ampiclox powder for
reconstitution:500 mg [contains
ampicillin 250 mg and cloxacillin
250 mg]
Cefotaxime(Claforan)
Vial .250 mg, 500 mg,1gram
Ceftriaxone
(Vial . 500 mg, 1gram)
Cefixime (Suprax)
Tablet: 200, 400 mg Suspension:
100 mg/5 mL
Ceftazidime
(Vial . 500 mg, 1gram)
Meropenem (Vial 500 mg , 1gram)
Vancomycin
(Vial 500 mg)
Teicoplanin (Targocid)
(Vial 200 , 400 mg)
Gentamicin(Garamycin)
(Amp.80mg/2ml ,40mg/2ml)
Amikacin
(Vial 100 , 500 mg)
Ciprofloxacin (2mg/ml)
Oral suspension:250 & 500mg/5mL
Flagyl (5mg/ml)
suspension 125/5 ml
Erythromycin
(susp.40mg/ml)
Acute hypotension (septic shock) | Shock secondary to excessive vasodilation (as noradrenaline)
▶ BY CONTINUOUS INTRAVENOUS INFUSION
Neonate: 20–100 nanograms/kg/minute (max. per dose 1 microgram/kg/minute), adjusted according to
response.
Child: 20–100 nanograms/kg/minute (max. per dose 1 microgram/kg/minute), adjusted according to response
Neonate up to 7 days: 60-120mg/kg/day IV (divided twice)
Neonate 7 days to 28 days and children: 90-180mg/kg/day IV (divided three times)
increased dose used in severe infection, community acquired pneumonia or salmonellosis.
Neonates: Postnatal age ≤7 days weight ≤2,000 g: 50 mg/kg/24 hr IV or IM q 12 hr
weight >2,000 g: 75 mg/kg/24 hr divided q 8 hr IV
Postnatal age >7 days , weight >2,000 g: 100 mg/kg/24 hr divided q 6 hr IV
Child: 100-200mg/kg/day(divided four times)
increased dose used in severe infection, community acquired pneumonia or salmonellosis and meningitis.
Children 2-10 years: IV: 250-500 mg every 6 hours
Children >10 years and Adults: IM, IV: 250-1000 mg every 6 hours
Severe susceptible infections due to sensitive Gram positive and Gram-negative bacteria | Meningitis
Neonate up to 7 days: 100 mg/kg/day IV (divided twice)
Neonate >7 days : 150 mg/kg/day IV (divided three times)
Child: 150-200 mg/kg/day IV (divided four times)
Mild to moderate infections(pneumonia):50 to 75 mg/kg/day IV in 1 to 2 divided doses
Serious infections(meningitis and Epiglottitis ):100 mg/kg/day IV in 1to 2 divided doses
Age: 6 months-12 years, ≤45 kg: 8 mg/kg/day PO in single daily dose or divided q12hr
Age: >12 years, >45 kg: 400 mg/day PO in single daily dose or divided q12hr
Severe susceptible infections due to sensitive Gram positive and Gram-negative bacteria IV
Neonate up to 7 days: 100 mg/kg/day divided q 12 hours
Neonate >7 days , wt > 1200 g and children: 150 mg/kg/day divided q 8 hours
Aerobic and anaerobic Gram-positive and Gram-negative infections | Hospital-acquired septicaemia IV
Neonate up to 7 days: 40 mg/kg/day(divided twice)
Neonate 7 days to 28 days: 60 mg/kg/day(divided three times)
Child 1 month–11 years (body-weight up to 50 kg): 30-60 mg/kg/day(divided 3 times)
Child 1 month–11 years (body-weight 50 kg and above): 1.5-3 g/day(divided 3 times)
Child 12–17 years: 1.5-3 g/day (divided 3 times)
Bacterial meningitis
Neonates:
Postnatal age ≤7 days, weight >2,000 g: 30 mg/kg/24 hr divided q 12 hr IV
Postnatal age >7 days, weight >2,000 g: 45 mg/kg/24 hr divided q 8 hr IV
Children:60 mg/kg/day IV(divided four times)
Potentially serious Gram-positive infections including endocarditis, and serious infections due to
Staphylococcus aureus IV
Neonate: Initially 16 mg/kg for 1 dose, followed by 8 mg/kg once daily, subsequent dose to be administered
24 hours after initial dose
Children: Initially 10 mg/kg every 12 hours for 3 doses, then 6 mg/kg once daily
Septicaemia | Meningitis and other CNS infections | Acute pyelonephritis | Endocarditis|
Neonatal sepsis
Neonate up to 7 days: 5 mg/kg every 24-36 hours IV (in two divided doses)
Neonate 7 days to 28 days: 7.5 mg/kg every 24 hours IV (divided three times)
Children : 2.5-5-7.5 mg/kg/day
Neonates:
Postnatal age ≤7 days:weight >2,000 g: 20 mg/ kg/day IV divided q 12 hr
postnatal age >7 days:weight >2,000 g: 30 mg/kg/day IV divided q 8 hr
Children: 15-25 mg/kg/day divided q 8-12 hr IV
Neonates: 20 mg/kg/day divided q 12 hr PO or IV
Children: 15-30 mg/kg/day divided q 12 hr PO or IV
Neonates
<7 days >2 kg: 1.5cc/kg/12 hr (15 mg/kg/day divided q12hr) PO or IV
>7 days >2 kg: 3cc/kg/12 hr (30mg/kg/day divided q12hr) PO or IV
Infants and Children
1.5cc/kg/6 hr (30 mg/kg/day divided q6hr) PO or IV
Pertussis
Infant and children : 40-50 mg/kg/day PO in 4 divided doses for 14 days
Mycoplasma pneumonia
Neonates: Postnatal age ≤7 days: 20 mg/kg/24 hr divided q 12 hr PO;
Neonates: Postnatal age >7 days ;weight >1,200 g: 30 mg/kg/24 hr divided q 8 hr PO
Children: Usual max dose 2 g/24 hr
4
Azythromycin Pertussis
(Susp.40mg/ml) 1-5 month : 10 mg/kg/day PO in a single dose for 5 days
Infants age ≥6 mo and children: 10 mg/kg in a single dose on day 1, then 5 mg/kg/ day PO on days 2-5
Clarithromycin Pertussis
(Suspension: 125 mg/5 mL, Neonates: not recommended
250 mg/5 mL) Infants and children:15mg/kg/day in 2 divided doses for 7 days
Acyclovir(Zovirax) Herpes Simplex, treatment BY MOUTH
(Susp.40mg/ml) Child 1–23 months: 100 mg 5 times a day usually for 5 days
(Amp;25 or 50 mg per 1ml) Child 2–17 years: 200 mg 5 times a day usually for 5 days

Herpes simplex encephalitis BY INTRAVENOUS INFUSION

Age<12 years: 20 mg/kg q8hr
Age≥12 years: 10-15 mg/kg q8hr

Varicella zoster (chickenpox) | Herpes zoster (shingles), treatment BY MOUTH

Child 1–23 months: 200 mg 4 times a day for 5 days
Child 2–5 years: 400 mg 4 times a day for 5 days
Child 6–11 years: 800 mg 4 times a day for 5 days
Child 12–17 years: 800 mg 5 times a day for 7 days

5
References
1. BNF for Children
2. Tintinalli's Emergency Medicine Manual
3. Oxford handbook paediatric
4. Nelson’s Pediatric Antimicrobial Therapy
5. Nelson Textbook of Pediatrics
6. Essential Clinical Skills in Pediatrics
7. Medscape
8. Uptodate