| Dosage per kg per Day | |
Drug Generic (Trade Name) | Route | Mild to Moderate Infections | Severe Infections | Comments |
Aminoglycosidesa
|
Amikacin (Amikin) | IV, IM | Inappropriate | 15–22.5 mg in 3 doses (daily adult dose, 15 mg/kg; maximum, 1.5 g) | 30 mg in 3 doses is recommended by some consultants. |
Gentamicin | IV, IM | Inappropriate | 3–7.5 mg in 3 doses (daily adult dose is the same) | Once-daily dosing (5–6 mg/kg every 24 h) is investigational in children. |
Kanamycin | IV, IM | Inappropriate | 15–22.5 mg in 3 doses (daily adult dose, 1-1.5 g) | 30 mg in 3 doses is recommended by some consultants. |
Neomycin (numerous types) | PO only | 100 mg in 4 doses | 100 mg in 4 doses | For some enteric infections. |
Tobramycin (Nebcin) | IV, IM | Inappropriate | 3–7.5 mg in 3 doses (daily adult dose, 3–5 mg in 3 doses) | Once daily dosing (5–6 mg/kg every 24 h) is investigational in children. |
Carbapenems |
Doripenem (Doribax) | IV | … | 500 mg every 8 h | Not approved for use in children. |
Imipenem/cilastatinb(Primaxin) | IV, IM | see package insert | see package insert | Approved for use in pediatric patients, neonates to 16 years of age. Caution in use for Treatment of meningitis because of possible seizures. |
Meropenemb Merrem) | IV | see package insert | see package insert | Approved for use in children 3 mo of age and older. Daily dose varies by indication with higher dosage used for Treatment of meningitis. |
Ertapenem (Invanz) | IV | see package insert | see package insert | Approved for children 3 mo to 12 y of age. Less active against Pseudomonas species, Acinetobacter species, and gram-positive cocci. |
Cephalosporinsb |
Cefaclor (Ceclor) | PO | 20–40 mg in 2 or 3 doses (daily adult dose, 750 mg–1.5 g) | Inappropriate | A twice-daily regimen has been demonstrated to be effective for Treatment of acute otitis media (AOM). |
Cefadroxil (Duricef) | PO | 30 mg in 2 doses (maximum daily adult dose, 2 g) | Inappropriate | First-generation activity. |
Cefazolin (Ancef, Kefzol) | IV, IM | 100 mg in 3 doses (maximum 4–6 g/day) | 100 mg in 3 doses (maximum 4–6 g/day) | First-generation activity. |
Cefdinir (Omnicef) | PO | 14 mg in 1 or 2 doses (maximum 600 mg/day) | Inappropriate | Inadequate activity against resistant pneumococci. |
Cefditoren (Spectracef) | PO | 800 mg total dose divided (maximum 800 mg/day) in 2 doses | No data available | Not approved for children younger than 12 y of age. |
Cefepime (Maxipime) | IV, IM | ≥2 mo of age: 100–150 mg in 3 doses (daily adult dose, 1–2 g) | ≥2 mo of age: 150 mg in 3 doses (daily adult dose, 2–4 g) | Not approved for Treatment of meningitis. Considered fourth generation. |
Cefixime (Suprax) | PO | 8 mg in 1 or 2 doses (maximum adult dose, 400 mg) | Inappropriate | Single-dose Treatment for gonorrhea (400 mg X 1). |
Cefoperazone (Cefobid) | IV, IM | 100–150 mg in 2 or 3 doses (maximum daily adult dose, 4 g) | No data available | Not approved for use in children. |
Cefotaxime (Claforan) | IV, IM | 75–100 mg in 3 or 4 doses (daily adult dose, 4–6 g) | 150–200 mg in 3 or 4 doses (daily adult dose, 8–10 g) | A regimen of 300 mg in 3 or 4 doses can be used for Treatment of meningitis. |
Cefotetan (Cefotan) | IV, IM | Inappropriate | 40–80 mg in 2 doses (maximum daily adult dose, 6 g) | Not licensed for use in children. |
Cefoxitin (Mefoxin) | IV, IM | 80–100 mg in 3–4 doses (daily adult dose, 3–4 g) | 80–160 mg in 4-6 doses (daily adult dose, 6–12 g) | Improved activity against Bacteroides fragilis. |
Cefpodoxime (Vantin) | PO | 10 mg in 2 doses (maximum daily adult dose, 800 mg) | Inappropriate | Similar to cefixime with greater activity against methicillin-susceptible staphylococci. |
Cefprozil (Cefzil) | PO | 15–30 mg in 2 doses (maximum daily adult dose, 1 g) | Inappropriate | 30 mg dosage recommended for Treatment of acute otitis media. |
Ceftazidime (Ceptaz, Fortaz, Tazidime) | IV, IM | 75–100 mg in 3 doses (daily adult dose, 3 g) | 125–150 mg in 3 doses (daily adult dose, 6 g) | Anti-Pseudomonas activity; has been approved for use in children. |
Ceftibuten (Cedax) | PO | 9 mg in 1 dose (maximum adult dose: 400 mg/day) | Inappropriate | Approved for people ≥6 mo of age. Inadequate activity against intermediate and resistant pneumococci. |
Ceftizoxime (Cefizox) | IV, IM | 100–150 mg in 3 doses (daily adult dose, 3–4 g) | 150–200 mg in 3 or 4 doses (daily adult dose, 4–6 g) | Third-generation activity. |
Ceftriaxone (Rocephin) | IV, IM | 50–75 mg in 1 or 2 doses (daily adult dose, 2 g) | 80–100 mg in 1 or 2 doses (daily adult dose, 4 g) | Larger dosage appropriate for penicillin-resistant pneumococcal meningitis. |
Cefuroxime (Zinacef) | IV, IM | 75–100 mg in 3 doses (daily adult dose, 2–4 g) | 100–150 mg in 3 doses (daily adult dose, 4–6 g) | Second-generation activity, less active than third-generation cephalosporins against penicillin-resistant Streptococcus pneumoniae. |
Cefuroxime axetil (Ceftin) | PO | 20–30 mg in 2 doses (daily adult dose, 1–2 g) | Inappropriate | The higher dosage recommended for Treatment of otitis media. Limited activity against penicillin-resistant S pneumoniae. |
Cephalexin (Keflex) | PO | 25–50 mg in 3–4 doses (daily adult dose, 1–4 g) | Inappropriate | First-generation activity. |
Cephalothin (Keflin) | IV, IM | 80–100 mg in 4 doses (daily adult dose, 2–4 g) | 100–150 mg in 4–6 doses (daily adult dose, 8–12 g) | First-generation activity. |
Cephradine (Velosef) | PO | 25–50 mg in 2–4 doses (daily adult dose, 1–4 g) | Inappropriate | First-generation activity. |
Chloramphenicol (Chloromycetin) |
Chloramphenicol | IV | Inappropriate | 50–100 mg in 4 doses (daily adult dose, 2–4 g) | Optimal dosage is determined by measurement of serum concentrations with resulting modifications to achieve therapeutic concentrations. Use only for serious infections because of the rare occurrence of aplastic anemia after administration. Oral formulation (palmitate) not available in the United States. |
Clindamycin (Cleocin) | IM, IV | 15–25 mg in 3–4 doses (daily adult dose, 600 mg-3.6 g) | 25–40 mg in 3–4 doses (daily adult dose, 1.2–2.7 g) | Active against anaerobes, especially Bacteroides species. Active against many multidrug-resistant pneumococci. |
| PO | 10–20 mg in 3–4 doses (daily adult dose, 600 mg–1.8 g) | Inappropriate | Effective for otitis media caused by many multidrug-resistant pneumococci. |
Fluoroquinolonesd |
Ciprofloxacin (Cipro) | PO | 20–30 mg in 2 doses (daily adult dose, 0.5–1.5 g) | 30 mg in 2 doses (daily adult dose, 1.0–1.5 g) | Only licensed for children younger than 18 y of age for specific indicationsd . |
Ciprofloxacin (Cipro), continued | IV | Inappropriate | 18–30 mg in 2 or 3 doses (daily adult dose, 400–800 mg in 2 doses) | … |
Ketolides |
Telithromycin | PO | 800 mg total dose, once daily (maximum adult dose 800 mg/day) | | Not approved for people younger than 18 y of age. Used for Treatment of community- acquired pneumonia. |
Macrolides/ streptogramins |
Azithromycin (Zithromax) | PO | 5–12 mg once daily (maximum daily adult dose, 600 mg) | Inappropriate | Pharyngitis, 6 mo of age or older: 12 mg/kg per day for 5 days. |
Clarithromycin (Biaxin) | PO | 15 mg in 2 doses (maximum daily adult dose, 1 g) | Inappropriate | Similar to erythromycin; more activity against Mycobacterium avium and Helicobacter pylori and preventing Mycobacterium tuberculosis. |
Erythromycins (numerous types) | PO | 30–50 mg in 2–4 doses (daily adult dose, 1–2 g) | Inappropriate | Available in base, stearate, ethylsuccinate, and estolate preparations. |
| IV | Inappropriate | 15–50 mg in 4 doses (daily adult dose, 1–4 g) | Administer in a continuous drip or by slow infusion over 60 min or longer. May cause cardiac arrhythmia. |
Metronidazole (Flagyl) | PO | 15–50 mg in 3 doses (maximum daily adult dose, 1–2.25 g) | Inappropriate | Safety in infants and children has not been established, except for intestinal amebiasis. |
Miscellaneous |
Daptomycin | IV | Inappropriate | 4 mg, once daily | Not approved for people < 18 y of age. Effective for complicated skin and soft tissue infections caused by staphylococci, streptococci, and enterococci. |
Monobactam |
Aztreonamb (Azactam) | IV, IM | 90 mg in 3 doses (daily adult dose, 3 g) | 90–120 mg in 3 or 4 doses (maximum daily adult dose, 8 g) | … |
Loracarbef (Lorabid) | PO | 6 mo–12 y of age: 15 mg/kg per day, every 12 h ≥13 y of age: 400 mg/day, in 2 doses | 6 mo–12 y of age: 30 mg/kg per day, every 12 h ≥13 y of age: 800 mg/day, in 2 doses | Pharyngitis, tonsillitis, sinusitis, and skin and soft tissue infections (use higher dose for sinusitis). |
Nitrofurantoin (Furadantin) | PO | 5–7 mg in 4 doses (daily adult dose, 200–400 mg) | Inappropriate | Should not be used for young infants; prophylactic dose is 1–2 mg/kg per day in 1 dose. |
Oxazolidinones |
Linezolid (Zyvox) | PO, IV | 30 mg in 3 doses (children < 12 y of age) 20 mg in 2 doses (adolescents and adults up to 1200 mg maximum) | 30 mg in 3 doses (children < 12 y of age) 20 mg in 2 doses (adolescents and adults up to 1200 mg maximum) | Myelosuppression may occur. Active against Enterococcus faecium, E faecalis, oxacillin-resistant S aureus, and penicillin-resistant S pneumoniae. |
PENICILLINSb |
Broad-spectrum penicillins |
Ampicillin (numerous types) | IV, IM | 100–150 mg in 4 doses (daily adult dose, 2–4 g) | 200–400 mg in 4 doses (daily adult dose, 6–12 g) | Larger dosage recommended for Treatment of meningitis. |
| PO | 50–100 mg in 4 doses (daily adult dose, 2–4 g) | Inappropriate | Diarrhea occurs in approximately 20% of recipients. |
Ampicillin-sulbactam (Unasyn) | IV | 100–150 mg of ampicillin in 4 doses | 200–400 mg of ampicillin in 4 doses (daily adult dose, 6–12 g) | Licensed for use in children 1 y of age and older. |
Amoxicillin (numerous types) | PO | 25–50 mg in 3 doses (daily adult dose, 750 mg–1.5 g); 90 mg/kg in 2 doses for AOM | Inappropriate | 90 mg/kg dose recommended for initial therapy of AOM.e |
Amoxicillin-clavulanic acid |
(Augmentin ES-600; 14:1 ratio) | PO | 90 mg of amoxicillin in 2 doses | Inappropriate | Preferred for recurrent AOM and Treatment failures. |
(Augmentin XR) | PO | 4 g total, in 2 doses (total 4000 mg) | Inappropriate | Oral extended-release formulation licensed for adults. |
Piperacillinf | IV, IM | 100–150 mg in 4 doses (daily adult dose, 6–8 g) | 200–300 mg in 4–6 doses (daily adult dose, 12–18 g) | … |
Piperacillin- tazobactamf (Zosyn) | IV | Inappropriate | 300 mg of piperacillin in 3 doses (children >9 months of age)240 mg of piperacillin in 3 doses (children 2–9 months of age) (daily adult dose 12–18 g) | Approved for use in children 2 mo of age and older with appendicitis and/or peritonitis. |
Ticarcillin (Ticar) | IV, IM | 100–200 mg in 4 doses (daily adult dose, 4–6 g) | 200–300 mg in 4 doses (daily adult dose, 12–24 g) | Contains 5.2 mEq of sodium/g. |
Ticarcillin-clavulanate (Timentin) | IV, IM | 100–200 mg of ticarcillin in 4 doses (daily adult dose, 4–6 g) | 200–300 mg of ticarcillin in 4 doses (daily adult dose, 12–24 g) | … |
Penicillin G and V b,f |
Penicillin G, crystalline potassium or sodium (numerous types) | IV, IM | 25 000–50 000 U in 4 doses | 250 000–400 000 U in 4–6 doses. Maximum adult dose 24 million U/24 h. | Larger dosage appropriate for central nervous system infections. |
Penicillin G procaine (numerous types) | IM | 25 000–50 000 U in 1–2 doses. Maximum adult dose 4.8 million U/24 h. | Inappropriate | Contraindicated for procaine allergy. |
Penicillin G benzathine (Bicillin LA, Permapen) | IM | < 27.3 kg (60 lb) in body weight: 600 000 U once ≥27.3 kg (60 lb): 1.2 million U once | Inappropriate | Major use is prevention of rheumatic fever by Treatment and prophylaxis of streptococcal infections. |
Penicillin V (numerous types) | PO | 25–50 mg in 3 or 4 doses. Maximum adult dose 500 mg/dose, every 6–8 h (2 g/24 h). | Inappropriate | Optimal to administer on an empty stomach. |
Penicillinase-resistant penicillinsb | | | | Methicillin (oxacillin)-resistant staphylococci usually are resistant to all other semisynthetic antistaphylococcal penicillins and cephalosporins. |
Penicillinase-resistant penicillinsb | | | | Methicillin (oxacillin)-resistant staphylococci usually are resistant to all other semisynthetic antistaphylococcal cephalosporins. |
Oxacillin | IV, IM | 100–150 mg in 4 doses (daily adult dose, 2–4 g) | 150–200 mg in 4–6 doses (daily adult dose, 4–12 g) | … |
Nafcillin | IV, IM, PO | 50–100 mg in 4 doses (daily adult dose, 2–4 g) | 100–150 mg in 4 doses (daily adult dose, 4–12 g) | Oral formulation not used because of poor absorption. |
Cloxacillin (Tegopen, Cloxapen) | PO | 50–100 mg in 4 doses (daily adult dose, 2–4 g) | Inappropriate | … |
Dicloxacillin | PO | 25–50 mg in 4 doses (daily adult dose, 1–2 g) | Inappropriate | Excellent serum concentrations after oral administration. |
Rifampin (numerous types) | PO | 10–20 mg in 1–2 doses (daily adult dose, 600 mg) | 20 mg in 2 doses. Maximum adult dose 600 mg/24 h. | Should not be used as monotherapy except when given for prophylaxis. |
| IV | 10–20 mg in 1–2 doses (daily adult dose, 600 mg) | 20 mg in 2 doses. Maximum adult dose 600 mg/24 h. | … |
Rifaximin (Xifaxan) | PO | ≥12 y of age: 600 mg/day, given 3 times/day | Inappropriate | Treatment of travelers’ diarrhea caused by noninvasive Escherichia coli. Nonabsorbable. |
Streptogramin |
Quinupristin/dalfopristin (Synercid) | IV | 15 mg in 2 doses (daily adult dose, same) | 22.5 mg in 3 doses (daily adult dose, same) | Modestly effective for vancomycin-resistant E faecium (but not Enterococcus faecalis) as well as Staphylococcus aureus. Limited use in children. |
Sulfonamides |
Sulfadiazine | PO | 100–150 mg in 4 doses (daily adult dose 4–6 g) | 120–150 mg in 4–6 doses (daily adult dose 4–6 g) | … |
Sulfisoxazole (Gantrisin) | PO | 120–150 mg in 4–6 doses (daily adult dose 2–4 g) | 120–150 mg in 4–6 doses (daily adult dose 2–4 g) | … |
Triple sulfonamides (numerous types) | PO | 120–150 mg in 4 doses | 120–150 mg in 4 doses | … |
Trimethoprim-sulfamethoxazole (Bactrim, Septra) | PO | 8–12 mg of trimethoprim, 40–60 mg of sulfamethoxazole in 2 doses (daily adult dose, 320 mg of trimethoprim, 1.6 g of sulfamethoxazole) | 20 mg of trimethoprim, 100 mg of sulfamethoxazole in 4 doses (for use only in Pneumocystis jiroveci pneumonia) | For prophylaxis in immunocompromised patients, recommended dose is 5 mg of trimethoprim, 25 mg of sulfamethoxazole per kg per day in 2 doses. |
Trimethoprim-sulfamethoxazole (Bactrim, Septra) | IV | Inappropriate | 8–12 mg of trimethoprim, 40–60 mg of sulfamethoxazole in 4 doses | Use intravenous formulation when PO formulation cannot be administered. |
| OR |
Trimethoprim-sulfamethoxazole (Bactrim, Septra) | | | 20 mg of trimethoprim, 100 mg of sulfamethoxazole in 4 doses | Treatment of Pneumocystis infection. |
Tetracyclines (numerous types) | IV | Inappropriate | 10–25 mg in 2–4 doses (daily adult dose, 1–2 g) | Responsible for staining of developing teeth; use only in children 8 y of age or older except in circumstances in which the benefits of therapy exceed the risks and alternative drugs are less effective or more toxic . |
Tetracyclines (numerous types) | PO | 20–50 mg in 4 doses (daily adult dose, 1–2 g) | Inappropriate | Responsible for staining of developing teeth; use only in children 8 y of age or older except in circumstances in which the benefits of therapy exceed the risks and alternative drugs are less effective or more toxic . |
Doxycycline (numerous types) | PO, IV | 2–4 mg in 1–2 doses (daily adult dose, 100–200 mg) | Inappropriate | Adverse effects similar to those of other tetracycline products except that risk of dental staining in children younger than 8 y of age is less. |
Vancomycin (Vancocin, Vancoled, Vancor) | IV | 40 mg in 3–4 doses (daily adult dose,g 1–2 g) | 40–60 mg in 4 doses (daily adult dose,g 2–4 g) | In meningitis, 60 mg/kg dose should be given over a period of at least 60 min; routine monitoring of serum concentrations is unnecessary. |
IV, indicates intravenous; IM, intramuscular; PO, oral; AOM, acute otitis media.
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