Dosages (mg/kg/day) and Intervals of Administration
Body Weight <2000g | Body Weight >2000g | |||||
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Antibiotics | Routes of Administration | Age 0–7 days | >7 days | Age 0–7 days | >7 days | Comments |
Acyclovir (zovirax, ocuvir) 250 mg, 500 mg vial | IV | 10 mg/kg q8h for 10-14 days Dilution to 5 mg/ml, infuse 8h over 1 hour 5 mg/kg q8h | Prophylactic dose: | Adverse reactions noted: Transient renal dysfunction and thrombophlebitis. Increase dosing interval q24 h when renal functions < 25% of normal. Oral absorption not tested in neonates. | ||
Amikacin (mikacin) (50 mg/ml 2 ml vial) | IM, IV | <28 wk 28-34 wk >34 wk | 7.5 mg/kg q24h 7.5 mg/kg q18h 7.5 mg/kg q12h IV infusion over 30 minutes | <28 wk 28-34 wk >34 wk | 7.5 mg/kg q18h 7.5 mg/kg q12h 7.5 mg/kg q8h | Ototoxicity, nephrotoxicity, neuromuscular blockade, BM suppression, eosinophilia and tremor. Synergestic action with diuretics. Therapeutic range: 20-30 mg/L (peak) and <8 mg/L (trough) CSF penetration is poor, even in meningitis. Preferred in serious infections of gram-negative bacilli. Susceptible pathogens include Pseudomonas, E. coli, Proteus, Klebsiella, Serratia, Staphylococcus. It exerts bactericidal action by inhibiting protein synthesis. |
Amoxicillin (mox) (250 mg, 500 ml vials) | PO IV, IM | 50 mg/kg q12 h | 50 mg/kg q8h Increase dose to 100 mg/kg in suspected meningitis | 50 mg/kg q12h | 50 mg/kg q8h | SE: rash, diarrhoea. It exerts bactericidal by virtue of its ability to inhibit synthesis of the bacterial cell wall. Susceptible pathogens include α and β–hemolytic streptococci, strep pneumoniae, strep faecalis, Bacillus anthrasis, Clostridium spp except C. difficile, some non-Betalactamase staphylococci, B. Pertusis, Haemophillus, E. coli, Proteus, Salmonella, Shigella, Treponema, Pseudomonas. |
Amoxyclav (augmentin) | PO, IV | ——— | 40 mg/kg/day q8h (Amoxycillin 6.7 mg/kg q8h | ——— | 40 mg/kg/day q8h (Amoxycillin 13.3 mg/kg q8h | Inhibits production of β–lactamases. Many β–lactamase producing strains |
Clavulinic acid 1.7 mg/kg q8h) | Clavulinic acid 3.3 mg/kg q8h) | of staph aureus and coagulase negative Staphylococcus species are made sensitive. | ||||
Amphotericin B (fungizone) Polyene antifungal (50 mg/vial) | IV | 0.5-1.0 mg/kg/O.D with maximum of 1.0 mg/kg/day for 4-6 weeks (total dose of 25-40mg) NOTE:
| Adverse reactions: hypotension, thrombophlebitis, renal dysfunction (hypokalemia, azotemia, RTA, hematologic (anemia, thrombocytopenia, granulocytopenia) Monitor closely hematologic and renal status (CBC, platelet count, serum BUN, creatinine, electrolytes). Reduce dosage or interrupt therapy or alternate day therapy when renal function falls to <20% of normal. Adverse effects appear to be less common in neonates. Fever, chills, nausea and vomiting are common side effects, may premedicate with acetaminophen and diphenhydramine 30min before and 4 hrs after infusion. | |||
Ampicillin (roscillin) | IV, IM Meningitis Other disease PO | 50 mg/kg q12h 25 mg/kg q12h | 50 mg/kg q8h 25 mg/kg q8h | 50 mg/kg q8h 25 mg/kg q8h | 50 mg/kg q6h 25 mg/kg q6h 62.5 mg/kg/dose q6h | At high doses SE are same as penicillin. May cause interstitial nephritis, hemolytic anaemia and pseudo-membranous colitis. More active than penicillin against Listeria Monocytogenes, E. coli, Proteus, Salmonella. CSF penetration is slightly better than penicillin G. |
Azlocillin | IV | 50 mg/kg q12h | 50 mg/kg q12h | 100 mg/kg q12h | 100 mg/kg q8h | Must not be mixed in same syringe or infusion with aminoglycosides. |
Aztreonam (Azenam) | IV, IM | 30 mg/kg q12h | 30 mg/kg q8h | 30 mg/kg q8h | 30 mg/kg q6h | β–lactum antibiotic, active against gram-negative enteric bacilli including pseudomonas aeruginosa. SE: Thrombophlebitis, eosinophilia; leukopenia, neutropenia, thrombocytopenia, increase liver enzymes, hypotension, seizures. If creatinine clearance is between 10–30 ml/min, the dose should be halved after giving an initial loading dose. In severe reveal failure or on dialysis should recieve the standard loading dose, followed by ¼ of the loading dose at standard dose interval. It interacts with penicillinbinding |
proteins of susceptible microorganisms and induces the formation of long filaments bacterial structures lending to lysis of the bacterial cell. | ||||||
Carbenicillin | IV, IM | 75 mg/kg q12h | 75 mg/kg q8h | 75 mg/kg q8h | 75 mg/kg q6h | It has additive inhibition of platelet function and hence may increase the risk of haemorrhage. May produce hypokalemia. Do not mix with genta. |
Cefaclor (keflor) (125 mg/ 5ml) | PO | — | — | — | 20 mg/kg q12h | Active against haemophillus influenzae including strains producing β– lactamases. |
Cefazolin (Reflin) (125 mg, 250 mg vials) | IV, IM | 20 mg/kg q12h | 20 mg/kg q12h | 20 mg/kg q12h | 20 mg/kg q8h | Caution with penicillin allergy or renal impairment. Leukopenia, thrombocytopenia, increase liver enzymes, false +ve urinary reducing substances. Active against gram-positive including staphylococcus aureus (even penicillinase producing organisms), Group A beta-hemolytic streptococci, Streptococcus pneumoniae, gram-negative including E. coli Proteus, Klebsiella, H. influenzae, Enterobacter. |
Cefotaxime (traxim) (500 mg vial) | IV, IM | 50 mg/kg q12h | 50 mg/kg q8h | 50 mg/kg q12h | 50 mg/kg q8h | Good CNS penetration. Rash. Thrombocytopenia, leucopenia. Active against staphylococci,H. influenzae, Salmonella, Shigella, Serratia, Spirochetes, Citrobacter, Neisseria, Proteus and Pseudomonas. In renal impairment with creatinine clearance of 5ml/min or less, dose is reduced to ½. |
Cefoxitin | IV | 15 mg/kg q8h | 30 mg/kg q6h | 15 mg/kg q8h | 30 mg/kg q6h | Thrombophlebitis. Activity against bacteroides fragilis and indole positive proteus. |
Ceftazidime (fortum, Tazid) (250 mg vial) | IV, IM Meningitis Other disease | 50 mg/kg q12h 30 mg/kg q12h | 50 mg/kg q8h 30 mg/kg q8h | 50 mg/kg q8h 30 mg/kg q12h | 50 mg/kg q8h 30 mg/kg q8h | Rash, false positive Coomb's test. Active against pseudomonas. It has extended spectrum of activity against gram-negative bacteria especially pseudomonas. Highly stable to betalactamases. In renal insufficiency dose is modified according to creatinine clearance. Urticaria, neutropenia, thrombocytopenia, pseudomembranous colitis, increased liver enzymes. |
Give IV infusion over 30 minutes | ||||||
Ceftriaxone (monocef) | IV, IM Meningitis | 100 OD | 100 OD | 100 OD | 100 OD | Reversible cholelithiasis sludging in GB and jaundice. |
(250 mg vial) | Loading Maintenance Other disease | 50 mg/kg q12h 50 OD | 50 mg/kg q12h 50 OD | 50 mg/kg q12h 50 OD | 50 mg/kg q12h 50 mg/kg OD | Caution in neonates with hyperbilirubinemia. Skin rash, pseudomembranous colitis. Potentiates nephrotoxicity along with aminoglycosides and frusemide. Chloramphenicol decreases its efficacy. Pseudomonas shows variable susceptibility. Stable against beta-lactamases. |
Cefuroxime (altacef, forcef) (250 mg vial) | IV, IM | 30 mg/kg q12h | 30 mg/kg q8h | 30 mg/kg q12h | 30 mg/kg q8h | Not recommended for meningitis. Pseudo-membranous colitis, transient increase in urea and creatinine, rash. Active against staphylococci, streptococci, Neisseriae, H. influenzae and gram-negative organisms including E. coli, Klebsiella, Proteus. Not active against Pseudomonas or streptococcus faecalis. Specially active against betalactamase producing strains of H. influenzae and N. Gonorrhoeae. |
For IV infusion, dilute reconstituted dose with NS or DS and infuse over 30 minutes. | ||||||
Cephalothin | IV, IM | 20 mg/kg q12h | 20 mg/kg q8h | 20 mg/kg q12h | 20 mg/kg q8h | Limited experience in neonates. |
Chloramphenicol (enteromycetin) (250 mg, 500 mg vial) (as sodium succinate) | IV, PO | 25 mg/kg once daily | 25 mg/kg once daily | 25 mg/kg once daily | 50 mg/kg q12 | Dose related or ideosyncratic BM suppression, “Gray baby” syndrome, phenobarbitone, rifampicin decreases chloramphenicol levels. Phenytoin increases chloramphenicol levels. Therapeutic levels = 15-25mg/L for meningitis; 10-20mg/L for other infection. Active against most gram-positive and gramnegative bacteria. Active against Neisseriae, Streptococcus pneumoniae, H. influenzae, staphylococci, streptococci, Salmonella, Shigella, Anaerobes, Ricketssiae and Brucella. Not effective against Pseudomonas. |
Give IV bolus with NS or DS | ||||||
Ciprofloxacin (cifran, ciplox) (2 mg/ml, 50 ml/ 100 ml for IV infusion) | PO IV | 7.5 mg/kg q12h 5 mg/kg q12h | 7.5 mg/kg q12h 5 mg/kg q12h | 7.5 mg/kg q12h 5 mg/kg q12h | 7.5 mg/kg q12h 5 mg/kg q12h | Damage to cartilage is observed in experimental animals. Has stood the test of time and no such thing documented in humans? Active against Pseudomonas. When given orally requires acidic media for absorption. Concurrent administration of sucralfate, magnesiumaluminium antacids and ranitidine decreases its absorption. Theophylline concentrations are markedly elevated when co-administered with ciprofloxacin. Potentials oral anticoagulants. |
Infusion given over 30-60 minutes | ||||||
Clindamycin (clincin) (150 mg/ml 2 ml vial) | IV, IM | 5 mg/kg q12h | 5 mg/kg q8h | 5 mg/kg q8h | 5 mg/kg q6h | Not indicated in meningitis, Diarrhoea, rash, Stevens-Johnson syndrome. Pseudomembranous colitis, Thrombo cytopenia, Granulocytopenia. Active against Staphylococci, Streptococci, Bacteroides fragilis and some anaerobes. |
Dilute to 6 mg in 1 ml with NS and D5 infuse slowly over 10-30 minutes. | ||||||
Clotrimazole Topical (candid) | Apply to skin BID x 4-8 wks Thrush: Dissolve slowly one troche in the mouth 5times/day x 14 days. | Erythema, blistering, urticaria where applied. | ||||
Cloxacillin (klox) (250 mg vial) | IV | 25 mg/kg q12h | 25 mg/kg q8h | 25 mg/kg q8h | 25 mg/kg q6h | Double dose for meningitis. Active against Staphylococcus aureus, coagulase negative staphylococci. Poor activity against Treponema pallidum and anaerobes. Its potency is lost in solution with erythromycin, gentamycin, kanamycin, colistin sulfate, chlorpromazine, vitamin C and polymyxin B sulfate. Chloramphenicol antagonizes its bactericidal activity. |
Dose may be increased to 100 mg/kg in severe infections. Do not mix with aminolycosides. | ||||||
Colistin sulphate Polymixin antimicrobial | PO, IM | 40 mg/kg q6h | 40 mg/kg q6h | 40 mg/kg q6h | 40 mg/kg q6h | Active against gram-negative anaerobes including most enterobacteria except proteus, providential and serratia. Activity is also seen against Pseudomonas, Legionella, H. influenzae, Acinetobacter, V. cholera, Salmonella, Shigella and pasteurella. |
Give deep IM | ||||||
Co-trimoxazole (bactrim, septran) (480 mg in 5 ml anpaele 240 mg/ 5 ml suspension | IV PO | Minor infections: Prophylaxis (UTI): Serious Infections and Pneumocystitis carinii pneumonia Pneumocystitis carinii prophylaxis | 4 mg TMP + 24 mg SMX/kg q12h 4 mg TMP + 20 mg SMX/kg once daily 10 mg TMP+ 50 mg SMX/kg q12h 480 mg/m2 q12h EOD (3 days/wk) | For use with caution in infants <1 month; (TMP) to (SMX) ratio is 1 to 5. Can displace bilirubin bound to albumin. Both inhibit folic acid synthesis by the pathogen but at different stages which results in some potentiation of action. Active against staphylococci, enterococci, E. coli, Proteus. Diffuses well into CSF and brain. Steven-Johnson syndrome, agranulocytosis, thrombocytopenia. | ||
Erythromycin (althrocin) (100 mg/ml drops) | PO, IV | 10 mg/kg q12h | 10 mg/kg q8h | 10 mg/kg q12h | 15 mg/kg q8h | May increase serum theophyllin level. Cyclosporine, digoxin, CBZ MPS increases serum levels. Caution: liver disease, with terfenadine cisapride. Estolate may cause cholestasis. Active against gram-positive organisms, including penicillinase producing staphylococci, diphtheria, mycoplasma, urea plasmas, chlamydia, bordetella pertusis and most gram-nega- |
IV infusion is given after diluting in 5% dextrose (not available in indian market) | ||||||
tive organisms. It is used as an alternative to penicillin, in those allergic to penicillin. Topical preparations are also available. Antibacterial activity potentiated by acetazolamide and sodium bicarbonate. | ||||||
Flucloxacillin 50 mg/ml suspension | IV, PO | – | 50 mg/kg q12h 25 mg/kg q12h | – | 50 mg/kg q8h 25 mg/kg q8h 25-50 mg/kg q6h | Double dose for meningitis. Active against Staphylococcus aureus,coagulase negative staphylococci. Poor activity against Treponema pallidumand anaerobes. |
Fluconazole (zocon) (2 mg/ml) 25 ml bottle | IV PO | < 14 days 14-28 days >28 days | 6-12 mg/kg every 72 hr 6-12 mg/kg every 48 hr 6-12 mg/kg every 24 hr | Systemic candidiasis and cryptococcal infection. 3 mg/kl for mucosal candidiasis. Reduce dose in renal impairement. In over 10-30 min. | ||
Flucytosine (5 FC)(10 mg/ml 250 ml bottle) | IV PO | 25 mg/kg q6h Theurapeutic level = 25-100mg/L | 25-50 mg/kg q6h | Adverse reactions noted: enterocolitis, nausea/vomiting diarrhoea, hepatotoxicity, bone marrow suppression. Monitor closely hematologic, renal and liver function status. Increase dosing interval q12h when renal function 50% of normal and to q24h when renal function <10% of normal. | ||
IV infusion over 20-40 min through filter | ||||||
Fucidic acid | IV, PO | 5 mg/kg q6h | 5 mg/kg q6h | 5 mg/kg q6h | 5 mg/kg q6h | For IV use dissolve powder in buffer provided and infuse dose over 6 hours. |
Ganciclovir 500 mg vial | IV | Induction 5 mg/kg q12h or 2-5 mg/kg q8h for 14-21 days. Maintenance therapy: 5 mg/kg OD for 5 days/wk. | Limited experience in neonates. Reduce dose in renal failure. Neutropenia, thrombocytopenia, retinal detachment. IM and SC administration are contraindicated because of high pH (II). | |||
Reconstitute with 10 ml water (50 mg/ml) Infuse over 1 hour. Irritant, handle carefully. | ||||||
Gentamycin (garamycin) (10 mg/ml, 40 mg/ml, 2 ml vial) | IV, IM | <28 wk 28-34 wk > 34 wk | 2.5 mg/kg q24h 2.5 mg/kg q18h 2.5 mg/kg q12h | <28 wk 28-34 wk > 34 wk | 2.5 mg/kg q18h 2.5 mg/kg q12h 2.5 mg/kg q8h | Proximal tubule dysfunction, ototoxicity. Therapeutic level=6–10mg/L (peak) <2mg/L (trough). Eliminated more quickly in patients with cystic fibrosis, multiple sclerosis, burns, neutropenic patients. Active against gramnegative organisms, weak activity against staphylococci and streptococci. Babies on dialysis an 8 hr dialysis reduces serum levels of gentamycin by 50%. At the end of each session give 2mg/kg. Cephalosporin, hydrocortisone and indomethacin potentiate nephrotoxicity. Potentiates neuromuscular blocking agents. Frusemide potentiates its toxicity. |
Imipenem beta-lactam antibiotic (500 mg with 500 mg cilastatin) | IM IV | 20 mg/kg q6-8h over 30-60mins. | 20 mg/kg q6-8h | 20 mg/kg q6-8h | 20 mg/kg q6-8h | Pruritis, urticaria, seizures, hypotension, increased lever enzymes, blood dyscrasias. IM formation cannot be given IV. Each gram contains 3.2 mEq sodium. |
Isoniazid (Isonex) 50 mg tab | PO | 5 mg/kg q12-24h | 5 mg/kg q12-24h | 5 mg/kg q12-24h | 5 mg/kg q12-24h | Pyridoxine supplement should be given (5 mg). |
Kanamycin (kancin) | IV, IM | 5 mg/kg q12h | 5 mg/kg q8h | 10 mg/kg q12h | 10 mg/kg q8h | Retinal toxicity and ototoxicity poorly absorbed orally. Give over 30min IV. Reduce dosage frequency with renal impairment. Active against Staphylococcus aureus (including penicillinase producing organisms), Staphylococcus epidermidis, H. influenzae, E. coli, Klebsiella, Serratia and Proteus. |
Meropenem (meronem) carbapenem beta-lactam (500 mg vial) | IV | Sepsis: 20 mg/kg q12h Meningitis: 40 mg/kg q8h | 20 mg/kg q12hr | 20 mg/kg q8hr | Limited experience in neonates. Dose should be reduced in patients with creatinine clearance less than 51ml/min. 26-50 ml/min give recommended dose q12h. 10-25ml/min give ½ the recommended dose q12h. <10 ml/min give ½ the recommended dose q24h monitor LFT, blood counts. | |
Slow IV injection | ||||||
Metronidazole (metrogyl) (5 mg/ml, 20 ml ampoule, 100 ml container) | IV | Loading 15mg/kg stat, maintenance 24 hr later as the following: | Neutropenia. Candidiasis may worsen. Potentiates anti-coagulants. Use with caution in patients with liver or renal disease (GFR <10ml/min). Active against anaerobes (useful in necrotising enterocolitis) and entamoeba histolytica. T½ is 23-25hrs (term) 59-109 hrs (preterm). CSF penetration is excellent. | |||
7.5 mg/kg q12h | 7.5 mg/kg q12h | 7.5 mg/kg q12h | 7.5 mg/kg q12h | |||
Infuse over 30 min. | ||||||
Methicillin | IV, IM | 25-50 mg/kg q12h | 25-50 mg/kg q8h | 25-50 mg/kg q8h | 25-50 mg/kg q6h | Double the dose for meningitis. Hematuria, nephritis, reversible BM suppression, eosinophilia, rash. |
Mezlocillin | IV | 75mg/kg q12h | 75mg/kg q8h | 75mg/kg q12h | 75mg/kg q6h | Allergic reaction, seizures, vomiting and hematological abnormalities (eosinophilia, leukopenia, neutropenia, anaemia) elevated BUN, creatinine and liver enzymes. |
Moxalactum | IV, IM | 50 mg/kg q12h | 50 mg/kg q8h | 50 mg/kg q12h | 150 mg/kg/ q8h | |
Nafcillin | IV | 25 mg/kg q12h | 25 mg/kg q8h | 25 mg/kg q8h | 25 mg/kg q6h | Similar to penicillin. Use with caution in infants with compromised hepatic function. Good CSF penetration. |
Neomycin sulfate | PO | 12.5 mg/kg q6h | 12.5 mg/kg q6h | 12.5 mg/kg q6h | 12.5 mg/kg q6h | Ototoxicity and nephrotoxicity |
Netilmycin (netromycin) (10mg, 25mg 50mg in 1 ml) | IV | 3.5 mg/kg q12h | 3.5 mg/kg q8h | 3.5 mg/kg q12h | 3.5 mg/kg q8h | Theurapeutic range 10-12 mg/L (peak) and <2mg/L (trough). Active against most gram-negative and some grampositive organisms, including some which are resistant to other aminoglycosides. Activity is also seen against Pseudomonas, methicillin resistant strains of Staph aureus and Proteus. Not active against streptococci or anaerobes. |
Do not mix with other antimicrobials | ||||||
Nystatin | PO Topical | 400,000-800,000 units/day d/v q6h (100,000 U/ml suspension) after feeds. Applied as ointment or cream 3–4 times daily (100,000U/g) | It is poorly absorbed from GI tract. | |||
Oxacillin | IV, IM | 25 mg/kg q12h | 25 mg/kg q8h | 25 mg/kg q8h | 25 mg/kg q6h | May cause thrombophlebitis and Clostridium difficile colitis. Limited experience in neonates. |
Palivizumab (synagis) | IM | 15 mg/kg once a month during RSV season (Nov-Apr) | Preferred over anterolateral aspect of thigh. | |||
Penicillin G (benzyl) | IV Meningitis | 50,000 u/kg 12h | 50,000 u/kg 12h | 50,000 u/kg 12h | 50,000 u/kg 12h | Active against few gram-positive and gram-negative bacteriae. Useful against Streptococci and pneumococci, congenital syphilis, tetanus, listeria and few anaerobes (gas gangrene). Diffuses well into tissues and body fluids, but penetration into the CSF is poor except when the meninges are inflamed. |
Other diseases | 25,000 u/kg q12h | 25,000 u/kg q8h | 25,000 u/kg q8h | 25,000 u/kg q6h | ||
Penicillin G (procaine) (Bisterpen) | IM | 50,000 U/kg OD | 50,000 U/kg OD | 50,000 U/kg OD | 50,000 U/kg OD | |
Penicillin Benzathine (Penidure) | IM | 50,000 U (one dose only) | 50,000 U (one dose only) | 50,000 U (one dose only) | 50,000 U (one dose only) | |
Penicillin V (keypen) | PO | 62.5 mg/kg q6h | 62.5 mg/kg q6h | 62.5 mg/kg q6h | 62.5 mg/kg q6h | |
Penicillin (piprapen) ureidopeni- | IV, IM | 200 mg/kg/d q8h | 200 mg/kg/d q6h | 300 mg/kg/d q8h | 300 mg/kg/d q6h | May increase the risk of haemorrhage with high doses. Active against all major gram-positive |
cillin. (with tazobaltam) (2.25 gm vial) | and gram-negative organisms except those producing beta-lactamases. It has a good antipseudomonas cover. | |||||
Polymyxin B sulfate (poly-B) | PO, IM, IV | 2.5 mg/kg q12h | 2.5 mg/kg q12h | 2.5 mg/kg q12h | 2.5 mg/kg q8h | Does not cross blood-brain barrier. Synergy with trimethoprim and useful combination with rifampicin, especially in treatment of multiresistant strains. |
Pyrimethamine PO 25 mg tab. | PO | Toxoplasmosis: Loading: 2 mg/kg OD for 2 days Maintenance: 1 mg/kg OD for 2 − 6 month, then 3 days per week to complete 12 m treatment | Supplement with folinic acid. Glossitis, seizures and rash. | |||
Rifampicin PO (R-cin) | PO | 10 mg/kg once daily | 10 mg/kg q12h | 10 mg/kg once daily | 10 mg/kg q12h | |
Ribavirin (Ribavin) | Aerosol | Administer using a (SPAG −2) small particle aerosol generator provided by the company. The drug is delivered via an oxygen hood or through the inhalation tubing of a ventilator. Concentration of drug in reservoir (20 mg/ml) is not varied with patient weight. Treatment is carried out for 12–18 hours per day for 3–7 days. | Rash and conjunctivitis have been observed. Special precautionary measures need to be taken when drug is being given through a ventilator to avoid drug deposition and consequent malfunctioning of expiratory valve. | |||
Spiramycin (Rovamycin) Macrolide (0.75 million IU tab) | PO | Immunocompromised: 0.75million IU/day d/v q8h for 5 days Toxoplasmosis: 0.15-0.30 million IU/kg/day d/v q12h for 6 wk Meningococcal meningitis prophylaxis: 150000 IU/kg/day for 5 days | Active against streptococci, staphylococci, diphtheria, pertusis, Listeria, Clostridia, Legionella, chlamydia, mycoplasma, N. meningitides, Toxoplasma gondii and Cryptosporidia. Not active against gram-negative aerobes. Synergism with metronidazole against anaerobes seen. | |||
Ticarcillin | IV, IM | 75 mg/kg q12h | 75 mg/kg q8h | 75 mg/kg q8h | 75 mg/kg q8h | Active against Pseudomonas |
Ticarcillin + clavulanic acid (Timentin) | IV | 75 mg/kg q12h | 75 mg/kg q8h | 75 mg/kg q8h | 75 mg/kg q6h | Hypersensitivity reaction, phlebitis, pseudomembranous colitis, hypernatremia and inhibition of platelet aggregation. Monitor renal function. |
Tobramycin (tobacin tobraneg) Aminoglycoside (10 mg/ml 1 ml, 2 ml vial) | IV, IM | 2 mg/kg q24h | 2 mg/kg q12h | 2 mg/kg q12h | 2 mg/kg q8h | More active against Pseudomonas. Active against Staphylococcus aureus, E. coli, Klebsiella, Proteus, Serratia and Citrobacter ototoxicity and impaired renal function. Less active against streptococcus. Adjust dose in renal failure. |
Vancomycin IV (vancorin) (500 mg vial) | IV | Recommended dosage designed to achieve one hour post infusion levels of 25-30 mg/L, trough levels of 5-10 mg/L and average vancomycin serum Concetrations at steady state of 13.5 mg/L, immediate post infusion. Vancomycin serum concentrations are predicted to be < 40 mg/L. | Infuse over 60min to avoid Redman's syndrome; increase dose in CNS infections to 60 mg/kg/day d/v q6h. Active only against gram-positive | |||
Dose (mg/kg/dose) | Dosing Interval | bacteria. Mainly used against penicillin-resistant staphylococci (Staphylococcus aureus, coagulase-negative staphylococci, streptococci and grampositive anaerobes including Clostridium difficile) | ||||
<27 wk | 27 | q36h | ||||
27-30 wk | 24 | q24h | ||||
31-36 wk | 27 | q18h | ||||
>37 wk | 22.5 | q12h | ||||
Dilute with NS or DS to give 5 mg in 1 ml. infuse over 1 hour | ||||||
Vidarabine | IV | <1 month: 15-30 mg/kg/day infused over 12-24 hour period for 10 consecutive days. (Minimum dilution is 0.45 mg/ml of IV fluid. In line filter > 0.45 micron recommended) | Adverse reactions noted in adults; nausea, vomiting diarrhoea, rash, ataxia, tremors, myoclonus and bone marrow depression. These have not been observed in neonates. Monitor hematologic, renal and hepatic status. Reduces dose by 25% in severe renal failure. | |||
Zidovudine (retrovir) 10 mg/ml, susp. and Inj. | PO IV | 2 mg/kg 6h for 6 wk 1.5 mg/kg 6h for 6 wk | Severe anaemia, neutropenia, GI upset. | |||
*All dose in mg/kg/dose, unless mentioned specifically. q8h indicates interval between doses. | ||||||
Comments code for anti-bacterial agents:
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Clearance of amikacin, gentamicin and vancomycin is influenced both by the gestational age (GA) and the postnatal age. Therefore in infant s> 7 days old, it might be useful to consider the postconceptional age (PCA) in the dosing schedule. Please note the dosage is in mg/kg/ dose. |
Organisms generally susceptible to penicillins
Gram-positive | Organisms | Natural penicillins | Penicillinase resistant | Aminopenicillins | Extended spectrum | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Penicillin G | Penicillin V | Cloxacillin | Amoxicillin | Ampicillin | Bacampicillin | Amoxicillin/pot. Clavulanate | Ampicillin/ sulbactam | Carbenicillin | Piperacillin | Ticarcillin | ||
✓=generally susceptible | ||||||||||||
Staphylococci | ✓1 | ✓1 | ✓ | ✓1 | ✓1 | ✓1 | ✓ | ✓ | ✓1 | ✓1 | ✓1 | |
Staphylococcus aureus | ✓1 | ✓1 | ✓ | ✓ | ✓ | ✓1 | ✓1 | ✓1 | ||||
Streptococci | ✓ | ✓ | ✓ | ✓ | ||||||||
Streptococcus pneumoniae | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |
Beta-hemolytic streptococci | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||
Streptococcus faecalis | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||
Streptococcus viridans | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |||||
Corynebacterium diphtheriae | ✓ | ✓ | ||||||||||
Bacillus anthracis | ✓ | ✓ | ✓ | ✓ | ||||||||
Listeria monocytogenes | ✓ | ✓ | ✓ | ✓ | ||||||||
Gram-negative | Escherichia coli | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||
Haemophilus influenzae | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓2 | ✓ | ||||
Klebsiella sp | ✓ | ✓ | ✓ | |||||||||
Neisseria gonorrhoeae | ✓1 | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||
Neisseria meningitis | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||||
Proteus mirabilis | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |||
Salmonella sp | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||||
Shigella sp | ✓ | ✓ | ✓ | ✓ | ||||||||
Morganella morganii | ✓ | ✓ | ✓ | ✓ | ||||||||
Proteus vulgaris | ✓ | ✓ | ✓ | ✓ | ||||||||
Providencia sp | ||||||||||||
Providencia rettgeri | ✓ | ✓ | ✓ | ✓ | ||||||||
Providencia stuarti | ✓ | |||||||||||
Enterobacter sp | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||||
Citrobacter sp | ✓ | ✓ | ✓ | |||||||||
Pseudomonas aeruginosa | ✓ | ✓ | ✓ | |||||||||
Serratia sp | ✓ | ✓ | ✓ | |||||||||
Acinetobacter sp | ✓ | ✓ | ||||||||||
Streptobacillus moniliformis | ✓ | ✓ | ||||||||||
Moraxella (Branhamella) catarrhalis | ✓ | ✓ | ✓ | |||||||||
Anaerobic | Clostridium sp | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |||
Peptococcus sp | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |||
Peptocostreptococcus sp | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |||||
Bacteroides sp | ✓3 | ✓ | ✓ | ✓ | ✓ | |||||||
Fusobacterium sp | ✓ | ✓ | ✓ | ✓ | ✓ | |||||||
Eubacterium sp | ✓ | ✓ | ✓ | |||||||||
Treponema pallidum | ✓ | ✓ | ||||||||||
Actinimyces bovis | ✓ | ✓ | ✓ | |||||||||
Veillonella sp | ✓ | |||||||||||
|
Organisms generally susceptible to cephalosporins
Organisms | First generation | Second generation | Third generation | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
✓=generally susceptible + = demonstrated in vitro activity | Cephalexin | Cefadroxil | Cefazolin | Cefaclor | Cefuroxime | Cefonicid | Cefixime | Cefoperazone | Cefotazime | Ceftizoxime | Ceftriaxone | Ceftazidime | |
Gram-positive | Staphylococci1 | ✓2 | ✓ | ✓ | ✓2 | ✓ | ✓2 | ✓ | ✓3 | ✓ | ✓ | ✓ | |
Staphylococci, beta-hemolytic | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |
Streptococcus pneumoniae | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |
Streptococcus pyogenes | |||||||||||||
Acinetobacter sp | ✓2 | ✓ | ✓ | + | + | ||||||||
Gram-negative | Citrobacter sp | ✓2 | + | + | ✓ | ✓ | + | + | ✓ | ||||
Enterobacter sp | ✓2 | ✓2 | + | ✓ | ✓ | ✓ | ✓ | ✓ | |||||
Escherichia coli | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |
Haemophilus influenzae | ✓ | ✓3 | ✓3 | ✓3 | ✓3 | ✓3 | ✓3 | ✓3 | ✓3 | ✓3 | ✓3 | ||
Haemophilus parainfluenzae | + | +3 | ✓ | ✓ | + | ||||||||
Hafnia alvei | |||||||||||||
Klebsiella sp | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | + | ✓ | ✓ | ✓ | ✓ | ✓ | |
Moraxella (Branhamella) catarrhalis | + | ✓ | + | ✓2 | + | ✓ | |||||||
Morganella (Proteus) morganii | ✓2 | ✓ | ✓ | ✓ | ✓ | ✓ | + | ||||||
Neisseria gonorrhoeae | + | ✓ | + | + | ✓3 | ✓ | ✓ | ✓ | + | ||||
Proteus mirabilis | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |
Proteus vulgaris | ✓ | + | ✓ | ✓ | ✓ | ✓ | ✓ | ||||||
Providencia sp | ✓ | + | + | + | + | + | |||||||
Providencia rettgeri | ✓ | ✓ | + | ✓ | ✓ | ✓ | + | + | |||||
Pseudomonas aeruginosa | ✓ | ✓2 | ✓2 | ✓2 | ✓ | ||||||||
Salmonella sp | ✓ | + | + | + | + | + | + | ||||||
Salmonella typhi | + | + | + | ||||||||||
Serratia sp | + | ✓ | ✓ | ✓ | ✓ | ✓ | |||||||
Shigella sp | ✓ | + | + | + | + | + | + | ||||||
Anaerobic | Bacteroides sp | ✓ | ✓ | ✓ | ✓ | + | ✓ | ||||||
Bacteroides fragilis | ✓ | ✓ | ✓ | + | |||||||||
Clostridium sp | ✓ | + | ✓ | ✓ | + | + | + | ||||||
Clostridium difficile | + | ||||||||||||
Eubacterium sp | + | + | |||||||||||
Fusobacterium sp | ✓ | + | + | ✓ | + | + | |||||||
Peptococcus sp | + | ✓ | + | ✓ | ✓ | ✓ | + | + | |||||
Peptostreptococcus sp | + | ✓ | + | ✓ | ✓ | ✓ | + | + | |||||
|
Significance of blood culture isolates
Significance | Organisms |
---|---|
Almost always significant | Group B Streptococcus Streptococcus pneumoniae Listeria monocytogenes Haemophilus influenzae Enterococci (Streptococcus faecalis, S. faecium, S. Bovis, etc). Group A Streptococcus Group C/G streptococci Neisseria meningitidis Neisseria gonorrhoea Gram–negative bacilli Candida and other fungi |
Sometimes significant (about 50%) | Staphylococcus aureus Coagulase–negative staphylococci (S. epidermidis etc.) Streptococcus viridans group (including S. mitis, S. mitior, S. milleri, S. Sanguis, etc)a Clostridium species Multiple isolates (polymicrobial) |
Almost always contaminats | Diphtheroids Propionibacterium Bacillus species |
Antibiotic guidelines in neonatal infection
Clinical Situations | Risk Factors | Possible Organisms | Suggested Regimes | Comments |
---|---|---|---|---|
‘Early’ onset sepsis/? RDS | PROM > 24 hr Maternal infection–fever, leucocytosis etc. Maternal colonisation | GBS E. coli Other enterobacteria | Benzylpenicillin + gentamicin | If all cultures subsequently prove negative, antibiotics can be stopped after 48 hours if the baby is well proven septicaemia is usually treated for 10 days |
Offensive or green liquor | Listeria monocytogenes | Benzylpenicillin + gentamcin | Convert penicillin to Ampicillin following confirmation of diagnosis | |
Sepsis after >5 days | Presence of septic spots, Umbillical flare, central venous line in situ | Staph aureus staph Spp Other gram-positive and - negative organisms | Flucloxacillin + gentamicin | In proven S. Epidermidis Septicaemia secondary To long – line Sepsis, change to vancomycin if symptoms not resolved by 48 hrs |
Pneumonia after prolonged stay in the neonatal unit | Ventilated Earlier course of antibiotics Last ET Aspirate | Not available, no growth or Staphylococcus | Flucloxacillin + gentamicin | |
Conjuctivitis/Pneumonitis | Coliforms Pseudomonas Aeruginosa Chlamydia | Cefotaxime Ceftazidime + gentamicin Erythromycin | ||
Necrotising enterocolitis | Preterm Birth asphyxia Umbilical catheterisation | `Gut organisms’ including anaerobes | Benzylpenicillin + gentamicin+ Metronidazole Or cefotaxime and metronidazole | |
Urinary tract infection | Commoner in males CSF | E. coli other enterobacteria GBS | Ampicillin + gentamicin Benzylpenicillin | |
Meningitis | Gram film: Gram-positive cocci in chains: Gram-negative bacilli, gram-positive bacilli | + gentamicin | ||
No bacteria seen | Coliforms Listeria monocytogenes | Cefotaxime and gentamicin Ampicillin and gentamicin Cefotaxime and gentamicin | Change according to culture and sensitivity results |
Septic risk scoring
0 | 1 | 2 | |
---|---|---|---|
Phase I | |||
Duration of ROM (hour) | <12 | 12-24 | >24 |
Maternal temperature (F) | 98-99 | 99-100 | >100 |
Apgar score at 5 minutes | 08-10 | 05-07 | <5 |
Amniotic fluid appearance | Clear | Meconium or blood-stained | Purulent or foul smelling |
Weight of infant (g) | >2500 | 1500-2500 | <1500 |
Phase II | |||
Appearance of placenta | Clear | opalescent | Purulent |
Gastric aspirate PMN count | 0-5 | 6-15 | >15 or bacteria engulfed in PMN |
Maternal temperature (F) | |||
1–2 hours postpartum | 98–99 | 99–100 | >100 |
Material WBC on | |||
day of delivery (mm3) | 10,000–15,000 | 15,000–20,000 | >20,000 |
Maternal urinalysis (microscopic) | Clear | Bacteria or white cells | Both bacteria and white cells |
State of infant | Normal | Questionable | Respiratory distress or lethargy |
Specific antibiotic therapy in early-onset neonatal septicemia
First line | Ampicillin + gentamicin / amikacin (to cover most Gram-positive and Gram-negative pathogens) |
In ampicillin resistance | A third generation cephalosporin + gentamicin / amikacin |
In accompanying meningitis | Ampicillin / amikacin + a third generation cephalosporin |
Specific antibiotic therapy in late-onset neonatal septicemia
First line | Ampicillin + gentamicin/amikacin |
Second line | Cefotaxime + amikacin. Add cloxacillin if staph is suspected. For resistant staph, vancomycin or coamoxyclav should be preferred. |
For nosocomial infections | Ceftazidime or cefoperazone + netilmicin |
Suggested antibiotic regimens for sepsis and meningitis
Organism | Antibiotic | Bacteremia | Meningitis |
---|---|---|---|
GBS | Ampicillin or penicillin G | 10-14 days | 21 days |
E. coli | Cefotaxime or ampicillin and gentamicin | 14 days 14 days | 21 days 21 days |
Enterobacter, Klebsiella | Cefotaxime or cefipime or meropenem and gentamicin | 14 days | 21 days |
Enterococcus | Ampicillin or vancomyin and gentamicin | 10 days | 21 days |
Listeria | Ampicillin and gentamicin | 10–14 days | 21 days |
Pseudomonas | Ceftazidime or piperacillin / tazobactam and gentamicin or tobramycin | 14 days | 21 days |
S. aureus | Nafcillin | 10-14 days | 21 days |
FIRST LINE ANTIBIOTICS
These are suggetions for initial treatment until sensitivity test results are available: |
Acinetobacter: Ticarcillin +/− tobramycin. |
Actinomyces isralli: Benzylypenicillin. |
Aeromonas: Cotrimoxazole. |
Afipla felis (cat scratch): Ciprofloxacin or cotrimoxazole. |
Bacillus anthracis: Benzylpenicillin. |
Bacteroides: oral: Benzylpenicillin metronidazole. |
Bordetella pertusis: Erythromycin. |
Borrelia burgdorferi (Lyme disease): Tetracycline or ceftriaxone. |
Borellia recurrents (relapsing fever): Tetracycline or benzylpenicillin. |
Branhamella catarrahalis: See moxarella catarrhalis. |
Brucella: Tetracycline + gentamicin, or cotrimoxazole. |
Calymmatobacterium granulomatis (granuloma inguinale): Tetracycline. |
Campylobacter jejuni: Ciprofloxacin or erythromycin. |
Chlamydia pneumoniae (TWAR strain): Tetracycline or erythromycin. |
Chlamydia psittaci (psittacosis, ornithosis): Tetracycline or erythromycin. |
Chlamydia trachomatis: Erythromycin. Trachoma: Topical and oral tetracycline or sulphonamide. |
Clostridia: Benzylpenicillin. Clostridium difficile: Vancomycin or metronidazole. |
Botulism: Oral vancomycin. |
Corynebacteria: Erythromycin. JK group: Vancomycin. |
Eikenella corrodens: Amoxycillin +/− clavulanic acid. |
Enterobacter: Cefotaxime + amikacin. |
Escherichia Coli: Cefotaxime +/− gentamycin |
Francisella tularensis (tularaemia): Gentamicin. |
Fusobacterium: Benzylpenicillin. |
Gardnerella (haemophilus) vaginalis: Metronidazole. |
Haemophilus ducreyi (chancroid): Erythromycin. |
Haemophilus influenzae: Cotrimoxazole. Severe inftn: Cefotaxime or ceftriaxone. |
Klebsiella pneumoniae: Cefotaxime +/− gentamicin. |
Legionella: Erythromycin + rifampicin. |
Leptospira: Benzylpenicillin. |
Leptotrichia buccalis: Benzylpenicillin. |
Listeria: Monocytogenes: Amoxycillin +/− gentamicin. |
Morganella morganil: Cefotaxime +/− gentamicin. |
Moxarella catarrhalis: Cotrimoxazole or cefotaxime. |
Mycoplasma pneumoniae: Erythomycin or tetracycline. |
Neisseria gonorrhoeae: Ceftriaxone. |
Neisseria meningitides: Benzylpenicillin. |
Nocardia: Cotrimoxazole. |
Pasturella multocida: Benzylpenicillin. |
Proteus: Cefotaxime +/− gentamicin. Indole negative: Amoxycillin. |
Providencia: Cefataxime +/− gentamicin. |
Pseudomonas cepacia: Cotrimoxazole. |
Pseudomonas mallei (glanders): Streptomycin + either tetracycline or chloramphenicol. |
Pseudomonas maltophilla: See xanthomonas maltophilia. |
Pseudomonas pseudomallei (melioidosis): Ceftazidime. |
Rickettsia: Tetracycline or chloramphenicol. |
Rochalimaea henselae (bacillary angioniatosis): Erythromycin. |
Salmonella: Cefotaxime. S.typhi: Ceftriaxone. |
Serratia: Cefotaxime +/− gentamicin. |
Shigella: Ciprofloxacin or cotrimoxazole or amoxycillin or ceftriaxone. |
Staphylococcus: Flucloxacillin +/− gentamicin. Resistant: Vancomycin +/− gentamicin and/or rifampicin. |
Streptobacillus moniliformis (rat bite fever): Benzylpenicillin. |
Streptococcus: Benzylpenicillin. Enterococcus: Amoxycillin + gentamicin or amikacin. S. Viridans: Benzylpenicillin +/− gentamicin. |
Treponema pallidum (syphilis): Benzylpenicillin. |
Treponema partenue (yaws): Benzylpenicillin. |
Ureaplasma urealyticum: Erythromycin. |
Vibrio cholerre (cholere): Tetracycline or cotrimoxazole |
Vibrio vulnificus: Tetracycline or cefotaxime. |
Xanthomonas maltophilia: Cotrimoxazole. |
Yersinia enterocolitica: Cotrimoxazole. |
Yersinia pestis (plague): Streptomycin. |
Viral Infection Therapy
Viral infection | Prevention/therapy |
---|---|
Hepatitis B virus | Hepatitis B immunoglobulin Hepatitis B vaccine |
Herpes simplex virus | Acyclovir Vidarabine |
Varicella-zoster virus | Acyclovir Vidarabine |
Respiratory syncytial virus | Ribavrin (aerosol) |
Cytomegalovirus | Ganciclovir (potential) |
Human immunodeficiency virus | Azidothymidine (AZT) (Potential) |