Pediatric Antimicrobial Dosing at Benioff Children's Hospital - San Francisco

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These antimicrobial dosing guidelines are intended for infants and children > 1 month of age. Click here for neonatal antimicrobial dosing guidelines.

Dosing recommendations are for usual doses to treat the most common conditions. For additional indication-specific dosing, or agents not included below, refer to Pediatric Empiric Antimicrobial Therapy Guidelines (EATG), or Lexi-Comp.

See Antibiotic Spectrum Guide and Pediatric Antibiogram for help choosing a drug to treat a specific pathogen. 

Consult a pharmacist or click here for renal dose adjustment. 

Notations: CrCl: creatinine clearance; ID-R: restricted antimicrobial (follow link for details); IV-PO: high oral bioavailability, consider IV to PO switch; LD: loading dose; MD: maintenance dose

Cost estimates based on Average Wholesale Price for 20kg child at usual dose: 

$: <= $30/day; $$: $30-100/day; $$$: > $100/day

 Tools: Bedside Schwartz Equation for Estimating CrCl in Children    Body Surface Area Calculator (powered by MDCalc)

Drug Usual Dose Dose Adjustment Maximum Dose

 

 

 

 

Acyclovir IV

$

 

 

 

 

Mucocutaneous HSV Infection Immunocompetent Host >= 3 mo

5 mg/kg/dose q8h

 

 

 

 

Adjust for

CrCl < 50 ml/min/1.73m2

 

 

 

 

None

 

 

 

 

CNS HSV Infection >= 3 mo- < 12 yo:

15 mg/kg/dose q8h

CNS HSV >= 12yo, HSV in Immunocompromised Host, or VZV Infection

10 mg/kg/dose q8h

HSV Infection <3mo

20 mg/kg/dose q8h

Acyclovir PO preferred for non-invasive infection in immunocompetent host > 3 months old - refer to Pediatric EATG or Lexi-Comp for dose  

 

Amphotericin B Liposomal IVID-R

(AmBisome)

$$$

 

 

5 mg/kg/dose q24h

 No recommended dose adjustment for renal dysfunction, but drug should be used with caution due to nephrotoxicity risk

 

None

 

**Lower dose may be appropriate for certain indications - consult ID pharmacist**  

 

Ampicillin IV

$$ 

 

 

50 mg/kg/dose q6h

 

 

Adjust for

CrCl < 50 ml/min/1.73m2

 

 Individual Dose

2g/dose

Daily Dose

12g/DAY

 

Endocarditis, Meningitis

300 mg/kg/day divided q4-6h  

Ampicillin-sulbactam IV

(Unasyn)

$$ 

 

 50 mg ampicillin/kg/dose q6h

 

Adjust for

CrCl < 50 ml/min/1.73m2

Usual Max

2g ampicillin q6h 

 

Amoxicillin PO 

$

  

 

25 mg/kg/dose BID

 

 

Adjust for

CrCl < 50 ml/min/1.73m2

 

Usual Max for High Dose 

1g BID

 

Absolute Max

2g BID

  

High Dose (Pneumococcal)

45 mg/kg/dose BID  

Refer to Pediatric EATG for dosing specific to indication, click here for guidance on formulations and maximum dosing by indication  

 

 

 

Amoxicillin-clavulanate PO

(Augmentin) 

$-$$

  

Age <= 3 mo

15 mg amoxicillin/kg/dose BID

(Use 125mg/5ml suspension)

 

 

 

Adjust for

CrCl < 50ml/min/1.73m2  

 

 

Usual Max for High Dose

Suspension: 1000mg BID

Tablet: 875mg BID

 

Absolute Max

2g BID   

 Standard Dose >= 3 mo

22.5 mg amoxicillin/kg/dose BID

(Use 400mg/5ml suspension)

High Dose (Pneumococcal)

45 mg amoxicillin/kg/dose BID

(Use 600mg/5ml suspension for wt < 40kg, 400mg/5ml suspension for wt >=40kg) 

 

Caspofungin IVID-R

$$$ 

 

Age 1-3 mo: 

25 mg/m2/dose q24h

 

 Adjust MD for severe hepatic dysfunction:

70 mg/m2 x 1, then 35 mg/m2 q24h

 

 LD: 70mg

MD: 50mg q24h

Age >= 3 mo: 

LD 70 mg/m2/dose x 1 then

MD 50 mg/m2/dose q24h

 

Cefazolin IV

 

 

 Mild-Moderate Infection

25 mg/kg/dose q8h

 

Adjust for

CrCl < 70 ml/min/1.73m2  

 

 Mild-Moderate

1g q8h

Severe Infection

50 mg/kg/dose q8h 

Severe

2g q8h 

 

 

 

Cephalexin PO

$

  

 

 

 

 Mild Infection (e.g. Cystitis)

25 mg/kg/dose BID

 

 

Adjust for

CrCl < 70 ml/min/1.73m2

  

 

 

 Usual Max

500mg/dose

Absolute Max (Severe Infection)

1g/dose

 

 

 

 

 

Moderate Infection (e.g. Cellulitis)

25mg/kg/dose TID 

Severe Infection (e.g. Bone/Joint)

25mg/kg/dose 4x/day 

Refer to Pediatric EATG for dosing specific to indication, and maximum dosing by indication  

 

Cefepime IV

 

 50 mg/kg/dose q12h

 

Adjust for

CrCl < 50 ml/min/1.73m2

 

 2g q12h

CF/Pseudomonas/Febrile Neutropenia/Meningitis

50 mg/kg/dose q8h 

High Dose

2g q8h 

Ceftazidime IV

$$

50 mg/kg/dose q8h

Adjust for

CrCl < 50 ml/min/1.73m2

2g q8h

 

 

Ceftriaxone IV

$

 

50 mg/kg/dose q24h

 

 

No adjustment

 

1g q24h

Endocarditis

100 mg/kg/dose q24h

Endocarditis

2g q24h

Meningitis

50 mg/kg/dose q12h

Meningitis

2g q12h

 

CiprofloxacinIV-PO 

*IV-PO ratio 1:1 until adult doses, then 4:5

$

 

 15 mg/kg/dose q12h

 

 

Adjust for

CrCl < 50 ml/min/1.73m2

 750mg PO q12h

400mg IV q8h

Cystic Fibrosis

20 mg/kg/dose PO q12h

15 mg/kg/dose IV q12h

Cystic Fibrosis

1000mg PO q12h

600mg IV q8h

**For Pseudomonas Infection, use maximum dose**

 

ClindamycinIV-PO

$

10 mg/kg/dose q8h

 

No adjustment

 

PO: 600mg q8h

IV: 900mg q8h

Bone/Joint Infection

13 mg/kg/dose q8h

FluconazoleIV-PO

$

12 mg/kg/dose q24h

Adjust for

CrCl < 50 ml/min/1.73m2

800mg q24h

Varies by site and severity

 

Gentamicin IV

$

 

2.5 mg/kg/dose q8h

Adjust for

CrCl < 50 ml/min/1.73m2

 

None

**Consult pharmacist for dose adjustment/level assessment**

 

LevofloxacinIV-PO 

$

Age 6 mo - < 5 yo:

10 mg/kg/dose q12h

 

Adjust for 

CrCl < 50 ml/min/1.73m2

 

750mg q24h

Age >= 5 yo: 

10 mg/kg/dose q24h

 

Meropenem IV

$$ 

 

 

20 mg/kg/dose q8h 

 

 Adjust for

CrCl < 50 ml/min/1.73m2

 

 

1g q8h

Cystic Fibrosis/Meningitis

40 mg/kg/dose q8h 

CF/Meningitis

2g q8h 

MetronidazoleIV-PO 

10 mg/kg/dose q8h 

 Adjust for

CrCl < 50 ml/min/1.73m2

500mg q8h 

 

Nafcillin IV 

$$

 

50 mg/kg/dose q6h

 

Adjust for concurrent hepatic and renal dysfunction

 

 Individual Dose

2g/dose

Daily Dose

12g/DAY

Piperacillin-tazobactam IV

(Zosyn)

$$

80 mg piperacillin/kg/dose q6h

 

Adjust for 

CrCl < 50 ml/min/1.73m2

 

4g piperacillin q6h

CF/Pseudomonas/Serious Infection

100 mg piperacillin/kg/dose q6h

 

Tobramycin IV

$

 

 

 

2.5 mg/kg/dose q8h

 

Adjust for

CrCl < 50 ml/min/1.73m2

 

 

None

 

 

 Cystic Fibrosis

10 mg/kg/dose q24h

**Consult pharmacist for dose adjustment/level assessment**  

 

TMP/SMX IV-PO

(Bactrim, Septra)

$

 

Mild to Moderate Infection

5 mg/kg/dose TMP BID

 

Adjust for

CrCl < 30 ml/min/1.73m2

 

Mild-Moderate

160mg TMP/dose

(no max for severe)

CF/Serious Infection/PCP

5 mg/kg/dose TMP q6h

 

Vancomycin IV

$

 

 

15 mg/kg/dose q6-8h*

 

*Consider q8-12h interval for Cardiac Dysfunction/CICUConsult pharmacist for renal adjustment

 

Initial Max 

1g/dose

 

CNS/Endocarditis/Bone/Joint Infection

20 mg/kg/dose q6h

**Consult pharmacist for dose adjustment/level assessment*

 

 

 

Voriconazole IVID-R

$$$

 

 2-<12 yo OR 12-14 yo & < 50kg

 LD: 9 mg/kg/dose q12h x 2, then

MD: 8 mg/kg/dose q12h

 

 

 

 

 

No adjustment for renal dysfunction but avoid IV formulation if CrCl < 50 ml/min/1.73m2

Avoid if severe hepatic dysfunction, decrease MD by 50% for mild-moderate hepatic dysfunction

   

 

 

 

 

 

 

 IV: No max

 

 

 

> 14 yo OR 12-14 yo & >= 50kg 

LD: 6 mg/kg/dose q12h x 2, then

MD: 4 mg/kg/dose q12h

 

 

Voriconazole POID-R

$$ 

 

2-<12 yo OR 12-14 yo & < 50kg 

9 mg/kg/dose BID

 PO Initial Max Maintenance Dose

2-<12 yo OR 12-14 yo & < 50kg

350mg/dose

> 14 yo OR 12-14 yo & >= 50kg  

LD: 400mg/dose BID x 2, then

MD: 200mg/dose BID

> 14 yo OR 12-14 yo & >= 50kg  

200mg/dose 

**For IV and PO, therapeutic drug monitoring recommended with trough level after 5 days on stable dose - consult ID/ASP pharmacist for guidance**