Neonatal Antimicrobial Dosing at Benioff Children's Hospital San Francisco

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These dosing guidelines are intended for use at UCSF Benioff Children's Hospital San Francisco. Please consult a pediatric pharmacist for individualized dosing recommendations in infants with renal impairment. 

Notation: GA - gestational age

Drug   Dose   Interval Mode
Acyclovir   20 mg/kg/dose   q 8 hours IV
Amphotericin  Conventional (Fungizone) 1 mg/kg/dose   q 24 hours IV
Liposomal (Ambisome) 5 mg/kg/dose   q 24 hours IV
Ampicillin  Meningitis 100 mg/kg/dose   see Interval A IV
Non-meningitis 50 mg/kg/dose   see Interval A IV
Azithromycin   (pertussis) 10 mg/kg/dose    q24h x 5 days IV/PO 
Cefazolin   25 mg/kg/dose    see Interval B  IV 
Cefepime      50 mg/kg/dose     q 12 hours  IV 
Meningitis  q 8 hours  IV 
Cefotaxime      50 mg/kg/dose     see Interval A  IV 
Meningitis  see Interval C  IV 
Ceftriaxone  May be considered in neonates >=41 weeks corrected GA and > 14 days post-natal age without hyperbilirubinemia or any anticipated calcium containing solutions within 48 hours of ceftriaxone therapy. Consult pharmacist for verification of criteria and dosing guidance.   
Ceftazidime    50 mg/kg/dose    see Interval B  IV 
Clindamycin    see Column E    q 8 hours  IV 
Fluconazole    Treatment  LOAD 25 mg/kg x 1, then 12 mg/kg/dose q24h   IV/PO 
Prophylaxis   6 mg/kg/dose:     

 

IV/PO

    <= 29 wks corrected GA & <= 28 d post-natal age: q 72 hours      

      > 29 wks corrected GA or  > 28 d post-natal age: q 48 hours

Gentamicin and Tobramycin   Click here for dosing and interval     
Meropenem      Usual 20 mg/kg/dose        

Meningitis/ Pseudomonas 

40 mg/kg/dose       
Intervals for both above doses: < 32 weeks GA & < 14 days postnatal age  q 12 hours IV 
> 32 weeks GA or >= 14 days postnatal age q 8 hours IV 

Metronidazole  

LOAD 15mg/kg x 1, followed 8-12 hours later by:    

<= 33 weeks corrected GA: 7.5 mg/kg/dose q 12 hours

 

IV  

34-40 weeks corrected GA: 7.5 mg/kg/dose q 8 hours
>= 41 weeks corrected GA: 10 mg/kg/dose q 8 hours
Nafcillin    50 mg/kg/dose    see Interval A  IV 
Penicillin G (aqueous) congenital syphilis  50,000 units/kg/dose    see Interval A IV 
Piperacillin/tazobactam                   Sepsis: 80 mg piperacillin/kg/dose see Interval C   IV  
Pseudomonas:  100mg piperacillin/kg/dose
TMP/SMX (Bactrim/Septra)   Not recommended <= 44 weeks corrected gestational age    
Vancomycin    <=29 wks corr GA: 10mg/kg/dose q12 hours IV 
    >29 wks corr GA: 15mg/kg/dose see Interval D   

 

Corrected gestational age (weeks) Postnatal age (days)   Interval A Interval B   Interval C  Interval D Column E 
<= 29   0 - 28 q12h  q12h   q12h

see

drug entry

 4 mg/kg/dose 
> 28 q8h   q8h q8h 
30-36   0 - 14  q12h q12h  q8h q12h    6 mg/kg/dose
> 14  q8h q8h  q6h q8h
37-44  0 - 7  q12h q12h  q8h q12h 8 mg/kg/dose 
> 7 q8h q8h q6h q8h
>= 45 All q6h q8h q6h q6h 10 mg/kg/dose