Neonatal Antimicrobial Dosing at Benioff Children's Hospitals (PDF Version)
UCSF Benioff Children’s Hospital
Antimicrobial Dosing Guideline for Neonates < 45 weeks Postmenstrual Age
|
Antimicrobial Stewardship Program (ASP) |
M-F 8:00 am to 4:30 pm for focused questions on antimicrobial selection, dose, monitoring, duration of therapy and for approvals (Voalte: Pediatric Antimicrobial Stewardship Team - ID/ASP Pharmacist or Provider) |
OAK/SF: Contact via Voalte |
|
Pediatric ID Consult Service |
For cases requiring in depth review and physician consultation please contact ID |
|
|
Online Resources |
Pediatric Empiric Antimicrobial Therapy Guidelines, Clinical Pathways, Detailed Guidelines, Antimicrobial Susceptibility Profiles |
|
|
Drug |
Postmenstrual age (PMA equivalent to gestational age plus postnatal age) |
Postnatal Age |
Usual Dose |
|
Acyclovir IV |
< 45 weeks |
ALL |
20 mg/kg/dose q8h |
|
Ampicillin IV (non-meningitis) |
<= 34 weeks |
<= 7 days |
50 mg/kg/dose q12h |
|
<= 34 weeks |
> 7 days |
75 mg/kg/dose q12h |
|
|
> 35 to < 45 weeks |
ALL |
50 mg/kg/dose q8h |
|
|
Ampicillin IV (meningitis) |
< 45 weeks |
<= 7 days |
100 mg/kg/dose q8h |
|
> 7 days |
75 mg/kg/dose q6h |
||
|
Azithromycin IV/PO |
< 45 weeks |
ALL |
10 mg/kg/dose q24h |
|
Cefazolin IV |
<= 29 weeks |
0 to 28 days |
25 mg/kg/dose q12h |
|
> 28 days |
25 mg/kg/dose q8h |
||
|
30 to 36 weeks |
0 to 14 days |
25 mg/kg/dose q12h |
|
|
> 14 days |
25 mg/kg/dose q8h |
||
|
37 to < 45 weeks |
0 to 7 days |
25 mg/kg/dose q12h |
|
|
> 7 days |
25 mg/kg/dose q8h |
||
|
Cefepime IV
Note: same dosing for meningitis
|
< 45 weeks |
<= 28 days |
50 mg/kg/dose q12h |
|
> 28 days |
50 mg/kg/dose q8h |
||
|
Ceftriaxone IV |
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 criteria and dosing guidance. |
||
|
Ceftazidime IV
Note: same dosing for meningitis
|
<= 29 weeks |
0 to 28 days |
50 mg/kg/dose q12h |
|
> 28 days |
50 mg/kg/dose q8h |
||
|
30 to 36 weeks |
0 to 14 days |
50 mg/kg/dose q12h |
|
|
> 14 days |
50 mg/kg/dose q8h |
||
|
37 to < 45 weeks |
0 to 7 days |
50 mg/kg/dose q12h |
|
|
> 7 days |
50 mg/kg/dose q8h |
||
|
Clindamycin IV/PO |
<= 29 weeks |
0 to 28 days |
7.5 mg/kg/dose q12h |
|
> 28 days |
7.5 mg/kg/dose q8h |
||
|
30 to 36 weeks |
0 to 14 days |
7.5 mg/kg/dose q12h |
|
|
> 14 days |
7.5 mg/kg/dose q8h |
||
|
37 to < 45 weeks |
0 to 7 days |
7.5 mg/kg/dose q12h |
|
|
> 7 days |
7.5 mg/kg/dose q8h |
||
|
Fluconazole IV/PO
Treatment: LOAD 25 mg/kg/dose X1, followed by maintenance dose |
<= 29 weeks |
0 to 14 days |
Prophylaxis: 6 mg/kg/dose q48h Treatment: 12 mg/kg/dose q48h |
|
> 14 days |
Prophylaxis: 6 mg/kg/dose q24h Treatment: 12 mg/kg/dose q24h |
||
|
> 29 to < 45 weeks |
0 to 7 days |
Prophylaxis: 6 mg/kg/dose q48h Treatment: 12 mg/kg/dose q48h |
|
|
> 7 days |
Prophylaxis: 6 mg/kg/dose q24h Treatment: 12 mg/kg/dose q24h |
||
|
Gentamicin IV or Tobramycin IV
Use a longer dosing interval for neonates with HIE or significant asphyxia e.g. increase from q24h to q36h
Monitoring: Oak: contact pharm for dosing adjustments SF: dosing per pharm
|
<= 29 weeks |
0 to 7 days |
5 mg/kg/dose q48h |
|
8 to 28 days |
4 mg/kg/dose q36h |
||
|
> 28 days |
4 mg/kg/dose q24h |
||
|
30 to 34 weeks |
0 to 7 days |
4.5 mg/kg/dose q36h |
|
|
> 7 days |
4 mg/kg/dose q24h |
||
|
35 to < 45 weeks |
ALL |
4 mg/kg/dose q24h |
|
|
Meropenem IV |
< 32 weeks |
< 14 days |
Non-meningitis: 20 mg/kg/dose q12h Meningitis: 40 mg/kg/dose q12h |
|
>= 14 days |
Non-meningitis: 20 mg/kg/dose q8h Meningitis: 40 mg/kg/dose q8h |
||
|
>= 32 to < 45 weeks |
ALL |
Non-meningitis: 20 mg/kg/dose q8h Meningitis: 40 mg/kg/dose q8h |
|
|
Metronidazole IV/PO
LOAD 15 mg/kg/dose X1, followed 8 to 12 hours later with maintenance dose
|
<= 25 weeks |
ALL |
7.5 mg/kg/dose q24h |
|
26 to 27 weeks |
ALL |
10 mg/kg/dose q24h |
|
|
28 to 33 weeks |
ALL |
7.5 mg/kg/dose q12h |
|
|
34 to 40 weeks |
ALL |
7.5 mg/kg/dose q8h |
|
|
> 41 to < 45 weeks |
ALL |
10 mg/kg/dose q8h |
|
|
Nafcillin IV or Oxacillin IV |
<= 29 weeks |
0 to 28 days |
Non-meningitis: 25 mg/kg/dose q12h Meningitis: 50 mg/kg/dose q12h
|
|
> 28 days |
Non-meningitis: 25 mg/kg/dose q8h Meningitis: 50 mg/kg/dose q8h |
||
|
30 to 36 weeks |
0 to 14 days |
Non-meningitis: 25 mg/kg/dose q12h Meningitis: 50 mg/kg/dose q12h |
|
|
> 14 days |
Non-meningitis: 25 mg/kg/dose q8h Meningitis: 50 mg/kg/dose q8h |
||
|
37 to < 45 weeks |
0 to 7 days |
Non-meningitis: 25 mg/kg/dose q12h Meningitis: 50 mg/kg/dose q12h |
|
|
> 7 days |
Non-meningitis: 25 mg/kg/dose q8h Meningitis: 50 mg/kg/dose q8h |
||
|
Penicillin G IV (aqueous) congenital syphilis and non-meningitis |
< 45 weeks |
<= 7 days |
50,000 units/kg/dose q12h |
|
> 7 days |
50,000 units/kg/dose q8h |
||
|
Penicillin G IV (aqueous) meningitis |
< 45 weeks |
<= 7 days |
150,000 units/kg/dose q8h |
|
> 7 days |
125,000 units/kg/dose q6h |
||
|
Piperacillin and Tazobactam IV (Dose for piperacillin component) |
<= 29 weeks |
0 to 28 days |
100 mg/kg/dose q12h |
|
> 28 days |
100 mg/kg/dose q8h |
||
|
30 to 36 weeks |
0 to 14 days |
100 mg/kg/dose q12h |
|
|
> 14 days |
100 mg/kg/dose q8h |
||
|
37 to < 45 weeks |
0 to 7 days |
100 mg/kg/dose q12h |
|
|
> 7 days |
100 mg/kg/dose q8h |
||
|
Sulfamethoxazole and Trimethoprim (Bactrim/Septra) |
Not usually recommended < 48 weeks PMA |
||
|
Vancomycin IV
Oak: contact pharm for dosing adjustments
SF: dosing per pharm |
<= 29 weeks |
ANY |
10 mg/kg/dose q12h |
|
30 to 36 weeks |
ANY |
12.5 mg/kg/dose q12h |
|
|
37 to < 45 weeks |
ANY |
15 mg/kg/dose q12h |
|