Neonatal Antimicrobial Dosing at Benioff Children's Hospitals PDF
These dosing guidelines are intended for use at UCSF Benioff Children's Hospitals. 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 |
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<= 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 |
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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 |
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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 |