Neonatal Antimicrobial Dosing at Benioff Children's Hospitals

 

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)

SF: Contact via Voalte

OAK: 510-801-BUGS

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

idmp.ucsf.edu

ID-Restricted agents (ID-R). Other restricted agents are noted in APeX.

An approving clinician’s ID number is needed to order a restricted agent. To obtain approval for a restricted agent,

contact Pediatric ASP between 8:00 am to 4:30 pm M-F. For off-hours approval (until 9:00 pm) contact the Pediatric ID Consult Service. From 9:00 pm to 8:00 am, use approval ID# 11111 for release of a single dose, then contact ASP for approval of subsequent doses.

 

Drug

 Postmenstrual age (PMA equivalent to gestational age plus postnatal age)

Postnatal Age

Usual Dose

Interval

Acyclovir IV

< 45 weeks

ALL

20 mg/kg/dose

q8h

Ampicillin IV (meningitis)

< 45 weeks

<= 7 days

100 mg/kg/dose

q8h

> 7 days

75 mg/kg/dose

q6h

Ampicillin IV (non-meningitis)

<= 34 weeks

<= 7 days

50 mg/kg/dose

q12h

<= 34 weeks

> 7 days

75 mg/kg/dose

q12h

> 34 to < 45 weeks

ALL

50 mg/kg/dose

q8h

Azithromycin IV/PO

(pertussis)

< 45 weeks

ALL

10 mg/kg/dose

q24h X 5 days

Cefazolin IV

<= 29 weeks

0 to 28 days

25 mg/kg/dose

q12h

> 28 days

q8h

30 to 36 weeks

0 to 14 days

25 mg/kg/dose

q12h

> 14 days

q8h

37 to < 45 weeks

0 to 7 days

25 mg/kg/dose

q12h

> 7 days

q8h

Cefepime IV

< 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

<= 29 weeks

0 to 28 days

50 mg/kg/dose

q12h

> 28 days

q8h

30 to 36 weeks

0 to 14 days

50 mg/kg/dose

q12h

> 14 days

q8h

37 to < 45 weeks

0 to 7 days

50 mg/kg/dose

q12h

> 7 days

q8h

Clindamycin IV/PO

<= 29 weeks

0 to 28 days

7.5 mg/kg/dose

q12h

> 28 days

q8h

30 to 36 weeks

0 to 14 days

7.5 mg/kg/dose

q12h

> 14 days

q8h

37 to < 45 weeks

0 to 7 days

7.5 mg/kg/dose

q12h

> 7 days

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

Treatment: 12 mg/kg/dose

q48h

> 14 days

q24h

> 29 to < 45 weeks

0 to 7 days

Prophylaxis: 6 mg/kg/dose

Treatment: 12 mg/kg/dose

q48h

> 7 days

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:

48 hour R/O: no levels required

Treatment: Peak and Trough with 3rd or 4th dose

<= 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

Meningitis: 40 mg/kg/dose

q12h

>= 14 days

q8h

>= 32 to < 45 weeks

ALL

q8h

Metronidazole IV/PO

 

LOAD 15 mg/kg/dose X1, followed 8 to 12 hours later with maintenance dose

 

24 to 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

> 40 to < 45 weeks

ALL

10 mg/kg/dose

q8h

Nafcillin IV or Oxacillin IV

<= 29 weeks

0 to 28 days

50 mg/kg/dose

q12h

> 28 days

q8h

30 to 36 weeks

0 to 14 days

50 mg/kg/dose

q12h

> 14 days

q8h

37 to < 45 weeks

0 to 7 days

50 mg/kg/dose

q12h

> 7 days

q8h

Penicillin G IV (aqueous) congenital syphilis

< 45 weeks

<= 7 days

50,000 units/kg/dose

q12h

> 7 days

50,000 units/kg/dose

q8h

Piperacillin and Tazobactam IV (Dose for piperacillin component)

<= 29 weeks

0 to 28 days

100 mg/kg/dose

q12h

> 28 days

q8h

30 to 36 weeks

0 to 14 days

100 mg/kg/dose

q12h

> 14 days

q8h

37 to < 45 weeks

0 to 7 days

100 mg/kg/dose

q12h

> 7 days

q8h

Sulfamethoxazole and Trimethoprim (Bactrim/Septra)

Not recommended < 48 weeks PMA

Vancomycin IV

<= 29 weeks

0 to 14 days

10 mg/kg/dose

q12h

> 14 days

30 to 36 weeks

0 to 14 days

15 mg/kg/dose

q12h

> 14 days

q8h

37 to < 45 weeks

0 to 7 days

15 mg/kg/dose

q12h

> 7 days

q8h