UCSF Benioff Children’s Hospital
Antimicrobial Dosing Guideline for Neonates < 45 weeks Postmenstrual Age
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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 |
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Pediatric ID Consult Service |
For cases requiring in depth review and physician consultation please contact ID |
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Online Resources |
Pediatric Empiric Antimicrobial Therapy Guidelines, Clinical Pathways, Detailed Guidelines, Antimicrobial Susceptibility Profiles |
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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. |
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Drug |
Postmenstrual age (PMA equivalent to gestational age plus postnatal age) |
Postnatal Age |
Usual Dose |
Interval |
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Acyclovir IV |
< 45 weeks |
ALL |
20 mg/kg/dose |
q8h |
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Ampicillin IV (meningitis) |
< 45 weeks |
<= 7 days |
100 mg/kg/dose |
q8h |
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> 7 days |
75 mg/kg/dose |
q6h |
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Ampicillin IV (non-meningitis) |
<= 34 weeks |
<= 7 days |
50 mg/kg/dose |
q12h |
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<= 34 weeks |
> 7 days |
75 mg/kg/dose |
q12h |
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> 34 to < 45 weeks |
ALL |
50 mg/kg/dose |
q8h |
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Azithromycin IV/PO (pertussis) |
< 45 weeks |
ALL |
10 mg/kg/dose |
q24h X 5 days |
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Cefazolin IV |
<= 29 weeks |
0 to 28 days |
25 mg/kg/dose |
q12h |
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> 28 days |
q8h |
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30 to 36 weeks |
0 to 14 days |
25 mg/kg/dose |
q12h |
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> 14 days |
q8h |
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37 to < 45 weeks |
0 to 7 days |
25 mg/kg/dose |
q12h |
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> 7 days |
q8h |
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Cefepime IV |
< 45 weeks |
<= 28 days |
50 mg/kg/dose |
q12h |
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> 28 days |
50 mg/kg/dose |
q8h |
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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. |
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Ceftazidime IV |
<= 29 weeks |
0 to 28 days |
50 mg/kg/dose |
q12h |
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> 28 days |
q8h |
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30 to 36 weeks |
0 to 14 days |
50 mg/kg/dose |
q12h |
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> 14 days |
q8h |
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37 to < 45 weeks |
0 to 7 days |
50 mg/kg/dose |
q12h |
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> 7 days |
q8h |
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Clindamycin IV/PO |
<= 29 weeks |
0 to 28 days |
7.5 mg/kg/dose |
q12h |
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> 28 days |
q8h |
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30 to 36 weeks |
0 to 14 days |
7.5 mg/kg/dose |
q12h |
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> 14 days |
q8h |
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37 to < 45 weeks |
0 to 7 days |
7.5 mg/kg/dose |
q12h |
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> 7 days |
q8h |
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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 |
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> 14 days |
q24h |
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> 29 to < 45 weeks |
0 to 7 days |
Prophylaxis: 6 mg/kg/dose Treatment: 12 mg/kg/dose |
q48h |
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> 7 days |
q24h |
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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 |
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8 to 28 days |
4 mg/kg/dose |
q36h |
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> 28 days |
4 mg/kg/dose |
q24h |
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30 to 34 weeks |
0 to 7 days |
4.5 mg/kg/dose |
q36h |
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> 7 days |
4 mg/kg/dose |
q24h |
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35 to < 45 weeks |
ALL |
4 mg/kg/dose |
q24h |
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Meropenem IV |
< 32 weeks |
< 14 days |
Non-meningitis: 20 mg/kg/dose Meningitis: 40 mg/kg/dose |
q12h |
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>= 14 days |
q8h |
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>= 32 to < 45 weeks |
ALL |
q8h |
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Metronidazole IV/PO
LOAD 15 mg/kg/dose X1, followed 8 to 12 hours later with maintenance dose
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24 to 25 weeks |
ALL |
7.5 mg/kg/dose |
q24h |
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26 to 27 weeks |
ALL |
10 mg/kg/dose |
q24h |
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28 to 33 weeks |
ALL |
7.5 mg/kg/dose |
q12h |
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34 to 40 weeks |
ALL |
7.5 mg/kg/dose |
q8h |
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> 40 to < 45 weeks |
ALL |
10 mg/kg/dose |
q8h |
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Nafcillin IV or Oxacillin IV |
<= 29 weeks |
0 to 28 days |
50 mg/kg/dose |
q12h |
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> 28 days |
q8h |
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30 to 36 weeks |
0 to 14 days |
50 mg/kg/dose |
q12h |
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> 14 days |
q8h |
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37 to < 45 weeks |
0 to 7 days |
50 mg/kg/dose |
q12h |
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> 7 days |
q8h |
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Penicillin G IV (aqueous) congenital syphilis |
< 45 weeks |
<= 7 days |
50,000 units/kg/dose |
q12h |
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> 7 days |
50,000 units/kg/dose |
q8h |
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Piperacillin and Tazobactam IV (Dose for piperacillin component) |
<= 29 weeks |
0 to 28 days |
100 mg/kg/dose |
q12h |
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> 28 days |
q8h |
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30 to 36 weeks |
0 to 14 days |
100 mg/kg/dose |
q12h |
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> 14 days |
q8h |
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37 to < 45 weeks |
0 to 7 days |
100 mg/kg/dose |
q12h |
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> 7 days |
q8h |
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Sulfamethoxazole and Trimethoprim (Bactrim/Septra) |
Not recommended < 48 weeks PMA |
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Vancomycin IV |
<= 29 weeks |
0 to 14 days |
10 mg/kg/dose |
q12h |
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> 14 days |
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30 to 36 weeks |
0 to 14 days |
15 mg/kg/dose |
q12h |
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> 14 days |
q8h |
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37 to < 45 weeks |
0 to 7 days |
15 mg/kg/dose |
q12h |
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> 7 days |
q8h |
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