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 | idmpsbx.ucsfsitebuilder.acsitefactory.com |
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 | |