Pediatric Antimicrobial Dosing at Benioff Children's Hospitals (PDF Version)
UCSF Benioff Children’s Hospitals
Antimicrobial Dosing Guideline for Infants and Children > 1 Month of Age
Approved by Pharmacy and Therapeutics Committee (11/98) Last Update 4/2025
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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) |
Oak/SF: Contact via Voalte |
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Pediatric ID Consult Service |
For cases requiring in depth review and physician consultation |
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Online Resources |
Pediatric Empiric Antimicrobial Therapy Guidelines, Clinical Pathways, Detailed Guidelines, Antimicrobial Susceptibility Profiles |
idmp.ucsf.edu |
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Shaded boxes indicate 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, call Pediatric ASP between 8:30 am to 5:00 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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For infants with renal dysfunction please use the neonatal antibiotic renal dosing reference
Dosing recommendations are for usual doses to treat the most common conditions.
For additional indication-specific dosing, or agents not included below, refer to the
Pediatric Empiric Antimicrobial Therapy Guidelines (EATG) (idmp.ucsf.edu), or Lexi-Comp.
Consult pharmacist or Lexidrug for renal dose adjustment.
For dosing in patients with Cystic Fibrosis (CF)
CKD EPI calculator CKiD U25 calculator
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Drug |
Usual Dose |
Dose Adjustment |
Maximum Dose |
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Acyclovir IV
Note: Use adjusted body weight for dosing in patients with obesity
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Mucocutaneous HSV Infection Immunocompetent Host ≥ 3 mo 5 mg/kg/dose q8h
CNS HSV Infection >= 3 mo to < 12 yo 15 mg/kg/dose q8h
CNS HSV >= 12 yo, HSV in Immunocompromised Host, or VZV Infection 10 mg/kg/dose q8h
HSV Infection < 3 mo 20 mg/kg/dose q8h |
Adjust for CrCl < 50 ml/min/1.73m2 |
Usual Max 1000 mg/dose |
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Acyclovir PO preferred for non-invasive infection in immunocompetent host > 3 months old – refer to Pediatric EATG or Lexi-Comp for dose |
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Amphotericin B Liposomal IV ID-R (Ambisome®) |
5 mg/kg/dose q24h |
No recommended dose adjustment for renal dysfunction, but drug should be used with caution due to nephrotoxicity risk |
None |
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Ampicillin IV |
50 mg/kg/dose q6h Endocarditis, Meningitis: 400 mg/kg/day divided q4h to q6h |
Adjust for CrCl < 50 ml/min/1.73m2 |
2000 mg/dose
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Ampicillin- sulbactam IV (Unasyn®) |
50 mg ampicillin/kg/dose q6h |
Adjust for CrCl < 30 ml/min/1.73m2 |
Usual Max 2000 mg ampicillin/dose |
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Amoxicillin PO |
22.5 mg/kg/dose bid
High Dose (Pneumococcal) 45 mg/kg/dose bid
Strep pharyngitis: 50 mg/kg/dose qday |
Adjust for CrCl < 30 ml/min/1.73m2 |
Usual Max 1000 mg/dose |
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Amoxicillin-clavulanate PO (Augmentin®) |
< 3 mo: 15 mg amox/kg/dose bid (Use 250 mg/5 mL suspension)
Standard Dose >= 3 mo 22.5 mg amox/kg/dose bid
High Dose (Pneumococcal) >= 3 mo 45 mg amox/kg/dose bid
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Adjust for CrCl < 30 ml/min/1.73m2 |
Usual Max Susp: 840 mg/dose or 880 mg/dose depending on concentration Tablet: 875 mg/dose bid
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Cefazolin IV |
Mild-Moderate Infection 25 mg/kg/dose q8h
Severe Infection 50 mg/kg/dose q8h |
Adjust for CrCl < 50 ml/min/1.73m2 |
Mild-Moderate 1000 mg/dose
Severe 2000 mg/dose |
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Cephalexin PO |
Mild-Moderate Infection 25 mg/kg/dose tid
Severe Infection e.g. osteomyelitis/pyelonephritis 50 mg/kg/dose tid |
Adjust for CrCl < 50 ml/min/1.73m2 |
Mild-Moderate 500 mg/dose
Severe 1000 mg/dose |
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Cefepime IV |
50 mg/kg/dose q8h
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Adjust for CrCl < 60 ml/min/1.73m2 |
2000 mg/dose
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Ceftazidime IV |
50 mg/kg/dose q8h
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Adjust for CrCl < 50 ml/min/1.73m2 |
2000 mg/dose
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Ceftriaxone IV |
50 mg/kg/dose q24h
Meningitis 50 mg/kg/dose q12h |
No adjustment |
2000 mg/dose |
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Ciprofloxacin IV/PO
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Enteral: 15 mg/kg/dose enterally bid IV: 10 mg/kg/dose IV q8h
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Adjust for CrCl < 30 ml/min/1.73m2 |
750 mg enterally bid 400 mg IV q8h
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Clindamycin IV/PO |
10 mg/kg/dose q8h
Bone/Joint Infection 13 mg/kg/dose q8h |
No adjustment |
Usual max Enteral: 600 mg/dose
IV: 600 mg dose IV necrotizing fasciitis: 900 mg/dose
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Fluconazole IV/PO |
Invasive Candidiasis 12 mg/kg/dose q24h |
Adjust for CrCl < 50 ml/min/1.73m2 |
Usual max 800 mg q24h Varies by site and severity |
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Gentamicin IV
Note: Use adjusted body weight for dosing in patients with obesity
Monitoring: Oak: contact pharm for dosing adjustments SF: dosing per pharm
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Synergy: 3 mg/kg/dose IV q24h
Treatment < 3 mo OR < 52 weeks PMA: 5 mg/kg/dose IV q24h
Treatment >= 3 mo AND >= 52 weeks PMA: 7 mg/kg/dose IV q24h
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Adjust for CrCl < 50 ml/min/1.73m2 |
Usual Max 1000 mg/dose |
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Levofloxacin IV/PO |
6 mo to < 5 yo: 10 mg/kg/dose q12h
>= 5 yo: 10 mg/kg/dose q24h |
Adjust for CrCl < 30 ml/min/1.73m2 |
750 mg/dose |
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Meropenem IV |
20 mg/kg/dose q8h Meningitis 40 mg/kg/dose q8h |
Adjust for CrCl < 50 ml/min/1.73m2 |
2000 mg/dose |
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Metronidazole IV/PO |
10 mg/kg/dose q8h
Appendicitis 30 mg/kg/dose q24h |
Adjust for CrCl < 10 ml/min/1.73m2 |
500 mg/dose
Appendicitis 1500 mg/dose |
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Nafcillin or Oxacillin IV |
50 mg/kg/dose q6h |
Adjust for concurrent hepatic and renal dysfunction |
Individual Dose 2000 mg/DOSE Daily Dose 12,000 mg/DAY |
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Penicillin G IV (aqueous) |
Mild-Moderate Infection 200,000 units/kg/day divided q4h
Severe Infection eg endocarditis, meningitis 400,000 units/kg/day divided q4h |
Adjust for CrCl < 10 ml/min/1.73m2
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4 million units/dose |
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Piperacillin/ Tazobactam IV (Zosyn®) |
100 mg piperacillin/kg/dose q6h |
Adjust for CrCl < 40 ml/min/1.73m2 |
4000 mg piperacillin/dose |
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Tobramycin IV
Note: Use adjusted body weight for dosing in patients with obesity
Monitoring: Oak: contact pharm for dosing adjustments SF: dosing per pharm
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Treatment < 3 mo OR < 52 weeks PMA: 5 mg/kg/dose IV q24h
Treatment >= 3 mo AND >= 52 weeks PMA: 7 mg/kg/dose IV q24h
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Adjust for CrCl < 50 ml/min/1.73m2 |
None |
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TMP/SMX IV/PO (Bactrim®, Septra®) |
Mild to Moderate Infection 5 mg/kg/dose TMP bid
Serious Infection/PCP 5 mg/kg/dose TMP q6h to q8h |
Adjust for CrCl < 30 ml/min/1.73m2 |
Mild-Moderate 160 mg TMP/dose
Severe Enteral: 320 mg TMP/dose IV: 480 mg TMP/dose
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Vancomycin IV
Oak: contact pharm for dosing adjustments
SF: dosing per pharm
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< 1 mo: Refer to Neonatal Dosing Guidelines 1 mo to < 3 mo (PMA 45 weeks to <= 52 weeks): 15 mg/kg/dose IV q8h >= 3 mo to < 12 yo: 17.5 mg/kg/dose IV q6h >= 12 yo to < 15 yo: 15 mg/kg/dose IV q6h >= 15 yo: 15 mg/kg/dose IV q8h
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CICU/cardiac dysfunction initial dosing: < 6 months: q12h; >= 6 months: q8h
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Initial Max 1000 mg/dose |
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Voriconazole IV/PO ID-R |
Empiric dosing if unknown pharmacogenomics (PGx): < 12 yo 10 mg/kg/dose enterally/IV bid >= 12 yo 6 mg/kg/dose enterally/IV bid
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No adjustment for renal dysfunction but avoid IV formulation if CrCl < 50 ml/min/1.73m2
Avoid if severe hepatic dysfunction |
Initial Max: 400 mg/dose |
Antibiotics in patients with Cystic Fibrosis (CF)
(If patient not responding on appropriate therapy, consider consulting ASP)
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Drug |
Suggested Dose |
Usual Max Dose |
Other Information |
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Pseudomonas (usually 2 antipseudomonal agents): Tobramycin + Ceftazidime
Pseudomonas + MSSA : Tobramycin + Cefepime
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Amikacin |
30 mg/kg/dose IV q24h |
Consider avoiding doses > 35 mg/kg/day |
Requires Therapeutic Drug Monitoring Peak range: 35 to 45 mcg/mL Trough: < 5 mcg/mL |
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Aztreonam |
50 mg/kg/dose IV q6h |
2000 mg IV q6h |
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Cefepime |
50 mg/kg/dose IV q8h |
2000 mg IV q8h |
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Ceftazidime |
50 mg/kg/dose IV q8h |
2000 mg IV q8h |
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Ciprofloxacin |
10 mg/kg/dose IV q8h |
400 mg IV q8h |
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Piperacillin/Tazobactam (Zosyn®) |
100 mg/kg/dose (piperacillin component) IV q6h |
4000 mg (piperacillin component) IV q6h |
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Meropenem |
40 mg/kg/dose IV q8h |
2000 mg IV q8h |
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Tobramycin |
10 mg/kg/dose IV q24h |
Consider avoiding doses >15 mg/kg/dose |
Requires Therapeutic Drug Monitoring Peak range: 20 to 35 mcg/mL Trough: < 1 mcg/mL |
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Stenotrophomonas maltophilia:
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TMP/SMX IV/PO (Bactrim®, Septra®) |
5 mg/kg/dose (TMP component) IV/PO tid/q8h |
Enteral: 320 mg TMP/dose IV: 480 mg TMP/dose |
Oral route preferred, if possible |
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Staphylococcus aureus: The role of staph including MRSA is difficult to assess when a patient is also infected with pseudomonas, but it is often treated if present on recent or current cultures. |
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Cefazolin |
50 mg/kg/dose IV q8h |
2000 mg IV q8h |
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Doxycycline |
5 mg/kg/day IV/PO bid/q12h |
200 mg IV/PO bid/q12h |
Oral route preferred, if possible |
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TMP/SMX IV/PO (Bactrim®, Septra®) |
5 mg/kg/dose (TMP component) IV/PO tid/q8h |
Enteral: 320 mg TMP/dose IV: 480 mg TMP/dose
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Oral route preferred, if possible |
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Vancomycin (Reserved for MRSA)
Oak: contact pharm for dosing adjustments
SF: dosing per pharm |
3 mo to < 12 yo: 17.5 mg/kg/dose IV q6h
>= 12 yo to < 15 yo: 15 mg/kg/dose IV q6h
>= 15 yo: 15 mg/kg/dose IV q8h |
Initial Max 1000 mg/dose |
Requires Therapeutic Drug Monitoring
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G.) Antibiotic Therapeutic Drug Monitoring:
Tobramycin
Extended-interval Dosing: Obtain post dose serum concentrations after the 1st dose
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Renal Function |
When to obtain level |
After which dose? |
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CrCl > 50 or CRRT |
Post dose levels 2 and 6 hours after end of infusion |
1st dose |
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CrCl < 50 |
Post dose levels 2 and 12 hours after end of infusion |
1st dose |
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HD or PD |
Level obtained prior to the hemodialysis treatment is recommended to guide dosing |
1st dose |