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These antimicrobial dosing guidelines are intended for infants and children > 1 month of age. Click here for neonatal antimicrobial dosing guidelines.
Dosing recommendations are for usual doses to treat the most common conditions. For additional indication-specific dosing, or agents not included below, refer to Pediatric Empiric Antimicrobial Therapy Guidelines (EATG), (currently linked guidelines are BCHSF-specific, refer to BCHO Empiric Therapy Guidelines for hospital-specific guidelines at BCHO) or Lexi-Comp.
Consult a pharmacist or click here for renal dose adjustment.
Notations: CrCl: creatinine clearance; ID-R: restricted antimicrobial (follow link for details); IV-PO: high oral bioavailability alternative, consider IV to PO switch; LD: loading dose; MD: maintenance dose
Cost estimates based on Average Wholesale Price for 20kg child at usual dose:
$: <= $30/day; $$: $30-100/day; $$$: > $100/day
Tools: Bedside Schwartz Equation for Estimating CrCl in Children Body Surface Area Calculator (powered by MDCalc)
| Drug | Usual Dose | Dose Adjustment | Maximum Dose |
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Acyclovir IV $
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Mucocutaneous HSV Infection Immunocompetent Host >= 3 mo 5 mg/kg/dose q8h |
Adjust for CrCl < 50 ml/min/1.73m2 |
None
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CNS HSV Infection >= 3 mo- < 12 yo: 15 mg/kg/dose q8h |
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CNS HSV >= 12yo, HSV in Immunocompromised Host, or VZV Infection 10 mg/kg/dose q8h |
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HSV Infection <3mo 20 mg/kg/dose q8h |
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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 IVID-R (AmBisome) $$$
|
5 mg/kg/dose q24h |
No recommended dose adjustment for renal dysfunction, but drug should be used with caution due to nephrotoxicity risk |
None
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| **Lower dose may be appropriate for certain indications - consult ID pharmacist** | |||
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Ampicillin IV (IV-PO) $$
|
50 mg/kg/dose q6h |
Adjust for CrCl < 50 ml/min/1.73m2 |
2g/dose
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Endocarditis, Meningitis 300 mg/kg/day divided q4-6h |
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Ampicillin-sulbactam IV (IV-PO) (Unasyn) $$ |
50 mg ampicillin/kg/dose q6h |
Adjust for CrCl < 50 ml/min/1.73m2 |
Usual Max 2g ampicillin q6h |
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Amoxicillin PO $
|
25 mg/kg/dose BID
|
Adjust for CrCl < 50 ml/min/1.73m2 |
Usual Max 1g BID
Absolute Max 2g BID
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High Dose (Pneumococcal) 45 mg/kg/dose BID |
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| Refer to Pediatric EATG for dosing specific to indication, click here for guidance on formulations and maximum dosing by indication | |||
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Amoxicillin-clavulanate PO (Augmentin) $-$$
|
<= 3 mo 15 mg amoxicillin/kg/dose BID (Use 125mg/5ml suspension) |
Adjust for CrCl < 50ml/min/1.73m2 |
Usual Max Suspension: 1000mg BID Tablet: 875mg BID
Absolute Max 2g BID |
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Standard Dose >= 3 mo 22.5 mg amoxicillin/kg/dose BID (Use 400mg/5ml suspension) |
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High Dose (Pneumococcal) 45 mg amoxicillin/kg/dose BID (Use 600mg/5ml suspension for wt < 40kg, 400mg/5ml suspension for wt >=40kg) |
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Caspofungin IVID-R $$$
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1-3 mo: 25 mg/m2/dose q24h |
Adjust MD for severe hepatic dysfunction: 70 mg/m2 x 1, then 35 mg/m2 q24h |
LD: 70mg MD: 50mg q24h |
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>= 3 mo: LD 70 mg/m2/dose x 1 then MD 50 mg/m2/dose q24h |
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Cefazolin IV $
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Mild-Moderate Infection 25 mg/kg/dose q8h |
Adjust for CrCl < 70 ml/min/1.73m2
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Mild-Moderate 1g q8h |
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Severe Infection 50 mg/kg/dose q8h |
Severe 2g q8h |
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Cephalexin PO $
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Mild Infection (e.g. Cystitis) 25 mg/kg/dose BID |
Adjust for CrCl < 70 ml/min/1.73m2
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Usual Max 500mg/dose Absolute Max (Severe Infection) 1g/dose
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Moderate Infection (e.g. Cellulitis) 25mg/kg/dose TID |
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Severe Infection (e.g. Bone/Joint) 33mg/kg/dose TID |
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| Refer to Pediatric EATG for dosing specific to indication, and maximum dosing by indication | |||
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Cefepime IV $
|
50 mg/kg/dose q12h |
Adjust for CrCl < 50 ml/min/1.73m2
|
2g q12h |
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CF/Pseudomonas/Febrile Neutropenia/Meningitis 50 mg/kg/dose q8h |
High Dose 2g q8h |
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Ceftazidime IV $$ |
50 mg/kg/dose q8h |
Adjust for CrCl < 50 ml/min/1.73m2 |
2g q8h |
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Ceftriaxone IV $ |
50mg/kg/dose q24h Meningitis 50mg/kg/dose q12h |
No adjustment |
1g q24h Meningitis 2g q12h |
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CiprofloxacinIV-PO *IV-PO ratio 1:1 until adult doses, then 4:5 $
|
10-15 mg/kg/dose q12h |
Adjust for CrCl < 50 ml/min/1.73m2 |
750mg PO q12h 400mg IV q8h |
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Cystic Fibrosis 20mg/kg/dose PO q12h 15mg/kg/dose IV q12h
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Cystic Fibrosis 1000mg PO q12h 600mg IV q8h |
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| **For Pseudomonas Infection, use maximum dose** | |||
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ClindamycinIV-PO $ |
10 mg/kg/dose q8h |
No adjustment |
PO: 600mg q8h IV: 900mg q8h |
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Bone/Joint Infection 13 mg/kg/dose q8h |
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FluconazoleIV-PO $ |
Invasive Candidiasis 12 mg/kg/dose q24h |
Adjust for CrCl < 50 ml/min/1.73m2 |
800mg q24h Varies by site and severity |
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Gentamicin IV $ |
Gram Negative Infection 2.5 mg/kg/dose q8h |
Adjust for CrCl < 50 ml/min/1.73m2 |
None |
| **Consult pharmacist for dose adjustment/level assessment** | |||
|
LevofloxacinIV-PO $ |
6 mo - < 5 yo: 10 mg/kg/dose q12h |
Adjust for CrCl < 50 ml/min/1.73m2 |
750mg q24h |
|
>= 5 yo: 10 mg/kg/dose q24h |
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Meropenem IV $$
|
20 mg/kg/dose q8h |
Adjust for CrCl < 50 ml/min/1.73m2
|
1g q8h |
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Cystic Fibrosis/Meningitis 40 mg/kg/dose q8h |
CF/Meningitis 2g q8h |
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MetronidazoleIV-PO |
10 mg/kg/dose q8h
Appendicitis/Intra-abdominal Infection 30mg/kg/dose q24h |
Adjust for CrCl < 50 ml/min/1.73m2 |
1500mg/day |
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Nafcillin IV $$ |
50 mg/kg/dose q6h |
Adjust for concurrent hepatic and renal dysfunction
|
Individual Dose 2g/dose Daily Dose 12g/DAY |
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Piperacillin-tazobactam IV (Zosyn) $$ |
80 mg piperacillin/kg/dose q6h |
Adjust for CrCl < 50 ml/min/1.73m2 |
4g piperacillin q6h |
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CF/Pseudomonas/Serious Infection 100 mg piperacillin/kg/dose q6h |
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Tobramycin IV $
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2.5 mg/kg/dose q8h |
Adjust for CrCl < 50 ml/min/1.73m2
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None
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Cystic Fibrosis 10 mg/kg/dose q24h |
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| **Consult pharmacist for dose adjustment/level assessment** | |||
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TMP/SMX IV-PO (Bactrim, Septra) $
|
Mild to Moderate Infection 5 mg/kg/dose TMP BID |
Adjust for CrCl < 30 ml/min/1.73m2 |
Mild-Moderate 160mg TMP/dose (no max for severe) |
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CF/Serious Infection/PCP 5 mg/kg/dose TMP q6h |
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Vancomycin IV $
|
3mo- <12yo 17.5mg/kg/dose q6h |
*Consider q8-12h interval for Cardiac Dysfunction/CICU Consult pharmacist for renal adjustment |
Initial Max 4g/day
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>=12yo 15mg/kg/dose q6h |
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**Consult pharmacist for patient-specific dosing** **Consult pharmacist for dose adjustment/level assessment** |
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Voriconazole IVID-R $$$
|
2-<12 yo OR 12-14 yo & < 50kg LD: 9 mg/kg/dose q12h x 2, then MD: 8 mg/kg/dose q12h |
No adjustment for renal dysfunction but avoid IV formulation if CrCl < 50 ml/min/1.73m2 Avoid if severe hepatic dysfunction, decrease MD by 50% for mild-moderate hepatic dysfunction
|
IV: No max
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> 14 yo OR 12-14 yo & >= 50kg LD: 6 mg/kg/dose q12h x 2, then MD: 4 mg/kg/dose q12h |
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Voriconazole POID-R $$
|
2-<12 yo OR 12-14 yo & < 50kg 9 mg/kg/dose BID |
PO Initial Max Maintenance Dose
2-<12 yo OR 12-14 yo & < 50kg 350mg/dose |
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> 14 yo OR 12-14 yo & >= 50kg LD: 400mg/dose BID x 2, then MD: 200mg/dose BID |
PO Initial Max Maintenance Dose > 14 yo OR 12-14 yo & >= 50kg 200mg/dose |
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| **For IV and PO, therapeutic drug monitoring recommended with trough level after 5 days on stable dose - consult ID/ASP pharmacist for guidance** | |||