PAEDIATRIC DOSAGE OF SOME DRUGS

1. Activated Charcoal per dose:

 Children up to one year of age: 1g/kg
 Children 1-12yr of age: 25-50g
 Adolescents and Adults: 25-100g
NB: Mix the charcoal in 8-10 times the amount of water e.g. 5g in 40ml of water. If possible, give
the whole amount at once; if the child has difficulty in tolerating it, the charcoal dose can be
divided.
2. Aminophyline (IV) 5mg/kg/dose over 10-15 min in asthmatic patients; 5mg/kg stat slowly, then 1-2mg/kg 8-12hrly
in newborn.
3. Acetaminophine: Suggested doses are 10–15 mg/kg orally to approximately 10 –20 mg/kg per rectum every 4 hours.
4. Albendazole: 400mg, single dose (oral)
5. Amikacin (I.V.) 7.5mg/kg/dose 12hrly
6. Amoxicillin (I.V./oral) 50-100mg/kg/day in 3DD.
7. Amoxicillin (Clavunated) (oral/I.V.) 25-50mg/kg/day in 2-3DD.
8. Ampi
Ampicillin (I.V.) in meningitis 300-400mg/kg/day in 4DD.
9. Ampicillin cloxacillin (oral/IV) 200mg/kg/day in 4DD.
10. Artemether (I.M.) 3.2mg/kg stat, then 1.6mg/kg daily x 3/7.
11. Artesunate 2.4 mg/kg (I.V. or I.M.) given on admission (time = 0), then at 12hr and 24hr, then once a day;
12. Artificial milk at 70mls/kg/day
13. Aspirin: For mild to moderate pain at doses of 10–15 mg/kg orally every 4 hours.
14. Atropine 0.02mg/kg (max 0.5mg)
15. ATS 750 I.U. as prophylaxis, 10,000 I.U in NNT.
16. Bicarbonate (I.V.) 1-3mls/kg in 1:1 dilution.
17. 10% calcium -gluconate slowly with 2ml/kg in double dilution and monitor for bradycardia. 10% Ca+ gluconate:
calcium-gluconate
(I.V.)0.5
0.5 – 1ml/kg in double dilution over 5 – 15mins
18. Camo
Camoquine (syr/tabs) 25-30mg/kg total dose in 3/7.
19. Ceftazidime (I.V.) 100mg/kg/day in 2DD
20. Ceftriaxone (I.V.) 100mg/kg/day or in 2DD.
21. Cefuroxime (oral/I.V.) 50-100mg/kg/day in 2-3DD.
22. Chloramphenicol 100mg/kg/day in 3DD.
23. Ciprofo
Ciprofoxacin (I.V./oral) 10-15mg/kg/day in 2DD. Ciprofoxacin (PO) 10mg/kg/dose
24. Co-trimoxazole (Septrin
(Septrin)) (Syr/Tabs) 5mls 12hrly in 0-4yrs, 1 Tab 12hrly in 5-10yrs.
25. Crystalline penicillin (I.V.) 100,000 I.U./kg/day in 4DD, in meningitis 400,000 I.U./kg/day in 4DD.
26. Dexamethasone (I.V.) 0.1mg/kg/dose 6hrly. The use of dexamethasone in meningitis is controversial, but when it is
used the dosage is 0.6 mg/kg/d in four divided doses for 4 days.
27. Dextrose Water 10% (D10W). 5ml/kg(I.V.). 4ml/kg/hr(7mg/kg/min). I.V.F. 70-80ml/kg/day
28. Diazepam (I.V. or I.M.) 0.2-0.3mg/kg/dose.
29. Digoxin (I.M./oral) 0.04mg/kg as total digitalising dose….half of the total dose stat, quarter of the total dose 8hrly x
doses.
30. Emal (I.M.) 3mg/kg daily x 3/7.
31. Ethambutol 15-20mg/kg/day
32. Erythromycin (Tabs) 100mg/kg/day in 4 DD.
33. Fansida
ansidar (IM) 2.5mg stat.
34. Fentanyl (analgesic): (I.V.) 1 – 2 microgram/kg/dose. Dilute and give slowly over 15 – 30 minutes. Onset of action is
within minutes. NOTE; Rapid administration leads to chest wall rigidity and inability to ventilate.
35. Fluconazole (P.O.) 12mg/kg stat; 6mg/kg every 72hr
36. Frusemide (I.V.) 1-2mg/kg/dose.
37. Gentamycin (I.V.) 3-5mg/kg/dose in 2 DD.
38. Hydrocortisone (I.V.) 3 - 5mg/kg/dose (usual order in 50/75/100mg). (Hydrocortisone 4mg/kg 6hrly))
39. Hypoglycaemia: Give 5 ml/kg of 10% glucose solution rapidly by IV injection
40. Ibuprofen: 4–10 mg/kg PO every 6–8 hours
41. Insulin (I.V.) at 0.01 to 0.1unit/kg/hr
42. Isoniazid 5-10mg/kg daily. Isoniazid 10-15mg/kg/day
43. Ivermectin: 200 microgram/kg (single dose)
44. Mannitol,
Mannitol, 20% (I.V.) 0.5mg -1.0mg/kg (2.5 – 5ml/kg) stat, then 8hrly x 3 doses.Given over 5 – 10 minutes
45. Mebendazole: (Syrup) 500mg stat
46. Methyldopa (Tabs) 10mg/kg /day in 2-3 DD.
47. Metronidazole 7.5mg/kg/ 8hrly.
 48. Morphine (analgesic): P.O. 0.3mg/kg q 3 – 4hr. I.V, I.M., SC 0.05 – 0.1mg/kg/dose (2-4hr). Dilute and give slowly
over 15 – 30minutes. Onset of action when given I.V. is 15 – 30minutes. NOTE, do not administer while premature
infant is hypotensive.
49. Na+ bicarbonate: 1mmol/ kg i.v in double dilution over 10 – 20mins
50. Naloxone: I.V. 0.1 – 0.8mg/kg (0.4mg/ml). Maximum dose is 2mg
51. Naproxen (analgesic): Naproxen is FDA-approved for children aged 2 –12 years (5 –7 mg/kg PO every 8 –12 hours)
52. Nystatin (Oral) 100,000 I.U/ml 6hrly x5/7 in all children.
53. Paludrine (Tabs) 50mg in 0-4yrs, 100mg in 5-10yrs daily.
54. Paracetamol: (oral, I.M.or rectal) 10 - 15mg/kg q 4hrly
55. Paraldehyde (I.M.) 0.2mls/kg in less than 1yr, 1mls/yr if greater than 1yr.
56. Perfoxacin (I.V.) 10mg/kg/dose in 2DD
57. Phenobarbitone (I.V.) 10-20mg (15mg) stat; 2.5mg/kg/dose 12hrly
58. Phenobarbitone (I.V.) 20mg/kg stat, then 3-5mg/kg /day in 2-3 DD.
59. Pyrazinamide 25-30mg/kg/day
60. pyridoxine (I.V.)50-100 mg and maintain on 10-100mg/day for pyridoxine dependent seizures, and 5mg/day for
pyridoxine deficient seizures.
61. Prednisolone 2mg/kg/day (max 40)
62. Pyrazinamide 20-40mg/kg daily.
63. Quinine (I.V.)20mg/kg into 10mls of IVF D10 x 4hrs as loading dose, then 10mg/kg into 10mls of IVF D10 8hrly.
64. Quinine (Oral)
( 10mg/kg/dose 8hrly.
65. Rif
Rifampicin 10mg/kg daily. Rifampicin 10-20mg/kg/day
66. Streptomycin (I.M.)
( 20-30mg/day. Streptomycin 20-40mg/kg/day
67. TT (I.M.) 0.5mls stat in all ages.
68. Thiacetazone 3-5mg/kg/day
69. Salbutamol (Nebulised) 0.15mg/kg/dose –max.-5mg/dose diluted in 2 -3 ml of normal saline, given over 10minutes.
70. Syr/tabs 4mg/kg stat, then 2mg/kg 12hrly x4/7.

Acyclovir (Zovirax); Antiviral; Cap: 200 mg

Inj: 500 mg, 1 gm
Oint: 5% [3, 15 gm]
Susp: 200 mg/5 mL
Tab: 400, 800 mg;
Herpes zoster (immunocompromised): 500 mg/m2/dose PO 4-5 times daily or 1500 mg/m2/day IV q8h
Herpes zoster (immunocompetent): 80 mg/kg/day PO 5 times daily (max 4000 mg/day) or 30 mg/kg/day IV q8h
Varicella zoster (chicken pox):
pox 80 mg/kg/day PO qid x 5 days (max 3200 mg/day)
Mucocutaneous HSV infection: 750 mg/m2/day IV q8h or 15 mg/kg/day IV q8h x 7 days.
Genital herpes or HSV (immunocompromised):
(immunocompromised 80 mg/kg/day PO 3-5 times daily (max 1000 mg/day)
Herpes encephalitis: birth-12 yrs: 60 mg/kg/day IV q8h; >12 yrs: 30 mg/kg/day IV q8h
Infuse each IV dose over 1 hour. Adjust in renal impairment. Patients should be well hydrated to avoid urolithiasis.
Topical: Apply to affected area q3h while awake for 7 days.
DIGOXIN DOSING SCHEDULE

AGE PARENTERAL ORAL

Premature 0.035mg/kg 0.04mg/kg

1 week – 2 years 0.05mg/kg 0.06mg/kg

<1 week OR > 2 0.04mg/kg 0.05mg/kg

years

Nonopioid analgesics used in the treatment of mild to moderate pain include acetaminophen, aspirin, and other nonsteroidal
anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen.

AMINOPHYLLINE (with paediatricians): loading dose: 5mg/kg, maintainance 1mg/kg/hour (max 20mg/kg/day)
Intravenous AEDs
1. phenobarbital (High-dose):: >30 mg/kg
2. Pentobarbital: 10 mg/kg, then 1 mg/kg per hour
3. Thiopental: 10 mg/kg, then 2 to 4 mg/kg per hour
4. Midazolam: 0.2 mg/kg, then 0.1 to 0.4 mg/kg per hour
 5. Clonazepam: 0.1 mg/kg
6. Lidocaine: 2 mg/kg, then 6 mg/kg per hour
7. Valproic acid: 10 to 25 mg/kg, then 20 mg/kg per day in 3 doses
8. Paraldehyde: 200 mg/kg, then 16 mg/kg per hour
9. Chlormethiazole: Initial infusion rate of 0.08 mg/kg per minute
10. Dexamethasone: 0.6 to 2.8 mg/kg
11. Pyridoxine (B6): 50 to 100 mg, then 100 mg every 10 minutes (up to 500mg)
Oral AEDs
12. Primidone: 15 to 25 mg/kg per day in 3 doses
13. Clonazepam: 0.1 mg/kg in 2 to 3 doses
14. Carbamazepine: 10 mg/kg, then 15 to 20 mg/kg per day in 2 doses
15. Oxcarbamazepine: no data on neonates, young infants
16. Valproic acid: 10 to 25 mg/kg, then 20 mg/kg per day in 3 doses
17. Vigabatrin: 50 mg/kg per day in 2 doses, up to 200 mg/kg per day
18. Lamotrigine:
Lamotrigine 12.5 mg in 2 doses
19. Topiramate: 3 mg/kg per day
20. Zonisamide: 2.5 mg/kg per day
21. Levetiracetam: 10 mg/kg per day in 2 doses
22. Folinic acid: 2.5 mg BID, up to 4 mg/kg per day
23. Calcium gluconate 5% 4ml/kg (I.V.) Hypocalcemia
24. MgSO4 50% 0.2 ml/kg (I.V.), Hypomagnesemia
25. Pyridoxine 50-100 mg (IV), Pyridoxine deficiency
26. Piperazine is also effective in whipworm infections. Children aged 2– 12 years should be given 75 mg/kg of piperazine in
a single dose to a maximum of 2.5 g, while those under 2 years should receive 50 mg/kg in a single dose
AED Initial Dose Maintenance Dose Route
Phenobarbital 20 mg/kg 3-4 mg/kg/day IV,IM,PO
Phenytoin 20 mg/kg 3-4 mg/kg/day IV, PO
Fosphenytoin 20 mg/kg PE 3-4 mg/kg/day IV,IM
Lorazepam 0.05-0.1 mg/kg Q 8-12 hours IV
Diazepam 0.25 mg/kg Q 8-12 hours IV
Initial drug of choice – Phenobarbital

DRUGS IN STATUS EPILEPTICUS

MIDAZOLAM (I.M., oral, nasal, rectal) iv 50-100-200 ugm/kg/dose (12-18yrs 300ugm/kg)
LORAZEPAM (im, oral, rectal) iv 50-100 ugm/kg/dose (12-18yrs 4mg)
DIAZEPAM (oral, rectal, iv)
PR: < 3 yrs 5 mg, > 3 yrs 10 mg
iv bolus 200 - 400 ugm/kg slowly, repeat in 10 mins (12-18 yrs 10-20 mg)
FURTHER DRUGS IN STATUS
PHENYTOIN (cardiac monitor: HR and BP)
20 g/kg iv in normal saline over 10-20 mins. May repeat 20 mg/kg (do not use in febrile status)
PHENOBARBITONE (in febrile status)
15-20 mg/kg iv over 10 mins
(10-20 mg/kg iv may be repeated)
PARALDEHYDE (im abscess, iv CSF peak 20-60 mins) rectal 0.4 ml/kg + equal volume of arachnis oil
ANTI-TUBERCULOSE DRUGS
Drugs
Drugs Dosages Side-effects
1. Streptomycin 20-40mg/kg/day -Toxicity to 8 th nerve
- Rash
- Renal damage
2. Isoniazid 10-15mg/kg/day - Peripheral neuritis
 - Hepatotoxicity
- Psychosis
3. Rifampicin 10-20mg/kg/day - Orange discoloration of urine and tears
- Gastrointestinal disturbance
- Hepatotoxicity
- Thrombocytopenmia
4. Pyrazinamide 25-30mg/kg/day - Hyperuricaemia
- Skin rash
- Hepatotoxicity
6. Ethambutol 15-20mg/kg/day - Optic neuritis
- Hepatotoxicity
5. Thiacetazone 3-5mg/kg/day - Skin rash
- Hepatotoxity
- Haemolytic anaemia
- Steven-Johnson’s syndrome in patient’s with HIV/AIDS

CPR DRUGS

Atropine (0.1 mg/ml) 0.02 mg/kg IV or ET

CaCl2 10% (100 mg/ml) 20 mg/Kg IV

Dextrose 50% (0.5g/ml) 0.5 g/kg (D25W) IV

Epinephrine 1:10000 (0.1 mg/ml) 0.01 mg/kg IV

0.1 mg/kg ET , 2nd IV

Epinephrine 1:1000 (1 mg/ml)

Lidocaine 2 % (20 mg/ml) 1 mg/kg IV or ET

NaHCO3 (1 mEq/ml) 1 mEq/kg IV

ANALGESICS, ANTIPYRETICS AND NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS)

 NON-NARCOTIC ANALGESICS
 ASPIRIN: Anti-inflammatory dose in rheumatic disease: 90 – 130mg/kg/D PO q 4hr.
Antipyretic dose: 30 – 60mg/kg/D q 4-6hr
 PARACETAMOL: 40 – 60mg/kg/D PO q 4-6hr. Injection 5mg/kg IM
 IBUPROFEN: 20 – 30mg/kg/D q 6 – 8 hr oral. Avoid in infants <6 months age.
 NIMESULIDE: 5mg/kg/D q 8 – 12hr
 NARCOTIC ANALGESICS (OPIOIDS)
 FENTANYL: 0.5 – 5 μg/kg/dose q 1 – 4hr IV. May be administered as a continuous infusion 1 – 5 μg/kg/hr
 PENTAZOCINE: 0.5 – 1mg/kg per dose 4 times a day. Contraindications: head injury, raised ICP, porphyria.
 CODEINE: For pains: 3mg/kg/D PO q 4hr.
4hr. For cough: 0.2mg/kg/dose 4hrly

APGAR SCORING SYSTEM

SIGN 0 1 2
 Appearance Blue or pale Pink body, blue Completely pink
(colour) extremity
 Pulse (Heart Absent < 100 > 100
 Rate)
 Grimace No response Grimace Cough or sneeze
(catheter
response)
 Activity (muscle Limb Some fexion Active motion
tone)
 Respiration Absent Slow, irregular Good, crying
INTERPRETATION OF THE APGAR SCORING SYSTEM
 0-3-severe birth asphyxia.
 4-5-moderate birth asphyxia.
 6-7-mild birth asphyxia. >7- normal.
 1st minute Apgar-signals the need for immediate resuscitation.
 5th, 10, 15, 20th minute Apgar-indicate level of success of resuscitation. Apgar score alone not designed to predict
neonatal outcome, however a low score combine with low arterial PH increase the risk of neonatal morbidity and
mortality.
LIMITATIONS OF THE APGAR SCORE
 False positive (no acidosis but  False negative (acidosis,
low apgar) normal apgar).
 Prematurity  Maternal acidosis.
 Narcotics, sedatives  High fetal catecholamine levels.
 Precipitous delivery  Some full term infants.
 Congenital myopathy
 Congenital neuropathy
 Spinal cord trauma
 CNS anomaly
 Choanal atresia
 Congenital pneumonia

PLATELET COUNTS (NORMAL VALUES)

MEAN VALUE±SD(perµL)
VLBW (< 1.5kg) 275,000 ± 60,000
Preterm (<2.5kg) 290,000 ± 70,000
Term 310,000 ± 68,000
HYPOGLYCAEMIA
BLOOD GLUCOSE SCREENING: Screen every 15 – 30 minutes, until greater than 50mg/dL (2.8mmol/L) on at least two
consecuyive tests. If greater than 150mg/dL (8.3mmol/L) on two consecutive tests; consider stress or prematurity as a cause.
SIGNS OF HYPOGLYCAEMIA
 Jitteriness
 Irritability
 Hypotonia, lethargy
 High-pitched or weak cry
 Hypothermia
 Poor suck/co-ordination
 Tachypnea
 Cyanosis
 Apnea
 Seizures
 Maintain blood glucose 50 – 110mg/dL (2.8 – 6.0mmol/L)
INITIAL I.V. FLUID AND RATE
 D10W without electrolytes
 Think of glucose as a medication
 80ml/kg/day→ delivers a glucose dose of 5.5mg/kg/minute
kg x 80∕
80∕24 = ml/hr (via an infusion pump)
  Give 2ml/kg D10W bolus I.V. over several minutes
 Screen blood glucose 15 – 30 minutes after bolus
UMBILICAL VEIN CATHETER
 Catheter sizes
 Under 1.5kg → 3.5 French
 Over 1.5kg → 5 French
PAEDIATRIC HIV
Intervention to limit Perinatal Transmission
The use of Zidovudine after the first trimester and during labour in the mother as well as in her new-born for the first six
weeks has been shown to reduce perinatal transmission by 67.0% in PACTG076 study (i.e. 8.0% transmission compared to 25%
in untreated group).
Antenatal: AZT 300mg bd p.o. starting from 14 weeks of gestation till delivery.
In Labour: AZT loading 2 mg/kg IV in first hour; 1 mg/kg/hour infusion until delivery; substitute with oral AZT 300mg 3 HOURLY
IF IV AZT is not available
Induction of labour: begin AZT at time of induction
Elective caesarean section: begin AZT 4 hours before surgery
Infant: Syrup AZT 2 mg/kg/dose 6 hourly beginning from < 8 to 12 hours of life (not > than 24 hours of life) until 6 weeks of age
Management of Babies Born to HIV Infected Mother
Children born to HIV positive mothers are usually asymptomatic at birth. However, all will have acquired maternal antibodies via
the placenta and therefore will test antibody positive at birth. The median time for losing this antibody, if the child is not
infected, is around 10 months but may be as late as 18 months.
During pregnancy
Counseling of mother – discuss the following:
•Transmission rate (natural course without intervention) – 25 to 30%. use of prophylactic AZT – reduces transmission to 8%,
elective LSCS with prophylactic AZT – reduces transmission to ~3%.
•Advise on bottle feeding as breast feeding can double the risk of transmission
•Difficulty in making early diagnosis because of presence of maternal antibody in babies of HIV positive mothers. Stress
importance of regular blood tests and follow-up.
Neonatal Period
•Admit all cases to nursery.
•Examine the child – look for evidence of congenital infections other than HIV and symptoms of drug withdrawal if appropriate.

•Start on Syrup Zidovudine (AZT) 2mg/kg/dose 6 hourly for 6 weeks within the first 8 hours and certainly no later than 24
hours. (Dose for premature baby >30 weeks: 2mg/kg 12hourly for 2 weeks, then 2mg/kg 8hourly). If oral feeding is
contraindicated, then use IV AZT at 1.5mg/kg/dose.
•Take blood for:
- HIV DNA PCR (need arrangement with IMR, do not take from cord blood.
Sensitivity reaches 90% by 1 month of age)
- FBP, LFT, RP
- HBsAg, Hepatitis C serology
- TORCHES (esp. toxoplasmosis & CMV), VDRL
Management of HIV Infected Children
Clinical Features
_ Common presenting features are:
•Persistent/ generalized lymphadenopathy
•Hepatosplenomegaly
•Failure to thrive
•Recurrent infections (respiratory, skin, gastrointestinal)
•Developmental delay / regression
WHO Recommendations for ART in Children When CD4 Testing Is Available:
Children with confirmed HIV infection with:
WHO paediatric stage 3 or 4, irrespective of CD4 cell %
Or
WHO paediatric stage 2 or 1, with:
•CD4 <25% (<1,500 cells/mm3) for infants less than 12 months of age or
•CD4 <20% (<750 cells/mm3) for children 12–35 months of age
• CD4 <15% (350 cells/mm3) for children 36– 59 months of age
• CD4 <15% (200 cells/mm3) for children ≥5 years old
Antibody-positive children <18 months with no virologic test* but with
• WHO paediatric stage 3 or 4, irrespective of CD4 cell %
• WHO paediatric stage 2 only if CD4 cell % <20%
• (WHO paediatric stage 1: don’t treat if no virologic tests are available)
* Must have confirmatory test at 18 months to continue with ART
WHO Recommendations for ART in Children When CD4 Test Is Not Available:
Less than 18 months of age:
• WHO stage 3 or 4, irrespective of total lymphocyte count (TLC)
• WHO stage 2 only if TLC <4,000/mm3 (age ≤ 11 months); <3,000/mm3 (age 12–18 months);
or mother has severe symptomatic disease (WHO adult stage 3 or 4) or died of AIDS
• WHO paediatric stage 1: don’t treat if no virologic tests are available
More than 18 months of age:
• WHO stage 3 or 4, irrespective of TLC
• WHO paediatric stage 2 only if TLC <3,000/mm3 if age 18–35 months; <2,500/mm3 if age
36–59 months or <2,000 if age is ≥ 5 years.
First-Line Therapy
Treatment for HIV-infected children should follow national recommendations.
If there are no national recommendations, then the following first-line options may be considered
• Less than 3 years of age and/or <10 kg— zidovudine/lamivudine/nevirapine
• More than 3 years of age and/or >10 kg— zidovudine/lamivudine/efavirenz
• Failed nevirapine prophylaxis— zidovudine/lamivudine/lopinavir and ritonavir co-formulation
SCABIES: Lindane, 0.3% lotion, should be applied to affected areas once daily for 2 days. If this is not available, benzyl
benzoate, 25% lotion, may be used. Although cheaper, it is more irritating; it should be avoided in malnourished
children, unless there is no alternative available. Family members should also be treated to prevent infestation or
reinfestation.
CANDIDIASIS: Nystatin oral suspension, 100 000 IU four times daily is recommended for oral, oesophageal and rectal
candidiasis. Nystatin cream (100 000 IU (1 g)) should be applied to affected areas of skin twice daily for 2
weeks. Children over 2 years with systemic candidiasis should be given ketoconazole, 5 mg/kg orally
daily until remission is obtained.
obtained
Treatment of Candidiasis
Oral Candidiasis
• Nystatin 1– 2 million U/day divided every 6 hours until resolution
Oesophageal Candidiasis
• Fluconazole 3– 6 mg/kg once daily or
• Amphotericin B, 0.3mg/kg/day

Common Skin Manifestations and Treatments

Scabies Treatment
Children <1yr
• 25% benzyl benzoate for 12 hours or gamma benzene hexachloride
• 2.5% sulphur ointment 3x daily for 3 days
• Screen and treat other household contacts where appropriate
• Wash and iron bedding and clothing or hang it out in the sun
Eczema Treatment
• Avoid soap and expose affected areas to sunlight
• Use aqueous cream instead of soap for washing; use moisturizer on dry areas
• Apply zinc oxide cream 2x daily; if not responding, use 1% hydrocortisone cream 2x daily
• Cut nails short
Ringworm Treatment
• Apply Whitield’s ointment (benzoic acid with salicylic acid) 2x daily for 2 to 5 weeks for body lesions; if not successful try
2% miconazole cream
• For scalp lesions give griseofulvin 10m/kg/day for 8 weeks; if not responding consider ketoconazole
Herpes zoster
Prophylaxis
• Hospitalise all cases and treat, if possible, with IV acyclovir 30mg/kg/day divided into doses every 8 hours for a total of 7 days
or 2 days after cessation of new lesion formation, whichever is longer
• Children who have been exposed to herpes zoster may receive prophylaxis using varicella-zoster immune globulin (VZIG) 125U
per 10 kg (max 625U) within 48–96 hours of exposure.
Herpes simplex
Treatment
• Local antiseptic (gentian violet)
• Analgesia (paracetamol)
• Admit all children with disseminated or severe herpes simplex and give acyclovir 5mg/kg intravenously 3 times a day or
200–400mg orally 5 times a day, for 7–10 days.
Impetigo Treatment
• Hygiene, proper washing, cut fingernails, soak crusts off in soapy water
• Apply 10% iodine solution 3x daily or zinc oxide cream
• Antibiotics indicated only if pyrexial, lymphadenopathy, or lesions are resistant to treatment (first-line = amoxycillin for 10
days; second-line = flocloxacillin or erythromycin for 10 days)

Measles
Measles is one of the major causes of morbidity and mortality in sub- Saharan Africa and is a severe illness in children with HIV
infection, particularly those with advanced immunodeficiency. Severe cases can occur without the typical rash and may be
complicated by pneumonia or encephalitis. HIV-infected children with measles have a high case fatality and should be treated in
hospital. Management should include 2 doses of vitamin A, calculated on the basis of the child ’s age (50,000 IU if aged <6
months; 200,000 IU in children aged 12 months to 1 year). Measles may occur in early infancy in HIV-infected children because
of inadequate transfer of maternal antibodies and infection may occur despite history of immunisation. Give measles
immunisation to HIV-infected children at 6 months and repeat at 9 months.
In management of acute diarrhoea, health workers should:
• Counsel mothers to begin administering available home fluids immediately upon onset of diarrhoea in a child.
• Treat dehydration with oral rehydration salts (or with an intravenous electrolyte solution in cases of severe dehydration).
• Emphasise continued feeding or increased feeding during and after the diarrhoeal episode.
• Use antibiotics only when appropriate, that is, in the presence of bloody diarrhoea or shigellosis, and abstain from
administering
anti-diarrhoeal drugs.
• Provide children with 20mg/day of zinc supplementation for 10-14 days (10 mg/day for infants under 6 months old).
• Provide mothers or caregivers two 1-litre packets of oral rehydration salts for home use until diarrhoea stops.
ANTIMALARIAL DRUGS

– artesunate 2.4 mg/kg bw i.v. or i.m. given on admission

(time = 0), then at 12 h and 24 h, then once a day;
– artemether 3.2 mg/kg bw i.m. given on admission then
1.6 mg/kg bw per day;
– quinine 20 mg salt/kg bw on admission (i.v. infusion or
divided i.m. injection), then 10 mg/kg bw every 8 h; infusion
rate should not exceed 5 mg salt/kg bw per hour.
Dosing schedule for Artemether(20mg)-Lumefantrine (120mg)

Body (age in 0 hr 8 hr 24hr 36 hr 48 hr 60 hr

weight in years)
kg

5 – 14 (< 3) 1 1 1 1 1 1

15 – 24 (≥3 – 8) 2 2 2 2 2 2

25 – 34 (≥9 –14) 3 3 3 3 3 3

>34 (>14) 4 4 4 4 4 4

Artesunate(50 mg) + Amodiaquine(153 mg base)

The total recommended treatment is 4 mg/kg bw of artesunate and 10 mg base/kg bw of amodiaquine given once a day for 3
days.

Dosing schedule for Artesunate + Amodiaquine

Age Dose in mg (No of tablets)

Artesunate (50 mg) Amodiaquine (153 mg)

Day 1 Day 2 Day 3 Day 1 Day 2 Day 3

5-11months 25 (1/2) 25 25 76 (1/2) 76 76

≥1-6yr 50 (1) 50 50 153 (1) 153 153
≥7-13yr 100 (2) 100 100 306 (2) 306 306
>13yr 200 (4) 200 200 612 (4) 612 612

DAILY REQUIREMENT
Fluids:
60-70ml/kg for full term on the 1st day of life, increasing by 10-20ml/kg daily till end of 1 st week.
80-90ml/kg for preterm on the 1st day of life, increasing by 10-20ml/kg daily till end of 1 st week.
Calorie: 100-110kcal/kg for full term up to 140kcal/kg for LBW
Milk feed contains 67Kcal per 100ml
Protein: 2-3g/kg

 ENTERIC FEVER
-CHLORAMPHENICOL: 50mg/kg/day (oral) OR 75mg/kg/day (I.V.) in 4DD
-AMPICILLIN: 200mg/kg/day in 4-6 doses can be given.
-AMOXICILLIN: 100mg/kg/day in 3DD
-TRIMETHOPRIM & SULFAMETHOXAZOLE:
SULFAMETHOXAZOLE 10mg/kg of TMP and 50mg/kg/day of SMX in 2DD
-CEFIXIME (oral) 20mg/kg/day in 2DD for 8 days
-CEFTRIAXONE (I.M.): 50mg/kg/day for 5 days
-OFLOXACIN (oral): 15mg/kg/day

SUPPORTIVE TREATMENT
-DEXAMETHASONE: 3mg/kg as initial dose followed by 1mg/kg every 6hr for 48hr improves the survival rate of patient
with shock, obtundation, stupor, or coma.
BLOOD TRANSFUSION for haemorrhage
PLATELET TRANSFUSION for thrombocytopaenia
ERADICATION OF CARRIER STATE
-High dose of AMPICILLIN or AMOXICILLIN for 4-6 weeks, along with PROBENECID or TMP and SMX result in cure of 80%
of cases

DRUGS USED IN HIV INFECTION

-NUCLEOSIDE TRANSCRIPTASE INHIBITORS
 ZIDOVUDINE 180mg/m2/12th hrly (P.O.)
 DIDANOSINE 90-150mg/m2/12th hrly (P.O.)
 LAMIVUDINE 4mg/Kg/12th hrly (P.O.)
 STAVUDINE 1mg/kg/12th hrly (P.O.)
 ZALCITABINE 0.01mg/kg/8th hrly (P.O.)
 ABACAVIR 8mg/kg/12hrly (P.O.)
-PROTEASE INHIBITORS
 INDINAVIR 500mg/m2/8th hrly (P.O.)
 NELFINAVIR 30-40mg/kg/8th hrly (P.O.)
 RITONAMIR 400mg/m2/12th hrly (P.O.)
-NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS
 NEVIRAPINE 120-200mg/m2/12th hrly
TREATMENT OF HYPERKALAEMIA
Aim of treatment is to reduce the potential of cardio toxicity and to remove K + from the body
 Na+ bicarbonate: 1mmol/ kg i.v in double dilution over 10 – 20mins
 10% Ca+ gluconate: 0.5 – 1ml/kg in double dilution over 5 – 15mins
 Glucose and Insulin: glucose 0.5g/kg and insulin 0.1 unit/kg i.v over 30mins
  B- agonist 5 – 10mg
 Kayexalate: 1g/kg oral or parenteral in sorbitol
 Dialysis

Hydrochlorothiazide 2–4 mg/kg/24 h as single dose or in 2 individual doses Potassium depletion, hyperuricemia
Furosemide 1–5 mg/kg/dose, 2–3 doses per day Potassium and volume depletion
Hydralazine 0.75 mg/kg/24 h in 4–6 divided doses Lupus erythematosus, tachycardia, headache
Amlodipine 0.2–0.5 mg/kg/d in 2 divided doses Fatigue, headache, facial flushing
Propranolol 0.2–5 mg/kg/dose, 2–3 doses per day Syncope, cardiac failure, hypoglycemia
Minoxidil 0.15 mg/kg/dose, 2–3 doses per day Tachycardia, angina, fluid retention, hirsutism
Captopril 0.3–2 mg/kg/dose, 2–3 doses per day Rash, hyperkalemia, glomerulopathy
Enalapril 0.2–0.5 mg/kg/d in 2 divided doses Proteinuria, cough, hyperkalemia
Nifedipine 0.5–1 mg/kg/d, 3 doses per day Flushing, tachycardia
Verapamil 3–7 mg/kg/d in 2 or 3 divided doses

Characteristics of Cerebrospinal Fluid in the Normal Child and in Central Nervous System Infections and Infammatory
Conditions.
Condition Initial Appearance Protein Glucose Other Tests Comments
Pressure Cells/ L (mg/dL) (mg/dL)
(mm H2O)

Normal < 160 Clear 0–5 15–35 50–80 CSF-IgG indexa < CSF protein in first
lymphocyte (lumbar), (two-thirds 0.7a; LDH 2–27 U/L month may be up
s; first 3 5–15 of blood to 170 mg/dL in
months, 1–3 (ventricular glucose); small-for-date or
PMNs; ); up to 150 may be premature infants;
neonates, (lumbar) for increased no increase in
up to 30 short time after WBCs due to
lymphocyte after birth; seizure seizure.
s, 20–50 to 6 months
RBCs up to 65
Bloody tap Normal or Bloody One One Normal RBC number should Spin down fluid,
low (sometimes additional additional fall between first supernatant will
with clot) WBC/700 milligram and third tubes; be clear and
RBCsb; RBCs per 800 wait 5 min between colorless.c
not RBCsb tubes
crenated

Bacterial 200–750+ Opalescent to Up to Up to Decreased; Smear and culture Very early, glucose
meningitis, acute purulent thousands, hundreds may be mandatory; LDH > may be normal;
mostly none 24 U/L; lactate, IL- PCR (meningo-
PMNs; early, 8, TNF elevated, and
few cells correlate with pneumococcus)
prognosis plasma, CSF may
aid diagnosis
Bacterial Usually Clear or Usually Elevated Normal or LDH usually > 24 Smear and culture
meningitis, increased opalescent increased; decreased U/L; PCR may be negative if
partially treated PMNs antibiotics have
usually been in use.
predominat
e
Tuberculous 150–750+ Opalescent; 250–500, 45–500; Decreased; Smear for acid-fast Consider AIDS
meningitis fibrin web or mostly parallels may be organism: CSF
pellicle lymphocyte cell count; none culture and
s; early, increases inoculation; PCR
Condition Initial Appearance Protein Glucose Other Tests Comments
Pressure Cells/ L (mg/dL) (mg/dL)
(mm H2O)

more PMNs. over time

Fungal meningitis Increased Variable; 10–500; Elevated Decreased India ink Often
often clear early, more and preparations, superimposed in
PMNs; then increasing cryptococcal patients who are
mostly antigen, PCR, debilitated or on
lymphocyte culture, immunosuppressiv
s inoculations, e therapy
immunofluorescen
ce tests
Aseptic Normal or Clear unless None to a 20–125 Normal; CSF, stool, blood, Acute and
meningoencephali slightly cell count > few may be throat washings for convalescent
tis (viral meningitis, increased hundred, low in viral cultures; LDH antibody titers for
or parameningeal 300/ L mostly mumps, < 28 U/L; PCR for some viruses; in
disease); lymphocyte herpes, or HSV, CMV, EBV, mumps, up to
encephalitis is s; PMNs other viral enterovirus, etc 1000 lymphocytes,
similar predominat infections serum amylase
e early often elevated;
rarely, a thousand
cells present in
enteroviral
infection
Parainfectious 80–450, Usually clear 0–50+, 15–75 Normal CSF-IgG index may No organisms;
encephalomyelitis usually mostly be increased; fulminant cases
(ADEM) increased lymphocyte oligoclonal bands resemble bacterial
s variable meningitis
Polyneuritis Normal Early: normal; Normal; Early: Normal CSF-IgG index may Try to find cause
and late: occasionally normal; be increased; (viral infections,
occasionall xanthochromi slight late: oligoclonal bands toxins, lupus,
y increased c if protein increase 45–1500 variable diabetes, etc)
high
Meningeal Often Clear to Cytologic Often Often Cytology Seen with
carcinomatosis elevated opalescent identificatio mildly to depressed leukemia,
n of tumor moderately medulloblastoma,
cells elevated meningeal
melanosis,
histiocytosis X.
Notes: May mimic
infectious
meningitis
Brain abscess Normal or Usually clear 5–500 in Usually Normal; Imaging study of Cell count related
increased 80%; mostly slightly occasionall brain (MRI) to proximity to
PMNs increased y meninges; findings
decreased as in purulent
meningitis if
abscess ruptures

Table 23–4. Gradation of coma.

Deep Coma Light Coma
Grade 4 Grade 3 Grade 2 Grade 1 Stupor
Response to pain 0 + Avoidance Avoidance Arousal unsustained
Tone/posture Flaccid Decerebrate Variable Variable Normal
Tendon refexes 0 +/– + + +
 Deep Coma Light Coma
Grade 4 Grade 3 Grade 2 Grade 1 Stupor
Pupil response 0 + + + +
Response to verbal stimuli 0 0 0 0 +
Other corneal refex 0 + + + +
Gag refex 0 + + + +

Table 23–6. Seizures by Age at Onset, Pattern, and Preferred Treatment.

Age Group and Seizure Age at Clinical Causative Factors Electroencephalogra Other Treatment
Type Onset Manifestatio phic Pattern Diagnostic and
ns Studies Comments
(Anticonvulsa
nts by Order
of Choice)
Neonatal seizures Birth to 2 Often Neurologic insults May correlate poorly Lumbar Phenobarbital,
wk atypical; (hypoxia/ischemia; with clinical seizures. puncture; CSF IV or IM; if
sudden intracranial Focal spikes or slow PCR for seizures not
limpness or hemorrhage) rhythms; multifocal herpes, controlled,
tonic present more in first discharges. enterovirus; add phenytoin
posturing, 3 d or after eighth Electroclinical serum Ca2+, IV (loading
brief apnea, day; metabolic dissociation may PO43-, glucose, dose 20 mg/kg
and disturbances alone occur: EEG-electrical Mg2+; BUN, each).
cyanosis; between third and seizure without amino acid Diazepam 0.3
odd cry; eyes eighth days; clinical screen, blood mg/kg. Treat
rolling up; hypoglycemia, manifestations and ammonia, underlying
blinking or hypocalcemia, vice versa. organic acid disorder.
mouthing or hyper- and screen, Sezures due to
chewing hyponatremia. Drug TORCHSa IgM. brain damage
movements; withdrawal. Ultrasound or often resistant
nystagmus, Pyridoxine CT/MRI for to
twitchiness dependency. CNS suspected anticonvulsant
or clonic infections. intracranial s. When cause
movements Structural hemorrhage in doubt, stop
—focal, abnormalities. and structural protein
multifocal, or abnormalities feedings until
generalized. enzyme
Some deficiencies of
seizures are urea cycle or
nonepileptic: amino acid
decerebrate, metabolism
or other ruled out.
posturings,
release from
forebrain
inhibition;
poor
response to
drugs.
West syndrome infantile 3–18 mos; Sudden, Pre- or perinatal Hypsarrhythmia; Funduscopic ACTH
spasms (See also occasionall usually brain damage or chaotic high-voltage and skin preferred (2–4
Lennox– Gastaut y up to 4 y symmetric malformation in slow waves, random examination, U/kg/d) IM
syndrome, below.) adduction approximately one- spikes, all leads trial of corticotropin
and flexion third; biochemical, (90%); other pyridoxine. gel once daily,
of limbs with infectious, abnormalities in 10%. Amino and then slow
concomitant degenerative causes Rarely normal. EEG organic acid withdrawal.
flexion of in approximately normalization early in screen. Some prefer
head and one-third; unknown course usually Chronic oral
Age Group and Seizure Age at Clinical Causative Factors Electroencephalogra Other Treatment
Type Onset Manifestatio phic Pattern Diagnostic and
ns Studies Comments
(Anticonvulsa
nts by Order
of Choice)
trunk; also in approximately correlates with inflammatory corticosteroids
abduction one third. With reduction of seizures; disease. . Zonisamide,
and extensor early onset, not helpful TORCHSa valproic acid,
movements pyridoxine prognostically screen, CT, or vigabatrin, B6
like Moro dependency, amino- regarding mental MRI scan pyridoxine
reflex. or organic aciduria. development. should be trial (Japan).
Tendency for Tuberous sclerosis in done to (1) In resistant
spasms to 5–10%. Chronic establish cases,
occur in inflammatory definite ketogenic or
clusters, on disease, eg, diagnosis, (2) medium-chain
waking or TORCHSa, homeobox aid in genetic triglyceride
falling gene mutations. counseling. diet (see text).
asleep, or SPECT or PET New drugs:
when scan may topiramate,
fatigued, or identify focal lamotrigine,
may be lesion. off-label use.
noted Retardation of
particularly varying degree
when the in
infant is approximately
being 90% of cases.
handled, is Occasionally,
ill, or is surgical
otherwise extirpation of
irritable. focal lesion
Tendency for may be
each patient curative.
to have own
stereotyped
pattern.
Febrile convulsions 3 mos to 5 Usually Nonneurologic Normal interictal Lumbar Treat
y generalized febrile illness EEG, especially when puncture in underlying
(maximum seizures, less (temperature rises obtatined 8–10 d infants or illness, fever.
6–18 mos). than 15 to 39°C or higher); after seizure. In older whenever Diazepam
Most mins; rarely positive family infants, 3/s suspicion of orally or
common focal in history, day care, generalized spike meningitis rectally as
childhood onset. May slow development, waves often seen exists. needed,
seizure: lead to prolonged neonatal (suggests genetic 0.3–0.5 mg/kg
incidence status hospitalization are epilepsy tid during
2% epilepticus. other risk factors. underpinnings). illness or for
Latter prolonged (>
usually 5–15 mins)
benign. seizure.
Recurrence Prophylaxis
risk of with
second phenobarbital
febrile or valproic
seizure 30%; acid rarely
50% if under needed:
1 y of age; maybe with
recurrence neurologic
risk is same deficits,
after status prolonged
epilepticus. seizures,
Age Group and Seizure Age at Clinical Causative Factors Electroencephalogra Other Treatment
Type Onset Manifestatio phic Pattern Diagnostic and
ns Studies Comments
(Anticonvulsa
nts by Order
of Choice)
family anxiety.
Myoclonic-astatic Any time Shock-like Multiple causes, Atypical slow (1–2.5 As dictated by Difficult to
(akinetic, atonic) in violent usually resulting in Hz) spike-wave index of treat. Valproic
seizures, formerly childhood; contractions diffuse neuronal complexes and bursts suspicion. acid,
atypical absence. When usually of one or damage. History of of high-voltage Nerve clonazepam,
mental retardation is 2–7 y more muscle West's syndrome; generalized spikes, conduction ethosuximide,
presented, this is called groups, prenatal or perinatal often with diffusely studies. Skin felbamate,
Lennox– Gastaut singly or brain damage; viral slow background or topiramate.
syndrome. irregularly meningoencephaliti frequencies. See text. conjunctival Ketogenic or
repetitive; des; CNS biopsy for medium-chain
may fling degenerative electron triglyceride
patient disorders; lead or microscopy, diet. ACTH or
suddently to other MRI scan, corticosteroids
side, encephalopathies; WBC as in West
forward, or structural cerebral lysosomal syndrome.
backward. abnormalities, eg, enzymes if Perhaps off-
Usually no or migrational metabolic label
only brief abnormalities. degenerative lamotrigine,
loss of disease levetiracetam,
consciousnes suspected. zonisomide.
s. Half of Protect head
patients or with helmet
more also and chin
have padding.
generalized
grand mal
seizures.
Absence (petit mal). 3–15 y Lapses of Unknown. Genetic 3/s bilaterally Hyperventilati Valproic acid,
Also juvenile and consciousnes component: synchronous, on when lamotrigine, or
myoclonic absence. s or vacant probably an symmetric, high- patient on ethosuximide;
stares, autosomal voltage spikes and inadequate or with latter,
lasting about dominant gene. waves. EEG no medication switch to
3–10 s, often normalization often valproate if
in clusters. correlates closely provokes major motor
Automatisms with control of attacks. seizures. In
of face and seizures. Imaging resistant
hands; clonic studies rarely cases,
activity in of value. ketogenic diet,
30–45%. zonisamide,
Often topiramate,
confused levetiracetam,
with acetazolamide
complex .
partial
seizures but
no aura or
postictal
confusion.
Simple partial or focal Any age Seizure may Often unknown; Focal spikes or slow If seizures are Carbamazepin
seizures involve any birth trauma, waves in appropriate difficult to e. Also used:
(motor/sensory/jackson part of body; inflammatory cortical region; control or oxcabazepine,
ian). may spread process, vascular sometimes diffusely progressive phenytoin,
in fixed accidents, abnormal or even deficits occur, lamotrigine,
Age Group and Seizure Age at Clinical Causative Factors Electroencephalogra Other Treatment
Type Onset Manifestatio phic Pattern Diagnostic and
ns Studies Comments
(Anticonvulsa
nts by Order
of Choice)
pattern meningoencephaliti normal. "Rolandic neuroradio- gabapentin,
(jacksonian s, etc. If seizures are spikes" diagnostic topiramate,
march), coupled with new or (centrotemporal studies, levetiracetam,
becoming progressive spikes) are typical; ? particularly and
generalized. neurologic deficits, genetic, often benign MRI brain zonisamide.
In children, a structural lesion (non-lesional) scan, Valproic acid
epileptogeni (eg, brain tumor) is pattern imperative useful adjunct.
c focus often likely. (see text).
"shifts," and
epileptic
manifestatio
ns may
change
concomitantl
y.
Complex partial seizures Any age Aura may be As above. Temporal As above, but MRI when Carbamazepin
(psychomotor, temporal a sensation lobes especially occurring in temporal structural e, phenytoin.
lobe, or limbic seizures of fear, sensitive to hypoxia; lobe and its lesions More than
are older terms). epigastric seizure may be a connections, eg, suspected. one drug may
discomfort, sequela of birth frontotemporal, PCR of be necessary.
odd smell or trauma, febrile temporoparietal, cerebrospinal Valproic acid
taste (usually convulsions, viral temporo-occipital fluid in acute may be useful.
unpleasant), encephalitis, regions. febrile In cases
visual or especially herpes. situation for uncontrolled
auditory Remediable other herpes or by drugs and
hallucination causes are small enteroviral where a
. Aura and cryptic tumors or encephalitis. primary
seizure vascular SPECT, PET epileptogenic
stereotyped malformations. May scan, video focus is
for each be genetic. EEG identifiable,
patient. monitoring excision of
Seizure may when epilepsy anterior third
consist of surgery of temporal
vague stare; considered. lobe.
facial, Oxcarbazepine
tongue, or , topiramate,
swallowing lamotrigine,
movements levetiracetam,
and throaty and
sounds; or zonisamide.
various
complex
automatisms
. Usually
brief, 15–90
s, followed
by
confusion.
History of
aura and of
automatisms
involving
more than
face and
Age Group and Seizure Age at Clinical Causative Factors Electroencephalogra Other Treatment
Type Onset Manifestatio phic Pattern Diagnostic and
ns Studies Comments
(Anticonvulsa
nts by Order
of Choice)
hands
establish
diagnosis.
Benign epilepsy of 5–16 y Partial motor Seizure history or Centrotemporal Seldom need Carbamazepin
childhood (with or abnormal EEG spikes or sharp waves CT or MRI e or other
centrotemporal or generalized findings in relatives ("rolandic scan. agent. (See
rolandic foci) seizures. of 40% of affected discharges") simple
Similar probands and appearing complex
seizure 18–20% of parents paroxysmally against partial
patterns may and siblings, a normal EEG seizures.)
be observed suggesting background. Often no
in patients transmission by a medication is
with focal single autosomal- necessary,
cortical dominant gene, especially if
lesions. possibly with age- seizure is
Usually dependent exclusively
nocturnal penetrance. nocturnal and
simple infrequent.
partial Lamotrigine,
seizures of topiramate,
face, tongue, levetiracetam,
hand. zonisamide.
Juvenile myoclonic Late Mild 40% of relatives Interictal EEG shows If course is Valproic acid,
epilepsy (of Janz) childhood myoclonic have myoclonias, variety of spike-and- unfavorable, lamotrigine,
and jerks of neck especially in wave sequences or 4- differentiate topiramate, ?
adolescenc and shoulder females; 15% have to 6-Hz multispike from levetiracetam,
e, peaking flexor the abnormal EEG and wave complexes progressive zonisamide.
at 13 y muscles after pattern with clinical ("fast spikes") myoclonic
awakening. attacks. syndromes by
Intelligence appropriate
usually biopsies
normal. (muscles,
Often liver, etc).
absence
seizures, and
generalized
tonic-clonic
seizures as
well.
Generalized tonic-clonic Any age Loss of Often unknown. Bilaterally As above Phenobarbital
seizures (grand mal) consciousnes Genetic component. synchronous, in infants;
(GTCS) s; tonic- May be seen with symmetrical multiple carbamazepin
clonic metabolic high-voltage spikes, e or valproic
movements, disturbances, spikes/waves (eg, acid;
often trauma, infection, 3/s). EEG often phenytoin;
preceded by intoxication, normal in those topiramate,
vague aura degnerative younger than age 4. lamotrigine.
or cry. disorders, brain Focal spikes may Combinations
Incontinence tumors. become "secondarily may be
in 15%. generalized." necessary.
Postictal
confusion;
sleep. Often
Age Group and Seizure Age at Clinical Causative Factors Electroencephalogra Other Treatment
Type Onset Manifestatio phic Pattern Diagnostic and
ns Studies Comments
(Anticonvulsa
nts by Order
of Choice)
mixed with
or masking
other seizure
patterns.

Guide to Pediatric Anticonvulsant Drug Therapy. a

Drug Average Total Steady Effective Side Effects and Precautions Directions and Remarks
Dosage State Blood Levelsb
(mg/kg/d)
Primary anticonvulsant
Carbamazepine 15–25 mg/kg/d 3–6 d Dizziness, ataxia, diplopia, Monitor CBC, platelet count, liver
(Tegretol) in 2–4 divided 4–12 drowsiness, nausea, rash. function tests periodically. Blood
(Carbatrol, Tegretol doses g/mL (> 15) Rare: hepatotoxicity, bone effects usually early and transient.
XR are sustained- marrow depression, Drug interactions: by fluoxetine,
release dystonia, inappropriate ADH propoxyphene, erythromycin,
formulations) secretion, bizarre behaviors,
tics. cimetidine; by felbamate,
phenobarbital, phenytoin.
Valproic acid 15–60 mg/kg/d 2–4 d Weight gain, occasional For prophylaxis in febrile
(Depakene, in 2–4 divided 50–120 gastric discomfort, convulsions, see text. Monitor
Depakote) (Depacon doses g/mL (> 140) constipation. Tremor, hair CBC, platelets, liver function tests
Extended-Release) loss in 5%. Rare: closely in first 6 months, then
hepatotoxicity, periodically. Can be given rectally
hyperammonemia, (suspension: 250 mg/5 mL).
leukopenia, polycystic Depacon is an IV preparation, 100
ovaries (more toxic in infants
younger than 2 years) mg/mL. Drug interactions: by
phenobarbital, phenytoin,

carbamazepine, by
lamotrigine, felbamate.
Phenytoin 5–10 mg/kg/d 5–10 d Gum hypertrophy, hirsutism, Good dental hygiene reduces gum
(Dilantin) in 1 or 2 doses 5–20 ataxia, nystagmus, diplopia, hyperplasia. May aggravate
g/mL (> 25) rash, anorexia, nausea, absence and myoclonic seizures.
osteomalacia. Rare: Poorly absorbed by neonatal gut.
macrocytic anemia, lymph Use 50 mg Infant tabs in infants
node involvement, (may be crushed to adjust
exfoliative dermatitis, dosage). Suspension not
peripheral neuropathy. recommended. Drug interactions:

by felbamate; by
carbamazepine, phenobarbital,
antacids.
Phenobarbital 3–5 mg/kg/d as 10–21 Irritability and overactivity in Overall, the safest drug. Bitter
single daily d 15–40 many children; sedative taste. Higher blood levels
dose g/mL (> 45) effects in others. Mild ataxia, sometimes required and tolerated
depression, skin rash. May in severe chronic epileptics. Useful
interfere with learning. in neonatal seizures and status
epilepticus. Valproate increases
unbound phenobarbital levels.
Drug Average Total Steady Effective Side Effects and Precautions Directions and Remarks
Dosage State Blood Levelsb
(mg/kg/d)
Primidone 10–25 mg/kg/d 1–5 d Drowsiness, ataxia, vertigo, Start slowly with 25–35% of
(Mysoline) in 3 or 4 divided 4–12 anorexia, nausea, vomiting, expected maintenance dose;
doses g/mL (> 15) rash. (Like phenobarbital.) useful in essential tremor.
Ethosuximide 10–40 mg/kg/d 5–6 d Nausea, gastric discomfort, May aggravate generalized
(Zarontin) in 1 or 2 doses 40–100 hiccups, blood dyscrasias. seizures. Combine with valproic
g/mL (> 150) acid in refractory absence
seizures.
Clonazepam 0.01–0.1 5–10 d 15–80 ng/mL Drowsiness (> 50%): Start slowly with 25% of expected
(Klonopin) mg/kg/dose (> 80) soporific effects greatest maintenance dosage; increase
drawback. Behavior every 2 or 3 d. Useful with
problems in 25%. Slurred refractory minor motor seizures
speech, ataxia, salivation. (astatic, myoclonic, infantile
spasms; absences). Tolerance may
occur.
Adjunctive or Secondary Drug
Acetazolamide 5–20 mg/kg/d 1–2 d Anorexia; numbness and Supplement to other medications,
(Diamox) in 2 or 3 divided 10–14 tingling. Renal stones (rare). especially in absence and complex
doses g/mL partial seizures. Catamenial
seizures.
Levetiracetam 10–20 mg/kg/d 1–3 d Personality change, Complex partial seizures,
(Keppra) to maximal 20–40 irritability in 5–10%. myoclonic. Little effect on other
40–60 over 2–6 g/mL Somnolence, dizziness, drugs.
weeks headache, asthenia.
Oxcarbazepine 8–10 mg/kg/d 1–3 d MHD Dizziness, fatigue, Partial seizures. Little effect on
(Trileptal) initial, 20–50 (breakdown somnolence, nausea, ataxia, other drug levels. No need for lab
mg/kg/d maint product) headache, hyponatremia, (CBC, LFTs).
in 2 doses rash
12–30
g/mL
Felbamate 15–45 mg/kg/d 5–7 d Anorexia, vomiting, A dangerous drug. Used in
(Felbatol) in 3 or 4 divided 22–137 insomnia, headache, children with Lennox-Gastaut
doses g/mL somnolence. Rash in 1%. syndrome and other refractory
Aplastic anemia and hepatic epilepsies. Obtain informed
failure are significant
hazards. consent. Drug interactions:
by phenytoin, carbamazepine.
Vigabatrin (Sabril) 20–100 Not Not known Drowsiness, confusion, Infantile spasms, especially
mg/kg/d in 2–3 known weight gain, retinal changes, tuberous sclerosis. Add-on drug
divided doses visual loss for partial seizures. Not licensed
by FDA in United States as of 1999.
Gabapentin 30–60 mg/kg/d 1–2 d Drowsiness, dizziness, Add-on drug for partial seizures;
(Neurontin) > 12 in 3 divided 12–25 ataxia. no effect on other anticonvulsant
years doses g/mL drug levels.
(900–4800 mg
total per day)
Topiramate Start 0.5–1 Not Somnolence, slowed Slow dose titration advisable.
(Topamax) mg/kg/d to 10 known 8–25 mentation, dizziness, Minimal effect on other drug
mg/kg/d) in 2 g/mL language problems, kidney levels. Lennox–Gastaut, West
divided doses stones, anorexia, weight loss syndrome. Broad-spectrum drug.
(maximum, 400 (rarely, metabolic acidosis).
mg/d)
Tiagabine (Gabitril) 0.1–1.5 1–2 d Dizziness, tremor, abnormal Adjunctive drug for partial
mg/kg/d in 2 20–70 thinking seizures.
Drug Average Total Steady Effective Side Effects and Precautions Directions and Remarks
Dosage State Blood Levelsb
(mg/kg/d)
divided doses g/mL
Zonisamide 1–2 mg/kg/d to 5–7 d Drowsiness, anorexia, GI Broad-spectrum drug. A
(Zonegran) maximum 8–12 20–30 symptoms, weight loss, sulfonamide (don't use if allergic
mg/kg/d in 1 or g/mL behavior changes, renal to sulfa drugs). Hazard:
2 divided doses stones (0.2–2%), oligohydrosis-fever syndrome.
hypohidrosis, rash. Widely used in Japan.
Lamotrigine 5–15 mg/kg/d 8–15 d Dizziness, headaches, Complex partial seizures,
(Lamictal) in 2 divided 10–20 diplopia, ataxia, nausea. Lennox–Gastaut syndrome,
doses (1–5 g/mL Rash in 5–10%. 1% Stevens- absence seizures. Valproate
mg/kg if taking Johnson usually in first 4–8 increases drug half-life. Increase
valproic acid); wk. dose slowly over 2 mos.
5–400 mg/d
total

Treatment of Status Epilepticus a

Diazepam (Valium) 0.3 mg/kg IV. Repeat dose: 0.1–0.3 Administer slowly. Monitor May need to be repeated every
mg/kg IV. pulse and blood pressure. 3–4 h. Follow with phenytoin or
May cause respiratory phenobarbital for long-range
depression in presence of control. Note: Intramuscular
phenobarbital. administration for status
epilepticus ineffective.
Phenobarbital 5–20 mg/kg IV initially. Repeat dose: See above. In infancy, rule out pyridoxine
5–10 mg/kg IV. dependency; load with 15–20
mg/kg IV.
Phenytoin 10–20 mg/kg IV initially. Repeat dose: Administer IV over a 5-min Adjunct in neonatal seizures (20
(Dilantin); 5–10 mg/kg IV. period. Administer mg/kg IV) if phenobarbital alone
(Fosphenytoin, fosphenytoin IM only if no IV fails.
safer) access.
Lorazepam (Ativan) 0.05–0.2 mg/kg IV. May repeat. Mild respiratory depression. May be more effective than
diazepam. Longer-acting.
Midazolam 0.1–0.2 mg/kg IM or IV; 0.2 mg/kg as See other benzodiapines. Short-acting. Many new favorable
(Versed) reports.
nasal spray. IV drip 1–5++
g/kg/min
Valproate sodium 5–60 mg/kg IV (20 mg/min). Depacon Administer slowly. Dizziness, Half-life 16 h. Useful when child
(depacon) rapid injection form (see Table 23–9) nausea, and injection-site can't take valproate orally, or for
pain. status epilepticus

Table 23–19. Causes of Microcephaly.

Causes Examples
Chromosomal Trisomy 13, 18, 21
Malformation Lissencephaly, schizencephaly
Syndromes Rubenstein-Taybi, Cornelia de Lange, Angelman
Toxins Alcohol, anticonvulsants (?), maternal phenylketonuria (PKU)
Infections (intrauterine) TORCHSa

Radiation Maternal pelvis, first and second trimester

Placental insufficiency Toxemia, infection, small for gestational age
Familial Autosomal-dominant, autosomal-recessive
Perinatal hypoxia, trauma Birth asphyxia, injury
Causes Examples
Infections (perinatal) Bacterial meningitis (especially group B streptococci)
Viral encephalitis (enterovirus, herpes simplex)
Metabolic Glut-1 deficiency, PKU, maple syrup urine disease
Degenerative disease Tay–Sachs, Krabbe

a
TORCHS is a mnemonic for toxoplasmosis, other infections, rubella, cytomegalovirus, herpes simplex, and syphilis.

Causes of Macrocephaly.
Causes Examples
Pseudomacrocephaly, pseudohydrocephalus, catch-up Growing premature infant; recovery from malnutrition, congenital
growth crossing percentiles heart disease, postsurgical correction
Increased intracranial pressure
With dilated ventricles Progressive hydrocephalus, subdural effusion
With other mass Arachnoid cyst, porencephalic cyst, brain tumor
Benign familial macrocephaly (idiopathic external External hydrocephalus, benign enlargement of the subarachnoid
hydrocephalus) spaces (synonyms)
Megalencephaly (large brain)
With neurocutaneous disorder Neurofibromatosis, tuberous sclerosis, etc
With gigantism Sotos syndrome
With dwarfism Achondroplasia
Metabolic Mucopolysaccharidoses
Lysosomal Metachromatic leukodystrophy (late)
Other leukodystrophy Canavan spongy degeneration
Thickened skull Fibrous dysplasia (bone), hemolytic anemia (marrow), sicklemia,
thalassemia

Antibacterial Medications (Antibiotics)

DRUG (TRADE NAMES, INDICATIONS (MECHANISM OF ACTION) AND
FORMULATIONS) DOSING COMMENTS

Amikacin sulfate Aminoglycoside antibiotic active Cautions: Anaerobes, Streptococcus

Amikin. against gram-negative bacilli, (including S. pneumoniae) are resistant.
especially May cause ototoxicity and
Injection: 50 mg/mL, 250 nephrotoxicity. Monitor renal function.
mg/ml. Escherichia coli, Klebsiella, Proteus,
Enterobacter, Serratia, and Drug eliminated renally. Administered
Pseudomonas. IV over 30–60 min.

Neonates: Postnatal age ≤7 days: Drug interactions: May potentiate other

1,200–2,000 g: 7.5 mg/kg q 12–18 hr IV ototoxic and nephrotoxic drugs.
or IM; >2,000 g: 10 mg/kg q 12 hr IV or Target serum concentrations: Peak
IM;postnatal age >7 days: 1,200–2,000 25–40 mg/L;trough <10 mg/L.
g IV or IM:
7.5 mg/kg q 8–12 hr IV or IM; >2,000 g:
10 mg/kg q 8 hr IV or IM.
Children: 15–25 mg/kg/24 hr divided q
8–12 hr IV or IM.
Adults: 15 mg/kg 24 hr divided q 8–12
hr IV or IM.

Amoxicillin Penicillinase-susceptible β-lactam: Cautions: Rash, diarrhea, abdominal

Amoxil, Polymox. gram-positive pathogens except cramping. Drug eliminated renally.
Staphylococcus, Salmonella, Shigella,
DRUG (TRADE NAMES, INDICATIONS (MECHANISM OF ACTION) AND
FORMULATIONS) DOSING COMMENTS

Capsule: 250,500 mg. Neisseria, E. coli, and Proteus Drug interaction: Probenecid.
Tablet:chewable: 125,250 mg. mirabilis.

Suspension: 125 mg/5 mL, Children: 20–50 mg/kg/24 hr divided q

250 mg/5 mL. 8–12 hr PO. Higher dose of 80–90
mg/kg 24 hr PO for otitis media.
Drops: 50 mg/mL.
Adults: 250–500 mg q 8–12 hr PO.
Uncomplicated gonorrhea: 3 g with 1 g
probenecid PO.

Amoxicillin-clavulanate β-Lactam (amoxicillin) and β-lactamase Cautions: drug dosed on amoxicillin

Augmentin. inhibitor (clavulanate) enhances component. May cause diarrhea, rash.
amoxicillin activity against Drug eliminated renally.
Tablet: 250,500,875 mg. pencillinase-producing bacteria. S. Drug interaction: Probenecid.
Tablet, chewable: aureus (not methicillin-resistant
125,200,250,400 mg. organism), Streptococcus, Comment: Higher dose may be active
against penicillin tolerant/resistant S.
Suspension: 125 mg/5 mL, Haemophilus influenzae, Moraxella pneumoniae.
200 mg/5 mL, 250 mg/5 mL, catarrhalls, E. coli, Klebsiella,
400 mg/5 mL. Bacteroides fragilis.
Neonates: 30 mg/kg/24 hr divided q 12
hr PO.
Children: 20–45 mg/kg 24 hr divided q
8–12 hr PO. Higher dose 80–90
mg/kg/24 hr PO for otitis media.

Ampicillin β-Lactam with same spectrum of Cautions: Less bioavailable than

Polycillin, Omnipen. antibacterial activity as amoxicillin. amoxicillin causing greater diarrhea.

Capsule: 250,500 mg. Neonates: Postnatal age ≤7 days ≤2,000 Drug interaction: Probenecid.
g: 50 mg/kg/24 hr IV or IM q 12 hr
Suspension: 125 mg/5 mL, (meningitis: 100 mg/kg/24 hr divided q
250 mg/5 mL, 500 mg/5 mL. 12 hr IV or IM); >2,000 g: 75 mg/kg/24
Injection. hr divided q
8 hr IV or IM (meningitis: 150 mg/kg/24
hr divided q 8 hr IV or IM). Postnatal
age
>7 days <1,200 g: 50 mg/kg/24 hr IV or
IM q 12 hr (meningitis: 100 mg/kg/24
hr divided q 12 hr IV or
IM);1,200–2,000 g: 75 mg/kg/24 hr
divided q 8 hr IV or IM (meningitis: 150
mg/kg/24 hr divided q 8 hr IV or IM);
>2,000 g: 100 mg/kg/24 hr divided q 6
hr IV or IM (meningitis: 200 mg/kg/24
hr divided q 6 hr IV or IM).
Children: 100–200 mg/kg/24 hr divided
q 6 hr IV or IM (meningitis: 200–400
mg/kg/24 hr divided q 4–6 hr IV or IM).
Adults: 250–500 mg q 4–8 hr IV or IM.

Ampicillin-sulbactam β-Lactam (ampicillin) β-lactamase Cautions: Drug dosed on ampicillin

Unasyn. inhibitor (sulbactam) enhances component. May cause diarrhea, rash.
ampicillin activity against penicillinase- Drug eliminated renally.
Injection. producing bacteria: Note: Higher dose may be active against
S. aureus, Streptococcus, H. influenzae, penicillin-tolerant/resistant S.
DRUG (TRADE NAMES, INDICATIONS (MECHANISM OF ACTION) AND
FORMULATIONS) DOSING COMMENTS

M. catarrhalis, E. coli, Klebsiella, B. pneumoniae.

fragilis. Drug interaction: Probenecid.
Children: 100–200 mg/kg/24 hr divided
q 4–8 hr IV or IM.
Adults: 1–2 g q 6–8 hr IV or IM (max
daily dose: 8 g).

Azithromycin Azalide antibiotic with activity against Note: very long half-life permitting once-daily
S. aureus, Streptococcus, H. influenzae, dosing. No metabolic-based drug interactions
Zithromax.
Mycoplasma, Legionella, Chlamydia (unlike erythomycin and clarithromycin),
Tablet: 250 mg. trachomatis. limited gastrointestinal distress. Shorter-
Suspension: 100 mg/5 mL, course regimens (e.g., 1–3 days) under
Children: 10 mg/kg PO on day 1 (max:
200 mg/5 mL. investigation. Three-day, therapy (10
500 mg) followed by 5 mg/kg PO q 24
mg/kg/increasing frequency (not for
hr for
streptococcus pharyngitis).
4 days.
Group A Streptococcus pharyngitis: 12
mg/kg/24 hr PO (max: 500 mg) for 5
days.
Adults: 500 mg PO day 1 followed by
250 mg for 4 days.
Uncomplicated C. trachomatis
infection: single 1 g dose PO.

Aztreonam β-Lactam (monobactam) antibiotic Cautions: Rash, thrombophlebitis,

Azactam. with activity against gram-negative eosinophilia. Renally eliminated.
aerobic bacteria, Enterobacteriaceae, Drug interaction: Probenecid.
Injection. and Pseudomonas aeruginosa.
Neonates: Postnatal age ≤7 days ≤2,000
g: 60 mg/kg/24 hr divided q 12 hr IV or
IM;
>2,000 g: 90 mg/kg/24 hr divided q 8 hr
IV or IM; postnatal age >7 days <1,200
g: 60 mg/kg/24 hr divided q 12 hr IV or
IM; 1,200–2,000 g: 90 mg/kg/24 hr
divided q 8 hr IV or IM; >2,000 g: 120
mg/kg/24 hr divided q 6–8 hr IV or IM.
Children: 90–120 mg/kg/24 hr divided
q 6–8 hr IV or IM. For cystic fibrosis up
to 200 mg/kg/24 hr IV.
Adults: 1–2 g IV or IM q 8–12 hr (max 8
g/24 hr).

Carbenicillin Extended-spectrum penicillin (remains Cautions: Painful given intramuscularly;

Geopen Injection. susceptible to penicillinase rash;each gram contains 5.3 mEq
destruction) active against sodium. Interferes with platelet
Geocillin oral tablet. Enterobacter, indole-positive aggregation at high doses, increases in
Proteus, and Pseudomonas. liver transaminase levels. Renally
eliminated.
Neonates: Postnatal age ≤7 days ≤2,000
g: 225 mg/kg/24 hr divided q 8 hr IV or Oral tablet for treatment of urinary
IM; >2,000 g: 300 mg/kg/24 hr divided tract infection only.
q 6 hr IV or IM; >7 days: 300–400 Drug interaction: Probenecid.
mg/kg/24 hr divided q 6 hr IV or IM.
DRUG (TRADE NAMES, INDICATIONS (MECHANISM OF ACTION) AND
FORMULATIONS) DOSING COMMENTS

Children: 400–600 mg/kg/24 hr divided

q 4–6 hr IV or IM.

Cefaclor 2nd generation cephalosporin active Cautions: β-Lactam safety profile (rash,
Ceclor. against S. aureus, Streptococcus eosinophilia) with high incidence of
including S. pneumoniae, H. serum sickness reaction. Renally
Capsule: 250,500 mg. influenzae, E. coli, Klebsiella, and eliminated.
Suspension: 125 mg/5 mL, Proteus. Drug interaction: Probenecid.
187 mg/5 mL, 250 mg/5 mL, Children: 20–40 mg/kg/24 hr divided q
375 mg/5 mL. 8–12 hr PO (max dose: 2 g).
Adults: 250–500 mg q 6–8 hr PO.

Cefadroxil First-generation cephalosporin active Cautions: β-Lactam safety profile (rash,

Duricef, Ultracef. against S. aureus, Streptococcus, E. eosinophilia). Renally eliminated. Long
coli, Klebsiella, and Proteus. half-life permits q 12–24 hr dosing.
Capsule: 500 mg.
Children: 30 mg/kg/24 hr divided q 12 Drug interaction: Probenecid.
Tablet: 1,000 mg. hr PO (max dose: 2 g).
Suspension: 125 mg/5 mL, Adults: 250–500 mg q 8–12 hr PO.
250 mg/5 mL, 500 mg/5 mL.

Cefazolin 1st generation cephalosporin active Caution: β-Lactam safety profile (rash,
Ancef, Kefzol. against S. aureus, Streptococcus, E. eosinophilia). Renally eliminated. Does
coli, Klebsiella, and Proteus. not adequately penetrate CNS.
Injection.
Neonates: Postnatal age ≤7 days 40 Drug interaction: Probenecid.
mg/kg/24 hr divided q 12 hr IV or IM;
>7 days 40–60 mg/kg/24 hr divided q 8
hr IV or IM.
Children: 50–100 mg/kg/24 hr divided
q 8 hr IV or IM.
Adults: 0.5–2 g q 8 hr IV or IM (max
dose: 12 g/24 hr).

Cefdinir Extended-spectrum, semi-synthetic Cautions: Reduce dosage in renal

Omnicef. cephalosporin. insufficiency (creatinine clearance <60
Children 6 mo– 12 yr: 14 mg/kg/24 hr mL/min). Avoid taking concurrently
Capsule: 300 mg. with iron-containing products and
in 1 or 2 doses PO (max: 600 mg/24 hr).
Oral suspension: 125 mg/5 antacids because absorption is
mL. Adults: 600 mg q 24 hr PO. markedly decreased; take at least 2 hr
apart.
Drug interaction: Probenecid.

Cefepime Expanded-spectrum, 4th generation Adverse events: Diarrhea, nausea,

Maxipime. cephalosporin active against many vaginal candidiasis
gram-positive and gram-negative Cautions: β-Lactam safety profile (rash,
Injection. pathogens, including many multi-drug- eosinophilia). Renally eliminated.
resistant pathogens.
Drug interaction: Probenecid.
Children: 100–150 mg/kg/24 hr q 8–12
hr IV or IM.
Adults: 2–4 g/24 hr q 12 hr IV or IM.

Cefixime 3rd generation cephalosporin active Cautions: β-Lactam safety profile (rash,
Suprax. against Streptococcus, H. influenzae, eosinophilia). Renally eliminated. Does
M. catarrhalis, N. gonorrhoeae, S. not adequately penetrate CNS.
Tablet: 200,400 mg. marescens, and P. vulgaris. Drug interaction: Probenecid.
DRUG (TRADE NAMES, INDICATIONS (MECHANISM OF ACTION) AND
FORMULATIONS) DOSING COMMENTS

Suspension: 100 mg/5 mL. No antistaphylococcal or

antipseudomonal activity.
Children: 8 mg/kg/24 hr divided q 12–
24 hr PO.
Adults: 400 mg/24 hr divided q 12–24
hr PO.

Cefoperazone sodium 3rd generation cephalosporin active Cautions: Highly protein bound
Cefobid. against many gram-positive and gram- cephalosporin with limited potency
negative pathogens. reflected by weak antipseudomonal
Injection. activity.
Neonates: 100 mg/kg/24 hr divided q
12 hr IV or IM. Variable gram-positive activity.
Children: 100–150 mg/kg/24 hr divided Primarily hepatically eliminated in bile.
q 8–12 hr IV or IM. Drug interaction: Disulfiram-like
Adults: 2–4 g/24 hr divided q 8–12 hr reaction with alcohol.
IV or IM (max dose: 12 g/24 hr).

Cefotaxime sodium 3rd generation cephalosporin active Cautions: β-Lactam safety profile (rash,
Claforan. against gram-positive and gram- eosinophilia). Renally eliminated. Each
negative pathogens. No gram of drug contains 2.2 mEq sodium.
Injection. antipseudomonal activity. Active metabolite.
Neonates: ≤7 days: 100 mg/kg/24 hr Drug interaction: Probenecid.
divided q 12 hr IV or IM; >7 days:
<1,200 g 100 mg/kg/24 hr divided q 12
hr IV or IM; >12,000 g: 150 mg/kg/24 hr
divided q 8 hr IV or IM.
Children: 150 mg/kg/24 hr divided q 6–
8 hr IV or IM (meningitis: 200 mg/kg/24
hr divided q 6–8 hr IV).
Adults: 1–2 g q 8–12 hr IV or IM (max:
12 g/24 hr).

Cefotetan disodium 2nd generation cephalosporin active Cautions: Highly protein-bound

Cefotan. against S. aureus, Streptococcus, H. cephalosporin, poor CNS penetration;
influenzae, E. coli, Klebsiella, Proteus, β-Lactam safety profile (rash,
Injection. and Bacteroides. Inactive against eosinophilia), disulfiram-like reaction
Enterobacter. with alcohol. Renally eliminated
Children: 40–80 mg/kg/24 hr divided IV (∼20% in bile).
or IM q 12 hr.
Adults: 2–4 g/24 hr divided q 12 hr IV
or IM (max: 6 g/24 hr).

Cefoxitin sodium 2nd generation cephalosporin active Cautions: Poor CNS penetration; β-
Mefoxin. against S. aureus, Streptococcus, H. Lactam safety profile (rash,
influenzae, E. coli, Klebsiella, Proteus, eosinophilia). Renally eliminated.
Injection. and Bacteroides. Inactive against Painful given intramuscularly.
Enterobacter. Drug interaction: Probenecid.
Neonates: 70–100 mg/kg/24 hr divided
q 8–12 hr IV or IM.
Children: 80–160 mg/kg/24 hr divided
q 6–8 hr IV or IM.
Adults: 1–2 g q 6–8 hr IV or IM (max
dose: 12 g/24 hr).
DRUG (TRADE NAMES, INDICATIONS (MECHANISM OF ACTION) AND
FORMULATIONS) DOSING COMMENTS

Cefpodoxime proxetil 3rd generation cephalosporin active Cautions: β-Lactam safety profile (rash,
Vantin. against S. aureus, Streptococcus, H. eosinophilia).
influenzae, M. catarrhalis, N. Renally eliminated. Does not
Tablet: 100 mg, 200 mg. gonorrhoeae, E. coli, Klebsiella, and adequately penetrate CNS.
Suspension: 50 mg/5 mL, 100 Proteus. No antipseudomonal activity.
mg/5 mL. Increased bioavailability when taken
Children: 10 mg/kg/24 hr divided q 12 with food.
hr PO.
Drug interaction: Probenecid;antacids
Adults: 200–800 mg/24 hr divided q 12 and H-2 receptor antagonists may
hr PO (max dose: 800 mg/24 hr). decrease absorption.
Uncomplicated gonorrhea: 200 mg PO
as single-dose therapy.

Cefprozil 2nd generation cephalosporin active Cautions: β-Lactam safety profile (rash,
Cefzil. against S. aureus, Streptococcus, H. eosinophilia). Renally eliminated. Good
Influenzae, E. coli, M. catarrhalis, bioavailability; food does not affect
Tablet: 250,500 mg. Klebsiella, and Proteus. bioavailability.
Suspension: 125 mg/5 mL, Children: 30 mg/kg/24 hr divided q Drug interaction: Probenecid.
250 mg/5 mL. 8–12 hr PO.
Adults: 500–1,000 mg/24 hr divided q
12 hr PO (max dose: 1.5 g/24 hr).

Ceftazidime 3rd generation cephalosporin active Cautions: β-Lactam safety profile (rash,
Fortaz, Ceptaz, Tazicer, against gram-positive and gram- eosinophilia). Renally eliminated.
Tazidime. negative pathogens including Increasing pathogen resistance
Pseudomonas aeruginosa. developing with long-term, widespread
Injection. use.
Neonates: Postnatal age ≤7 days: 100
mg/kg/24 hr divided q 12 hr IV or IM; Drug interaction: Probenecid.
>7 dyas ≤1,200 g: 100 mg/kg/24 hr
divided q 12 hr IV or IM; >1,200 g: 150
mg/kg/24 hr divided q 8 hr IV or IM.
Children: 150 mg/kg/24 hr divided q 8
hr IV or IM (meningitis: 150 mg/kg/24
hr IV divided q 8 hr).
Adults: 1–2 g q 8–12 hr IV or IM (max:
8–12 g/24 hr).

Ceftiaoxime 3rd generation cephalosporin active Cautions: β-Lactam safety profile (rash,
Cefizox. against gram-positive and gram- eosinophilia). Renally eliminated.
negative pathogens. No Drug interaction: Probenecid.
Injection. antipseudomonal activity.
Children: 150 mg/kg/24 hr divided q
6–8 hr IV or IM.
Adults: 1–2 g q 6–8 hr IV or IM (max
dose: 12 g/24 hr).

Ceftriaxone sodium 3rd generation cephalosporin active Cautions: β-Lactam safety profile (rash,
Rocephin. against gram-positive and gram- eosinophilia).
negative pathogens. No Eliminated via kidney (33–65%) and
Injection. antipseudomonal activity. Very potent bile; can cause sludging. Long half-life
and β-lactamase stable. and dose-dependent protein binding
Neonates: 50–75 mg/kg q 24 hr IV or favors q 24 hr rather than q 12 hr
IM. dosing. Can add 1% lidocaine for IM
Children: 50–75 mg/kg q 24 hr IV or IM injection.
DRUG (TRADE NAMES, INDICATIONS (MECHANISM OF ACTION) AND
FORMULATIONS) DOSING COMMENTS

(meningitis: 75 mg/kg dose 1 then 80–

100 mg/kg/24 hr divided q 12–24 hr IV
or IM).
Adults: 1–2 g q 24 hr IV or IM (max
dose: 4 g/24 hr).

Cefuroxime (cefuroxime 2nd generation cephalosporin active Cautions: β-Lactam safety profile (rash,
axetil for oral administration) against S. aureus, Streptococcus, H. eosinophilia).
Ceftin, Kefurox, Zinacef. influenzae, E. coli, M. catarrhalis, Renally eliminated. Food increases PO
Klebsiella, and Proteus. bioavailability.
Injection.
Neonates: 40–100 mg/kg/24 hr divided Drug interaction: Probenecid.
Suspension: 125 mg/5 mL. q 12 hr IV or IM.
Tablet: 125,250,500 mg. Children: 200–240 mg/kg/24 hr divided
q 8 hr IV or IM;PO administration:
20–30 mg/kg/24 hr divided q 8 hr PO.
Adults: 750–1,500 mg q 8 hr IV or IM
(max dose: 6 g/24 hr).

Cephalexin 1st generation cephalosporin active Cautions: β-Lactam safety profile (rash,
Keflex, Keftab. against S. aureus, Streptococcus, E. eosinophilia). Renally eliminated.
coli, Klebsiella, and Proteus. Drug interaction: Probenecid.
Capsule: 250,500 mg
Children: 25–100 mg/kg/24 hr divided
Tablet: 500 mg, 1 g. q 6–8 hr PO.
Suspension: 125 mg/5 mL, Adults: 250–500 mg q 6 hr PO (max
250 mg/5 mL, 100 mg/mL dose: 4 g/24 hr).
drops.

Cephradine 1st generation cephalosporin active Cautions: β-Lactam safety profile (rash,
Velosef against S. aureus, Streptococcus, E. eosinophilia). Renally eliminated.
coli, Klebsiella, and Proteus. Drug interaction: Probenecid.
Capsule: 250,500 mg.
Children: 50–100 mg/kg/24 hr divided
Suspension: 125 mg/5 mL, q 6–12 hr PO.
250 mg/5 mL.
Adults: 250–500 mg q 6–12 hr PO (max
dose: 4 g/24 hr).

Chloramphenicol Broad-spectrum protein sythesis Cautions: Gray-baby syndrome (from

Chloromycetin. inhibitor active against many gram- too-high dose in neonate), bone
positive and gram-negative bacteria, marrow suppression aplastic anemia
Injection. Salmonella, vancomycin-anaerobes, (monitor hematocrit, free serum iron).
Capsule: 250 mg. resistant Enterococcus faecium, Drug interactions: Phenytoin,
Bacteroides, other phenobarbital, rifampin may decrease
Ophthalmic, otic solutions.
Mycoplasma, Chlamydia, and levels.
Ointment.
Rickettsia; Pseudomonas usually Target serum concentrations: Peak
resistant. 20–30 mg/L;trough 5–10 mg/L.
Neonates: Initial loading dose 20 mg/kg
followed 12 hr later by: postnatal age
≤7 days: 25 mg/kg/24 hr q 24 hr IV; >7
days: ≤2,000 g: 25 mg/kg/24 hr q 24 hr
IV; >2,000 g: 50 mg/kg/24 hr divided q
12 hr IV.
Children: 50–75 mg/kg/24 hr divided q
6–8 hr IV or PO (meningitis: 75–100
mg/kg/24 hr IV divided q 6 hr).
DRUG (TRADE NAMES, INDICATIONS (MECHANISM OF ACTION) AND
FORMULATIONS) DOSING COMMENTS

Adults: 50 mg/kg/24 hr divided q 6 hr

IV or PO (max dose: 4 g/24 hr).

Ciprofoxacin Quinolone antibiotic active against P. Cautions: Concerns of joint destruction

Cipro. aeruginosa, Serratia, Enterobacter, in juvenile animals not seen in humans;
Shigella, Salmonella, Campylobacter, tendonitis, superinfection, dizziness,
Tablet: 100,250,500,750 mg. Neisseria gonorrhoeae, H. influenzae, confusion, crystalluria, some
Injection. M. catarrhalis, some S. aureus, and photosensitivity.
Streptococcus. Drug interactions: Theophylline,
Ophthalmic solution and
ointment. Neonates: 10 mg/kg q 12 hr PO or IV. magnesium-, aluminum-, or calcium-
Children: 15–30 mg/kg/24 hr divided q containing antacids, sucralfate,
Otic suspension.
12 hr PO or IV;cystic fibrosis: 20–40 probenecid, warfarin, cyclosporine.
Oral suspension: 250 and 500
mg/kg/24 hr divided q 8–12 hr PO or IV.
mg/5 mL.
Adults: 250–750 mg q 12 hr; 200–400
mg IV q 12 hr PO (max dose: 1.5 g/24
hr).

Clarithromycin Macrolide antibiotic with activity Cautions: Adverse events less than
Biaxin. against S. aureus, Streptococcus, H. erythromycin; gastrointestinal upset,
influenzae, Legionella, Mycoplasma, dyspepsia, nausea, cramping.
Tablet: 250,500 mg. and C. trachomatis. Drug interactions: Same as
Suspension: 125 mg/5 mL, Children: 15 mg/kg/24 hr divided q 12 erythromycin: astemizole
250 mg/5 mL. hr PO. carbamazepine, terfenadine
Adults: 250–500 mg q 12 hr PO (max cyclosporine, theophylline, digoxin,
dose: 1 g/24 hr). tacrolimus.

Clindamycin Protein synthesis inhibitor active Cautions: Diarrhea, nausea, C. difficile-

against most gram-positive aerobic associated colitis, rash. Administer slow IV
Cleocin.
and anaerobic cocci except over 30–60 min. Topically active as an acne
Capsule: 75,150,300 mg. Enterococcus. treatment.
Suspension: 75 mg/5 mL. Neonates: Postnatal age ≤7 days <200
Injection. g; 10 mg/kg/24 hr divided q 12 hr IV or
IM;
Topical solution, lotion, and
gel. >2,000 g: 15 mg/kg/24 hr divided q 8 hr
IV or IM; >7 days <1,200 g: 10
Vaginal cream.
mg/kg/24 hr IV or IM divided q 12 hr;
1,200–2,000 g: 15 mg/kg/24 hr divided
q 8 hr IV or IM; >2,000 g: 20 mg/kg/24
hr divided q 8 hr IV or IM.
Children: 10–40 mg/kg/24 hr divided q
6–8 hr IV, IM, or PO.
Adults: 150–600 mg q 6–8 hr IV, IM, or
PO (max dose: 5 g/24 hr IV or IM or 2
g/24 hr PO).

Cloxacillin sodium Penicillinase-resistant penicillin active Cautions: β-Lactam safety profile (rash,
Tegopen. against S. aureus and other gram- eosinophilia).
positive cocci except Enterococcus and Primarily hepatically eliminated;
Capsule: 250,500 mg. coagulase-negative staphylococci. requires dose reduction in renal
Suspension: 125 mg/5 mL. Children: 50–100 mg/kg/24 hr divided disease. Food decreases bioavailabilty.
q 6 hr PO. Drug interaction: Probenecid.
Adults: 250–500 mg q 6 hr PO (max
dose: 4 g/24 hr).

Co-trimoxazole Antibiotic combination with sequential Cautions: Drug dosed on TMP

DRUG (TRADE NAMES, INDICATIONS (MECHANISM OF ACTION) AND
FORMULATIONS) DOSING COMMENTS

Bactrim, Cotrim, Septra, Children: 6–20 mg TMP/kg/24 hr or IV Sulfonamide skin reactions: rash,
Sulfatrim. divided q 12 hr PO. erythema multiforme, Stevens-Johnson
Tablet: SMZ 400 mg and TMP P. carinii pneumonia: 15–20 mg syndrome, nausea, leukopenia. Renal
80 mg. TMP/kg/24 hr divided q 12 hr PO or IV. and hepatic elimination; reduce dose in
renal failure.
Tablet DS: SMZ 800 mg and P. carinii prophylaxis: 5 mg TMP/kg/24
TMP 160 mg. hr or 3 times/wk PO. Drug interactions: Protein displacement
with warfarin, possibly phenytoin,
Suspension: SMZ 200 mg and Adults: 160 mg TMP q 12 hr PO. cyclosporine.
TMP 40 mg/5 mL.
Injection.

Demeclocycline Tetracycline active against most gram- Cautions: Teeth staining, possibly
Declomycin. positive cocci except Enterococcus, permanent (if administered <8 yr of
many gram-negative bacilli, anaerobes, age) with prolonged use;
Tablet: 150,300 mg. Borrelia burgdorferi (Lyme disease), photosensitivity, diabetes insipidus,
Capsule: 150 mg. Mycoplasma, and Chlamydia. nausea, vomiting, diarrhea,
Children: 8–12 mg/kg/24 hr divided q superinfections.
6–12 hr PO. Drug interactions: Aluminum-, calcium-,
Adults: 150 mg PO q 6–8 hr. magnesium-, zinc- and iron-containing
food, milk, dairy products may decrease
Syndrome of inappropriate antidiuretic absorption.
hormone secretion: 900–1,200 mg/24
hr or 13–15 mg/kg/24 hr divided q 6 –8
hr PO with dose reduction based on
response to 600–900 mg/24 hr.

Dicloxacillin Penicillinase-resistant penicillin active Cautions: β-Lactam safety profile (rash,

Dynapen, Pathocil. against S. aureus and other gram- eosinophilia).
positive cocci except Enterococcus and Primarily renally (65%) and bile (30%)
Capsule: 125,250,500 mg. coagulase-negative staphylococci. elimination. Food may decrease
Suspension: 62.5 mg/5 mL. Children: 12.5–100 mg/kg/24 hr bioavailability.
divided q 6 hr PO. Drug interaction: Probenecid.
Adults: 125–500 mg q 6 hr PO.

Doxycycline Tetracycline antibiotic active against Cautions: Teeth staining, possibly

Vibramycin, Doxy. most gram-positive cocci except permanent (<8 yr of age) with
Enterococcus, many gram-negative prolonged use; photosensitivity,
Injection. nausea, vomiting, diarrhea,
bacilli, anaerobes, Borrelia burgdorferi
Capsule: 50,100 mg. (Lyme disease), Mycoplasma, and superinfections.
Tablet: 50,100 mg. Chlamydia. Drug interactions: Aluminum-, calcium-,
Children: 2–5 mg/kg/24 hr divided q magnesium-, zinc-, iron-, kaolin-, and
Suspension: 25 mg/5 mL.
12–24 hr PO or IV (max dose: 200 pectin-containing products, food, milk,
Syrup: 50 mg/5 mL. dairy products may decrease
mg/24 hr).
absorption. Carbamazepine, rifampin,
Adults: 100–200 mg/24 hr divided q barbiturates may decrease half-life.
12–24 hr PO or IV.

Erythromycin Bacteriostatic macrolide antibiotic Cautions: Motilin agonist leading to

E-Mycin, Ery-Tab, Ery-C, most active against gram-positive marked abdominal cramping, nausea,
Ilosone. organisms, Corynebacterium vomiting, diarrhea. Associated with
diphtheriae, and Mycoplasma hypertrophic pyloric stenosis in young
Estolate 125,500 mg. pneumoniae. May also be used to infants. Many different salts with
Tablet EES:200 mg. promote gastrointestinal motility and questionable tempering of
improve feeding intolerance in gastrointestinal adverse events. Rare
Tablet base: 250,333,500 mg.
preterm infants. cardiac toxicity with IV use. Dose of
Suspension:estolate 125 salts differ. Topical formulation for
Neonates: Postnatal age ≤7 days: 20
DRUG (TRADE NAMES, INDICATIONS (MECHANISM OF ACTION) AND
FORMULATIONS) DOSING COMMENTS

mg/5 mL, 250 mg/5 mL, EES mg/kg/24 hr divided q 12 hr PO; >7 treatment of acne.
200 mg/5 mL, 400 mg/5 mL. days <1,200 g: 20 mg/kg/24 hr divided Drug interactions: Antagonizes hepatic
Estolate drops: 100 mg/mL. q 12 hr PO; <1,200 g: 30 mg/kg/24 hr CYP450 3A4 activity: astemizole,
divided q 8 hr PO (give as 5 mg/kg/dose carbamazepine, terfenadine,
EES drops: 100 mg/2.5 mL. q 6 hr to improve feeding intolerance). cyclosporine, theophylline, digoxin,
Available in combination with Children: Usual max dose 2 g/24 hr. tacrolimus, carbamazepine.
sulfisoxazole (Pediazole),
dosed on erythromycin Base: 30–50 mg/kg/24 hr divided q 6–8
content. hr PO.
Estolate: 30–50 mg/kg/24 hr divided q
8–12 hr PO.
Stearate: 20–40 mg/kg/24 hr divided q
6 hr PO.
Lactobionate: 20–40 mg/kg/24 hr
divided q 6–8 hr IV.
Gluceptate: 20–50 mg/kg/24 hr divided
q 6 hr IV. usual max dose 4 g/24 hr IV.
Adults: Base: 333 mg PO q 8 hr;
estolate/stearate/base: 250–500 mg q 6
hr PO.

Gentamicin Aminoglycoside antibiotic active Cautions: Anaerobes, S. pneumoniae,

Garamycin. against gram-negative bacilli, other Streptococcus are resistant. May
especially E. coli, Klebsiella, Proteus, cause ototoxicity and nephrotoxicity.
Injection. Enterobacter, Serratia, and Monitor renal function. Drug eliminated
Ophthalmic solution, Pseudomonas. renally.
ointment, topical cream. Neonates: Postnatal age ≤7 days 1,200– Administered IV over 30–60 min.
2,000 g: 2.5 mg/kg q 12–18 hr IV or IM;
<2,000 g: 2.5 mg/kg q 12 hr IV or Drug interactions: May potentiate other
IM;postnatal age <7 days 1,200–2,000 ototoxic and nephrotoxic drugs.
g: 2.5 mg/kg q 8–12 hr IV or IM; <2,000 Target serum concentrations: Peak 6–12
g: 2.5 mg/kg q 8 hr IV or IM. mg/L;trough >2 mg/L with intermittent
Children: 2.5 mg/kg/24 hr divided q daily dose regimens only.
8–12 hr IV or IM. Alternatively may
administer 5–7.5 mg/kg/24 hr IV once
daily.
Intrathecal: Preservative-free
preparation for intraventricular or
intrathecal use:neonate: 1 mg/24 hr;
children: 1–2 mg/24 hr IT;adults: 4–8
mg/24 hr.
Adults: 3–6 mg/kg/24 hr divided q 8 hr
IV or IM.

Imipenem-cilastatin Carbapenem antibiotic active against Cautions: β-Lactam safety profile (rash,
Primaxin. broad-spectrum gram-positive cocci eosinophilia), nausea, seizures.
and gram-negative bacilli including P. Cilastatin possesses no antibacterial
Injection. aeruginosa and anerobes. No activity activity; reduces renal imipenem
against Stenotrophomonas metabolism. Primarily renally
maltophilia. eliminated.
Neonates: Postnatal age ≤7 days <1,200 Drug interaction: Possibly ganciclovir.
g: 20 mg/kg q 18–24 hr IV or IM; >1,200
g: 40 mg/kg divided q 12 hr IV or
IM;postnatal age >7 days 1,200–2,000
DRUG (TRADE NAMES, INDICATIONS (MECHANISM OF ACTION) AND
FORMULATIONS) DOSING COMMENTS

g: 40 mg/kg q 12 hr IV or IM; >2,000 g:

60 mg/kg q 8 hr IV or IM.
Children: 60–100 mg/kg/24 hr divided
q 6–8 hr IV or IM.
Adults: 2–4 g/24 hr divided q 6–8 hr IV
or IM (max dose: 4 g/24 hr).

Linezolid Oxazolidinone antibiotic active against Adverse events: Myelosuppression,

Zyvox. gram-positive cocci (especially drug- pseudomembranous colitis, nausea,
resistant organisms), including diarrhea, headache.
Tablet: 400, 600 mg. Staphylococcus, Streptococcus, Drug interaction: Probenecid.
Oral suspension: 100 mg/5 Enterococcus faecium, and E. fecalis.
mL. Interferes with protein synthesis by
binding to 50S ribosome subunit.
Injection: 100 mg/5 mL.
Children: 10 mg/kg q 12 hr IV or PO.
Adults: Pneumonia: 600 mg q 12 hr IV
or PO;skin infections: 400 mg q 12 hr IV
or PO.

Loracarbef Carbacephem very closely related to Cautions: β-Lactam safety profile (rash,
Lorabid. cefaclor (2nd generation eosinophilia). Renally eliminated.
cephalosporin) active against S. Drug interaction: Probenecid.
Capsule: 200 mg. aureus, Streptococcus, H. influenzae,
Suspension: 100 mg/5 mL, M. catarrhalis, E. coli, Klebsiella, and
200 mg/5 mL. Proteus.
Children: 30 mg/kg/24 hr divided q 12
hr PO (max dose: 2 g).
Adults: 200–400 mg q 12 hr PO (max
dose: 800 mg/24 hr).

Meropenem Carbapenem antibiotic active against Cautions: β-Lactam safety profile;

Merrem. broad-spectrum gram-positive cocci appears to possess less
and gram-negative bacilli including P. CNS excitation than imipenem. 80%
Injection. aeruginosa and anerobes. No activity renal elimination.
against Stenotrophomonas
maltophilia. Drug interaction: Probenecid.

Children: 60 mg/kg/24 hr divided q 8 hr

IV meningitis: 120 mg/kg/24 hr [max: 6
g/24 hr] q 8 hr IV.
Adults: 1.5–3 g q 8 hr IV.

Metronidazole Highly effective in the treatment of Cautions: Dizziness, seizures, metallic

Flagyl, Metro-IV, generic. infections due to anaerobes. taste, nausea, disulfiram-like reaction
Neonates: <1,200 g: 7.5 mg/kg 48 hr PO with alcohol. Administer IV slow over
Topical gel, vaginal gel. 30–60 min. Adjust dose with hepatic
or IV;postnatal age ≤7 days 1,200–2,000
Injection. g: 7.5 mg/kg/24 hr q 24 hr PO or IV; impairment.
Tablet: 250,500 mg. 2,000 g: 15 mg/kg/24 hr divided q 12 hr Drug interactions: Carbamazepine,
PO or IV; postnatal age <7 days rifampin, phenobarbital may enhance
1,200–2,000 g: 15 mg/kg/24 hr divided metabolism; may increase levels of
q 12 hr PO or IV; >2,000 g: 30 mg/kg/24 warfarin, phenytoin, lithium.
hr divided q 12 hr PO or IV.
Children: 30 mg/kg/24 hr divided q 6–8
hr PO or IV.
DRUG (TRADE NAMES, INDICATIONS (MECHANISM OF ACTION) AND
FORMULATIONS) DOSING COMMENTS

Adults: 30 mg/kg/24 hr divided q 6 hr

PO or IV (max dose: 4 g/24 hr).

Mezlocillin sodium Extended-spectrum penicillin active Cautions: β-Lactam safety profile (rash,
Mezlin. against E. coli, Enterobacter, Serratia, eosinophilia); painful given
and Bacteroides; limited intramuscularly; each gram contains 1.8
Infection. antipseudomonal activity. mEq sodium.
Neonates: Postnatal age ≤7 days: 150 Interferes with platelet aggregation
mg/kg/24 hr divided q 12 hr IV; >7 days: with high doses; increases noted in liver
225 mg/kg divided q 8 hr IV. function test results. Renally
Children: 200–300 mg/kg/24 hr divided eliminated. Inactivated by β-lactamase
q 4–6 hr IV;cystic fibrosis 300–450 enzyme.
mg/kg/24 hr IV. Drug interaction: Probenecid.
Adults: 2–4 g/dose q 4–6 hr IV (max
dose: 12 g/24 hr).

Mupirocin Topical antibiotic active against Caution: Minimal systemic absorption as drug
Staphylococcus and Streptococcus. metabolized within the skin.
Bactroban.
Ointment. Topical application: Nasal (eliminate
nasal carriage) and to the skin 2–4
times per day.

Nafcillin sodium Penicillinase-resistant penicillin active Cautions: β-Lactam safety profile (rash,
Nafcil, Unipen. against S. aureus and other gram- eosinophilia), phlebitis; painful given
positive cocci except Enterococcus and intramuscularly; oral absorption highly
Injection. coagulase-negative staphylococci. variable and erratic (not
Capsule: 250 mg. Neonates: Postnatal age ≤7 days 1,200– recommended).
Tablet: 500 mg. 2,000 g: 50 mg/kg/24 hr divided q 12 hr Adverse effect: Neutropenia.
IV or IM; >2,000 g: 75 mg/kg/24 hr
divided q 8 hr IV or IM;postnatal age >7
days 1,200–2,000 g: 75 mg/kg/q 8 hr;
>2,000 g: 100 mg/kg divided q 6–8 hr IV
(meningitis: 200 mg/kg/24 hr divided q
6 hr IV).
Children: 100–200 mg/kg/24 hr divided
q 4–6 hr IV.
Adults: 4–12 g/24 hr divided q 4–6 hr IV
(max dose: 12 g/24 hr).

Nalidixic acid 1st generation quinolone effective for Cautions: Vertigo, dizziness, rash. Not
NegGram. short-term treatment of lower urinary for use in systemic infections.
tract infections caused by E. coli, Drug interactions: Liquid antacids.
Tablet: 250,500,1,000 mg. Enterobacter, Klebsiella, and Proteus.
Suspension: 250 mg/5 mL. Children: 50–55 mg/kg/24 hr divided q
6 hr PO;suppressive therapy 25–33
mg/kg/24 hr divided q 6–8 hr PO.
Adults: 1 g q 6 hr PO;suppressive
therapy: 500 mg q 6 hr PO.

Neomycin sulfate Aminoglycoside antibiotic used for Cautions: In patients with renal
Mycifradin, generic. topical application or orally before dysfunction because small amount
surgery to decrease gastrointestinal absorbed may accumulate.
Tablet: 500 mg. fora (nonabsorbable) and Adverse events: Primarily related to
Topical cream, ointment. hyperammonemia. topical application, abdominal cramps,
DRUG (TRADE NAMES, INDICATIONS (MECHANISM OF ACTION) AND
FORMULATIONS) DOSING COMMENTS

Solution: 125 mg/5 mL. Infants: 50 mg/kg/24 hr divided q 6 hr diarrhea, rash. Aminoglycoside
PO. ototoxicity and nephrotoxicity if
Children: 50–100 mg/kg/24 hr divided absorbed.
q 6–8 hr PO.
Adults: 500–2,000 mg/dose q 6–8 hr
PO.

Nitrofurantoin Effective in the treatment of lower Cautions: Vertigo, dizziness, rash,

Furadantin, Furan, urinary tract infections caused by jaundice, interstitial pneumonitis.
Macrodantin. gram-positive and gram-negative Do not use with moderate to severe
pathogens. renal dysfunction.
Capsule: 50,100 mg.
Children: 5–7 mg/kg/24 hr divided q 6 Drug interactions: Liquid antacids.
Extended-release capsule: hr PO (max dose: 400 mg/24 hr);
100 mg. suppressive therapy 1–2.5 mg/kg/24 hr
Macrocrystal: 50,100 mg. divided q 12–24 hr PO (max dose: 100
mg/24 hr).
Suspension: 25 mg/5 mL.
Adults: 50–100 mg/24 hr divided q 6 hr
PO.

Ofoxacin Quinolone antibiotic for treatment of Adverse events: Burning, stinging, eye redness
conjunctivitis or corneal ulcers (ophthalmic solution), dizziness with otic
Ocuflox 0.3% ophthalmic
(ophthalmic solution); and otitis solution if not warmed.
solution: 1,5,10 mL.
externa and chronic suppurative otitis
Floxin 0.3% otic solution: 5,10 media (otic solution) caused by
mL. susceptible gram-positive, gram-
negative, anaerobic bacteria, or
Chlamydia trachomatis.
Child >1–12 yr:
Conjunctivitis: 1–2 drops in affected
eye(s) q 2–4 hr for 2 days, then 1–2
drops qid for 5 days.
Corneal ulcers: 1–2 drops q 30 min
while awake and at 4 hours at night for
2 days, then 1–2 drops hourly for 5 days
while awake, then 1–2 drops q 6 hr for
2 days.
Otitis externa (otic solution):5 drops
into affected ear bid for 10 days.
Chronic suppurative otitis media: treat
for 14 days.
Child >12 yr and adults:
Ophthalmic solution doses same as for
younger children.
Otitis externa (otic solution): Use 10
drops bid for 10 or 14 days as for
younger children.

Oxacillin sodium Penicillinase-resistant penicillin active Cautions: β-Lactam safety profile (rash,
Prostaphlin. against S. aureus and other gram- eosinophilia).
positive cocci except Enterococcus and Moderate oral bioavailability (35–65%).
Injection. coagulase-negative staphylococci. Primarily renally eliminated.
Capsule: 250,500 mg. Neonates: Postnatal age ≤7 days 1,200– Drug interaction: Probenecid.
DRUG (TRADE NAMES, INDICATIONS (MECHANISM OF ACTION) AND
FORMULATIONS) DOSING COMMENTS

Suspension: 250 mg/5 mL. 2,000 g: 50 mg/kg/24 hr divided q 12 hr Adverse effect: Neutropenia.
IV; >2,000 g: 75 mg/kg/24 hr IV divided
q 8 hr IV;postnatal age >7 days <1,200
g: 50 mg/kg/24 hr IV divided q 12 hr IV;
1,200–2,000 g: 75 mg/kg/24 hr divided
q 8 hr IV; >2,000 g: 100 mg/kg/24 hr IV
divided q 6 hr IV.
Infants: 100–200 mg/kg/24 hr divided q
4–6 hr IV.
Children: PO 50–100 mg/kg/24 hr
divided q 4–6 hr IV.
Adults: 2–12 g/24 hr divided q 4–6 hr IV
(max dose: 12 g/24 hr).

Penicillin G Penicillin active against most gram- Cautions: β-Lactam safety profile (rash,
Injection. positive cocci; S. pneumoniae eosinophilia), allergy, seizures with
(resistance is increasing), group A excessive doses particularly in patients
Tablets. streptococcus, and some gram- with marked renal disease. Substantial
negative bacteria (e.g., N. pathogen resistance.
gonorrhoeae, N. meningitidis). Primarily renally eliminated.
Neonates: Postnatal age ≤7 days 1,200– Drug interaction: Probenecid.
2,000 g: 50,000 units/kg/24 hr divided
q 12 hr IV or IM (meningitis: 100,000
units/kg/24 hr divided q 12 hr IV or IM);
>2,000 g: 75,000 units/kg/24 hr divided
q 8 hr IV or IM (meningitis: 150,000
units/kg/24 hr divided q 8 hr IV or IM);
postnatal age >7 days ≤1,200 g: 50,000
units/kg/24 hr divided q 12 hr IV
(meningitis: 100,000 units/kg/24 hr
divided q 12 hr IV);1,200–2,000 g:
75,000 units/kg/24 hr q 8 hr IV
(meningitis: 225,000 units/kg/24 hr
divided q 8 hr IV); >2,000 g: 100,000
units/kg/24 hr divided q 6 hr IV
(meningitis: 200,000 units/kg/24 hr
divided q 6 hr IV).
Children: 100,000–250,000 units/kg/24
hr divided q 4–6 hr IV or IM (max:
400,000 units/kg/24 hr).
Adults: 2–24 million units/24 hr divided
q 4–6 hr IV or IM

Penicillin G, benzathine Long-acting repository form of Cautions: β-Lactam safety profile (rash,
Bicillin. penicillin effective in the treatment of eosinophilia), allergy.
infections responsive to persistent, low Administer by IM injection only.
Injection. penicillin concentrations (1–4 wk), Substantial pathogen resistance.
e.g., group A streptococcus Primarily renally eliminated.
pharyngitis, rheumatic fever
prophylaxis. Drug interaction: Probenecid.

Neonates >1,200 g: 50,000 units/kg IM

once.
Children: 300,000–1.2 million units/kg
q 3–4 wk IM (max: 1.2–2.4 million
DRUG (TRADE NAMES, INDICATIONS (MECHANISM OF ACTION) AND
FORMULATIONS) DOSING COMMENTS

units/dose).
Adults: 1.2 million units IM q 3–4 wk.

Penicillin G, procaine Repository form of penicillin providing Cautions: β-Lactam safety profile (rash,
Crysticillin. low penicillin concentrations for 12 hr. eosinophilia) allergy. Administer by IM
Neonates >1,200 g: 50,000 units/kg/24 injection only. Substantial pathogen
Injection. resistance. Primarily renally eliminated.
hr IM.
Children: 25,000–50,000 units/kg/24 hr Drug interaction: Probenecid.
IM for 10 days (max: 4.8 million
units/dose).
Gonorrhea: 100,000 units/kg (max: 4.8
million units/24 hr) IM once with
probenecid 25 mg/kg (max dose: 1 g)
Adults: 0.6–4.8 million units q 12–24 hr
IM.

Penicillin V Preferred oral dosing form of penicillin, Cautions: β-Lactam safety profile (rash,
Pen VK, V-Cillin K. active against most gram-positive eosinophilia), allergy, seizures with
cocci; S. pneumoniae (resistance is excessive doses particularly in patients
Tablet: 125,250,500 mg. increasing), other Streptococcus, and with renal disease. Substantial
Suspension: 125 mg/5 mL, some gram-negative bacteria (e.g., N. pathogen resistance. Primarily renally
250 mg/5 mL. gonorrhoeae, N. meningitidis). eliminated. Inactivated by penicillinase.
Children: 25–50 mg/kg/24 hr divided q Drug interaction:Probenecid.
4–8 hr PO.
Adults: 125–500 mg q 6–8 hr PO (max
dose: 3 g/24 hr).

Piperacillin Extended-spectrum penicillin active Cautions: β-Lactam safety profile (rash,

Pipracil. against E. coli, Enterobacter, Serratia, eosinophilia); painful given
P. aeruginosa, and Bacteroides. intramuscularly; each gram contains 1.9
Injection. mEq sodium. Interferes with platelet
Neonates: Postnatal age ≤7 days 150
mg/kg/24 hr divided q 8–12 hr IV; >7 aggregation/serum sickness–like
days; 200 mg/kg divided q 6–8 hr IV. reaction with high doses; increases in
liver function tests.
Children: 200–300 mg/kg/24 hr divided
q 4–6 hr IV;cystic fibrosis: 350–500 Renally eliminated. Inactivated by
mg/kg/24 hr IV. penicillinase.

Adults: 2–4 g/dose q 4–6 hr (max dose: Drug interaction: Probenecid.

24 g/24 hr) IV.

Piperacillin-tazobactam Extended-spectrum penicillin Cautions: β-Lactam safety profile (rash,

Zosyn. (piperacillin) combined with a β- eosinophilia); painful given
lactamase inhibitor (tazobactam) intramuscularly; each gram contains 1.9
Injection. active against S. aureus, H. influenzae, mEq sodium. Interferes with platelet
E. coli, Enterobacter, Serratia, aggregation, serum sinckness–like
Acinetobacter, P. aeruginosa, and reaction with high doses, increases in
Bacteroides. liver function test results. Renally
Children: 300–400 mg/kg/24 hr divided eliminated.
q 6–8 hr IV or IM. Drug interaction: Probenecid.
Adults: 3.375 g q 6–8 hr IV or IM.

Quinupristin/dalfopristin Streptogramin antibiotic (quinupristin) Adverse events: Pain, edema, or

Synercid. active against vancomycin-resistant E. phlebitis at injection site, nausea,
faecium (VRE) and methicillin-resistant diarrhea.
DRUG (TRADE NAMES, INDICATIONS (MECHANISM OF ACTION) AND
FORMULATIONS) DOSING COMMENTS

IV injection: powder for S. aureus. Not active against E. Drug interactions: Synercid is a potent
reconstitution, 10 mL faecalis. inhibitor of CYP3A4.
contains Children and adults: VRE:7.5 mg/kg q 8
150 mg quinupristin, 350 mg hr IV for VRE;skin infections: 7.5 mg/kg
dalfopristin. q 12 hr IV.

Sulfadiazine Sulfonamide antibiotic primarily Cautions: Rash, Stevens-Johnson

Tablet: 500 mg. indicated for the treatment of lower syndrome, nausea, leukopenia,
urinary tract infections due to E. coli, P. crystalluria. Renal and hepatic
mirabilis, and Klebsiella. elimination; avoid use with renal
Toxoplasmosis: disease. Half-life ∼10 hr.

Neonates: 100 mg/kg/24 hr divided q Drug interactions: Protein displacement

12 hr PO with pyrimethamine 1 with warfarin, phenytoin,
mg/kg/24 hr PO (with folinic acid). methotrexate.

Children: 120–200 mg/kg/24 hr divided

q 6 hr PO with pyrimethamine 2
mg/kg/24 hr divided q 12 hr PO ≥3 days
then 1 mg/kg/24 hr (max dose: 25
mg/24 hr) with folinic acid.
Rheumatic fever prophylaxis: ≤30 kg:
500 mg/24 hr q 24 hr PO; >30 kg: 1
g/24 hr q 24 hr PO.

Sulfamethoxazole Sulfonamide antibiotic used for the Cautions: Rash, Stevens-Johnson

Gantanol. treatment of otitis media, chronic syndrome, nausea, leukopenia,
bronchitis, and lower urinary tract crystalluria. Renal and hepatic
Tablet: 500 mg. infections due to susceptible bacteria. elimination; avoid use with renal
Suspension: 500 mg/5 mL. Children: 50–60 mg/kg/24 hr divided q disease. Half-life 12 hr. Initial dose often
12 hr PO. a loading dose (doubled).

Adults: 1 g/dose q 12 hr PO (max dose: Drug interactions: Protein displacement

3 g/24 hr). with warfarin, phenytoin,
methotrexate.

Sulfisoxazole Sulfonamide antibiotic used for the Cautions: Rash, Stevens-Johnson

Gantrisin. treatment of otitis media, chronic syndrome, nausea, leukopenia,
bronchitis, and lower urinary tract crystalluria. Renal and hepatic
Tablet: 500 mg. infections due to susceptible bacteria. elimination; avoid use with renal
Suspension: 500 mg/5 mL. Children: 120–150 mg/kg/24 hr divided disease. Half-life ∼7–12 hr. Initial dose
q 4–6 hr PO (max dose: 6 g/24 hr). often a loading dose (doubled).
Ophthalmic solution,
ointment. Adults: 4–8 g/24 hr divided q 4–6 hr Drug interactions: Protein displacement
PO. with warfarin, phenytoin,
methotrexate.

Ticarcillin Extended-spectrum penicillin active Cautions: β-Lactam safety profile (rash,

Ticar. against E. coli, Enterobacter, Serratia, eosinophilia); painful given
P. aeruginosa, and Bacteroides. intramuscularly; each gram contains 5–
Injection. 6 mEq sodium. Interferes with platelet
Neonates: Postnatal age ≤7 days <2,000
g: 150 mg/kg/24 hr divided q 8–12 hr aggregation; increases in liver function
IV; >7 days: <2,000 g: 225 mg/kg/24 hr tests. Renally eliminated. Inactivated by
divided q 8 hr IV; >7 days <1,200 g: 150 penicillinase.
mg/kg/24 hr divided q 12 hr IV; Drug interaction: Probenecid.
1,200–2,000 g: 225 mg/kg/24 hr
divided q 8 hr IV; >2,000 g: 300
mg/kg/24 hr divided q 6–8 hr IV.
DRUG (TRADE NAMES, INDICATIONS (MECHANISM OF ACTION) AND
FORMULATIONS) DOSING COMMENTS

Children: 200–400 mg/kg/24 hr divided

q 4–6 hr IV;cystic fibrosis: 400—600
mg/kg/24 hr IV.
Adults: 2–4 g/dose q 4–6 hr IV (max
dose: 24 g/24 hr).

Ticarcillin-clavulanate Extended-spectrum penicillin Cautions: β-Lactam safety profile (rash,

Timentin. (ticarcillin) combined with a β- eosinophilia); painful given
lactamase inhibitor (clavulanate) intramuscularly; each gram contains
Injection. active against S. aureus, H. influenzae, 5–6 mEq sodium. Interferes with
Enterobacter, E. coli, Serratia, P. platelet aggregation; increases in liver
aeruginosa, Acinetobacter, and function tests. Renally eliminated.
Bacteroides. Drug interaction: Probenecid.
Children: 280–400 mg/kg/24 hr q 4–8
hr IV or IM.
Adults: 3.1 g q 4–8 hr IV or IM (max
dose: 18–24 g/24 hr).

Tobramycin Aminoglycoside antibiotic active Cautions: S. pneumoniae, other

Nebcin, Tobrex. against gram-negative bacilli, Streptococcus, and anaerobes are
especially E. coli, Klebsiella, resistant. May cause ototoxicity and
Injection. Enterobacter, Serratia, Proteus, and nephrotoxicity. Monitor renal function.
Ophthalmic solution, Pseudomonas. Drug eliminated renally. Administered
ointment. Neonates: Postnatal age ≤7 days, IV over 30–60 min.
1,200–2,000 g: 2.5 mg/kg q 12–18 hr IV Drug interactions: May potentiate other
or IM; >2,000 g: 2.5 mg/kg q 12 hr IV or ototoxic and nephrotoxic drugs.
IM;postnatal age >7 days, 1,200–2,000 Target serum concentrations: Peak 6–12
g: 2.5 mg/kg q 8–12 hr IV or IM; >2,000 mg/L;trough <2 mg/L.
g: 2.5 mg/kg q 8 hr IV or IM.
Children: 2.5 mg/kg/24 hr divided q
8–12 hr IV or IM. Alternatively may
administer 5–7.5 mg/kg/24 hr IV.
Preservative-free preparation for
intraventricular or intrathecal
use:neonate: 1 mg/24 hr; children: 1–2
mg/24 hr; adults: 4–8 mg/24 hr.
Adults: 3–6 mg/kg/24 hr divided q 8 hr
IV or IM.

Trimethoprim Folic acid antagonist effective in the Cautions: Megaloblastic anemia, bone
Proloprim, Trimpex. prophylaxis and treatment of E. coli, marrow suppression, nausea, epigastric
Klebsiella, Proteus mirabilis, and distress, rash.
Tablet: 100,200 mg Enterobacter urinary tract infections; Durg interactions: Possible interactions
P. carinii pneumonia. with phenytoin, cyclosporine, rifampin,
Children: For urinary tract infection: warfarin.
4–6 mg/kg/24 hr divided q 12 hr PO.
Children >12 yr and adults: 100–200 mg
q 12 hr PO.
P. carinii pneumonia (with
dapsone):15–20 mg/kg/24 hr divided q
6 hr for 21 days PO.

Vancomycin Glycopeptide antibiotic active against Cautions: Ototoxicity and

most gram-positive pathogens nephrotoxicity particularly when co-
DRUG (TRADE NAMES, INDICATIONS (MECHANISM OF ACTION) AND
FORMULATIONS) DOSING COMMENTS

Vancocin, Luphocin. including Staphylococcus (including administered with other ototoxic and
Injection. methicillin-resistant S. aureus and nephrotoxic drugs. Infuse IV over 45–60
coagulase-negative staphylococci), S. min. Flushing (red-man syndrome)
Capsule: 125 mg, 250 mg. pneumoniae including penicillin- associated with rapid IV infusions, fever,
Suspension. resistant strains, Enterococcus chills, phlebitis (central line is
(resistance is increasing), and preferred). Renally eliminated.
Clostridium difficile-associated colitis. Target serum concentrations: Peak (1 hr
Neonates: Postnatal age ≤7 days, after 1 hr infusion) 30–40 mg/L;trough
<1,200 g: 15 mg/kg/24 hr divided q 24 5–10 mg/L.
hr IV; 1.200–2,000 g: 15 mg/kg/24 hr
divided q 12–18 hr IV; >2,000 g: 30
mg/kg/24 hr divided q 12 hr
IV;postnatal age >7 days, <1,200 g: 15
mg/kg/24 hr divided q 24 hr IV;
1,200–2,000 g: 15 mg/kg/24 hr divided
q 8–12 hr IV; >2,000 g: 45 mg/kg/24 hr
divided q 8 hr IV.
Children: 45–60 mg/kg/24 hr divided q
8–12 hr IV; Clostridium difficile-
associated colitis; 40–50 mg/kg/24 hr
divided q 6–8 hr PO.
Adults: 0.5–1 g IV q 12 hr IV.

Penicillins remain the drugs of choice for many common pediatric infections caused by group A and group B streptococcus,
Treponema pallidum (syphilis), Listeria monocytogenes, and Neisseria meningitidis. The semisynthetic penicillins (nafcillin,
cloxacillin, dicloxacillin) are useful for management of susceptible staphylococcal infections, although increasing incidence of
MRSA has limited the usefulness of these drugs. The aminopenicillins (ampicillin, amoxicillin) were developed to provide broad-
spectrum activity against gram-negative organisms, including E. coli and H. influenzae, but the emergence of resistance has
limited their utility in many clinical settings. The carboxypenicillins (carbenicillin, ticarcillin) and ureidopenicillins (piperacillin,
mezlocillin, azlocillin) also have bactericidal activity against most strains of P. aeruginosa.

Resistance to penicillin is mediated by a variety of mechanisms (see Table 179-1 ). The production of β-lactamase is a common
mechanism exhibited by many organisms that may be overcome, with variable success, by including a β-lactamase inhibitor with
the penicillin. These combination products (ampicillin-sulbactam, amoxicillin-clavulanate, piperacillin-tazobactam) are very
useful for management of resistant isolates if the resistance is β-lactamase mediated. Notably, S. aureus and S. pneumoniae
mediate β-lactam resistance through mechanisms other than β-lactamase production, rendering these combination agents of
little value for the management of these infections.

Classification of Parenteral and Oral Cephalosporins

CEPHALOSPORINS 1ST GENERATION 2ND GENERATION CEPHAMYCINS 3RD GENERATION 4TH GENERATION
Parenteral Cefazolin (Ancef, Kefzol) Cefamandole Cefmetazole Cefoperazole Cefepime
(Mandol) (Zefazone) (Cefobid) (Maxipime)
Cephalothin (Keflin, Cefonicid (Monocid) Cefotetan (Cefotan) Cefotaxime Cefpirome
Seffin) (Claforan)
Cephapirin (Cefadyl) Cefuroxime (Kefurox, Cefoxitin (Mefoxin) Ceftazidime
Zinacef) (Fortaz)
Cephradine (Velosef) Ceftizoxime
(Cefizox)
Ceftriaxone
(Rocephin)
CEPHALOSPORINS 1ST GENERATION 2ND GENERATION CEPHAMYCINS 3RD GENERATION 4TH GENERATION
Oral Cefadroxil (Duricef, Cefaclor (Ceclor) Cefdinir (Omnicef)
Ultracef)
Cephalexin (Keflex, Cefprozil (Cefzil) Cefditoren
Biocef, Keftab) (Spectracef)
Cephradine (Velosef) Cefuroxime-axetil Cefixime (Suprax)
(Ceftin)
Loracarbef (Lorabid) Cefpodoxime
(Vantin)
Ceftibuten (Cedax)

lactamase inhibitor ticarcillin-clavulanate Pseudomonas

combination
Carbapenems Imipenem-cilastatin Broad-spectrum, gram- MRSA,b many Central nervous
meropenem, ertapenem negative rods, enterococci system (CNS), seizures
anaerobes,
Pseudomonas
Cephalosporin group
First-generation (I) Cefazolin, cephalexin, Gram-positive Gram-negative, Rash; anaphylaxis,
cephalothin, cephapirin, Enterococcus, some drug fever
cephradine Staphylococcus
(coagulase-negative)
Second-generation (II) Cefaclor, cefamandole, Gram-positive, some Enterococcus, Serum sickness
cefprozil, cefonicid, Haemophilus, some Pseudomonas, some (cefaclor)
cefuroxime, loracarbef Enterobacteriaceae Staphylococcus
(coagulase-negative)
Cefoxitin, cefotetan Same as second-
generation plus
anaerobes
Group Examples Some Common Common Resistant Common or Unique
Susceptible Organismsa Organisms Adverse Reactions

Third-generation (III) Cefotaxime, ceftizoxime, Streptococcus, Pseudomonas, Biliary sludging

ceftriaxone, cefpodoxime, Haemophilus, Staphylococcus (ceftriaxone) rash
ceftibuten, cefdinir Enterobacteriaceae,
Neisseria
Ceftazidime, cefepime (Same as other third- Staphylococcus
generation
cephalosporins), plus
Pseudomonas
Other drugs
Clindamycin Clindamycin Gram-positive, Gram-negative, Nausea, vomiting,
anaerobes Enterococcus, MRSA hepatotoxicity
Vancomycin Vancomycin Gram-positive Gram-negative "Red man" syndrome,
shock, ototoxicity,
renal
Macrolides and azilides Erythromycin, Gram-positive Gram-negative Nausea and vomiting
clarithromycin, Bordetella,
azithromycin Haemophilus,
Mycoplasma,
Chlamydia, Legionella
Monobactams Aztreonam Gram-negative aerobes, Gram-positive cocci Rash, diarrhea
Pseudomonas
Oxazolidinones Linezolid Gram-positive aerobes Gram-negative Diarrhea,
aerobes thrombocytopenia
Streptogamins Quinupristin/dalfopristin Gram-positive aerobes Gram-negative Arthralgia myalgia
aerobes
Fluoroquinolonesc Ciprofloxacin, ofloxacin Gram-negative, Enterococcus, Gastrointestinal (GI),
Chlamydia, Streptococcus, S rash, CNS
Pseudomonas pneumoniae,
(ciprofloxacin) anaerobes,
Staphylococcus
Gatifloxacin, levofloxacin, Gram-negative, Some Enterococcus GI, rash, CNS, severe
moxifloxacin streptococci, S hepatitisd
pneumoniae,
staphylococci,
anaerobesd

Tetracyclines Chlortetracycline, Anaerobes, Many Teeth staining,e rash,

tetracycline, doxycycline, Mycoplasma, Enterobacteriaceae, flora overgrowth,
minocycline Chlamydia, Rickettsia, Staphylococcus hepatotoxicity,
Ehrlichia pseudotumor cerebri

Sulfonamides Many Gram-negative (urine) Gram-positive Rash, renal, bone

marrow suppression,
Stevens-Johnson
syndrome
Trimethoprim- Trimethoprim- S aureus, gram- Streptococcus, Rash, renal, bone
sulfamethoxazole sulfamethoxazole negative, S Pseudomonas, marrow suppression,
pneumoniae, H anaerobes Stevens-Johnson
influenzae syndrome
Rifampin Rifampin Neisseria, Haemophilus, Resistance develops Rash, GI,
Staphylococcus, rapidly if used as sole hepatotoxicity, CNS,
Streptococcus agent bone marrow
Group Examples Some Common Common Resistant Common or Unique
Susceptible Organismsa Organisms Adverse Reactions

suppression, alters
metabolism of other
drugs
Aminoglycosides Amikacin, gentamicin, Gram-negative, Gram-positive, Nephrotoxicity,
kanamycin, streptomycin, including P aeruginosa anaerobes, some ototoxicity,
tobramycin pseudomonads potentiates
neuromuscular
blocking agents

a
Not all strains susceptible; always obtain antimicrobial susceptibility tests on significant isolates.

b
MRSA = methicillin-resistant S aureus.

c
Not approved for children.

d
Trovofloxacin only.

e
Dose-dependent in children < age 9 years.

Guidelines for Use of Common Parenteral Antibacterial Agents a in Children Age 1 Month or Older.
Route Doseb (mg/kg/d) Maximum Daily Interval Adjustmentc
Dose (hours) Blood Levelsd (
g/mL)

Peak Trough
Amikacin IM, IV 15–22.5 1.5 g 8 R 15–25 5–10
Ampicillin IM, IV 100–400 12 g 4–6 R
Aztreonam IM, IV 90–120 6g 6–8 R
Cefazolin IM, IV 50–100 6g 8 R
e
Cefepime IM, IV 100–150 4–6 g 8–12 R

Cefotaxime IM, IV 100–200 12 g 6–8 R

Cefoxitin IM, IV 80–160 12 g 4–6 R
Ceftazidime IM, IV 100–150 6g 8 R
Ceftizoxime IM, IV 150–200 12 g 6–8 R
Ceftriaxone IM, IV 50–100 4g 12–24 R
Cefuroxime IM, IV 100–150 6g 6–8 R
Cephalothin IM, IV 75–125 12 g 4–6 R
Cephradine IM, IV 50–100 8g 6 R
Clindamycin IM, IV 25–40 4g 6–8 R, H
Gentamicin IM, IV 3–7.5 300 mg 8 R 5–10 <2
Linezolid IV, PO 20 1.2 g 12 R
Meropenem IV 60–120 2g 8 R
Metronidazole IV 30 4g 6 H
Nafcillin IM, IV 150 12 g 6 H
Penicillin G IM, IV 100,000–250,000 20 million units 4–6 H, R
units/kg
Pencillin G IM 50,000 units/kg 2.4 million units Single dose None
 Route Doseb (mg/kg/d) Maximum Daily Interval Adjustmentc
Dose (hours) Blood Levelsd (
g/mL)

Peak Trough
(benzathine)
Penicillin G (procaine) IM 25,000–50,000 4.8 million units 12–24 R
units/kg
Tetracyclinef IVf 20–30 2g 12 R

Ticarcillin IV 200–300 24 g 4–6 R

Tobramycin IM, IV 3–6 300 mg 8 R 5–10 <2
Vancomycin IV 40–60 2g 6 R 20–40g < 5–10g

a
Not including some newly released drugs, ones not recommended for use in children, or ones not widely used.

b
Always consult package insert for complete prescribing information. Dosage may differ for alternative routes, newborns (see
Table 35–6), or patients with liver or renal failure (see Adjustment column) and may not be recommended for use in pregnant
women or newborns. Maximum dosage may be indicated only in severe infections or by parenteral routes.

c
Mode of excretion (R = renal, H = hepatic) of antimicrobial agent should be assessed at the onset of therapy and dosage
modified or levels determined as indicated in package insert.

d
Suggested levels to reduce toxicity.

e
Safety and efficacy are not established in children < age 2 months.

f
Use with caution in children < age 9 years because of tooth staining with repeated doses.

g
Target peak and trough vancomycin levels are not well correlated with either toxicity or outcome. Measure selectively in
meningitis, impaired or changing renal function, or altered volume of distribution.

Guidelines for Use of Common Oral Antibacterial Agents in Children Age 1 Month or Older.

Agenta Doseb (mg/kg/d) Interval (hours) Other Considerations

Amoxicillin 40 8–12 Gastrointestinal (GI) side effects

c
Amoxicillin (high dose) 80–90 12 GI side effects

Amoxicillin-clavulanate 45 12 GI side effects

Ampicillin 50 6 GI side effects
Azithromycin 10 (first dose) then 5; 12 for pharyngitis 24 GI side effects
Cefaclor 40 8 Serum sickness–like illness
Cefadroxil 30 12
Cefpodoxime 10 12 Taste (suspension)
Cefprozil 30 12 GI side effects
Ceftibuten 9 24 GI side effects
Cefuroxime 30–40 12 GI side effects
Agenta Doseb (mg/kg/d) Interval (hours) Other Considerations

Cephalexin 25–50 6
Cephradine 25–50 6
Clarithromycin 15 12 GI side effects
Clindamycin 20–30 6 GI side effects
Cloxacillin 50–100 6 GI side effects
Dicloxacillin 12–25 6 GI side effects
d
Doxycycline 2–4 12–24 Tooth staining < 9 years

Erythromycine 20–50 6–12 GI side effects

Erythromycin-sulfisoxazole 40 (erythromycin) 6–8

Furazolidone 5–8 6
Linezolid 20 12 GI side effects
Loracarbef 15; 30 for otitis 12
Metronidazole 15–35 8
Nitrofurantoin 5–7 6
Oxacillin 50–100 6
Penicillin V 25–50 6 Taste (suspension)
Rifampin 10–20 12–24
Sulfisoxazole 120–150 6
Tetracyclined 25–50c 6 Teeth staining < 9 years

Trimethoprim-sulfamethoxazole 8–12 (TMP) 12 Stevens–Johnson syndrome

a
Not including some newly released drugs, ones not recommended for use in children, or ones not widely used.

b
Always consult package insert for complete prescribing information. Dosage may differ for alternative routes, newborns (see
Table 35–6), or patients with liver or renal failure (see Table 35 –4, Adjustment column) and may not be recommended for use in
pregnant women or newborns. Maximum dosage may be indicated only in severe infections or by parenteral routes.

c
Higher dose amoxicillin indicated for therapy of otitis media in regions where rates of penicillin-resistant S pneumoniae are
common.

d
Use with caution in children < age 9 years because of tooth staining with repeated doses.

e
Preparation-dependent.

Guidelines for Use of Selected Antimicrobial Agents in Newborns.

Route Body Wt (g) Maximum Dosage (mg/kg/d) [Frequency]

Blood Levels ( g/mL)
< 7 Days 8– 30 Days Peak Trough
Amikacina IV, IM < 2000 15 [q12h] 22.5 [q8h] 15–25 5–10
> 2000 20 [q12h] 30 [q8h]
Ampicillin IV, IM < 2000 100 [q12h] 150 [q8h]
> 2000 150 [q8h] 200 [q6h]
 Route Body Wt (g) Maximum Dosage (mg/kg/d) [Frequency]
Blood Levels ( g/mL)
< 7 Days 8– 30 Days Peak Trough
Cefotaxime IV, IM 100 [q12h] 150 [q8h]
Ceftazidime IV, IM < 2000 100 [q12h] 150 [q8h]
> 2000 100 [q8h] 150 [q8h]
Clindamycin IV, IM, PO < 2000 10 [q12h] 15 [q8h]
> 2000 15 [q8h] 20 [q6h]
Erythromycin PO 20 [q12h] 30 [q8h]
Gentamicina IV, IM 5 [q12–18h] 7.5 [q8h] 5–10 <2

Nafcillin IV < 2000 50 [q12h] 75 [q8h]

> 2000 75 [q8h] 150 [q6h]
Oxacillin IV, IM < 2000 100 [q12h] 150 [q8h]
> 2000 50 [q8h] 200 [q6h]
b
Penicillin G IV < 2000 100,000 [q12h] 150,000 [q8h]
> 2000 150,000 [q8h] 200,000 [q6h]
Ticarcillin IV, IM < 2000 150 [q12h] 225 [q8h]
> 2000 225 [q8h] 300 [q6h]
a
Tobramycin IV, IM 5 [q12–18h] 7.5 [q8h] 5–10 <2

Vancomycinc IV 20 [q12h] 30 [q8h] 20–40

a
Neonates weighting < 1200 g may require even smaller doses. Antibiotic levels should be closely monitored.

b
Penicillin dosages are in units/kg/d. Other preparations (eg, benzathine penicillin) may be given IM. See specific diseases for
dosage.

c
Target peak and trough vancomycin levels are not well correlated with either toxicity or outcome.

Pain and Anxiety Control.

Drug Dose and Method of Advantages Disadvantages Usual
Administrationa Duration of
Effect
Morphine IV, 0.1 mg/kg; continuous Excellent pain relief, Respiratory depression, hypotension, 2–4 h
infusion, 0.01–0.05 reversible nausea, suppression of intestinal
mg/kg/h motility, histamine release
Meperidine IV, 1 mg/kg Good pain relief, reversible Respiratory depression, histamine 2–4 h
release, nausea, suppression of
intestinal motility
Fentanyl IV, 1–2 g/kg; continuous Excellent pain relief, Respiratory depression, chest wall 30 min
infusion, 0.5–2g/kg/h reversible, short half-life rigidity, severe nausea and vomiting
Diazepam IV, 0.1 mg/kg Sedation and seizure control Respiratory depression, jaundice, 1–3 h
phlebitis
Lorazepam IV, 0.1 mg/kg Longer half-life, sedation and Nausea and vomiting, respiratory 2–4 h
seizure control depression, phlebitis
Midazolam IV, 0.1 mg/kg Short half-life, only Respiratory depression 30–60 min
benzodiazepine given as
continuous infusion
a
Intravenous (IV) administration is most common in the ICU. The effects of morphine, meperidine, and fentanyl are reversible
by administration of naloxone (opioid antagonist).

Emergency Pediatric Drugs.

Drug Indications Dosage and Route Comment

Atropine 1. Bradycardia, 0.01–0.02 mg/kg (minimum, Atropine may be useful in hemodynamically
especially cardiac in 0.1 mg; maximum, 2 mg) IV, significant primary cardiac-based bradycardias.
origin IO, ET. May repeat every 5 Because of paradoxic bradycardia sometimes
2. Vagally mediated min. seen in infants, a minimum dose of 0.1 mg is
bradycardia, eg, during recommended by the American Heart
laryngoscopy and Association. Epinephrine is the first-line drug in
intubation pediatrics for bradycardia caused by hypoxia or
3. Anticholinesterase ischemia.
poisoning
Bicarbonate 1. Documented 1 mEq/kg IV or IO; by arterial Infuse slowly. Sodium bicarbonate will be
metabolic acidosis blood gas: 0.3 x kg x base effective only if the patient is adequately
2. Hyperkalemia deficit. May repeat every 5 oxygenated, ventilated, and perfused. Some
min. adverse side effects.
Calcium 1. Documented 10–30 mg/kg slowly IV, Calcium is no longer indicated for asystole.
chloride 10% hypocalcemia preferably centrally, or IO with Potent tissue necrosis results if infiltration
2. Calcium channel caution. occurs. Use with caution.
blocker overdose
3. Hyperkalemia,
hypermagnesemia
Epinephrine 1. Bradycardia, Bradycardia and first Epinephrine is the single most important drug in
especially dose in arrests: 0.01 pediatric resuscitation. Evidence from animal
hypoxic–ischemic mg/kg of 1:10,000 studies and small series of human subjects
2. Hypotension (by solution IV or IO. indicates that the present recommended dose
infusion) Second and may be insufficient, and some clinicians use
3. Asystole subsequent doses in doses of 0.1–0.3 mg/kg IV. A randomized
4. Fine ventricular arrests: 0.1–0.2 mg/kg controlled trial has not been done.
fibrillation refractory to of 1:1000 solution IV
initial defibrillation or IO. Repeat every
5. Pulseless electrical 3–5 min.
activity ET: 10x intended IV
6. Anaphylaxis dose
SC: 0.01 mg/kg of
1:1000 solution (=
0.01 mL/kg)
(anaphylactic shock).
Maximum dose:
0.3–0.5 mL.
Constant infusion by

IV drip: 0.1–1
g/kg/min.
Glucose 1. Hypoglycemia 0.5–1 g/kg IV or, IO. May Neonates: 1 mL/kg D10W. Older children: 2– 4
2. Altered mental status repeat as necessary. mL/kg D25W, 6–10 mL/kg D10W.
(empirical)
3. With insulin, for
hyperkalemia
Naloxone 1. Opioid overdose 0.1 mg/kg IV, IO, or ET; Side effects are few. A dose of 2 mg may be
2. Altered mental status maximum dose, 2 mg. May given in young children. Repeat as necessary, or
Drug Indications Dosage and Route Comment
(empirical) repeat as necessary. give as constant infusion in opioid overdoses.
ET, endotracheally, IO, intraosseously, IV, intravenously, SC, subcutaneously.