Skip to Main Content

++
Table Graphic Jump Location
Favorite Table | Download (.pdf) | Print

Antibiotic

Organisms Covered

Dose

Notes

Ampicillin

Gram-positive organisms (Streptococcus spp.)

Susceptible Escherichia coli

Listeria monocytogenes

Empiric treatment for early- or late-onset (age >72 hrs) sepsis:

  • ≤7 d old: 150 mg/kg/dose IV q12h
  • >7 d old: 75 mg/kg/dose IV q6h

Treatment >48 h:

  • Meningitis or no CSF obtained: 75 mg/kg/dose IV q6h
  • Sepsis without meningitis: 75 mg/kg/dose IV q12h

Piperacillin

Pseudomonas aeruginosa Enterococcus spp.

Other Gram-negative enteric and anaerobes

PCN-susceptible Staphylococcus spp.

Streptococcus spp.

  • ≤7 d: 50 mg/kg/dose q8h
  • >7 d: 50 mg/kg/dose q6h

Moderate CSF penetration

Penicillin GK

GBS

Treponema pallidum

GBS meningitis:

  • ≤7 d postnatal age: 450,000 units/kg/d divided every 8 h
  • >7 d postnatal age: 450,000–500,000 units/kg/d divided every 4 h

Other GBS infections: 200,000 units/kg/d divided every 6 h

Nafcillin

Methicillin-sensitive Staphylococcus aureus

Non-CNS infections:

  • <30 wk postmenstrual age (PMA):
    • ≤7 d: 25 mg/kg/dose q12h
    • >7 d: 25 mg/kg/dose q8h
  • 30–37 wk PMA:
    • ≤7 d: 25 mg/kg/dose q12h
    • >7 d: 25 mg/kg/dose q8h
  • >37 wk PMA:
    • ≤7 d: 25 mg/kg/dose q12h
    • >7 d: 25 mg/kg/dose q6h

Meningitis:

  • Use 50 mg/kg/dose at same interval as listed above

Cleared primarily by the liver → monitor LFTs on treatment

Can cause interstitial nephritis → monitor renal function weekly on treatment

Can cause bone marrow suppression → monitor CBC weekly on therapy

Vancomycin

Aerobic and anaerobic Gram-positive cocci and bacilli

Methicillin-resistant S. aureus (MRSA)

Coagulase-negative staphylococci

Clostridium difficile

Bacillus spp.

Ampicillin-resistant Enterococcus

  • <30 wk PMA:
    • ≤7 d: 20 mg/kg/dose IV q24h
    • >7 d: 20 mg/kg/dose IV q18h
  • 30–37 wk PMA:
    • ≤7 d: 20 mg/kg/dose IV q18h
    • >7 d: 15 mg/kg/dose IV q12h
  • >37 wk PMA:
    • ≤7 d: 15 mg/kg/dose IV q12h
    • >7 d: 15 mg/kg/dose IV q8h
  • >44 wk PMA (meningitis):
    • 15 mg/kg/dose IV q6h

Only 10%–15% of serum concentration enters CSF.

Optimal serum concentration:

  • Trough: 15–20 mcg/mL

Gentamicin, amikacin, tobramycin

Broad Gram-negative bacillus coverage

Synergistic against S. aureus, GBS, L. monocytogenes, enterococci

Gentamicin

  • Indications: early- or late-onset sepsis (age >72 h); covers Gram-negative rods; use for synergy
    • <35 wk PMA: 3 mg/kg/dose IV q24h
    • ≥35wk PMA: 4 mg/kg/dose IV q24h
  • If given >48 h (>2 doses), draw gentamicin trough before and peak level after the third dose. Monitor BUN/Cr:
    • Optimum levels: peak= 5–10 mcg/mL, trough = <1.5 mcg/mL
  • For SYNERGY (against S. aureus, Enterococcus):
    • 1–1.5 mg/kg/dose IV q24h

Tobramycin

  • <30 wk PMA:
    • ≤7 d: 3 mg/kg/dose q24h
    • >7 d: 3 mg/kg/dose q18h
  • 30–37 wk PMA:
    • ≤7 d: 3 mg/kg/dose q18h
    • >7 d: 2.5 mg/kg/dose q12h
  • >37 wk PMA:
    • ≤7 d: 2.5 mg/kg/dose q12h
    • >7 d: 2.5 mg/kg/dose q8h
  • Optimum levels: peak = 8–10 mcg/mL; trough = <2 mcg/mL

Amikacin

  • <30 wk PMA:
    • ≤7 d: 15 mg/kg/dose q24h
    • >7 d: 15 mg/kg/dose q18h
  • 30–37 wk PMA:
    • ≤7 d: 15 mg/kg/dose q18h
    • >7 d: 15 mg/kg/dose q12h

CSF penetration depends on meningeal inflammation.

Monitor peak and trough levels, as these antibiotics can cause nephrotoxicity and ototoxicity.

  • >37 wk PMA:
    • ≤7 d: 15 mg/kg/dose q12h
    • >7 d: 15 mg/kg/dose q8h
  • Optimum levels: peak = 15–40 mcg/mL; trough = <10 mcg/mL

Clindamycin

Gram-positive cocci

Anaerobes (including Bacteroides fragilis)

  • ≤37 wk PMA:
    • ≤7 ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessPediatrics Full Site: One-Year Subscription

Connect to the full suite of AccessPediatrics content and resources including 20+ textbooks such as Rudolph’s Pediatrics and The Pediatric Practice series, high-quality procedural videos, images, and animations, interactive board review, an integrated pediatric drug database, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessPediatrics

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.