TY - CHAP M1 - Book, Section TI - Chapter 38. Infectious Diseases A1 - Lowry, Adam W. A1 - Bhakta, Kushal Y. A1 - Nag, Pratip K. PY - 2011 T2 - Texas Children's Hospital Handbook of Pediatrics and Neonatology AB - Table Graphic Jump Location|Download (.pdf)|PrintAntibioticOrganisms CoveredDoseNotesAmpicillinGram-positive organisms (Streptococcus spp.)Susceptible Escherichia coliListeria monocytogenesEmpiric 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 q6hTreatment >48 h:Meningitis or no CSF obtained: 75 mg/kg/dose IV q6hSepsis without meningitis: 75 mg/kg/dose IV q12hPiperacillinPseudomonas aeruginosa Enterococcus spp.Other Gram-negative enteric and anaerobesPCN-susceptible Staphylococcus spp.Streptococcus spp.≤7 d: 50 mg/kg/dose q8h>7 d: 50 mg/kg/dose q6hModerate CSF penetrationPenicillin GKGBSTreponema pallidumGBS 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 hOther GBS infections: 200,000 units/kg/d divided every 6 hNafcillinMethicillin-sensitive Staphylococcus aureusNon-CNS infections:7 d: 25 mg/kg/dose q8h30–37 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 q6hMeningitis:Use 50 mg/kg/dose at same interval as listed aboveCleared primarily by the liver → monitor LFTs on treatmentCan cause interstitial nephritis → monitor renal function weekly on treatmentCan cause bone marrow suppression → monitor CBC weekly on therapyVancomycinAerobic and anaerobic Gram-positive cocci and bacilliMethicillin-resistant S. aureus (MRSA)Coagulase-negative staphylococciClostridium difficileBacillus spp.Ampicillin-resistant Enterococcus7 d: 20 mg/kg/dose IV q18h30–37 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 q6hOnly 10%–15% of serum concentration enters CSF.Optimal serum concentration:Trough: 15–20 mcg/mLGentamicin, amikacin, tobramycinBroad Gram-negative bacillus coverageSynergistic against S. aureus, GBS, L. monocytogenes, enterococciGentamicinIndications: early- or late-onset sepsis (age >72 h); covers Gram-negative rods; use for synergy 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 = 7 d: 3 mg/kg/dose q18h30–37 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 q8hOptimum levels: peak = 8–10 mcg/mL; trough = 7 d: 15 mg/kg/dose q18h30–37 wk PMA: ≤7 d: 15 mg/kg/dose q18h>7 d: 15 mg/kg/dose q12hCSF 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 q8hOptimum levels: peak = 15–40 mcg/mL; trough = 7 d: 10 mg/kg/dose q8h>37 wk PMA: 13 mg/kg/dose q8hPoor CSF penetrationCleared by the liver → monitor LFTs while on therapyFirst-generation cephalosporins (cefazolin, cephalexin)Susceptible Staphylococcus, Streptococcus, and pneumococciCefazolin:≤7 d postnatal age: 20 mg/kg/dose q12h>7 d postnatal age: 2000 g: 20 mg/kg/dose q8hPoor CSF penetrationSecond- generation cephalosporins (cefuroxime, cefoxitin, cefotetan, cefprozil)Same as first generationplusHaemophilus influenzaeE. coliCitrobacterKlebsiellaEnterobacter cloacaeImproved activity over first-generation against β-lactamase–producing organismsLittle data in neonates, so use is limitedThird-generation cephalosporins (ceftriaxone, cefdinir, ... SN - PB - The McGraw-Hill Companies CY - New York, NY Y2 - 2024/10/08 UR - accesspediatrics.mhmedical.com/content.aspx?aid=7452516 ER -