Chapter 7.  Pediatric Infectious Diseases and Pediatric Drug Summaries				411
Empiric Therapy of Skin and Soft Tissue Infections
Skin and Soft Tissue Infections
	Usual	Preferred IV	Alternate	PO Therapy or
Subset	Pathogens	Therapy†	IV Therapy†	IV-to-PO Switch†
Cellulitis,	S.. aureus	Cefazolin or	Clindamycin‡ ×	Cephalexin or Cefadroxil or
impetigo	Group A	nafcillin or	7–10 days	Dicloxacillin or Clindamycin
	streptococci	oxacillin ×		or amoxicillin/clavulanate
		7–10 days		or Erythromycin or
				Azithromycin ×7–10 days
Severe	CA-MRSA	Vancomycin	Vancomycin or	TMP–SMX or Doxycycline
pyodermas,		plus	Linezolid × 7–14 days	× 7–14 days**
abscesses		Clindamycin ×
		7–14 days
Animal bite	Group A	Ampicillin-	Piperacillin or Ticarcillin	Amoxicillin/clavulanate or
wounds (dog/	streptococci	sulbactam ×	× 7–10 days	Doxycycline × 7–10 days
cat)	P.. multocida	7–10 days	Penicillin allergy:
	Capnocyto­
			Clindamycin plus
	phaga S..
			TMP–SMX ×7–10 days
	aureus
			(dog bites); Doxycycline
			or Cefuroxime ×
			7–10 days (cat bites)
Human bite	Oral anaerobes	Ampicillin-	Piperacillin or Ticarcillin	Amoxicillin/clavulanate or
wounds	E.. corrodens	sulbactam ×	× 5–7 days	Doxycycline × 5–7 days
	Group A	5–7 days	Penicillin allergic patient:
	streptococci
			Clindamycin plus
	S.. aureus
			TMP–SMX × 5–7 days
Cat scratch	Bartonella	Gentamicin ×		Azithromycin ×5 days or
disease (CSD)*	henselae	10–14 days	—	TMP–SMX or Ciprofloxacin
				or Rifampin ×10–14 days

†See pp. 414–422 for drug dosages.

**In children > 8 years of age..

*No well-controlled trials of antibiotic treatment for CSD to demonstrate benefit.

‡Preferred therapy for patients in geographic regions with a high prevalence of MRSA or for those with penicillin/cephalosporin allergy..

412 A n t i b i o t i c E s s e n t i a l s

Skin and Soft Tissue Infections (cont’d)

			PO Therapy or
Subset	Pathogens	IV Therapy†	IV-to-PO Switch†
Chicken pox	VZV	Acyclovir ×	Acyclovir or Valacyclovir × 7–10 days
Immuno-		7–10 days
compromised
host
Immuno-	VZV	Acyclovir × 5	Acyclovir or Valacyclovir × 5 days
competent		days
host
H.. zoster	VZV	Same as for	Acyclovir or Valacyclovir × 10 days
(Shingles)		chicken pox	(for individuals ≥ 12 years of age)

Duration of therapy represents total time IV, PO, or IV + PO. . Most patients on IV therapy able to take PO meds should be switched to PO therapy soon after clinical improvement..

†See pp. 414–422 for drug dosages.

Cellulitis

Clinical Presentation:  Erythema, warmth, and tenderness of skin.. Impetigo is characterized by a vesiculopapular rash with honey-colored discharge..

Diagnostic Considerations:  Primarily a clinical diagnosis. . Group A streptococci is the primary pathogens in healthy children.. Cellulitis, alone without a pustular component, is caused by streptococci (not staphylococci)..

Pitfalls:  Differential diagnosis of cellulitis may include hypersensitivity to insect bites.. Herpetic ­whitlow (HSV) may be mistaken for a bacterial skin or paronychial infection..

Therapeutic Considerations:  First generation cephalosporin or semi-synthetic penicillin with antistaphylococcal activity (i..e.., dicloxacillin, nafcillin, oxacillin) are drugs of choice.. Increasing incidence of community-acquired MRSA may affect treatment decisions..

Prognosis:  Excellent.. Impetigo may only require topical treatment (Mupirocin)..

Bite Wounds

Clinical Presentation:  80% of animal bite wounds in children are from dogs, and 15%–50% of dog bites become infected.. More than 50% of cat bites become infected, and due to their long teeth, there is an increased risk of inoculation into bone/joints with development of osteomyelitis/septic arthritis.. Human bite wounds are most prone to infection, and 75%–90% of all human bites become infected..

Diagnostic Considerations:  Clinical diagnosis.. Culture of wound exudate may yield organism.. Pitfalls:  Failure to assess depth of infection, especially with cat bites, may result in late identification of bone/joint infection.. Macrolides are ineffective against P.. multocida..

Therapeutic Considerations:  It is important to cover oral anaerobes, S.. aureus, and Group A streptococci in human bite wounds. . P. . multocida is an important pathogen in cat and dog bite wounds. . Facial/hand lesions require plastic surgery evaluation.. Recurrent debridement may be necessary, especially with human bite wound infections of hand.. Assess tetanus immunization status for all bite wounds

Chapter 7.  Pediatric Infectious Diseases and Pediatric Drug Summaries

413

(p.. 377).. For human bites consider the risk of HIV and hepatitis B.. For dog bites consider the risk of rabies.. Antimicrobial therapy initiated within 8 hours of a bite wound and administered for 2–3 days may decrease the rate of infection..

Prognosis:  Good with early debridement and antibiotics..

Cat Scratch Disease (CSD)

Clinical Presentation:  Classic presentation is a papular lesion at site of cat scratch with lymphadenitis in the draining region (axillary, epitrochlear, inguinal, cervical most commonly). . Frequently associated with fever/malaise 1–2 weeks after scratch.. Infection can present with conjunctivitis and ipsilateral preauricular lymph node (Parinaud oculoglandular syndrome).. Unusual presentations in normal hosts include encephalitis, hepatitis, microabscesses in liver/spleen, fever of unknown origin, osteolytic lesions..

Diagnostic Considerations:  Most often secondary to kitten scratch with Bartonella henselae. . Diagnosed using specific serology for antibodies to B.. henselae..

Pitfalls:  Failure to obtain history of kitten exposure.. Surgical excision of lymph node is generally not necessary..

Therapeutic Considerations:  Most lesions are self-limited and resolve over 2–4 months. . If lymph nodes are fluctuant, I&D may be indicated.. Antibiotic therapy may be helpful in severe cases with hepatosplenomegaly.. Doxycycline, erythromycin, or azithromycin are helpful in immunocompromised hosts.. Prognosis:  Very good with spontaneous resolution over 2–4 months..

Chicken Pox/Shingles (VZV)

Clinical Presentation:  Primary illness is chicken pox, a generalized pruritic, vesicular rash with fever that erupts in crops of lesions over 3–5 days followed by crusting and recovery.. Complications include bacterial superinfection of skin lesions, sepsis, cerebellar ataxia, thrombocytopenia, hepatitis, pneumonia and encephalitis.. The disease tends to be more severe in adolescents and adults, particularly if immunocompromised.. Primary infection early in pregnancy can rarely result in varicella embryopathy with imb atrophy and CNS malformations in the neonate.. Reactivation disease (shingles) may occur in children and in normal hosts and remains localized to a single dermatome.. Post-herpetic neuralgia occurs less often in children than adults.. Reactivation disease in immunocompromised hosts can spread and re-disseminate..

Diagnostic Considerations:  The characteristic eruption of chicken pox occurs in waves—multi- ple stages appear at the same time, from new papules and vesicles to more advanced larger crusted lesions—and is unique to varicella.. Direct fluorescent antibody staining of a scraped lesion or PCR can confirm the diagnosis..

Pitfalls:  Initially lesions may be primarily papular, and if the diagnosis is not considered, exposure of others can occur..

Therapeutic Considerations:  Antiviral therapy with acyclovir, if started within 24 hours of rash, should be considered for children > 12 years of age, those on steroid or salicylate therapy, and those with underlying chronic pulmonary, skin, or immunosuppressive states.. Oral administration is acceptable, although IV therapy may be preferred for immunocompromised hosts at risk of disseminated disease.. More severe varicella has been observed in individuals acquiring the infection from a household contact, presumably due to a higher inoculum with closer contact; non-immune household contacts may be considered for acyclovir therapy at onset of rash in child.. Additionally,

414	A n t i b i o t i c E s s e n t i a l s

individuals ≥ 13 years may develop more extensive varicella than younger children.. Immunocompromised children or pregnant women without a history of varicella or immunization may benefit from prophylaxis with varicella zoster immune globulin (VZIG) within 96 hours of varicella exposure.. Newborns whose mothers develop chicken pox within 5 days before or 48 hours after delivery and exposed premature infants are also candidates for VZIG.. A like-attenuated varicella vaccine has been licensed since 1995 for use in individuals ≥ 12 months of age who have not had chicken pox.. A twodose vaccine schedule is recommended for children ≥ 12 months of age..

Prognosis:  Overall prognosis is good with complete recovery and minimal risk of scarring unless immunosuppressed host with disseminated disease. . Although rare, Group A streptococcal toxic shock syndrome (manifest as cellulitis or in conjunction with necrotizing fasciitis complicating varicella skin lesions) and Group A streptococcal septicemia, which can occur in the absence of apparent secondarily infected skin lesions, may be fatal complications of varicella in normal children..

Common Pediatric Antimicrobial Drugs

Drug	Dosage in Neonates	Dosage in Infants/Children*
Acyclovir	20 mg/kg (IV) q8h × 14–21 days..	HSV encephalitis: 10 mg/kg (IV) q8h ×
	Dosing interval may need to be	14–21 days
	increased for infants < 34 weeks	Primary HSV infection: 10–20 mg/kg (PO)
	post-maturational age (GA + CA) or if	q6h × 5–10 days or 5 mg/kg/dose (IV)
	significant renal impairment or liver	q8h × 5 days
	failure followed by	Varicella in immunocompromised hosts:
	Chronic suppression: 75 mg/kg	10 mg/kg (IV) q8h × 7–10 days
	(PO) q12h × 6 months	Varicella in immunocompetent hosts:
		20 mg/kg (PO) q6h × 5 days (maximum
		800 mg/dose)
Albendazole	Not applicable	400 mg (PO) q24h
Amikacin**	During first week of life dosing is based	5–7..5 mg/kg (IV or IM) q8h
	on gestational age (administer IV dose

over 30 min)

•≤ 27 weeks (or asphyxia, PDA, or indomethacin): 18 mg/kg (IV) q48h

•28–30 weeks: 18 mg/kg (IV) q36h

•31–33 weeks: 16 mg/kg (IV) q36h

•≥34weeks:15mg/kg(IV)q24h

	Chapter 7.  Pediatric Infectious Diseases and Pediatric Drug Summaries		415
Drug	Dosage in Neonates	Dosage in Infants/Children*

After first week of life: Initial dose of 15 mg/kg, then draw serum

concentrations 30 min after end of infusion (peak) and 12–24 hours later (trough) to determine dosing interval.. Aim for peak of 20–30 mcg/mL and trough of 2–5 mcg/mL

Amoxicillin	Not indicated			22..5–45 mg/kg (PO) q12h
Amoxicillin-	Not indicated			22..5–45 mg/kg (of amoxicillin
clavulanate				component) (PO) q12h
Amphotericin B	0..5–1 mg/kg (IV over 2–6 hours) q24-48h (Some authorities recommend an initial
(conventional)	test dose of 0..1–0..5 mg/kg IV over 2–6 hours)
Ampicillin	25–50 mg/kg/dose (IV or IM)..			25–50 mg/kg (IV or IM) q6h
	Severe Group B streptococcal sepsis:
	100 mg/kg/dose.. Dosing interval is
	based on gestational age (GA) and
	chronological age (CA):
	GA + CA	CA (days)	Interval
	(weeks)		(hours)
	≤ 29	0–28	12
		> 28	8
	30–36	0–14	12
		> 14	8
	≥ 37	0–7	12
		> 7	8
Ampicillin-	Not indicated			25–50 mg/kg (of ampicillin component)
sulbactam				(IV) q6h
Azithromycin	Not indicated			Otitis media/sinusitis: 30 mg/kg (PO) × 1
				dose or 10 mg/kg (PO) q24h × 3 days or
				10 mg/kg (PO) on day 1 followed by 5 mg/
				kg (PO) q24h on days 2–5
				Pharyngitis/tonsillitis: 12 mg/kg (PO)
				q24h × 5 days

*Dosages are generally based on weight (mg/kg), up to adult dose as maximum..

**Drug can be given IM but absorption may be variable..

416	A n t i b i o t i c E s s e n t i a l s
Drug	Dosage in Neonates	Dosage in Infants/Children*
		Community-acquired pneumonia (not
		indicated for moderate or severe disease):
		10 mg/kg (PO) × 5 days or 10 mg/kg (IV
		or PO) on day 1 followed by 5 mg/kg (IV
		or PO) q24h on days 2–5
		Skin/soft tissue infections (including Cat
		Scratch Disease): 10 mg/kg (PO) on day
		1 followed by 5 mg/kg (PO) q24h on
		days 2–5
Aztreonam	30 mg/kg (IV or IM).. See ampicillin for	30 mg/kg (IV or IM) q6-8h
	dosing interval (p.. 415)
Caspofungin	70 mg/m2 loading dose, then	70 mg/m2 loading dose, then
	25 mg/m2 (IV) q24h	50 mg/m2 (IV) q24h (> 3 months)
Cefadroxil	Not indicated	15 mg/kg (PO) q12h
Cefazolin	25 mg/kg (IV or IM).. See ampicillin for	25–100 mg/kg/day (IV or IM) divided
	dosing interval (p.. 415)	q6–q8h
Cefdinir	Not indicated	7 mg/kg (PO) q12h or 14 mg/kg (PO)
		q24h
Cefepime	50 mg/kg (IV) q12h	33..3–50 mg/kg (IV or IM) q8h
Cefotaxime	50 mg/kg (IV or IM)..	25–50 mg/kg (IV or IM) q6–8h
	(25 mg/kg/dose is adequate for
	gonococcal infection).. See ampicillin
	for dosing interval (p.. 415)
Cefotetan	Not indicated	20–40 mg/kg (IV or IM) q12h
Cefoxitin	25–33 mg/kg/dose (IV or IM).. See	80–160 mg/kg/day (IV or IM) divided
	ampicillin for dosing interval (p.. 415)	q4–8h
Cefpodoxime	Not indicated	5 mg/kg (PO) q12h
Cefprozil	Not indicated	15 mg/kg (PO) q12h
Ceftazidime	30 mg/kg/dose (IV or IM).. See	25–50 mg/kg (IV or IM) q8h
	ampicillin for dosing interval (p.. 415)
Ceftibuten	Not indicated	9 mg/kg (PO) q24h
Ceftizoxime	Not indicated	50 mg/kg (IV or IM) q6–8h

*Dosages are generally based on weight (mg/kg), up to adult dose as maximum..

	Chapter 7.  Pediatric Infectious Diseases and Pediatric Drug Summaries						417
Drug	Dosage in Neonates					Dosage in Infants/Children*
Ceftriaxone‡	Sepsis and disseminated gonococcal					50 mg/kg (IV or IM) q24h.. Meningitis: 50
	infection: 50 mg/kg (IV or IM) q24h					mg/kg (IV or IM) q12h or 100 mg/kg (IV
	Meningitis: 100 mg/kg loading dose					or IM) q24h
	followed by 80 mg/kg (IV or IM) q24h					Acute otitis media: 50 mg/kg (IM) × 1
	Uncomplicated gonococcal					dose (or 3 doses IM q24h in high-risk
	ophthalmia:					patients)
	50 mg/kg (maximum 125 mg) as a
	single dose (IV or IM)
Cefuroxime	Not indicated					10–15 mg/kg (PO) q12h
						25–50 mg/kg (IV or IM) q8h
Cephalexin	Not indicated					6..25–25 mg/kg (PO) q6h
Cephalothin	Not indicated					25 mg/kg (IV or IM) q4-6h
Clarithromycin	Not indicated					7..5 mg/kg (PO) q12h
Clindamycin	5..0–7..5 mg (IV or PO).. Dosing interval					5–10 mg/kg (IV or IM) q6-8h or 10–30
	is based on gestational age (GA) and					mg/kg/day (PO) divided q6-8h
	chronological age (CA)
	GA + CA		CA (days)		Interval
	(weeks)				(hours)
	< 29		0–28		12
			> 28		8
	30–36		0–14		12
			> 14		8
	37–44		0–7		8
			> 7		6
Dicloxacillin	Not indicated					6..25–12..5 mg/kg (PO) q6h
Doxycycline	Contraindicated					> 45 kg: 100 mg (PO) q12h
						≤ 45 kg: 1..1–2..5 mg/kg (PO) q12h
						Use only in children > 8 years (unless
						RMSF)
						1–2 mg/kg (IV) q12–24h

* Dosages are generally based on weight (mg/kg), up to adult dose as maximum..

‡Do not use in presence of hyperbilirubinemia..

418			A n t i b i o t i c E s s e n t i a l s
Drug	Dosage in Neonates				Dosage in Infants/Children*
Erythromycin	Chlamydia pneumonitis/conjunctivitis				10–12..5 mg/kg (PO) q6–8h
	or pertussis: 12..5 mg/kg (PO) q6h (E..				5–12..5 mg/kg (IV) q6h
	estolate preferred)
	Other infections: E.. estolate 10 mg/kg
	(PO) q8h or E.. ethylsuccinate 10 mg/
	kg (PO) q6h
	Severe infections and PO not possible:
	5–10 mg/kg (IV over ≥ 60 min) q6h
Ertapenem	Not indicated				15 mg/kg (IV) q12h (not to exceed 1 gm/
					day)
Ethambutol	See p.. 401				See p.. 401
Ethionamide	See p.. 401				See p.. 401
Fluconazole	Systemic infection or meningitis: 12				10 mg/kg (IV or PO) loading dose
	mg/kg (IV over 30 min or PO) × 1 dose,				followed by 12 mg/kg (IV or PO) q24h
	then 6 mg/kg/dose (IV or PO) with
	dosing interval based on gestational
	age (GA) and chronological age (CA)
	(below)
	Prophylaxis (e..g.., extremely low birth
	weight infants in NICU with high rates
	of fungal disease): 3 mg/kg/dose (IV
	or PO) according to dosing interval
	grid (below)
	Thrush: 6 mg/kg (PO) × 1 dose, then 3
	mg/kg (PO) q24h
	GA + CA		CA (days)	Interval
	(weeks)			(weeks)
	≤ 29		0–14	72
			> 14	48
	30–36		0–14	48
			> 14	24
	37–44		0–7	48
			> 7	24

*Dosages are generally based on weight (mg/kg), up to adult dose as maximum..

	Chapter 7.  Pediatric Infectious Diseases and Pediatric Drug Summaries			419
Drug		Dosage in Neonates	Dosage in Infants/Children*
Gentamicin**	During first week of life dosing is based		2–2..5 mg/kg (IV or IM) q8h
	on gestational age (administer IV dose		or
	over 30 min):		4..5–7..5 mg/kg (IV) q24h
	•	≤ 29 weeks (or asphyxia, PDA, or
	•	indomethacin): 5 mg/kg (IV) q48h
		30–33 weeks: 4..5 mg/kg (IV) q48h
	•	34–37 weeks: 4 mg/kg (IV) q36h
	•	≥ 38 weeks: 4 mg/kg (IV) q24h

After first week of life: Initial dose of 4 mg/kg, then draw serum

concentrations 30 min after end of infusion (peak) and 12–24 hours later (trough) to determine dosing interval.. Aim for peak of 5–12 mcg/mL and trough of 0..5–1 mcg/mL

Imipenem	20–25 mg/kg (IV) q12h	15–25 mg/kg (IV or IM) q6h
Iodoquinol	No information	10–13..3 mg/kg (PO) q8h
Isoniazid	See p.. 401	See p.. 401
Linezolid	10 mg/kg (IV) q12h	10 mg/kg (IV) q8h
Liposomal/	1–5 mg/kg (IV over 2 hours) q24h	3–6 mg/kg (IV) q24h
lipid complex
Amphotericin
preparations
Meropenem	20 mg/kg (IV) q12h	10 mg/kg (IV) q8h (skin); 20 mg/kg (IV)
		q8h (intraabdominal); 40 mg/kg (IV) q8h
		(meningitis)
Methenamine	Not indicated	15–25 mg (PO) q6–8h
mandelate
Metronidazole	15 mg/kg (IV or PO) × 1 dose, then 7..5	5–12..5 mg/kg (PO) q8h
	mg/kg/dose (IV or PO) with dosing	15 mg/kg (IV) × 1 dose followed by
	interval based on gestational age (GA)	7..5 mg/kg (IV) q6h
	and chronological age (CA):

*Dosages are generally based on weight (mg/kg), up to adult dose as maximum..

**Drug can be given IM but absorption may be variable..

420		A n t i b i o t i c E s s e n t i a l s
Drug	Dosage in Neonates				Dosage in Infants/Children*
	GA + CA	CA (days)		Interval
	(weeks)			(hours)
	≤ 29	0–28		24
		> 28		48
	30–36	0–14		24
		> 14		12
	37–44	0–7		24
		> 7		12
Micafungin	10 mg/kg (IV) of q24h				4–12 mg/kg (IV) q24 (higher dose for
					patients < 8 year of age
Mupirocin	Not indicated				Nasal cream: ½ of single use tube into
					nostril q12h × 5 days;
					Cream: apply q8h × 5–10 days
Nafcillin	25–50 mg/kg/dose (IV).. See ampicillin				12..5–50 mg/kg (IV or IM) q6h
	for dosing interval (p.. 415)
Nitazoxanide	Not applicable				Children 1–3 years old: 100 mg (PO)
					q12h; children 4–11 years old: 200 mg
					(PO) q12h
Nitrofurantoin	Not indicated				UTI: 1..25–1..75 mg/kg (PO) q6h
					UTI prophylaxis: 1–2 mg/kg (PO) q24h
Nystatin	Oral: 1 mL (preterm) to 2 mL (term) of				Suspension: 4–6 mL swish and swallow
	100,000 U/mL suspension applied with				4×/day
	swab to each side of mouth q6h until 3				Troche: 1–2 troches 4–5×/ day
	days after resolution of lesions
	Topical: Apply ointment or cream to
	affected area q6h until 3 days after
	resolution of lesions..
Oxacillin	25–50 mg/kg/dose (IV).. See ampicillin				25–50 mg/kg (IV or IM) q6h
	for dosing interval (p.. 415)
Paromomycin	Not applicable				10 mg/kg (PO) q8h
Penicillin G	25,000–50,000 IU/kg/dose (IV).. See				12,500–75,000 U/kg (IV or IM) q4–6h
	ampicillin for dosing interval (p.. 415)
	Meningitis: 75,000–100,000 IU/kg

*Dosages are generally based on weight (mg/kg), up to adult dose as maximum..

	Chapter 7.  Pediatric Infectious Diseases and Pediatric Drug Summaries		421
Drug	Dosage in Neonates	Dosage in Infants/Children*
	(IV) in meningitis (IV)..† Q8–12h based
	on GA + CA, See ampicillin for dosing
	interval (p.. 415).. Crystalline penicillin G:
	IM: procaine penicillin G q24 hours..
	Congenital syphilis: Aqueous penicillin
	G 50,000 IU/kg (slow IV push) q12h ×7
	days, then q8h to complete 10–14 days
	or procaine penicillin G 50,000 IU/kg
	(IM) q24h ×10–14 days
Penicillin V	Not indicated	6..25–12..5 mg/kg (PO) q6-8h
Piperacillin	50–100 mg/kg/dose (IV or IM)..	25–75 mg/kg (IV or IM) q6h; may increase
	See ampicillin for dosing interval (p..	to q4h in severe infection, especially with
	415)	pseudomonas
Piperacillin-	Not indicated	100–300 mg/kg/day (IV) (of piperacillin
tazobactam		component) divided q6-8h
Pyrazinamide	See p.. 401	See p.. 401
Quinupristin/	No information	7..5 mg/kg (IV) q12h
dalfopristin
Rifampin	10–20 mg/kg (PO) q24h or 5–10 mg/	20 mg/kg (PO) q24h or 10 mg/kg (PO)
	kg (IV) q24h	q12h
		10–20 mg/kg/day (IV) divided q12–24h
Streptomycin	See p.. 401	See p.. 401
Sulfisoxazole	Contraindicated	30–35 mg/kg (PO) q6h
		Otitis media prophylaxis: 37..5 mg/kg
		(PO) q12h
Tetracycline	Contraindicated	5–12..5 mg/kg (PO) q6h.. Use only in
		children > 8 years
Ticarcillin	75–100 mg/kg/dose (IV).. See ampicillin	25–75 mg/kg (IV or IM) q6h
	for dosing interval (p.. 415)
Ticarcillin-	75–100 mg/kg/dose (of ticarcillin	25–75 mg/kg (of ticarcillin component)
clavulanate	component) (IV).. See ampicillin for	(IV or IM) q6h
	dosing interval (p.. 415)
Tinidazole	Not applicable	50–60 mg/kg (PO) q24h
Tobramycin	Same as gentamicin (p.. 419)	2–2..5 mg/kg (IV or IM) q8h or 4..5–7..5 mg/
		kg (IV) of q24h

*Dosages are generally based on weight (mg/kg), up to adult dose as maximum..

422		A n t i b i o t i c		E s s e n t i a l s
Drug	Dosage in Neonates				Dosage in Infants/Children*
Trimethoprim-	Contraindicated				UTI: 4–5 mg/kg (of trimethoprim
sulfameth-					component) (PO) q12h
oxazole					Pneumocystis carinii pneumonia (PCP)
(TMP–SMX)					5 mg/kg (PO) q6h (typically after initial
					IV therapy)
					UTI prophylaxis: 2–4 mg/kg (PO) q24h
					IV dosing
					PCP or severe infection: 5 mg/kg (of
					trimethoprim component) (IV) q6h
					Minor infections: 4–6 mg/kg (of
					trimethoprim component) (IV) q12h
Vancomycin	Bacteremia: 10 mg/kg/dose (IV)				10–20 mg/kg (IV) q6h
	Meningitis: 15 mg/kg/dose (IV)..
	Administer IV dose over 60 min..
	Dosing interval is based on gestational
	age (GA) and chronological age (CA):
	GA + CA	CA (days)	Interval
	(weeks)		(weeks)
	≤ 29	0–14	18
		> 14	12
	30–36	0–14	12
		> 14	8
	37–44	0–7	12
		> 7	8
Voriconazole	Not applicable				7 mg/kg (IV) q12h
					8 mg/kg (PO) q12h × 1 day, then 7 mg/
					kg (PO) q12h

*Dosages are generally based on weight (mg/kg), up to adult dose as maximum..