Recommended Dosages of Selected Parenteral Antibiotics for Neonates
Intervals of Administration | |||||||
|---|---|---|---|---|---|---|---|
Antibiotic | Route of Administration | Individual Dose | Body Weight ≤ 2000 g | Body Weight > 2000 g | Comments | ||
Age | Age | ||||||
≤ 7 days | 8–28 days | ≤ 7 days | 8–28 days | ||||
see Table: Recommended Dosages of Select Aminoglycosides for Neonates) | — | — | — | — | — | — | — |
IV | 1 mg/kg | Every 24 hours | Every 24 hours | Every 24 hours | Every 24 hours | After dilution in 5% or 10% D/W (saline solution should not be used), infusion of a test dose of 0.1 mg/kg (maximum 1 mg) over 1 hour to assess patient’s febrile and hemodynamic response;* if no serious adverse effects are observed, infusion of a therapeutic dose (usually 0.25–1.5 mg/kg over 2–6 hours), which may be given the same day as the test dose After the patient improves, may give the dose every other day until therapy is complete Monitoring of potassium levels and hematologic and renal functions required | |
IV | 5 mg/kg | Every 24 hours | Every 24 hours | Every 24 hours | Every 24 hours | — | |
IV | 5 mg/kg | Every 24 hours | Every 24 hours | Every 24 hours | Every 24 hours | — | |
IV, IM | 50–75 mg/kg | 50 mg/kg every 12 hours | 75 mg/kg every 12 hours | 50 mg/kg every 8 hours | 50 mg/kg every 8 hours | IV as 15- to 30-minute infusion (≤ 10 mg/kg/minute) | |
For GBS meningitis | IV | 75–100 mg/kg | 100 mg/kg every 8 hours | 75 mg/kg every 6 hours | 100 mg/kg every 8 hours | 75 mg/kg every 6 hours | |
IV | 10 mg/kg | Every 24 hours | Every 24 hours | Every 24 hours | Every 24 hours | For chlamydial pneumonia, 20 mg/kg every 24 hours | |
IV, IM | 25 mg/kg | Every 12 hours | Every 8 hours† | Every 12 hours | Every 8 hours | Limited data No primary indication; not used as initial therapy for sepsis or meningitis | |
IV, IM | 30–50 mg/kg | 30 mg/kg every 12 hours | 30 mg/kg every 12 hours | 50 mg/kg every 12 hours | 50 mg/kg every 12 hours | May be used for Pseudomonas aeruginosa infections (consider using 50 mg/kg every 8 hours for P. aeruginosa and other serious gram-negative pathogens) Sometimes used for meningitis, although usually as a 2nd-line drug and not always recommended | |
IV, IM | 50 mg/kg | Every 12 hours | Every 8 hours† | Every 12 hours | Every 8 hours | Often a first-line therapy for neonatal meningitis | |
IV, IM | 33–35 mg/kg | 35 mg/kg every 12 hours | 33 mg/kg every 8 hours† | 33 mg/kg every 8 hours | 33 mg/kg every 8 hours | — | |
IV, IM | 50 mg/kg | Every 12 hours | Every 8 hours† | Every 12 hours | Every 8 hours | Penetrates well into inflamed meninges 70–90% of drug excreted unchanged in urine | |
IV, IM | 50 mg/kg | — | — | Every 24 hours | Every 24 hours | Limited data Contraindicated in neonates receiving or expected to receive infusions of calcium-containing solutions 2nd-line drug for meningitis, after the first week of life (40–50 mg/kg every 12 hours or 80–100 mg/kg every 24 hours) | |
IV, IM | 50 mg/kg | Every 12 hours | Every 8 hours† | Every 12 hours | Every 8 hours | — | |
— | |||||||
For treatment | IV | 12 mg/kg | Every 24 hours | Every 24 hours | Every 24 hours | Every 24 hours | Loading dose of 25 mg/kg followed 24 hours later by maintenance dose listed |
For prophylaxis | IV | 6 mg/kg | Twice weekly | Twice weekly | Twice weekly | Twice weekly | |
see Table: Recommended Dosages of Select Aminoglycosides for Neonates) | — | — | — | — | — | — | — |
— | |||||||
For meningitis | IV | 40 mg/kg | Every 12 hours | Every 8 hours§ | Every 8 hours | Every 8 hours | |
For sepsis, intra-abdominal infection§ | IV | 20–30 mg/kg | 20 mg/kg every 12 hours | 20 mg/kg every 8 hours§ | 20 mg/kg every 8 hours | 30 mg/kg every 8 hours | |
— | |||||||
For meningitis | IV, IM | 50 mg/kg | Every 12 hours | Every 8 hours† | Every 8 hours | Every 6 hours | Monitoring of CBC and liver tests required Excretion may be decreased due to renal and hepatic immaturity, leading to possible accumulation in serum, which may have adverse effects |
For other diseases | IV, IM | 25 mg/kg | Every 12 hours | Every 8 hours† | Every 8 hours | Every 6 hours | |
— | — | — | — | — | — | — | |
IM | 50,000 units/kg | Every 24 hours | Every 24 hours | Every 24 hours | Every 24 hours | — | |
— | |||||||
For congenital syphilis, other indications | IV | 50,000 units/kg | Every 12 hours | Every 8 hours | Every 12 hours | Every 8 hours | |
For GBS meningitis | IV | 100,000 units/kg | Every 6 hours | Every 6 hours | Every 6 hours | Every 6 hours | |
IM | 50,000 units/kg | Every 24 hours | Every 24 hours | Every 24 hours | Every 24 hours | CAUTION: Sterile abscess and procaine toxicity | |
IV (dose based on piperacillin component) | 80–100 mg/kg | 100 mg/kg every 8 hours | 80 mg/kg every 6 hours║ | 80 mg/kg every 6 hours | 80 mg/kg every 6 hours | — | |
IV | 10 mg/kg | Every 24 hours | Every 24 hours | Every 24 hours | Every 24 hours | ||
see Table: Recommended Dosages of Select Aminoglycosides for Neonates) | — | — | — | — | — | — | — |
— | — | — | — | — | — | ||
† Use the dose for age ≤ 7 days until 14 days of age if the birth weight is < 1000 g. | |||||||
§ Adjust dosage after 14 days of age instead of after 7 days of age. | |||||||
║ When postmenstrual age reaches > 30 weeks. | |||||||
CBC = complete blood count; GBS = group B streptococcus. | |||||||
Adapted from Bradley JS, Nelson JD: Nelson's Pediatric Antimicrobial Therapy, ed. 24. Itasca, American Academy of Pediatrics, 2018. | |||||||