Antibiotics Review _ __________________________________________________________________________
THE PENICILLINS
Agent
Adult Dosing Range
Pediatric Dosing Range
Route
Common Side Effects
Comments
Natural Penicillins Penicillin G benzathine
1.2–2.4 MU
50,000 U/kg in one dose Max: 2.4 MU divided between 2 injection sites
IM Rash, GI upset
Indicated for syphilis and group A strep infections. Note: Do not administer IV (except parenteral/aqueous preparation) or IM near nerve or artery. Cardiopulmonary arrest and death have occurred from accidental IV administration.
Penicillin G benzathine or penicillin G procaine
2.4 MU in one dose <14 kg: O.6 MU
IM Rash, GI upset
14 to 27 kg: 1.2 MU in one dose 100,000–400,000 U/ kg/day in divided doses every 4 to 6 hours Max: 24 MU/day Pneumonia (off label): 50–75 mg/kg/day in 3 to 4 divided doses Pharyngitis: 250 mg 2 to 3 times per day Manufacturer recommendation: >3 months and <40 kg: 20–100 mg/ kg/day in divided doses every 8 to 12 hrs ≤3 months: 20–30 mg/kg/day divided every 12 hrs AAP recommendation: All infants and children <40 kg: 25–50 mg/kg/day in divided doses every 8 hrs 15–40 mg/kg/day divided every 8 hrs, or 25–45 mg/kg/day divided every 12 hrs Max: 4g/day <3 mos: 30 mg/kg/day every 12 hrs (125 mg/5 mL suspension only) PO: 50–100 mg/kg/ day in 4 divided doses Max: 2–4 g/day IV, IM: 25–200 mg/ kg/day every 3 to 4 hrs Max: 12 g/day
Penicillin G (parenteral/ aqueous)
2–30 MU per day
IM, IV Rash, GI upset
PO
Rash, GI upset
––
Penicillin V potassium
125–500 mg every 6 to 8 hours
Aminopenicillins Amoxicillin
PO
Rash, diarrhea
Not to be confused with amoxicillin/clavulanate ES formulation. Extended-release tablet 775 mg once daily for adults and children ≥12 years of age
250–500 mg every 8 hrs, or 500–875 mg twice daily
250–500 mg every 8 hrs, or 875 mg every 12 hrs
PO
Rash, diarrhea
Dosing for amoxicillin/ clavulanate is based on the amoxicillin component; the ES formulation of amoxicillin/clavulanate is not interchangeable with the regular suspension and requires product specific dosing. The IV form can be given in divided doses or in a continuous infusion.
Amoxicillin/ clavulanate
PO, IV, IM Rash, GI symptoms
Ampicillin
250–500 mg every 6 hrs
(very common)
Table 1 continues on next page.
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