___________________________________________________________________________ Antibiotics Review
THE PENICILLINS (Continued)
Agent
Adult Dosing Range
Pediatric Dosing Range
Route
Common Side Effects
Comments
Ampicillin/ sulbactam
1.5–3 g every 6 hrs IV
≥1 year: IV: 100–400 mg/kg/day every 6 hrs Max: 8 g/day
IV, IM Rash, diarrhea, local pain at injection or infusion site (very common with IM use)
Dosing for ampicillin/ sulbactam is based on the ampicillin component.
Penicillinase-Resistant Penicillins Dicloxacillin 125–500 mg every 6 hrs
<40 kg: 12.5–100 mg/kg/day in 4 doses divided every 6 hrs >40 kg: 125–250 mg every 6 hrs Neonates: 50 mg/kg/ day in 4 divided doses Children: IV: 50–200 mg/kg/day in 4 divided doses IM: 25 mg/kg every 12 hrs <40 kg: 50–100 mg/ kg/day in divided doses every 6 hrs
PO
Rash, diarrhea
Use with caution in neonates, as elimination of drug is slow.
Nafcillin
IV: 0.5–2 g every 4 to 6 hrs IM: 0.5 g every 4 to 6 hrs
IV, IM Phlebitis at IV site, neutropenia, rash
Tissue necrosis can occur with IV extravasation.
Oxacillin
0.25–2 g every 4 to 6 hrs
IV, IM Phlebitis at IV site, hepatitis, rash
Drug-induced hepatitis is usually reversible if drug is discontinued. Neonatal dosing may require the use of alternate container system/ dosage forms. May contain a significant amount of sodium.
>40 kg: 250–1,000 mg every 4 to 6 hrs
Antipseudomonal Penicillins Piperacillin
IV, IM: 3–4 g every 4 to 6 hrs Max: 24 g/day
Neonates: IV, IM: 100 mg/kg every 12 hrs Infants/children: IV, IM: 200–300 mg/kg/day divided every 4 to 6 hrs Infants 2 to 9 months: 80 mg piperacillin/kg/ dose every 8 hrs Infants and children >9 months: 100 mg piperacillin/kg/dose
IV, IM Rash, GI upset, phlebitis at infusion site
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Piperacillin/ tazobactam
IV: 3.375–4.5 every 6 to 8 hrs Max: 18 g/day
IV
Rash, GI upset
Dosing for adults and pediatrics based on traditional infusion method (IV infusion over 30 minutes). Dosage in pediatric patients based on piperacillin component. Pediatric dose is mg/kg/dose, not mg/kg/day. Potential warfarin interaction. Ticarcillin/clavulanate doses are based on the ticarcillin component.
Ticarcillin or ticarcillin/ clavulanate potassium
<60 kg: 200–300 mg/kg/day divided every 4 to 6 hrs >60 kg: 3.1 g every 4 to 6 hrs Max: 18 g/day
Use adult dosing by weight
IV
Rash, GI upset
Prescribing information is given for comparison purposes only. The higher dosage ranges reflect dosages for more severe infections. Please consult the manufacturer’s package insert for the antibiotic for complete prescribing information, maximum dosages, and indications. AAP = American Academy of Pediatrics; MU = million units; ES = extra strength. Source: [6; 16] Table 1
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