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* Children: 15-25 mg/kg/24 hr divided q 8-12 hr IV or IM
* Children: 15-25 mg/kg/24 hr divided q 8-12 hr IV or IM
* Adults: 15 mg/kg 24 hr divided q 8-12 hr IV or IM
* Adults: 15 mg/kg 24 hr divided q 8-12 hr IV or IM
| Ototoxicity and nephrotoxicity
|  
* Ototoxicity
* Nephrotoxicity
|-
|-
| '''Amoxicillin'''
| '''Amoxicillin'''

Revision as of 02:01, 3 June 2015

Antibiotic Antimicrobial Spectrum Dosing Information Adverse Reaction
Amikacin
  • Escherichia coli
  • Klebsiella
  • Proteus
  • Enterobacter
  • Serratia
  • Pseudomonas
  • Neonates (postnatal age ≤ 7 days): 7.5 mg/kg q 12-18 hr IV or IM (≤ 2,000 g); 10 mg/kg q 12 hr IV or IM (> 2,000 g)
  • Neonates (postnatal age > 7 days): 7.5 mg/kg q 8-12 hr IV or IM (≤ 2,000 g); 10 mg/kg q 8 hr IV or IM (> 2,000 g)
  • Children: 15-25 mg/kg/24 hr divided q 8-12 hr IV or IM
  • Adults: 15 mg/kg 24 hr divided q 8-12 hr IV or IM
  • Ototoxicity
  • Nephrotoxicity
Amoxicillin
  • Gram-positive pathogens except Staphylococcus
  • Salmonella
  • Shigella
  • Neisseria
  • E. coli
  • Proteus mirabilis
  • Children: 20-50 mg/kg/24 hr divided q 8-12 hr PO. Higher dose of 80-90 mg/kg 24 hr PO for otitis media
  • Adults: 250-500 mg q 8-12 hr PO
 Rash, diarrhea, abdominal cramping
Amoxicillin-clavulanate S. aureus (not methicillin-resistant organism), Streptococcus, Haemophilus influenzae, Moraxella catarrhalis, E. coli, Klebsiella, Bacteroides fragilis.
  • Neonates: 30 mg/kg/24 hr divided q 12 hr PO.
  • Children: 20-45 mg/kg 24 hr divided q 8-12 hr PO. Higher dose 80-90 mg/kg/24 hr PO for otitis media.
 Diarrhea, rash
Ampicillin Gram-positive pathogens except Staphylococcus; Salmonella, Shigella, Neisseria, E. coli, and Proteus mirabilis
  • Neonates (postnatal age ≤ 7 days): 50 mg/kg/24 hr IV or IM q 12 hr (≤ 2,000 g); 75 mg/kg/24 hr divided q 8 hr IV or IM (> 2,000 g)
  • Neonates (postnatal age > 7 days): 50 mg/kg/24 hr IV or IM q 12 hr (< 1,200 g); 75 mg/ kg/24 hr divided q 8 hr IV or IM (1,200 - 2,000 g); 100 mg/kg/24 hr divided q 6 hr IV or IM (> 2,000 g)
  • Children: 100-200 mg/kg/24 hr divided q 6 hr IV or IM
  • Adults: 250-500 mg q 4-8 hr IV or IM
 Diarrhea
Ampicillin-sulbactam S. aureus, H. influenzae, M. catarrhalis, E. coli, Klebsiella, B. fragilis.
  • Children: 100-200 mg/kg/24 hr divided q 4-8 hr IV or IM
  • Adults: 1-2 g q 6-8 hr IV or IM (max daily dose: 8 g)
 Diarrhea, rash

Azithromycin Zithromax. Tablet: 250 mg.

Suspension: 100 mg/5 mL, 200 mg/5 mL.

Azalide antibiotic with activity against S. aureus, Streptococcus,

H. influenzae, Mycoplasma, Legionella, Chlamydia trachomatis.

Children: 10 mg/kg PO on day 1 (max dose: 500 mg) followed by 5 mg/kg PO q 24 hr for 4 days.

Group A streptococcus pharyngitis: 12 mg/kg/24 hr PO (max dose: 500 mg) for 5 days.

Adults: 500 mg PO day 1 followed by 250 mg for 4 days. Uncomplicated C. trachomatis infection: single 1 g dose PO.

Note: Very long half-life permitting once-daily dosing. No metabolic-based drug interactions (unlike erythromycin and clarithromycin), limited gastrointestinal distress. Shorter- course regimens (e.g., 1-3 days) under investigation. 3-day, therapy (10 mg/kg/24 hr

3 days) and single-dose therapy (30 mg/ kg): use with increasing frequency (not for streptococcus pharyngitis).

Aztreonam

Azactam.

β-lactam (monobactam) antibiotic with activity against gram-negative aerobic bacteria, Enterobacteriaceae, and Pseudomonas aeruginosa.

Cautions: Rash, thrombophlebitis, eosinophilia. Renally eliminated.

Drug interaction: Probenecid.

Injection.

Neonates: Postnatal age ≤7 days ≤2,000 g: 60 mg/kg/24 hr divided q 12 hr IV or IM; 2,000 g: 90 mg/kg/24 hr divided q 8 hr IV or IM; postnatal age 7 days 1,200 g: 60 mg/kg/24 hr divided q 12 hr IV or IM; 1,200-2,000 g: 90 mg/kg/24 hr divided q 8 hr IV or IM;

2,000 g: 120 mg/kg/24 hr divided q 6-8 hr IV or IM.



Children: 90-120 mg/kg/24 hr divided q 6-8 hr IV or IM. For cystic fibrosis up to 200 mg/kg/24 hr IV.



Adults: 1-2 g IV or IM q 8-12 hr (max dose: 8 g/24 hr).

Carbenicillin Geopen Injection. Geocillin oral tablet.

Extended-spectrum penicillin (remains susceptible to penicillinase destruction) active against Enterobacter, indole-positive Proteus, and Pseudomonas.

Cautions: Painful given intramuscularly; rash; each gram contains 5.3 mEq sodium. Interferes with platelet aggregation at high doses, increases in liver transaminase levels. Renally eliminated. Oral tablet for treatment of urinary tract infection only.

Drug interaction: Probenecid.


Neonates: Postnatal age ≤7 days ≤2,000 g: 225 mg/kg/24 hr divided q 8 hr IV or IM; 2,000 g: 300 mg/kg/24 hr divided q 6 hr IV or IM;

7 days: 300-400 mg/kg/24 hr divided q 6 hr IV or IM.



Children: 400-600 mg/kg/24 hr divided q 4-6 hr IV or IM.


Cefaclor

Ceclor.

Capsule: 250, 500 mg.

2nd generation cephalosporin active against S. aureus, Streptococcus including S. pneumoniae, H. influenzae, E. coli, Klebsiella, and Proteus.

Cautions: -Lactam safety profile (rash, eosinophilia) with high incidence of serum sickness reaction. Renally eliminated.

Drug interaction: Probenecid.

Suspension: 125 mg/5 mL, 187 mg/5 mL, 250 mg/5 mL, 375 mg/5 mL.

Children: 20-40 mg/kg/24 hr divided q 8-12 hr PO (max dose: 2 g). Adults: 250-500 mg q 6-8 hr PO.


Cefadroxil

Duricef, Ultracef.

1st-generation cephalosporin active against S. aureus, Streptococcus, E. coli, Klebsiella, and Proteus.

Cautions: -Lactam safety profile (rash, eosinophilia). Renally eliminated. Long half-life permits q 12-24 hr dosing.

Capsule: 500 mg.

Children: 30 mg/kg/24 hr divided q 12 hr PO (max dose: 2 g).

Drug interaction: Probenecid.

Tablet: 1,000 mg.



Suspension: 125 mg/5 mL, 250 mg/5 mL, 500 mg/5 mL.

Adults: 250-500 mg q 8-12 hr PO.


Cefazolin

Ancef, Kefzol.

1st generation cephalosporin active against S. aureus, Streptococcus, E. coli, Klebsiella, and Proteus.

Caution: -Lactam safety profile (rash, eosinophilia). Renally eliminated. Does not adequately penetrate CNS.

Injection.

Neonates: Postnatal age ≤7 days 40 mg/kg/24 hr divided q 12 hr IV or IM; 7 days 40-60 mg/kg/24 hr divided q 8 hr IV or IM.

Drug interaction: Probenecid.


Children: 50-100 mg/kg/24 hr divided q 8 hr IV or IM.



Adults: 0.5-2g q 8 hr IV or IM (max dose: 12 g/24 hr).


Cefdinir Omnicef. Capsule: 300 mg.

Oral suspension: 125 mg/5 mL.

Extended-spectrum, semi-synthetic cephalosporin.

Children 6 mo-12 yr: 14 mg/kg/24 hr in 1 or 2 doses PO (max dose: 600 mg/24 hr).

Adults: 600 mg q 24 hr PO.

Cautions: Reduce dosage in renal insufficiency (creatinine clearance 60 mL/min). Avoid taking concurrently with iron-containing products and antacids because absorption is markedly decreased; take at least 2 hr apart.



Drug interaction: Probenecid.

Cefepime Maxipime. Injection.

Expanded-spectrum, 4th generation cephalosporin active against many gram-positive and gram-negative pathogens, including Pseudomonas aeruginosa many multidrug-resistant pathogens.

Adverse events: Diarrhea, nausea, vaginal candidiasis

Cautions: -Lactam safety profile (rash, eosinophilia). Renally eliminated.


Children: 100-150 mg/kg/24 hr q 8-12 hr IV or IM.

Drug interaction: Probenecid.


Adults: 2-4 g/24 hr q 12 hr IV or IM.


Cefixime

Suprax.

Tablet: 200, 400 mg.

3rd generation cephalosporin active against Streptococci, H. influenzae, M. catarrhalis, Neisseria gonorrhoeae, Serratia marcescens, and P. vulgaris. No antistaphylococcal or antipseudomonal activity.

Cautions: -Lactam safety profile (rash, eosinophilia). Renally eliminated. Does not adequately penetrate CNS.

Drug interaction: Probenecid.

Suspension: 100 mg/5 mL.

Children: 8 mg/kg/24 hr divided q 12-24 hr PO.



Adults: 400 mg/24 hr divided q 12-24 hr PO.


Cefoperazone sodium

Cefobid. Injection.

3rd generation cephalosporin active against many gram-positive and gram-negative pathogens.

Neonates: 100 mg/kg/24 hr divided q 12 hr IV or IM. Children: 100-150 mg/kg/24 hr divided q 8-12 hr IV or IM.

Adults: 2-4 g/24 hr divided q 8-12 hr IV or IM (max dose: 12 g/24 hr).

Cautions: Highly protein bound cephalosporin with limited potency reflected by weak antipseudomonal activity. Variable gram- positive activity. Primarily hepatically eliminated in bile.

Drug interaction: Disulfiram-like reaction with alcohol.

Cefotaxime sodium

Claforan. Injection.

3rd generation cephalosporin active against gram-positive and gram-negative pathogens. No antipseudomonal activity.

Neonates: ≤7 days: 100 mg/kg/24 hr divided q 12 hr IV or IM; 7 days: 1,200 g 100 mg/kg/24 hr divided q 12 hr IV or IM;

12,000 g: 150 mg/kg/24 hr divided q 8 hr IV or IM.

Cautions: -Lactam safety profile (rash, eosinophilia). Renally eliminated. Each gram of drug contains 2.2 mEq sodium. Active metabolite.

Drug interaction: Probenecid.


Children: 150 mg/kg/24 hr divided q 6-8 hr IV or IM (meningitis: 200 mg/kg/24 hr divided q 6-8 hr IV).



Adults: 1-2 g q 8-12 hr IV or IM (max dose: 12 g/24 hr).


Cefotetan disodium

Cefotan. Injection.

2nd generation cephalosporin active against S. aureus, Streptococcus, H. influenzae, E. coli, Klebsiella, Proteus, and Bacteroides. Inactive against Enterobacter.

Children: 40-80 mg/kg/24 hr divided IV or IM q 12 hr.

Cautions: Highly protein-bound cephalosporin, poor CNS penetration; -Lactam safety profile (rash, eosinophilia), disulfiram-like reaction with alcohol. Renally eliminated (∼20% in bile).


Adults: 2-4 g/24 hr divided q 12 hr IV or IM (max dose: 6 g/24 hr).

Cefoxitin sodium Mefoxin. Injection.

2nd generation cephalosporin active against S. aureus, Streptococcus, H. influenzae, E. coli, Klebsiella, Proteus, and Bacteroides. Inactive against Enterobacter.

Cautions: Poor CNS penetration; -Lactam safety profile (rash, eosinophilia). Renally eliminated. Painful given intramuscularly.


Neonates: 70-100 mg/kg/24 hr divided q 8-12 hr IV or IM.

Drug interaction: Probenecid.


Children: 80-160 mg/kg/24 hr divided q 6-8 hr IV or IM.



Adults: 1-2 g q 6-8 hr IV or IM (max dose: 12 g/24 hr).


Cefpodoxime proxetil

Vantin.

Tablet: 100 mg, 200 mg.

Suspension: 50 mg/5 mL, 100 mg/5 mL.

3rd generation cephalosporin active against S. aureus, Streptococcus, H. influenzae, M. catarrhalis, N. gonorrhoeae,

E. coli, Klebsiella, and Proteus. No antipseudomonal activity.

Children: 10 mg/kg/24 hr divided q 12 hr PO.

Adults: 200-800 mg/24 hr divided q 12 hr PO (max dose: 800 mg/24 hr).

Uncomplicated gonorrhea: 200 mg PO as single-dose therapy.

Cautions: -Lactam safety profile (rash, eosinophilia). Renally eliminated. Does not adequately penetrate CNS. Increased bioavailability when taken with food.

Drug interaction: Probenecid; antacids and H-2 receptor antagonists may decrease absorption.

Cefprozil

Cefzil.

Tablet: 250, 500 mg.

Suspension: 125 mg/5 mL, 250 mg/5 mL.

2nd generation cephalosporin active against S. aureus, Streptococcus, H. influenzae, E. coli, M. catarrhalis, Klebsiella, and Proteus.

Children: 30 mg/kg/24 hr divided q 8-12 hr PO.

Adults: 500-1,000 mg/24 hr divided q 12 hr PO (max dose: 1.5 g/24 hr).

Cautions: -Lactam safety profile (rash, eosinophilia). Renally eliminated. Good bioavailability; food does not affect bioavailability.

Drug interaction: Probenecid.

Ceftazidime

Fortaz, Ceptaz, Tazicer, Tazidime. Injection.

3rd generation cephalosporin active against gram-positive and gram-negative pathogens, including Pseudomonas aeruginosa.

Neonates: Postnatal age ≤7 days: 100 mg/kg/24 hr divided q 12 hr IV or IM; 7 days ≤1,200 g: 100 mg/kg/24 hr divided q 12 hr IV or IM; 1,200 g: 150 mg/kg/24 hr divided q 8 hr IV or IM.

Children: 150 mg/kg/24 hr divided q 8 hr IV or IM (meningitis: 150 mg/kg/24 hr IV divided q 8 hr).

Adults: 1-2 g q 8-12 hr IV or IM (max dose: 8-12 g/24 hr).

Cautions: -Lactam safety profile (rash, eosinophilia). Renally eliminated. Increasing pathogen resistance developing with

long-term, widespread use.

Drug interaction: Probenecid.

Ceftiaoxime Cefizox. Injection.

3rd generation cephalosporin active against gram-positive and gram-negative pathogens. No antipseudomonal activity.

Children: 150 mg/kg/24 hr divided q 6-8 hr IV or IM. Adults: 1-2 g q 6-8 hr IV or IM (max dose: 12 g/24 hr).

Cautions: -Lactam safety profile (rash, eosinophilia). Renally eliminated.

Drug interaction: Probenecid.

Ceftriaxone sodium

Rocephin. Injection.

3rd generation cephalosporin active against gram-positive and gram-negative pathogens. No antipseudomonal activity.

Neonates: 50-75 mg/kg q 24 hr IV or IM.

Children: 50-75 mg/kg q 24 hr IV or IM (meningitis: 75 mg/kg dose 1 then 80-100 mg/kg/24 hr divided q 12-24 hr IV or IM).

Adults: 1-2 g q 24 hr IV or IM (max dose: 4 g/24 hr).

Cautions: -Lactam safety profile (rash, eosinophilia). Eliminated via kidney (33-65%) and bile; can cause sludging. Long half-life and dose-dependent protein binding favors q 24 hr rather than q 12 hr dosing. Can add 1% lidocaine for IM injection.

Cefuroxime (cefuroxime axetil for oral administration)

Ceftin, Kefurox, Zinacef. Injection.

Suspension: 125 mg/5 mL. Tablet: 125, 250, 500 mg.

2nd generation cephalosporin active against S. aureus, Streptococcus, H. influenzae, E. coli, M. catarrhalis, Klebsiella, and Proteus.

Neonates: 40-100 mg/kg/24 hr divided q 12 hr IV or IM. Children: 200-240 mg/kg/24 hr divided q 8 hr IV or IM; PO

administration: 20-30 mg/kg/24 hr divided q 8 hr PO. Adults: 750-1,500 mg q 8 hr IV or IM (max dose: 6 g/24 hr).

Cautions: -Lactam safety profile (rash, eosinophilia). Renally eliminated. Food increases PO bioavailability.

Drug interaction: Probenecid.

Cephalexin

Keflex, Keftab. Capsule: 250, 500 mg

Tablet: 500 mg, 1 g.

Suspension: 125 mg/5 mL, 250 mg/5 mL, 100 mg/mL drops.

1st generation cephalosporin active against S. aureus, Streptococcus, E. coli, Klebsiella, and Proteus.

Children: 25-100 mg/kg/24 hr divided q 6-8 hr PO. Adults: 250-500 mg q 6 hr PO (max dose: 4 g/24 hr).

Cautions: -Lactam safety profile (rash, eosinophilia). Renally eliminated.

Drug interaction: Probenecid.

Cephradine

Velosef

Capsule: 250, 500 mg.

Suspension: 125 mg/5 mL, 250 mg/5 mL.

1st generation cephalosporin active against S. aureus, Streptococcus, E. coli, Klebsiella, and Proteus.

Children: 50-100 mg/kg/24 hr divided q 6-12 hr PO. Adults: 250-500 mg q 6-12 hr PO (max dose: 4 g/24 hr).

Cautions: -Lactam safety profile (rash, eosinophilia). Renally eliminated.

Drug interaction: Probenecid.

Chloramphenicol Chloromycetin. Injection. Capsule: 250 mg.

Ophthalmic, otic solutions. Ointment.

Broad-spectrum protein synthesis inhibitor active against many gram-positive and gram-negative bacteria, Salmonella, vancomycin-resistant Enterococcus faecium, Bacteroides, other anaerobes, Mycoplasma, Chlamydia, and Rickettsia; usually inactive against Pseudomonas.

Neonates: Initial loading dose 20 mg/kg followed 12 hr later by: postnatal age ≤7 days: 25 mg/kg/24 hr q 24 hr IV; 7 days:

≤2,000 g: 25 mg/kg/24 hr q 24 hr IV; 2,000 g: 50 mg/kg/24 hr divided q 12 hr IV.

Children: 50-75 mg/kg/24 hr divided q 6-8 hr IV or PO (meningitis: 75-100 mg/kg/24 hr IV divided q 6 hr).

Adults: 50 mg/kg/24 hr divided q 6 hr IV or PO (max dose: 4 g/24 hr).

Cautions: Gray-baby syndrome (from too-high dose in neonate), bone marrow suppression aplastic anemia (monitor hematocrit, free serum iron).

Drug interactions: Phenytoin, phenobarbital, rifampin may decrease levels.

Target serum concentrations: Peak 20-30 mg/L; trough 5-10 mg/L.


Ciprofloxacin

Cipro.

Tablet: 100, 250, 500, 750 mg.

Injection.

Ophthalmic solution and ointment. Otic suspension.

Oral suspension: 250 and 500 mg/5 mL.

Quinolone antibiotic active against P. aeruginosa, Serratia, Enterobacter, Shigella, Salmonella, Campylobacter, N. gonorrhoeae, H. influenzae, M. catarrhalis, some S. aureus, and some Streptococcus.

Neonates: 10 mg/kg q 12 hr PO or IV.

Children: 15-30 mg/kg/24 hr divided q 12 hr PO or IV; cystic fibrosis: 20-40 mg/kg/24 hr divided q 8-12 hr PO or IV.

Adults: 250-750 mg q 12 hr; 200-400 mg IV q 12 hr PO (max dose: 1.5 g/24 hr).

Cautions: Concerns of joint destruction in juvenile animals not seen in humans; tendonitis, superinfection, dizziness, confusion, crystalluria, some photosensitivity.

Drug interactions: Theophylline; magnesium-, aluminum-, or calcium-containing antacids; sucralfate; probenecid; warfarin; cyclosporine.

Clarithromycin

Biaxin.

Tablet: 250, 500 mg.

Suspension: 125 mg/5 mL, 250 mg/5 mL.

Macrolide antibiotic with activity against S. aureus, Streptococcus, H. influenzae, Legionella, Mycoplasma, and

C. trachomatis.

Children: 15 mg/kg/24 hr divided q 12 hr PO.

Adults: 250-500 mg q 12 hr PO (max dose: 1 g/24 hr).

Cautions: Adverse events less than erythromycin; gastrointestinal upset, dyspepsia, nausea, cramping.

Drug interactions: Same as erythromycin: astemizole carbamazepine, terfenadine cyclosporine, theophylline, digoxin, tacrolimus.

Clindamycin

Cleocin.

Capsule: 75, 150, 300 mg. Suspension: 75 mg/5 mL. Injection.

Topical solution, lotion, and gel. Vaginal cream.

Protein synthesis inhibitor active against most gram-positive aerobic and anaerobic cocci except Enterococcus.

Neonates: Postnatal age ≤7 days 200 g; 10 mg/kg/24 hr divided q 12 hr IV or IM; 2,000 g: 15 mg/kg/24 hr divided q 8 hr IV or IM;

7 days 1,200 g: 10 mg/kg/24 hr IV or IM divided q 12 hr; 1,200-2,000 g: 15 mg/kg/24 hr divided q 8 hr IV or IM; 2,000 g: 20 mg/kg/24 hr divided q 8 hr IV or IM.

Children: 10-40 mg/kg/24 hr divided q 6-8 hr IV, IM, or PO.

Adults: 150-600 mg q 6-8 hr IV, IM, or PO (max dose: 5 g/24 hr IV or IM or 2 g/24 hr PO).

Cautions: Diarrhea, nausea, Clostridium difficile–associated colitis, rash. Administer slow IV over 30-60 min. Topically active as an acne treatment.

Cloxacillin sodium

Tegopen.

Capsule: 250, 500 mg. Suspension: 125 mg/5 mL.

Penicillinase-resistant penicillin active against S. aureus and other gram-positive cocci except Enterococcus and coagulase- negative staphylococci.

Children: 50-100 mg/kg/24 hr divided q 6 hr PO. Adults: 250-500 mg q 6 hr PO (max dose: 4 g/24 hr).

Cautions: -Lactam safety profile (rash, eosinophilia). Primarily hepatically eliminated; requires dose reduction in renal disease. Food decreases bioavailability.

Drug interaction: Probenecid.

Co-trimoxazole (trimethoprim- sulfamethoxazole; TMP-SMZ)

Bactrim, Cotrim, Septra, Sulfatrim. Tablet: SMZ 400 mg and TMP 80 mg.

Tablet DS: SMZ 800 mg and TMP 160 mg. Suspension: SMZ 200 mg and TMP

40 mg/5 mL. Injection.

Antibiotic combination with sequential antagonism of bacterial folate synthesis with broad antibacterial activity: Shigella, Legionella, Nocardia, Chlamydia, Pneumocystis jiroveci. Dosage based on TMP component.

Children: 6-20 mg TMP/kg/24 hr or IV divided q 12 hr PO.

Pneumocystis carinii pneumonia: 15-20 mg TMP/kg/24 hr divided q 12 hr PO or IV.

P. carinii prophylaxis: 5 mg TMP/kg/24 hr or 3 times/wk PO. Adults: 160 mg TMP q 12 hr PO.

Cautions: Drug dosed on TMP (trimethoprim) component. Sulfonamide skin reactions: rash, erythema multiforme,

Stevens-Johnson syndrome, nausea, leukopenia. Renal and hepatic elimination; reduce dose in renal failure.

Drug interactions: Protein displacement with warfarin, possibly phenytoin, cyclosporine.

Demeclocycline

Declomycin.

Tablet: 150, 300 mg.

Capsule: 150 mg.

Tetracycline active against most gram-positive cocci except Enterococcus, many gram-negative bacilli, anaerobes, Borrelia burgdorferi (Lyme disease), Mycoplasma, and Chlamydia.

Children: 8-12 mg/kg/24 hr divided q 6-12 hr PO. Adults: 150 mg PO q 6-8 hr.

Syndrome of inappropriate antidiuretic hormone secretion: 900- 1,200 mg/24 hr or 13-15 mg/kg/24 hr divided q 6-8 hr PO with dose reduction based on response to 600-900 mg/24 hr.

Cautions: Teeth staining, possibly permanent (if administered 8 yr of age) with prolonged use; photosensitivity, diabetes insipidus, nausea, vomiting, diarrhea, superinfections.

Drug interactions: Aluminum-, calcium-, magnesium-, zinc- and iron-containing food, milk, dairy products may decrease absorption.

Dicloxacillin

Dynapen, Pathocil.

Capsule: 125, 250, 500 mg. Suspension: 62.5 mg/5 mL.

Penicillinase-resistant penicillin active against S. aureus and other gram-positive cocci except Enterococcus and coagulase- negative staphylococci.

Children: 12.5-100 mg/kg/24 hr divided q 6 hr PO. Adults: 125-500 mg q 6 hr PO.

Cautions: -Lactam safety profile (rash, eosinophilia). Primarily renally (65%) and bile (30%) elimination. Food may decrease bioavailability.

Drug interaction: Probenecid.

Doripenem Doribax. Injection.

Carbapenem antibiotic with broad-spectrum activity against gram-positive cocci and gram-negative bacilli, including

P. aeruginosa and anaerobes.

Children: dose unknown. Adults: 500 mg q 8 hr IV.

Cautions: -Lactam safety profile; does not undergo hepatic metabolism. Renal elimination (70-75%); dose adjustment for renal failure.

Drug interactions: Valproic acid, probenecid.

Doxycycline Vibramycin, Doxy. Injection.

Capsule: 50, 100 mg.

Tablet: 50, 100 mg. Suspension: 25 mg/5 mL. Syrup: 50 mg/5 mL.

Tetracycline antibiotic active against most gram-positive cocci except Enterococcus, many gram-negative bacilli, anaerobes,

B. burgdorferi (Lyme disease), Mycoplasma, and Chlamydia.

Children: 2-5 mg/kg/24 hr divided q 12-24 hr PO or IV (max dose: 200 mg/24 hr).

Adults: 100-200 mg/24 hr divided q 12-24 hr PO or IV.

Cautions: Teeth staining, possibly permanent (8 yr of age) with prolonged use; photosensitivity, nausea, vomiting, diarrhea, superinfections.

Drug interactions: Aluminum-, calcium-, magnesium-, zinc-, iron-, kaolin-, and pectin-containing products, food, milk, dairy products may decrease absorption. Carbamazepine, rifampin, barbiturates may decrease half-life.

Erythromycin

E-Mycin, Ery-Tab, Ery-C, Ilosone. Estolate 125, 500 mg.

Tablet EES: 200 mg.

Tablet base: 250, 333, 500 mg. Suspension: estolate 125 mg/5 mL,

250 mg/5 mL, EES 200 mg/5 mL, 400 mg/5 mL.

Estolate drops: 100 mg/mL. EES drops:

100 mg/2.5 mL. Available in combination with sulfisoxazole (Pediazole), dosed on erythromycin content.

Bacteriostatic macrolide antibiotic most active against gram- positive organisms, Corynebacterium diphtheriae, and Mycoplasma pneumoniae.

Neonates: Postnatal age ≤7 days: 20 mg/kg/24 hr divided q 12 hr PO;

7 days 1,200 g: 20 mg/kg/24 hr divided q 12 hr PO; 1,200 g:

30 mg/kg/24 hr divided q 8 hr PO (give as 5 mg/kg/dose q 6 hr to

improve feeding intolerance). Children: Usual max dose 2 g/24 hr.

Base: 30-50 mg/kg/24 hr divided q 6-8 hr PO. Estolate: 30-50 mg/kg/24 hr divided q 8-12 hr PO. Stearate: 20-40 mg/kg/24 hr divided q 6 hr PO. Lactobionate: 20-40 mg/kg/24 hr divided q 6-8 hr IV.

Gluceptate: 20-50 mg/kg/24 hr divided q 6 hr IV; usual max dose 4 g/24 hr IV.

Adults: Base: 333 mg PO q 8 hr; estolate/stearate/base: 250-500 mg q 6 hr PO.

Cautions: Motilin agonist leading to marked abdominal cramping, nausea, vomiting, diarrhea. Associated with hypertrophic pyloric stenosis in young infants. Many different salts with questionable tempering of gastrointestinal adverse events. Rare cardiac toxicity with IV use. Dose of salts differ. Topical formulation for treatment of acne.

Drug interactions: Antagonizes hepatic CYP 3A4 activity: astemizole, carbamazepine, terfenadine, cyclosporine, theophylline, digoxin, tacrolimus, carbamazepine.

Gentamicin Garamycin. Injection.

Ophthalmic solution, ointment, topical cream.

Aminoglycoside antibiotic active against gram-negative bacilli, especially E. coli, Klebsiella, Proteus, Enterobacter, Serratia, and Pseudomonas.

Neonates: Postnatal age ≤7 days 1,200-2,000 g: 2.5 mg/kg q

12-18 hr IV or IM; 2,000 g: 2.5 mg/kg q 12 hr IV or IM; postnatal

age 7 days 1,200-2,000 g: 2.5 mg/kg q 8-12 hr IV or IM;

2,000 g: 2.5 mg/kg q 8 hr IV or IM.

Children: 2.5 mg/kg/24 hr divided q 8-12 hr IV or IM. Alternatively

may administer 5-7.5 mg/kg/24 hr IV once daily. Intrathecal: Preservative-free preparation for intraventricular or

intrathecal use: neonate: 1 mg/24 hr; children: 1-2 mg/24 hr IT; adults: 4-8 mg/24 hr.

Adults: 3-6 mg/kg/24 hr divided q 8 hr IV or IM.

Cautions: Anaerobes, S. pneumoniae, and other Streptococcus are resistant. May cause ototoxicity and nephrotoxicity. Monitor renal function. Drug eliminated renally. Administered IV over 30-60 min.

Drug interactions: May potentiate other ototoxic and nephrotoxic drugs.

Target serum concentrations: Peak 6-12 mg/L; trough 2 mg/L with intermittent daily dose regimens only.

Imipenem-cilastatin

Primaxin. Injection.

Carbapenem antibiotic with broad-spectrum activity against gram-positive cocci and gram-negative bacilli, including

P. aeruginosa and anaerobes. No activity against

Stenotrophomonas maltophilia.

Neonates: Postnatal age ≤7 days 1,200 g: 20 mg/kg q 18-24 hr IV or IM; 1,200 g: 40 mg/kg divided q 12 hr IV or IM; postnatal age

7 days 1,200-2,000 g: 40 mg/kg q 12 hr IV or IM; 2,000 g: 60 mg/kg q 8 hr IV or IM.

Children: 60-100 mg/kg/24 hr divided q 6-8 hr IV or IM.

Adults: 2-4 g/24 hr divided q 6-8 hr IV or IM (max dose: 4 g/24 hr).

Cautions: -Lactam safety profile (rash, eosinophilia), nausea, seizures. Cilastatin possesses no antibacterial activity; reduces renal imipenem metabolism. Primarily renally eliminated.

Drug interaction: Possibly ganciclovir.

Linezolid

Zyvox.

Tablet: 400, 600 mg.

Oral suspension: 100 mg/5 mL. Injection: 100 mg/5 mL.

Oxazolidinone antibiotic active against gram-positive cocci (especially drug-resistant organisms), including Staphylococcus, Streptococcus, E. faecium, and Enterococcus faecalis. Interferes with protein synthesis by binding to 50S ribosome subunit.

Children: 10 mg/kg q 12 hr IV or PO.

Adults: Pneumonia: 600 mg q 12 hr IV or PO; skin infections: 400 mg q 12 hr IV or PO.

Adverse events: Myelosuppression, pseudomembranous colitis, nausea, diarrhea, headache.

Drug interaction: Probenecid.

Loracarbef

Lorabid.

Capsule: 200 mg.

Suspension: 100 mg/5 mL, 200 mg/5 mL.

Carbacephem very closely related to cefaclor (2nd generation cephalosporin) active against S. aureus, Streptococcus, H. influenzae, M. catarrhalis, E. coli, Klebsiella, and Proteus.

Children: 30 mg/kg/24 hr divided q 12 hr PO (max dose: 2 g). Adults: 200-400 mg q 12 hr PO (max dose: 800 mg/24 hr).

Cautions: -Lactam safety profile (rash, eosinophilia). Renally eliminated.

Drug interaction: Probenecid.

Meropenem Merrem. Injection.

Carbapenem antibiotic with broad-spectrum activity against gram-positive cocci and gram-negative bacilli, including P. aeruginosa and anaerobes. No activity against Stenotrophomonas maltophilia.

Children: 60 mg/kg/24 hr divided q 8 hr IV meningitis: 120 mg/ kg/24 hr (max dose: 6 g/24 hr) q 8 hr IV.

Adults: 1.5-3 g q 8 hr IV.

Cautions: -Lactam safety profile; appears to possess less CNS excitation than imipenem. 80% renal elimination.

Drug interaction: Probenecid.

Metronidazole

Flagyl, Metro-IV, generic. Topical gel, vaginal gel. Injection.

Tablet: 250, 500 mg.

Highly effective in the treatment of infections due to anaerobes.

Neonates: 1,200 g: 7.5 mg/kg 48 hr PO or IV; postnatal age ≤7 days 1,200-2,000 g: 7.5 mg/kg/24 hr q 24 hr PO or IV; 2,000 g: 15 mg/ kg/24 hr divided q 12 hr PO or IV; postnatal age 7 days

1,200-2,000 g: 15 mg/kg/24 hr divided q 12 hr PO or IV; 2,000 g: 30 mg/kg/24 hr divided q 12 hr PO or IV.

Children: 30 mg/kg/24 hr divided q 6-8 hr PO or IV.

Adults: 30 mg/kg/24 hr divided q 6 hr PO or IV (max dose: 4 g/24 hr).

Cautions: Dizziness, seizures, metallic taste, nausea, disulfiram-like reaction with alcohol. Administer IV slow over 30-60 min. Adjust dose with hepatic impairment.

Drug interactions: Carbamazepine, rifampin, phenobarbital may enhance metabolism; may increase levels of warfarin, phenytoin, lithium.

Mezlocillin sodium

Mezlin. Infection.

Extended-spectrum penicillin active against E. coli, Enterobacter, Serratia, and Bacteroides; limited antipseudomonal activity. Neonates: Postnatal age ≤7 days: 150 mg/kg/24 hr divided q 12 hr IV;

7 days: 225 mg/kg divided q 8 hr IV.

Children: 200-300 mg/kg/24 hr divided q 4-6 hr IV; cystic fibrosis

300-450 mg/kg/24 hr IV.

Adults: 2-4 g/dose q 4-6 hr IV (max dose: 12 g/24 hr).

Cautions: -Lactam safety profile (rash, eosinophilia); painful given intramuscularly; each gram contains 1.8 mEq sodium. Interferes with platelet aggregation with high doses; increases noted in liver function test results. Renally eliminated. Inactivated by

-lactamase enzyme.

Drug interaction: Probenecid.

Mupirocin Bactroban. Ointment.

Topical antibiotic active against Staphylococcus and

Streptococcus.

Topical application: Nasal (eliminate nasal carriage) and to the skin 2-4 times per day.

Caution: Minimal systemic absorption as drug metabolized within the skin.

Nafcillin sodium Nafcil, Unipen. Injection. Capsule: 250 mg.

Tablet: 500 mg.

Penicillinase-resistant penicillin active against S. aureus and other gram-positive cocci, except Enterococcus and coagulase-negative staphylococci.

Neonates: Postnatal age ≤7 days 1,200-2,000 g: 50 mg/kg/24 hr divided q 12 hr IV or IM; 2,000 g: 75 mg/kg/24 hr divided q 8 hr IV or IM; postnatal age 7 days 1,200-2,000 g: 75 mg/kg/q 8 hr;

2,000 g: 100 mg/kg divided q 6-8 hr IV (meningitis: 200 mg/ kg/24 hr divided q 6 hr IV).

Children: 100-200 mg/kg/24 hr divided q 4-6 hr IV.

Adults: 4-12 g/24 hr divided q 4-6 hr IV (max dose: 12 g/24 hr).

Cautions: -Lactam safety profile (rash, eosinophilia), phlebitis; painful given intramuscularly; oral absorption highly variable and erratic (not recommended).

Adverse effect: Neutropenia.

Nalidixic acid

NegGram.

Tablet: 250, 500, 1,000 mg. Suspension: 250 mg/5 mL.

1st generation quinolone effective for short-term treatment of lower urinary tract infections caused by E. coli, Enterobacter, Klebsiella, and Proteus.

Children: 50-55 mg/kg/24 hr divided q 6 hr PO; suppressive therapy 25-33 mg/kg/24 hr divided q 6-8 hr PO.

Adults: 1 g q 6 hr PO; suppressive therapy: 500 mg q 6 hr PO.

Cautions: Vertigo, dizziness, rash. Not for use in systemic infections.

Drug interactions: Liquid antacids.

Neomycin sulfate Mycifradin, generic. Tablet: 500 mg.

Topical cream, ointment. Solution: 125 mg/5 mL.

Aminoglycoside antibiotic used for topical application or orally before surgery to decrease gastrointestinal flora (nonabsorbable) and hyperammonemia.

Infants: 50 mg/kg/24 hr divided q 6 hr PO. Children: 50-100 mg/kg/24 hr divided q 6-8 hr PO. Adults: 500-2,000 mg/dose q 6-8 hr PO.

Cautions: In patients with renal dysfunction because small amount absorbed may accumulate.

Adverse events: Primarily related to topical application, abdominal cramps, diarrhea, rash. Aminoglycoside ototoxicity and nephrotoxicity if absorbed.

Nitrofurantoin

Furadantin, Furan, Macrodantin. Capsule: 50, 100 mg.

Extended-release capsule: 100 mg. Macrocrystal: 50, 100 mg. Suspension: 25 mg/5 mL.

Effective in the treatment of lower urinary tract infections caused by gram-positive and gram-negative pathogens.

Children: 5-7 mg/kg/24 hr divided q 6 hr PO (max dose:

400 mg/24 hr); suppressive therapy 1-2.5 mg/kg/24 hr divided q 12-24 hr PO (max dose: 100 mg/24 hr).

Adults: 50-100 mg/24 hr divided q 6 hr PO.

Cautions: Vertigo, dizziness, rash, jaundice, interstitial pneumonitis. Do not use with moderate to severe renal dysfunction.

Drug interactions: Liquid antacids.

Ofloxacin

Ocuflox 0.3% ophthalmic solution: 1, 5,

10 mL.

Floxin 0.3% otic solution: 5, 10 mL.

Quinolone antibiotic for treatment of conjunctivitis or corneal ulcers (ophthalmic solution) and otitis externa or chronic suppurative otitis media (otic solution) caused by susceptible gram-positive, gram-negative, anaerobic bacteria, or Chlamydia trachomatis.

Child 1-12 yr:

Conjunctivitis: 1-2 drops in affected eye(s) q 2-4 hr for 2 days, then

1-2 drops qid for 5 days.

Corneal ulcers: 1-2 drops q 30 min while awake and at 4 hours at night for 2 days, then 1-2 drops hourly for 5 days while awake, then 1-2 drops q 6 hr for 2 days.

Otitis externa (otic solution): 5 drops into affected ear bid for 10 days.

Chronic suppurative otitis media: treat for 14 days.

Child 12 yr and adults: Ophthalmic solution doses same as for younger children. Otitis externa (otic solution): Use 10 drops bid for 10 or 14 days as for younger children.

Adverse events: Burning, stinging, eye redness (ophthalmic solution), dizziness with otic solution if not warmed.

Oxacillin sodium Prostaphlin. Injection.

Capsule: 250, 500 mg. Suspension: 250 mg/5 mL.

Penicillinase-resistant penicillin active against S. aureus and other gram-positive cocci, except Enterococcus and coagulase-negative staphylococci.

Neonates: Postnatal age ≤7 days 1,200-2,000 g: 50 mg/kg/24 hr divided q 12 hr IV; 2,000 g: 75 mg/kg/24 hr IV divided q 8 hr IV; postnatal age 7 days 1,200 g: 50 mg/kg/24 hr IV divided q 12 hr IV; 1,200-2,000 g: 75 mg/kg/24 hr divided q 8 hr IV; 2,000 g:

100 mg/kg/24 hr IV divided q 6 hr IV.

Infants: 100-200 mg/kg/24 hr divided q 4-6 hr IV. Children: PO 50-100 mg/kg/24 hr divided q 4-6 hr IV.

Adults: 2-12 g/24 hr divided q 4-6 hr IV (max dose: 12 g/24 hr).

Cautions: -Lactam safety profile (rash, eosinophilia).

Moderate oral bioavailability (35-65%). Primarily renally eliminated.

Drug interaction: Probenecid.

Adverse effect: Neutropenia.

Penicillin G Injection. Tablets.

Penicillin active against most gram-positive cocci; S. pneumoniae (resistance is increasing), group A streptococcus, and some gram-negative bacteria (e.g., N. gonorrhoeae, N. meningitidis).

Neonates: Postnatal age ≤7 days 1,200-2,000 g: 50,000 units/ kg/24 hr divided q 12 hr IV or IM (meningitis: 100,000 units/

kg/24 hr divided q 12 hr IV or IM); 2,000 g: 75,000 units/kg/24 hr divided q 8 hr IV or IM (meningitis: 150,000 units/kg/24 hr divided q 8 hr IV or IM); postnatal age 7 days ≤1,200 g: 50,000 units/ kg/24 hr divided q 12 hr IV (meningitis: 100,000 units/kg/24 hr divided q 12 hr IV); 1,200-2,000 g: 75,000 units/kg/24 hr q 8 hr IV (meningitis: 225,000 units/kg/24 hr divided q 8 hr IV); 2,000 g: 100,000 units/kg/24 hr divided q 6 hr IV (meningitis: 200,000 units/ kg/24 hr divided q 6 hr IV).

Children: 100,000-250,000 units/kg/24 hr divided q 4-6 hr IV or IM (max dose: 400,000 units/kg/24 hr).

Adults: 2-24 million units/24 hr divided q 4-6 hr IV or IM.

Cautions: -Lactam safety profile (rash, eosinophilia), allergy, seizures with excessive doses particularly in patients with marked renal disease. Substantial pathogen resistance. Primarily renally eliminated.

Drug interaction: Probenecid.

Penicillin G, benzathine

Bicillin. Injection.

Long-acting repository form of penicillin effective in the treatment of infections responsive to persistent, low penicillin concentrations (1-4 wk), e.g., group A streptococcus pharyngitis, rheumatic fever prophylaxis.

Neonates 1,200 g: 50,000 units/kg IM once.

Children: 300,000-1.2 million units/kg q 3-4 wk IM (max dose:

1.2-2.4 million units/dose).

Adults: 1.2 million units IM q 3-4 wk.

Cautions: -Lactam safety profile (rash, eosinophilia), allergy. Administer by IM injection only. Substantial pathogen resistance. Primarily renally eliminated.

Drug interaction: Probenecid.

Penicillin G, procaine

Crysticillin. Injection.

Repository form of penicillin providing low penicillin concentrations for 12 hr.

Neonates 1,200 g: 50,000 units/kg/24 hr IM.

Children: 25,000-50,000 units/kg/24 hr IM for 10 days (max dose:

4.8 million units/dose).

Gonorrhea: 100,000 units/kg (max dose: 4.8 million units/24 hr) IM once with probenecid 25 mg/kg (max dose: 1 g)

Adults: 0.6-4.8 million units q 12-24 hr IM.

Cautions: -Lactam safety profile (rash, eosinophilia) allergy. Administer by IM injection only. Substantial pathogen resistance. Primarily renally eliminated.

Drug interaction: Probenecid.

Penicillin V

Pen VK, V-Cillin K.

Tablet: 125, 250, 500 mg.

Suspension: 125 mg/5 mL, 250 mg/5 mL.

Preferred oral dosing form of penicillin, active against most gram-positive cocci; S. pneumoniae (resistance is increasing), other Streptococcus, and some gram-negative bacteria (e.g.,

N. gonorrhoeae, N. meningitidis).

Children: 25-50 mg/kg/24 hr divided q 4-8 hr PO. Adults: 125-500 mg q 6-8 hr PO (max dose: 3 g/24 hr).

Cautions: -Lactam safety profile (rash, eosinophilia), allergy, seizures with excessive doses particularly in patients with renal disease. Substantial pathogen resistance. Primarily renally eliminated. Inactivated by penicillinase.

Drug interaction: Probenecid.

Piperacillin Pipracil. Injection.

Extended-spectrum penicillin active against E. coli, Enterobacter, Serratia, P. aeruginosa, and Bacteroides.

Neonates: Postnatal age ≤7 days 150 mg/kg/24 hr divided q 8-12 hr IV; 7 days; 200 mg/kg divided q 6-8 hr IV.

Children: 200-300 mg/kg/24 hr divided q 4-6 hr IV; cystic fibrosis: 350-500 mg/kg/24 hr IV.

Adults: 2-4 g/dose q 4-6 hr (max dose: 24 g/24 hr) IV.

Cautions: -Lactam safety profile (rash, eosinophilia); painful given intramuscularly; each gram contains 1.9 mEq sodium. Interferes with platelet aggregation/serum sickness-like reaction with high doses; increases in liver function tests. Renally eliminated. Inactivated by penicillinase.

Drug interaction: Probenecid.

Piperacillin-tazobactam

Zosyn. Injection.

Extended-spectrum penicillin (piperacillin) combined with a

β-lactamase inhibitor (tazobactam) active against S. aureus, H. influenzae, E. coli, Enterobacter, Serratia, Acinetobacter, P. aeruginosa, and Bacteroides.

Children: 300-400 mg/kg/24 hr divided q 6-8 hr IV or IM. Adults: 3.375 g q 6-8 hr IV or IM.

Cautions: -Lactam safety profile (rash, eosinophilia); painful given intramuscularly; each gram contains 1.9 mEq sodium.

Interferes with platelet aggregation, serum sickness–like reaction with high doses, increases in liver function test results. Renally eliminated.

Drug interaction: Probenecid.

Quinupristin/dalfopristin

Synercid.

IV injection: powder for reconstitution, 10 mL contains 150 mg quinupristin,

350 mg dalfopristin.

Streptogramin antibiotic (quinupristin) active against vancomycin-resistant E. faecium (VRE) and methicillin- resistant S. aureus (MRSA). Not active against E. faecalis.

Children and adults: VRE: 7.5 mg/kg q 8 hr IV for VRE; skin infections:

7.5 mg/kg q 12 hr IV.

Adverse events: Pain, edema, or phlebitis at injection site, nausea, diarrhea.

Drug interactions: Synercid is a potent inhibitor of CYP 3A4.

Sulfadiazine

Tablet: 500 mg.

Sulfonamide antibiotic primarily indicated for the treatment of lower urinary tract infections due to E. coli, P. mirabilis, and Klebsiella.

Toxoplasmosis:

Neonates: 100 mg/kg/24 hr divided q 12 hr PO with pyrimethamine 1 mg/kg/24 hr PO (with folinic acid).

Children: 120-200 mg/kg/24 hr divided q 6 hr PO with pyrimethamine 2 mg/kg/24 hr divided q 12 hr PO ≥3 days then 1 mg/kg/24 hr (max dose: 25 mg/24 hr) with folinic acid.

Rheumatic fever prophylaxis: ≤30 kg: 500 mg/24 hr q 24 hr PO;

30 kg: 1 g/24 hr q 24 hr PO.

Cautions: Rash, Stevens-Johnson syndrome, nausea, leukopenia, crystalluria. Renal and hepatic elimination; avoid use with renal disease. Half-life ∼10 hr.

Drug interactions: Protein displacement with warfarin, phenytoin, methotrexate.

Sulfamethoxazole

Gantanol. Tablet: 500 mg.

Suspension: 500 mg/5 mL.

Sulfonamide antibiotic used for the treatment of otitis media, chronic bronchitis, and lower urinary tract infections due to susceptible bacteria.

Children: 50-60 mg/kg/24 hr divided q 12 hr PO. Adults: 1 g/dose q 12 hr PO (max dose: 3 g/24 hr).

Cautions: Rash, Stevens-Johnson syndrome, nausea, leukopenia, crystalluria. Renal and hepatic elimination; avoid use with renal disease. Half-life 12 hr. Initial dose often a loading dose (doubled).

Drug interactions: Protein displacement with warfarin, phenytoin, methotrexate.

Sulfisoxazole Gantrisin. Tablet: 500 mg.

Suspension: 500 mg/5 mL. Ophthalmic solution, ointment.

Sulfonamide antibiotic used for the treatment of otitis media, chronic bronchitis, and lower urinary tract infections due to susceptible bacteria.

Children: 120-150 mg/kg/24 hr divided q 4-6 hr PO (max dose: 6 g/24 hr).

Adults: 4-8 g/24 hr divided q 4-6 hr PO.

Cautions: Rash, Stevens-Johnson syndrome, nausea, leukopenia, crystalluria. Renal and hepatic elimination; avoid use with renal disease. Half-life ∼7-12 hr. Initial dose often a loading dose (doubled).

Drug interactions: Protein displacement with warfarin, phenytoin, methotrexate.

Ticarcillin Ticar. Injection.

Extended-spectrum penicillin active against E. coli, Enterobacter, Serratia, P. aeruginosa, and Bacteroides.

Neonates: Postnatal age ≤7 days 2,000 g: 150 mg/kg/24 hr divided q 8-12 hr IV; 7 days 2,000 g: 225 mg/kg/24 hr divided q 8 hr IV;

7 days 1,200 g: 150 mg/kg/24 hr divided q 12 hr IV; 1,200-

2,000 g: 225 mg/kg/24 hr divided q 8 hr IV; 2,000 g: 300 mg/

kg/24 hr divided q 6-8 hr IV.

Children: 200-400 mg/kg/24 hr divided q 4-6 hr IV; cystic fibrosis: 400-600 mg/kg/24 hr IV.

Adults: 2-4 g/dose q 4-6 hr IV (max dose: 24 g/24 hr).

Cautions: -Lactam safety profile (rash, eosinophilia); painful given intramuscularly; each gram contains 5-6 mEq sodium. Interferes with platelet aggregation; increases in liver function tests. Renally eliminated. Inactivated by penicillinase.

Drug interaction: Probenecid.

Ticarcillin-clavulanate

Timentin. Injection.

Extended-spectrum penicillin (ticarcillin) combined with a

β-lactamase inhibitor (clavulanate) active against S. aureus, H. influenzae, Enterobacter, E. coli, Serratia, P. aeruginosa, Acinetobacter, and Bacteroides.

Children: 280-400 mg/kg/24 hr q 4-8 hr IV or IM.

Adults: 3.1 g q 4-8 hr IV or IM (max dose: 18-24 g/24 hr).

Cautions: -Lactam safety profile (rash, eosinophilia); painful given intramuscularly; each gram contains 5-6 mEq sodium. Interferes with platelet aggregation; increases in liver function tests. Renally eliminated.

Drug interaction: Probenecid.

Tigecycline Tygacil. Injection.

Tetracycline-class antibiotic (glycylcycline) active against Enterobacteriaceae, including ESBL producers; streptococci (including VRE); staphylococci (including MRSA); and anaerobes.

Children: unknown.

Adults: 100 mg loading dose followed by 50 mg q 12 hr IV.

Cautions: Pregnancy; children under 8 yr of age; photosensitivity; hypersensitivity to tetracyclines; hepatic impairment (~60% hepatic clearance).

Drug interaction: Warfarin; mycophenolate mofetil.

Tobramycin Nebcin, Tobrex. Injection.

Ophthalmic solution, ointment.

Aminoglycoside antibiotic active against gram-negative bacilli, especially E. coli, Klebsiella, Enterobacter, Serratia, Proteus, and Pseudomonas.

Neonates: Postnatal age ≤7 days, 1,200-2,000 g: 2.5 mg/kg q

12-18 hr IV or IM; 2,000 g: 2.5 mg/kg q 12 hr IV or IM; postnatal

age 7 days, 1,200-2,000 g: 2.5 mg/kg q 8-12 hr IV or IM;

2,000 g: 2.5 mg/kg q 8 hr IV or IM.

Children: 2.5 mg/kg/24 hr divided q 8-12 hr IV or IM. Alternatively

may administer 5-7.5 mg/kg/24 hr IV. Preservative-free preparation for intraventricular or intrathecal use: neonate: 1 mg/24 hr; children: 1-2 mg/24 hr; adults: 4-8 mg/24 hr.

Adults: 3-6 mg/kg/24 hr divided q 8 hr IV or IM.

Cautions: S. pneumoniae, other Streptococcus, and anaerobes are resistant. May cause ototoxicity and nephrotoxicity. Monitor renal function. Drug eliminated renally. Administered IV over 30-60 min.

Drug interactions: May potentiate other ototoxic and nephrotoxic drugs.

Target serum concentrations: Peak 6-12 mg/L; trough 2 mg/L.

Trimethoprim Proloprim, Trimpex. Tablet: 100, 200 mg

Folic acid antagonist effective in the prophylaxis and treatment of E. coli, Klebsiella, P. mirabilis, and Enterobacter urinary tract infections; P. carinii pneumonia.

Children: For urinary tract infection: 4-6 mg/kg/24 hr divided q 12 hr PO.

Children 12 yr and adults: 100-200 mg q 12 hr PO. P. carinii pneumonia (with dapsone): 15-20 mg/kg/24 hr divided q 6 hr for 21 days PO.

Cautions: Megaloblastic anemia, bone marrow suppression, nausea, epigastric distress, rash.

Drug interactions: Possible interactions with phenytoin, cyclosporine, rifampin, warfarin.

Vancomycin Vancocin, Luphocin. Injection.

Capsule: 125 mg, 250 mg. Suspension.

Glycopeptide antibiotic active against most gram-positive pathogens including Staphylococcus (including MRSA and coagulase-negative staphylococci), S. pneumoniae including penicillin-resistant strains, Enterococcus (resistance is increasing), and C. difficile–associated colitis.

Neonates: Postnatal age ≤7 days, 1,200 g: 15 mg/kg/24 hr divided q 24 hr IV; 1,200-2,000 g: 15 mg/kg/24 hr divided q 12-18 hr IV;

2,000 g: 30 mg/kg/24 hr divided q 12 hr IV; postnatal age 7

days, 1,200 g: 15 mg/kg/24 hr divided q 24 hr IV; 1,200-2,000 g:

15 mg/kg/24 hr divided q 8-12 hr IV; 2,000 g: 45 mg/kg/24 hr

divided q 8 hr IV.

Children: 45-60 mg/kg/24 hr divided q 8-12 hr IV; C. difficile– associated colitis; 40-50 mg/kg/24 hr divided q 6-8 hr PO.

40-50 mg/kg/24 hr divided q 6-8 hr PO.

Cautions: Ototoxicity and nephrotoxicity particularly when co-administered with other ototoxic and nephrotoxic drugs.

Infuse IV over 45-60 min. Flushing (red man syndrome) associated with rapid IV infusions, fever, chills, phlebitis (central line is preferred). Renally eliminated.

Target serum concentrations: Peak (1 hr after

1 hr infusion) 30-40 mg/L; trough 5-10 mg/L.

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