Parenteral antibiotics | Infants ≤28 days | Infants >28 days |
Gram-positive cocci |
CA-MRSA not a concern (one of the following) |
Nafcillin or oxacillin | - GA ≤34 weeks:
- Age ≤7 days: 25 mg/kg IV every 12 hours
- Age >7 days: 25 mg/kg IV every 8 hours
- GA >34 weeks:
- Age ≤7 days: 25 mg/kg IV every 8 hours
- Age >7 days: 25 mg/kg IV every 6 hours
| - 100 to 200 mg/kg IV per day in 4 to 6 doses
|
CA-MRSA a concern (one of the following) |
Clindamycin¶ | - PMA ≤32 weeks: 5 mg/kg IV every 8 hours
- PMA 33 to 40 weeks: 7 mg/kg IV every 8 hours
- PMA >40 weeks: 9 mg/kg IV every 8 hours
| - 20 to 40 mg/kg IV per day in 3 or 4 doses
|
VancomycinΔ | - Loading dose: 20 mg/kg IV
- Maintenance dosing according to GA and serum creatinine as indicated below. The interval between the loading dose and the first maintenance dose should be the same as the dosing interval for the maintenance regimen. This dosing regimen was designed with a target trough concentration of 5 to 10 mg/L [1].
- GA ≤28 weeks:
- <0.5 mg/dL: 15 mg/kg IV every 12 hours
- 0.5 to 0.7 mg/dL: 20 mg/kg IV every 24 hours
- 0.8 to 1 mg/dL: 15 mg/kg IV every 24 hours
- 1.1. to 1.4 mg/dL: 10 mg/kg IV every 24 hours
- >1.4 mg/dL: 15 mg/kg IV every 48 hours
- GA >28 weeks:
- <0.7 mg/dL: 15 mg/kg IV every 12 hours
- 0.7 to 0.9 mg/dL: 20 mg/kg IV every 24 hours
- 1 to 1.2 mg/dL: 15 mg/kg IV every 24 hours
- 1.3 to 1.6 mg/dL: 10 mg/kg IV every 24 hours
- >1.6 mg/dL: 15 mg/kg IV every 48 hours
| - Refer to UpToDate content related to alternative methods of dosing vancomycin for children older than 28 days◊
|
Gram-negative organisms (one of the following) |
Gentamicin§ | - GA <30 weeks:
- Age ≤14 days: 5 mg/kg IV every 48 hours
- Age >14 days: 5 mg/kg IV every 36 hours
- GA 30 to 34 weeks:
- Age ≤10 days: 5 mg/kg IV every 36 hours
- Age >10 days: 5 mg/kg IV every 24 hours
- GA ≥35 weeks:
- Age ≤7 days: 4 mg/kg IV every 24 hours
- Age >7 days: 5 mg/kg IV every 24 hours
| - 6 to 7.5 mg/kg IV per day in 3 doses, or
- 5 to 7.5 mg/kg IV per day once daily
|
Amikacin§ | - GA <30 weeks:
- Age ≤14 days: 15 mg/kg IV every 48 hours
- Age >14 days: 15 mg/kg IV every 24 hours
- GA 30 to 34 weeks:
- Age ≤10 days: 15 mg/kg IV every 36 hours
- Age >10 days: 15 mg/kg IV every 24 hours
- GA ≥35 weeks:
- Age ≤7 days: 15 mg/kg IV every 24 hours
- Age >7 days: 18 mg/kg IV every 24 hours
| - 15 to 22.5 mg/kg IV per day in 2 or 3 doses or once daily
|
Cefotaxime¥ (if available) | | - 150 to 180 mg/kg IV per day in 3 doses
- 200 to 225 mg/kg IV per day in 4 doses for meningitis
|
Ceftazidime¥ (if cefotaxime not available) | - Age <7 days: 50 mg/kg IV every 12 hours
- Age ≥7 days: 50 mg/kg IV every 8 hours
| - 90 to 150 mg/kg IV per day in 3 doses
- 200 to 300 mg/kg IV per day in 3 doses for suspected Pseudomonas (severe infection)
|
Ceftriaxone¥‡ (if cefotaxime not available) | - 50 mg/kg IV every 24 hours
| - 50 to 75 mg/kg IV per day
- 100 mg/kg IV per day in 1 or 2 doses for meningitis
|
Gram stain not available or no organisms seen |
CA-MRSA not a concern |
Nafcillin or oxacillin, plus one of the following: - Gentamicin§
- Amikacin§
- Cefotaxime¥
- Ceftazidime¥
- Ceftriaxone¥
| - Dosing regimens provided above
|
CA-MRSA a concern |
Clindamycin¶ or vancomycin, plus one of the following: - Gentamicin§
- Amikacin§
- Cefotaxime¥
- Ceftazidime¥
- Ceftriaxone¥
| - Dosing regimens provided above
|