Bacteria | Antibiotic | Pediatric dose* | Adult dose | Comments |
Staphylococcus aureus (methicillin-sensitive) | Cefazolin | 100 mg/kg per day in 3 or 4 divided doses | 1.5 g every 6 hours or 2 g every 8 hours | Maximum 6 g per day. |
OR | ||||
Nafcillin | 100 to 200 mg/kg per day in 4 or 6 divided doses | 2 g every 4 to 6 hours | Maximum 12 g per day. | |
Oral regimens (for mild exacerbations)¶ | ||||
One of the following, guided by susceptibility testing:
| ||||
S. aureus (methicillin-resistant)[1] | Vancomycin◊ | 60 mg/kg per day in 3 (or 4) divided doses | 45 to 60 mg/kg per day in 3 divided doses | Maximum 3.6 g per day for children and 4.0 g per day for adults. These doses are for patients with normal renal function. Dose and frequency are adjusted based on serum vancomycin concentrations, using either trough-directed or AUC-guided dosing§. To reduce the risk of renal toxicity, a beta-lactam other than piperacillin-tazobactam should be selected when being used in combination with vancomycin and tobramycin[2]. |
OR | ||||
Linezolid | Children <12 years: Use adult dose | 600 mg intravenously or orally every 12 hours | Risk of myelosuppression (most commonly thrombocytopenia) with treatment >14 days or when renal insufficiency is present[3]. | |
OR | ||||
Ceftaroline | 45 mg/kg per day intravenously in 3 divided doses | 600 mg intravenously every 8 hours | Maximum 1800 mg per day. | |
Oral regimens¶ | ||||
One of the following, guided by susceptibility testing:
| ||||
Pseudomonas aeruginosa | One of the following: | |||
Piperacillin-tazobactam¥‡ | 350 to 450 mg/kg† per day in 4 divided doses | 4.5 g every 6 hours | Maximum 16 g† per day. | |
Ceftazidime¥ | 150 to 200 mg/kg per day in 3 or 4 divided doses | 2 g every 6 to 8 hours | Maximum 8 g per day. | |
Cefepime | 150 mg/kg per day in 3 divided doses | 2 g every 8 hours | Maximum 6 g per day. | |
Imipenem-cilastatin | 60 to 100 mg/kg per day in 4 divided doses | 0.5 to 1 g every 6 hours | Maximum 4 g per day. | |
Meropenem | 120 mg/kg per day in 3 divided doses | 2 g every 8 hours | Maximum 6 g per day. | |
Ticarcillin-clavulanate¥‡ | 400 mg/kg** per day in 4 or 6 divided doses | 3.1 g every 4 to 6 hours | Maximum 18 g** per day. | |
PLUS | ||||
Ciprofloxacin | Oral dose: 30 mg/kg per day in 3 divided doses | Oral dose: 400 mg every 8 to 12 hours | Maximum dose:
Can be used in preference to aminoglycoside or colistin due to less toxicity, particularly when Pseudomonas is sensitive. | |
OR | ||||
Levofloxacin | Oral and intravenous dose:
| Oral and intravenous dose:
| Maximum dose:
Can be used in preference to an aminoglycoside or colistin due to less toxicity, particularly when in vitro testing demonstrates that the P. aeruginosa is sensitive to levofloxacin. | |
OR | ||||
Tobramycin¶¶,ΔΔ | 10 mg/kg every 24 hours | 10 mg/kg every 24 hours | Refer to the UpToDate topic on treatment of acute pulmonary exacerbations for a discussion of serum concentration monitoring for aminoglycosides and for dose and interval adjustment for renal insufficiency. Dose and frequency from a previous course that achieved the therapeutic range may be considered for determining the initial dose. | |
OR | ||||
Amikacin¶¶,ΔΔ | 30 to 35 mg/kg every 24 hours | 30 to 35 mg/kg every 24 hours | ||
OR | ||||
Colistin (colistimethate sodium) | 2.5 to 5 mg/kg◊◊ (colistin base activity§§) per day in 3 divided doses | 2.5 to 5 mg/kg◊◊ (colistin-base activity§§) per day in 3 divided doses | Maximum 300 mg per day (colistin-base activity§§). Colistin is a second-line drug that may be useful when the P. aeruginosa demonstrates in vitro resistance to all aminoglycosides or when the patient fails to improve on an aminoglycoside-containing regimen. IMPORTANT: Dose units and recommended dosing regimens vary by product and country. Doses shown here are specific to United States-licensed information for Coly-Mycin M, which labels its product as units of "colistin-base activity"§§. Consult local official product information for details before using this agent. | |
S. aureus (methicillin-sensitive) AND P. aeruginosa | Same antibiotics shown above for P. aeruginosa alone EXCEPT that ceftazidime should not be used, because of poor activity against S. aureus. | |||
S. aureus (methicillin-resistant) AND P. aeruginosa | Same antibiotics shown above for P. aeruginosa alone. | |||
PLUS one of the following (3 antibiotics total): | ||||
Vancomycin◊ | 60 mg/kg per day in 3 (or 4) divided doses | 45 to 60 mg/kg per day in 3 divided doses | Maximum 3.6 g per day for children and 4.0 g per day for adults. These doses are for patients with normal renal function. Dose and frequency are adjusted based on serum vancomycin concentrations, using either trough-directed or AUC-guided dosing§. To reduce the risk of renal toxicity, a beta-lactam other than piperacillin-tazobactam should be selected when being used in combination with vancomycin and tobramycin[2]. | |
OR | ||||
Linezolid | Children <12 years: Use adult dose | 600 mg intravenously or orally every 12 hours | Risk of myelosuppression (most commonly thrombocytopenia) with treatment >14 days or when renal insufficiency is present[3]. |