PAEDIATRICS ANTIMICROBIAL DOSING GUIDELINE (1month - 12 years old)

HOSPITAL UiTM PUNCAK ALAM

*For neonates(<1 month), please refer IBM Micromedex Neofax 2020 UNLESS if the neonate dosing stated in
this guideline

Prepared by : Fara Nabila Mohamed Raseli (Pharmacist)

Afzan Raihan Izzati Hamzah (Pharmacist)
Reviewed by : Dr Lew Sook Weih
Reviewed Date : 12th April 2022

ORAL PREPARATIONS
No. Antimicrobial Dose
1. Acyclovir 200mg/5ml Varicella zoster (chickenpox) & Herpes zoster
Suspension (shingles) treatment [7];
1m - 23m: 200mg 4 times a day for 5 days
2y - 5y: 400mg 4 times a day for 5 days
6y - 11y: 800mg 4 times a day for 5 days
12y - 17y: 800mg 5 times a day for 7 days
Herpes simplex treatment [7];
1m - 23m: 100mg 5 times a day usually for 5
days (longer if new lesions appear during
treatment or if healing incomplete)
2y - 17y: 200mg 5 times a day usually for 5
days (longer if new lesions appear during
treatment or if healing incomplete)
2. Amoxicillin 250mg/5ml High dose: 25mg/kg/dose TDS
Suspension [Max: 500mg/dose][2]
3. Amoxicillin 200mg + 20-25mg amoxicillin/kg/dose BD
Clavunic Acid 28.5mg in [Max: 875mg amoxicillin/dose][2]
5ml Suspension [7:1]
Renal Impairment Dose
For herpes zoster(shingles)[7];
- 10-25ml/min/1.73m²2: 100% oral
dose every 8H
- <10ml/min/1.73m²: 100% oral dose
every 12H
For herpes simplex [7];
- <10ml/min/1.73m²: 100% normal
dose every 12H
Dosing based on high dose
80-90mg/kg/day divided every 12H
[2]:
- >30mL/min/1.73m²: No adjustment
required
- 10-29 mL/min/1.73m²:
20mg/kg/dose every 12H
- <10mL/min/1.73m²: 20mg/kg/dose
every 24H
- Hemodialysis: 20mg/kg/dose every
24H; give after dialysis
- Peritoneal dialysis: 20mg/kg/dose
every 24H
Augmentin Product Insert [5];
- >30ml/min: No adjustment
- 30ml/min: suspension 228mg/5ml is
not recommended

4. Azithromycin 200mg/5ml 10mg/kg/dose OD D1[Max: 500mg/dose][2], No dosage adjustment [2]

Suspension then 5mg/kg/dose OD D2-D5
[Max: 250mg/dose][2]

OR

10mg/kg/dose OD D1-D3 [Max: 500mg/dose]

5 Cefuroxime 125mg/5ml 10-15mg/kg/dose BD [1,2] Renally adjusted dose
Suspension [Max: 500mg/dose][2] recommendations are based on doses
of 30mg/kg/day divided every 12H
[2];
- ≥30 mL/min/1.73m²: No adjustment
required
- 10-29 mL/min/1.73m²:
15mg/kg/dose every 12H
- <10mL/min/1.73m²: 15mg/kg/dose
every 24H
- Intermittent hemodialysis:
15mg/kg/dose every 24H
- Peritoneal dialysis (PD):
15mg/kg/dose every 24H
6. Cloxacillin Sodium 15mg/kg/dose QID No dosage adjustment [2]
125mg/5ml Suspension
7. Erythromycin 10mg/kg/dose QID Renally adjusted dose
Ethylsuccinate [Max: 2000mg/day][2] recommendations are based on oral
doses of 30-50mg/kg/day divided
400mg/5ml Suspension
every 6-8H [2];
- ≥ 10 mL/min/1.73 m2: No
adjustment required
- < 10 mL/min/1.73 m2: Intermittent
hemodialysis, peritoneal dialysis:
10-17mg/kg/dose every 8H
8. Metronidazole 10mg/ml 15mg/kg STAT, then 7.5mg/kg/dose TDS [6] No dosage adjustment [2]
Suspension [Max: 2250mg/day][2]

9. Phenoxymethylpenicillin 25-50mg/kg/day in divided every 6H No dosage adjustment [2]

125mg/5ml Suspension [Max: 2000mg/day][2]
[Penicillin V]

10. Sulphametoxazole General: 4mg TMP/kg/dose BD Renally adjusted dose

200mg + Trimethoprim UTI prophylaxis: 2mg TMP/kg/dose ON recommendations are based on doses
of 3-5mg TMP/kg/dose every 12H [2];
40mg in 5ml Suspension [Max: 160mg TMP/dose][2]
- >50ml/min/1.73m²: No adjustment
- 10-50ml/min/1.73m²: 4mg
TMP/kg/dose every 18H
- <10ml/min/1.73m²: 4mg
TMP/kg/dose every 24H
INJECTABLE PREPARATIONS
No. Antimicrobial Dose Renal Impairment Dose
1 Inj Acyclovir 250mg Usual: Schwartz[3]
10-20 mg/kg 8hourly[4] ≥ 50 ml/min/1.73m²: No adjustment
25-50 ml/min/1.73m²: 100% 12hourly
Perinatally acquired varicella: 10-25 ml/min/1.73m²: 100% 24hourly
10-15 mg/kg 8hourly [3] < 10 ml/min/1.73m²: 50% 24hourly
2 Inj Amikacin 25mg/kg stat, then 18mg/kg 24hourly [1] Schwartz[3]
250mg/2ml < 50 ml/min/1.73m²: Longer interval
For Neonates(<1month), refer dosing chart needed
below: Adjust dose based on TDM level
PMA Postnatal Dosage
age
 0-7 days 14mg/kg/dose
48hly

<29 8-28 days 12mg/kg/dose

weeks 36hly

≥29 days 12mg/kg/dose

24hly

0-7 days 12mg/kg/dose

30-34 36hly
weeks
≥8 days 12mg/kg/dose
24hly

≥35 ALL 12mg/kg/dose

weeks 24hly
[8]

3 Inj Amoxicillin/ < 3 months: 30mg/kg/dose 12hourly [6] Cockcroft-Gault[4]

Clavulanic Acid >3 months: 30mg/kg/dose 8hourly[6] ≥ 30 ml/min: No adjustment
1000mg/200mg 10-29 ml/min: 100% 12hourly
(1200mg) *Dose are based on Co-Amoxiclav < 10 ml/min: 100% 24hourly
(Amoxicillin & Clavulanate) combination
4 Inj Ampicillin 500mg 25-50 mg/kg 6hourly (Max:2g/dose)[1] Schwartz[2]
≥ 50 ml/min/1.73m²: No adjustment
30-50 ml/min/1.73m²: 35-50mg/kg
6hourly
10-29 ml/min/1.73m²: 35-50mg/kg
8-12hourly
< 10 ml/min/1.73m²: 35-50mg/kg
12hourly
5 Inj 37.5-75 mg/kg 6hourly of Unasyn Schwartz[2]
Ampicillin/Sulbactam (Ampicillin & Sulbactam) combination ≥ 30 ml/min/1.73m²: No adjustment
1000mg/500mg (Max 3g/dose) 15-29 ml/min/1.73m²: 100% 12hourly
(1500mg) [2][6] 5-14 ml/min/1.73m²: 100% 24hourly

6 Inj Azithromycin 10mg/kg OD on D1(Max: 500mg/dose),

then 5mg/kg/OD on D2-D5
(Max: 250mg/dose)
[4] No dosage adjustment

or

15mg/kg OD D1(Max: 500mg/dose), then

5mg/kg OD D2-D5 (Max: 250mg/dose)
[1]

7 Inj BenzylPenicillin Tonsillitis/Pharyngitis: 25, 000 u/kg Schwartz[2]

(1 MU/600mg) 6hourly[3] Uremic patients with
(5 MU/3000mg) Pneumonia: 50,000 u/kg 6hourly[4] > 10 ml/min/1.73m²: 100% stat, then
1mg = 1667u Meningitis: 100,000 u/kg 6hourly[4] 50% 4-5 hourly
< 10 ml/min/1.73m²: 100% stat then
Meningitis For Neonates(<1month): 50% 8-10 hourly
100,000 u/kg/dose
Refer Dosing Interval Chart below
 Dosing Interval Chart

PMA PostNatal Interval

(Weeks) (Days) (Hours)

0 to 28 12
≤29
>28 8

0 to 14 12
30 to 36
>14 8

0 to 7 12
37 to 44
>7 8

≥45 ALL 6
[8]
8 Inj Cefepime 1g 25-50mg/kg 8-12hourly[1] Cockcroft-Gault[4]
30-50 ml/min: 50mg/kg 12hourly
10-29 ml/min: 50mg/kg 24hourly
< 10 ml/min: 25mg/kg 24hourly

9 Inj Cefotaxime 500mg 25-50mg/kg 6hourly [1] Schwartz[2]

25-50mg/kg 8hourly (if neonate first week of
life)[1]
≥ 50 ml/min/1.73m²: No adjustment
30-50 ml/min/1.73m²: 35-70mg/kg
8-12hourly
10-29 ml/min/1.73m²: 35-70mg/kg
12hourly
< 10 ml/min/1.73m²: 35-70mg/kg
24hourly

10 Inj Ceftazidime 2g 25-50 mg/kg 6-8hourly Schwartz[2]

(Max:2g/dose) ≥ 50 ml/min/1.73m²: No adjustment
[1] 30-50 ml/min/1.73m²: 50mg/kg
12hourly
10-29 ml/min/1.73m²: 50mg/kg
24hourly
< 10 ml/min/1.73m²: 50mg/kg
48hourly

11 Inj Ceftriaxone 1g 50-100mg/kg/day in 1-2 divided doses No dosage adjustment[2]

(Max:2g/dose)
[1]
12 Inj Cefuroxime 750mg 25mg/kg/dose 8hourly Schwartz[2]
[1] ≥ 30 ml/min/1.73m²: No adjustment
10-29 ml/min/1.73m²: 100% 12hourly
< 10 ml/min/1.73m²: 100% 24hourly

13 Inj Cloxacillin 500mg 15mg/kg 6hourly[1] No adjustment[2]

25-50mg/kg 6 hourly (Severe)
(Max: 2g/dose)
[1]
14 Inj Fluconazole 6-12mg/kg stat, then 3-12mg/kg 24hourly Schwartz[2]
100mg/50ml (Max:600mg/day) > 50 ml/min/1.73m²: No adjustment
[2] ≤ 50 ml/min/1.73m²: 50% 24hourly
15 Inj Gentamicin 1month-10 years:8mg/kg stat, 6mg/kg Adjust dose based on TDM level[2]
80mg/2ml 24hourly [1] Lower dose should be used in renal
10 years - 12 years:7mg/kg stat, 5mg/kg adjustment
24hourly [1]

Synergistic cover for Meningitis For

Neonates(<1month) with Benzylpenicillin
Inj: Refer Dosing Chart below:

Dosing Chart

PMA Postnatal Dose Interval

(weeks) (days) (mg/ (hours)
kg)

0 to 7 5 48

≤29* 8 to 28 4 26

≥29 4 24

0 to 7 4.5 36
30 to 34
≥8 4 24

≥35 ALL 4 24

*or significant asphyxia,PDA, or

treatment with indomethacin
[8]
16 Inj Imipenem/Cilastin 15-25mg/kg 6 hourly [1] Schwartz[2]
500mg/500mg >50 ml/min/1.73m²: No adjustment
30-50 ml/min/1.73m²: 7-13mg/kg
8hourly
10-29 ml/min/1.73m²: 7.5-12.5mg/kg
12hourly
< 10 ml/min/1.73m²: 7.5-12.5mg/kg
24hourly

17 Inj Meropenem 1g 10-20mg/kg 8hourly Schwartz[2]

(Max:1g/dose) >50 ml/min/1.73m²: No adjustment
[1] 30-50 ml/min/1.73m²: 100%
Meningitis: 20-40mg/kg 8hourly 12hourly
(Max:2g/dose) 10-29 ml/min/1.73m²: 50% 12hourly
[1] < 10 ml/min/1.73m²: 50% 24hourly

18 Inj Metronidazole 15mg/kg/dose stat, 7.5mg/kg 8hourly No adjustment[2]

500mg/100ml (Max:500mg/dose)
[1]

19 Inj Piperacillin/ 90-112.5mg/kg 8hourly Schwartz[2]

Tazobactam 4g/0.5g (Max:18g/day) >50 ml/min/1.73m²: No adjustment
[3] 30-50 ml/min/1.73m²: 40-56mg/kg of
Pip-Tazo 6hourly
 *Dose are based on Pip-Tazo <30 ml/min/1.73m²: 40-56mg/kg of
(Piperacillin-Tazobactam combination) Pip-Tazo 8hourly
20 Inj Sulfamethoxazole/ 4mg/kg 12hourly of Trimethoprim base Schwartz[2]
Trimethoprim (TMP) >50 ml/min/1.73m²: No adjustment
400mg/80mg (Max: 160mg/dose of TMP base) 10-50 ml/min/1.73m²: 4mg/kg/dose
[1] of TMP 18hourly
Severe infection/PCP/Meningitis: <10 m
15-20mg/kg/day of TMP base divided
6-8hourly
[3] l/min/1.73m²: 4mg/kg/dose of TMP
Avoid in infants <6 weeks [6] 24hourly

21 Inj Vancomycin 500mg 15-20mg/kg 8-12hourly Adjust dose based on TDM level
(Max:2g/dose or 4g/day) Schwartz [2]
[1] >50 ml/min/1.73m²: No adjustment
30-50 ml/min/1.73m²: 10mg/kg
12hourly
10-29 ml/min/1.73m²: 10mg/kg
18-24hourly
<10 ml/min/1.73m²: 10mg/kg/dose
stat, then adjust accordingly based on
TDM level

References:
1. Drug Doses Frank Shann 17th Edition, 2017
2. Taketomo CK, Hodding, JH, Kraus DM. Paediatric & Neonatal Dosage Handbook, 22nd ed.
USA:Lexi-Comp, Inc;2015
3. Paediatrics Injectable Antibiotics Dilution Protocol 2018 (Hospital Sungai Buloh)
4. National Antimicrobial Guideline 3rd Edition, 2019
5. Augmentin Product Insert.
6. Formulari Ubat Kementerian Kesihatan Malaysia.
7. BNF for Children, 2020 - 2021.
8. Micromedex NeoFax Essentials 2020