Usual Adult Dose for Bacteremia

15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Comments:

• Heavier patients should not exceed 1.5 grams/day.
• Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
• Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
• Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.

Uses:
Short-term treatment of susceptible strains of Gram-negative bacteria, including Pseudomonas species, Escherichia coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species causing the following infections:

• Bacterial septicemia
• Serious infections of the bones and joints, burns, intraabdominal infections, respiratory tract, skin and soft tissue
• Serious postoperative infections, including postvascular surgery
• Initial/empirical therapy in severe infection, with suspected gram-negative, staphylococcal, or mixed staphylococcal/gram-negative infections, or in patients allergic to other antibiotics

Surgical Infection Society (SIS) and Infectious Diseases Society of America (IDSA) Recommendations:
15 to 20 mg/kg IV every 24 hours

Comments:

• Initial doses should be based on body weight.
• Maintenance doses should be determined by concentration monitoring.

Uses:

• Empirical treatment of patients with healthcare-associated intra-abdominal infections
• Treatment of patients with severe reactions to beta-lactam antibiotics who have complicated intra-abdominal infections

American Thoracic Society (ATS) and IDSA Recommendations:
10 to 15 mg/kg IV once a day OR 25 mg/kg IV 3 times a week
Duration of therapy:

• Initial therapy: At least 2 weeks
• Serious skin and soft tissue infections: At least 4 months
• Bone infections: At least 6 months

Comments:

• Patients 50 years of age and older or those with prolonged treatment (greater than 3 weeks) should be given lower daily doses (10 mg/kg/day).
• This drug should be given with azithromycin, clarithromycin, high-dose cefoxitin, or imipenem.

Use: Treatment of serous skin, soft tissue, and bone infections caused by Mycoplasma abscessus

Usual Adult Dose for Intraabdominal Infection

15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Comments:

• Heavier patients should not exceed 1.5 grams/day.
• Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
• Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
• Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.

Uses:
Short-term treatment of susceptible strains of Gram-negative bacteria, including Pseudomonas species, Escherichia coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species causing the following infections:

• Bacterial septicemia
• Serious infections of the bones and joints, burns, intraabdominal infections, respiratory tract, skin and soft tissue
• Serious postoperative infections, including postvascular surgery
• Initial/empirical therapy in severe infection, with suspected gram-negative, staphylococcal, or mixed staphylococcal/gram-negative infections, or in patients allergic to other antibiotics

Surgical Infection Society (SIS) and Infectious Diseases Society of America (IDSA) Recommendations:
15 to 20 mg/kg IV every 24 hours

Comments:

• Initial doses should be based on body weight.
• Maintenance doses should be determined by concentration monitoring.

Uses:

• Empirical treatment of patients with healthcare-associated intra-abdominal infections
• Treatment of patients with severe reactions to beta-lactam antibiotics who have complicated intra-abdominal infections

American Thoracic Society (ATS) and IDSA Recommendations:
10 to 15 mg/kg IV once a day OR 25 mg/kg IV 3 times a week
Duration of therapy:

• Initial therapy: At least 2 weeks
• Serious skin and soft tissue infections: At least 4 months
• Bone infections: At least 6 months

Comments:

• Patients 50 years of age and older or those with prolonged treatment (greater than 3 weeks) should be given lower daily doses (10 mg/kg/day).
• This drug should be given with azithromycin, clarithromycin, high-dose cefoxitin, or imipenem.

Use: Treatment of serous skin, soft tissue, and bone infections caused by Mycoplasma abscessus

Usual Adult Dose for Joint Infection

15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Comments:

• Heavier patients should not exceed 1.5 grams/day.
• Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
• Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
• Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.

Uses:
Short-term treatment of susceptible strains of Gram-negative bacteria, including Pseudomonas species, Escherichia coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species causing the following infections:

• Bacterial septicemia
• Serious infections of the bones and joints, burns, intraabdominal infections, respiratory tract, skin and soft tissue
• Serious postoperative infections, including postvascular surgery
• Initial/empirical therapy in severe infection, with suspected gram-negative, staphylococcal, or mixed staphylococcal/gram-negative infections, or in patients allergic to other antibiotics

Surgical Infection Society (SIS) and Infectious Diseases Society of America (IDSA) Recommendations:
15 to 20 mg/kg IV every 24 hours

Comments:

• Initial doses should be based on body weight.
• Maintenance doses should be determined by concentration monitoring.

Uses:

• Empirical treatment of patients with healthcare-associated intra-abdominal infections
• Treatment of patients with severe reactions to beta-lactam antibiotics who have complicated intra-abdominal infections

American Thoracic Society (ATS) and IDSA Recommendations:
10 to 15 mg/kg IV once a day OR 25 mg/kg IV 3 times a week
Duration of therapy:

• Initial therapy: At least 2 weeks
• Serious skin and soft tissue infections: At least 4 months
• Bone infections: At least 6 months

Comments:

• Patients 50 years of age and older or those with prolonged treatment (greater than 3 weeks) should be given lower daily doses (10 mg/kg/day).
• This drug should be given with azithromycin, clarithromycin, high-dose cefoxitin, or imipenem.

Use: Treatment of serous skin, soft tissue, and bone infections caused by Mycoplasma abscessus

Usual Adult Dose for Osteomyelitis

15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Comments:

• Heavier patients should not exceed 1.5 grams/day.
• Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
• Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
• Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.

Uses:
Short-term treatment of susceptible strains of Gram-negative bacteria, including Pseudomonas species, Escherichia coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species causing the following infections:

• Bacterial septicemia
• Serious infections of the bones and joints, burns, intraabdominal infections, respiratory tract, skin and soft tissue
• Serious postoperative infections, including postvascular surgery
• Initial/empirical therapy in severe infection, with suspected gram-negative, staphylococcal, or mixed staphylococcal/gram-negative infections, or in patients allergic to other antibiotics

Surgical Infection Society (SIS) and Infectious Diseases Society of America (IDSA) Recommendations:
15 to 20 mg/kg IV every 24 hours

Comments:

• Initial doses should be based on body weight.
• Maintenance doses should be determined by concentration monitoring.

Uses:

• Empirical treatment of patients with healthcare-associated intra-abdominal infections
• Treatment of patients with severe reactions to beta-lactam antibiotics who have complicated intra-abdominal infections

American Thoracic Society (ATS) and IDSA Recommendations:
10 to 15 mg/kg IV once a day OR 25 mg/kg IV 3 times a week
Duration of therapy:

• Initial therapy: At least 2 weeks
• Serious skin and soft tissue infections: At least 4 months
• Bone infections: At least 6 months

Comments:

• Patients 50 years of age and older or those with prolonged treatment (greater than 3 weeks) should be given lower daily doses (10 mg/kg/day).
• This drug should be given with azithromycin, clarithromycin, high-dose cefoxitin, or imipenem.

Use: Treatment of serous skin, soft tissue, and bone infections caused by Mycoplasma abscessus

Usual Adult Dose for Pneumonia

15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Comments:

• Heavier patients should not exceed 1.5 grams/day.
• Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
• Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
• Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.

Uses:
Short-term treatment of susceptible strains of Gram-negative bacteria, including Pseudomonas species, Escherichia coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species causing the following infections:

• Bacterial septicemia
• Serious infections of the bones and joints, burns, intraabdominal infections, respiratory tract, skin and soft tissue
• Serious postoperative infections, including postvascular surgery
• Initial/empirical therapy in severe infection, with suspected gram-negative, staphylococcal, or mixed staphylococcal/gram-negative infections, or in patients allergic to other antibiotics

Surgical Infection Society (SIS) and Infectious Diseases Society of America (IDSA) Recommendations:
15 to 20 mg/kg IV every 24 hours

Comments:

• Initial doses should be based on body weight.
• Maintenance doses should be determined by concentration monitoring.

Uses:

• Empirical treatment of patients with healthcare-associated intra-abdominal infections
• Treatment of patients with severe reactions to beta-lactam antibiotics who have complicated intra-abdominal infections

American Thoracic Society (ATS) and IDSA Recommendations:
10 to 15 mg/kg IV once a day OR 25 mg/kg IV 3 times a week
Duration of therapy:

• Initial therapy: At least 2 weeks
• Serious skin and soft tissue infections: At least 4 months
• Bone infections: At least 6 months

Comments:

• Patients 50 years of age and older or those with prolonged treatment (greater than 3 weeks) should be given lower daily doses (10 mg/kg/day).
• This drug should be given with azithromycin, clarithromycin, high-dose cefoxitin, or imipenem.

Use: Treatment of serous skin, soft tissue, and bone infections caused by Mycoplasma abscessus

Usual Adult Dose for Skin or Soft Tissue Infection

15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Comments:

• Heavier patients should not exceed 1.5 grams/day.
• Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
• Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
• Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.

Uses:
Short-term treatment of susceptible strains of Gram-negative bacteria, including Pseudomonas species, Escherichia coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species causing the following infections:

• Bacterial septicemia
• Serious infections of the bones and joints, burns, intraabdominal infections, respiratory tract, skin and soft tissue
• Serious postoperative infections, including postvascular surgery
• Initial/empirical therapy in severe infection, with suspected gram-negative, staphylococcal, or mixed staphylococcal/gram-negative infections, or in patients allergic to other antibiotics

Surgical Infection Society (SIS) and Infectious Diseases Society of America (IDSA) Recommendations:
15 to 20 mg/kg IV every 24 hours

Comments:

• Initial doses should be based on body weight.
• Maintenance doses should be determined by concentration monitoring.

Uses:

• Empirical treatment of patients with healthcare-associated intra-abdominal infections
• Treatment of patients with severe reactions to beta-lactam antibiotics who have complicated intra-abdominal infections

American Thoracic Society (ATS) and IDSA Recommendations:
10 to 15 mg/kg IV once a day OR 25 mg/kg IV 3 times a week
Duration of therapy:

• Initial therapy: At least 2 weeks
• Serious skin and soft tissue infections: At least 4 months
• Bone infections: At least 6 months

Comments:

• Patients 50 years of age and older or those with prolonged treatment (greater than 3 weeks) should be given lower daily doses (10 mg/kg/day).
• This drug should be given with azithromycin, clarithromycin, high-dose cefoxitin, or imipenem.

Use: Treatment of serous skin, soft tissue, and bone infections caused by Mycoplasma abscessus

Usual Adult Dose for Urinary Tract Infection

Serious complicated/recurrent urinary tract infections: 15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals
Uncomplicated urinary tract infections: 250 mg IM or IV (over 30 to 60 minutes) 2 times a day
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Comments:

• Heavier patients should not exceed 1.5 grams/day.
• Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
• Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
• Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.
• This drug should not be used to treat initial uncomplicated urinary tract infections unless the causative organisms are not susceptible to less potent antibiotics.

Uses:

• Short-term treatment of serious complicated and recurrent urinary tract infections caused by susceptible strains of Gram-negative bacteria, including Pseudomonas species, E coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species
• Uncomplicated initial episodes of urinary tract infections caused by organisms not susceptible to antibiotics having less potential toxicity

Usual Adult Dose for Meningitis

15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Comments:

• Heavier patients should not exceed 1.5 grams/day.
• Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
• Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
• Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.

Use: Treatment of meningitis and serious infections of the central nervous system caused by susceptible strains of Gram-negative bacteria, including Pseudomonas species, E coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species

IDSA, American Academy of Neurology (AAN), American Association of Neurological Surgeons (AANS), and Neurocritical Care Society (NCS) Recommendations:
Healthcare-Associated Ventriculitis and Meningitis:
IV: 15 mg/kg IV per day, given in divided doses every 8 hours
Intraventricular: 5 to 50 mg via intraventricular route once a day

Duration of therapy:

• Neisseria meningitis or Haemophilus influenzae: 7 days
• Coagulase-negative staphylococcus or Propionibacterium acnes with no/minimal cerebrospinal fluid pleocytosis, normal CSF glucose, few symptoms/systemic features: 10 days
• Coagulase-negative staphylococcus or P acnes with significant CSF pleocytosis, Staphylococcus aureus or gram-negative bacilli with/without significant CSF pleocytosis, CSF hypoglycorrhachia, or symptoms/systemic features: 10 to 14 days
• Streptococcus pneumoniae: 10 to 14 days
• Streptococcus agalactiae: 14 to 21 days
• Aerobic gram-negative bacilli: 21 days
• Listeria monocytogenes: At least 21 days
• Repeatedly positive CSF cultures on appropriate antimicrobial treatment: Continue treatment for 10 to 14 days after the last positive culture

Comments:

• The usual intraventricular dose was 30 mg/day.
• The intraventricular drain should be clamped for approximately 15 to 60 minutes to allow the drug to equilibrate.

Use: Treatment of healthcare-associated ventriculitis and meningitis

Usual Adult Dose for Peritonitis

15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Comments:

• Heavier patients should not exceed 1.5 grams/day.
• Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
• Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
• Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.

Use: Treatment of peritonitis caused by susceptible strains of Gram-negative bacteria, including Pseudomonas species, E coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species

International Society for Peritoneal Dialysis (ISPD) Recommendations:
Intermittent (1 exchange daily): 2 mg/kg intraperitoneally once a day

Continuous (all exchanges):

• Loading dose: 25 mg/L
• Maintenance dose: 4 mg/L

Comments:

• Intermittent dosing is recommended, and should be allowed to dwell for at least 6 hours.
• Prolonged courses of treatment should be avoided.

Use: Treatment of peritonitis

Usual Adult Dose for Bacterial Infection

US Department of Health and Human Services (US HHS), National Institutes of Health (NIH), Health Resources and Services Administration (HRSA), and US Centers for Disease Control and Prevention (US CDC) Recommendations:
10 to 15 mg/kg IV once OR 25 mg/kg IV 3 times a week

Use: Treatment of mycobacterial infections

Usual Adult Dose for Tuberculosis - Active

ATS, US CDC, IDSA Recommendations:
15 mg/kg IM or IV once a day OR 25 mg IM or IV 3 times a week

Comment: Patients with renal dysfunction and/or those who are older may require 15 mg/kg given 3 times a week.

Use: Second-line treatment of drug-susceptible tuberculosis caused by susceptible organisms

Usual Adult Dose for Mycobacterium avium-intracellulare - Treatment

ATS and IDSA Recommendations:
Severe, extensive (multilobar) fibro cavitary disease OR previously treated disease: 25 mg/kg IV 3 times a week
Duration of therapy: 2 to 3 months

Nodular/bronchiectatic disease: 8 to 10 mg/kg IM or IV 2 to 3 times a week
Maximum dose: 500 mg/dose (patients older than 50 years)
Duration of therapy: At least 2 months (extensive disease)

Comment: A longer duration of therapy may be used in patients with very extensive disease and/or in those who cannot tolerate other agents.

US HHS, NIH, HRSA, and US CDC Recommendations:
10 to 15 mg/kg IV once a day

Comment: This drug may be considered as a third or fourth drug in patients with advanced immunosuppression (e.g., CD4 counts less than 50 cells/mcL), high mycobacterial loads (greater than 2 log CFU/mL), or in the absence of effective antiretroviral therapy.

Use: Third or fourth drug option as an alternative treatment in patients with disseminated Mycobacterium avium complex (MAC) disease

Usual Geriatric Dose for Bacteremia

15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Comments:

• Heavier patients should not exceed 1.5 grams/day.
• Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
• Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
• Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.

Use:
Short-term treatment of susceptible strains of Gram-negative bacteria, including Pseudomonas species, E coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species causing the following infections:

• Bacterial septicemia
• Serious infections of the bones and joints, burns, intraabdominal infections, respiratory tract, skin and soft tissue
• Serious postoperative infections, including postvascular surgery
• Initial/empirical therapy in severe infection, with suspected gram-negative, staphylococcal, or mixed staphylococcal/gram-negative infections, or in patients allergic to other antibiotics

ATS and IDSA Recommendations:
10 to 15 mg/kg IV once a day OR 25 mg/kg IV 3 times a week
Duration of therapy:

• Initial therapy: At least 2 weeks
• Serious skin and soft tissue infections: At least 4 months
• Bone infections: At least 6 months

Comments:

• Patients 50 years of age and older or those with prolonged treatment (greater than 3 weeks) should be given lower daily doses (10 mg/kg/day).
• This drug should be given with azithromycin, clarithromycin, high-dose cefoxitin, or imipenem.

Use: Treatment of serous skin, soft tissue, and bone infections caused by M abscessus

Usual Geriatric Dose for Intraabdominal Infection

15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Comments:

• Heavier patients should not exceed 1.5 grams/day.
• Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
• Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
• Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.

Use:
Short-term treatment of susceptible strains of Gram-negative bacteria, including Pseudomonas species, E coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species causing the following infections:

• Bacterial septicemia
• Serious infections of the bones and joints, burns, intraabdominal infections, respiratory tract, skin and soft tissue
• Serious postoperative infections, including postvascular surgery
• Initial/empirical therapy in severe infection, with suspected gram-negative, staphylococcal, or mixed staphylococcal/gram-negative infections, or in patients allergic to other antibiotics

ATS and IDSA Recommendations:
10 to 15 mg/kg IV once a day OR 25 mg/kg IV 3 times a week
Duration of therapy:

• Initial therapy: At least 2 weeks
• Serious skin and soft tissue infections: At least 4 months
• Bone infections: At least 6 months

Comments:

• Patients 50 years of age and older or those with prolonged treatment (greater than 3 weeks) should be given lower daily doses (10 mg/kg/day).
• This drug should be given with azithromycin, clarithromycin, high-dose cefoxitin, or imipenem.

Use: Treatment of serous skin, soft tissue, and bone infections caused by M abscessus

Usual Geriatric Dose for Joint Infection

15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Comments:

• Heavier patients should not exceed 1.5 grams/day.
• Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
• Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
• Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.

Use:
Short-term treatment of susceptible strains of Gram-negative bacteria, including Pseudomonas species, E coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species causing the following infections:

• Bacterial septicemia
• Serious infections of the bones and joints, burns, intraabdominal infections, respiratory tract, skin and soft tissue
• Serious postoperative infections, including postvascular surgery
• Initial/empirical therapy in severe infection, with suspected gram-negative, staphylococcal, or mixed staphylococcal/gram-negative infections, or in patients allergic to other antibiotics

ATS and IDSA Recommendations:
10 to 15 mg/kg IV once a day OR 25 mg/kg IV 3 times a week
Duration of therapy:

• Initial therapy: At least 2 weeks
• Serious skin and soft tissue infections: At least 4 months
• Bone infections: At least 6 months

Comments:

• Patients 50 years of age and older or those with prolonged treatment (greater than 3 weeks) should be given lower daily doses (10 mg/kg/day).
• This drug should be given with azithromycin, clarithromycin, high-dose cefoxitin, or imipenem.

Use: Treatment of serous skin, soft tissue, and bone infections caused by M abscessus

Usual Geriatric Dose for Osteomyelitis

15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Comments:

• Heavier patients should not exceed 1.5 grams/day.
• Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
• Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
• Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.

Use:
Short-term treatment of susceptible strains of Gram-negative bacteria, including Pseudomonas species, E coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species causing the following infections:

• Bacterial septicemia
• Serious infections of the bones and joints, burns, intraabdominal infections, respiratory tract, skin and soft tissue
• Serious postoperative infections, including postvascular surgery
• Initial/empirical therapy in severe infection, with suspected gram-negative, staphylococcal, or mixed staphylococcal/gram-negative infections, or in patients allergic to other antibiotics

ATS and IDSA Recommendations:
10 to 15 mg/kg IV once a day OR 25 mg/kg IV 3 times a week
Duration of therapy:

• Initial therapy: At least 2 weeks
• Serious skin and soft tissue infections: At least 4 months
• Bone infections: At least 6 months

Comments:

• Patients 50 years of age and older or those with prolonged treatment (greater than 3 weeks) should be given lower daily doses (10 mg/kg/day).
• This drug should be given with azithromycin, clarithromycin, high-dose cefoxitin, or imipenem.

Use: Treatment of serous skin, soft tissue, and bone infections caused by M abscessus

Usual Geriatric Dose for Pneumonia

15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Comments:

• Heavier patients should not exceed 1.5 grams/day.
• Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
• Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
• Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.

Use:
Short-term treatment of susceptible strains of Gram-negative bacteria, including Pseudomonas species, E coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species causing the following infections:

• Bacterial septicemia
• Serious infections of the bones and joints, burns, intraabdominal infections, respiratory tract, skin and soft tissue
• Serious postoperative infections, including postvascular surgery
• Initial/empirical therapy in severe infection, with suspected gram-negative, staphylococcal, or mixed staphylococcal/gram-negative infections, or in patients allergic to other antibiotics

ATS and IDSA Recommendations:
10 to 15 mg/kg IV once a day OR 25 mg/kg IV 3 times a week
Duration of therapy:

• Initial therapy: At least 2 weeks
• Serious skin and soft tissue infections: At least 4 months
• Bone infections: At least 6 months

Comments:

• Patients 50 years of age and older or those with prolonged treatment (greater than 3 weeks) should be given lower daily doses (10 mg/kg/day).
• This drug should be given with azithromycin, clarithromycin, high-dose cefoxitin, or imipenem.

Use: Treatment of serous skin, soft tissue, and bone infections caused by M abscessus

Usual Geriatric Dose for Skin or Soft Tissue Infection

15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Comments:

• Heavier patients should not exceed 1.5 grams/day.
• Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
• Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
• Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.

Use:
Short-term treatment of susceptible strains of Gram-negative bacteria, including Pseudomonas species, E coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species causing the following infections:

• Bacterial septicemia
• Serious infections of the bones and joints, burns, intraabdominal infections, respiratory tract, skin and soft tissue
• Serious postoperative infections, including postvascular surgery
• Initial/empirical therapy in severe infection, with suspected gram-negative, staphylococcal, or mixed staphylococcal/gram-negative infections, or in patients allergic to other antibiotics

ATS and IDSA Recommendations:
10 to 15 mg/kg IV once a day OR 25 mg/kg IV 3 times a week
Duration of therapy:

• Initial therapy: At least 2 weeks
• Serious skin and soft tissue infections: At least 4 months
• Bone infections: At least 6 months

Comments:

• Patients 50 years of age and older or those with prolonged treatment (greater than 3 weeks) should be given lower daily doses (10 mg/kg/day).
• This drug should be given with azithromycin, clarithromycin, high-dose cefoxitin, or imipenem.

Use: Treatment of serous skin, soft tissue, and bone infections caused by M abscessus

Usual Geriatric Dose for Tuberculosis - Active

ATS, US CDC, and IDSA Recommendations:
15 mg/kg IM or IV once a day OR 15 to 25 mg IM or IV 3 times a week

Comment: Patients with renal dysfunction and/or those who are older may require 15 mg/kg given 3 times a week.

Use: Second-line treatment of drug-susceptible tuberculosis caused by susceptible organisms

Usual Pediatric Dose for Bacteremia

Newborns:
Loading dose: 10 mg/kg IM once
Maintenance dose: 7.5 mg/kg IM or via IV infusion (over 1 to 2 hours) every 12 hours
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Older infants and children:
Serious complicated/recurrent urinary tract infections: 15 mg/kg IM or IV per day, given in 2 to 3 equal doses at equally divided intervals
Uncomplicated urinary tract infections: 250 mg IM or IV 2 times a day
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Older infants and children: 15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Comments:

• Infants should receive an IV infusion over 1 to 2 hours; children should be administered IV formulations over 30 to 60 minutes.
• Heavier patients should not exceed 1.5 grams/day.
• Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
• Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
• Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.
• Concomitant therapy with a penicillin-type agent may be needed in the treatment of neonatal sepsis.

Uses:
Short-term treatment of susceptible strains of Gram-negative bacteria, including Pseudomonas species, E coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species causing the following infections:

• Bacterial septicemia
• Neonatal sepsis
• Serious infections of the bones and joints, burns, intraabdominal infections, respiratory tract, skin and soft tissue
• Serious postoperative infections, including postvascular surgery
• Initial/empirical therapy in severe infection, with suspected gram-negative, staphylococcal, or mixed staphylococcal/gram-negative infections, or in patients allergic to other antibiotics

SIS and IDSA Recommendations:
15 to 22.5 mg/kg IV per day, given in divided doses every 8 to 24 hours

Comments:

• Initial doses should be based on body weight.
• Maintenance doses should be determined by concentration monitoring.

Uses:

• Treatment of patients with complicated intra-abdominal infections
• Treatment of patients with severe reactions to beta-lactam antibiotics who have complicated intra-abdominal infections

Usual Pediatric Dose for Intraabdominal Infection

Newborns:
Loading dose: 10 mg/kg IM once
Maintenance dose: 7.5 mg/kg IM or via IV infusion (over 1 to 2 hours) every 12 hours
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Older infants and children:
Serious complicated/recurrent urinary tract infections: 15 mg/kg IM or IV per day, given in 2 to 3 equal doses at equally divided intervals
Uncomplicated urinary tract infections: 250 mg IM or IV 2 times a day
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Older infants and children: 15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Comments:

• Infants should receive an IV infusion over 1 to 2 hours; children should be administered IV formulations over 30 to 60 minutes.
• Heavier patients should not exceed 1.5 grams/day.
• Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
• Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
• Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.
• Concomitant therapy with a penicillin-type agent may be needed in the treatment of neonatal sepsis.

Uses:
Short-term treatment of susceptible strains of Gram-negative bacteria, including Pseudomonas species, E coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species causing the following infections:

• Bacterial septicemia
• Neonatal sepsis
• Serious infections of the bones and joints, burns, intraabdominal infections, respiratory tract, skin and soft tissue
• Serious postoperative infections, including postvascular surgery
• Initial/empirical therapy in severe infection, with suspected gram-negative, staphylococcal, or mixed staphylococcal/gram-negative infections, or in patients allergic to other antibiotics

SIS and IDSA Recommendations:
15 to 22.5 mg/kg IV per day, given in divided doses every 8 to 24 hours

Comments:

• Initial doses should be based on body weight.
• Maintenance doses should be determined by concentration monitoring.

Uses:

• Treatment of patients with complicated intra-abdominal infections
• Treatment of patients with severe reactions to beta-lactam antibiotics who have complicated intra-abdominal infections

Usual Pediatric Dose for Joint Infection

Newborns:
Loading dose: 10 mg/kg IM once
Maintenance dose: 7.5 mg/kg IM or via IV infusion (over 1 to 2 hours) every 12 hours
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Older infants and children:
Serious complicated/recurrent urinary tract infections: 15 mg/kg IM or IV per day, given in 2 to 3 equal doses at equally divided intervals
Uncomplicated urinary tract infections: 250 mg IM or IV 2 times a day
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Older infants and children: 15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Comments:

• Infants should receive an IV infusion over 1 to 2 hours; children should be administered IV formulations over 30 to 60 minutes.
• Heavier patients should not exceed 1.5 grams/day.
• Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
• Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
• Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.
• Concomitant therapy with a penicillin-type agent may be needed in the treatment of neonatal sepsis.

Uses:
Short-term treatment of susceptible strains of Gram-negative bacteria, including Pseudomonas species, E coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species causing the following infections:

• Bacterial septicemia
• Neonatal sepsis
• Serious infections of the bones and joints, burns, intraabdominal infections, respiratory tract, skin and soft tissue
• Serious postoperative infections, including postvascular surgery
• Initial/empirical therapy in severe infection, with suspected gram-negative, staphylococcal, or mixed staphylococcal/gram-negative infections, or in patients allergic to other antibiotics

SIS and IDSA Recommendations:
15 to 22.5 mg/kg IV per day, given in divided doses every 8 to 24 hours

Comments:

• Initial doses should be based on body weight.
• Maintenance doses should be determined by concentration monitoring.

Uses:

• Treatment of patients with complicated intra-abdominal infections
• Treatment of patients with severe reactions to beta-lactam antibiotics who have complicated intra-abdominal infections

Usual Pediatric Dose for Osteomyelitis

Newborns:
Loading dose: 10 mg/kg IM once
Maintenance dose: 7.5 mg/kg IM or via IV infusion (over 1 to 2 hours) every 12 hours
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Older infants and children:
Serious complicated/recurrent urinary tract infections: 15 mg/kg IM or IV per day, given in 2 to 3 equal doses at equally divided intervals
Uncomplicated urinary tract infections: 250 mg IM or IV 2 times a day
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Older infants and children: 15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Comments:

• Infants should receive an IV infusion over 1 to 2 hours; children should be administered IV formulations over 30 to 60 minutes.
• Heavier patients should not exceed 1.5 grams/day.
• Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
• Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
• Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.
• Concomitant therapy with a penicillin-type agent may be needed in the treatment of neonatal sepsis.

Uses:
Short-term treatment of susceptible strains of Gram-negative bacteria, including Pseudomonas species, E coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species causing the following infections:

• Bacterial septicemia
• Neonatal sepsis
• Serious infections of the bones and joints, burns, intraabdominal infections, respiratory tract, skin and soft tissue
• Serious postoperative infections, including postvascular surgery
• Initial/empirical therapy in severe infection, with suspected gram-negative, staphylococcal, or mixed staphylococcal/gram-negative infections, or in patients allergic to other antibiotics

SIS and IDSA Recommendations:
15 to 22.5 mg/kg IV per day, given in divided doses every 8 to 24 hours

Comments:

• Initial doses should be based on body weight.
• Maintenance doses should be determined by concentration monitoring.

Uses:

• Treatment of patients with complicated intra-abdominal infections
• Treatment of patients with severe reactions to beta-lactam antibiotics who have complicated intra-abdominal infections

Usual Pediatric Dose for Pneumonia

Newborns:
Loading dose: 10 mg/kg IM once
Maintenance dose: 7.5 mg/kg IM or via IV infusion (over 1 to 2 hours) every 12 hours
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Older infants and children:
Serious complicated/recurrent urinary tract infections: 15 mg/kg IM or IV per day, given in 2 to 3 equal doses at equally divided intervals
Uncomplicated urinary tract infections: 250 mg IM or IV 2 times a day
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Older infants and children: 15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Comments:

• Infants should receive an IV infusion over 1 to 2 hours; children should be administered IV formulations over 30 to 60 minutes.
• Heavier patients should not exceed 1.5 grams/day.
• Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
• Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
• Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.
• Concomitant therapy with a penicillin-type agent may be needed in the treatment of neonatal sepsis.

Uses:
Short-term treatment of susceptible strains of Gram-negative bacteria, including Pseudomonas species, E coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species causing the following infections:

• Bacterial septicemia
• Neonatal sepsis
• Serious infections of the bones and joints, burns, intraabdominal infections, respiratory tract, skin and soft tissue
• Serious postoperative infections, including postvascular surgery
• Initial/empirical therapy in severe infection, with suspected gram-negative, staphylococcal, or mixed staphylococcal/gram-negative infections, or in patients allergic to other antibiotics

SIS and IDSA Recommendations:
15 to 22.5 mg/kg IV per day, given in divided doses every 8 to 24 hours

Comments:

• Initial doses should be based on body weight.
• Maintenance doses should be determined by concentration monitoring.

Uses:

• Treatment of patients with complicated intra-abdominal infections
• Treatment of patients with severe reactions to beta-lactam antibiotics who have complicated intra-abdominal infections

Usual Pediatric Dose for Skin or Soft Tissue Infection

Newborns:
Loading dose: 10 mg/kg IM once
Maintenance dose: 7.5 mg/kg IM or via IV infusion (over 1 to 2 hours) every 12 hours
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Older infants and children:
Serious complicated/recurrent urinary tract infections: 15 mg/kg IM or IV per day, given in 2 to 3 equal doses at equally divided intervals
Uncomplicated urinary tract infections: 250 mg IM or IV 2 times a day
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Older infants and children: 15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Comments:

• Infants should receive an IV infusion over 1 to 2 hours; children should be administered IV formulations over 30 to 60 minutes.
• Heavier patients should not exceed 1.5 grams/day.
• Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
• Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
• Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.
• Concomitant therapy with a penicillin-type agent may be needed in the treatment of neonatal sepsis.

Uses:
Short-term treatment of susceptible strains of Gram-negative bacteria, including Pseudomonas species, E coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species causing the following infections:

• Bacterial septicemia
• Neonatal sepsis
• Serious infections of the bones and joints, burns, intraabdominal infections, respiratory tract, skin and soft tissue
• Serious postoperative infections, including postvascular surgery
• Initial/empirical therapy in severe infection, with suspected gram-negative, staphylococcal, or mixed staphylococcal/gram-negative infections, or in patients allergic to other antibiotics

SIS and IDSA Recommendations:
15 to 22.5 mg/kg IV per day, given in divided doses every 8 to 24 hours

Comments:

• Initial doses should be based on body weight.
• Maintenance doses should be determined by concentration monitoring.

Uses:

• Treatment of patients with complicated intra-abdominal infections
• Treatment of patients with severe reactions to beta-lactam antibiotics who have complicated intra-abdominal infections

Usual Pediatric Dose for Meningitis

Newborns:
Loading dose: 10 mg/kg IM once
Maintenance dose: 7.5 mg/kg IM or via IV infusion (over 1 to 2 hours) every 12 hours
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Older infants and children:
Serious complicated/recurrent urinary tract infections: 15 mg/kg IM or IV per day, given in 2 to 3 equal doses at equally divided intervals
Uncomplicated urinary tract infections: 250 mg IM or IV 2 times a day
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Older infants and children: 15 mg/kg IM or IV (over 30 to 60 minutes) per day, given in 2 to 3 equal doses at equally divided intervals
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Comments:

• Infants should receive an IV infusion over 1 to 2 hours; children should be administered IV formulations over 30 to 60 minutes.
• Heavier patients should not exceed 1.5 grams/day.
• Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
• Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
• Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.

Use: Treatment of meningitis and serious infections of the central nervous system caused by susceptible strains of Gram-negative bacteria, including Pseudomonas species, E coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species

IDSA Recommendations:
Bacterial Meningitis:
0 to 7 days: 15 to 20 mg/kg IV per day, given in divided doses every 12 hours
8 to 28 days: 30 mg/kg IV per day, given in divided doses every 8 hours
Infants and children: 20 to 30 mg/kg IV per day, given in divided doses every 8 hours
Duration of therapy:

Use: Adjunct empirical treatment of purulent meningitis caused by S agalactiae, E coli, L monocytogenes, Klebsiella species in patients younger than 1 month

IDSA, AAN, AANS, and NCS Recommendations:
Healthcare-associated Ventriculitis and Meningitis:
Infants and children:

• IV: 22.5 mg/kg IV per day, given in divided doses every 8 hours
• Intraventricular: 5 to 50 mg via intraventricular route once a day

Duration of therapy:

• Neisseria meningitis or Haemophilus influenzae: 7 days
• Coagulase-negative staphylococcus or P acnes with no/minimal cerebrospinal fluid pleocytosis, normal CSF glucose, few symptoms/systemic features: 10 days
• Coagulase-negative staphylococcus or P acnes with significant CSF pleocytosis, S aureus or gram-negative bacilli with/without significant CSF pleocytosis, CSF hypoglycorrhachia, or symptoms/systemic features: 10 to 14 days
• S pneumoniae: 10 to 14 days
• S agalactiae: 14 to 21 days
• Aerobic gram-negative bacilli: 21 days
• L monocytogenes: At least 21 days
• Repeatedly positive CSF cultures on appropriate antimicrobial treatment: Continue treatment for 10 to 14 days after the last positive culture

Comments:

• Neonate duration of therapy is 2 weeks beyond the first sterile CSF culture OR at least 3 weeks, whichever is longer.
• The usual intraventricular dose was 30 mg/day.
• The intraventricular drain should be clamped for approximately 15 to 60 minutes to allow the drug to equilibrate.

Use: Treatment of healthcare-associated ventriculitis and meningitis

Usual Pediatric Dose for Peritonitis

Newborns:
Loading dose: 10 mg/kg IM once
Maintenance dose: 7.5 mg/kg IM or via IV infusion (over 1 to 2 hours) every 12 hours
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Older infants and children:
Serious complicated/recurrent urinary tract infections: 15 mg/kg IM or IV per day, given in 2 to 3 equal doses at equally divided intervals
Uncomplicated urinary tract infections: 250 mg IM or IV 2 times a day
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Older infants and children: 15 mg/kg IM or IV per day, given in 2 to 3 equal doses at equally divided intervals
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Comments:

• Infants should receive an IV infusion over 1 to 2 hours; children should be administered IV formulations over 30 to 60 minutes.
• Heavier patients should not exceed 1.5 grams/day.
• Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
• Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
• Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.

Use: Treatment of peritonitis caused by susceptible strains of Gram-negative bacteria, including Pseudomonas species, E coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species

ISPD Recommendations:
Continuous peritoneal dialysis:

• Loading dose: 25 mg/L
• Maintenance dose: 12 mg/L

Intermittent peritoneal dialysis:

• Anuric patients: 0.6 mg/kg intraperitoneally once a day
• Non-anuric patients: 0.75 mg/kg intraperitoneally once a day

Comments:

• Continuous: Loading doses should be allowed to dwell for at least 3 to 6 hours.
• Intermittent: Doses should be administered via the long-dwell (unless otherwise specified) and be allowed to dwell for at least 6 hours.
• Prolonged courses of treatment should be avoided.

Use: Treatment of peritonitis

Usual Pediatric Dose for Urinary Tract Infection

Newborns:
Loading dose: 10 mg/kg IM once
Maintenance dose: 7.5 mg/kg IM or via IV infusion (over 1 to 2 hours) every 12 hours
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Older infants and children:
Serious complicated/recurrent urinary tract infections: 15 mg/kg IM or IV per day, given in 2 to 3 equal doses at equally divided intervals
Uncomplicated urinary tract infections: 250 mg IM or IV 2 times a day
Maximum dose: 15 mg/kg/day
Duration of therapy: 7 to 10 days

Comments:

• Infants should receive an IV infusion over 1 to 2 hours; children should be administered IV formulations over 30 to 60 minutes.
• Heavier patients should not exceed 1.5 grams/day.
• Some recommended dose regimens include 7.5 mg/kg IM every 12 hours or 5 mg/kg IM every 8 hours.
• Most infections typically respond in 24 to 48 hours; if clinical response does not occur within 3 to 5 days, treatment should be stopped and the susceptibility pattern of the organism should be rechecked.
• Drug serum levels, renal, auditory, and vestibular functions should be monitored in patients who require treatment beyond 10 days.
• This drug should not be used to treat initial uncomplicated urinary tract infections unless the causative organisms are not susceptible to less potent antibiotics.

Uses:

• Short-term treatment of serious complicated and recurrent urinary tract infections caused by susceptible strains of Gram-negative bacteria, including Pseudomonas species, E coli, indole-positive/-negative species of Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species
• Uncomplicated initial episodes of urinary tract infections caused by organisms not susceptible to antibiotics having less potential toxicity

Usual Pediatric Dose for Bacterial Infection

American Academy of Pediatrics (AAP) Recommendations:
Severe Infections:
7 days or younger and 2 kg or less: 15 mg IV or IM every 48 hours
7 days or younger and greater than 2 kg: 15 mg IV or IM every 24 hours
8 to 28 days and 2 kg or less: 15 mg IV or IM every 24 hours
8 to 28 days and greater than 2 kg: 17.5 mg every 24 hours
Older than 28 days: 15 to 22.5 mg IV or IM in 2 to 3 doses OR 15 to 20 mg IV or IM once a day

Comments:

• Serum concentrations should guide ongoing treatment.
• Patients with cystic fibrosis should receive higher doses.

Usual Pediatric Dose for Mycobacterium avium-intracellulare - Treatment

US HHS, NIH, HRSA, and US CDC Recommendations:
15 to 30 mg/kg IV in 1 to 2 divided doses per day
Maximum dose: 1.5 grams/day
Duration of therapy: At least 12 months

Comments:

• If rifabutin cannot be administered AND a third agent must be added to a macrolide and ethambutol, this drug may be used.
• This drug may be added in patients with more severe symptoms or disseminated disease requiring a fourth agent.

Use: Third or fourth drug option as an alternative treatment in patients with disseminated MAC disease

Usual Pediatric Dose for Tuberculosis - Active

SIS and IDSA Recommendations:
Children: 15 to 20 mg/kg IM or IV once a day OR 25 to 30 mg/kg IM or IV 2 times a week

Comment: Patients with renal dysfunction may require 15 mg/kg given 3 times a week.

Use: Second-line treatment of drug-susceptible tuberculosis caused by susceptible organisms

AAP, US HHS, NIH, HRSA, and US CDC Recommendations:
Infants, Children, and Adolescents: 15 to 30 mg/kg IM or IV once a day
Maximum dose: 1 gram
Duration of therapy: 2 months (with isoniazid, rifampin, and pyrazinamide)

Comment: Some experts state that this regimen may be used as an adjunctive treatment/second-line for drug-susceptible tuberculosis in HIV-infected patients undergoing DOT.

Uses:

• Adjunctive treatment of drug-resistant tuberculosis
• Adjunctive treatment of drug-susceptible meningitis caused by M bovis in geographic areas where resistance to streptomycin is common

Renal Dose Adjustments

Known/suspected renal dysfunction: Frequent monitoring recommended.

IM Administration:

• Prolonged intervals (creatinine clearance unknown): Administer the recommended single dose (7.5 mg/kg IM) at the dosage interval determined by multiplying the serum creatinine by 9
• Reduced dose (serum assay concentrations unknown):
• Loading dose: 7.5 mg/kg IM once
• Maintenance dose given IM every 12 hours: (observed creatinine clearance divided by normal creatinine clearance) multiplied by the loading dose OR recommended dose divided by the steady state creatinine clearance

Signs/symptoms of renal irritation occurring during treatment (e.g., casts, white/red cells, albumin): Increase hydration.
Evidence of renal dysfunction occurring during treatment (e.g., decreased creatinine clearance, decreased urine specific gravity, increased blood urea nitrogen/creatinine, oliguria): Dose reductions should be considered; closely monitor renal and eighth nerve function.
Increased azotemia OR a progressive decrease in urinary output occurring during treatment: Stop treatment.
Evidence of nephrotoxicity: Discontinue the drug OR adjust the dose.

SIS and IDSA Recommendations:
Renal dysfunction: Patients may require 15 mg/kg given 3 times a week

US HHS, NIH, HRSA, and US CDC Recommendations:
Renal dysfunction: Use with caution; dose adjustments should be determined by target peak and trough concentrations.

Liver Dose Adjustments

Data not available

Dose Adjustments

Therapeutic drug monitoring/range:

• Peak: Less than 35 mcg/mL
• Trough: Less than 10 mcg/mL
• Peak and trough levels should be measured intermittently throughout treatment.

Lack of clinical response within 3 to 5 days:

• Stop treatment and recheck antibiotic susceptibility of the organism.

Signs/symptoms of ototoxicity (e.g., dizziness, hearing loss, raring in the ears, tinnitus, vertigo): Discontinue the drug OR adjust the dose.

US HHS, NIH, HRSA, and US CDC Recommendations:
Mycobacterial infections:
Therapeutic drug monitoring/range:

• Target peak concentration: 35 to 45 mcg/mL
• Target trough concentration: Less than 4 mcg/mL

ATS and IDSA Recommendations:
10 to 15 mg/kg IV once a day OR 25 mg/kg IV 3 times a week
Duration of therapy:

• Initial therapy: At least 2 weeks
• Serious skin and soft tissue infections: At least 4 months
• Bone infections: At least 6 months

Comments:

• Patients receiving prolonged treatment (greater than 3 weeks) should be given lower daily doses (10 mg/kg/day).
• This drug should be given with azithromycin, clarithromycin, high-dose cefoxitin, or imipenem.

Uses: Treatment of serous skin, soft tissue, and bone infections caused by M abscessus

Precautions

US BOXED WARNINGS:
PARENTERAL USE:

• Patients treated with parenteral aminoglycosides should be under close clinical observation because of the potential ototoxicity and nephrotoxicity associated with their use.
• Safety for treatment periods which are longer than 14 days has not been established.

NEUROTOXICITY AND OTOTOXICITY:

• Neurotoxicity, manifested as vestibular and permanent bilateral auditory ototoxicity, can occur in patients with preexisting renal damage and in patients with normal renal function treated at higher doses and/or for periods longer than those recommended.
• The risk of aminoglycoside-induced ototoxicity is greater in patients with renal damage.
• High frequency deafness usually occurs first and can be detected only by audiometric testing. Vertigo may occur and may be evidence of vestibular injury.
• Other manifestations of neurotoxicity may include numbness, skin tingling, muscle twitching and convulsions.
• The risk of hearing loss due to aminoglycosides increases with the degree of exposure to either high peak or high trough serum concentrations.
• Patients developing cochlear damage may not have symptoms during therapy to warn them of developing eighth-nerve toxicity, and total or partial irreversible bilateral deafness may occur after the drug has been discontinued.
• Aminoglycoside-induced ototoxicity is usually irreversible.

NEPHROTOXICITY:

• Aminoglycosides are potentially nephrotoxic.
• The risk of nephrotoxicity is greater in patients with impaired renal function and in those who receive high doses or prolonged therapy.

NEUROMUSCULAR BLOCKADE AND RESPIRATORY PARALYSIS:

• Neuromuscular blockade and respiratory paralysis have been reported following parenteral injection, topical instillation (as in orthopedic and abdominal irrigation or in local treatment of empyema), and following oral use of aminoglycosides.
• The possibility of these phenomena should be considered if aminoglycosides are administered by any route, especially in patients receiving anesthetics; neuromuscular blocking agents such as tubocurarine, succinylcholine, decamethonium; or in patients receiving massive transfusions of citrate-anticoagulated blood.
• If blockage occurs, calcium salts may reverse these phenomena, but mechanical respiratory assistance may be necessary.

MONITORING:

• Renal and eighth-nerve function should be closely monitored especially in patients with known/suspected renal impairment at the onset of therapy and also in those whose renal function is initially normal but who develop signs or renal dysfunction during treatment.
• Serum concentrations of this drug should be monitored when feasible to assure adequate levels and to avoid potentially toxic levels and prolonged peak concentrations above 35 mcg/mL.
• Urine should be examined for decreased specific gravity, increased excretion of proteins, and the presence of cells/casts.
• Blood urea nitrogen, serum creatinine or creatinine clearance should be measured periodically
• Serial audiograms should be obtained where feasible in patients old enough to be tested, particularly high-risk patients.
• Evidence of ototoxicity (dizziness, vertigo, tinnitus, roaring in the ears and hearing loss) or nephrotoxicity requires discontinuation of the drug or dosage adjustment.

CONCURRENT OR SEQUENTIAL USE WITH OTHER DRUGS:

• Concurrent and/or sequential systemic oral or topical use of other neurotoxic or nephrotoxicity products, particularly bacitracin, cisplatin, amphotericin B, cephaloridine, paromomycin, viomycin, polymyxin B, colistin, vancomycin, or other aminoglycosides should be aided.
• Other factors that may increase the risk of toxicity are advanced age and dehydration.
• The concurrent use of this drug with potent diuretics (ethacrynic acid, furosemide) should be avoided since diuretics by themselves may cause ototoxicity.
• In addition, when administered IV, diuretics may enhance aminoglycoside toxicity by alternating antibiotic concentrations in serum and tissue.

CONTRAINDICATIONS:

• Hypersensitivity or serious toxic reactions to the active component, other aminoglycosides, or any of the ingredients

NARROW THERAPEUTIC INDEX:

• This drug should be considered a narrow therapeutic index (NTI) drug as small differences in dose or blood concentrations may lead to serious therapeutic failures or adverse drug reactions.

Recommendations:

• Generic substitution should be done cautiously, if at all, as current bioequivalence standards are generally insufficient for NTI drugs.
• Additional and/or more frequent monitoring should be done to ensure receipt of an effective dose while avoiding unnecessary toxicities.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:

• This drug should be administered separately from other drugs

Reconstitution/preparation techniques:

• IV solutions should be added to 100 or 200 mL of a sterile diluent
• This drug should not be physically premixed with other drugs

IV compatibility:

• Compatible: 0.9% sodium chloride, 5% dextrose, 5% dextrose-0.2% sodium chloride, 5% dextrose-0.45% sodium chloride, lactated Ringer's, Normosol(R) M in 5% dextrose/Plasma-Lyte 56 in 5% dextrose, Normosol(R) R in 5% dextrose/Plasma-Lyte 148 in 5% dextrose
• Chemical incompatibility: Penicillins, cephalosporins

General:

• Doses should be determined by pretreatment weight, clinical status, and drug concentrations.
• This drug demonstrated efficacy in treating infections caused by gentamicin and tobramycin-resistant strains of gram-negative organisms, including Proteus rettgeri, Providencia stuartii, Serratia marcescens, and Pseudomonas aeruginosa.
• Peak concentrations should be measured 30 to 90 minutes after administration; trough concentrations should be measured just prior to the next dose.

Monitoring:

• Genitourinary: Urine examined for specific gravity, protein excretion, presence of cells/casts
• Other: Serial audiograms in patients old enough to be tested, especially those at high-risk of ototoxicity
• Renal: Renal function (e.g., blood urea nitrogen, serum creatinine, creatinine clearance) prior to starting treatment and daily thereafter

Patient advice:

• Advise patients to speak to their healthcare provider if they become pregnant, intend to become pregnant, or are breastfeeding.
• Patients should be told to report any unusual or severe side effects, including signs/symptoms of ototoxicity and nephrotoxicity.
• Patients should be instructed to report signs/symptoms of Clostridium difficile infection (e.g., watery/bloody stools, stomach cramps, fever), for up to 2 months after stopping treatment.
• Patients should be directed to take the full course of treatment, even if they feel better.

Frequently asked questions

• What type of drug is Arikayce?