Usual Adult Dose for Cholecystitis

Mild infections due to susceptible gram-positive cocci: 250 to 500 mg IV or IM every 8 hours
Moderate to severe infections: 500 mg to 1 g IV or IM every 6 to 8 hours
Severe, life-threatening infections (e.g., endocarditis, septicemia): 1 to 1.5 g IV every 6 hours

Comments:

• In rare cases, doses up to 12 g/day have been used for severe, life-threatening infections.

Uses: For the treatment of the following infections due to susceptible bacteria:

• Biliary tract infections due to Escherichia coli, various strains of streptococci, Proteus mirabilis, Klebsiella species, and Staphylococcus aureus
• Bone and joint infections due to S aureus
• Genital infections (i.e., prostatitis, epididymitis) due to E coli, P mirabilis, Klebsiella species, and some strains of enterococci
• Respiratory tract infections due to Streptococcus pneumoniae, S aureus, S pyogenes/group A beta-hemolytic streptococci, Klebsiella species, and Haemophilus influenzae
• Skin and skin structure infections due to S aureus, S pyogenes/group A beta-hemolytic streptococci, S agalactiae, and other strains of streptococci

Usual Adult Dose for Epididymitis - Non-Specific

Mild infections due to susceptible gram-positive cocci: 250 to 500 mg IV or IM every 8 hours
Moderate to severe infections: 500 mg to 1 g IV or IM every 6 to 8 hours
Severe, life-threatening infections (e.g., endocarditis, septicemia): 1 to 1.5 g IV every 6 hours

Comments:

• In rare cases, doses up to 12 g/day have been used for severe, life-threatening infections.

Uses: For the treatment of the following infections due to susceptible bacteria:

• Biliary tract infections due to Escherichia coli, various strains of streptococci, Proteus mirabilis, Klebsiella species, and Staphylococcus aureus
• Bone and joint infections due to S aureus
• Genital infections (i.e., prostatitis, epididymitis) due to E coli, P mirabilis, Klebsiella species, and some strains of enterococci
• Respiratory tract infections due to Streptococcus pneumoniae, S aureus, S pyogenes/group A beta-hemolytic streptococci, Klebsiella species, and Haemophilus influenzae
• Skin and skin structure infections due to S aureus, S pyogenes/group A beta-hemolytic streptococci, S agalactiae, and other strains of streptococci

Usual Adult Dose for Joint Infection

Mild infections due to susceptible gram-positive cocci: 250 to 500 mg IV or IM every 8 hours
Moderate to severe infections: 500 mg to 1 g IV or IM every 6 to 8 hours
Severe, life-threatening infections (e.g., endocarditis, septicemia): 1 to 1.5 g IV every 6 hours

Comments:

• In rare cases, doses up to 12 g/day have been used for severe, life-threatening infections.

Uses: For the treatment of the following infections due to susceptible bacteria:

• Biliary tract infections due to Escherichia coli, various strains of streptococci, Proteus mirabilis, Klebsiella species, and Staphylococcus aureus
• Bone and joint infections due to S aureus
• Genital infections (i.e., prostatitis, epididymitis) due to E coli, P mirabilis, Klebsiella species, and some strains of enterococci
• Respiratory tract infections due to Streptococcus pneumoniae, S aureus, S pyogenes/group A beta-hemolytic streptococci, Klebsiella species, and Haemophilus influenzae
• Skin and skin structure infections due to S aureus, S pyogenes/group A beta-hemolytic streptococci, S agalactiae, and other strains of streptococci

Usual Adult Dose for Osteomyelitis

Mild infections due to susceptible gram-positive cocci: 250 to 500 mg IV or IM every 8 hours
Moderate to severe infections: 500 mg to 1 g IV or IM every 6 to 8 hours
Severe, life-threatening infections (e.g., endocarditis, septicemia): 1 to 1.5 g IV every 6 hours

Comments:

• In rare cases, doses up to 12 g/day have been used for severe, life-threatening infections.

Uses: For the treatment of the following infections due to susceptible bacteria:

• Biliary tract infections due to Escherichia coli, various strains of streptococci, Proteus mirabilis, Klebsiella species, and Staphylococcus aureus
• Bone and joint infections due to S aureus
• Genital infections (i.e., prostatitis, epididymitis) due to E coli, P mirabilis, Klebsiella species, and some strains of enterococci
• Respiratory tract infections due to Streptococcus pneumoniae, S aureus, S pyogenes/group A beta-hemolytic streptococci, Klebsiella species, and Haemophilus influenzae
• Skin and skin structure infections due to S aureus, S pyogenes/group A beta-hemolytic streptococci, S agalactiae, and other strains of streptococci

Usual Adult Dose for Prostatitis

Mild infections due to susceptible gram-positive cocci: 250 to 500 mg IV or IM every 8 hours
Moderate to severe infections: 500 mg to 1 g IV or IM every 6 to 8 hours
Severe, life-threatening infections (e.g., endocarditis, septicemia): 1 to 1.5 g IV every 6 hours

Comments:

• In rare cases, doses up to 12 g/day have been used for severe, life-threatening infections.

Uses: For the treatment of the following infections due to susceptible bacteria:

• Biliary tract infections due to Escherichia coli, various strains of streptococci, Proteus mirabilis, Klebsiella species, and Staphylococcus aureus
• Bone and joint infections due to S aureus
• Genital infections (i.e., prostatitis, epididymitis) due to E coli, P mirabilis, Klebsiella species, and some strains of enterococci
• Respiratory tract infections due to Streptococcus pneumoniae, S aureus, S pyogenes/group A beta-hemolytic streptococci, Klebsiella species, and Haemophilus influenzae
• Skin and skin structure infections due to S aureus, S pyogenes/group A beta-hemolytic streptococci, S agalactiae, and other strains of streptococci

Usual Adult Dose for Skin or Soft Tissue Infection

Mild infections due to susceptible gram-positive cocci: 250 to 500 mg IV or IM every 8 hours
Moderate to severe infections: 500 mg to 1 g IV or IM every 6 to 8 hours
Severe, life-threatening infections (e.g., endocarditis, septicemia): 1 to 1.5 g IV every 6 hours

Comments:

• In rare cases, doses up to 12 g/day have been used for severe, life-threatening infections.

Uses: For the treatment of the following infections due to susceptible bacteria:

• Biliary tract infections due to Escherichia coli, various strains of streptococci, Proteus mirabilis, Klebsiella species, and Staphylococcus aureus
• Bone and joint infections due to S aureus
• Genital infections (i.e., prostatitis, epididymitis) due to E coli, P mirabilis, Klebsiella species, and some strains of enterococci
• Respiratory tract infections due to Streptococcus pneumoniae, S aureus, S pyogenes/group A beta-hemolytic streptococci, Klebsiella species, and Haemophilus influenzae
• Skin and skin structure infections due to S aureus, S pyogenes/group A beta-hemolytic streptococci, S agalactiae, and other strains of streptococci

Usual Adult Dose for Bacterial Infection

Mild infections due to susceptible gram-positive cocci: 250 to 500 mg IV or IM every 8 hours
Moderate to severe infections: 500 mg to 1 g IV or IM every 6 to 8 hours
Severe, life-threatening infections (e.g., endocarditis, septicemia): 1 to 1.5 g IV every 6 hours

Comments:

• In rare cases, doses up to 12 g/day have been used for severe, life-threatening infections.

Uses: For the treatment of the following infections due to susceptible bacteria:

• Biliary tract infections due to Escherichia coli, various strains of streptococci, Proteus mirabilis, Klebsiella species, and Staphylococcus aureus
• Bone and joint infections due to S aureus
• Genital infections (i.e., prostatitis, epididymitis) due to E coli, P mirabilis, Klebsiella species, and some strains of enterococci
• Respiratory tract infections due to Streptococcus pneumoniae, S aureus, S pyogenes/group A beta-hemolytic streptococci, Klebsiella species, and Haemophilus influenzae
• Skin and skin structure infections due to S aureus, S pyogenes/group A beta-hemolytic streptococci, S agalactiae, and other strains of streptococci

Usual Adult Dose for Skin and Structure Infection

Mild infections due to susceptible gram-positive cocci: 250 to 500 mg IV or IM every 8 hours
Moderate to severe infections: 500 mg to 1 g IV or IM every 6 to 8 hours
Severe, life-threatening infections (e.g., endocarditis, septicemia): 1 to 1.5 g IV every 6 hours

Comments:

• In rare cases, doses up to 12 g/day have been used for severe, life-threatening infections.

Uses: For the treatment of the following infections due to susceptible bacteria:

• Biliary tract infections due to Escherichia coli, various strains of streptococci, Proteus mirabilis, Klebsiella species, and Staphylococcus aureus
• Bone and joint infections due to S aureus
• Genital infections (i.e., prostatitis, epididymitis) due to E coli, P mirabilis, Klebsiella species, and some strains of enterococci
• Respiratory tract infections due to Streptococcus pneumoniae, S aureus, S pyogenes/group A beta-hemolytic streptococci, Klebsiella species, and Haemophilus influenzae
• Skin and skin structure infections due to S aureus, S pyogenes/group A beta-hemolytic streptococci, S agalactiae, and other strains of streptococci

Usual Adult Dose for Septicemia

1 to 1.5 g IV every 6 hours

Comments:

• In rare cases, doses up to 12 g/day have been used.

Use: For the treatment of septicemia due to S pneumoniae, S aureus, P mirabilis, E coli, and Klebsiella species

Usual Adult Dose for Endocarditis

1 to 1.5 g IV every 6 hours

Comments:

• In rare cases, doses up to 12 g/day have been used.

Use: For the treatment of endocarditis due to S aureus and S pyogenes/group A beta-hemolytic streptococci

American Heart Association (AHA) and Infectious Diseases Society of America (IDSA) Recommendations: 2 g IV every 8 hours

Duration of Therapy:

• Native valve infective endocarditis: 6 weeks
• Endocarditis involving a prosthetic valve or other prosthetic material: At least 6 weeks

Comments:

• Recommended for infections due to oxacillin-susceptible strains of staphylococci in penicillin-allergic (nonanaphylactoid type) patients
• For infection involving a prosthetic valve or other prosthetic material: This drug should be used with gentamicin for the first 2 weeks and rifampin for at least 6 weeks.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Pneumonia

500 mg IV or IM every 12 hours

Use: For the treatment of pneumococcal pneumonia

Usual Adult Dose for Urinary Tract Infection

1 g IV or IM every 12 hours

Use: For the treatment of acute, uncomplicated urinary tract infections due to E coli, P mirabilis, Klebsiella species, and some strains of Enterobacter and enterococci

Usual Adult Dose for Surgical Prophylaxis

Preoperative: 1 to 2 g IV or 1 g IM 30 to 60 minutes before the start of surgery
Intraoperative (for procedures lasting 2 hours or more): 500 mg to 1 g IV or IM during surgery
Postoperative: 500 mg to 1 g IV or IM every 6 to 8 hours for 24 hours

Comments:

• Preoperative, intraoperative, and postoperative use of this drug may reduce the incidence of certain postoperative infections in patients undergoing surgical procedures classified as contaminated or potentially contaminated (e.g., vaginal hysterectomy, cholecystectomy in high-risk patients [e.g., older than 70 years, acute cholecystitis, obstructive jaundice, common duct bile stones]).
• The preoperative dose should be administered just prior (30 to 60 minutes) to the start of surgery so that there are adequate antibiotic levels in the serum and tissues when the first incision is made.
• This drug should be administered (if necessary) at appropriate intervals during surgery to provide adequate antibiotic levels at expected moments of highest exposure to infective organisms; for lengthy surgical procedures (e.g., 2 hours or more), drug administration should be adjusted based on the duration of the procedure.
• Perioperative use may also be effective in surgical patients for whom infection at the operative site would present serious risk (e.g., during open-heart surgery and prosthetic arthroplasty); prophylactic administration may be continued for 3 to 5 days after surgery completed.
• If signs of infection observed, specimens for culture and susceptibility testing should be obtained to isolate and identify infecting organisms in order to start appropriate therapy.

Use: As perioperative prophylaxis to prevent postoperative infection in contaminated or potentially contaminated surgery

American Society of Health-System Pharmacists (ASHP), IDSA, Surgical Infection Society (SIS), and Society for Healthcare Epidemiology of America (SHEA) Recommendations:
Preoperative dose:

• Less than 120 kg: 2 g IV as a single dose
• At least 120 kg: 3 g IV as a single dose

Redosing interval (from start of preoperative dose): 4 hours

Comments:

• This drug should be started within 60 minutes before surgical incision.
• A single prophylactic dose is usually sufficient; if prophylaxis is continued postoperatively, duration should be less than 24 hours.
• To ensure adequate serum and tissue drug levels, readministration may be needed if the procedure duration exceeds the recommended redosing interval.
• Redosing may be needed if drug half-life is shortened (e.g., extensive burns) or if prolonged/excessive bleeding during surgery; redosing may not be needed if drug half-life is prolonged (e.g., renal dysfunction).
• Coadministration with other agents may be recommended, depending on type of procedure.
• Current guidelines should be consulted for additional information.

Uses: Recommended for surgical prophylaxis for the following procedures:

• Appendectomy for uncomplicated appendicitis
• Biliary tract: Open procedure; elective, high-risk laparoscopic procedure
• Cardiac: Coronary artery bypass; cardiac device insertion procedures (e.g., pacemaker implantation); ventricular assist devices
• Cesarean delivery
• Colorectal
• Gastroduodenal: Procedures involving entry into lumen of gastrointestinal (GI) tract (bariatric, pancreaticoduodenectomy); procedures without entry into GI tract (antireflux, highly selective vagotomy) for high-risk patients
• Head and neck: Clean with placement of prosthesis (excludes tympanostomy tubes); clean-contaminated cancer surgery; other clean-contaminated procedures (excluding tonsillectomy, functional endoscopic sinus procedures)
• Heart, lung, heart-lung transplantation
• Hernia repair (hernioplasty and herniorrhaphy)
• Hysterectomy: Vaginal or abdominal
• Neurosurgery: Elective craniotomy and CSF-shunting procedures; implantation of intrathecal pumps
• Orthopedic: Spinal procedures with and without instrumentation; hip fracture repair, implantation of internal fixation devices (e.g., nails, screws, plates, wires); total joint replacement
• Pancreas, pancreas-kidney transplantation
• Plastic surgery: Clean with risk factors or clean-contaminated
• Small intestine: Nonobstructed; obstructed
• Thoracic: Noncardiac procedures (including lobectomy, pneumonectomy, lung resection, thoracotomy); video-assisted thoracoscopic surgery
• Urologic: Lower tract instrumentation with risk factors for infection (includes transrectal prostate biopsy); clean without entry into urinary tract and involving implanted prosthesis; clean with entry into urinary tract; clean-contaminated
• Vascular

Usual Adult Dose for Bacterial Endocarditis Prophylaxis

AHA Recommendations: 1 g IV or IM as a single dose 30 to 60 minutes before procedure

Comments:

• Recommended as an alternative in patients, with or without penicillin/ampicillin allergy, unable to take oral medication (unless history of anaphylaxis, angioedema, or urticaria with penicillins or ampicillin)
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Prevention of Perinatal Group B Streptococcal Disease

US CDC Recommendations: 2 g IV initially followed by 1 g IV every 8 hours until delivery

Comments:

• Recommended as the preferred agent for penicillin-allergic (nonanaphylactoid type) patients
• Use of this drug for at least 4 hours before delivery is considered adequate intrapartum antibiotic prophylaxis.
• Current guidelines should be consulted for additional information.

Use: As intrapartum antibiotic prophylaxis for prevention of early-onset group B streptococcal disease

Usual Adult Dose for Peritonitis

International Society for Peritoneal Dialysis (ISPD) Recommendations:
Continuous (all exchanges):

• Loading dose: 500 mg/L intraperitoneally
• Maintenance dose: 125 mg/L intraperitoneally

Intermittent (1 exchange daily): 15 to 20 mg/kg intraperitoneally once a day

Duration of Therapy: 14 to 21 days

Comments:

• Intraperitoneal antibiotics can be administered continuously (i.e., in each exchange) or intermittently (i.e., once a day).
• In intermittent dosing, the antibiotic-containing dialysis solution should dwell for at least 6 hours to allow adequate absorption.
• Current guidelines should be consulted for additional information.

Use: For the treatment of peritoneal dialysis (PD)-related peritonitis

Usual Pediatric Dose for Cholecystitis

1 month or older:

• Mild to moderate infections: 25 to 50 mg/kg/day IV or IM in 3 or 4 equally divided doses
• Severe infections: 100 mg/kg/day IV or IM in 3 or 4 equally divided doses

Uses: For the treatment of the following infections due to susceptible bacteria:

• Biliary tract infections due to E coli, various strains of streptococci, P mirabilis, Klebsiella species, and S aureus
• Bone and joint infections due to S aureus
• Genital infections (i.e., prostatitis, epididymitis) due to E coli, P mirabilis, Klebsiella species, and some strains of enterococci
• Respiratory tract infections due to S pneumoniae, S aureus, S pyogenes/group A beta-hemolytic streptococci, Klebsiella species, and H influenzae
• Skin and skin structure infections due to S aureus, S pyogenes/group A beta-hemolytic streptococci, S agalactiae, and other strains of streptococci
• Urinary tract infections due to E coli, P mirabilis, Klebsiella species, and some strains of Enterobacter and enterococci

American Academy of Pediatrics (AAP) Recommendations:
7 days or younger: 25 mg/kg IV or IM every 12 hours

8 to 28 days:
Up to 2 kg: 25 mg/kg IV or IM every 12 hours
Greater than 2 kg: 25 mg/kg IV or IM every 8 hours

1 month or older:
Mild to moderate infections: 25 to 50 mg/kg/day IV or IM in 3 divided doses
Maximum dose: 3 g/day

Severe infections: 100 to 150 mg/kg IV or IM in 3 divided doses
Maximum dose: 6 g/day

Usual Pediatric Dose for Epididymitis - Non-Specific

1 month or older:

• Mild to moderate infections: 25 to 50 mg/kg/day IV or IM in 3 or 4 equally divided doses
• Severe infections: 100 mg/kg/day IV or IM in 3 or 4 equally divided doses

Uses: For the treatment of the following infections due to susceptible bacteria:

• Biliary tract infections due to E coli, various strains of streptococci, P mirabilis, Klebsiella species, and S aureus
• Bone and joint infections due to S aureus
• Genital infections (i.e., prostatitis, epididymitis) due to E coli, P mirabilis, Klebsiella species, and some strains of enterococci
• Respiratory tract infections due to S pneumoniae, S aureus, S pyogenes/group A beta-hemolytic streptococci, Klebsiella species, and H influenzae
• Skin and skin structure infections due to S aureus, S pyogenes/group A beta-hemolytic streptococci, S agalactiae, and other strains of streptococci
• Urinary tract infections due to E coli, P mirabilis, Klebsiella species, and some strains of Enterobacter and enterococci

American Academy of Pediatrics (AAP) Recommendations:
7 days or younger: 25 mg/kg IV or IM every 12 hours

8 to 28 days:
Up to 2 kg: 25 mg/kg IV or IM every 12 hours
Greater than 2 kg: 25 mg/kg IV or IM every 8 hours

1 month or older:
Mild to moderate infections: 25 to 50 mg/kg/day IV or IM in 3 divided doses
Maximum dose: 3 g/day

Severe infections: 100 to 150 mg/kg IV or IM in 3 divided doses
Maximum dose: 6 g/day

Usual Pediatric Dose for Joint Infection

1 month or older:

• Mild to moderate infections: 25 to 50 mg/kg/day IV or IM in 3 or 4 equally divided doses
• Severe infections: 100 mg/kg/day IV or IM in 3 or 4 equally divided doses

Uses: For the treatment of the following infections due to susceptible bacteria:

• Biliary tract infections due to E coli, various strains of streptococci, P mirabilis, Klebsiella species, and S aureus
• Bone and joint infections due to S aureus
• Genital infections (i.e., prostatitis, epididymitis) due to E coli, P mirabilis, Klebsiella species, and some strains of enterococci
• Respiratory tract infections due to S pneumoniae, S aureus, S pyogenes/group A beta-hemolytic streptococci, Klebsiella species, and H influenzae
• Skin and skin structure infections due to S aureus, S pyogenes/group A beta-hemolytic streptococci, S agalactiae, and other strains of streptococci
• Urinary tract infections due to E coli, P mirabilis, Klebsiella species, and some strains of Enterobacter and enterococci

American Academy of Pediatrics (AAP) Recommendations:
7 days or younger: 25 mg/kg IV or IM every 12 hours

8 to 28 days:
Up to 2 kg: 25 mg/kg IV or IM every 12 hours
Greater than 2 kg: 25 mg/kg IV or IM every 8 hours

1 month or older:
Mild to moderate infections: 25 to 50 mg/kg/day IV or IM in 3 divided doses
Maximum dose: 3 g/day

Severe infections: 100 to 150 mg/kg IV or IM in 3 divided doses
Maximum dose: 6 g/day

Usual Pediatric Dose for Osteomyelitis

1 month or older:

• Mild to moderate infections: 25 to 50 mg/kg/day IV or IM in 3 or 4 equally divided doses
• Severe infections: 100 mg/kg/day IV or IM in 3 or 4 equally divided doses

Uses: For the treatment of the following infections due to susceptible bacteria:

• Biliary tract infections due to E coli, various strains of streptococci, P mirabilis, Klebsiella species, and S aureus
• Bone and joint infections due to S aureus
• Genital infections (i.e., prostatitis, epididymitis) due to E coli, P mirabilis, Klebsiella species, and some strains of enterococci
• Respiratory tract infections due to S pneumoniae, S aureus, S pyogenes/group A beta-hemolytic streptococci, Klebsiella species, and H influenzae
• Skin and skin structure infections due to S aureus, S pyogenes/group A beta-hemolytic streptococci, S agalactiae, and other strains of streptococci
• Urinary tract infections due to E coli, P mirabilis, Klebsiella species, and some strains of Enterobacter and enterococci

American Academy of Pediatrics (AAP) Recommendations:
7 days or younger: 25 mg/kg IV or IM every 12 hours

8 to 28 days:
Up to 2 kg: 25 mg/kg IV or IM every 12 hours
Greater than 2 kg: 25 mg/kg IV or IM every 8 hours

1 month or older:
Mild to moderate infections: 25 to 50 mg/kg/day IV or IM in 3 divided doses
Maximum dose: 3 g/day

Severe infections: 100 to 150 mg/kg IV or IM in 3 divided doses
Maximum dose: 6 g/day

Usual Pediatric Dose for Pneumonia

1 month or older:

• Mild to moderate infections: 25 to 50 mg/kg/day IV or IM in 3 or 4 equally divided doses
• Severe infections: 100 mg/kg/day IV or IM in 3 or 4 equally divided doses

Uses: For the treatment of the following infections due to susceptible bacteria:

• Biliary tract infections due to E coli, various strains of streptococci, P mirabilis, Klebsiella species, and S aureus
• Bone and joint infections due to S aureus
• Genital infections (i.e., prostatitis, epididymitis) due to E coli, P mirabilis, Klebsiella species, and some strains of enterococci
• Respiratory tract infections due to S pneumoniae, S aureus, S pyogenes/group A beta-hemolytic streptococci, Klebsiella species, and H influenzae
• Skin and skin structure infections due to S aureus, S pyogenes/group A beta-hemolytic streptococci, S agalactiae, and other strains of streptococci
• Urinary tract infections due to E coli, P mirabilis, Klebsiella species, and some strains of Enterobacter and enterococci

American Academy of Pediatrics (AAP) Recommendations:
7 days or younger: 25 mg/kg IV or IM every 12 hours

8 to 28 days:
Up to 2 kg: 25 mg/kg IV or IM every 12 hours
Greater than 2 kg: 25 mg/kg IV or IM every 8 hours

1 month or older:
Mild to moderate infections: 25 to 50 mg/kg/day IV or IM in 3 divided doses
Maximum dose: 3 g/day

Severe infections: 100 to 150 mg/kg IV or IM in 3 divided doses
Maximum dose: 6 g/day

Usual Pediatric Dose for Prostatitis

1 month or older:

• Mild to moderate infections: 25 to 50 mg/kg/day IV or IM in 3 or 4 equally divided doses
• Severe infections: 100 mg/kg/day IV or IM in 3 or 4 equally divided doses

Uses: For the treatment of the following infections due to susceptible bacteria:

• Biliary tract infections due to E coli, various strains of streptococci, P mirabilis, Klebsiella species, and S aureus
• Bone and joint infections due to S aureus
• Genital infections (i.e., prostatitis, epididymitis) due to E coli, P mirabilis, Klebsiella species, and some strains of enterococci
• Respiratory tract infections due to S pneumoniae, S aureus, S pyogenes/group A beta-hemolytic streptococci, Klebsiella species, and H influenzae
• Skin and skin structure infections due to S aureus, S pyogenes/group A beta-hemolytic streptococci, S agalactiae, and other strains of streptococci
• Urinary tract infections due to E coli, P mirabilis, Klebsiella species, and some strains of Enterobacter and enterococci

American Academy of Pediatrics (AAP) Recommendations:
7 days or younger: 25 mg/kg IV or IM every 12 hours

8 to 28 days:
Up to 2 kg: 25 mg/kg IV or IM every 12 hours
Greater than 2 kg: 25 mg/kg IV or IM every 8 hours

1 month or older:
Mild to moderate infections: 25 to 50 mg/kg/day IV or IM in 3 divided doses
Maximum dose: 3 g/day

Severe infections: 100 to 150 mg/kg IV or IM in 3 divided doses
Maximum dose: 6 g/day

Usual Pediatric Dose for Skin or Soft Tissue Infection

1 month or older:

• Mild to moderate infections: 25 to 50 mg/kg/day IV or IM in 3 or 4 equally divided doses
• Severe infections: 100 mg/kg/day IV or IM in 3 or 4 equally divided doses

Uses: For the treatment of the following infections due to susceptible bacteria:

• Biliary tract infections due to E coli, various strains of streptococci, P mirabilis, Klebsiella species, and S aureus
• Bone and joint infections due to S aureus
• Genital infections (i.e., prostatitis, epididymitis) due to E coli, P mirabilis, Klebsiella species, and some strains of enterococci
• Respiratory tract infections due to S pneumoniae, S aureus, S pyogenes/group A beta-hemolytic streptococci, Klebsiella species, and H influenzae
• Skin and skin structure infections due to S aureus, S pyogenes/group A beta-hemolytic streptococci, S agalactiae, and other strains of streptococci
• Urinary tract infections due to E coli, P mirabilis, Klebsiella species, and some strains of Enterobacter and enterococci

American Academy of Pediatrics (AAP) Recommendations:
7 days or younger: 25 mg/kg IV or IM every 12 hours

8 to 28 days:
Up to 2 kg: 25 mg/kg IV or IM every 12 hours
Greater than 2 kg: 25 mg/kg IV or IM every 8 hours

1 month or older:
Mild to moderate infections: 25 to 50 mg/kg/day IV or IM in 3 divided doses
Maximum dose: 3 g/day

Severe infections: 100 to 150 mg/kg IV or IM in 3 divided doses
Maximum dose: 6 g/day

Usual Pediatric Dose for Bacterial Infection

1 month or older:

• Mild to moderate infections: 25 to 50 mg/kg/day IV or IM in 3 or 4 equally divided doses
• Severe infections: 100 mg/kg/day IV or IM in 3 or 4 equally divided doses

Uses: For the treatment of the following infections due to susceptible bacteria:

• Biliary tract infections due to E coli, various strains of streptococci, P mirabilis, Klebsiella species, and S aureus
• Bone and joint infections due to S aureus
• Genital infections (i.e., prostatitis, epididymitis) due to E coli, P mirabilis, Klebsiella species, and some strains of enterococci
• Respiratory tract infections due to S pneumoniae, S aureus, S pyogenes/group A beta-hemolytic streptococci, Klebsiella species, and H influenzae
• Skin and skin structure infections due to S aureus, S pyogenes/group A beta-hemolytic streptococci, S agalactiae, and other strains of streptococci
• Urinary tract infections due to E coli, P mirabilis, Klebsiella species, and some strains of Enterobacter and enterococci

American Academy of Pediatrics (AAP) Recommendations:
7 days or younger: 25 mg/kg IV or IM every 12 hours

8 to 28 days:
Up to 2 kg: 25 mg/kg IV or IM every 12 hours
Greater than 2 kg: 25 mg/kg IV or IM every 8 hours

1 month or older:
Mild to moderate infections: 25 to 50 mg/kg/day IV or IM in 3 divided doses
Maximum dose: 3 g/day

Severe infections: 100 to 150 mg/kg IV or IM in 3 divided doses
Maximum dose: 6 g/day

Usual Pediatric Dose for Urinary Tract Infection

1 month or older:

• Mild to moderate infections: 25 to 50 mg/kg/day IV or IM in 3 or 4 equally divided doses
• Severe infections: 100 mg/kg/day IV or IM in 3 or 4 equally divided doses

Uses: For the treatment of the following infections due to susceptible bacteria:

• Biliary tract infections due to E coli, various strains of streptococci, P mirabilis, Klebsiella species, and S aureus
• Bone and joint infections due to S aureus
• Genital infections (i.e., prostatitis, epididymitis) due to E coli, P mirabilis, Klebsiella species, and some strains of enterococci
• Respiratory tract infections due to S pneumoniae, S aureus, S pyogenes/group A beta-hemolytic streptococci, Klebsiella species, and H influenzae
• Skin and skin structure infections due to S aureus, S pyogenes/group A beta-hemolytic streptococci, S agalactiae, and other strains of streptococci
• Urinary tract infections due to E coli, P mirabilis, Klebsiella species, and some strains of Enterobacter and enterococci

American Academy of Pediatrics (AAP) Recommendations:
7 days or younger: 25 mg/kg IV or IM every 12 hours

8 to 28 days:
Up to 2 kg: 25 mg/kg IV or IM every 12 hours
Greater than 2 kg: 25 mg/kg IV or IM every 8 hours

1 month or older:
Mild to moderate infections: 25 to 50 mg/kg/day IV or IM in 3 divided doses
Maximum dose: 3 g/day

Severe infections: 100 to 150 mg/kg IV or IM in 3 divided doses
Maximum dose: 6 g/day

Usual Pediatric Dose for Skin and Structure Infection

1 month or older:

• Mild to moderate infections: 25 to 50 mg/kg/day IV or IM in 3 or 4 equally divided doses
• Severe infections: 100 mg/kg/day IV or IM in 3 or 4 equally divided doses

Uses: For the treatment of the following infections due to susceptible bacteria:

• Biliary tract infections due to E coli, various strains of streptococci, P mirabilis, Klebsiella species, and S aureus
• Bone and joint infections due to S aureus
• Genital infections (i.e., prostatitis, epididymitis) due to E coli, P mirabilis, Klebsiella species, and some strains of enterococci
• Respiratory tract infections due to S pneumoniae, S aureus, S pyogenes/group A beta-hemolytic streptococci, Klebsiella species, and H influenzae
• Skin and skin structure infections due to S aureus, S pyogenes/group A beta-hemolytic streptococci, S agalactiae, and other strains of streptococci
• Urinary tract infections due to E coli, P mirabilis, Klebsiella species, and some strains of Enterobacter and enterococci

American Academy of Pediatrics (AAP) Recommendations:
7 days or younger: 25 mg/kg IV or IM every 12 hours

8 to 28 days:
Up to 2 kg: 25 mg/kg IV or IM every 12 hours
Greater than 2 kg: 25 mg/kg IV or IM every 8 hours

1 month or older:
Mild to moderate infections: 25 to 50 mg/kg/day IV or IM in 3 divided doses
Maximum dose: 3 g/day

Severe infections: 100 to 150 mg/kg IV or IM in 3 divided doses
Maximum dose: 6 g/day

Usual Pediatric Dose for Septicemia

1 month or older: 100 mg/kg/day IV or IM in 3 or 4 equally divided doses

Use: For the treatment of septicemia due to S pneumoniae, S aureus, P mirabilis, E coli, and Klebsiella species

Usual Pediatric Dose for Endocarditis

1 month or older: 100 mg/kg/day IV or IM in 3 or 4 equally divided doses

Use: For the treatment of endocarditis due to S aureus and S pyogenes/group A beta-hemolytic streptococci

AHA Recommendations:
1 year or older: 100 mg/kg/day IV in divided doses every 8 hours
Maximum dose: 12 g/day
Duration of Therapy: At least 4 to 6 weeks

Comments:

• Alternative regimen for highly penicillin G-susceptible streptococci (minimum bactericidal concentration [MBC] up to 0.1 mcg/mL), staphylococci (S aureus or coagulase-negative staphylococci) susceptible to up to 1 mcg/mL penicillin G (rare), and staphylococci resistant to 0.1 mcg/mL penicillin G
• Streptococci highly susceptible to penicillin G include most viridans streptococci, groups A, B, C, G, nonenterococcal group D streptococci (S bovis, S equinus).
• For staphylococci resistant to 0.1 mcg/mL penicillin G, this drug may be used with or without gentamicin for the first 3 to 5 days.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Bacterial Endocarditis Prophylaxis

AHA Recommendations:
Children: 50 mg/kg IV or IM as a single dose 30 to 60 minutes before procedure
Maximum dose: 1 g/dose

Comments:

• Recommended as an alternative in patients, with or without penicillin/ampicillin allergy, unable to take oral medication (unless history of anaphylaxis, angioedema, or urticaria with penicillins or ampicillin)
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Surgical Prophylaxis

ASHP, IDSA, SIS, and SHEA Recommendations:
Preoperative dose: 30 mg/kg IV as a single dose
Maximum dose:

• Less than 120 kg: 2 g/dose
• At least 120 kg: 3 g/dose

Redosing interval (from start of preoperative dose): 4 hours

Comments:

• This drug should be started within 60 minutes before surgical incision.
• A single prophylactic dose is usually sufficient; if prophylaxis is continued postoperatively, duration should be less than 24 hours.
• To ensure adequate serum and tissue drug levels, readministration may be needed if the procedure duration exceeds the recommended redosing interval.
• Redosing may be needed if drug half-life is shortened (e.g., extensive burns) or if prolonged/excessive bleeding during surgery; redosing may not be needed if drug half-life is prolonged (e.g., renal dysfunction).
• Coadministration with other agents may be recommended, depending on type of procedure.
• Current guidelines should be consulted for additional information.

Uses: Recommended for surgical prophylaxis for the following procedures:

• Appendectomy for uncomplicated appendicitis
• Biliary tract: Open procedure; elective, high-risk laparoscopic procedure
• Cardiac: Coronary artery bypass; cardiac device insertion procedures (e.g., pacemaker implantation); ventricular assist devices
• Cesarean delivery
• Colorectal
• Gastroduodenal: Procedures involving entry into lumen of GI tract (bariatric, pancreaticoduodenectomy); procedures without entry into GI tract (antireflux, highly selective vagotomy) for high-risk patients
• Head and neck: Clean with placement of prosthesis (excludes tympanostomy tubes); clean-contaminated cancer surgery; other clean-contaminated procedures (excluding tonsillectomy, functional endoscopic sinus procedures)
• Heart, lung, heart-lung transplantation
• Hernia repair (hernioplasty and herniorrhaphy)
• Hysterectomy: Vaginal or abdominal
• Neurosurgery: Elective craniotomy and CSF-shunting procedures; implantation of intrathecal pumps
• Orthopedic: Spinal procedures with and without instrumentation; hip fracture repair, implantation of internal fixation devices (e.g., nails, screws, plates, wires); total joint replacement
• Pancreas, pancreas-kidney transplantation
• Plastic surgery: Clean with risk factors or clean-contaminated
• Small intestine: Nonobstructed; obstructed
• Thoracic: Noncardiac procedures (including lobectomy, pneumonectomy, lung resection, thoracotomy); video-assisted thoracoscopic surgery
• Urologic: Lower tract instrumentation with risk factors for infection (includes transrectal prostate biopsy); clean without entry into urinary tract and involving implanted prosthesis; clean with entry into urinary tract; clean-contaminated
• Vascular

Usual Pediatric Dose for Peritonitis

ISPD Recommendations:
PROPHYLAXIS:
Touch contamination: 125 mg/L intraperitoneally

Invasive dental procedures: 25 mg/kg IV as a single dose 30 to 60 minutes before procedure
Maximum dose: 1 g/dose

GI procedures: 25 mg/kg IV as a single dose, infused within 60 minutes before start of surgical procedure
Maximum dose: 2 g/dose

TREATMENT:
Continuous:

• Loading dose: 500 mg/L intraperitoneally
• Maintenance dose: 125 mg/L intraperitoneally

Intermittent: 20 mg/kg intraperitoneally once a day

Comments:

• For continuous therapy, the exchange with the loading dose should dwell for 3 to 6 hours; all subsequent exchanges during therapy should contain the maintenance dose.
• For intermittent therapy, the dose should be applied once a day in the long-dwell (unless otherwise specified).
• Current guidelines should be consulted for additional information.

Uses:

• As antibacterial prophylaxis in PD patients for:
• Touch contamination (instillation of PD fluid after disconnection of system, disconnection during PD)
• Invasive dental procedures (manipulation of gingival tissue or periapical region of teeth, or perforation of oral mucosa)
• High-risk GI procedures (esophageal stricture dilation, treatment of varices, endoscopic retrograde cholangiopancreatography, percutaneous endoscopic gastrostomy)
• For the treatment of PD-related peritonitis

Renal Dose Adjustments

Adults:

• CrCl 35 to 54 mL/min: Usual dose every 8 hours or longer.
• CrCl 11 to 34 mL/min: 50% of usual dose every 12 hours
• CrCl 10 mL/min or less: 50% of usual dose every 18 to 24 hours

Pediatric patients:

• CrCl 40 to 70 mL/min: 60% of usual daily dose in equally divided doses every 12 hours
• CrCl 20 to 40 mL/min: 25% of usual daily dose in equally divided doses every 12 hours
• CrCl 5 to 20 mL/min: 10% of usual daily dose every 24 hours

Comments:

• In adults, all reduced dose recommendations apply after an initial loading dose appropriate to the severity of the infection.
• In pediatric patients, all dose recommendations apply after an initial loading dose.

Liver Dose Adjustments

Data not available

Precautions

Safety and efficacy have not been established in premature infants and patients younger than 1 month; this drug is not recommended for use in these patients.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:

• Duplex(R) Container: Administer IV over about 30 minutes; do not use plastic containers in series connections.
• Galaxy(R) Containers (PL 2040 Plastic): Administer as continuous or intermittent IV infusion; do not use plastic containers in series connections.
• Powder in vials: May administer IV or IM
• IM: Inject into large muscle mass.
• IV: May administer via direct (bolus) injection, intermittent infusion, or continuous infusion; for direct injection, inject slowly over 3 to 5 minutes directly or through tubing for patients receiving parenteral fluids.
• IV route is preferred for severe or life-threatening infections.

Storage requirements:

• Duplex(R) Container: Unactivated: Store at 20C to 25C (68F to 77F), excursions permitted to 15C to 30C (59F to 86F); after reconstitution (activation): May store up to 24 hours at room temperature or 7 days under refrigeration
• Galaxy(R) Container: Store at or below -20C (-4F) and handle with care; thawed solution is stable for 48 hours at 25C (77F) or for 30 days at 5C (41F); do not refreeze.
• Powder in vials: Before reconstitution: Store at 20C to 25C (68F to 77F), protect from light; after reconstitution/dilution: Solution is stable for 24 hours at room temperature or for 10 days at 5C (41F).

Reconstitution/preparation techniques:

• Duplex(R) Container and powder in vials: The manufacturer product information should be consulted.
• Galaxy(R) Containers: Thaw frozen container at room temperature (25C [77F]) or in refrigerator (5C [41F]); do not force thaw by immersion in water baths or by microwave irradiation.

IV compatibility:

• Compatible diluents and IV solutions (powder in vials): Sterile Water for Injection; Bacteriostatic Water for Injection (pharmacy bulk vials); Sodium Chloride Injection, USP; 5% or 10% Dextrose (Glucose) Injection, USP; 5% Dextrose in Lactated Ringer's Injection, USP; 5% Dextrose and 0.9% Sodium Chloride Injection, USP; 5% Dextrose and 0.45% Sodium Chloride Injection, USP; 5% Dextrose and 0.2% Sodium Chloride Injection, USP; Lactated Ringer's Injection, USP; Invert Sugar 5% or 10% in Sterile Water for Injection; Ringer's Injection, USP; 5% Sodium Bicarbonate Injection, USP
• Duplex(R) Container: Do not introduce additives into container.
• Galaxy(R) Containers: Do not add supplementary medication.

General:

• This drug is for the treatment of serious infections due to susceptible strains of the designated bacteria.
• Culture and susceptibility information should be considered when selecting/modifying antibacterial therapy or, if no data are available, local epidemiology and susceptibility patterns may be considered when selecting empiric therapy.
• This drug eradicates streptococci from the nasopharynx but no data are available regarding efficacy in the subsequent prevention of rheumatic fever; injectable penicillin G benzathine is considered the drug of choice to treat and prevent streptococcal infections (including rheumatic fever prophylaxis).
• Sodium content is about 48 mg (2 mEq) per gram of drug.

Monitoring:

• Hematologic: Prothrombin time in at-risk patients (e.g., renal or liver dysfunction, poor nutritional state, prolonged antimicrobial therapy)
• Renal: Renal function in elderly patients

Patient advice:

• Avoid missing doses and complete the entire course of therapy.
• Contact physician immediately if watery and bloody stools occur.