Usual Adult Dose for Bacteremia

Pneumonia associated with bacteremia: 1 to 2 grams via IV injection over 30 minutes every 8 to 12 hours

Mild to moderate urinary tract infections (UTIs) associated with bacteremia: 0.5 to 1 gram via IV injection over 30 minutes every 12 hours

Severe UTIs associated with bacteremia: 2 grams via IV injection over 30 minutes every 12 hours

Duration of therapy:

• Pneumonia: 10 days
• Mild to moderate UTIs: 7 to 10 days
• Severe UTIs: 10 days

Uses:

• Treatment of moderate to severe pneumonia and concurrent bacteremia caused by susceptible strains of Streptococcus pneumoniae, Pseudomonas aeruginosa, Klebsiella pneumoniae, or Enterobacter species
• Treatment of complicated and uncomplicated mild to moderate urinary tract infections and concurrent bacteremia caused by susceptible isolates of Escherichia coli, K pneumoniae, or Proteus mirabilis
• Treatment of complicated and uncomplicated severe urinary tract infections and concurrent bacteremia caused by susceptible isolates of E coli or K pneumoniae

Infectious Diseases Society of America (IDSA) Recommendations:
2 grams IV every 8 hours with/without aminoglycoside

Comment: Preferred treatments may be given with or without aminoglycosides.

Uses:

• Adjunctive preferred treatment of IV catheter-related bloodstream infections caused by P aeruginosa
• Alternative treatment of IV catheter-related bloodstream infections caused by Enterobacter species and Serratia marcescens

Usual Adult Dose for Febrile Neutropenia

Empiric treatment: 2 grams via IV injection over 30 minutes every 8 hours

• Duration of therapy: 7 days OR until resolution of neutropenia

Comments:

• The continued need for antibiotic treatment should be frequently reassessed in patients whose fever resolves but remain neutropenic for longer than 7 days.
• Use may be inappropriate in patients at high risk for severe infection (e.g., patients with a history of recent bone marrow transplantation, hypotension at presentation, underlying hematologic malignancy, with severe/prolonged neutropenia).

Use: Monotherapy for empiric treatment of febrile neutropenia

Usual Adult Dose for Intraabdominal Infection

Complicated intraabdominal infections: 2 grams via IV injection over 30 minutes every 8 to 12 hours

Intraabdominal infections caused by Pseudomonas: 2 grams via IV injection over 30 minutes every 8 hours

Duration of therapy: 7 to 10 days

Use: In combination with metronidazole for the treatment of complicated intraabdominal infections caused by susceptible isolates of Bacteroides fragilis, Enterobacter species, E coli, K pneumoniae, P aeruginosa, or viridans group streptococci (VGS)

Surgical Infection Society (SIS) and IDSA Recommendations:
Initial dose: 2 grams IV every 8 to 12 hours PLUS metronidazole

Comment: Maintenance doses should be based on adjusted body weight and serum drug concentrations.

Uses:

• Empiric combination treatment of complicated extra-biliary community-acquired intraabdominal infections in patients with severe physiologic disturbance, advanced age, or immunocompromised stage caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae or P aeruginosa, or gram-negative bacilli (GNB) less than 20% resistant to this drug
• Adjunctive empiric treatment of community-acquired acute cholecystitis of severe physiologic disturbance, advanced age, and/or immunocompromised state
• Adjunctive empiric treatment of acute cholangitis following bilio-enteric anastomosis of any severity
• Adjunctive empiric treatment of healthcare-associated biliary infection of any severity

Usual Adult Dose for Pneumonia

Moderate to severe pneumonia: 1 to 2 grams via IV injection over 30 minutes every 8 to 12 hours

Pneumonia caused by P aeruginosa: 2 grams via IV injection over 30 minutes every 8 hours

Duration of therapy: 10 days

Use: Treatment of moderate to severe pneumonia caused by susceptible strains of Enterobacter species, K pneumoniae, P aeruginosa, or S pneumoniae

IDSA and American Thoracic Society (ATS) Recommendations:
2 grams IV every 8 hours

Uses:

• Initial empiric treatment for hospital-acquired pneumonia (non-ventilator-associated pneumonia) in patients not at high risk of mortality and with no factors increasing the likelihood of methicillin-resistant Staphylococcus aureus (MRSA)
• Initial empiric treatment for hospital-acquired pneumonia (non-ventilator-associated pneumonia) in patients not at high-risk of mortality, but with factors increasing the likelihood of MRSA (e.g., previous IV antibiotic treatment within 90 days, treatment in a unit where the prevalence of MRSA among S aureus isolates is unknown OR greater than 20%)
• Initial empiric treatment for hospital-acquired pneumonia (non-ventilator-associated pneumonia) in patients at high-risk of mortality or receipt of IV antibiotics during the prior 90 days
• Adjunctive empiric treatment for suspected ventilator-associated pneumonia in units where empiric MRSA coverage and double antipseudomonal/gram-negative coverage are appropriate

Usual Adult Dose for Nosocomial Pneumonia

Moderate to severe pneumonia: 1 to 2 grams via IV injection over 30 minutes every 8 to 12 hours

Pneumonia caused by P aeruginosa: 2 grams via IV injection over 30 minutes every 8 hours

Duration of therapy: 10 days

Use: Treatment of moderate to severe pneumonia caused by susceptible strains of Enterobacter species, K pneumoniae, P aeruginosa, or S pneumoniae

IDSA and American Thoracic Society (ATS) Recommendations:
2 grams IV every 8 hours

Uses:

• Initial empiric treatment for hospital-acquired pneumonia (non-ventilator-associated pneumonia) in patients not at high risk of mortality and with no factors increasing the likelihood of methicillin-resistant Staphylococcus aureus (MRSA)
• Initial empiric treatment for hospital-acquired pneumonia (non-ventilator-associated pneumonia) in patients not at high-risk of mortality, but with factors increasing the likelihood of MRSA (e.g., previous IV antibiotic treatment within 90 days, treatment in a unit where the prevalence of MRSA among S aureus isolates is unknown OR greater than 20%)
• Initial empiric treatment for hospital-acquired pneumonia (non-ventilator-associated pneumonia) in patients at high-risk of mortality or receipt of IV antibiotics during the prior 90 days
• Adjunctive empiric treatment for suspected ventilator-associated pneumonia in units where empiric MRSA coverage and double antipseudomonal/gram-negative coverage are appropriate

Usual Adult Dose for Skin and Structure Infection

2 grams via IV injection over 30 minutes every 12 hours

• Duration of therapy: 10 days

Uses:

• Treatment of uncomplicated skin and skin structure infections caused by S aureus (only methicillin-susceptible isolates) or Streptococcus pyogenes
• Treatment of moderate to severe uncomplicated skin and skin structure infections caused by MSSA or S pyogenes

Usual Adult Dose for Pyelonephritis

Mild to moderate uncomplicated OR complicated infections: 0.5 to 1 gram IM OR via IV injection over 30 minutes every 12 hours

Severe uncomplicated OR complicated infections: 2 grams via IV injection over 30 minutes every 12 hours

Duration of therapy:

• Mild to moderate: 7 to 10 days
• Severe: 10 days

Comment: Mild to moderate uncomplicated and complicated infections caused by E coli may be treated via IM administration; other isolates should be treated via IV administration.

Uses:

• Treatment of complicated and uncomplicated mild to moderate UTIs caused by susceptible isolates of E coli, K pneumoniae, or P mirabilis
• Treatment of complicated and uncomplicated severe urinary tract infections caused by susceptible isolates of E coli or K pneumoniae
• Treatment of pyelonephritis

Usual Adult Dose for Urinary Tract Infection

Mild to moderate uncomplicated OR complicated infections: 0.5 to 1 gram IM OR via IV injection over 30 minutes every 12 hours

Severe uncomplicated OR complicated infections: 2 grams via IV injection over 30 minutes every 12 hours

Duration of therapy:

• Mild to moderate: 7 to 10 days
• Severe: 10 days

Comment: Mild to moderate uncomplicated and complicated infections caused by E coli may be treated via IM administration; other isolates should be treated via IV administration.

Uses:

• Treatment of complicated and uncomplicated mild to moderate UTIs caused by susceptible isolates of E coli, K pneumoniae, or P mirabilis
• Treatment of complicated and uncomplicated severe urinary tract infections caused by susceptible isolates of E coli or K pneumoniae
• Treatment of pyelonephritis

Usual Adult Dose for Meningitis

IDSA, American Academy of Neurology (AAN), American Association of Neurological Surgeons (AANS), and Neurocritical Care Society (NCS) Recommendations:
2 grams IV every 8 hours

• Maximum dose: 8 grams/day

Duration of therapy:

• Neisseria meningitis or Haemophilus influenzae: 7 days
• Coagulase-negative staphylococcus or Propionibacterium acnes with no/minimal cerebrospinal fluid (CSF) pleocytosis, normal CSF glucose, few symptoms/systemic features: 10 days
• Coagulase-negative staphylococcus or P acnes with significant CSF pleocytosis, S aureus or GNB with/without significant CSF pleocytosis, CSF hypoglycorrhachia, or symptoms/systemic features: 10 to 14 days
• S pneumoniae: 10 to 14 days
• Streptococcus agalactiae: 14 to 21 days
• Aerobic GNB: 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

Uses:

• Standard treatment of healthcare-associated ventriculitis and meningitis caused by P aeruginosa
• Alternative treatment of healthcare-associated ventriculitis and meningitis caused by S pneumoniae with a penicillin minimum inhibitory concentration (MIC) at least 0.12 mcg/mL AND a cefotaxime/ceftriaxone MIC less than 1 mcg/mL
• Alternative treatment of healthcare-associated ventriculitis and meningitis caused by beta-lactamase negative H influenzae
• Alternative treatment of healthcare-associated ventriculitis and meningitis caused by ESBL GNB
• Alternative empiric treatment for meningitis caused by H influenzae or E coli
• Adjunctive empiric treatment of patients with penetrating head trauma and purulent meningitis caused by S aureus, coagulase-negative staphylococci (especially Staphylococcus epidermidis), aerobic GNB (e.g., P aeruginosa)
• Adjunctive empiric treatment of postneurosurgery patients with purulent meningitis caused by aerobic GNB (e.g., P aeruginosa), S aureus, and/or coagulase-negative staphylococci, especially S epidermidis
• Adjunctive empiric treatment of patients with CSF shunt and purulent meningitis caused by coagulase-negative staphylococci (especially S epidermidis), S aureus, aerobic GNB (e.g., P aeruginosa), and/or P acnes
• Alternative treatment of bacterial meningitis caused by S pneumoniae with a penicillin MIC between 0.1 to 1 mcg/mL
• Standard treatment of bacterial meningitis caused by P aeruginosa
• Alternative treatment of bacterial meningitis caused by beta-lactamase negative OR beta-lactamase positive H influenzae

Usual Adult Dose for Meningitis - Meningococcal

IDSA, American Academy of Neurology (AAN), American Association of Neurological Surgeons (AANS), and Neurocritical Care Society (NCS) Recommendations:
2 grams IV every 8 hours

• Maximum dose: 8 grams/day

Duration of therapy:

• Neisseria meningitis or Haemophilus influenzae: 7 days
• Coagulase-negative staphylococcus or Propionibacterium acnes with no/minimal cerebrospinal fluid (CSF) pleocytosis, normal CSF glucose, few symptoms/systemic features: 10 days
• Coagulase-negative staphylococcus or P acnes with significant CSF pleocytosis, S aureus or GNB with/without significant CSF pleocytosis, CSF hypoglycorrhachia, or symptoms/systemic features: 10 to 14 days
• S pneumoniae: 10 to 14 days
• Streptococcus agalactiae: 14 to 21 days
• Aerobic GNB: 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

Uses:

• Standard treatment of healthcare-associated ventriculitis and meningitis caused by P aeruginosa
• Alternative treatment of healthcare-associated ventriculitis and meningitis caused by S pneumoniae with a penicillin minimum inhibitory concentration (MIC) at least 0.12 mcg/mL AND a cefotaxime/ceftriaxone MIC less than 1 mcg/mL
• Alternative treatment of healthcare-associated ventriculitis and meningitis caused by beta-lactamase negative H influenzae
• Alternative treatment of healthcare-associated ventriculitis and meningitis caused by ESBL GNB
• Alternative empiric treatment for meningitis caused by H influenzae or E coli
• Adjunctive empiric treatment of patients with penetrating head trauma and purulent meningitis caused by S aureus, coagulase-negative staphylococci (especially Staphylococcus epidermidis), aerobic GNB (e.g., P aeruginosa)
• Adjunctive empiric treatment of postneurosurgery patients with purulent meningitis caused by aerobic GNB (e.g., P aeruginosa), S aureus, and/or coagulase-negative staphylococci, especially S epidermidis
• Adjunctive empiric treatment of patients with CSF shunt and purulent meningitis caused by coagulase-negative staphylococci (especially S epidermidis), S aureus, aerobic GNB (e.g., P aeruginosa), and/or P acnes
• Alternative treatment of bacterial meningitis caused by S pneumoniae with a penicillin MIC between 0.1 to 1 mcg/mL
• Standard treatment of bacterial meningitis caused by P aeruginosa
• Alternative treatment of bacterial meningitis caused by beta-lactamase negative OR beta-lactamase positive H influenzae

Usual Adult Dose for Meningitis - Haemophilus influenzae

IDSA, American Academy of Neurology (AAN), American Association of Neurological Surgeons (AANS), and Neurocritical Care Society (NCS) Recommendations:
2 grams IV every 8 hours

• Maximum dose: 8 grams/day

Duration of therapy:

• Neisseria meningitis or Haemophilus influenzae: 7 days
• Coagulase-negative staphylococcus or Propionibacterium acnes with no/minimal cerebrospinal fluid (CSF) pleocytosis, normal CSF glucose, few symptoms/systemic features: 10 days
• Coagulase-negative staphylococcus or P acnes with significant CSF pleocytosis, S aureus or GNB with/without significant CSF pleocytosis, CSF hypoglycorrhachia, or symptoms/systemic features: 10 to 14 days
• S pneumoniae: 10 to 14 days
• Streptococcus agalactiae: 14 to 21 days
• Aerobic GNB: 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

Uses:

• Standard treatment of healthcare-associated ventriculitis and meningitis caused by P aeruginosa
• Alternative treatment of healthcare-associated ventriculitis and meningitis caused by S pneumoniae with a penicillin minimum inhibitory concentration (MIC) at least 0.12 mcg/mL AND a cefotaxime/ceftriaxone MIC less than 1 mcg/mL
• Alternative treatment of healthcare-associated ventriculitis and meningitis caused by beta-lactamase negative H influenzae
• Alternative treatment of healthcare-associated ventriculitis and meningitis caused by ESBL GNB
• Alternative empiric treatment for meningitis caused by H influenzae or E coli
• Adjunctive empiric treatment of patients with penetrating head trauma and purulent meningitis caused by S aureus, coagulase-negative staphylococci (especially Staphylococcus epidermidis), aerobic GNB (e.g., P aeruginosa)
• Adjunctive empiric treatment of postneurosurgery patients with purulent meningitis caused by aerobic GNB (e.g., P aeruginosa), S aureus, and/or coagulase-negative staphylococci, especially S epidermidis
• Adjunctive empiric treatment of patients with CSF shunt and purulent meningitis caused by coagulase-negative staphylococci (especially S epidermidis), S aureus, aerobic GNB (e.g., P aeruginosa), and/or P acnes
• Alternative treatment of bacterial meningitis caused by S pneumoniae with a penicillin MIC between 0.1 to 1 mcg/mL
• Standard treatment of bacterial meningitis caused by P aeruginosa
• Alternative treatment of bacterial meningitis caused by beta-lactamase negative OR beta-lactamase positive H influenzae

Usual Adult Dose for Meningitis - Pneumococcal

IDSA, American Academy of Neurology (AAN), American Association of Neurological Surgeons (AANS), and Neurocritical Care Society (NCS) Recommendations:
2 grams IV every 8 hours

• Maximum dose: 8 grams/day

Duration of therapy:

• Neisseria meningitis or Haemophilus influenzae: 7 days
• Coagulase-negative staphylococcus or Propionibacterium acnes with no/minimal cerebrospinal fluid (CSF) pleocytosis, normal CSF glucose, few symptoms/systemic features: 10 days
• Coagulase-negative staphylococcus or P acnes with significant CSF pleocytosis, S aureus or GNB with/without significant CSF pleocytosis, CSF hypoglycorrhachia, or symptoms/systemic features: 10 to 14 days
• S pneumoniae: 10 to 14 days
• Streptococcus agalactiae: 14 to 21 days
• Aerobic GNB: 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

Uses:

• Standard treatment of healthcare-associated ventriculitis and meningitis caused by P aeruginosa
• Alternative treatment of healthcare-associated ventriculitis and meningitis caused by S pneumoniae with a penicillin minimum inhibitory concentration (MIC) at least 0.12 mcg/mL AND a cefotaxime/ceftriaxone MIC less than 1 mcg/mL
• Alternative treatment of healthcare-associated ventriculitis and meningitis caused by beta-lactamase negative H influenzae
• Alternative treatment of healthcare-associated ventriculitis and meningitis caused by ESBL GNB
• Alternative empiric treatment for meningitis caused by H influenzae or E coli
• Adjunctive empiric treatment of patients with penetrating head trauma and purulent meningitis caused by S aureus, coagulase-negative staphylococci (especially Staphylococcus epidermidis), aerobic GNB (e.g., P aeruginosa)
• Adjunctive empiric treatment of postneurosurgery patients with purulent meningitis caused by aerobic GNB (e.g., P aeruginosa), S aureus, and/or coagulase-negative staphylococci, especially S epidermidis
• Adjunctive empiric treatment of patients with CSF shunt and purulent meningitis caused by coagulase-negative staphylococci (especially S epidermidis), S aureus, aerobic GNB (e.g., P aeruginosa), and/or P acnes
• Alternative treatment of bacterial meningitis caused by S pneumoniae with a penicillin MIC between 0.1 to 1 mcg/mL
• Standard treatment of bacterial meningitis caused by P aeruginosa
• Alternative treatment of bacterial meningitis caused by beta-lactamase negative OR beta-lactamase positive H influenzae

Usual Adult Dose for Meningitis - Listeriosis

IDSA, American Academy of Neurology (AAN), American Association of Neurological Surgeons (AANS), and Neurocritical Care Society (NCS) Recommendations:
2 grams IV every 8 hours

• Maximum dose: 8 grams/day

Duration of therapy:

• Neisseria meningitis or Haemophilus influenzae: 7 days
• Coagulase-negative staphylococcus or Propionibacterium acnes with no/minimal cerebrospinal fluid (CSF) pleocytosis, normal CSF glucose, few symptoms/systemic features: 10 days
• Coagulase-negative staphylococcus or P acnes with significant CSF pleocytosis, S aureus or GNB with/without significant CSF pleocytosis, CSF hypoglycorrhachia, or symptoms/systemic features: 10 to 14 days
• S pneumoniae: 10 to 14 days
• Streptococcus agalactiae: 14 to 21 days
• Aerobic GNB: 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

Uses:

• Standard treatment of healthcare-associated ventriculitis and meningitis caused by P aeruginosa
• Alternative treatment of healthcare-associated ventriculitis and meningitis caused by S pneumoniae with a penicillin minimum inhibitory concentration (MIC) at least 0.12 mcg/mL AND a cefotaxime/ceftriaxone MIC less than 1 mcg/mL
• Alternative treatment of healthcare-associated ventriculitis and meningitis caused by beta-lactamase negative H influenzae
• Alternative treatment of healthcare-associated ventriculitis and meningitis caused by ESBL GNB
• Alternative empiric treatment for meningitis caused by H influenzae or E coli
• Adjunctive empiric treatment of patients with penetrating head trauma and purulent meningitis caused by S aureus, coagulase-negative staphylococci (especially Staphylococcus epidermidis), aerobic GNB (e.g., P aeruginosa)
• Adjunctive empiric treatment of postneurosurgery patients with purulent meningitis caused by aerobic GNB (e.g., P aeruginosa), S aureus, and/or coagulase-negative staphylococci, especially S epidermidis
• Adjunctive empiric treatment of patients with CSF shunt and purulent meningitis caused by coagulase-negative staphylococci (especially S epidermidis), S aureus, aerobic GNB (e.g., P aeruginosa), and/or P acnes
• Alternative treatment of bacterial meningitis caused by S pneumoniae with a penicillin MIC between 0.1 to 1 mcg/mL
• Standard treatment of bacterial meningitis caused by P aeruginosa
• Alternative treatment of bacterial meningitis caused by beta-lactamase negative OR beta-lactamase positive H influenzae

Usual Adult Dose for Meningitis - Streptococcus Group B

IDSA, American Academy of Neurology (AAN), American Association of Neurological Surgeons (AANS), and Neurocritical Care Society (NCS) Recommendations:
2 grams IV every 8 hours

• Maximum dose: 8 grams/day

Duration of therapy:

• Neisseria meningitis or Haemophilus influenzae: 7 days
• Coagulase-negative staphylococcus or Propionibacterium acnes with no/minimal cerebrospinal fluid (CSF) pleocytosis, normal CSF glucose, few symptoms/systemic features: 10 days
• Coagulase-negative staphylococcus or P acnes with significant CSF pleocytosis, S aureus or GNB with/without significant CSF pleocytosis, CSF hypoglycorrhachia, or symptoms/systemic features: 10 to 14 days
• S pneumoniae: 10 to 14 days
• Streptococcus agalactiae: 14 to 21 days
• Aerobic GNB: 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

Uses:

• Standard treatment of healthcare-associated ventriculitis and meningitis caused by P aeruginosa
• Alternative treatment of healthcare-associated ventriculitis and meningitis caused by S pneumoniae with a penicillin minimum inhibitory concentration (MIC) at least 0.12 mcg/mL AND a cefotaxime/ceftriaxone MIC less than 1 mcg/mL
• Alternative treatment of healthcare-associated ventriculitis and meningitis caused by beta-lactamase negative H influenzae
• Alternative treatment of healthcare-associated ventriculitis and meningitis caused by ESBL GNB
• Alternative empiric treatment for meningitis caused by H influenzae or E coli
• Adjunctive empiric treatment of patients with penetrating head trauma and purulent meningitis caused by S aureus, coagulase-negative staphylococci (especially Staphylococcus epidermidis), aerobic GNB (e.g., P aeruginosa)
• Adjunctive empiric treatment of postneurosurgery patients with purulent meningitis caused by aerobic GNB (e.g., P aeruginosa), S aureus, and/or coagulase-negative staphylococci, especially S epidermidis
• Adjunctive empiric treatment of patients with CSF shunt and purulent meningitis caused by coagulase-negative staphylococci (especially S epidermidis), S aureus, aerobic GNB (e.g., P aeruginosa), and/or P acnes
• Alternative treatment of bacterial meningitis caused by S pneumoniae with a penicillin MIC between 0.1 to 1 mcg/mL
• Standard treatment of bacterial meningitis caused by P aeruginosa
• Alternative treatment of bacterial meningitis caused by beta-lactamase negative OR beta-lactamase positive H influenzae

Usual Adult Dose for Joint Infection

IDSA Recommendations:
P aeruginosa osteomyelitis: 2 grams IV every 8 to 12 hours

Enterobacteriaceae osteomyelitis and prosthetic joint infections: 2 grams IV every 12 hours

Duration of therapy:

• Severe, soft tissue-only diabetic foot infections: 2 to 4 weeks
• Residual infected, but viable, bone in diabetic foot infections: 4 to 6 weeks
• Osteomyelitis and prosthetic joint infections: 6 weeks
• No surgery or postoperative residual dead bone in diabetic foot infections: 3 months or longer

Comments:

• Patients with diabetic foot infections should be started on parenteral treatment and should be switched to oral formulations when possible.
• Obligate anaerobe coverage should be considered in patients with severe diabetic foot infections.

Uses:

• Preferred treatment of native vertebral osteomyelitis cause by Enterobacteriaceae species
• Preferred treatment of native vertebral osteomyelitis caused by P aeruginosa
• Preferred treatment of prosthetic joint infections caused by P aeruginosa
• Preferred treatment of prosthetic joint infections caused by Enterobacter species
• Adjunctive empiric treatment (with vancomycin) of moderate or severe diabetic foot infections caused by MRSA, Enterobacteriaceae, Pseudomonas, and/or obligate anaerobes

Usual Adult Dose for Osteomyelitis

IDSA Recommendations:
P aeruginosa osteomyelitis: 2 grams IV every 8 to 12 hours

Enterobacteriaceae osteomyelitis and prosthetic joint infections: 2 grams IV every 12 hours

Duration of therapy:

• Severe, soft tissue-only diabetic foot infections: 2 to 4 weeks
• Residual infected, but viable, bone in diabetic foot infections: 4 to 6 weeks
• Osteomyelitis and prosthetic joint infections: 6 weeks
• No surgery or postoperative residual dead bone in diabetic foot infections: 3 months or longer

Comments:

• Patients with diabetic foot infections should be started on parenteral treatment and should be switched to oral formulations when possible.
• Obligate anaerobe coverage should be considered in patients with severe diabetic foot infections.

Uses:

• Preferred treatment of native vertebral osteomyelitis cause by Enterobacteriaceae species
• Preferred treatment of native vertebral osteomyelitis caused by P aeruginosa
• Preferred treatment of prosthetic joint infections caused by P aeruginosa
• Preferred treatment of prosthetic joint infections caused by Enterobacter species
• Adjunctive empiric treatment (with vancomycin) of moderate or severe diabetic foot infections caused by MRSA, Enterobacteriaceae, Pseudomonas, and/or obligate anaerobes

Usual Adult Dose for Endocarditis

American Heart Association (AHA) and IDSA Recommendations:
Early, culture-negative endocarditis: 2 grams IV 3 times per day PLUS vancomycin, gentamicin, AND rifampin

• Maximum dose: 6 grams/day
• Duration of therapy: At least 6 weeks

Comment: Gentamicin should be added to patients with enterococcal infections.

Uses:

• Empiric alternative treatment (with gentamicin) of community-acquired native valve or late prosthetic valve (over 1 year after surgery) endocarditis
• Empiric treatment of nosocomial endocarditis associated with vascular cannula or early prosthetic valve endocarditis (1 year or less after surgery)
• Adjunctive empiric treatment of nosocomial endocarditis associated with enteric GNB
• Empiric treatment in early, culture-negative, prosthetic valve endocarditis

Usual Adult Dose for Peritonitis

International Society for Peritoneal Dialysis (ISPD) Recommendations:
Intermittent (1 exchange daily): 1000 mg intraperitoneally once a day

Continuous (all exchanges):

• Loading dose: 250 to 500 mg/L
• Maintenance dose: 100 to 125 mg/L

Duration of therapy: 3 weeks

Comments:

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

Use: Adjunctive treatment of peritonitis caused by P aeruginosa

Usual Pediatric Dose for Bacteremia

Empiric febrile neutropenia treatment:
2 months to 16 years up to 40 kg: 50 mg/kg via IV injection over 30 minutes every 8 hours

• Maximum dose: 2 grams/dose

16 to 18 years: 2 grams via IV injection over 30 minutes every 8 hours

Duration of therapy: 7 days OR until resolution of neutropenia

Bacteremia:
16 years and older:

• Pneumonia associated with bacteremia: 1 to 2 grams via IV injection over 30 minutes every 8 to 12 hours
• Mild to moderate UTIs associated with bacteremia: 0.5 to 1 gram via IV injection over 30 minutes every 12 hours
• Severe UTIs associated with bacteremia: 2 grams via IV injection over 30 minutes every 12 hours

Duration of therapy:

• Pneumonia: 10 days
• Mild to moderate UTIs: 7 to 10 days
• Severe UTIs: 10 days

Comments:

• The continued need for antibiotic treatment should be frequently reassessed in patients whose fever resolves but remain neutropenic for longer than 7 days.
• Use may be inappropriate in patients at high risk for severe infection (e.g., patients with a history of recent bone marrow transplantation, hypotension at presentation, underlying hematologic malignancy, with severe/prolonged neutropenia).

Uses:

• Monotherapy for empiric treatment of febrile neutropenia
• Treatment of moderate to severe pneumonia and concurrent bacteremia caused by susceptible strains of S pneumoniae, P aeruginosa, K pneumoniae, or Enterobacter species
• Treatment of complicated and uncomplicated mild to moderate urinary tract infections and concurrent bacteremia caused by susceptible isolates of E coli, K pneumoniae, or P mirabilis
• Treatment of complicated and uncomplicated severe urinary tract infections and concurrent bacteremia caused by susceptible isolates of E coli or K pneumoniae

IDSA:
Neonates 14 days and younger: 30 mg/kg IV every 12 hours
Infants older than 14 days: 50 mg/kg IV every 12 hours
Children 40 kg and less: 50 mg/kg IV every 12 hours

Comments:

• Preferred treatments may be given with or without aminoglycosides.
• Dosing recommendations were not provided for patients 2 weeks to 2 months of age.

Uses:

• Adjunctive preferred treatment of IV catheter-related bloodstream infections caused by P aeruginosa
• Alternative treatment of IV catheter-related bloodstream infections caused by Enterobacter species and S marcescens

Usual Pediatric Dose for Febrile Neutropenia

Empiric febrile neutropenia treatment:
2 months to 16 years up to 40 kg: 50 mg/kg via IV injection over 30 minutes every 8 hours

• Maximum dose: 2 grams/dose

16 to 18 years: 2 grams via IV injection over 30 minutes every 8 hours

Duration of therapy: 7 days OR until resolution of neutropenia

Bacteremia:
16 years and older:

• Pneumonia associated with bacteremia: 1 to 2 grams via IV injection over 30 minutes every 8 to 12 hours
• Mild to moderate UTIs associated with bacteremia: 0.5 to 1 gram via IV injection over 30 minutes every 12 hours
• Severe UTIs associated with bacteremia: 2 grams via IV injection over 30 minutes every 12 hours

Duration of therapy:

• Pneumonia: 10 days
• Mild to moderate UTIs: 7 to 10 days
• Severe UTIs: 10 days

Comments:

• The continued need for antibiotic treatment should be frequently reassessed in patients whose fever resolves but remain neutropenic for longer than 7 days.
• Use may be inappropriate in patients at high risk for severe infection (e.g., patients with a history of recent bone marrow transplantation, hypotension at presentation, underlying hematologic malignancy, with severe/prolonged neutropenia).

Uses:

• Monotherapy for empiric treatment of febrile neutropenia
• Treatment of moderate to severe pneumonia and concurrent bacteremia caused by susceptible strains of S pneumoniae, P aeruginosa, K pneumoniae, or Enterobacter species
• Treatment of complicated and uncomplicated mild to moderate urinary tract infections and concurrent bacteremia caused by susceptible isolates of E coli, K pneumoniae, or P mirabilis
• Treatment of complicated and uncomplicated severe urinary tract infections and concurrent bacteremia caused by susceptible isolates of E coli or K pneumoniae

IDSA:
Neonates 14 days and younger: 30 mg/kg IV every 12 hours
Infants older than 14 days: 50 mg/kg IV every 12 hours
Children 40 kg and less: 50 mg/kg IV every 12 hours

Comments:

• Preferred treatments may be given with or without aminoglycosides.
• Dosing recommendations were not provided for patients 2 weeks to 2 months of age.

Uses:

• Adjunctive preferred treatment of IV catheter-related bloodstream infections caused by P aeruginosa
• Alternative treatment of IV catheter-related bloodstream infections caused by Enterobacter species and S marcescens

Usual Pediatric Dose for Bacterial Infection

Empiric febrile neutropenia treatment:
2 months to 16 years up to 40 kg: 50 mg/kg via IV injection over 30 minutes every 8 hours

• Maximum dose: 2 grams/dose

16 to 18 years: 2 grams via IV injection over 30 minutes every 8 hours

Duration of therapy: 7 days OR until resolution of neutropenia

Bacteremia:
16 years and older:

• Pneumonia associated with bacteremia: 1 to 2 grams via IV injection over 30 minutes every 8 to 12 hours
• Mild to moderate UTIs associated with bacteremia: 0.5 to 1 gram via IV injection over 30 minutes every 12 hours
• Severe UTIs associated with bacteremia: 2 grams via IV injection over 30 minutes every 12 hours

Duration of therapy:

• Pneumonia: 10 days
• Mild to moderate UTIs: 7 to 10 days
• Severe UTIs: 10 days

Comments:

• The continued need for antibiotic treatment should be frequently reassessed in patients whose fever resolves but remain neutropenic for longer than 7 days.
• Use may be inappropriate in patients at high risk for severe infection (e.g., patients with a history of recent bone marrow transplantation, hypotension at presentation, underlying hematologic malignancy, with severe/prolonged neutropenia).

Uses:

• Monotherapy for empiric treatment of febrile neutropenia
• Treatment of moderate to severe pneumonia and concurrent bacteremia caused by susceptible strains of S pneumoniae, P aeruginosa, K pneumoniae, or Enterobacter species
• Treatment of complicated and uncomplicated mild to moderate urinary tract infections and concurrent bacteremia caused by susceptible isolates of E coli, K pneumoniae, or P mirabilis
• Treatment of complicated and uncomplicated severe urinary tract infections and concurrent bacteremia caused by susceptible isolates of E coli or K pneumoniae

IDSA:
Neonates 14 days and younger: 30 mg/kg IV every 12 hours
Infants older than 14 days: 50 mg/kg IV every 12 hours
Children 40 kg and less: 50 mg/kg IV every 12 hours

Comments:

• Preferred treatments may be given with or without aminoglycosides.
• Dosing recommendations were not provided for patients 2 weeks to 2 months of age.

Uses:

• Adjunctive preferred treatment of IV catheter-related bloodstream infections caused by P aeruginosa
• Alternative treatment of IV catheter-related bloodstream infections caused by Enterobacter species and S marcescens

Usual Pediatric Dose for Intraabdominal Infection

2 months to 16 years up to 40 kg:
Uncomplicated/complicated UTIs, uncomplicated skin and skin structure infections, and pneumonia: 50 mg/kg via IV injection over 30 minutes every 12 hours

• Maximum dose: 2 grams/dose

Moderate to severe pneumonia due to P aeruginosa: 50 mg/kg via IV injection over 30 minutes every 8 hours

• Maximum dose: 2 grams/dose

16 and older:

• Complicated intraabdominal infections OR moderate to severe pneumonia: 1 to 2 grams via IV injection over 30 minutes every 8 to 12 hours

• Intraabdominal infections OR pneumonia caused by Pseudomonas aeruginosa: 2 grams via IV injection over 30 minutes every 8 hours

Duration of therapy:

• Abdominal infections OR mild to moderate UTIs: 7 to 10 days
• Severe UTIs or pneumonia: 10 days

Comment: Mild to moderate uncomplicated and complicated UTIs caused by E coli may be treated via IM administration; other isolates should be treated via IV administration.

Uses:

• Treatment of complicated and uncomplicated mild to moderate UTIs caused by susceptible isolates of E coli, K pneumoniae, or P mirabilis
• Treatment of complicated and uncomplicated severe urinary tract infections caused by susceptible isolates of E coli or K pneumoniae
• Treatment of pyelonephritis
• Treatment of uncomplicated skin and skin structure infections caused by S aureus (only methicillin susceptible isolates) or S pyogenes
• Treatment of moderate to severe uncomplicated skin and skin structure infections caused by MSSA or S pyogenes
• Treatment of moderate to severe pneumonia caused by susceptible strains of Enterobacter species, K pneumoniae, P aeruginosa, or S pneumoniae

SIS and IDSA Recommendations:
Initial dose: 50 mg/kg IV every 12 hours PLUS metronidazole

Comment: Maintenance doses should be based on adjusted body weight and serum drug concentrations.

Use: Empiric combination treatment of complicated extra-biliary community-acquired intraabdominal infections in patients with severe physiologic disturbance, advanced age, or immunocompromised stage caused by ESBL-producing Enterobacteriaceae or P aeruginosa, or GNB less than 20% resistant to this drug and metronidazole

Usual Pediatric Dose for Pneumonia

2 months to 16 years up to 40 kg:
Uncomplicated/complicated UTIs, uncomplicated skin and skin structure infections, and pneumonia: 50 mg/kg via IV injection over 30 minutes every 12 hours

• Maximum dose: 2 grams/dose

Moderate to severe pneumonia due to P aeruginosa: 50 mg/kg via IV injection over 30 minutes every 8 hours

• Maximum dose: 2 grams/dose

16 and older:

• Complicated intraabdominal infections OR moderate to severe pneumonia: 1 to 2 grams via IV injection over 30 minutes every 8 to 12 hours

• Intraabdominal infections OR pneumonia caused by Pseudomonas aeruginosa: 2 grams via IV injection over 30 minutes every 8 hours

Duration of therapy:

• Abdominal infections OR mild to moderate UTIs: 7 to 10 days
• Severe UTIs or pneumonia: 10 days

Comment: Mild to moderate uncomplicated and complicated UTIs caused by E coli may be treated via IM administration; other isolates should be treated via IV administration.

Uses:

• Treatment of complicated and uncomplicated mild to moderate UTIs caused by susceptible isolates of E coli, K pneumoniae, or P mirabilis
• Treatment of complicated and uncomplicated severe urinary tract infections caused by susceptible isolates of E coli or K pneumoniae
• Treatment of pyelonephritis
• Treatment of uncomplicated skin and skin structure infections caused by S aureus (only methicillin susceptible isolates) or S pyogenes
• Treatment of moderate to severe uncomplicated skin and skin structure infections caused by MSSA or S pyogenes
• Treatment of moderate to severe pneumonia caused by susceptible strains of Enterobacter species, K pneumoniae, P aeruginosa, or S pneumoniae

SIS and IDSA Recommendations:
Initial dose: 50 mg/kg IV every 12 hours PLUS metronidazole

Comment: Maintenance doses should be based on adjusted body weight and serum drug concentrations.

Use: Empiric combination treatment of complicated extra-biliary community-acquired intraabdominal infections in patients with severe physiologic disturbance, advanced age, or immunocompromised stage caused by ESBL-producing Enterobacteriaceae or P aeruginosa, or GNB less than 20% resistant to this drug and metronidazole

Usual Pediatric Dose for Pyelonephritis

2 months to 16 years up to 40 kg:
Uncomplicated/complicated UTIs, uncomplicated skin and skin structure infections, and pneumonia: 50 mg/kg via IV injection over 30 minutes every 12 hours

• Maximum dose: 2 grams/dose

Moderate to severe pneumonia due to P aeruginosa: 50 mg/kg via IV injection over 30 minutes every 8 hours

• Maximum dose: 2 grams/dose

16 and older:

• Complicated intraabdominal infections OR moderate to severe pneumonia: 1 to 2 grams via IV injection over 30 minutes every 8 to 12 hours

• Intraabdominal infections OR pneumonia caused by Pseudomonas aeruginosa: 2 grams via IV injection over 30 minutes every 8 hours

Duration of therapy:

• Abdominal infections OR mild to moderate UTIs: 7 to 10 days
• Severe UTIs or pneumonia: 10 days

Comment: Mild to moderate uncomplicated and complicated UTIs caused by E coli may be treated via IM administration; other isolates should be treated via IV administration.

Uses:

• Treatment of complicated and uncomplicated mild to moderate UTIs caused by susceptible isolates of E coli, K pneumoniae, or P mirabilis
• Treatment of complicated and uncomplicated severe urinary tract infections caused by susceptible isolates of E coli or K pneumoniae
• Treatment of pyelonephritis
• Treatment of uncomplicated skin and skin structure infections caused by S aureus (only methicillin susceptible isolates) or S pyogenes
• Treatment of moderate to severe uncomplicated skin and skin structure infections caused by MSSA or S pyogenes
• Treatment of moderate to severe pneumonia caused by susceptible strains of Enterobacter species, K pneumoniae, P aeruginosa, or S pneumoniae

SIS and IDSA Recommendations:
Initial dose: 50 mg/kg IV every 12 hours PLUS metronidazole

Comment: Maintenance doses should be based on adjusted body weight and serum drug concentrations.

Use: Empiric combination treatment of complicated extra-biliary community-acquired intraabdominal infections in patients with severe physiologic disturbance, advanced age, or immunocompromised stage caused by ESBL-producing Enterobacteriaceae or P aeruginosa, or GNB less than 20% resistant to this drug and metronidazole

Usual Pediatric Dose for Urinary Tract Infection

2 months to 16 years up to 40 kg:
Uncomplicated/complicated UTIs, uncomplicated skin and skin structure infections, and pneumonia: 50 mg/kg via IV injection over 30 minutes every 12 hours

• Maximum dose: 2 grams/dose

Moderate to severe pneumonia due to P aeruginosa: 50 mg/kg via IV injection over 30 minutes every 8 hours

• Maximum dose: 2 grams/dose

16 and older:

• Complicated intraabdominal infections OR moderate to severe pneumonia: 1 to 2 grams via IV injection over 30 minutes every 8 to 12 hours

• Intraabdominal infections OR pneumonia caused by Pseudomonas aeruginosa: 2 grams via IV injection over 30 minutes every 8 hours

Duration of therapy:

• Abdominal infections OR mild to moderate UTIs: 7 to 10 days
• Severe UTIs or pneumonia: 10 days

Comment: Mild to moderate uncomplicated and complicated UTIs caused by E coli may be treated via IM administration; other isolates should be treated via IV administration.

Uses:

• Treatment of complicated and uncomplicated mild to moderate UTIs caused by susceptible isolates of E coli, K pneumoniae, or P mirabilis
• Treatment of complicated and uncomplicated severe urinary tract infections caused by susceptible isolates of E coli or K pneumoniae
• Treatment of pyelonephritis
• Treatment of uncomplicated skin and skin structure infections caused by S aureus (only methicillin susceptible isolates) or S pyogenes
• Treatment of moderate to severe uncomplicated skin and skin structure infections caused by MSSA or S pyogenes
• Treatment of moderate to severe pneumonia caused by susceptible strains of Enterobacter species, K pneumoniae, P aeruginosa, or S pneumoniae

SIS and IDSA Recommendations:
Initial dose: 50 mg/kg IV every 12 hours PLUS metronidazole

Comment: Maintenance doses should be based on adjusted body weight and serum drug concentrations.

Use: Empiric combination treatment of complicated extra-biliary community-acquired intraabdominal infections in patients with severe physiologic disturbance, advanced age, or immunocompromised stage caused by ESBL-producing Enterobacteriaceae or P aeruginosa, or GNB less than 20% resistant to this drug and metronidazole

Usual Pediatric Dose for Skin and Structure Infection

2 months to 16 years up to 40 kg:
Uncomplicated/complicated UTIs, uncomplicated skin and skin structure infections, and pneumonia: 50 mg/kg via IV injection over 30 minutes every 12 hours

• Maximum dose: 2 grams/dose

Moderate to severe pneumonia due to P aeruginosa: 50 mg/kg via IV injection over 30 minutes every 8 hours

• Maximum dose: 2 grams/dose

16 and older:

• Complicated intraabdominal infections OR moderate to severe pneumonia: 1 to 2 grams via IV injection over 30 minutes every 8 to 12 hours

• Intraabdominal infections OR pneumonia caused by Pseudomonas aeruginosa: 2 grams via IV injection over 30 minutes every 8 hours

Duration of therapy:

• Abdominal infections OR mild to moderate UTIs: 7 to 10 days
• Severe UTIs or pneumonia: 10 days

Comment: Mild to moderate uncomplicated and complicated UTIs caused by E coli may be treated via IM administration; other isolates should be treated via IV administration.

Uses:

• Treatment of complicated and uncomplicated mild to moderate UTIs caused by susceptible isolates of E coli, K pneumoniae, or P mirabilis
• Treatment of complicated and uncomplicated severe urinary tract infections caused by susceptible isolates of E coli or K pneumoniae
• Treatment of pyelonephritis
• Treatment of uncomplicated skin and skin structure infections caused by S aureus (only methicillin susceptible isolates) or S pyogenes
• Treatment of moderate to severe uncomplicated skin and skin structure infections caused by MSSA or S pyogenes
• Treatment of moderate to severe pneumonia caused by susceptible strains of Enterobacter species, K pneumoniae, P aeruginosa, or S pneumoniae

SIS and IDSA Recommendations:
Initial dose: 50 mg/kg IV every 12 hours PLUS metronidazole

Comment: Maintenance doses should be based on adjusted body weight and serum drug concentrations.

Use: Empiric combination treatment of complicated extra-biliary community-acquired intraabdominal infections in patients with severe physiologic disturbance, advanced age, or immunocompromised stage caused by ESBL-producing Enterobacteriaceae or P aeruginosa, or GNB less than 20% resistant to this drug and metronidazole

Usual Pediatric Dose for Meningitis

IDSA, AAN, AANS, and NCS Recommendations:
50 mg/kg IV every 8 hours

Duration of therapy:

• N meningitis or H influenzae: 7 days
• Coagulase-negative staphylococcus or P acnes with no/minimal CSF pleocytosis, normal CSF glucose, few symptoms/systemic features: 10 days
• Coagulase-negative staphylococcus or P acnes with significant CSF pleocytosis, S aureus or GNB with/without significant CSF pleocytosis, CSF hypengyophobically, or symptoms/systemic features: 10 to 14 days
• S pneumoniae: 10 to 14 days
• S agalactiae: 14 to 21 days
• Aerobic GNB: 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:

• Neonates weighing less than 2000 grams may require lower doses and/or longer dosage intervals.
• The duration of treatment in neonates should be 2 weeks beyond the first sterile CSF culture OR at least 3 weeks of treatment, whichever is longer.

Uses:

• Standard treatment of healthcare-associated ventriculitis and meningitis caused by P aeruginosa
• Alternative treatment of healthcare-associated ventriculitis and meningitis caused by S pneumoniae with a penicillin MIC at least 0.12 mcg/mL AND a cefotaxime/ceftriaxone MIC less than 1 mcg/mL
• Alternative treatment of healthcare-associated ventriculitis and meningitis caused by beta-lactamase negative H influenzae
• Alternative treatment of healthcare-associated ventriculitis and meningitis caused by ESBL GNB

Usual Pediatric Dose for Meningitis - Meningococcal

IDSA, AAN, AANS, and NCS Recommendations:
50 mg/kg IV every 8 hours

Duration of therapy:

• N meningitis or H influenzae: 7 days
• Coagulase-negative staphylococcus or P acnes with no/minimal CSF pleocytosis, normal CSF glucose, few symptoms/systemic features: 10 days
• Coagulase-negative staphylococcus or P acnes with significant CSF pleocytosis, S aureus or GNB with/without significant CSF pleocytosis, CSF hypengyophobically, or symptoms/systemic features: 10 to 14 days
• S pneumoniae: 10 to 14 days
• S agalactiae: 14 to 21 days
• Aerobic GNB: 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:

• Neonates weighing less than 2000 grams may require lower doses and/or longer dosage intervals.
• The duration of treatment in neonates should be 2 weeks beyond the first sterile CSF culture OR at least 3 weeks of treatment, whichever is longer.

Uses:

• Standard treatment of healthcare-associated ventriculitis and meningitis caused by P aeruginosa
• Alternative treatment of healthcare-associated ventriculitis and meningitis caused by S pneumoniae with a penicillin MIC at least 0.12 mcg/mL AND a cefotaxime/ceftriaxone MIC less than 1 mcg/mL
• Alternative treatment of healthcare-associated ventriculitis and meningitis caused by beta-lactamase negative H influenzae
• Alternative treatment of healthcare-associated ventriculitis and meningitis caused by ESBL GNB

Usual Pediatric Dose for Meningitis - Haemophilus influenzae

IDSA, AAN, AANS, and NCS Recommendations:
50 mg/kg IV every 8 hours

Duration of therapy:

• N meningitis or H influenzae: 7 days
• Coagulase-negative staphylococcus or P acnes with no/minimal CSF pleocytosis, normal CSF glucose, few symptoms/systemic features: 10 days
• Coagulase-negative staphylococcus or P acnes with significant CSF pleocytosis, S aureus or GNB with/without significant CSF pleocytosis, CSF hypengyophobically, or symptoms/systemic features: 10 to 14 days
• S pneumoniae: 10 to 14 days
• S agalactiae: 14 to 21 days
• Aerobic GNB: 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:

• Neonates weighing less than 2000 grams may require lower doses and/or longer dosage intervals.
• The duration of treatment in neonates should be 2 weeks beyond the first sterile CSF culture OR at least 3 weeks of treatment, whichever is longer.

Uses:

• Standard treatment of healthcare-associated ventriculitis and meningitis caused by P aeruginosa
• Alternative treatment of healthcare-associated ventriculitis and meningitis caused by S pneumoniae with a penicillin MIC at least 0.12 mcg/mL AND a cefotaxime/ceftriaxone MIC less than 1 mcg/mL
• Alternative treatment of healthcare-associated ventriculitis and meningitis caused by beta-lactamase negative H influenzae
• Alternative treatment of healthcare-associated ventriculitis and meningitis caused by ESBL GNB

Usual Pediatric Dose for Meningitis - Pneumococcal

IDSA, AAN, AANS, and NCS Recommendations:
50 mg/kg IV every 8 hours

Duration of therapy:

• N meningitis or H influenzae: 7 days
• Coagulase-negative staphylococcus or P acnes with no/minimal CSF pleocytosis, normal CSF glucose, few symptoms/systemic features: 10 days
• Coagulase-negative staphylococcus or P acnes with significant CSF pleocytosis, S aureus or GNB with/without significant CSF pleocytosis, CSF hypengyophobically, or symptoms/systemic features: 10 to 14 days
• S pneumoniae: 10 to 14 days
• S agalactiae: 14 to 21 days
• Aerobic GNB: 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:

• Neonates weighing less than 2000 grams may require lower doses and/or longer dosage intervals.
• The duration of treatment in neonates should be 2 weeks beyond the first sterile CSF culture OR at least 3 weeks of treatment, whichever is longer.

Uses:

• Standard treatment of healthcare-associated ventriculitis and meningitis caused by P aeruginosa
• Alternative treatment of healthcare-associated ventriculitis and meningitis caused by S pneumoniae with a penicillin MIC at least 0.12 mcg/mL AND a cefotaxime/ceftriaxone MIC less than 1 mcg/mL
• Alternative treatment of healthcare-associated ventriculitis and meningitis caused by beta-lactamase negative H influenzae
• Alternative treatment of healthcare-associated ventriculitis and meningitis caused by ESBL GNB

Usual Pediatric Dose for Meningitis - Listeriosis

IDSA, AAN, AANS, and NCS Recommendations:
50 mg/kg IV every 8 hours

Duration of therapy:

• N meningitis or H influenzae: 7 days
• Coagulase-negative staphylococcus or P acnes with no/minimal CSF pleocytosis, normal CSF glucose, few symptoms/systemic features: 10 days
• Coagulase-negative staphylococcus or P acnes with significant CSF pleocytosis, S aureus or GNB with/without significant CSF pleocytosis, CSF hypengyophobically, or symptoms/systemic features: 10 to 14 days
• S pneumoniae: 10 to 14 days
• S agalactiae: 14 to 21 days
• Aerobic GNB: 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:

• Neonates weighing less than 2000 grams may require lower doses and/or longer dosage intervals.
• The duration of treatment in neonates should be 2 weeks beyond the first sterile CSF culture OR at least 3 weeks of treatment, whichever is longer.

Uses:

• Standard treatment of healthcare-associated ventriculitis and meningitis caused by P aeruginosa
• Alternative treatment of healthcare-associated ventriculitis and meningitis caused by S pneumoniae with a penicillin MIC at least 0.12 mcg/mL AND a cefotaxime/ceftriaxone MIC less than 1 mcg/mL
• Alternative treatment of healthcare-associated ventriculitis and meningitis caused by beta-lactamase negative H influenzae
• Alternative treatment of healthcare-associated ventriculitis and meningitis caused by ESBL GNB

Usual Pediatric Dose for Meningitis - Streptococcus Group B

IDSA, AAN, AANS, and NCS Recommendations:
50 mg/kg IV every 8 hours

Duration of therapy:

• N meningitis or H influenzae: 7 days
• Coagulase-negative staphylococcus or P acnes with no/minimal CSF pleocytosis, normal CSF glucose, few symptoms/systemic features: 10 days
• Coagulase-negative staphylococcus or P acnes with significant CSF pleocytosis, S aureus or GNB with/without significant CSF pleocytosis, CSF hypengyophobically, or symptoms/systemic features: 10 to 14 days
• S pneumoniae: 10 to 14 days
• S agalactiae: 14 to 21 days
• Aerobic GNB: 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:

• Neonates weighing less than 2000 grams may require lower doses and/or longer dosage intervals.
• The duration of treatment in neonates should be 2 weeks beyond the first sterile CSF culture OR at least 3 weeks of treatment, whichever is longer.

Uses:

• Standard treatment of healthcare-associated ventriculitis and meningitis caused by P aeruginosa
• Alternative treatment of healthcare-associated ventriculitis and meningitis caused by S pneumoniae with a penicillin MIC at least 0.12 mcg/mL AND a cefotaxime/ceftriaxone MIC less than 1 mcg/mL
• Alternative treatment of healthcare-associated ventriculitis and meningitis caused by beta-lactamase negative H influenzae
• Alternative treatment of healthcare-associated ventriculitis and meningitis caused by ESBL GNB

Usual Pediatric Dose for Peritonitis

ISPD Recommendations:
Continuous peritoneal dialysis:

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

Intermittent peritoneal dialysis: 15 mg/kg intraperitoneally once a day

Duration of therapy:

• Coagulase-negative staphylococci OR Streptococcus species: 2 weeks
• E coli OR Klebsiella species: 2 weeks
• E coli OR Klebsiella species resistant to third-generation cephalosporins: 3 weeks
• Acinetobacter species: 2 to 3 weeks
• Enterobacter, Citrobacter, Serratia, and Proteus species: At least 2 to 3 weeks
• MSSA: 3 weeks
• Pseudomonas species: 3 weeks

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.
• If initial cultures remain sterile at 72 hours and signs/symptoms of peritonitis improve, treatment may continue for 2 weeks.
• Prolonged courses of treatment should be avoided.

Uses:

• Preferred empiric treatment of peritonitis caused by gram-positive bacteria
• Adjunctive treatment (with an aminoglycoside) of peritonitis caused by S aureus with resistance rates to methicillin or oxacillin exceeding 10% OR in patients with a history of MRSA
• Treatment of peritonitis caused by susceptible gram-negative bacteria (e.g., E coli, Proteus species, or Klebsiella species)
• Adjunctive treatment of peritonitis caused by P aeruginosa

Usual Pediatric Dose for Endocarditis

AHA Recommendations:
Early, culture-negative endocarditis: 150 mg/kg per day, given in divided doses 3 times per day PLUS vancomycin, gentamicin, AND rifampin

Nosocomial endocarditis: 100 to 150 mg/kg IV per day, given in divided doses every 8 to 12 hours

• Maximum dose: 6 grams/day

Duration of therapy: At least 6 weeks

Comment: Gentamicin should be added to patients with enterococci infections.

Uses:

• Empiric alternative treatment (with gentamicin) of community-acquired native valve or late prosthetic valve (over 1 year after surgery) endocarditis
• Empiric treatment of nosocomial endocarditis associated with vascular cannula or early prosthetic valve endocarditis (1 year or less after surgery)
• Adjunctive empiric treatment of nosocomial endocarditis associated with gram-negative enteric bacilli
• Empiric treatment in early, culture-negative, prosthetic valve endocarditis
• Alternative treatment for streptococcal infections highly susceptible to penicillin G (e.g., groups A, B, C, G nonenterococcal, group D streptococci) and streptococci relatively resistant to penicillin (e.g., enterococci, less-susceptible VGS)
• Alternative treatment for endocarditis caused by S aureus or coagulase-negative staphylococci susceptible or resistant to penicillin G and/or oxacillin in patients highly allergic to beta-lactam antibiotics

Renal Dose Adjustments

Pediatric patients: Dose adjustment(s) may be required; however, no specific guidelines have been suggested. The manufacturer recommends dosage regimen changes proportional to those in adults.

Adults:
Initial dose:

• Patients with renal dysfunction and not undergoing hemodialysis: No adjustment recommended.

Maintenance dose:
Mild infections:

• CrCl greater than 60 mL/min: 500 mg IV every 12 hours
• CrCl 30 to 60 mL/min: 500 mg IV every 24 hours
• CrCl 11 to 29 mL/min: 500 mg IV every 24 hours
• CrCl less than 11 mL/min: 250 mg IV every 24 hours

Moderate infections:

• CrCl greater than 60 mL/min: 1 gram IV every 12 hours
• CrCl 30 to 60 mL/min: 1 gram IV every 24 hours
• CrCl 11 to 29 mL/min: 500 mg IV every 24 hours
• CrCl less than 11 mL/min: 250 mg IV every 24 hours

Severe infections:

• CrCl greater than 60 mL/min: 2 grams IV every 12 hours
• CrCl 30 to 60 mL/min: 2 grams IV every 24 hours
• CrCl 11 to 29 mL/min: 1 gram IV every 24 hours
• CrCl less than 11 mL/min: 500 mg IV every 24 hours

Life-threatening infections:

• CrCl greater than 60 mL/min: 2 grams IV every 8 hours
• CrCl 30 to 60 mL/min: 2 grams IV every 12 hours
• CrCl 11 to 29 mL/min: 2 grams IV every 24 hours
• CrCl less than 11 mL/min: 1 gram IV every 24 hours

Liver Dose Adjustments

No adjustment recommended.

Precautions

CONTRAINDICATIONS:

• Immediate hypersensitivity to the active component, cephalosporin antibiotics, other beta-lactam antibiotics, penicillins, or to any of the ingredients
• Patients with a known allergy to corn/corn products should not take injection solutions containing dextrose

Safety and efficacy have not been established in patients younger than 2 months.

Consult WARNINGS section for additional precautions.

Dialysis

Continuous ambulatory peritoneal dialysis (CAPD):

• Mild infection: 500 mg IV every 48 hours
• Moderate infection: 1 gram IV every 48 hours
• Severe/life-threatening infection: 2 grams IV every 48 hours

Hemodialysis:
Loading dose: 1 gram IV ONCE
Maintenance dose:

• Febrile neutropenia: 1 gram IV every 24 hours
• All other infections: 500 mg IV every 24 hours

Comments:

• Maintenance doses for patients receiving hemodialysis should be given following hemodialysis.
• When possible, doses should be given at the same time each day.

Other Comments

Administration advice:

• Once prepared, this drug should be administered immediately or as soon as possible after reconstitution.
• IM: This drug should be injected deep into the body of a large muscle.
• IV: This drug should be infused over at least 30 minutes.

Storage requirements:

• Protect from light.
• The manufacturer product information should be consulted.

Reconstitution/preparation techniques:

• IM: Providers may constitute this drug with 0.5% or 1% lidocaine (lignocaine); however, this drug usually causes little to no pain with IM administration.

IV compatibility:

• Compatible diluents and IV solutions: Dextrose 5% injection; glucose 5% and lactated Ringer's injection; glucose 5% with sodium chloride 0.9% injection/solution; lidocaine (lignocaine) 0.5% or 1% injection; M/6 sodium lactate injection; Ringer lactate solution; Ringer lactate with glucose 5% solution; sodium chloride 0.9% solution; sodium lactate 1/6M solution; sterile glucose 5% injection; sterile glucose 5% or 10% solution; sterile water for injection

General:

• Local epidemiological and susceptibility patterns should be used to guide treatment selection in the absence of patient-specific culture and susceptibility information.

Monitoring:

• HEMATOLOGIC: WBC count, especially in patients receiving empiric treatment for neutropenia
• RENAL: Renal function tests, especially when used concomitantly with high doses of aminoglycosides and/or potent diuretics

Patient advice:

• Inform patients that this drug may cause altered consciousness, confusion, dizziness, or hallucinations, and they should avoid driving or operating machinery if these side effects occur.
• Advise patients to speak to their healthcare provider if they become pregnant, intend to become pregnant, or are breastfeeding.
• Patients should be directed to take the full course of treatment, even if they feel better.
• Patients should be instructed to report signs/symptoms of Clostridium difficile (e.g., watery/bloody stools, stomach cramps, fever), for up to 2 months after stopping treatment.