Usual Adult Dose for Bacteremia

Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Use: Treatment of bacteremia or septicemia caused by Escherichia coli, Klebsiella species, Serratia marcescens, Staphylococcus aureus, and Streptococcus species

Usual Adult Dose for Septicemia

Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Use: Treatment of bacteremia or septicemia caused by Escherichia coli, Klebsiella species, Serratia marcescens, Staphylococcus aureus, and Streptococcus species

Usual Adult Dose for Sepsis

Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Use: Treatment of bacteremia or septicemia caused by Escherichia coli, Klebsiella species, Serratia marcescens, Staphylococcus aureus, and Streptococcus species

Usual Adult Dose for Cesarean Section

1 g IV as soon as the umbilical cord is clamped, then additional 1 g IM or IV doses at 6 and 12 hours after the initial dose

Use: To reduce the incidence of postoperative infections

Usual Adult Dose for Meningitis

Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comment: Efficacy in treating Klebsiella pneumoniae and E coli have been studied in less than 10 infections.

Use: Treatment of central nervous system infections (including meningitis and ventriculitis) caused by Neisseria meningitides, Haemophilus influenzae, Streptococcus pneumoniae, K pneumoniae, and E coli

Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), American Association of Neurological Surgeons (AANS), and Neurocritical Care Society (NCS) Recommendations: 8 to 12 g per day, given at 4 to 6 hour intervals

Comment: Vancomycin should be added to isolates with a penicillin MIC of 0.12 mcg/mL or higher and a third-generation cephalosporin MIC of 1 mcg/mL or greater.

Uses:

• Treatment of healthcare-associated ventriculitis and meningitis caused by gram-negative bacilli susceptible to third-generation cephalosporins
• Recommended treatment of bacterial meningitis caused by N meningitides, H influenzae, S pneumoniae, and E coli
• Empirical antimicrobial therapy in patients 50 years and younger with purulent meningitis caused by N meningitides or S pneumoniae
• Empirical antimicrobial therapy in patients over 50 years of age with purulent meningitis caused by S pneumoniae, N meningitides, Listeria monocytogenes, or aerobic gram-negative bacilli
• Empirical antimicrobial therapy in patients with basilar skull fractures with purulent meningitis caused by S pneumoniae, H influenzae, Group A beta-hemolytic streptococci

Usual Adult Dose for CNS Infection

Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comment: Efficacy in treating Klebsiella pneumoniae and E coli have been studied in less than 10 infections.

Use: Treatment of central nervous system infections (including meningitis and ventriculitis) caused by Neisseria meningitides, Haemophilus influenzae, Streptococcus pneumoniae, K pneumoniae, and E coli

Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), American Association of Neurological Surgeons (AANS), and Neurocritical Care Society (NCS) Recommendations: 8 to 12 g per day, given at 4 to 6 hour intervals

Comment: Vancomycin should be added to isolates with a penicillin MIC of 0.12 mcg/mL or higher and a third-generation cephalosporin MIC of 1 mcg/mL or greater.

Uses:

• Treatment of healthcare-associated ventriculitis and meningitis caused by gram-negative bacilli susceptible to third-generation cephalosporins
• Recommended treatment of bacterial meningitis caused by N meningitides, H influenzae, S pneumoniae, and E coli
• Empirical antimicrobial therapy in patients 50 years and younger with purulent meningitis caused by N meningitides or S pneumoniae
• Empirical antimicrobial therapy in patients over 50 years of age with purulent meningitis caused by S pneumoniae, N meningitides, Listeria monocytogenes, or aerobic gram-negative bacilli
• Empirical antimicrobial therapy in patients with basilar skull fractures with purulent meningitis caused by S pneumoniae, H influenzae, Group A beta-hemolytic streptococci

Usual Adult Dose for Pelvic Inflammatory Disease

Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comments:

• Efficacy in treating Enterobacter species, Klebsiella species, Bacteriodes fragilis, and Fusobacterium nucleatum have been studied in less than 10 infections.
• This drug is not active against Chlamydia trachomatis. Patients with pelvic inflammatory disease suspected to be caused by C trachomatis should be given appropriate anti-chlamydial treatment.

Use: Treatment of endometriosis, pelvic inflammatory disease, and pelvic cellulitis caused by Staphylococcus epidermidis, Streptococcus species, Enterococcus species, Enterobacter species, E coli, Klebsiella species, Proteus mirabilis, Bacteroides species, Clostridium species, anaerobic cocci (e.g., Peptostreptococcus species, Peptococcus species), and Fusobacterium species

Usual Adult Dose for Endometritis

Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comments:

• Efficacy in treating Enterobacter species, Klebsiella species, Bacteriodes fragilis, and Fusobacterium nucleatum have been studied in less than 10 infections.
• This drug is not active against Chlamydia trachomatis. Patients with pelvic inflammatory disease suspected to be caused by C trachomatis should be given appropriate anti-chlamydial treatment.

Use: Treatment of endometriosis, pelvic inflammatory disease, and pelvic cellulitis caused by Staphylococcus epidermidis, Streptococcus species, Enterococcus species, Enterobacter species, E coli, Klebsiella species, Proteus mirabilis, Bacteroides species, Clostridium species, anaerobic cocci (e.g., Peptostreptococcus species, Peptococcus species), and Fusobacterium species

Usual Adult Dose for Gonococcal Infection - Uncomplicated

Urethritis/cervicitis: 0.5 g IM once

Rectal gonorrhea:

• Females: 0.5 g IM once
• Males: 1 g IM once

Use: Treatment of uncomplicated cervical/urethral and rectal gonorrhea caused by Neisseria gonorrhoeae, including penicillinase producing strains

US Centers for Disease Control and Prevention (CDC) Recommendations:
Urogenital and anorectal infections: 500 mg IM once

Use: Alternative treatment of uncomplicated gonococcal infections of the cervix, urethra, and rectum

Usual Adult Dose for Intraabdominal Infection

Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comment: Efficacy in treating Streptococcus species, Peptostreptococcus species, Pseudomonas aeruginosa, P mirabilis, and Clostridium species have been studied in less than 10 infections.

Use: Treatment of intraabdominal infections caused by Streptococcus species, E coli, Klebsiella species, Bacteroides species, anaerobic cocci, P mirabilis, and Clostridium species

IDSA and National Institutes of Health (NIH) Recommendations: 1 g IV every 8 hours

Uses:

• Empiric treatment of bacterial enteric infections for patients with advanced HIV and clinically severe diarrhea (e.g., 6 or more liquid stools/day or bloody stool and/or with fever/chills)
• Treatment of salmonellosis in patients with HIV

Surgical Infection Society (SIS) and IDSA Recommendations: 1 to 2 g IV every 6 to 8 hours PLUS metronidazole

Use: Empirical treatment of community-acquired mild-to-moderate perforated/abscessed appendicitis and other infections of mild-to-moderate severity

Usual Adult Dose for Joint Infection

Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comment: Efficacy in treating Streptococcus pyogenes, P aeruginosa, and P mirabilis have been studied in less than 10 infections.

Use: Treatment of bone and/or joint infections caused by penicillinase and non-penicillinase producing S aureus, Streptococcus species, Pseudomonas species, and P mirabilis

Usual Adult Dose for Osteomyelitis

Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comment: Efficacy in treating Streptococcus pyogenes, P aeruginosa, and P mirabilis have been studied in less than 10 infections.

Use: Treatment of bone and/or joint infections caused by penicillinase and non-penicillinase producing S aureus, Streptococcus species, Pseudomonas species, and P mirabilis

Usual Adult Dose for Peritonitis

Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comment: Efficacy in treating Streptococcus species, Peptostreptococcus species, P aeruginosa, P mirabilis, and Clostridium species have been studied in less than 10 infections.

Use: Treatment of peritonitis caused by Streptococcus species, E coli, Klebsiella species, Bacteroides species, anaerobic cocci, P mirabilis, and Clostridium species

International Society for Peritoneal Dialysis (ISPD) Recommendations:
Intermittent: 500 to 1000 mg intraperitoneally once a day

Use: Empirical treatment of peritonitis suspected to be caused by gram-negative organisms

Usual Adult Dose for Pneumonia

Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comment: Efficacy in treating S pyogenes and S marcescens have been studied in less than 10 infections.

Use: Treatment of serious lower respiratory tract infections (including pneumonia) caused by S pneumoniae/Diplococcus pneumoniae, S pyogenes (Group A streptococci), other streptococci (except enterococci), penicillinase/non-penicillinase producing S aureus, E coli, Klebsiella species, H influenzae (including ampicillin-resistant organisms), Haemophilus parainfluenzae, P mirabilis, S marcescens, Enterobacter species, and indole positive Proteus and Pseudomonas species

Usual Adult Dose for Skin or Soft Tissue Infection

Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comment: Efficacy in treating Acinetobacter species, Citrobacter freundii, Proteus vulgaris, Providencia rettgeri, and Peptostreptococcus have been studied in less than 10 infections.

Use: Treatment of skin and structure infections caused by penicillinase and non-penicillinase producing S aureus, Staphylococcus epidermidis, Streptococcus pyogenes (Group A streptococci), other streptococci, Enterococcus species, Acinetobacter species, E coli, Citrobacter species, Enterobacter species, Klebsiella species, P mirabilis, P vulgaris, Morganella morganii, P rettgeri, Pseudomonas species, S marcescens, Bacteroides species, and anaerobic cocci

IDSA Recommendations:
Animal bites: 1 to 2 g IV every 6 to 8 hours
Mixed infections: 2 g IV every 6 hours PLUS metronidazole or clindamycin
Vibrio infections: 2 g IV 3 times a day PLUS doxycycline

Uses:

• Treatment of necrotizing infections of the skin, fascia, and muscle caused by mixed infections or Vibrio vulnificus
• Treatment of infections following animal bites

Usual Adult Dose for Surgical Prophylaxis

1 g IM or IV once

Comments:

• This drug should be given 30 to 90 minutes prior to surgery.
• Some experts recommend preoperative bowel preparation with mechanical cleansing and use of a non-absorbable antibiotic in patients undergoing gastrointestinal procedures.

Use: To reduce the incidence of specific infections in patients undergoing contaminated or possibly contaminated surgical procedures (e.g., abdominal/vaginal hysterectomy, gastrointestinal/genitourinary tract surgery)

American Society of Health-System Pharmacists (ASHP), IDSA, SIS, and Society for Healthcare Epidemiology of America (SHEA) Recommendations:
Non-obese patients: 1 g IV once PLUS ampicillin
Obese patients: 2 g IV once PLUS ampicillin

Comment: The recommended redosing interval is 3 hours.

Use: Surgical antimicrobial prophylaxis in patients undergoing liver transplantation

Usual Adult Dose for Urinary Tract Infection

Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comment: Efficacy in treating S aureus, P vulgaris, M morganii, and P rettgeri have been studied in less than 10 infections.

Use: Treatment of urinary tract infections caused by Enterococcus species, S epidermidis, penicillinase/non-penicillinase producing S aureus, Citrobacter species, Enterobacter species, E coli, Klebsiella species, P mirabilis, P vulgaris, P stuartii, M morganii, P rettgeri, S marcescens, and Pseudomonas species

Usual Adult Dose for Gonococcal Infection - Disseminated

US CDC Recommendations: 1 g IV every 8 hours

Comment: The patient's sexual partner(s) within the past 60 days should be evaluates/treated.

Use: Alternative treatment of arthritis and arthritis-dermatitis syndrome caused by N gonorrhoeae

Usual Adult Dose for Lyme Disease - Neurologic

AAN and IDSA Recommendations: 2 g IV every 8 hours

• Duration of therapy: 14 to 28 days

Use: Treatment of nervous system Lyme disease

Usual Adult Dose for Sinusitis

IDSA Recommendations: 2 g IV every 4 to 6 hours

Uses: Treatment of severe acute bacterial rhinosinusitis requiring hospitalization

Usual Adult Dose for Rhinitis

IDSA Recommendations: 2 g IV every 4 to 6 hours

Uses: Treatment of severe acute bacterial rhinosinusitis requiring hospitalization

Usual Pediatric Dose for Bacteremia

0 to 1 week: 50 mg/kg IV every 12 hours
1 to 4 weeks: 50 mg/kg IV every 8 hours

1 month to 12 years:
Less than 50 kg: 50 to 180 mg/kg IM or IV per day, given in 4 to 6 equal doses
50 kg or more:

• Uncomplicated infections: 1 g IM or IV every 12 hours
• Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
• Infections needing higher-doses: 2 g IV every 6 to 8 hours
• Life-threatening infections: 2 g IV every 4 hours

Maximum dose: 12 g/day

12 years and older:
Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comment: Higher doses should be used to treat more severe/serious infections.

Use: Treatment of bacteremia or septicemia caused by E coli, Klebsiella species, S marcescens, S aureus, and Streptococcus species

IDSA Recommendations:
Neonates 0 to 4 weeks and less than 1200 g: 100 mg/kg IV per day, given in divided doses every 12 hours
Postnatal age 7 days or less and 1200 to 2000 g: 100 mg/kg IV per day, given in divided doses every 12 hours
Postnatal age 7 days or less and greater than 2000 g: 100 to 150 mg/kg IV per day, given in divided doses every 8 to 12 hours
Postnatal age over 7 days and 1200 to 2000 g: 150 mg/kg IV per day, given in divided doses every 8 hours
Postnatal age over 7 days and over 2000 g: 150 to 200 mg/kg IV per day, given in divided doses every 6 to 8 hours
Infants and children 12 years and younger: 100 to 150 mg/kg per day, given in divided doses every 8 hours

Use: Treatment of catheter-related infections

Usual Pediatric Dose for Septicemia

0 to 1 week: 50 mg/kg IV every 12 hours
1 to 4 weeks: 50 mg/kg IV every 8 hours

1 month to 12 years:
Less than 50 kg: 50 to 180 mg/kg IM or IV per day, given in 4 to 6 equal doses
50 kg or more:

• Uncomplicated infections: 1 g IM or IV every 12 hours
• Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
• Infections needing higher-doses: 2 g IV every 6 to 8 hours
• Life-threatening infections: 2 g IV every 4 hours

Maximum dose: 12 g/day

12 years and older:
Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comment: Higher doses should be used to treat more severe/serious infections.

Use: Treatment of bacteremia or septicemia caused by E coli, Klebsiella species, S marcescens, S aureus, and Streptococcus species

IDSA Recommendations:
Neonates 0 to 4 weeks and less than 1200 g: 100 mg/kg IV per day, given in divided doses every 12 hours
Postnatal age 7 days or less and 1200 to 2000 g: 100 mg/kg IV per day, given in divided doses every 12 hours
Postnatal age 7 days or less and greater than 2000 g: 100 to 150 mg/kg IV per day, given in divided doses every 8 to 12 hours
Postnatal age over 7 days and 1200 to 2000 g: 150 mg/kg IV per day, given in divided doses every 8 hours
Postnatal age over 7 days and over 2000 g: 150 to 200 mg/kg IV per day, given in divided doses every 6 to 8 hours
Infants and children 12 years and younger: 100 to 150 mg/kg per day, given in divided doses every 8 hours

Use: Treatment of catheter-related infections

Usual Pediatric Dose for Sepsis

0 to 1 week: 50 mg/kg IV every 12 hours
1 to 4 weeks: 50 mg/kg IV every 8 hours

1 month to 12 years:
Less than 50 kg: 50 to 180 mg/kg IM or IV per day, given in 4 to 6 equal doses
50 kg or more:

• Uncomplicated infections: 1 g IM or IV every 12 hours
• Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
• Infections needing higher-doses: 2 g IV every 6 to 8 hours
• Life-threatening infections: 2 g IV every 4 hours

Maximum dose: 12 g/day

12 years and older:
Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comment: Higher doses should be used to treat more severe/serious infections.

Use: Treatment of bacteremia or septicemia caused by E coli, Klebsiella species, S marcescens, S aureus, and Streptococcus species

IDSA Recommendations:
Neonates 0 to 4 weeks and less than 1200 g: 100 mg/kg IV per day, given in divided doses every 12 hours
Postnatal age 7 days or less and 1200 to 2000 g: 100 mg/kg IV per day, given in divided doses every 12 hours
Postnatal age 7 days or less and greater than 2000 g: 100 to 150 mg/kg IV per day, given in divided doses every 8 to 12 hours
Postnatal age over 7 days and 1200 to 2000 g: 150 mg/kg IV per day, given in divided doses every 8 hours
Postnatal age over 7 days and over 2000 g: 150 to 200 mg/kg IV per day, given in divided doses every 6 to 8 hours
Infants and children 12 years and younger: 100 to 150 mg/kg per day, given in divided doses every 8 hours

Use: Treatment of catheter-related infections

Usual Pediatric Dose for Meningitis

0 to 1 week: 50 mg/kg IV every 12 hours
1 to 4 weeks: 50 mg/kg IV every 8 hours

1 month to 12 years:
Less than 50 kg: 50 to 180 mg/kg IM or IV per day, given in 4 to 6 equal doses
50 kg or more:

• Uncomplicated infections: 1 g IM or IV every 12 hours
• Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
• Infections needing higher-doses: 2 g IV every 6 to 8 hours
• Life-threatening infections: 2 g IV every 4 hours

Maximum dose: 12 g/day

12 years and older:
Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comments:

• Higher doses should be used to treat more severe/serious infections.
• Efficacy in treating K pneumoniae and E coli have been studied in less than 10 infections.

Use: Treatment of central nervous system infections (including meningitis and ventriculitis) caused by N meningitides, H influenzae, S pneumoniae, K pneumoniae, and E coli

IDSA, AAN, AANS, and NCS Recommendations:
Bacterial meningitis:
0 to 7 days: 100 to 150 mg/kg IV per day, given in divided doses every 8 to 12 hours PLUS ampicillin
8 to 28 days: 150 to 200 mg/kg IV per day, given in divided doses every 6 to 8 hours PLUS ampicillin
Infants and children: 225 to 300 mg/kg IV per day, given in divided doses every 6 to 8 hours PLUS vancomycin

Nosocomial meningitis:
Children: 300 mg/kg IV per day, given at 6 to 8 hour intervals

Comment: Vancomycin should be added to patients over 1 month of age and/or in isolates with a penicillin MIC of 0.12 mcg/mL or higher and a third-generation cephalosporin MIC of 1 mcg/mL or greater.

Uses:

• Empirical antimicrobial therapy in patients less than 1 month of age with purulent meningitis caused by S agalactiae, E coli, L monocytogenes, or Klebsiella species
• Empirical antimicrobial therapy in patients 1 to 23 months of age with purulent meningitis caused by S pneumoniae, N meningitides, S agalactiae, H influenzae, or E coli
• Empirical antimicrobial therapy in patients 2 years and older with purulent meningitis caused by N meningitides or S pneumoniae
• Empirical antimicrobial therapy in patients with basilar skull fractures with purulent meningitis caused by S pneumoniae, H influenzae, Group A beta-hemolytic streptococci

Usual Pediatric Dose for CNS Infection

0 to 1 week: 50 mg/kg IV every 12 hours
1 to 4 weeks: 50 mg/kg IV every 8 hours

1 month to 12 years:
Less than 50 kg: 50 to 180 mg/kg IM or IV per day, given in 4 to 6 equal doses
50 kg or more:

• Uncomplicated infections: 1 g IM or IV every 12 hours
• Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
• Infections needing higher-doses: 2 g IV every 6 to 8 hours
• Life-threatening infections: 2 g IV every 4 hours

Maximum dose: 12 g/day

12 years and older:
Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comments:

• Higher doses should be used to treat more severe/serious infections.
• Efficacy in treating K pneumoniae and E coli have been studied in less than 10 infections.

Use: Treatment of central nervous system infections (including meningitis and ventriculitis) caused by N meningitides, H influenzae, S pneumoniae, K pneumoniae, and E coli

IDSA, AAN, AANS, and NCS Recommendations:
Bacterial meningitis:
0 to 7 days: 100 to 150 mg/kg IV per day, given in divided doses every 8 to 12 hours PLUS ampicillin
8 to 28 days: 150 to 200 mg/kg IV per day, given in divided doses every 6 to 8 hours PLUS ampicillin
Infants and children: 225 to 300 mg/kg IV per day, given in divided doses every 6 to 8 hours PLUS vancomycin

Nosocomial meningitis:
Children: 300 mg/kg IV per day, given at 6 to 8 hour intervals

Comment: Vancomycin should be added to patients over 1 month of age and/or in isolates with a penicillin MIC of 0.12 mcg/mL or higher and a third-generation cephalosporin MIC of 1 mcg/mL or greater.

Uses:

• Empirical antimicrobial therapy in patients less than 1 month of age with purulent meningitis caused by S agalactiae, E coli, L monocytogenes, or Klebsiella species
• Empirical antimicrobial therapy in patients 1 to 23 months of age with purulent meningitis caused by S pneumoniae, N meningitides, S agalactiae, H influenzae, or E coli
• Empirical antimicrobial therapy in patients 2 years and older with purulent meningitis caused by N meningitides or S pneumoniae
• Empirical antimicrobial therapy in patients with basilar skull fractures with purulent meningitis caused by S pneumoniae, H influenzae, Group A beta-hemolytic streptococci

Usual Pediatric Dose for Intraabdominal Infection

0 to 1 week: 50 mg/kg IV every 12 hours
1 to 4 weeks: 50 mg/kg IV every 8 hours

1 month to 12 years:
Less than 50 kg: 50 to 180 mg/kg IM or IV per day, given in 4 to 6 equal doses
50 kg or more:

• Uncomplicated infections: 1 g IM or IV every 12 hours
• Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
• Infections needing higher-doses: 2 g IV every 6 to 8 hours
• Life-threatening infections: 2 g IV every 4 hours

Maximum dose: 12 g/day

12 years and older:
Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comments:

• Higher doses should be used to treat more severe/serious infections.
• Efficacy in treating Streptococcus species, Peptostreptococcus species, P aeruginosa, P mirabilis, and Clostridium species have been studied in less than 10 infections.

Use: Treatment of peritonitis caused by Streptococcus species, E coli, Klebsiella species, Bacteroides species, anaerobic cocci, P mirabilis, and Clostridium species

IDSA and NIH Recommendations:
Adolescents: 1 g IV every 8 hours

Uses:

• Empiric treatment of bacterial enteric infections for patients with advanced HIV and clinically severe diarrhea (e.g., 6 or more liquid stools/day or bloody stool and/or with fever/chills)
• Treatment of salmonellosis in patients with HIV

Surgical Infection Society (SIS) and Infectious Diseases Society of America (IDSA) Recommendations: 150 to 200 mg/kg IV per day, given in divided doses every 6 to 8 hours

Use: Empirical treatment of community-acquired infections

Usual Pediatric Dose for Joint Infection

0 to 1 week: 50 mg/kg IV every 12 hours
1 to 4 weeks: 50 mg/kg IV every 8 hours

1 month to 12 years:
Less than 50 kg: 50 to 180 mg/kg IM or IV per day, given in 4 to 6 equal doses
50 kg or more:

• Uncomplicated infections: 1 g IM or IV every 12 hours
• Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
• Infections needing higher-doses: 2 g IV every 6 to 8 hours
• Life-threatening infections: 2 g IV every 4 hours

Maximum dose: 12 g/day

12 years and older:
Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comments:

• Higher doses should be used to treat more severe/serious infections.
• Efficacy in treating S pyogenes, P aeruginosa, and P mirabilis have been studied in less than 10 infections.

Use: Treatment of bone and/or joint infections caused by penicillinase and non-penicillinase producing S aureus, Streptococcus species, Pseudomonas species, and P mirabilis

Usual Pediatric Dose for Osteomyelitis

0 to 1 week: 50 mg/kg IV every 12 hours
1 to 4 weeks: 50 mg/kg IV every 8 hours

1 month to 12 years:
Less than 50 kg: 50 to 180 mg/kg IM or IV per day, given in 4 to 6 equal doses
50 kg or more:

• Uncomplicated infections: 1 g IM or IV every 12 hours
• Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
• Infections needing higher-doses: 2 g IV every 6 to 8 hours
• Life-threatening infections: 2 g IV every 4 hours

Maximum dose: 12 g/day

12 years and older:
Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comments:

• Higher doses should be used to treat more severe/serious infections.
• Efficacy in treating S pyogenes, P aeruginosa, and P mirabilis have been studied in less than 10 infections.

Use: Treatment of bone and/or joint infections caused by penicillinase and non-penicillinase producing S aureus, Streptococcus species, Pseudomonas species, and P mirabilis

Usual Pediatric Dose for Peritonitis

0 to 1 week: 50 mg/kg IV every 12 hours
1 to 4 weeks: 50 mg/kg IV every 8 hours

1 month to 12 years:
Less than 50 kg: 50 to 180 mg/kg IM or IV per day, given in 4 to 6 equal doses
50 kg or more:

• Uncomplicated infections: 1 g IM or IV every 12 hours
• Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
• Infections needing higher-doses: 2 g IV every 6 to 8 hours
• Life-threatening infections: 2 g IV every 4 hours

Maximum dose: 12 g/day

12 years and older:
Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comments:

• Higher doses should be used to treat more severe/serious infections.
• Efficacy in treating Streptococcus species, Peptostreptococcus species, P aeruginosa, P mirabilis, and Clostridium species have been studied in less than 10 infections.

Use: Treatment of peritonitis caused by Streptococcus species, E coli, Klebsiella species, Bacteroides species, anaerobic cocci, P mirabilis, and Clostridium species

ISPD Recommendations:
Continuous peritoneal dialysis:

• Loading dose: 500 mg/L intraperitoneally once
• Maintenance dose: 250 mg/L intraperitoneally

Intermittent peritoneal dialysis: 30 mg/kg intraperitoneally once a day

• Duration of therapy: 2 weeks

Comments:

• Patients receiving continuous dialysis should allow the loading dose to dwell for 3 to 6 hours.
• Patients receiving intermittent dialysis should be given the dose once a day in the long dwell.

Use: Treatment of peritonitis caused by E coli or Klebsiella species

Usual Pediatric Dose for Pneumonia

0 to 1 week: 50 mg/kg IV every 12 hours
1 to 4 weeks: 50 mg/kg IV every 8 hours

1 month to 12 years:
Less than 50 kg: 50 to 180 mg/kg IM or IV per day, given in 4 to 6 equal doses
50 kg or more:

• Uncomplicated infections: 1 g IM or IV every 12 hours
• Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
• Infections needing higher-doses: 2 g IV every 6 to 8 hours
• Life-threatening infections: 2 g IV every 4 hours

Maximum dose: 12 g/day

12 years and older:
Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comments:

• Higher doses should be used to treat more severe/serious infections.
• Efficacy in treating S pyogenes and S marcescens have been studied in less than 10 infections.

Use: Treatment of serious lower respiratory tract infections (including pneumonia) caused by S pneumoniae/D pneumoniae, S pyogenes (Group A streptococci), other streptococci (except enterococci), penicillinase/non-penicillinase producing S aureus, E coli, Klebsiella species, H influenzae (including ampicillin-resistant organisms), H parainfluenzae, P mirabilis, S marcescens, Enterobacter species, and indole positive Proteus and Pseudomonas species

IDSA and NIH Recommendations:
Children: 40 to 50 mg/kg IV 4 times a day OR 50 to 65 mg/kg IV 3 times a day

• Maximum dose: 8 to 10 g/day

Use: Treatment of bacterial pneumonia caused by S pneumoniae, S aureus, H influenzae, or P aeruginosa in patients exposed to or with HIV

Pediatric Infectious Diseases Society (PIDS) and IDSA Recommendations:
Older than 3 months: 150 mg/kg IV per day, given in divided doses every 8 hours

Uses:

• Preferred treatment of community-acquired pneumonia caused by H influenzae types A to

F or non-typeable

• Alternative treatment of community-acquired pneumonia caused by Group A Streptococcus or S pneumoniae with penicillin MICs of 2 mcg/mL or less

Usual Pediatric Dose for Skin or Soft Tissue Infection

0 to 1 week: 50 mg/kg IV every 12 hours
1 to 4 weeks: 50 mg/kg IV every 8 hours

1 month to 12 years:
Less than 50 kg: 50 to 180 mg/kg IM or IV per day, given in 4 to 6 equal doses
50 kg or more:

• Uncomplicated infections: 1 g IM or IV every 12 hours
• Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
• Infections needing higher-doses: 2 g IV every 6 to 8 hours
• Life-threatening infections: 2 g IV every 4 hours

Maximum dose: 12 g/day

12 years and older:
Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comments:

• Higher doses should be used to treat more severe/serious infections.
• Efficacy in treating Acinetobacter species, C freundii, P vulgaris, P rettgeri, and Peptostreptococcus have been studied in less than 10 infections.

Use: Treatment of skin and structure infections caused by penicillinase and non-penicillinase producing S aureus, S epidermidis, S pyogenes (Group A streptococci), other streptococci, Enterococcus species, Acinetobacter species, E coli, Citrobacter species, Enterobacter species, Klebsiella species, P mirabilis, P vulgaris, M morganii, P rettgeri, Pseudomonas species, S marcescens, Bacteroides species, and anaerobic cocci

IDSA Recommendations:
Children: 50 mg/kg IV per day, given in divided doses every 6 hours PLUS metronidazole or clindamycin

Use: Treatment of necrotizing infections of the skin, fascia, and muscle caused by mixed infections

Usual Pediatric Dose for Urinary Tract Infection

0 to 1 week: 50 mg/kg IV every 12 hours
1 to 4 weeks: 50 mg/kg IV every 8 hours

1 month to 12 years:
Less than 50 kg: 50 to 180 mg/kg IM or IV per day, given in 4 to 6 equal doses
50 kg or more:

• Uncomplicated infections: 1 g IM or IV every 12 hours
• Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
• Infections needing higher-doses: 2 g IV every 6 to 8 hours
• Life-threatening infections: 2 g IV every 4 hours

Maximum dose: 12 g/day

12 years and older:
Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comments:

• Higher doses should be used to treat more severe/serious infections.
• Efficacy in treating S aureus, P vulgaris, M morganii, and P rettgeri have been studied in less than 10 infections.

Use: Treatment of urinary tract infections caused by Enterococcus species, S epidermidis, penicillinase/non-penicillinase producing S aureus, Citrobacter species, Enterobacter species, E coli, Klebsiella species, P mirabilis, P vulgaris, P stuartii, M morganii, P rettgeri, S marcescens, and Pseudomonas species

Usual Pediatric Dose for Surgical Prophylaxis

ASHP, IDSA, SIS, and SHEA Recommendations:
Pediatric patients: 50 mg/kg IV once PLUS ampicillin

• Maximum dose: 1 g/dose

Comment: The recommended redosing interval is 3 hours.

Use: Surgical antimicrobial prophylaxis in patients undergoing liver transplantation

Usual Pediatric Dose for Gonococcal Infection - Uncomplicated

US CDC Recommendations:
Adolescents:
Urogenital and anorectal infections: 500 mg IM once

Use: Alternative treatment of uncomplicated gonococcal infections of the cervix, urethra, and rectum

Usual Pediatric Dose for Gonococcal Infection - Disseminated

US CDC Recommendations:
Neonates: 25 mg/kg IM or IV every 12 hours
Duration of therapy:

• Disseminated gonococcal infection (DGI): 7 days
• DGI with meningitis: 10 to 14 days

Adolescents: 1 g IV every 8 hours

Comments:

• The patient's sexual partner(s) within the past 60 days should be evaluates/treated.
• Treatment should be used with caution in infants with hyperbilirubinemia.

Uses:

• Treatment of DGI and gonococcal scalp abscesses
• Alternative treatment of arthritis and arthritis-dermatitis syndrome caused by N gonorrhoeae

Usual Pediatric Dose for Lyme Disease - Neurologic

AAN and IDSA Recommendations:
Pediatric patients: 150 to 200 mg/kg IV per day, given in 3 to 4 divided doses

• Maximum dose: 6 g/day
• Duration of therapy: 14 to 28 days

Use: Treatment of nervous system Lyme disease

Usual Pediatric Dose for Sinusitis

IDSA Recommendations:
Children: 100 to 200 mg/kg IV per day, given in divided doses every 6 hours

Use: Treatment of severe acute bacterial rhinosinusitis requiring hospitalization

Usual Pediatric Dose for Rhinitis

IDSA Recommendations:
Children: 100 to 200 mg/kg IV per day, given in divided doses every 6 hours

Use: Treatment of severe acute bacterial rhinosinusitis requiring hospitalization

Renal Dose Adjustments

CrCl 20 to 90 mL/min: Dose adjustment(s) may be required; however, no specific guidelines have been suggested. Caution recommended.
CrCl less than 20 mL/min: The dose should be reduced by 50% of the normal dose.
Duration of therapy: At least 10 days (Infections caused by Group A beta-hemolytic streptococci)

Comments:

• Treatment should continue for at least 48 to 72 hours after the patient's condition improves and/or evidence of bacterial eradication occurs.
• Patients with persistent infections may require weeks of treatment, but should not receive doses lower than indicated.

Liver Dose Adjustments

Data not available

Dose Adjustments

Abnormal blood counts during treatment: Consider discontinuation of this drug.

Precautions

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:

• IM: This drug should be injected deep into the body of a large muscle. Providers should aspirate the solution to ensure that treatment did not enter blood vessels. Doses up to 2 g may be given if divided and administered into different areas of the body.
• Intermittent IV: This drug should be injected over at least 3 to 5 minutes.

Storage requirements:

• Premixed injection solution: Store in the freezer until ready to use. Once thawed, this drug is stable for 10 days (5C or below) or 24 hours (22C or below); the solution should not be refrozen.
• Powder for reconstitution: Once reconstituted in original containers or disposable plastic syringes, this drug is stable for up to 13 weeks (frozen), 5 days (at 5C or below), or 24 hours (at 22C or below

IV compatibility:

• This drug should not be admixed with aminoglycoside antibiotics.

General:

• Limitation of use: This drug is not active against Chlamydia trachomatis.
• IV administration is preferred in patients with severe or life-threatening infections (e.g., bacteremia, septicemia, peritonitis, meningitis) or those with lower resistance due to debilitating conditions (e.g., malnutrition, trauma, surgery, diabetes, heart failure, malignancy [especially with present/impending shock]).
• Spectrum of Activity: Susceptibility varies geographically and may change over time; local susceptibility data should be consulted, if available. This drug has shown activity in vitro and in clinical infections against most isolates of Enterococcus species (may be intrinsically resistant), S aureus (methicillin-susceptible isolates only), S epidermidis, S pneumoniae, S pyogenes, viridans group streptococci, Acinetobacter species, Citrobacter species, Enterobacter species, E coli, H influenzae, H parainfluenzae, Klebsiella species, M morganii, N gonorrhoeae, N meningitidis, Proteus mirabilis, P vulgaris, P rettgeri, P stuartii, S marcescens, Bacteroides species, Clostridium species (most Clostridium difficile isolates are resistant), Fusobacterium species, Peptococcus species, and Peptostreptococcus species; most extended spectrum beta-lactamase-producing and carbapenemase-producing isolates are resistant. This drug has shown in vitro activity against Providencia species, Salmonella species, and Shigella species; however, efficacy has not been established in treating clinical infections.

Monitoring:

• Hematologic: White blood cell counts, especially in patients receiving treatment for longer than 7 days
• Hepatic: Hepatic function tests, especially in patients with hepatic dysfunction or with decreased hepatic blood flow
• Renal: Renal function tests, especially in patients with renal dysfunction or when given with aminoglycoside antibiotics

Patient advice:

• Patients should be told to report any unusual or severe side effects.
• Patients should be instructed to report signs/symptoms of C difficile infection (e.g., watery/bloody stools, stomach cramps, fever), for up to 2 months after stopping treatment.
• Patients should be directed to take the full course of treatment, even if they feel better.