Drug Detail:Claforan (Cefotaxime [ sef-oh-tax-eem ])
Drug Class: Third generation cephalosporins
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
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
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
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
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
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
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
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
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
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
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
- 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
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
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.