Usual Adult Dose for Aspiration Pneumonia

Uncomplicated infections (bacteremia absent/unlikely): 1 gram IV every 6 to 8 hours
Moderately severe to severe infections: 1 gram IV every 4 hours OR 2 grams IV every 6 to 8 hours
Infections needing high-doses: 2 grams IV every 4 hours OR 3 grams IV every 6 hours
Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)

Comments:

• This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
• Uncomplicated infections included cutaneous infections, pneumonia, and urinary tract infections.
• High-dose infections include gas gangrene.
• Surgical drainage should be performed in infections involving collections of pus.

Uses:

• Treatment of bone and joint infections caused by Staphylococcus aureus (including penicillinase-producing strains)
• Treatment of intraabdominal infections (e.g., intraabdominal abscess, peritonitis) caused by Bacteroides species (including Bacteroides fragilis), Clostridium species, Escherichia coli, and Klebsiella species
• Treatment of lower respiratory tract infections (e.g., lung abscesses, pneumonia) caused by Bacteroides species, Escherichia coli, Haemophilus influenzae, Klebsiella species, other streptococci (excluding enterococci, e.g., Enterococcus faecalis/Streptococcus faecalis), S aureus (including penicillinase-producing strains), and Streptococcus pneumoniae
• Treatment of skin and structure infections cause by Bacteroides species (including B fragilis), Clostridium species, E coli, Klebsiella species, Peptococcus niger, Peptostreptococcus species, Proteus mirabilis, S aureus (including penicillinase-producing strains), Staphylococcus epidermidis, Streptococcus pyogenes and other streptococci (excluding enterococci, e.g., E faecalis/S faecalis)
• Treatment of urinary tract infections caused by E coli, Klebsiella species, Morganella morganii, P mirabilis, Proteus vulgaris, and Providencia species (including Providencia rettgeri)

Infectious Diseases Society of America (IDSA) Recommendations:
1 gram IV every 6 to 8 hours

Duration of therapy:

• Bone/joint infection without residual infected tissue (e.g., postamputation): 2 to 5 days)
• Moderate diabetic foot infection, including residual infected soft tissue (soft tissue only): 1 to 3 weeks
• Severe diabetic foot infection (soft tissue only): 2 to 4 weeks
• Residual infected, but viable, bone: 4 to 6 weeks
• No surgery or postoperative residual dead bone: 3 months or longer

Comment: Patients with diabetic foot infections should be started on parenteral treatment and should be switched to oral formulations when possible.

Uses:

• Alternative treatment of infections following animal bites
• Preemptive antimicrobial therapy to prevent infection in dog or cat bites
• Alternative treatment for infected animal bite-related wounds caused by Pasteurella multocida
• Empiric treatment of moderate or severe diabetic foot infections caused by methicillin-susceptible S aureus (MSSA), other Streptococcus species, Enterobacteriaceae, and/or obligate anaerobes

Usual Adult Dose for Intraabdominal Infection

Uncomplicated infections (bacteremia absent/unlikely): 1 gram IV every 6 to 8 hours
Moderately severe to severe infections: 1 gram IV every 4 hours OR 2 grams IV every 6 to 8 hours
Infections needing high-doses: 2 grams IV every 4 hours OR 3 grams IV every 6 hours
Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)

Comments:

• This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
• Uncomplicated infections included cutaneous infections, pneumonia, and urinary tract infections.
• High-dose infections include gas gangrene.
• Surgical drainage should be performed in infections involving collections of pus.

Uses:

• Treatment of bone and joint infections caused by Staphylococcus aureus (including penicillinase-producing strains)
• Treatment of intraabdominal infections (e.g., intraabdominal abscess, peritonitis) caused by Bacteroides species (including Bacteroides fragilis), Clostridium species, Escherichia coli, and Klebsiella species
• Treatment of lower respiratory tract infections (e.g., lung abscesses, pneumonia) caused by Bacteroides species, Escherichia coli, Haemophilus influenzae, Klebsiella species, other streptococci (excluding enterococci, e.g., Enterococcus faecalis/Streptococcus faecalis), S aureus (including penicillinase-producing strains), and Streptococcus pneumoniae
• Treatment of skin and structure infections cause by Bacteroides species (including B fragilis), Clostridium species, E coli, Klebsiella species, Peptococcus niger, Peptostreptococcus species, Proteus mirabilis, S aureus (including penicillinase-producing strains), Staphylococcus epidermidis, Streptococcus pyogenes and other streptococci (excluding enterococci, e.g., E faecalis/S faecalis)
• Treatment of urinary tract infections caused by E coli, Klebsiella species, Morganella morganii, P mirabilis, Proteus vulgaris, and Providencia species (including Providencia rettgeri)

Infectious Diseases Society of America (IDSA) Recommendations:
1 gram IV every 6 to 8 hours

Duration of therapy:

• Bone/joint infection without residual infected tissue (e.g., postamputation): 2 to 5 days)
• Moderate diabetic foot infection, including residual infected soft tissue (soft tissue only): 1 to 3 weeks
• Severe diabetic foot infection (soft tissue only): 2 to 4 weeks
• Residual infected, but viable, bone: 4 to 6 weeks
• No surgery or postoperative residual dead bone: 3 months or longer

Comment: Patients with diabetic foot infections should be started on parenteral treatment and should be switched to oral formulations when possible.

Uses:

• Alternative treatment of infections following animal bites
• Preemptive antimicrobial therapy to prevent infection in dog or cat bites
• Alternative treatment for infected animal bite-related wounds caused by Pasteurella multocida
• Empiric treatment of moderate or severe diabetic foot infections caused by methicillin-susceptible S aureus (MSSA), other Streptococcus species, Enterobacteriaceae, and/or obligate anaerobes

Usual Adult Dose for Joint Infection

Uncomplicated infections (bacteremia absent/unlikely): 1 gram IV every 6 to 8 hours
Moderately severe to severe infections: 1 gram IV every 4 hours OR 2 grams IV every 6 to 8 hours
Infections needing high-doses: 2 grams IV every 4 hours OR 3 grams IV every 6 hours
Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)

Comments:

• This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
• Uncomplicated infections included cutaneous infections, pneumonia, and urinary tract infections.
• High-dose infections include gas gangrene.
• Surgical drainage should be performed in infections involving collections of pus.

Uses:

• Treatment of bone and joint infections caused by Staphylococcus aureus (including penicillinase-producing strains)
• Treatment of intraabdominal infections (e.g., intraabdominal abscess, peritonitis) caused by Bacteroides species (including Bacteroides fragilis), Clostridium species, Escherichia coli, and Klebsiella species
• Treatment of lower respiratory tract infections (e.g., lung abscesses, pneumonia) caused by Bacteroides species, Escherichia coli, Haemophilus influenzae, Klebsiella species, other streptococci (excluding enterococci, e.g., Enterococcus faecalis/Streptococcus faecalis), S aureus (including penicillinase-producing strains), and Streptococcus pneumoniae
• Treatment of skin and structure infections cause by Bacteroides species (including B fragilis), Clostridium species, E coli, Klebsiella species, Peptococcus niger, Peptostreptococcus species, Proteus mirabilis, S aureus (including penicillinase-producing strains), Staphylococcus epidermidis, Streptococcus pyogenes and other streptococci (excluding enterococci, e.g., E faecalis/S faecalis)
• Treatment of urinary tract infections caused by E coli, Klebsiella species, Morganella morganii, P mirabilis, Proteus vulgaris, and Providencia species (including Providencia rettgeri)

Infectious Diseases Society of America (IDSA) Recommendations:
1 gram IV every 6 to 8 hours

Duration of therapy:

• Bone/joint infection without residual infected tissue (e.g., postamputation): 2 to 5 days)
• Moderate diabetic foot infection, including residual infected soft tissue (soft tissue only): 1 to 3 weeks
• Severe diabetic foot infection (soft tissue only): 2 to 4 weeks
• Residual infected, but viable, bone: 4 to 6 weeks
• No surgery or postoperative residual dead bone: 3 months or longer

Comment: Patients with diabetic foot infections should be started on parenteral treatment and should be switched to oral formulations when possible.

Uses:

• Alternative treatment of infections following animal bites
• Preemptive antimicrobial therapy to prevent infection in dog or cat bites
• Alternative treatment for infected animal bite-related wounds caused by Pasteurella multocida
• Empiric treatment of moderate or severe diabetic foot infections caused by methicillin-susceptible S aureus (MSSA), other Streptococcus species, Enterobacteriaceae, and/or obligate anaerobes

Usual Adult Dose for Osteomyelitis

Uncomplicated infections (bacteremia absent/unlikely): 1 gram IV every 6 to 8 hours
Moderately severe to severe infections: 1 gram IV every 4 hours OR 2 grams IV every 6 to 8 hours
Infections needing high-doses: 2 grams IV every 4 hours OR 3 grams IV every 6 hours
Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)

Comments:

• This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
• Uncomplicated infections included cutaneous infections, pneumonia, and urinary tract infections.
• High-dose infections include gas gangrene.
• Surgical drainage should be performed in infections involving collections of pus.

Uses:

• Treatment of bone and joint infections caused by Staphylococcus aureus (including penicillinase-producing strains)
• Treatment of intraabdominal infections (e.g., intraabdominal abscess, peritonitis) caused by Bacteroides species (including Bacteroides fragilis), Clostridium species, Escherichia coli, and Klebsiella species
• Treatment of lower respiratory tract infections (e.g., lung abscesses, pneumonia) caused by Bacteroides species, Escherichia coli, Haemophilus influenzae, Klebsiella species, other streptococci (excluding enterococci, e.g., Enterococcus faecalis/Streptococcus faecalis), S aureus (including penicillinase-producing strains), and Streptococcus pneumoniae
• Treatment of skin and structure infections cause by Bacteroides species (including B fragilis), Clostridium species, E coli, Klebsiella species, Peptococcus niger, Peptostreptococcus species, Proteus mirabilis, S aureus (including penicillinase-producing strains), Staphylococcus epidermidis, Streptococcus pyogenes and other streptococci (excluding enterococci, e.g., E faecalis/S faecalis)
• Treatment of urinary tract infections caused by E coli, Klebsiella species, Morganella morganii, P mirabilis, Proteus vulgaris, and Providencia species (including Providencia rettgeri)

Infectious Diseases Society of America (IDSA) Recommendations:
1 gram IV every 6 to 8 hours

Duration of therapy:

• Bone/joint infection without residual infected tissue (e.g., postamputation): 2 to 5 days)
• Moderate diabetic foot infection, including residual infected soft tissue (soft tissue only): 1 to 3 weeks
• Severe diabetic foot infection (soft tissue only): 2 to 4 weeks
• Residual infected, but viable, bone: 4 to 6 weeks
• No surgery or postoperative residual dead bone: 3 months or longer

Comment: Patients with diabetic foot infections should be started on parenteral treatment and should be switched to oral formulations when possible.

Uses:

• Alternative treatment of infections following animal bites
• Preemptive antimicrobial therapy to prevent infection in dog or cat bites
• Alternative treatment for infected animal bite-related wounds caused by Pasteurella multocida
• Empiric treatment of moderate or severe diabetic foot infections caused by methicillin-susceptible S aureus (MSSA), other Streptococcus species, Enterobacteriaceae, and/or obligate anaerobes

Usual Adult Dose for Peritonitis

Uncomplicated infections (bacteremia absent/unlikely): 1 gram IV every 6 to 8 hours
Moderately severe to severe infections: 1 gram IV every 4 hours OR 2 grams IV every 6 to 8 hours
Infections needing high-doses: 2 grams IV every 4 hours OR 3 grams IV every 6 hours
Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)

Comments:

• This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
• Uncomplicated infections included cutaneous infections, pneumonia, and urinary tract infections.
• High-dose infections include gas gangrene.
• Surgical drainage should be performed in infections involving collections of pus.

Uses:

• Treatment of bone and joint infections caused by Staphylococcus aureus (including penicillinase-producing strains)
• Treatment of intraabdominal infections (e.g., intraabdominal abscess, peritonitis) caused by Bacteroides species (including Bacteroides fragilis), Clostridium species, Escherichia coli, and Klebsiella species
• Treatment of lower respiratory tract infections (e.g., lung abscesses, pneumonia) caused by Bacteroides species, Escherichia coli, Haemophilus influenzae, Klebsiella species, other streptococci (excluding enterococci, e.g., Enterococcus faecalis/Streptococcus faecalis), S aureus (including penicillinase-producing strains), and Streptococcus pneumoniae
• Treatment of skin and structure infections cause by Bacteroides species (including B fragilis), Clostridium species, E coli, Klebsiella species, Peptococcus niger, Peptostreptococcus species, Proteus mirabilis, S aureus (including penicillinase-producing strains), Staphylococcus epidermidis, Streptococcus pyogenes and other streptococci (excluding enterococci, e.g., E faecalis/S faecalis)
• Treatment of urinary tract infections caused by E coli, Klebsiella species, Morganella morganii, P mirabilis, Proteus vulgaris, and Providencia species (including Providencia rettgeri)

Infectious Diseases Society of America (IDSA) Recommendations:
1 gram IV every 6 to 8 hours

Duration of therapy:

• Bone/joint infection without residual infected tissue (e.g., postamputation): 2 to 5 days)
• Moderate diabetic foot infection, including residual infected soft tissue (soft tissue only): 1 to 3 weeks
• Severe diabetic foot infection (soft tissue only): 2 to 4 weeks
• Residual infected, but viable, bone: 4 to 6 weeks
• No surgery or postoperative residual dead bone: 3 months or longer

Comment: Patients with diabetic foot infections should be started on parenteral treatment and should be switched to oral formulations when possible.

Uses:

• Alternative treatment of infections following animal bites
• Preemptive antimicrobial therapy to prevent infection in dog or cat bites
• Alternative treatment for infected animal bite-related wounds caused by Pasteurella multocida
• Empiric treatment of moderate or severe diabetic foot infections caused by methicillin-susceptible S aureus (MSSA), other Streptococcus species, Enterobacteriaceae, and/or obligate anaerobes

Usual Adult Dose for Pneumonia

Uncomplicated infections (bacteremia absent/unlikely): 1 gram IV every 6 to 8 hours
Moderately severe to severe infections: 1 gram IV every 4 hours OR 2 grams IV every 6 to 8 hours
Infections needing high-doses: 2 grams IV every 4 hours OR 3 grams IV every 6 hours
Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)

Comments:

• This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
• Uncomplicated infections included cutaneous infections, pneumonia, and urinary tract infections.
• High-dose infections include gas gangrene.
• Surgical drainage should be performed in infections involving collections of pus.

Uses:

• Treatment of bone and joint infections caused by Staphylococcus aureus (including penicillinase-producing strains)
• Treatment of intraabdominal infections (e.g., intraabdominal abscess, peritonitis) caused by Bacteroides species (including Bacteroides fragilis), Clostridium species, Escherichia coli, and Klebsiella species
• Treatment of lower respiratory tract infections (e.g., lung abscesses, pneumonia) caused by Bacteroides species, Escherichia coli, Haemophilus influenzae, Klebsiella species, other streptococci (excluding enterococci, e.g., Enterococcus faecalis/Streptococcus faecalis), S aureus (including penicillinase-producing strains), and Streptococcus pneumoniae
• Treatment of skin and structure infections cause by Bacteroides species (including B fragilis), Clostridium species, E coli, Klebsiella species, Peptococcus niger, Peptostreptococcus species, Proteus mirabilis, S aureus (including penicillinase-producing strains), Staphylococcus epidermidis, Streptococcus pyogenes and other streptococci (excluding enterococci, e.g., E faecalis/S faecalis)
• Treatment of urinary tract infections caused by E coli, Klebsiella species, Morganella morganii, P mirabilis, Proteus vulgaris, and Providencia species (including Providencia rettgeri)

Infectious Diseases Society of America (IDSA) Recommendations:
1 gram IV every 6 to 8 hours

Duration of therapy:

• Bone/joint infection without residual infected tissue (e.g., postamputation): 2 to 5 days)
• Moderate diabetic foot infection, including residual infected soft tissue (soft tissue only): 1 to 3 weeks
• Severe diabetic foot infection (soft tissue only): 2 to 4 weeks
• Residual infected, but viable, bone: 4 to 6 weeks
• No surgery or postoperative residual dead bone: 3 months or longer

Comment: Patients with diabetic foot infections should be started on parenteral treatment and should be switched to oral formulations when possible.

Uses:

• Alternative treatment of infections following animal bites
• Preemptive antimicrobial therapy to prevent infection in dog or cat bites
• Alternative treatment for infected animal bite-related wounds caused by Pasteurella multocida
• Empiric treatment of moderate or severe diabetic foot infections caused by methicillin-susceptible S aureus (MSSA), other Streptococcus species, Enterobacteriaceae, and/or obligate anaerobes

Usual Adult Dose for Bacterial Infection

Uncomplicated infections (bacteremia absent/unlikely): 1 gram IV every 6 to 8 hours
Moderately severe to severe infections: 1 gram IV every 4 hours OR 2 grams IV every 6 to 8 hours
Infections needing high-doses: 2 grams IV every 4 hours OR 3 grams IV every 6 hours
Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)

Comments:

• This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
• Uncomplicated infections included cutaneous infections, pneumonia, and urinary tract infections.
• High-dose infections include gas gangrene.
• Surgical drainage should be performed in infections involving collections of pus.

Uses:

• Treatment of bone and joint infections caused by Staphylococcus aureus (including penicillinase-producing strains)
• Treatment of intraabdominal infections (e.g., intraabdominal abscess, peritonitis) caused by Bacteroides species (including Bacteroides fragilis), Clostridium species, Escherichia coli, and Klebsiella species
• Treatment of lower respiratory tract infections (e.g., lung abscesses, pneumonia) caused by Bacteroides species, Escherichia coli, Haemophilus influenzae, Klebsiella species, other streptococci (excluding enterococci, e.g., Enterococcus faecalis/Streptococcus faecalis), S aureus (including penicillinase-producing strains), and Streptococcus pneumoniae
• Treatment of skin and structure infections cause by Bacteroides species (including B fragilis), Clostridium species, E coli, Klebsiella species, Peptococcus niger, Peptostreptococcus species, Proteus mirabilis, S aureus (including penicillinase-producing strains), Staphylococcus epidermidis, Streptococcus pyogenes and other streptococci (excluding enterococci, e.g., E faecalis/S faecalis)
• Treatment of urinary tract infections caused by E coli, Klebsiella species, Morganella morganii, P mirabilis, Proteus vulgaris, and Providencia species (including Providencia rettgeri)

Infectious Diseases Society of America (IDSA) Recommendations:
1 gram IV every 6 to 8 hours

Duration of therapy:

• Bone/joint infection without residual infected tissue (e.g., postamputation): 2 to 5 days)
• Moderate diabetic foot infection, including residual infected soft tissue (soft tissue only): 1 to 3 weeks
• Severe diabetic foot infection (soft tissue only): 2 to 4 weeks
• Residual infected, but viable, bone: 4 to 6 weeks
• No surgery or postoperative residual dead bone: 3 months or longer

Comment: Patients with diabetic foot infections should be started on parenteral treatment and should be switched to oral formulations when possible.

Uses:

• Alternative treatment of infections following animal bites
• Preemptive antimicrobial therapy to prevent infection in dog or cat bites
• Alternative treatment for infected animal bite-related wounds caused by Pasteurella multocida
• Empiric treatment of moderate or severe diabetic foot infections caused by methicillin-susceptible S aureus (MSSA), other Streptococcus species, Enterobacteriaceae, and/or obligate anaerobes

Usual Adult Dose for Urinary Tract Infection

Uncomplicated infections (bacteremia absent/unlikely): 1 gram IV every 6 to 8 hours
Moderately severe to severe infections: 1 gram IV every 4 hours OR 2 grams IV every 6 to 8 hours
Infections needing high-doses: 2 grams IV every 4 hours OR 3 grams IV every 6 hours
Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)

Comments:

• This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
• Uncomplicated infections included cutaneous infections, pneumonia, and urinary tract infections.
• High-dose infections include gas gangrene.
• Surgical drainage should be performed in infections involving collections of pus.

Uses:

• Treatment of bone and joint infections caused by Staphylococcus aureus (including penicillinase-producing strains)
• Treatment of intraabdominal infections (e.g., intraabdominal abscess, peritonitis) caused by Bacteroides species (including Bacteroides fragilis), Clostridium species, Escherichia coli, and Klebsiella species
• Treatment of lower respiratory tract infections (e.g., lung abscesses, pneumonia) caused by Bacteroides species, Escherichia coli, Haemophilus influenzae, Klebsiella species, other streptococci (excluding enterococci, e.g., Enterococcus faecalis/Streptococcus faecalis), S aureus (including penicillinase-producing strains), and Streptococcus pneumoniae
• Treatment of skin and structure infections cause by Bacteroides species (including B fragilis), Clostridium species, E coli, Klebsiella species, Peptococcus niger, Peptostreptococcus species, Proteus mirabilis, S aureus (including penicillinase-producing strains), Staphylococcus epidermidis, Streptococcus pyogenes and other streptococci (excluding enterococci, e.g., E faecalis/S faecalis)
• Treatment of urinary tract infections caused by E coli, Klebsiella species, Morganella morganii, P mirabilis, Proteus vulgaris, and Providencia species (including Providencia rettgeri)

Infectious Diseases Society of America (IDSA) Recommendations:
1 gram IV every 6 to 8 hours

Duration of therapy:

• Bone/joint infection without residual infected tissue (e.g., postamputation): 2 to 5 days)
• Moderate diabetic foot infection, including residual infected soft tissue (soft tissue only): 1 to 3 weeks
• Severe diabetic foot infection (soft tissue only): 2 to 4 weeks
• Residual infected, but viable, bone: 4 to 6 weeks
• No surgery or postoperative residual dead bone: 3 months or longer

Comment: Patients with diabetic foot infections should be started on parenteral treatment and should be switched to oral formulations when possible.

Uses:

• Alternative treatment of infections following animal bites
• Preemptive antimicrobial therapy to prevent infection in dog or cat bites
• Alternative treatment for infected animal bite-related wounds caused by Pasteurella multocida
• Empiric treatment of moderate or severe diabetic foot infections caused by methicillin-susceptible S aureus (MSSA), other Streptococcus species, Enterobacteriaceae, and/or obligate anaerobes

Usual Adult Dose for Skin and Structure Infection

Uncomplicated infections (bacteremia absent/unlikely): 1 gram IV every 6 to 8 hours
Moderately severe to severe infections: 1 gram IV every 4 hours OR 2 grams IV every 6 to 8 hours
Infections needing high-doses: 2 grams IV every 4 hours OR 3 grams IV every 6 hours
Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)

Comments:

• This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
• Uncomplicated infections included cutaneous infections, pneumonia, and urinary tract infections.
• High-dose infections include gas gangrene.
• Surgical drainage should be performed in infections involving collections of pus.

Uses:

• Treatment of bone and joint infections caused by Staphylococcus aureus (including penicillinase-producing strains)
• Treatment of intraabdominal infections (e.g., intraabdominal abscess, peritonitis) caused by Bacteroides species (including Bacteroides fragilis), Clostridium species, Escherichia coli, and Klebsiella species
• Treatment of lower respiratory tract infections (e.g., lung abscesses, pneumonia) caused by Bacteroides species, Escherichia coli, Haemophilus influenzae, Klebsiella species, other streptococci (excluding enterococci, e.g., Enterococcus faecalis/Streptococcus faecalis), S aureus (including penicillinase-producing strains), and Streptococcus pneumoniae
• Treatment of skin and structure infections cause by Bacteroides species (including B fragilis), Clostridium species, E coli, Klebsiella species, Peptococcus niger, Peptostreptococcus species, Proteus mirabilis, S aureus (including penicillinase-producing strains), Staphylococcus epidermidis, Streptococcus pyogenes and other streptococci (excluding enterococci, e.g., E faecalis/S faecalis)
• Treatment of urinary tract infections caused by E coli, Klebsiella species, Morganella morganii, P mirabilis, Proteus vulgaris, and Providencia species (including Providencia rettgeri)

Infectious Diseases Society of America (IDSA) Recommendations:
1 gram IV every 6 to 8 hours

Duration of therapy:

• Bone/joint infection without residual infected tissue (e.g., postamputation): 2 to 5 days)
• Moderate diabetic foot infection, including residual infected soft tissue (soft tissue only): 1 to 3 weeks
• Severe diabetic foot infection (soft tissue only): 2 to 4 weeks
• Residual infected, but viable, bone: 4 to 6 weeks
• No surgery or postoperative residual dead bone: 3 months or longer

Comment: Patients with diabetic foot infections should be started on parenteral treatment and should be switched to oral formulations when possible.

Uses:

• Alternative treatment of infections following animal bites
• Preemptive antimicrobial therapy to prevent infection in dog or cat bites
• Alternative treatment for infected animal bite-related wounds caused by Pasteurella multocida
• Empiric treatment of moderate or severe diabetic foot infections caused by methicillin-susceptible S aureus (MSSA), other Streptococcus species, Enterobacteriaceae, and/or obligate anaerobes

Usual Adult Dose for Pelvic Inflammatory Disease

Uncomplicated infections (bacteremia absent/unlikely): 1 gram IV every 6 to 8 hours
Moderately severe to severe infections: 1 gram IV every 4 hours OR 2 grams IV every 6 to 8 hours
Infections needing high-doses: 2 grams IV every 4 hours OR 3 grams IV every 6 hours
Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)

Comments:

• This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
• This drug does not have activity against Chlamydia trachomatis.
• Patients with pelvic inflammatory disease potentially caused by C trachomatis should be given appropriate anti-chlamydial therapy.
• Surgical drainage should be performed in infections involving collections of pus.

Use: Treatment of gynecological infections (e.g., endometritis, pelvic cellulitis, pelvic inflammatory disease) caused by Bacteroides species (including B fragilis), Clostridium species, E coli, Neisseria gonorrhoeae (including penicillinase-producing strains), P niger, Peptostreptococcus species, and Streptococcus agalactiae

US Centers for Disease Control and Prevention (US CDC) Recommendations:
Parenteral Treatment: 2 grams IV every 6 hours PLUS IV/oral doxycycline and IV gentamicin

• Duration of therapy: 14 days

Alternative IM/Oral Treatment: 2 grams IM ONCE PLUS probenecid orally ONCE PLUS doxycycline orally given 2 times a day

• Duration of therapy: 14 days

Comments:

• At least 24 hours of inpatient observation is recommended for patients with tubo-ovarian abscesses.
• Daily doses have not been evaluated for treatment of this condition; however, it has been efficacious in analogous conditions.
• Oral therapy may be initiated within 24 to 28 hours of clinical improvement.

Use: Recommended adjunctive treatment of pelvic inflammatory disease due to C trachomatis, N gonorrhoeae, or Mycoplasma hominis

Usual Adult Dose for Endometritis

Uncomplicated infections (bacteremia absent/unlikely): 1 gram IV every 6 to 8 hours
Moderately severe to severe infections: 1 gram IV every 4 hours OR 2 grams IV every 6 to 8 hours
Infections needing high-doses: 2 grams IV every 4 hours OR 3 grams IV every 6 hours
Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)

Comments:

• This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
• This drug does not have activity against Chlamydia trachomatis.
• Patients with pelvic inflammatory disease potentially caused by C trachomatis should be given appropriate anti-chlamydial therapy.
• Surgical drainage should be performed in infections involving collections of pus.

Use: Treatment of gynecological infections (e.g., endometritis, pelvic cellulitis, pelvic inflammatory disease) caused by Bacteroides species (including B fragilis), Clostridium species, E coli, Neisseria gonorrhoeae (including penicillinase-producing strains), P niger, Peptostreptococcus species, and Streptococcus agalactiae

US Centers for Disease Control and Prevention (US CDC) Recommendations:
Parenteral Treatment: 2 grams IV every 6 hours PLUS IV/oral doxycycline and IV gentamicin

• Duration of therapy: 14 days

Alternative IM/Oral Treatment: 2 grams IM ONCE PLUS probenecid orally ONCE PLUS doxycycline orally given 2 times a day

• Duration of therapy: 14 days

Comments:

• At least 24 hours of inpatient observation is recommended for patients with tubo-ovarian abscesses.
• Daily doses have not been evaluated for treatment of this condition; however, it has been efficacious in analogous conditions.
• Oral therapy may be initiated within 24 to 28 hours of clinical improvement.

Use: Recommended adjunctive treatment of pelvic inflammatory disease due to C trachomatis, N gonorrhoeae, or Mycoplasma hominis

Usual Adult Dose for Septicemia

Moderately severe to severe infections: 1 gram IV every 4 hours OR 2 grams IV every 6 to 8 hours
Infections needing high-doses: 2 grams IV every 4 hours OR 3 grams IV every 6 hours
Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)

Comments:

• This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
• Surgical drainage should be performed in infections involving collections of pus.

Use: Treatment of septicemia caused by Bacteroides species (including B fragilis), E coli, Klebsiella species, S aureus (including penicillinase-producing strains), and S pneumoniae

Usual Adult Dose for Cesarean Section

Single-dose regimen: 2 grams IV ONCE as soon as the umbilical cord is clamped

3-dose regimen: 2 grams IV every 4 hours for 3 doses, given as soon as the umbilical cord is clamped, then at 4 and 8 hours after the initial dose

Comment: This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.

Use: Prophylaxis of infection in patients undergoing cesarean section

Usual Adult Dose for Surgical Prophylaxis

2 grams IV 30 to 60 minutes prior to surgery, followed by 2 grams every 6 hours after the first dose

• Duration of therapy: 24 hours

Comment: This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.

Use: Prophylaxis of infection in patients undergoing abdominal hysterectomy uncontaminated gastrointestinal surgery, or vaginal hysterectomy

American Society of Health-System Pharmacists (ASHP), IDSA, Society for Healthcare Epidemiology of America (SHEA), and Surgical Infection Society (SIS) Recommendations:
2 grams IV ONCE

Comment: The recommended redosing interval from the initiation of the preoperative dose is 2 hours.

Uses:
Recommended agent for surgical prophylaxis in patients who are undergoing the following procedures:

• Appendectomy for uncomplicated appendicitis
• Biliary tract (e.g., elective high-risk, open procedure)
• Colorectal
• Hysterectomy (abdominal/vaginal)
• Small intestine (e.g., obstructed)
• Some urologic procedures (e.g., clean-contaminated with entry into urinary tract)

Alternative agent for surgical prophylaxis in patients who are undergoing the following procedures:

• Open biliary tract procedures

Adjunctive agent (with metronidazole) for surgical prophylaxis in patients who are undergoing colon procedures

Usual Adult Dose for Gonococcal Infection - Uncomplicated

US CDC recommendations:
Uncomplicated anorectal and urogenital gonococcal infections: 2 grams IM ONCE plus probenecid

Comments:

• This regimen with probenecid is recommended if ceftriaxone is not an option.
• Doxycycline therapy for 7 days (if not pregnant) or single dose azithromycin is also recommended to treat possible concurrent chlamydial infection.
• The patient's sexual partner(s) should also be evaluated/treated.

Use: Treatment of uncomplicated gonococcal infections of the cervix, urethra, and rectum caused by N gonorrhoeae

Usual Pediatric Dose for Intraabdominal Infection

3 months and older: 80 to 160 mg/kg IV per day, given in 4 to 6 equal doses

• Maximum dose: 12 grams/day
• Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)

Comments:

• This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
• Higher doses should be used to treat severe or serious infections.
• Surgical drainage should be performed in infections involving collections of pus.

Uses:

• Treatment of bone and joint infections caused by S aureus (including penicillinase-producing strains)
• Treatment of intraabdominal infections (e.g., intraabdominal abscess, peritonitis) caused by Bacteroides species (including B fragilis), Clostridium species, E coli, and Klebsiella species
• Treatment of lower respiratory tract infections (e.g., lung abscesses, pneumonia) caused by Bacteroides species, E coli, H influenzae, Klebsiella species, other streptococci (excluding enterococci, e.g., E faecalis/S faecalis), S aureus (including penicillinase-producing strains), and S pneumoniae
• Treatment of septicemia caused by Bacteroides species (including B fragilis), E coli, Klebsiella species, S aureus (including penicillinase-producing strains), and S pneumoniae
• Treatment of skin and structure infections cause by Bacteroides species (including B fragilis), Clostridium species, E coli, Klebsiella species, P niger, Peptostreptococcus species, P mirabilis, S aureus (including penicillinase-producing strains), S epidermidis, S pyogenes and other streptococci (excluding enterococci, e.g., E faecalis/S faecalis)
• Treatment of urinary tract infections caused by Escherichia coli, Klebsiella species, M morganii, P mirabilis, P vulgaris, and Providencia species (including Providencia rettgeri)

American Academy of Pediatrics (AAP) Recommendations:
Gestational age less than 32 weeks:
Postnatal age (PNA) 7 days or less: 35 mg/kg IV OR IM every 12 hours
PNA over 72 years: 35 mg/kg IV OR IM every 8 hours

Gestational age 32 weeks and older: 35 mg/kg IV OR IM every 8 hours

Pediatric patients beyond the newborn period: 80 to 160 mg/kg IV OR IM per day, given in divided doses 3 to 4 times a day

• Maximum dose: 12 grams/day

Neonates (72 hours) or older: 40 mg/kg IV ONCE with/without IV gentamicin

• Maximum dose: 3 grams/dose

Uses:

• Treatment of ruptured viscus in traumatic wounds caused by enteric gram-negative bacilli, Clostridium species, enterococci, and/or anaerobes (Bacteroides species)
• Treatment of ruptured viscus via colorectal or appendectomy caused by enteric gram-negative bacilli, Clostridium species, enterococci, and/or anaerobes (Bacteroides species)

International Society for Peritoneal Dialysis (ISPD) Recommendations:
PROPHYLAXIS: 30 to 40 mg/kg IV ONCE

• Maximum dose: 2 grams/dose

Comment: Empirical doses should be given just prior to the procedure.

Uses:

• Preferred empirical treatment for other gastrointestinal or genitourinary procedures in patients undergoing peritoneal dialysis
• Treatment of peritonitis

Usual Pediatric Dose for Joint Infection

3 months and older: 80 to 160 mg/kg IV per day, given in 4 to 6 equal doses

• Maximum dose: 12 grams/day
• Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)

Comments:

• This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
• Higher doses should be used to treat severe or serious infections.
• Surgical drainage should be performed in infections involving collections of pus.

Uses:

• Treatment of bone and joint infections caused by S aureus (including penicillinase-producing strains)
• Treatment of intraabdominal infections (e.g., intraabdominal abscess, peritonitis) caused by Bacteroides species (including B fragilis), Clostridium species, E coli, and Klebsiella species
• Treatment of lower respiratory tract infections (e.g., lung abscesses, pneumonia) caused by Bacteroides species, E coli, H influenzae, Klebsiella species, other streptococci (excluding enterococci, e.g., E faecalis/S faecalis), S aureus (including penicillinase-producing strains), and S pneumoniae
• Treatment of septicemia caused by Bacteroides species (including B fragilis), E coli, Klebsiella species, S aureus (including penicillinase-producing strains), and S pneumoniae
• Treatment of skin and structure infections cause by Bacteroides species (including B fragilis), Clostridium species, E coli, Klebsiella species, P niger, Peptostreptococcus species, P mirabilis, S aureus (including penicillinase-producing strains), S epidermidis, S pyogenes and other streptococci (excluding enterococci, e.g., E faecalis/S faecalis)
• Treatment of urinary tract infections caused by Escherichia coli, Klebsiella species, M morganii, P mirabilis, P vulgaris, and Providencia species (including Providencia rettgeri)

American Academy of Pediatrics (AAP) Recommendations:
Gestational age less than 32 weeks:
Postnatal age (PNA) 7 days or less: 35 mg/kg IV OR IM every 12 hours
PNA over 72 years: 35 mg/kg IV OR IM every 8 hours

Gestational age 32 weeks and older: 35 mg/kg IV OR IM every 8 hours

Pediatric patients beyond the newborn period: 80 to 160 mg/kg IV OR IM per day, given in divided doses 3 to 4 times a day

• Maximum dose: 12 grams/day

Neonates (72 hours) or older: 40 mg/kg IV ONCE with/without IV gentamicin

• Maximum dose: 3 grams/dose

Uses:

• Treatment of ruptured viscus in traumatic wounds caused by enteric gram-negative bacilli, Clostridium species, enterococci, and/or anaerobes (Bacteroides species)
• Treatment of ruptured viscus via colorectal or appendectomy caused by enteric gram-negative bacilli, Clostridium species, enterococci, and/or anaerobes (Bacteroides species)

International Society for Peritoneal Dialysis (ISPD) Recommendations:
PROPHYLAXIS: 30 to 40 mg/kg IV ONCE

• Maximum dose: 2 grams/dose

Comment: Empirical doses should be given just prior to the procedure.

Uses:

• Preferred empirical treatment for other gastrointestinal or genitourinary procedures in patients undergoing peritoneal dialysis
• Treatment of peritonitis

Usual Pediatric Dose for Osteomyelitis

3 months and older: 80 to 160 mg/kg IV per day, given in 4 to 6 equal doses

• Maximum dose: 12 grams/day
• Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)

Comments:

• This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
• Higher doses should be used to treat severe or serious infections.
• Surgical drainage should be performed in infections involving collections of pus.

Uses:

• Treatment of bone and joint infections caused by S aureus (including penicillinase-producing strains)
• Treatment of intraabdominal infections (e.g., intraabdominal abscess, peritonitis) caused by Bacteroides species (including B fragilis), Clostridium species, E coli, and Klebsiella species
• Treatment of lower respiratory tract infections (e.g., lung abscesses, pneumonia) caused by Bacteroides species, E coli, H influenzae, Klebsiella species, other streptococci (excluding enterococci, e.g., E faecalis/S faecalis), S aureus (including penicillinase-producing strains), and S pneumoniae
• Treatment of septicemia caused by Bacteroides species (including B fragilis), E coli, Klebsiella species, S aureus (including penicillinase-producing strains), and S pneumoniae
• Treatment of skin and structure infections cause by Bacteroides species (including B fragilis), Clostridium species, E coli, Klebsiella species, P niger, Peptostreptococcus species, P mirabilis, S aureus (including penicillinase-producing strains), S epidermidis, S pyogenes and other streptococci (excluding enterococci, e.g., E faecalis/S faecalis)
• Treatment of urinary tract infections caused by Escherichia coli, Klebsiella species, M morganii, P mirabilis, P vulgaris, and Providencia species (including Providencia rettgeri)

American Academy of Pediatrics (AAP) Recommendations:
Gestational age less than 32 weeks:
Postnatal age (PNA) 7 days or less: 35 mg/kg IV OR IM every 12 hours
PNA over 72 years: 35 mg/kg IV OR IM every 8 hours

Gestational age 32 weeks and older: 35 mg/kg IV OR IM every 8 hours

Pediatric patients beyond the newborn period: 80 to 160 mg/kg IV OR IM per day, given in divided doses 3 to 4 times a day

• Maximum dose: 12 grams/day

Neonates (72 hours) or older: 40 mg/kg IV ONCE with/without IV gentamicin

• Maximum dose: 3 grams/dose

Uses:

• Treatment of ruptured viscus in traumatic wounds caused by enteric gram-negative bacilli, Clostridium species, enterococci, and/or anaerobes (Bacteroides species)
• Treatment of ruptured viscus via colorectal or appendectomy caused by enteric gram-negative bacilli, Clostridium species, enterococci, and/or anaerobes (Bacteroides species)

International Society for Peritoneal Dialysis (ISPD) Recommendations:
PROPHYLAXIS: 30 to 40 mg/kg IV ONCE

• Maximum dose: 2 grams/dose

Comment: Empirical doses should be given just prior to the procedure.

Uses:

• Preferred empirical treatment for other gastrointestinal or genitourinary procedures in patients undergoing peritoneal dialysis
• Treatment of peritonitis

Usual Pediatric Dose for Peritonitis

3 months and older: 80 to 160 mg/kg IV per day, given in 4 to 6 equal doses

• Maximum dose: 12 grams/day
• Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)

Comments:

• This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
• Higher doses should be used to treat severe or serious infections.
• Surgical drainage should be performed in infections involving collections of pus.

Uses:

• Treatment of bone and joint infections caused by S aureus (including penicillinase-producing strains)
• Treatment of intraabdominal infections (e.g., intraabdominal abscess, peritonitis) caused by Bacteroides species (including B fragilis), Clostridium species, E coli, and Klebsiella species
• Treatment of lower respiratory tract infections (e.g., lung abscesses, pneumonia) caused by Bacteroides species, E coli, H influenzae, Klebsiella species, other streptococci (excluding enterococci, e.g., E faecalis/S faecalis), S aureus (including penicillinase-producing strains), and S pneumoniae
• Treatment of septicemia caused by Bacteroides species (including B fragilis), E coli, Klebsiella species, S aureus (including penicillinase-producing strains), and S pneumoniae
• Treatment of skin and structure infections cause by Bacteroides species (including B fragilis), Clostridium species, E coli, Klebsiella species, P niger, Peptostreptococcus species, P mirabilis, S aureus (including penicillinase-producing strains), S epidermidis, S pyogenes and other streptococci (excluding enterococci, e.g., E faecalis/S faecalis)
• Treatment of urinary tract infections caused by Escherichia coli, Klebsiella species, M morganii, P mirabilis, P vulgaris, and Providencia species (including Providencia rettgeri)

American Academy of Pediatrics (AAP) Recommendations:
Gestational age less than 32 weeks:
Postnatal age (PNA) 7 days or less: 35 mg/kg IV OR IM every 12 hours
PNA over 72 years: 35 mg/kg IV OR IM every 8 hours

Gestational age 32 weeks and older: 35 mg/kg IV OR IM every 8 hours

Pediatric patients beyond the newborn period: 80 to 160 mg/kg IV OR IM per day, given in divided doses 3 to 4 times a day

• Maximum dose: 12 grams/day

Neonates (72 hours) or older: 40 mg/kg IV ONCE with/without IV gentamicin

• Maximum dose: 3 grams/dose

Uses:

• Treatment of ruptured viscus in traumatic wounds caused by enteric gram-negative bacilli, Clostridium species, enterococci, and/or anaerobes (Bacteroides species)
• Treatment of ruptured viscus via colorectal or appendectomy caused by enteric gram-negative bacilli, Clostridium species, enterococci, and/or anaerobes (Bacteroides species)

International Society for Peritoneal Dialysis (ISPD) Recommendations:
PROPHYLAXIS: 30 to 40 mg/kg IV ONCE

• Maximum dose: 2 grams/dose

Comment: Empirical doses should be given just prior to the procedure.

Uses:

• Preferred empirical treatment for other gastrointestinal or genitourinary procedures in patients undergoing peritoneal dialysis
• Treatment of peritonitis

Usual Pediatric Dose for Pneumonia

3 months and older: 80 to 160 mg/kg IV per day, given in 4 to 6 equal doses

• Maximum dose: 12 grams/day
• Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)

Comments:

• This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
• Higher doses should be used to treat severe or serious infections.
• Surgical drainage should be performed in infections involving collections of pus.

Uses:

• Treatment of bone and joint infections caused by S aureus (including penicillinase-producing strains)
• Treatment of intraabdominal infections (e.g., intraabdominal abscess, peritonitis) caused by Bacteroides species (including B fragilis), Clostridium species, E coli, and Klebsiella species
• Treatment of lower respiratory tract infections (e.g., lung abscesses, pneumonia) caused by Bacteroides species, E coli, H influenzae, Klebsiella species, other streptococci (excluding enterococci, e.g., E faecalis/S faecalis), S aureus (including penicillinase-producing strains), and S pneumoniae
• Treatment of septicemia caused by Bacteroides species (including B fragilis), E coli, Klebsiella species, S aureus (including penicillinase-producing strains), and S pneumoniae
• Treatment of skin and structure infections cause by Bacteroides species (including B fragilis), Clostridium species, E coli, Klebsiella species, P niger, Peptostreptococcus species, P mirabilis, S aureus (including penicillinase-producing strains), S epidermidis, S pyogenes and other streptococci (excluding enterococci, e.g., E faecalis/S faecalis)
• Treatment of urinary tract infections caused by Escherichia coli, Klebsiella species, M morganii, P mirabilis, P vulgaris, and Providencia species (including Providencia rettgeri)

American Academy of Pediatrics (AAP) Recommendations:
Gestational age less than 32 weeks:
Postnatal age (PNA) 7 days or less: 35 mg/kg IV OR IM every 12 hours
PNA over 72 years: 35 mg/kg IV OR IM every 8 hours

Gestational age 32 weeks and older: 35 mg/kg IV OR IM every 8 hours

Pediatric patients beyond the newborn period: 80 to 160 mg/kg IV OR IM per day, given in divided doses 3 to 4 times a day

• Maximum dose: 12 grams/day

Neonates (72 hours) or older: 40 mg/kg IV ONCE with/without IV gentamicin

• Maximum dose: 3 grams/dose

Uses:

• Treatment of ruptured viscus in traumatic wounds caused by enteric gram-negative bacilli, Clostridium species, enterococci, and/or anaerobes (Bacteroides species)
• Treatment of ruptured viscus via colorectal or appendectomy caused by enteric gram-negative bacilli, Clostridium species, enterococci, and/or anaerobes (Bacteroides species)

International Society for Peritoneal Dialysis (ISPD) Recommendations:
PROPHYLAXIS: 30 to 40 mg/kg IV ONCE

• Maximum dose: 2 grams/dose

Comment: Empirical doses should be given just prior to the procedure.

Uses:

• Preferred empirical treatment for other gastrointestinal or genitourinary procedures in patients undergoing peritoneal dialysis
• Treatment of peritonitis

Usual Pediatric Dose for Septicemia

3 months and older: 80 to 160 mg/kg IV per day, given in 4 to 6 equal doses

• Maximum dose: 12 grams/day
• Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)

Comments:

• This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
• Higher doses should be used to treat severe or serious infections.
• Surgical drainage should be performed in infections involving collections of pus.

Uses:

• Treatment of bone and joint infections caused by S aureus (including penicillinase-producing strains)
• Treatment of intraabdominal infections (e.g., intraabdominal abscess, peritonitis) caused by Bacteroides species (including B fragilis), Clostridium species, E coli, and Klebsiella species
• Treatment of lower respiratory tract infections (e.g., lung abscesses, pneumonia) caused by Bacteroides species, E coli, H influenzae, Klebsiella species, other streptococci (excluding enterococci, e.g., E faecalis/S faecalis), S aureus (including penicillinase-producing strains), and S pneumoniae
• Treatment of septicemia caused by Bacteroides species (including B fragilis), E coli, Klebsiella species, S aureus (including penicillinase-producing strains), and S pneumoniae
• Treatment of skin and structure infections cause by Bacteroides species (including B fragilis), Clostridium species, E coli, Klebsiella species, P niger, Peptostreptococcus species, P mirabilis, S aureus (including penicillinase-producing strains), S epidermidis, S pyogenes and other streptococci (excluding enterococci, e.g., E faecalis/S faecalis)
• Treatment of urinary tract infections caused by Escherichia coli, Klebsiella species, M morganii, P mirabilis, P vulgaris, and Providencia species (including Providencia rettgeri)

American Academy of Pediatrics (AAP) Recommendations:
Gestational age less than 32 weeks:
Postnatal age (PNA) 7 days or less: 35 mg/kg IV OR IM every 12 hours
PNA over 72 years: 35 mg/kg IV OR IM every 8 hours

Gestational age 32 weeks and older: 35 mg/kg IV OR IM every 8 hours

Pediatric patients beyond the newborn period: 80 to 160 mg/kg IV OR IM per day, given in divided doses 3 to 4 times a day

• Maximum dose: 12 grams/day

Neonates (72 hours) or older: 40 mg/kg IV ONCE with/without IV gentamicin

• Maximum dose: 3 grams/dose

Uses:

• Treatment of ruptured viscus in traumatic wounds caused by enteric gram-negative bacilli, Clostridium species, enterococci, and/or anaerobes (Bacteroides species)
• Treatment of ruptured viscus via colorectal or appendectomy caused by enteric gram-negative bacilli, Clostridium species, enterococci, and/or anaerobes (Bacteroides species)

International Society for Peritoneal Dialysis (ISPD) Recommendations:
PROPHYLAXIS: 30 to 40 mg/kg IV ONCE

• Maximum dose: 2 grams/dose

Comment: Empirical doses should be given just prior to the procedure.

Uses:

• Preferred empirical treatment for other gastrointestinal or genitourinary procedures in patients undergoing peritoneal dialysis
• Treatment of peritonitis

Usual Pediatric Dose for Bacterial Infection

3 months and older: 80 to 160 mg/kg IV per day, given in 4 to 6 equal doses

• Maximum dose: 12 grams/day
• Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)

Comments:

• This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
• Higher doses should be used to treat severe or serious infections.
• Surgical drainage should be performed in infections involving collections of pus.

Uses:

• Treatment of bone and joint infections caused by S aureus (including penicillinase-producing strains)
• Treatment of intraabdominal infections (e.g., intraabdominal abscess, peritonitis) caused by Bacteroides species (including B fragilis), Clostridium species, E coli, and Klebsiella species
• Treatment of lower respiratory tract infections (e.g., lung abscesses, pneumonia) caused by Bacteroides species, E coli, H influenzae, Klebsiella species, other streptococci (excluding enterococci, e.g., E faecalis/S faecalis), S aureus (including penicillinase-producing strains), and S pneumoniae
• Treatment of septicemia caused by Bacteroides species (including B fragilis), E coli, Klebsiella species, S aureus (including penicillinase-producing strains), and S pneumoniae
• Treatment of skin and structure infections cause by Bacteroides species (including B fragilis), Clostridium species, E coli, Klebsiella species, P niger, Peptostreptococcus species, P mirabilis, S aureus (including penicillinase-producing strains), S epidermidis, S pyogenes and other streptococci (excluding enterococci, e.g., E faecalis/S faecalis)
• Treatment of urinary tract infections caused by Escherichia coli, Klebsiella species, M morganii, P mirabilis, P vulgaris, and Providencia species (including Providencia rettgeri)

American Academy of Pediatrics (AAP) Recommendations:
Gestational age less than 32 weeks:
Postnatal age (PNA) 7 days or less: 35 mg/kg IV OR IM every 12 hours
PNA over 72 years: 35 mg/kg IV OR IM every 8 hours

Gestational age 32 weeks and older: 35 mg/kg IV OR IM every 8 hours

Pediatric patients beyond the newborn period: 80 to 160 mg/kg IV OR IM per day, given in divided doses 3 to 4 times a day

• Maximum dose: 12 grams/day

Neonates (72 hours) or older: 40 mg/kg IV ONCE with/without IV gentamicin

• Maximum dose: 3 grams/dose

Uses:

• Treatment of ruptured viscus in traumatic wounds caused by enteric gram-negative bacilli, Clostridium species, enterococci, and/or anaerobes (Bacteroides species)
• Treatment of ruptured viscus via colorectal or appendectomy caused by enteric gram-negative bacilli, Clostridium species, enterococci, and/or anaerobes (Bacteroides species)

International Society for Peritoneal Dialysis (ISPD) Recommendations:
PROPHYLAXIS: 30 to 40 mg/kg IV ONCE

• Maximum dose: 2 grams/dose

Comment: Empirical doses should be given just prior to the procedure.

Uses:

• Preferred empirical treatment for other gastrointestinal or genitourinary procedures in patients undergoing peritoneal dialysis
• Treatment of peritonitis

Usual Pediatric Dose for Urinary Tract Infection

3 months and older: 80 to 160 mg/kg IV per day, given in 4 to 6 equal doses

• Maximum dose: 12 grams/day
• Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)

Comments:

• This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
• Higher doses should be used to treat severe or serious infections.
• Surgical drainage should be performed in infections involving collections of pus.

Uses:

• Treatment of bone and joint infections caused by S aureus (including penicillinase-producing strains)
• Treatment of intraabdominal infections (e.g., intraabdominal abscess, peritonitis) caused by Bacteroides species (including B fragilis), Clostridium species, E coli, and Klebsiella species
• Treatment of lower respiratory tract infections (e.g., lung abscesses, pneumonia) caused by Bacteroides species, E coli, H influenzae, Klebsiella species, other streptococci (excluding enterococci, e.g., E faecalis/S faecalis), S aureus (including penicillinase-producing strains), and S pneumoniae
• Treatment of septicemia caused by Bacteroides species (including B fragilis), E coli, Klebsiella species, S aureus (including penicillinase-producing strains), and S pneumoniae
• Treatment of skin and structure infections cause by Bacteroides species (including B fragilis), Clostridium species, E coli, Klebsiella species, P niger, Peptostreptococcus species, P mirabilis, S aureus (including penicillinase-producing strains), S epidermidis, S pyogenes and other streptococci (excluding enterococci, e.g., E faecalis/S faecalis)
• Treatment of urinary tract infections caused by Escherichia coli, Klebsiella species, M morganii, P mirabilis, P vulgaris, and Providencia species (including Providencia rettgeri)

American Academy of Pediatrics (AAP) Recommendations:
Gestational age less than 32 weeks:
Postnatal age (PNA) 7 days or less: 35 mg/kg IV OR IM every 12 hours
PNA over 72 years: 35 mg/kg IV OR IM every 8 hours

Gestational age 32 weeks and older: 35 mg/kg IV OR IM every 8 hours

Pediatric patients beyond the newborn period: 80 to 160 mg/kg IV OR IM per day, given in divided doses 3 to 4 times a day

• Maximum dose: 12 grams/day

Neonates (72 hours) or older: 40 mg/kg IV ONCE with/without IV gentamicin

• Maximum dose: 3 grams/dose

Uses:

• Treatment of ruptured viscus in traumatic wounds caused by enteric gram-negative bacilli, Clostridium species, enterococci, and/or anaerobes (Bacteroides species)
• Treatment of ruptured viscus via colorectal or appendectomy caused by enteric gram-negative bacilli, Clostridium species, enterococci, and/or anaerobes (Bacteroides species)

International Society for Peritoneal Dialysis (ISPD) Recommendations:
PROPHYLAXIS: 30 to 40 mg/kg IV ONCE

• Maximum dose: 2 grams/dose

Comment: Empirical doses should be given just prior to the procedure.

Uses:

• Preferred empirical treatment for other gastrointestinal or genitourinary procedures in patients undergoing peritoneal dialysis
• Treatment of peritonitis

Usual Pediatric Dose for Skin and Structure Infection

3 months and older: 80 to 160 mg/kg IV per day, given in 4 to 6 equal doses

• Maximum dose: 12 grams/day
• Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)

Comments:

• This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
• Higher doses should be used to treat severe or serious infections.
• Surgical drainage should be performed in infections involving collections of pus.

Uses:

• Treatment of bone and joint infections caused by S aureus (including penicillinase-producing strains)
• Treatment of intraabdominal infections (e.g., intraabdominal abscess, peritonitis) caused by Bacteroides species (including B fragilis), Clostridium species, E coli, and Klebsiella species
• Treatment of lower respiratory tract infections (e.g., lung abscesses, pneumonia) caused by Bacteroides species, E coli, H influenzae, Klebsiella species, other streptococci (excluding enterococci, e.g., E faecalis/S faecalis), S aureus (including penicillinase-producing strains), and S pneumoniae
• Treatment of septicemia caused by Bacteroides species (including B fragilis), E coli, Klebsiella species, S aureus (including penicillinase-producing strains), and S pneumoniae
• Treatment of skin and structure infections cause by Bacteroides species (including B fragilis), Clostridium species, E coli, Klebsiella species, P niger, Peptostreptococcus species, P mirabilis, S aureus (including penicillinase-producing strains), S epidermidis, S pyogenes and other streptococci (excluding enterococci, e.g., E faecalis/S faecalis)
• Treatment of urinary tract infections caused by Escherichia coli, Klebsiella species, M morganii, P mirabilis, P vulgaris, and Providencia species (including Providencia rettgeri)

American Academy of Pediatrics (AAP) Recommendations:
Gestational age less than 32 weeks:
Postnatal age (PNA) 7 days or less: 35 mg/kg IV OR IM every 12 hours
PNA over 72 years: 35 mg/kg IV OR IM every 8 hours

Gestational age 32 weeks and older: 35 mg/kg IV OR IM every 8 hours

Pediatric patients beyond the newborn period: 80 to 160 mg/kg IV OR IM per day, given in divided doses 3 to 4 times a day

• Maximum dose: 12 grams/day

Neonates (72 hours) or older: 40 mg/kg IV ONCE with/without IV gentamicin

• Maximum dose: 3 grams/dose

Uses:

• Treatment of ruptured viscus in traumatic wounds caused by enteric gram-negative bacilli, Clostridium species, enterococci, and/or anaerobes (Bacteroides species)
• Treatment of ruptured viscus via colorectal or appendectomy caused by enteric gram-negative bacilli, Clostridium species, enterococci, and/or anaerobes (Bacteroides species)

International Society for Peritoneal Dialysis (ISPD) Recommendations:
PROPHYLAXIS: 30 to 40 mg/kg IV ONCE

• Maximum dose: 2 grams/dose

Comment: Empirical doses should be given just prior to the procedure.

Uses:

• Preferred empirical treatment for other gastrointestinal or genitourinary procedures in patients undergoing peritoneal dialysis
• Treatment of peritonitis

Usual Pediatric Dose for Pelvic Inflammatory Disease

3 months and older: 80 to 160 mg/kg IV per day, given in 4 to 6 equal doses

• Maximum dose: 12 grams/day
• Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)

Comments:

• This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
• This drug does not have activity against C trachomatis.
• Patients with pelvic inflammatory disease potentially caused by C trachomatis should be given appropriate anti-chlamydial therapy.
• Surgical drainage should be performed in infections involving collections of pus.

Use: Treatment of gynecological infections (e.g., endometritis, pelvic cellulitis, pelvic inflammatory disease) caused by Bacteroides species (including B fragilis), Clostridium species, E coli, N gonorrhoeae (including penicillinase-producing strains), P niger, Peptostreptococcus species, and S agalactiae

US CDC Recommendations:
Parenteral Treatment: 2 grams IV every 6 hours PLUS IV/oral doxycycline and IV gentamicin

• Duration of therapy: 14 days

Alternative IM/Oral Treatment: 2 grams IM ONCE PLUS probenecid orally ONCE PLUS doxycycline orally given 2 times a day

• Duration of therapy: 14 days

Comments:

• At least 24 hours of inpatient observation is recommended for patients with tubo-ovarian abscesses.
• Daily doses have not been evaluated for treatment of this condition; however, it has been efficacious in analogous conditions.
• Oral therapy may be initiated within 24 to 28 hours of clinical improvement.

Use: Recommended adjunctive treatment of pelvic inflammatory disease due to C trachomatis, N gonorrhoeae, or M hominis

Usual Pediatric Dose for Endometritis

3 months and older: 80 to 160 mg/kg IV per day, given in 4 to 6 equal doses

• Maximum dose: 12 grams/day
• Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)

Comments:

• This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
• This drug does not have activity against C trachomatis.
• Patients with pelvic inflammatory disease potentially caused by C trachomatis should be given appropriate anti-chlamydial therapy.
• Surgical drainage should be performed in infections involving collections of pus.

Use: Treatment of gynecological infections (e.g., endometritis, pelvic cellulitis, pelvic inflammatory disease) caused by Bacteroides species (including B fragilis), Clostridium species, E coli, N gonorrhoeae (including penicillinase-producing strains), P niger, Peptostreptococcus species, and S agalactiae

US CDC Recommendations:
Parenteral Treatment: 2 grams IV every 6 hours PLUS IV/oral doxycycline and IV gentamicin

• Duration of therapy: 14 days

Alternative IM/Oral Treatment: 2 grams IM ONCE PLUS probenecid orally ONCE PLUS doxycycline orally given 2 times a day

• Duration of therapy: 14 days

Comments:

• At least 24 hours of inpatient observation is recommended for patients with tubo-ovarian abscesses.
• Daily doses have not been evaluated for treatment of this condition; however, it has been efficacious in analogous conditions.
• Oral therapy may be initiated within 24 to 28 hours of clinical improvement.

Use: Recommended adjunctive treatment of pelvic inflammatory disease due to C trachomatis, N gonorrhoeae, or M hominis

Usual Pediatric Dose for Surgical Prophylaxis

3 months and older: 30 to 40 mg/kg IV 30 to 60 minutes prior to surgery, followed by 30 to 40 mg/kg every 6 hours after the first dose

• Duration of therapy: 24 hours

Comment: This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.

Use: Prophylaxis of infection in patients undergoing abdominal hysterectomy uncontaminated gastrointestinal surgery, or vaginal hysterectomy

AAP Recommendations:
Neonates (72 hours) or older: 40 mg/kg IV ONCE PLUS IV gentamicin

• Maximum dose: 3 grams/dose

Use: Preoperative antimicrobial prophylaxis in neonatal patients older than 72 hours and children undergoing uncomplicated, nonperforated colorectal or appendectomy with the following likely pathogens: enteric gram-negative bacilli, enterococci, and/or anaerobes (Bacteroides species)

ASHP, IDSA, SHEA, and SIS Recommendations:
40 mg/kg IV ONCE

• Maximum dose: 2 grams/dose

Comment: The recommended redosing interval from the initiation of the preoperative dose is 2 hours.

Uses:
Recommended agent for surgical prophylaxis in patients who are undergoing the following procedures:

• Appendectomy for uncomplicated appendicitis
• Biliary tract (e.g., elective high-risk, open procedure)
• Colorectal
• Hysterectomy (abdominal/vaginal)
• Small intestine (e.g., obstructed)
• Some urologic procedures (e.g., clean-contaminated with entry into urinary tract)

Alternative agent for surgical prophylaxis in patients who are undergoing the following procedures:

• Open biliary tract procedures

Adjunctive agent (with metronidazole) for surgical prophylaxis in patients who are undergoing colon procedures

Usual Pediatric Dose for Cesarean Section

Single-dose regimen: 2 grams IV ONCE as soon as the umbilical cord is clamped

3-dose regimen: 2 grams IV every 4 hours for 3 doses, given as soon as the umbilical cord is clamped, then at 4 and 8 hours after the initial dose

Comment: This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.

Use: Prophylaxis of infection in patients undergoing cesarean section

Usual Pediatric Dose for Gonococcal Infection - Uncomplicated

US CDC recommendations:
Uncomplicated anorectal and urogenital gonococcal infections in adolescents: 2 grams IM ONCE plus probenecid

Comments:

• This regimen with probenecid is recommended if ceftriaxone is not an option.
• Doxycycline therapy for 7 days (if not pregnant) or single dose azithromycin is also recommended to treat possible concurrent chlamydial infection.
• The patient's sexual partner(s) should also be evaluated/treated.

Use: Treatment of uncomplicated gonococcal infections of the cervix, urethra, and rectum caused by N gonorrhoeae

Renal Dose Adjustments

Pediatric:
3 months and older: Doses and frequencies should be adjusted consisted with adult renal dose adjustments.

Adults:
Loading dose: 1 to 2 grams via IV injection over 3 to 5 minutes ONCE

Maintenance dose:

• Mild renal dysfunction (CrCl 30 to 50 mL/min): 1 to 2 grams over 3 to 5 minutes or IV infusion every 8 to 12 hours
• Moderate renal dysfunction (CrCl 10 to 29 mL/min): 1 to 2 grams over 3 to 5 minutes or IV infusion every 12 to 24 hours
• Severe renal dysfunction (CrCl 5 to 9 mL/min): 0.5 to 1 gram over 3 to 5 minutes or IV infusion every 12 to 48 hours
• Essentially no renal function (CrCl less than 5 mL/min): 0.5 to 1 gram over 3 to 5 minutes or IV infusion every 24 to 48 hours

Liver Dose Adjustments

Data not available

Precautions

CONTRAINDICATIONS:

• Hypersensitivity to the active component, the cephalosporin group of antibiotics, or to any of the ingredients

Safety and efficacy have not been established in patients younger than 3 months.

Consult WARNINGS section for additional precautions.

Dialysis

Hemodialysis:
Pediatric:
3 months and older: Doses and frequencies should be adjusted consistent with adult renal dose adjustments.

Adults:
Loading dose: 1 to 2 grams IV after each hemodialysis

Maintenance dose:

• Mild renal dysfunction (CrCl 30 to 50 mL/min): 1 to 2 grams IV every 8 to 12 hours
• Moderate renal dysfunction (CrCl 10 to 29 mL/min): 1 to 2 grams IV every 12 to 24 hours
• Severe renal dysfunction (CrCl 5 to 9 mL/min): 0.5 to 1 gram IV every 12 to 48 hours
• Essentially no renal function (CrCl less than 5 mL/min): 0.5 to 1 gram IV every 24 to 48 hours

Other Comments

Administration advice:

• IM: This drug should be given deep into a large muscle (e.g., upper outer quadrant of the gluteus maximus, lateral thigh).
• IV: This drug may be given via IV injection (over 3 to 5 minutes) OR infusion; intraarterial administration should be avoided.

Storage requirements:

• The manufacturer product information should be consulted.

Reconstitution/preparation techniques:

• The manufacturer product information should be consulted.

IV compatibility:

• The manufacturer product information should be consulted.

General:

• Local epidemiological and susceptibility patterns should be used to guide treatment selection in the absence of patient-specific culture and susceptibility information.
• Some experts recommend against using this drug to treat meningitis.

Monitoring:

• HEMATOLOGIC: Hematopoietic system function tests periodically, especially during prolonged treatment
• HEPATIC: Liver function tests periodically, especially during prolonged treatment
• RENAL: Renal function monitoring, especially regularly when used with aminoglycosides and periodically during prolonged treatment

Patient advice:

• 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