Usual Adult Dose for Bacteremia

1 to 2 g IV or IM once a day (or in equally divided doses twice a day)

Duration of therapy: 4 to 14 days

• Complicated infections: Longer therapy may be required.
• Infections due to Streptococcus pyogenes: At least 10 days

Comments:

• Dose and duration depend on the nature and severity of the infection.
• The total daily dose should not exceed 4 g.

Uses: For the treatment of the following infections when due to susceptible organisms:

• Bacterial septicemia due to Staphylococcus aureus, S pneumoniae, Escherichia coli, Haemophilus influenzae, or Klebsiella pneumoniae
• Bone and joint infections due to S aureus, S pneumoniae, E coli, Proteus mirabilis, K pneumoniae, or Enterobacter species
• Lower respiratory tract infections due to S pneumoniae, S aureus, H influenzae, H parainfluenzae, K pneumoniae, E coli, Enterobacter aerogenes, P mirabilis, or Serratia marcescens
• Urinary tract infections (complicated and uncomplicated) due to E coli, P mirabilis, P vulgaris, Morganella morganii, or K pneumoniae

Usual Adult Dose for Joint Infection

1 to 2 g IV or IM once a day (or in equally divided doses twice a day)

Duration of therapy: 4 to 14 days

• Complicated infections: Longer therapy may be required.
• Infections due to Streptococcus pyogenes: At least 10 days

Comments:

• Dose and duration depend on the nature and severity of the infection.
• The total daily dose should not exceed 4 g.

Uses: For the treatment of the following infections when due to susceptible organisms:

• Bacterial septicemia due to Staphylococcus aureus, S pneumoniae, Escherichia coli, Haemophilus influenzae, or Klebsiella pneumoniae
• Bone and joint infections due to S aureus, S pneumoniae, E coli, Proteus mirabilis, K pneumoniae, or Enterobacter species
• Lower respiratory tract infections due to S pneumoniae, S aureus, H influenzae, H parainfluenzae, K pneumoniae, E coli, Enterobacter aerogenes, P mirabilis, or Serratia marcescens
• Urinary tract infections (complicated and uncomplicated) due to E coli, P mirabilis, P vulgaris, Morganella morganii, or K pneumoniae

Usual Adult Dose for Osteomyelitis

1 to 2 g IV or IM once a day (or in equally divided doses twice a day)

Duration of therapy: 4 to 14 days

• Complicated infections: Longer therapy may be required.
• Infections due to Streptococcus pyogenes: At least 10 days

Comments:

• Dose and duration depend on the nature and severity of the infection.
• The total daily dose should not exceed 4 g.

Uses: For the treatment of the following infections when due to susceptible organisms:

• Bacterial septicemia due to Staphylococcus aureus, S pneumoniae, Escherichia coli, Haemophilus influenzae, or Klebsiella pneumoniae
• Bone and joint infections due to S aureus, S pneumoniae, E coli, Proteus mirabilis, K pneumoniae, or Enterobacter species
• Lower respiratory tract infections due to S pneumoniae, S aureus, H influenzae, H parainfluenzae, K pneumoniae, E coli, Enterobacter aerogenes, P mirabilis, or Serratia marcescens
• Urinary tract infections (complicated and uncomplicated) due to E coli, P mirabilis, P vulgaris, Morganella morganii, or K pneumoniae

Usual Adult Dose for Pneumonia

1 to 2 g IV or IM once a day (or in equally divided doses twice a day)

Duration of therapy: 4 to 14 days

• Complicated infections: Longer therapy may be required.
• Infections due to Streptococcus pyogenes: At least 10 days

Comments:

• Dose and duration depend on the nature and severity of the infection.
• The total daily dose should not exceed 4 g.

Uses: For the treatment of the following infections when due to susceptible organisms:

• Bacterial septicemia due to Staphylococcus aureus, S pneumoniae, Escherichia coli, Haemophilus influenzae, or Klebsiella pneumoniae
• Bone and joint infections due to S aureus, S pneumoniae, E coli, Proteus mirabilis, K pneumoniae, or Enterobacter species
• Lower respiratory tract infections due to S pneumoniae, S aureus, H influenzae, H parainfluenzae, K pneumoniae, E coli, Enterobacter aerogenes, P mirabilis, or Serratia marcescens
• Urinary tract infections (complicated and uncomplicated) due to E coli, P mirabilis, P vulgaris, Morganella morganii, or K pneumoniae

Usual Adult Dose for Septicemia

1 to 2 g IV or IM once a day (or in equally divided doses twice a day)

Duration of therapy: 4 to 14 days

• Complicated infections: Longer therapy may be required.
• Infections due to Streptococcus pyogenes: At least 10 days

Comments:

• Dose and duration depend on the nature and severity of the infection.
• The total daily dose should not exceed 4 g.

Uses: For the treatment of the following infections when due to susceptible organisms:

• Bacterial septicemia due to Staphylococcus aureus, S pneumoniae, Escherichia coli, Haemophilus influenzae, or Klebsiella pneumoniae
• Bone and joint infections due to S aureus, S pneumoniae, E coli, Proteus mirabilis, K pneumoniae, or Enterobacter species
• Lower respiratory tract infections due to S pneumoniae, S aureus, H influenzae, H parainfluenzae, K pneumoniae, E coli, Enterobacter aerogenes, P mirabilis, or Serratia marcescens
• Urinary tract infections (complicated and uncomplicated) due to E coli, P mirabilis, P vulgaris, Morganella morganii, or K pneumoniae

Usual Adult Dose for Bacterial Infection

1 to 2 g IV or IM once a day (or in equally divided doses twice a day)

Duration of therapy: 4 to 14 days

• Complicated infections: Longer therapy may be required.
• Infections due to Streptococcus pyogenes: At least 10 days

Comments:

• Dose and duration depend on the nature and severity of the infection.
• The total daily dose should not exceed 4 g.

Uses: For the treatment of the following infections when due to susceptible organisms:

• Bacterial septicemia due to Staphylococcus aureus, S pneumoniae, Escherichia coli, Haemophilus influenzae, or Klebsiella pneumoniae
• Bone and joint infections due to S aureus, S pneumoniae, E coli, Proteus mirabilis, K pneumoniae, or Enterobacter species
• Lower respiratory tract infections due to S pneumoniae, S aureus, H influenzae, H parainfluenzae, K pneumoniae, E coli, Enterobacter aerogenes, P mirabilis, or Serratia marcescens
• Urinary tract infections (complicated and uncomplicated) due to E coli, P mirabilis, P vulgaris, Morganella morganii, or K pneumoniae

Usual Adult Dose for Urinary Tract Infection

1 to 2 g IV or IM once a day (or in equally divided doses twice a day)

Duration of therapy: 4 to 14 days

• Complicated infections: Longer therapy may be required.
• Infections due to Streptococcus pyogenes: At least 10 days

Comments:

• Dose and duration depend on the nature and severity of the infection.
• The total daily dose should not exceed 4 g.

Uses: For the treatment of the following infections when due to susceptible organisms:

• Bacterial septicemia due to Staphylococcus aureus, S pneumoniae, Escherichia coli, Haemophilus influenzae, or Klebsiella pneumoniae
• Bone and joint infections due to S aureus, S pneumoniae, E coli, Proteus mirabilis, K pneumoniae, or Enterobacter species
• Lower respiratory tract infections due to S pneumoniae, S aureus, H influenzae, H parainfluenzae, K pneumoniae, E coli, Enterobacter aerogenes, P mirabilis, or Serratia marcescens
• Urinary tract infections (complicated and uncomplicated) due to E coli, P mirabilis, P vulgaris, Morganella morganii, or K pneumoniae

Usual Adult Dose for Bronchitis

1 to 2 g IV or IM once a day (or in equally divided doses twice a day)

Duration of therapy: 4 to 14 days

• Complicated infections: Longer therapy may be required.
• Infections due to Streptococcus pyogenes: At least 10 days

Comments:

• Dose and duration depend on the nature and severity of the infection.
• The total daily dose should not exceed 4 g.

Uses: For the treatment of the following infections when due to susceptible organisms:

• Bacterial septicemia due to Staphylococcus aureus, S pneumoniae, Escherichia coli, Haemophilus influenzae, or Klebsiella pneumoniae
• Bone and joint infections due to S aureus, S pneumoniae, E coli, Proteus mirabilis, K pneumoniae, or Enterobacter species
• Lower respiratory tract infections due to S pneumoniae, S aureus, H influenzae, H parainfluenzae, K pneumoniae, E coli, Enterobacter aerogenes, P mirabilis, or Serratia marcescens
• Urinary tract infections (complicated and uncomplicated) due to E coli, P mirabilis, P vulgaris, Morganella morganii, or K pneumoniae

Usual Adult Dose for Gonococcal Infection - Uncomplicated

250 mg IM as a single dose

Uses: For the treatment of uncomplicated cervical/urethral and rectal gonorrhea due to Neisseria gonorrhoeae (including penicillinase- and nonpenicillinase-producing strains) and pharyngeal gonorrhea due to nonpenicillinase-producing strains of N gonorrhoeae

US CDC Recommendations:

• Less than 150 kg: 500 mg IM as a single dose
• At least 150 kg: 1 g IM as a single dose

Comments:

• The recommended regimen for uncomplicated infections of the pharynx, cervix, urethra, and rectum
• The patient's sexual partner(s) should also be evaluated/treated.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Intraabdominal Infection

1 to 2 g IV or IM once a day (or in equally divided doses twice a day)

Duration of therapy: 4 to 14 days

• Complicated infections: Longer therapy may be required.

Comments:

• Dose and duration depend on the nature and severity of the infection.
• The total daily dose should not exceed 4 g.
• Most strains of Clostridium difficile have been reported as resistant.

Uses: For the treatment of intraabdominal infections due to E coli, K pneumoniae, Bacteroides fragilis, Clostridium species, or Peptostreptococcus species

Infectious Diseases Society of America (IDSA) and Surgical Infection Society (SIS) Recommendations: 1 to 2 g IV every 12 to 24 hours

Comments:

• With metronidazole, recommended for complicated community-acquired infection (perforated or abscessed appendicitis and other infections of mild to moderate severity)
• Recommended for community-acquired acute cholecystitis of mild to moderate severity
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Meningitis

1 to 2 g IV or IM once a day (or in equally divided doses twice a day)

Duration of therapy: 4 to 14 days

• Complicated infections: Longer therapy may be required.

Comments:

• Dose and duration depend on the nature and severity of the infection.
• The total daily dose should not exceed 4 g.
• This drug has been effective in a limited number of cases of meningitis and shunt infection due to S epidermidis and E coli.

Use: For the treatment of meningitis due to H influenzae, N meningitidis, or S pneumoniae

IDSA Recommendations:

• Bacterial meningitis: 4 g IV every 24 hours (or in equally divided doses every 12 hours) for 7 to at least 21 days
• Healthcare-associated ventriculitis and meningitis: 2 g IV every 12 hours

US CDC Recommendations:

• Gonococcal meningitis: 1 to 2 g IV every 12 to 24 hours for 10 to 14 days

Comments:

• Duration of bacterial meningitis therapy should be based on isolated pathogen.
• With azithromycin, the recommended regimen for gonococcal meningitis; the patient's sexual partner(s) should also be evaluated/treated.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Pelvic Inflammatory Disease

1 to 2 g IV or IM once a day (or in equally divided doses twice a day)

Duration of therapy: 4 to 14 days

• Complicated infections: Longer therapy may be required.

Comments:

• Dose and duration depend on the nature and severity of the infection.
• The total daily dose should not exceed 4 g.
• This drug has no activity against Chlamydia trachomatis; appropriate antichlamydial therapy should be added when C trachomatis is a suspected pathogen.

Use: For the treatment of pelvic inflammatory disease (PID) due to N gonorrhoeae

US CDC Recommendations: 250 mg IM as a single dose

Comments:

• Part of a recommended IM/oral regimen for acute PID (of mild to moderate severity); this drug should be used with doxycycline (with or without metronidazole).
• Patients not responding to IM/oral therapy within 72 hours should be reevaluated to confirm diagnosis and should receive IV therapy.
• The patient's sexual partner(s) should also be evaluated/treated.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Skin or Soft Tissue Infection

1 to 2 g IV or IM once a day (or in equally divided doses twice a day)

Duration of therapy: 4 to 14 days

• Complicated infections: Longer therapy may be required.
• Infections due to S pyogenes: At least 10 days

Comments:

• Dose and duration depend on the nature and severity of the infection.
• The total daily dose should not exceed 4 g.

Uses: For the treatment of skin and skin structure infections due to S aureus, S epidermidis, S pyogenes, viridans group streptococci, E coli, E cloacae, K oxytoca, K pneumoniae, P mirabilis, M morganii, Pseudomonas aeruginosa, S marcescens, Acinetobacter calcoaceticus, B fragilis, or Peptostreptococcus species

IDSA Recommendations:

• Incisional surgical site infection: 1 g IV every 24 hours
• Aeromonas hydrophila necrotizing infection: 1 to 2 g IV every 24 hours
• Vibrio vulnificus necrotizing infection: 1 g IV once a day
• Infection after animal bite: 1 g IV every 12 hours

Comments:

• Recommended for use with metronidazole as a combination regimen for treatment of incisional surgical site infections after intestinal or genitourinary tract surgery.
• Recommended for use with metronidazole for treatment of incisional surgical site infections after surgery of axilla or perineum; coverage for methicillin-resistant S aureus may be needed.
• In combination with doxycycline, recommended as a preferred IV drug for the treatment of necrotizing infections of the skin, fascia, and muscle due to A hydrophila or V vulnificus
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Skin and Structure Infection

1 to 2 g IV or IM once a day (or in equally divided doses twice a day)

Duration of therapy: 4 to 14 days

• Complicated infections: Longer therapy may be required.
• Infections due to S pyogenes: At least 10 days

Comments:

• Dose and duration depend on the nature and severity of the infection.
• The total daily dose should not exceed 4 g.

Uses: For the treatment of skin and skin structure infections due to S aureus, S epidermidis, S pyogenes, viridans group streptococci, E coli, E cloacae, K oxytoca, K pneumoniae, P mirabilis, M morganii, Pseudomonas aeruginosa, S marcescens, Acinetobacter calcoaceticus, B fragilis, or Peptostreptococcus species

IDSA Recommendations:

• Incisional surgical site infection: 1 g IV every 24 hours
• Aeromonas hydrophila necrotizing infection: 1 to 2 g IV every 24 hours
• Vibrio vulnificus necrotizing infection: 1 g IV once a day
• Infection after animal bite: 1 g IV every 12 hours

Comments:

• Recommended for use with metronidazole as a combination regimen for treatment of incisional surgical site infections after intestinal or genitourinary tract surgery.
• Recommended for use with metronidazole for treatment of incisional surgical site infections after surgery of axilla or perineum; coverage for methicillin-resistant S aureus may be needed.
• In combination with doxycycline, recommended as a preferred IV drug for the treatment of necrotizing infections of the skin, fascia, and muscle due to A hydrophila or V vulnificus
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Surgical Prophylaxis

1 g IV as a single dose 30 to 120 minutes before surgery

Comments:

• Preoperative use of this drug may reduce the incidence of postoperative infections in patients undergoing surgical procedures classified as contaminated or potentially contaminated (e.g., vaginal or abdominal hysterectomy, cholecystectomy for chronic calculous cholecystitis in high-risk patients [such as those older than 70 years] with acute cholecystitis not requiring therapeutic antimicrobials, obstructive jaundice, common duct bile stones) and in surgical patients for whom infection at the operative site would present serious risk (e.g., during coronary artery bypass surgery).
• This drug shown to be as effective as cefazolin to prevent infection after coronary artery bypass surgery; no placebo-controlled trials to evaluate any cephalosporin preventing infection after coronary artery bypass surgery.

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

• Preoperative dose: 2 g IV as a single dose, starting within 60 minutes before surgical incision

Comments:

• A single prophylactic dose is usually sufficient; if prophylaxis is continued postoperatively, duration should be less than 24 hours.
• Readministration may be needed for unusually long procedures to ensure adequate serum and tissue drug levels.
• Redosing may be needed if drug half-life is shortened (e.g., extensive burns) or if prolonged/excessive bleeding during surgery; redosing may not be needed if drug half-life is prolonged (e.g., renal dysfunction).
• Current guidelines should be consulted for additional information.

Uses: For surgical prophylaxis for the following procedures:

• Biliary tract (recommended regimen): Open procedure and elective, high-risk laparoscopic procedure; should limit to patients requiring antimicrobial therapy for acute cholecystitis or acute biliary tract infections (which may not be established before incision), not patients undergoing cholecystectomy for noninfected biliary conditions (including biliary colic or dyskinesia without infection)
• Colorectal (with metronidazole, as a recommended regimen)

Usual Adult Dose for Chancroid

US CDC Recommendations: 250 mg IM as a single dose

Comments:

• The causative organism is H ducreyi.
• Patients should be reexamined 3 to 7 days after therapy.
• Uncircumcised men and HIV-infected patients do not respond as well to therapy as circumcised men and HIV-negative patients; HIV testing recommended at chancroid diagnosis.
• HIV-infected patients may require repeated or longer treatment regimens; these patients should be monitored closely.
• Patients should be retested for syphilis and HIV 3 months after chancroid diagnosis, if initial tests were negative.
• The patient's sexual partner(s) should also be evaluated/treated.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Conjunctivitis

US CDC Recommendations: 1 g IM as a single dose

Comments:

• With azithromycin, the recommended regimen for gonococcal conjunctivitis
• Consultation with an infectious disease specialist and a one-time lavage of the infected eye with saline solution should be considered.
• The patient's sexual partner(s) should also be evaluated/treated.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Endocarditis

American Heart Association (AHA) and IDSA Recommendations:

• Native valve infective endocarditis (NVE) due to highly penicillin-susceptible viridans group streptococci (VGS) or S gallolyticus (bovis): 2 g IV or IM every 24 hours for 4 weeks
• When used with gentamicin: 2 g IV or IM every 24 hours for 2 weeks
• Prosthetic valve (or other prosthetic material) infection due to VGS or S gallolyticus (bovis): 2 g IV or IM every 24 hours for 6 weeks
• NVE or prosthetic valve (or other prosthetic material) infection due to Enterococcus species by a strain susceptible to penicillin and gentamicin (if able to tolerate beta-lactam therapy): 2 g IV every 12 hours for 6 weeks
• NVE or prosthetic valve (or other prosthetic material) infection due to Enterococcus species by a strain susceptible to penicillin and resistant to aminoglycosides or streptomycin-susceptible gentamicin-resistant (if able to tolerate beta-lactam therapy): 2 g IV every 12 hours for 6 weeks
• NVE or prosthetic valve (or other prosthetic material) infection due to HACEK microorganisms: 2 g IV or IM every 24 hours
• Duration of therapy: 4 weeks (NVE); 6 weeks (prosthetic valve infection)

US CDC Recommendations:

• Gonococcal endocarditis: 1 to 2 g IV every 12 to 24 hours for at least 4 weeks

Comments:

• Recommended for patients with normal renal function
• With or without gentamicin, recommended for NVE due to highly penicillin-susceptible VGS or S gallolyticus (bovis)
• The 2-week regimen (with gentamicin) is not intended for patients with known cardiac/extracardiac abscess, CrCl less than 20 mL/min, impaired 8th cranial nerve function, or Abiotrophia, Granulicatella, or Gemella species infection.
• With or without gentamicin (penicillin-susceptible strain [MIC up to 0.12 mcg/mL]) or with gentamicin (relatively/fully penicillin-resistant strain [MIC greater than 0.12 mcg/mL]), recommended for prosthetic valve (or other prosthetic material) infection due to VGS or S gallolyticus (bovis)
• With ampicillin, recommended for NVE or prosthetic valve (or other prosthetic material) infection due to Enterococcus species by a strain susceptible to penicillin and gentamicin (if able to tolerate beta-lactam therapy)
• With ampicillin, recommended for NVE or prosthetic valve (or other prosthetic material) infection due to Enterococcus species by a strain susceptible to penicillin and resistant to aminoglycosides or streptomycin-susceptible gentamicin-resistant (if able to tolerate beta-lactam therapy)
• Recommended as preferred therapy for NVE or prosthetic valve (or other prosthetic material) infection due to HACEK microorganisms
• HACEK indicates Haemophilus species, Aggregatibacter species, Cardiobacterium hominis, Eikenella corrodens, and Kingella species
• With azithromycin, recommended regimen for the treatment of gonococcal endocarditis
• The patient's sexual partner(s) should also be evaluated/treated.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Bacterial Endocarditis Prophylaxis

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

Comments:

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

Usual Adult Dose for Epididymitis - Sexually Transmitted

US CDC Recommendations: 250 mg IM as a single dose

Comments:

• With doxycycline, the recommended regimen for acute epididymitis most likely due to sexually-transmitted chlamydia and gonorrhea
• With levofloxacin or ofloxacin, the recommended regimen for acute epididymitis most likely due to sexually-transmitted chlamydia and gonorrhea and enteric organisms (men practicing insertive anal sex)
• All patients should be tested for other sexually-transmitted infections (including HIV).
• The patient's sexual partner(s) should also be evaluated/treated.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Gonococcal Infection - Disseminated

US CDC Recommendations:

• Arthritis and arthritis-dermatitis syndrome: 1 g IV or IM every 24 hours
• Gonococcal endocarditis and meningitis: 1 to 2 g IV every 12 to 24 hours

Duration of therapy:

• Arthritis-dermatitis syndrome: At least 7 days (total)
• Gonococcal endocarditis: At least 4 weeks
• Gonococcal meningitis: 10 to 14 days

Comments:

• With azithromycin, the recommended regimen for disseminated gonococcal infection (DGI)
• Hospitalization and consultation with an infectious disease specialist recommended for initial therapy, particularly for patients who may be noncompliant with therapy, have an uncertain diagnosis, or have purulent synovial effusions/other complications; patients should be examined for clinical signs of endocarditis and meningitis.
• Arthritis-dermatitis syndrome: Can switch to oral therapy (guided by antimicrobial susceptibility testing) 24 to 48 hours after significant clinical improvement
• The patient's sexual partner(s) should also be evaluated/treated.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Lyme Disease - Arthritis

IDSA, American Academy of Neurology (AAN), and American College of Rheumatology (ACR) Recommendations: 2 g IV once a day

Duration of Therapy:

• Carditis: 14 to 21 days
• Meningitis or radiculopathy: 14 to 21 days
• Recurrent/refractory arthritis: 14 days; can extend repeat IV therapy up to 28 days if inflammation not resolving

Comments:

• Recommended as the initial IV treatment of Lyme carditis in patients requiring hospitalization; therapy can be completed orally after evidence of clinical improvement.
• Recommended as the preferred IV agent for patients with Lyme disease-associated meningitis, cranial neuropathy, radiculoneuropathy, or other peripheral nervous system (PNS) manifestations
• Recommended as IV therapy in patients with Lyme arthritis who had no/minimal response (moderate to severe joint swelling with minimal reduction of joint effusion) to an initial oral regimen
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Lyme Disease - Carditis

IDSA, American Academy of Neurology (AAN), and American College of Rheumatology (ACR) Recommendations: 2 g IV once a day

Duration of Therapy:

• Carditis: 14 to 21 days
• Meningitis or radiculopathy: 14 to 21 days
• Recurrent/refractory arthritis: 14 days; can extend repeat IV therapy up to 28 days if inflammation not resolving

Comments:

• Recommended as the initial IV treatment of Lyme carditis in patients requiring hospitalization; therapy can be completed orally after evidence of clinical improvement.
• Recommended as the preferred IV agent for patients with Lyme disease-associated meningitis, cranial neuropathy, radiculoneuropathy, or other peripheral nervous system (PNS) manifestations
• Recommended as IV therapy in patients with Lyme arthritis who had no/minimal response (moderate to severe joint swelling with minimal reduction of joint effusion) to an initial oral regimen
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Lyme Disease - Neurologic

IDSA, American Academy of Neurology (AAN), and American College of Rheumatology (ACR) Recommendations: 2 g IV once a day

Duration of Therapy:

• Carditis: 14 to 21 days
• Meningitis or radiculopathy: 14 to 21 days
• Recurrent/refractory arthritis: 14 days; can extend repeat IV therapy up to 28 days if inflammation not resolving

Comments:

• Recommended as the initial IV treatment of Lyme carditis in patients requiring hospitalization; therapy can be completed orally after evidence of clinical improvement.
• Recommended as the preferred IV agent for patients with Lyme disease-associated meningitis, cranial neuropathy, radiculoneuropathy, or other peripheral nervous system (PNS) manifestations
• Recommended as IV therapy in patients with Lyme arthritis who had no/minimal response (moderate to severe joint swelling with minimal reduction of joint effusion) to an initial oral regimen
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Meningococcal Meningitis Prophylaxis

US CDC Recommendations: 250 mg IM as a single dose

Comments:

• Recommended as a chemoprophylaxis regimen for high-risk contacts of individuals with invasive meningococcal disease
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Neurosyphilis

US CDC, National Institutes of Health (NIH), and HIV Medicine Association of the IDSA (HIVMA/IDSA) Recommendations for HIV-infected Patients: 2 g IV or IM once a day for 10 to 14 days

Comments:

• Recommended for penicillin-allergic patients (when desensitization to penicillin is not possible) with neurosyphilis, otic, or ocular disease
• The patient's sexual partner(s) should also be evaluated/treated.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Proctitis

US CDC Recommendations:

• Less than 150 kg: 500 mg IM as a single dose
• At least 150 kg: 1 g IM as a single dose

Comments:

• The recommended regimen for acute proctitis
• All patients should be tested for HIV and syphilis.
• The patient's sexual partner(s) should also be evaluated/treated.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Salmonella Enteric Fever

US CDC, NIH, and HIVMA/IDSA Recommendations for HIV-infected Patients: 1 g IV every 24 hours

Duration of Salmonellosis Therapy:
For gastroenteritis without bacteremia:

• If CD4 count at least 200 cells/mm3: 7 to 14 days
• If CD4 count less than 200 cells/mm3: 2 to 6 weeks

For gastroenteritis with bacteremia:

• If CD4 count at least 200 cells/mm3: 14 days; longer if persistent bacteremia or complicated infection (e.g., metastatic foci of infection present)
• If CD4 count less than 200 cells/mm3: 2 to 6 weeks

Comments:

• Recommended as alternative empiric therapy for bacterial enteric infections (pending diagnostic studies) and as alternative therapy for salmonella gastroenteritis with or without bacteremia
• Empiric therapy for bacterial enteric infections recommended for patients with advanced HIV (CD4 count less than 200 cells/mm3 or concomitant AIDS-defining illnesses) and clinically severe diarrhea (at least 6 stools/day or bloody stool) and/or associated fever/chills. Fecal samples should be obtained for diagnostic testing before starting therapy; therapy should be adjusted based on those results.
• All HIV-infected patients with salmonellosis should receive antibacterial therapy due to increased risk of bacteremia (by 20- to 100-fold) and mortality (by up to 7-fold) compared to HIV-negative subjects.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Salmonella Gastroenteritis

US CDC, NIH, and HIVMA/IDSA Recommendations for HIV-infected Patients: 1 g IV every 24 hours

Duration of Salmonellosis Therapy:
For gastroenteritis without bacteremia:

• If CD4 count at least 200 cells/mm3: 7 to 14 days
• If CD4 count less than 200 cells/mm3: 2 to 6 weeks

For gastroenteritis with bacteremia:

• If CD4 count at least 200 cells/mm3: 14 days; longer if persistent bacteremia or complicated infection (e.g., metastatic foci of infection present)
• If CD4 count less than 200 cells/mm3: 2 to 6 weeks

Comments:

• Recommended as alternative empiric therapy for bacterial enteric infections (pending diagnostic studies) and as alternative therapy for salmonella gastroenteritis with or without bacteremia
• Empiric therapy for bacterial enteric infections recommended for patients with advanced HIV (CD4 count less than 200 cells/mm3 or concomitant AIDS-defining illnesses) and clinically severe diarrhea (at least 6 stools/day or bloody stool) and/or associated fever/chills. Fecal samples should be obtained for diagnostic testing before starting therapy; therapy should be adjusted based on those results.
• All HIV-infected patients with salmonellosis should receive antibacterial therapy due to increased risk of bacteremia (by 20- to 100-fold) and mortality (by up to 7-fold) compared to HIV-negative subjects.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for STD Prophylaxis

US CDC Recommendations: 250 mg IM as a single dose

Comments:

• With azithromycin and (metronidazole or tinidazole), the recommended regimen for presumptive therapy after sexual assault
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Syphilis - Early

US CDC, NIH, and HIVMA/IDSA Recommendations for HIV-infected Patients: 1 g IV or IM once a day for 10 to 14 days

Comments:

• Recommended as alternative therapy for penicillin-allergic patients with early-stage infection (primary, secondary, and early-latent syphilis); if cannot ensure compliance or follow-up, penicillin-allergic patients should be desensitized and treated with benzathine penicillin G.
• The patient's sexual partner(s) should also be evaluated/treated.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Bacteremia

1 month or older: 50 to 75 mg/kg/day IV or IM in divided doses every 12 hours
Maximum dose: 2 g/day

Uses: For the treatment of serious miscellaneous infections when due to susceptible organisms; may include:

• Bacterial septicemia due to S aureus, S pneumoniae, E coli, H influenzae, or K pneumoniae
• Bone and joint infections due to S aureus, S pneumoniae, E coli, P mirabilis, K pneumoniae, or Enterobacter species
• Urinary tract infections due to E coli, P mirabilis, P vulgaris, M morganii, or K pneumoniae

American Academy of Pediatrics (AAP) Recommendations:
Neonates: 50 mg/kg IV or IM every 24 hours

1 month or older:
Mild to moderate infections: 50 to 75 mg/kg IV or IM once a day
Maximum dose: 1 g/day

Severe infections: 100 mg/kg IV or IM once a day (or in equally divided doses twice a day)
Maximum dose: 4 g/day

Comments:

• Neonates should not receive this drug IV if they are receiving (or expected to receive) calcium-containing IV solutions (including parenteral nutrition).
• In pediatric patients beyond the newborn period, larger doses appropriate for penicillin-resistant pneumococcal pneumonia.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Joint Infection

1 month or older: 50 to 75 mg/kg/day IV or IM in divided doses every 12 hours
Maximum dose: 2 g/day

Uses: For the treatment of serious miscellaneous infections when due to susceptible organisms; may include:

• Bacterial septicemia due to S aureus, S pneumoniae, E coli, H influenzae, or K pneumoniae
• Bone and joint infections due to S aureus, S pneumoniae, E coli, P mirabilis, K pneumoniae, or Enterobacter species
• Urinary tract infections due to E coli, P mirabilis, P vulgaris, M morganii, or K pneumoniae

American Academy of Pediatrics (AAP) Recommendations:
Neonates: 50 mg/kg IV or IM every 24 hours

1 month or older:
Mild to moderate infections: 50 to 75 mg/kg IV or IM once a day
Maximum dose: 1 g/day

Severe infections: 100 mg/kg IV or IM once a day (or in equally divided doses twice a day)
Maximum dose: 4 g/day

Comments:

• Neonates should not receive this drug IV if they are receiving (or expected to receive) calcium-containing IV solutions (including parenteral nutrition).
• In pediatric patients beyond the newborn period, larger doses appropriate for penicillin-resistant pneumococcal pneumonia.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Osteomyelitis

1 month or older: 50 to 75 mg/kg/day IV or IM in divided doses every 12 hours
Maximum dose: 2 g/day

Uses: For the treatment of serious miscellaneous infections when due to susceptible organisms; may include:

• Bacterial septicemia due to S aureus, S pneumoniae, E coli, H influenzae, or K pneumoniae
• Bone and joint infections due to S aureus, S pneumoniae, E coli, P mirabilis, K pneumoniae, or Enterobacter species
• Urinary tract infections due to E coli, P mirabilis, P vulgaris, M morganii, or K pneumoniae

American Academy of Pediatrics (AAP) Recommendations:
Neonates: 50 mg/kg IV or IM every 24 hours

1 month or older:
Mild to moderate infections: 50 to 75 mg/kg IV or IM once a day
Maximum dose: 1 g/day

Severe infections: 100 mg/kg IV or IM once a day (or in equally divided doses twice a day)
Maximum dose: 4 g/day

Comments:

• Neonates should not receive this drug IV if they are receiving (or expected to receive) calcium-containing IV solutions (including parenteral nutrition).
• In pediatric patients beyond the newborn period, larger doses appropriate for penicillin-resistant pneumococcal pneumonia.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Septicemia

1 month or older: 50 to 75 mg/kg/day IV or IM in divided doses every 12 hours
Maximum dose: 2 g/day

Uses: For the treatment of serious miscellaneous infections when due to susceptible organisms; may include:

• Bacterial septicemia due to S aureus, S pneumoniae, E coli, H influenzae, or K pneumoniae
• Bone and joint infections due to S aureus, S pneumoniae, E coli, P mirabilis, K pneumoniae, or Enterobacter species
• Urinary tract infections due to E coli, P mirabilis, P vulgaris, M morganii, or K pneumoniae

American Academy of Pediatrics (AAP) Recommendations:
Neonates: 50 mg/kg IV or IM every 24 hours

1 month or older:
Mild to moderate infections: 50 to 75 mg/kg IV or IM once a day
Maximum dose: 1 g/day

Severe infections: 100 mg/kg IV or IM once a day (or in equally divided doses twice a day)
Maximum dose: 4 g/day

Comments:

• Neonates should not receive this drug IV if they are receiving (or expected to receive) calcium-containing IV solutions (including parenteral nutrition).
• In pediatric patients beyond the newborn period, larger doses appropriate for penicillin-resistant pneumococcal pneumonia.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Bacterial Infection

1 month or older: 50 to 75 mg/kg/day IV or IM in divided doses every 12 hours
Maximum dose: 2 g/day

Uses: For the treatment of serious miscellaneous infections when due to susceptible organisms; may include:

• Bacterial septicemia due to S aureus, S pneumoniae, E coli, H influenzae, or K pneumoniae
• Bone and joint infections due to S aureus, S pneumoniae, E coli, P mirabilis, K pneumoniae, or Enterobacter species
• Urinary tract infections due to E coli, P mirabilis, P vulgaris, M morganii, or K pneumoniae

American Academy of Pediatrics (AAP) Recommendations:
Neonates: 50 mg/kg IV or IM every 24 hours

1 month or older:
Mild to moderate infections: 50 to 75 mg/kg IV or IM once a day
Maximum dose: 1 g/day

Severe infections: 100 mg/kg IV or IM once a day (or in equally divided doses twice a day)
Maximum dose: 4 g/day

Comments:

• Neonates should not receive this drug IV if they are receiving (or expected to receive) calcium-containing IV solutions (including parenteral nutrition).
• In pediatric patients beyond the newborn period, larger doses appropriate for penicillin-resistant pneumococcal pneumonia.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Urinary Tract Infection

1 month or older: 50 to 75 mg/kg/day IV or IM in divided doses every 12 hours
Maximum dose: 2 g/day

Uses: For the treatment of serious miscellaneous infections when due to susceptible organisms; may include:

• Bacterial septicemia due to S aureus, S pneumoniae, E coli, H influenzae, or K pneumoniae
• Bone and joint infections due to S aureus, S pneumoniae, E coli, P mirabilis, K pneumoniae, or Enterobacter species
• Urinary tract infections due to E coli, P mirabilis, P vulgaris, M morganii, or K pneumoniae

American Academy of Pediatrics (AAP) Recommendations:
Neonates: 50 mg/kg IV or IM every 24 hours

1 month or older:
Mild to moderate infections: 50 to 75 mg/kg IV or IM once a day
Maximum dose: 1 g/day

Severe infections: 100 mg/kg IV or IM once a day (or in equally divided doses twice a day)
Maximum dose: 4 g/day

Comments:

• Neonates should not receive this drug IV if they are receiving (or expected to receive) calcium-containing IV solutions (including parenteral nutrition).
• In pediatric patients beyond the newborn period, larger doses appropriate for penicillin-resistant pneumococcal pneumonia.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Meningitis

1 month or older:
Initial dose: 100 mg/kg IV or IM at the start of therapy
Maximum dose: 4 g/dose

Maintenance dose: 100 mg/kg IV or IM once a day (or in equally divided doses every 12 hours)
Maximum dose: 4 g/day
Duration of therapy: 7 to 14 days

Comments:

• This drug has been effective in a limited number of cases of meningitis and shunt infection due to S epidermidis and E coli.

Use: For the treatment of meningitis due to H influenzae, N meningitidis, or S pneumoniae

IDSA Recommendations:

• Infants and children with bacterial meningitis: 80 to 100 mg/kg IV every 24 hours (or in equally divided doses every 12 hours) for 7 to at least 21 days
• Infants and children with healthcare-associated ventriculitis and meningitis: 100 mg/kg IV every 24 hours (or in equally divided doses every 12 hours)

Maximum dose: 4 g/day

US CDC Recommendations:

• Neonates with DGI and documented meningitis: 25 to 50 mg/kg IV or IM every 24 hours for 10 to 14 days
• Adolescents with gonococcal meningitis: 1 to 2 g IV every 12 to 24 hours for 10 to 14 days

Comments:

• Duration of bacterial meningitis therapy should be based on isolated pathogen.
• A recommended regimen for DGI in neonates
• This drug should be used with caution in hyperbilirubinemic neonates, especially if premature.
• With azithromycin, the recommended regimen for gonococcal meningitis in adolescents; the patient's sexual partner(s) should also be evaluated/treated.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Otitis Media

50 mg/kg IM as a single dose
Maximum dose: 1 g/dose

Uses: For the treatment of acute bacterial otitis media due to S pneumoniae, H influenzae (including beta-lactamase producing strains), or Moraxella catarrhalis (including beta-lactamase producing strains)

AAP Recommendations:
1 month or older: 50 mg/kg IM once a day
Maximum dose: 1 g/dose
Duration of therapy: 1 to 3 days

Comments:

• Recommended for acute otitis media
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Skin and Structure Infection

1 month or older: 50 to 75 mg/kg IV or IM once a day (or in equally divided doses twice a day)
Maximum dose: 2 g/day

Uses: For the treatment of skin and skin structure infections due to S aureus, S epidermidis, S pyogenes, viridans group streptococci, E coli, E cloacae, K oxytoca, K pneumoniae, P mirabilis, M morganii, P aeruginosa, S marcescens, A calcoaceticus, B fragilis, or Peptostreptococcus species

Usual Pediatric Dose for Pneumonia

1 month or older: 50 to 75 mg/kg/day IV or IM in divided doses every 12 hours
Maximum dose: 2 g/day

Uses: For the treatment of serious miscellaneous infections when due to susceptible organisms; may include lower respiratory tract infections due to S pneumoniae, S aureus, H influenzae, H parainfluenzae, K pneumoniae, E coli, E aerogenes, P mirabilis, or S marcescens

US CDC, NIH, HIVMA/IDSA, Pediatric Infectious Diseases Society (PIDS), and AAP Recommendations for HIV-exposed and HIV-infected Children: 50 to 100 mg/kg IV or IM once a day (or in equally divided doses twice a day)
Maximum dose: 4 g/day

Comments:

• Recommended as a preferred regimen for bacterial pneumonia due to S pneumoniae (occasionally S aureus, H influenzae)
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Bronchitis

1 month or older: 50 to 75 mg/kg/day IV or IM in divided doses every 12 hours
Maximum dose: 2 g/day

Uses: For the treatment of serious miscellaneous infections when due to susceptible organisms; may include lower respiratory tract infections due to S pneumoniae, S aureus, H influenzae, H parainfluenzae, K pneumoniae, E coli, E aerogenes, P mirabilis, or S marcescens

US CDC, NIH, HIVMA/IDSA, Pediatric Infectious Diseases Society (PIDS), and AAP Recommendations for HIV-exposed and HIV-infected Children: 50 to 100 mg/kg IV or IM once a day (or in equally divided doses twice a day)
Maximum dose: 4 g/day

Comments:

• Recommended as a preferred regimen for bacterial pneumonia due to S pneumoniae (occasionally S aureus, H influenzae)
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Intraabdominal Infection

1 month or older: 50 to 75 mg/kg/day IV or IM in divided doses every 12 hours
Maximum dose: 2 g/day

Uses: For the treatment of serious miscellaneous infections when due to susceptible organisms; may include intraabdominal infections due to E coli, K pneumoniae, B fragilis, Clostridium species, or Peptostreptococcus species

IDSA and SIS Recommendations: 50 to 75 mg/kg IV once a day (or in equally divided doses twice a day)
Maximum dose: 2 g/day

Comments:

• With metronidazole, recommended for complicated community-acquired infection
• Dose should be maximized if undrained intraabdominal abscess may be present.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Gonococcal Infection - Uncomplicated

US CDC Recommendations:
Neonates (without signs of infection) born to mothers with gonococcal infection: 25 to 50 mg/kg IV or IM as a single dose
Maximum dose: 125 mg/dose

Infants and children weighing up to 45 kg: 25 to 50 mg/kg IV or IM as a single dose
Maximum IM dose: 125 mg/dose

Children weighing more than 45 kg and adolescents:

• Less than 150 kg: 500 mg IM as a single dose
• At least 150 kg: 1 g IM as a single dose

Comments:

• The recommended regimen for neonates without signs of gonococcal infection; mothers with gonorrhea and their sexual partner(s) should be evaluated/treated.
• This drug should be used with caution in hyperbilirubinemic neonates, especially if premature.
• The recommended regimen for children with uncomplicated gonococcal vulvovaginitis, cervicitis, urethritis, pharyngitis, or proctitis; no data regarding use of dual therapy. Children should be tested for syphilis, chlamydial infections, and HIV.
• The recommended regimen for uncomplicated infections of the pharynx, cervix, urethra, and rectum in adolescents. The patient's sexual partner(s) should also be evaluated/treated.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Gonococcal Infection - Disseminated

US CDC Recommendations:
Neonates:

• DGI or gonococcal scalp abscesses: 25 to 50 mg/kg IV or IM every 24 hours

Duration of therapy: 7 days

• If meningitis documented: 10 to 14 days

Children:

• Arthritis or bacteremia:

45 kg or less: 50 mg/kg IV or IM every 24 hours for 7 days
Maximum dose: 1 g/day

Greater than 45 kg: 1 g IV or IM once a day for 7 days

Adolescents:

• Arthritis and arthritis-dermatitis syndrome: 1 g IV or IM every 24 hours
• Gonococcal endocarditis and meningitis: 1 to 2 g IV every 12 to 24 hours

Duration of therapy:

• Arthritis-dermatitis syndrome: At least 7 days (total)
• Gonococcal endocarditis: At least 4 weeks
• Gonococcal meningitis: 10 to 14 days

Comments:

• A recommended regimen for DGI and gonococcal scalp abscesses in neonates
• This drug should be used with caution in hyperbilirubinemic neonates, especially if premature.
• The recommended regimen for DGI in children; no data regarding use of dual therapy. Children should be tested for syphilis, chlamydial infections, and HIV.
• With azithromycin, the recommended regimen for DGI in adolescents; the patient's sexual partner(s) should also be evaluated/treated.
• Hospitalization and consultation with an infectious disease specialist recommended for initial therapy, particularly for adolescents who may be noncompliant with therapy, have an uncertain diagnosis, or have purulent synovial effusions/other complications; patients should be examined for clinical signs of endocarditis and meningitis.
• Arthritis-dermatitis syndrome in adolescents: Can switch to oral therapy (guided by antimicrobial susceptibility testing) 24 to 48 hours after significant clinical improvement
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Meningococcal Meningitis Prophylaxis

AAP and US CDC Recommendations:
Less than 15 years: 125 mg IM as a single dose
15 years or older: 250 mg IM as a single dose

Comments:

• For most children, recommended as an alternative chemoprophylaxis regimen for high-risk contacts of individuals with invasive meningococcal disease
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Endocarditis

AHA Recommendations:
1 year or older: 100 mg/kg/day IV in divided doses every 12 hours OR 80 mg/kg IV every 24 hours
Maximum dose: 4 g/day
Duration of therapy: At least 4 to 6 weeks

US CDC Recommendations for Adolescents:

• Gonococcal endocarditis: 1 to 2 g IV every 12 to 24 hours for at least 4 weeks

Comments:

• Daily dosage should be administered in divided doses twice a day if over 2 g/day.
• Recommended regimen (and an alternative regimen) for infective endocarditis due to highly penicillin G-susceptible streptococci (minimum bactericidal concentration [MBC] up to 0.1 mcg/mL)
• With ampicillin (for aminoglycoside-resistant enterococci or aminoglycoside-intolerant patient) or gentamicin (not for enterococcal endocarditis), recommended as an alternative regimen for infective endocarditis due to relatively penicillin-resistant streptococci (MBC at least 0.2 mcg/mL)
• With gentamicin, recommended regimen for infective endocarditis due to gram-negative enteric bacilli
• Recommended regimen for infective endocarditis due to HACEK group
• HACEK organisms include Haemophilus species, Aggregatibacter species, C hominis, E corrodens, and Kingella species.
• With azithromycin, recommended regimen for the treatment of gonococcal endocarditis in adolescents
• The patient's sexual partner(s) should also be evaluated/treated.
• Pediatric dose should not exceed adult dose.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Bacterial Endocarditis Prophylaxis

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

Comments:

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

Usual Pediatric Dose for Lyme Disease

IDSA, AAN, and ACR Recommendations for Children: 50 to 75 mg/kg IV once a day
Maximum dose: 2 g/dose

Duration of Therapy:

• Carditis: 14 to 21 days
• Meningitis or radiculopathy: 14 to 21 days
• Recurrent/refractory arthritis: 14 days; can extend repeat IV therapy up to 28 days if inflammation not resolving

Comments:

• Recommended as the initial IV treatment of Lyme carditis in patients requiring hospitalization; therapy can be completed orally after evidence of clinical improvement.
• Recommended as the preferred IV agent for patients with Lyme disease-associated meningitis, cranial neuropathy, radiculoneuropathy, or other PNS manifestations
• Recommended as IV therapy in patients with Lyme arthritis who had no/minimal response (moderate to severe joint swelling with minimal reduction of joint effusion) to an initial oral regimen
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Salmonella Enteric Fever

US CDC, NIH, and HIVMA/IDSA Recommendations for HIV-infected Adolescents: 1 g IV every 24 hours

Duration of Salmonellosis Therapy:
For gastroenteritis without bacteremia:

• If CD4 count at least 200 cells/mm3: 7 to 14 days
• If CD4 count less than 200 cells/mm3: 2 to 6 weeks

For gastroenteritis with bacteremia:

• If CD4 count at least 200 cells/mm3: 14 days; longer if persistent bacteremia or complicated infection (e.g., metastatic foci of infection present)
• If CD4 count less than 200 cells/mm3: 2 to 6 weeks

Comments:

• Recommended as alternative empiric therapy for bacterial enteric infections (pending diagnostic studies) and as alternative therapy for salmonella gastroenteritis with or without bacteremia
• Empiric therapy for bacterial enteric infections recommended for patients with advanced HIV (CD4 count less than 200 cells/mm3 or concomitant AIDS-defining illnesses) and clinically severe diarrhea (at least 6 stools/day or bloody stool) and/or associated fever/chills. Fecal samples should be obtained for diagnostic testing before starting therapy; therapy should be adjusted based on those results.
• All HIV-infected patients with salmonellosis should receive antibacterial therapy due to increased risk of bacteremia (by 20- to 100-fold) and mortality (by up to 7-fold) compared to HIV-negative subjects.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Salmonella Gastroenteritis

US CDC, NIH, and HIVMA/IDSA Recommendations for HIV-infected Adolescents: 1 g IV every 24 hours

Duration of Salmonellosis Therapy:
For gastroenteritis without bacteremia:

• If CD4 count at least 200 cells/mm3: 7 to 14 days
• If CD4 count less than 200 cells/mm3: 2 to 6 weeks

For gastroenteritis with bacteremia:

• If CD4 count at least 200 cells/mm3: 14 days; longer if persistent bacteremia or complicated infection (e.g., metastatic foci of infection present)
• If CD4 count less than 200 cells/mm3: 2 to 6 weeks

Comments:

• Recommended as alternative empiric therapy for bacterial enteric infections (pending diagnostic studies) and as alternative therapy for salmonella gastroenteritis with or without bacteremia
• Empiric therapy for bacterial enteric infections recommended for patients with advanced HIV (CD4 count less than 200 cells/mm3 or concomitant AIDS-defining illnesses) and clinically severe diarrhea (at least 6 stools/day or bloody stool) and/or associated fever/chills. Fecal samples should be obtained for diagnostic testing before starting therapy; therapy should be adjusted based on those results.
• All HIV-infected patients with salmonellosis should receive antibacterial therapy due to increased risk of bacteremia (by 20- to 100-fold) and mortality (by up to 7-fold) compared to HIV-negative subjects.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for STD Prophylaxis

US CDC Recommendations:
Adolescents: 250 mg IM as a single dose

Comments:

• With azithromycin and (metronidazole or tinidazole), the recommended regimen for presumptive therapy after sexual assault
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Conjunctivitis

US CDC Recommendations:
Adolescents: 1 g IM as a single dose

Comments:

• With azithromycin, the recommended regimen for gonococcal conjunctivitis
• Consultation with an infectious disease specialist and a one-time lavage of the infected eye with saline solution should be considered.
• The patient's sexual partner(s) should also be evaluated/treated.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Ocular Infection

US CDC Recommendations:
Neonates: 25 to 50 mg/kg IV or IM as a single dose
Maximum dose: 125 mg/dose

Comments:

• The recommended regimen for gonococcal ophthalmia neonatorum
• An infectious disease specialist should be consulted.
• This drug should be used with caution in hyperbilirubinemic neonates, especially if premature.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Chancroid

AAP Recommendations:
1 month or older: 50 mg/kg IM as a single dose
Maximum dose: 250 mg/dose

Comments:

• Recommended for chancroid due to H ducreyi
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Surgical Prophylaxis

ASHP, IDSA, SIS, and SHEA Recommendations:
1 year or older:
Preoperative dose: 50 to 75 mg/kg IV as a single dose, starting within 60 minutes before surgical incision
Maximum dose: 2 g/dose

Comments:

• A single prophylactic dose is usually sufficient; if prophylaxis is continued postoperatively, duration should be less than 24 hours.
• Readministration may be needed for unusually long procedures to ensure adequate serum and tissue drug levels.
• Redosing may be needed if drug half-life is shortened (e.g., extensive burns) or if prolonged/excessive bleeding during surgery; redosing may not be needed if drug half-life is prolonged (e.g., renal dysfunction).
• Pediatric dose should not exceed adult dose.
• Current guidelines should be consulted for additional information.

Uses: For surgical prophylaxis for the following procedures:

• Biliary tract (recommended regimen): Open procedure and elective, high-risk laparoscopic procedure; should limit to patients requiring antimicrobial therapy for acute cholecystitis or acute biliary tract infections (which may not be established before incision), not patients undergoing cholecystectomy for noninfected biliary conditions (including biliary colic or dyskinesia without infection)
• Colorectal (with metronidazole, as a recommended regimen)

Renal Dose Adjustments

Renal dysfunction alone: No adjustment recommended.

Significant renal dysfunction plus liver dysfunction: Caution recommended; dose should not exceed 2 g/day.

Comments:

• No adjustment normally needed when standard doses are used in patients with renal failure.
• Close clinical monitoring for safety and efficacy recommended for patients with both severe renal and liver dysfunction.

Liver Dose Adjustments

Liver dysfunction alone: No adjustment recommended.

Liver dysfunction plus significant renal dysfunction: Caution recommended; dose should not exceed 2 g/day.

Dose Adjustments

Elderly patients: No adjustment needed for doses up to 2 g/day, as long as there is no severe renal and liver dysfunction.

Precautions

CONTRAINDICATIONS:

• Known hypersensitivity to the active component, any of the ingredients, or any other cephalosporin
• According to some manufacturers: History of anaphylaxis to the active component, cephalosporin antibacterials, penicillins, or other beta-lactam antibacterials
• Neonates (up to 28 days of age) requiring (or expected to require) treatment with IV solutions containing calcium (including continuous calcium-containing infusions [e.g., parenteral nutrition]) due to risk of ceftriaxone-calcium precipitate
• Premature neonates up to postmenstrual age of 41 weeks (gestational age plus chronological age)
• Hyperbilirubinemic neonates
• IV administration of ceftriaxone solutions containing lidocaine
• Contraindications to lidocaine (when used as a solvent with this drug for IM injection)

Consult WARNINGS section for additional precautions.

Dialysis

Renal failure: No adjustment normally needed when standard doses are used.

Comments:

• This drug is not removed by hemodialysis or peritoneal dialysis; no supplemental dosing needed after dialysis.
• Plasma drug levels should be monitored to determine if dose adjustments are needed.

Some experts recommend:

• Hemodialysis: Doses should be administered after dialysis sessions.
• Continuous venovenous hemofiltration: 1 to 2 g IV every 24 hours

Other Comments

Administration advice:

• May administer IV or IM
• IM: Inject well within body of relatively large muscle; aspiration helps avoid accidental injection into a blood vessel.
• IV: Administer by IV infusion over 30 minutes (except in neonates); in neonates, administer over 60 minutes to reduce risk of bilirubin encephalopathy.
• Do not administer simultaneously with IV solutions containing calcium, including continuous calcium-containing infusions (e.g., parenteral nutrition) via a Y-site.
• In patients other than neonates, may administer this drug and calcium-containing IV solutions sequentially if infusion lines are thoroughly flushed with a compatible fluid between infusions
• Duplex container: Do not use plastic containers in series connections.
• In general, continue this drug for at least 2 days after signs/symptoms of infection have disappeared; usual duration of therapy is 4 to 14 days; in complicated infections, longer therapy may be required; when treating infections due to S pyogenes, continue therapy for at least 10 days.
• If vancomycin, amsacrine, aminoglycosides, or fluconazole need to be used concomitantly with this drug by intermittent IV infusion, administer sequentially and use a compatible fluid to thoroughly flush IV line between administrations

Storage requirements:

• Duplex container: Store unactivated unit folded (until activation intended) at 20C to 25C (68F to 77F), excursion permitted to 15C to 30C (59F to 86F); do not freeze; after reconstitution (activation), use within 24 hours if stored at room temperature or within 7 days if stored under refrigeration.
• Powder (prior to reconstitution): Store at room temperature (25C [77F]) or below; protect from light.
• Solutions (after reconstitution): The manufacturer product information should be consulted; do not refreeze frozen solutions.

Reconstitution/preparation techniques:

• The manufacturer product information should be consulted.
• IM: The maximum concentration for IM injection is 350 mg/mL; may dilute with 1% lidocaine
• IV: Diluents containing calcium (e.g., Ringer's solution, Hartmann's solution) should not be used to reconstitute vials of this drug or further dilute a reconstituted vial for IV use (precipitate can form).

IV compatibility:

• Duplex container: Compatible fluids for flushing IV lines: 0.9% sodium chloride injection, 5% dextrose in water
• Duplex container: Do not introduce additives into the container.
• Vials: Compatible diluents (at room temperature, at concentrations between 10 and 40 mg/mL): Sterile water (glass or polyvinyl chloride [PVC] container), 0.9% sodium chloride solution (glass or PVC container), 5% dextrose solution (glass or PVC container), 10% dextrose solution (glass or PVC container), 5% dextrose and 0.9% sodium chloride solution (PVC container), 5% dextrose and 0.45% sodium chloride solution (glass or PVC container), sodium lactate (PVC container), 10% invert sugar (glass container), 5% sodium bicarbonate (glass container), FreAmine III (glass container), Normosol-M in 5% dextrose (glass or PVC container), Ionosol-B in 5% dextrose (glass container), 5% mannitol (glass container), 10% mannitol (glass container)
• Vials: Compatibility with metronidazole shown; concentration should not exceed 5 to 7.5 mg/mL metronidazole with ceftriaxone 10 mg/mL as an admixture. Metronidazole at concentrations greater than 8 mg/mL will precipitate.
• Vancomycin, amsacrine, aminoglycosides, and fluconazole are physically incompatible.
• Should not physically mix with or piggyback into solution containing other antimicrobial drugs or into diluent solutions other than those listed (due to possible incompatibility)
• Precipitation of ceftriaxone-calcium can occur when this drug is mixed with calcium-containing solutions in the same IV line.
• The manufacturer product information should be consulted.

General:

• To reduce the development of drug-resistant organisms and maintain effective therapy, antibiotics should be used only to treat or prevent infections proven or strongly suspected to be caused by susceptible bacteria.
• Culture and susceptibility information should be considered when selecting/modifying antibacterial therapy or, if no data are available, local epidemiology and susceptibility patterns may be considered when selecting empiric therapy.
• Appropriate culture and susceptibility testing recommended before therapy to isolate and identify infecting organisms and to establish susceptibility to this drug. Therapy may be started before test results are known; appropriate therapy should be continued when results are available.
• If C trachomatis is a suspected pathogen, appropriate antichlamydial coverage should be added as this drug has no activity against the organism.
• The IV route is preferred for severe or life-threatening infections and for patients with reduced resistance (e.g., malnutrition, trauma, surgery, heart failure, malignancy, shock).

Monitoring:

• Hematologic: Prothrombin time in patients with impaired vitamin K synthesis or low vitamin K stores
• Renal: Renal function in elderly patients

Patient advice:

• Avoid missing doses and complete the entire course of therapy.

Frequently asked questions

• Pregnancy - is it safe to take ceftriaxone during pregnancy?