Erythromycin Dosage

Drug Detail:Erythromycin (Erythromycin (oral/injection) [ er-ith-roe-mye-sin ])

Drug Class: Macrolides

Usual Adult Dose for Amebiasis

ORAL:
Erythromycin Base (Base) or Erythromycin Stearate (Stearate):
Mild to moderate infections: 250 mg orally every 6 hours, 333 mg orally every 8 hours, OR 500 mg orally every 12 hours
Severe infections: 1 gram orally every 6 hours

Maximum dose: 4 grams/day

Erythromycin Ethylsuccinate (Ethylsuccinate): 400 mg orally every 6 hours

Maximum dose: Up to 4 grams/day

PARENTERAL:
Erythromycin Lactobionate (Lactobionate): 15 to 20 mg/kg IV per day via intermittent IV infusion over 20 to 60 minutes no more than every 6 hours or via slow continuous IV infusion

Maximum dose: 4 grams/day

Duration of therapy:

Intestinal amebiasis: 10 to 14 days
Streptococcal infections: At least 10 days

Comments:

This drug should be taken approximately 1 hour prior to meals.
Higher doses may be increased (up to 4 grams/day), depending on the severity of the infection.
Ethylsuccinate formulations doses may be given every 12 hours in 2 divided doses OR every 8 hours in 3 divided doses if desired.
Many strains of Haemophilus influenzae are not susceptible to concentrations of this drug typically achieved by dosing; concomitant dosing with sulfonamides should be used in patients with upper respiratory tract infections caused by H influenzae.
Resistant staphylococcal skin infections may reemerge with treatment.
Patients with extrahepatic amebiasis should be given treatment with other antibiotics.
Parenteral formulations should be replaced by oral formulations as soon as possible.

Uses:

As an adjunct to antitoxin to prevent the establishment of carriers and to eradicate the organism in carriers of diphtheria caused by Corynebacterium diphtheriae
Treatment of erythrasma due to Corynebacterium minutissimum
Treatment of listeriosis caused by Listeria monocytogenes
Treatment of mild to moderate lower respiratory tract infections caused by Streptococcus pneumoniae (Diplococcus pneumoniae) or Streptococcus pyogenes (Group A beta-hemolytic streptococci [GAS])
Treatment of mild to moderate skin and structure infections caused by Staphylococcus aureus or S pyogenes
Treatment of mild to moderate upper respiratory tract infections caused by H influenzae (when used concomitantly with adequate doses of sulfonamides), S pneumoniae (D pneumoniae), or S pyogenes (GAS)
Treatment of respiratory tract infections due to Mycoplasma pneumoniae
Oral formulations: Treatment of intestinal amebiasis caused by Entamoeba histolytica

Usual Adult Dose for Campylobacter Gastroenteritis

Maximum dose: 4 grams/day

Erythromycin Ethylsuccinate (Ethylsuccinate): 400 mg orally every 6 hours

Maximum dose: Up to 4 grams/day

PARENTERAL:
Erythromycin Lactobionate (Lactobionate): 15 to 20 mg/kg IV per day via intermittent IV infusion over 20 to 60 minutes no more than every 6 hours or via slow continuous IV infusion

Maximum dose: 4 grams/day

Duration of therapy:

Intestinal amebiasis: 10 to 14 days
Streptococcal infections: At least 10 days

Comments:

This drug should be taken approximately 1 hour prior to meals.
Higher doses may be increased (up to 4 grams/day), depending on the severity of the infection.
Ethylsuccinate formulations doses may be given every 12 hours in 2 divided doses OR every 8 hours in 3 divided doses if desired.
Many strains of Haemophilus influenzae are not susceptible to concentrations of this drug typically achieved by dosing; concomitant dosing with sulfonamides should be used in patients with upper respiratory tract infections caused by H influenzae.
Resistant staphylococcal skin infections may reemerge with treatment.
Patients with extrahepatic amebiasis should be given treatment with other antibiotics.
Parenteral formulations should be replaced by oral formulations as soon as possible.

Uses:

As an adjunct to antitoxin to prevent the establishment of carriers and to eradicate the organism in carriers of diphtheria caused by Corynebacterium diphtheriae
Treatment of erythrasma due to Corynebacterium minutissimum
Treatment of listeriosis caused by Listeria monocytogenes
Treatment of mild to moderate lower respiratory tract infections caused by Streptococcus pneumoniae (Diplococcus pneumoniae) or Streptococcus pyogenes (Group A beta-hemolytic streptococci [GAS])
Treatment of mild to moderate skin and structure infections caused by Staphylococcus aureus or S pyogenes
Treatment of mild to moderate upper respiratory tract infections caused by H influenzae (when used concomitantly with adequate doses of sulfonamides), S pneumoniae (D pneumoniae), or S pyogenes (GAS)
Treatment of respiratory tract infections due to Mycoplasma pneumoniae
Oral formulations: Treatment of intestinal amebiasis caused by Entamoeba histolytica

Usual Adult Dose for Mycoplasma Pneumonia

Maximum dose: 4 grams/day

Erythromycin Ethylsuccinate (Ethylsuccinate): 400 mg orally every 6 hours

Maximum dose: Up to 4 grams/day

PARENTERAL:
Erythromycin Lactobionate (Lactobionate): 15 to 20 mg/kg IV per day via intermittent IV infusion over 20 to 60 minutes no more than every 6 hours or via slow continuous IV infusion

Maximum dose: 4 grams/day

Duration of therapy:

Intestinal amebiasis: 10 to 14 days
Streptococcal infections: At least 10 days

Comments:

This drug should be taken approximately 1 hour prior to meals.
Higher doses may be increased (up to 4 grams/day), depending on the severity of the infection.
Ethylsuccinate formulations doses may be given every 12 hours in 2 divided doses OR every 8 hours in 3 divided doses if desired.
Many strains of Haemophilus influenzae are not susceptible to concentrations of this drug typically achieved by dosing; concomitant dosing with sulfonamides should be used in patients with upper respiratory tract infections caused by H influenzae.
Resistant staphylococcal skin infections may reemerge with treatment.
Patients with extrahepatic amebiasis should be given treatment with other antibiotics.
Parenteral formulations should be replaced by oral formulations as soon as possible.

Uses:

As an adjunct to antitoxin to prevent the establishment of carriers and to eradicate the organism in carriers of diphtheria caused by Corynebacterium diphtheriae
Treatment of erythrasma due to Corynebacterium minutissimum
Treatment of listeriosis caused by Listeria monocytogenes
Treatment of mild to moderate lower respiratory tract infections caused by Streptococcus pneumoniae (Diplococcus pneumoniae) or Streptococcus pyogenes (Group A beta-hemolytic streptococci [GAS])
Treatment of mild to moderate skin and structure infections caused by Staphylococcus aureus or S pyogenes
Treatment of mild to moderate upper respiratory tract infections caused by H influenzae (when used concomitantly with adequate doses of sulfonamides), S pneumoniae (D pneumoniae), or S pyogenes (GAS)
Treatment of respiratory tract infections due to Mycoplasma pneumoniae
Oral formulations: Treatment of intestinal amebiasis caused by Entamoeba histolytica

Usual Adult Dose for Otitis Media

Maximum dose: 4 grams/day

Erythromycin Ethylsuccinate (Ethylsuccinate): 400 mg orally every 6 hours

Maximum dose: Up to 4 grams/day

PARENTERAL:
Erythromycin Lactobionate (Lactobionate): 15 to 20 mg/kg IV per day via intermittent IV infusion over 20 to 60 minutes no more than every 6 hours or via slow continuous IV infusion

Maximum dose: 4 grams/day

Duration of therapy:

Intestinal amebiasis: 10 to 14 days
Streptococcal infections: At least 10 days

Comments:

This drug should be taken approximately 1 hour prior to meals.
Higher doses may be increased (up to 4 grams/day), depending on the severity of the infection.
Ethylsuccinate formulations doses may be given every 12 hours in 2 divided doses OR every 8 hours in 3 divided doses if desired.
Many strains of Haemophilus influenzae are not susceptible to concentrations of this drug typically achieved by dosing; concomitant dosing with sulfonamides should be used in patients with upper respiratory tract infections caused by H influenzae.
Resistant staphylococcal skin infections may reemerge with treatment.
Patients with extrahepatic amebiasis should be given treatment with other antibiotics.
Parenteral formulations should be replaced by oral formulations as soon as possible.

Uses:

As an adjunct to antitoxin to prevent the establishment of carriers and to eradicate the organism in carriers of diphtheria caused by Corynebacterium diphtheriae
Treatment of erythrasma due to Corynebacterium minutissimum
Treatment of listeriosis caused by Listeria monocytogenes
Treatment of mild to moderate lower respiratory tract infections caused by Streptococcus pneumoniae (Diplococcus pneumoniae) or Streptococcus pyogenes (Group A beta-hemolytic streptococci [GAS])
Treatment of mild to moderate skin and structure infections caused by Staphylococcus aureus or S pyogenes
Treatment of mild to moderate upper respiratory tract infections caused by H influenzae (when used concomitantly with adequate doses of sulfonamides), S pneumoniae (D pneumoniae), or S pyogenes (GAS)
Treatment of respiratory tract infections due to Mycoplasma pneumoniae
Oral formulations: Treatment of intestinal amebiasis caused by Entamoeba histolytica

Usual Adult Dose for Pharyngitis

Maximum dose: 4 grams/day

Erythromycin Ethylsuccinate (Ethylsuccinate): 400 mg orally every 6 hours

Maximum dose: Up to 4 grams/day

PARENTERAL:
Erythromycin Lactobionate (Lactobionate): 15 to 20 mg/kg IV per day via intermittent IV infusion over 20 to 60 minutes no more than every 6 hours or via slow continuous IV infusion

Maximum dose: 4 grams/day

Duration of therapy:

Intestinal amebiasis: 10 to 14 days
Streptococcal infections: At least 10 days

Comments:

This drug should be taken approximately 1 hour prior to meals.
Higher doses may be increased (up to 4 grams/day), depending on the severity of the infection.
Ethylsuccinate formulations doses may be given every 12 hours in 2 divided doses OR every 8 hours in 3 divided doses if desired.
Many strains of Haemophilus influenzae are not susceptible to concentrations of this drug typically achieved by dosing; concomitant dosing with sulfonamides should be used in patients with upper respiratory tract infections caused by H influenzae.
Resistant staphylococcal skin infections may reemerge with treatment.
Patients with extrahepatic amebiasis should be given treatment with other antibiotics.
Parenteral formulations should be replaced by oral formulations as soon as possible.

Uses:

As an adjunct to antitoxin to prevent the establishment of carriers and to eradicate the organism in carriers of diphtheria caused by Corynebacterium diphtheriae
Treatment of erythrasma due to Corynebacterium minutissimum
Treatment of listeriosis caused by Listeria monocytogenes
Treatment of mild to moderate lower respiratory tract infections caused by Streptococcus pneumoniae (Diplococcus pneumoniae) or Streptococcus pyogenes (Group A beta-hemolytic streptococci [GAS])
Treatment of mild to moderate skin and structure infections caused by Staphylococcus aureus or S pyogenes
Treatment of mild to moderate upper respiratory tract infections caused by H influenzae (when used concomitantly with adequate doses of sulfonamides), S pneumoniae (D pneumoniae), or S pyogenes (GAS)
Treatment of respiratory tract infections due to Mycoplasma pneumoniae
Oral formulations: Treatment of intestinal amebiasis caused by Entamoeba histolytica

Usual Adult Dose for Pneumonia

Maximum dose: 4 grams/day

Erythromycin Ethylsuccinate (Ethylsuccinate): 400 mg orally every 6 hours

Maximum dose: Up to 4 grams/day

PARENTERAL:
Erythromycin Lactobionate (Lactobionate): 15 to 20 mg/kg IV per day via intermittent IV infusion over 20 to 60 minutes no more than every 6 hours or via slow continuous IV infusion

Maximum dose: 4 grams/day

Duration of therapy:

Intestinal amebiasis: 10 to 14 days
Streptococcal infections: At least 10 days

Comments:

This drug should be taken approximately 1 hour prior to meals.
Higher doses may be increased (up to 4 grams/day), depending on the severity of the infection.
Ethylsuccinate formulations doses may be given every 12 hours in 2 divided doses OR every 8 hours in 3 divided doses if desired.
Many strains of Haemophilus influenzae are not susceptible to concentrations of this drug typically achieved by dosing; concomitant dosing with sulfonamides should be used in patients with upper respiratory tract infections caused by H influenzae.
Resistant staphylococcal skin infections may reemerge with treatment.
Patients with extrahepatic amebiasis should be given treatment with other antibiotics.
Parenteral formulations should be replaced by oral formulations as soon as possible.

Uses:

As an adjunct to antitoxin to prevent the establishment of carriers and to eradicate the organism in carriers of diphtheria caused by Corynebacterium diphtheriae
Treatment of erythrasma due to Corynebacterium minutissimum
Treatment of listeriosis caused by Listeria monocytogenes
Treatment of mild to moderate lower respiratory tract infections caused by Streptococcus pneumoniae (Diplococcus pneumoniae) or Streptococcus pyogenes (Group A beta-hemolytic streptococci [GAS])
Treatment of mild to moderate skin and structure infections caused by Staphylococcus aureus or S pyogenes
Treatment of mild to moderate upper respiratory tract infections caused by H influenzae (when used concomitantly with adequate doses of sulfonamides), S pneumoniae (D pneumoniae), or S pyogenes (GAS)
Treatment of respiratory tract infections due to Mycoplasma pneumoniae
Oral formulations: Treatment of intestinal amebiasis caused by Entamoeba histolytica

Usual Adult Dose for Skin or Soft Tissue Infection

Maximum dose: 4 grams/day

Erythromycin Ethylsuccinate (Ethylsuccinate): 400 mg orally every 6 hours

Maximum dose: Up to 4 grams/day

PARENTERAL:
Erythromycin Lactobionate (Lactobionate): 15 to 20 mg/kg IV per day via intermittent IV infusion over 20 to 60 minutes no more than every 6 hours or via slow continuous IV infusion

Maximum dose: 4 grams/day

Duration of therapy:

Intestinal amebiasis: 10 to 14 days
Streptococcal infections: At least 10 days

Comments:

This drug should be taken approximately 1 hour prior to meals.
Higher doses may be increased (up to 4 grams/day), depending on the severity of the infection.
Ethylsuccinate formulations doses may be given every 12 hours in 2 divided doses OR every 8 hours in 3 divided doses if desired.
Many strains of Haemophilus influenzae are not susceptible to concentrations of this drug typically achieved by dosing; concomitant dosing with sulfonamides should be used in patients with upper respiratory tract infections caused by H influenzae.
Resistant staphylococcal skin infections may reemerge with treatment.
Patients with extrahepatic amebiasis should be given treatment with other antibiotics.
Parenteral formulations should be replaced by oral formulations as soon as possible.

Uses:

As an adjunct to antitoxin to prevent the establishment of carriers and to eradicate the organism in carriers of diphtheria caused by Corynebacterium diphtheriae
Treatment of erythrasma due to Corynebacterium minutissimum
Treatment of listeriosis caused by Listeria monocytogenes
Treatment of mild to moderate lower respiratory tract infections caused by Streptococcus pneumoniae (Diplococcus pneumoniae) or Streptococcus pyogenes (Group A beta-hemolytic streptococci [GAS])
Treatment of mild to moderate skin and structure infections caused by Staphylococcus aureus or S pyogenes
Treatment of mild to moderate upper respiratory tract infections caused by H influenzae (when used concomitantly with adequate doses of sulfonamides), S pneumoniae (D pneumoniae), or S pyogenes (GAS)
Treatment of respiratory tract infections due to Mycoplasma pneumoniae
Oral formulations: Treatment of intestinal amebiasis caused by Entamoeba histolytica

Usual Adult Dose for Upper Respiratory Tract Infection

Maximum dose: 4 grams/day

Erythromycin Ethylsuccinate (Ethylsuccinate): 400 mg orally every 6 hours

Maximum dose: Up to 4 grams/day

PARENTERAL:
Erythromycin Lactobionate (Lactobionate): 15 to 20 mg/kg IV per day via intermittent IV infusion over 20 to 60 minutes no more than every 6 hours or via slow continuous IV infusion

Maximum dose: 4 grams/day

Duration of therapy:

Intestinal amebiasis: 10 to 14 days
Streptococcal infections: At least 10 days

Comments:

This drug should be taken approximately 1 hour prior to meals.
Higher doses may be increased (up to 4 grams/day), depending on the severity of the infection.
Ethylsuccinate formulations doses may be given every 12 hours in 2 divided doses OR every 8 hours in 3 divided doses if desired.
Many strains of Haemophilus influenzae are not susceptible to concentrations of this drug typically achieved by dosing; concomitant dosing with sulfonamides should be used in patients with upper respiratory tract infections caused by H influenzae.
Resistant staphylococcal skin infections may reemerge with treatment.
Patients with extrahepatic amebiasis should be given treatment with other antibiotics.
Parenteral formulations should be replaced by oral formulations as soon as possible.

Uses:

As an adjunct to antitoxin to prevent the establishment of carriers and to eradicate the organism in carriers of diphtheria caused by Corynebacterium diphtheriae
Treatment of erythrasma due to Corynebacterium minutissimum
Treatment of listeriosis caused by Listeria monocytogenes
Treatment of mild to moderate lower respiratory tract infections caused by Streptococcus pneumoniae (Diplococcus pneumoniae) or Streptococcus pyogenes (Group A beta-hemolytic streptococci [GAS])
Treatment of mild to moderate skin and structure infections caused by Staphylococcus aureus or S pyogenes
Treatment of mild to moderate upper respiratory tract infections caused by H influenzae (when used concomitantly with adequate doses of sulfonamides), S pneumoniae (D pneumoniae), or S pyogenes (GAS)
Treatment of respiratory tract infections due to Mycoplasma pneumoniae
Oral formulations: Treatment of intestinal amebiasis caused by Entamoeba histolytica

Usual Adult Dose for Bronchitis

Maximum dose: 4 grams/day

Erythromycin Ethylsuccinate (Ethylsuccinate): 400 mg orally every 6 hours

Maximum dose: Up to 4 grams/day

PARENTERAL:
Erythromycin Lactobionate (Lactobionate): 15 to 20 mg/kg IV per day via intermittent IV infusion over 20 to 60 minutes no more than every 6 hours or via slow continuous IV infusion

Maximum dose: 4 grams/day

Duration of therapy:

Intestinal amebiasis: 10 to 14 days
Streptococcal infections: At least 10 days

Comments:

This drug should be taken approximately 1 hour prior to meals.
Higher doses may be increased (up to 4 grams/day), depending on the severity of the infection.
Ethylsuccinate formulations doses may be given every 12 hours in 2 divided doses OR every 8 hours in 3 divided doses if desired.
Many strains of Haemophilus influenzae are not susceptible to concentrations of this drug typically achieved by dosing; concomitant dosing with sulfonamides should be used in patients with upper respiratory tract infections caused by H influenzae.
Resistant staphylococcal skin infections may reemerge with treatment.
Patients with extrahepatic amebiasis should be given treatment with other antibiotics.
Parenteral formulations should be replaced by oral formulations as soon as possible.

Uses:

As an adjunct to antitoxin to prevent the establishment of carriers and to eradicate the organism in carriers of diphtheria caused by Corynebacterium diphtheriae
Treatment of erythrasma due to Corynebacterium minutissimum
Treatment of listeriosis caused by Listeria monocytogenes
Treatment of mild to moderate lower respiratory tract infections caused by Streptococcus pneumoniae (Diplococcus pneumoniae) or Streptococcus pyogenes (Group A beta-hemolytic streptococci [GAS])
Treatment of mild to moderate skin and structure infections caused by Staphylococcus aureus or S pyogenes
Treatment of mild to moderate upper respiratory tract infections caused by H influenzae (when used concomitantly with adequate doses of sulfonamides), S pneumoniae (D pneumoniae), or S pyogenes (GAS)
Treatment of respiratory tract infections due to Mycoplasma pneumoniae
Oral formulations: Treatment of intestinal amebiasis caused by Entamoeba histolytica

Usual Adult Dose for Diphtheria

Maximum dose: 4 grams/day

Erythromycin Ethylsuccinate (Ethylsuccinate): 400 mg orally every 6 hours

Maximum dose: Up to 4 grams/day

PARENTERAL:
Erythromycin Lactobionate (Lactobionate): 15 to 20 mg/kg IV per day via intermittent IV infusion over 20 to 60 minutes no more than every 6 hours or via slow continuous IV infusion

Maximum dose: 4 grams/day

Duration of therapy:

Intestinal amebiasis: 10 to 14 days
Streptococcal infections: At least 10 days

Comments:

This drug should be taken approximately 1 hour prior to meals.
Higher doses may be increased (up to 4 grams/day), depending on the severity of the infection.
Ethylsuccinate formulations doses may be given every 12 hours in 2 divided doses OR every 8 hours in 3 divided doses if desired.
Many strains of Haemophilus influenzae are not susceptible to concentrations of this drug typically achieved by dosing; concomitant dosing with sulfonamides should be used in patients with upper respiratory tract infections caused by H influenzae.
Resistant staphylococcal skin infections may reemerge with treatment.
Patients with extrahepatic amebiasis should be given treatment with other antibiotics.
Parenteral formulations should be replaced by oral formulations as soon as possible.

Uses:

As an adjunct to antitoxin to prevent the establishment of carriers and to eradicate the organism in carriers of diphtheria caused by Corynebacterium diphtheriae
Treatment of erythrasma due to Corynebacterium minutissimum
Treatment of listeriosis caused by Listeria monocytogenes
Treatment of mild to moderate lower respiratory tract infections caused by Streptococcus pneumoniae (Diplococcus pneumoniae) or Streptococcus pyogenes (Group A beta-hemolytic streptococci [GAS])
Treatment of mild to moderate skin and structure infections caused by Staphylococcus aureus or S pyogenes
Treatment of mild to moderate upper respiratory tract infections caused by H influenzae (when used concomitantly with adequate doses of sulfonamides), S pneumoniae (D pneumoniae), or S pyogenes (GAS)
Treatment of respiratory tract infections due to Mycoplasma pneumoniae
Oral formulations: Treatment of intestinal amebiasis caused by Entamoeba histolytica

Usual Adult Dose for Gastroenteritis

Maximum dose: 4 grams/day

Erythromycin Ethylsuccinate (Ethylsuccinate): 400 mg orally every 6 hours

Maximum dose: Up to 4 grams/day

PARENTERAL:
Erythromycin Lactobionate (Lactobionate): 15 to 20 mg/kg IV per day via intermittent IV infusion over 20 to 60 minutes no more than every 6 hours or via slow continuous IV infusion

Maximum dose: 4 grams/day

Duration of therapy:

Intestinal amebiasis: 10 to 14 days
Streptococcal infections: At least 10 days

Comments:

This drug should be taken approximately 1 hour prior to meals.
Higher doses may be increased (up to 4 grams/day), depending on the severity of the infection.
Ethylsuccinate formulations doses may be given every 12 hours in 2 divided doses OR every 8 hours in 3 divided doses if desired.
Many strains of Haemophilus influenzae are not susceptible to concentrations of this drug typically achieved by dosing; concomitant dosing with sulfonamides should be used in patients with upper respiratory tract infections caused by H influenzae.
Resistant staphylococcal skin infections may reemerge with treatment.
Patients with extrahepatic amebiasis should be given treatment with other antibiotics.
Parenteral formulations should be replaced by oral formulations as soon as possible.

Uses:

As an adjunct to antitoxin to prevent the establishment of carriers and to eradicate the organism in carriers of diphtheria caused by Corynebacterium diphtheriae
Treatment of erythrasma due to Corynebacterium minutissimum
Treatment of listeriosis caused by Listeria monocytogenes
Treatment of mild to moderate lower respiratory tract infections caused by Streptococcus pneumoniae (Diplococcus pneumoniae) or Streptococcus pyogenes (Group A beta-hemolytic streptococci [GAS])
Treatment of mild to moderate skin and structure infections caused by Staphylococcus aureus or S pyogenes
Treatment of mild to moderate upper respiratory tract infections caused by H influenzae (when used concomitantly with adequate doses of sulfonamides), S pneumoniae (D pneumoniae), or S pyogenes (GAS)
Treatment of respiratory tract infections due to Mycoplasma pneumoniae
Oral formulations: Treatment of intestinal amebiasis caused by Entamoeba histolytica

Usual Adult Dose for Legionella Pneumonia

ORAL:
Base or Stearate: 1 to 4 grams orally per day, given in divided doses
Ethylsuccinate: 1.6 to 4 grams orally per day, given in divided doses

PARENTERAL:
Lactobionate: 1 to 4 grams per day, given IV in divided doses via intermittent IV infusion over 20 to 60 minutes no more than every 6 hours or via slow continuous IV infusion

Comment:

In-vitro data suggest that this drug may be effective in treating Legionnaires' disease.
Parenteral formulations should be replaced by oral formulations as soon as possible.

Use: Treatment of Legionnaires' disease caused by Legionella pneumophila

Usual Adult Dose for Bacterial Endocarditis Prophylaxis

ORAL: 1 gram orally ONCE, 1 hour prior to the procedure, then 500 mg orally 6 hours later

Use: Prevention of bacterial endocarditis in patients with penicillin allergies and idiopathic hypertrophic subaortic stenosis (IHSS), most congenital cardiac malformations, previous history of bacterial endocarditis and mitral valve prolapse with insufficiency when they undergo dental/surgical procedures of the upper respiratory tract, prosthetic cardiac valves, and rheumatic/other acquired valvular dysfunction surgically constructed systemic pulmonary shunts

Usual Adult Dose for Rheumatic Fever Prophylaxis

ORAL:
Base: 250 mg orally 2 times a day
Ethylsuccinate: 400 mg orally 2 times a day
Duration of therapy:

Initial prophylaxis: 10 days

Comments:

This drug should be limited to use in situations where infections are known/strongly suspected to be caused by susceptible bacteria.
The American Heart Association (AHA) considers penicillin to be the drug of choice in the prevention of initial and recurrent attack of rheumatic fever.

Uses:

Alternative agent in the prevention of initial attacks of rheumatic fever caused by S pyogenes infections of the upper respiratory tract (e.g., pharyngitis, tonsillitis) in patients with a history of rheumatic heart disease who are allergic to penicillin
Alternative agent in the long-term prevention of recurrent attacks of rheumatic fever caused by S pyogenes in patients who are allergic to penicillin and sulfonamides

Usual Adult Dose for Nongonococcal Urethritis

ORAL:
Base or Stearate: 500 mg orally 4 times a day OR 666 mg orally every 8 hours
Ethylsuccinate: 800 mg orally 3 times a day
Duration of therapy: At least 7 days

Comments:

This drug should be taken on an empty stomach.
Dose adjustments may be made in patients who cannot tolerate recommended doses.

Uses:

Treatment of nongonococcal urethritis caused by Ureaplasmin urealyticum in situations where tetracyclines are contraindicated or are not tolerated
Treatment of uncomplicated endocervical, rectal, or urogenital infections due to Chlamydia trachomatis in situations where tetracyclines are contraindicated or not tolerated
Treatment of urogenital infections caused by C trachomatis during pregnancy

US Centers for Disease Control and Prevention (US CDC) Recommendations:
Base: 500 mg orally 4 times a day
Ethylsuccinate: 800 mg orally 4 times a day
Duration of therapy: 7 days

Uses:

Alternative treatment of mild to moderate urethritis and cervicitis due to C trachomatis
Alternative treatment of nongonococcal urethritis, cervicitis, and chlamydial infections

Usual Adult Dose for Chlamydia Infection

ORAL:
Base or Stearate: 500 mg orally 4 times a day OR 666 mg orally every 8 hours
Ethylsuccinate: 800 mg orally 3 times a day
Duration of therapy: At least 7 days

Comments:

This drug should be taken on an empty stomach.
Dose adjustments may be made in patients who cannot tolerate recommended doses.

Uses:

Treatment of nongonococcal urethritis caused by Ureaplasmin urealyticum in situations where tetracyclines are contraindicated or are not tolerated
Treatment of uncomplicated endocervical, rectal, or urogenital infections due to Chlamydia trachomatis in situations where tetracyclines are contraindicated or not tolerated
Treatment of urogenital infections caused by C trachomatis during pregnancy

US Centers for Disease Control and Prevention (US CDC) Recommendations:
Base: 500 mg orally 4 times a day
Ethylsuccinate: 800 mg orally 4 times a day
Duration of therapy: 7 days

Uses:

Alternative treatment of mild to moderate urethritis and cervicitis due to C trachomatis
Alternative treatment of nongonococcal urethritis, cervicitis, and chlamydial infections

Usual Adult Dose for Pertussis

ORAL:
Base, Ethylsuccinate, or Stearate: 40 to 50 mg/kg orally per day, given in divided doses

Maximum dose: 4 grams/day
Duration of therapy: 5 to 14 days

Comments:

Dosage recommendations are based on doses used in clinical trials; optimum doses and durations of therapy have not been established.
This drug should be taken approximately 1 hour prior to meals.
This drug eliminates Bordetella pertussis from the nasopharynx of infected patients, which renders then noninfectious.
Clinical studies suggest that this drug may be used for prophylaxis of pertussis in susceptible individuals who were exposed.

Use: Treatment of pertussis (whooping cough) caused by B pertussis

Usual Adult Dose for Pelvic Inflammatory Disease

PARENTERAL:
Lactobionate: 500 mg via IV infusion over 20 to 60 minutes every 6 hours

Duration of therapy: 3 days

ORAL:
Base or Stearate: 500 mg orally every 12 hours, 333 mg orally every 8 hours, OR 250 mg orally every 6 hours
Ethylsuccinate: 800 mg orally every 8 hours OR 400 mg orally every 6 hours
Duration of therapy: 7 days

Comments:

A serologic test for syphilis should be conducted prior to and after 3 months of treatment.
Patients should be given parenteral treatment for 3 days, followed by oral treatment for an additional 7 days.

Uses:

Alternative agent in the treatment in acute pelvic inflammatory disease caused by Neisseria gonorrhoeae in patients with a penicillin sensitivity
Treatment of acute pelvic inflammatory disease caused by N gonorrhoeae

Usual Adult Dose for Syphilis - Early

ORAL:
Base or Stearate: 30 to 40 grams orally, given in divided doses over 10 to 15 days
Succinate: 48 to 64 grams orally, given in divided doses over 10 to 15 days

Comments:

Dosage recommendations are based on doses used in clinical trials; optimal doses and duration of therapy have not been established.
Spinal fluid examinations should be conducted prior to and after treatment.
Infants born to patients treated during pregnancy for early syphilis should be treated with a penicillin regimen.

Use: Alternative treatment for primary syphilis caused by Treponema palladium in patients who are allergic to penicillins

Usual Adult Dose for Bowel Preparation

ORAL:
Base:
Proposed 8 AM surgery: 1 gram orally once at 1 PM, 2 PM, and 11 PM on the day preceding the surgery with neomycin

Comments:

Patients should evacuate the rectum a 6:30 AM on the day of the scheduled operation.
The local bowel preparation regimen protocol and/or the manufacturer product information should be consulted.
Supplemental IV fluids should be given as needed.
Enemas should not be given.

Use: Preoperative prophylaxis for elective colorectal surgery

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

Base: 1 gram orally ONCE

Use: Antibiotic for colorectal surgery prophylaxis in conjunction with mechanical bowel preparation

Usual Adult Dose for Bacteremia

IDSA Recommendations:
ORAL:
Impetigo:
Base, Estolate, Stearate: 250 mg orally 4 times a day
Ethylsuccinate: 400 mg orally 4 times a day

Bacillary angiomatosis:
Base, Estolate, Stearate: 500 mg orally 4 times a day

Duration of therapy:

Impetigo: 7 days
Bacillary angiomatosis: 2 to 8 weeks

Comments:

Some impetigo caused by S aureus and S pyogenes strains may be resistant.
Cellulitis prophylaxis should be performed during the acute stage of cellulitis and should continue as part of routine care for as long as predisposing factors persist.
Prophylaxis should be considered in patients who develop 3 to 4 episodes of cellulitis per year despite controlling for predisposing factors.

Uses:

Treatment of impetigo caused by Staphylococcus and Streptococcus species
Recommended treatment of bacillary angiomatosis

US Department of Health and Human Services (US HHS), US National Institutes of Health (US NIH), Health Resources and Services Administration (HRSA), and US CDC Recommendations:
ORAL/PARENTERAL:
Bacillary angiomatosis, Bacteremia, Osteomyelitis, and Peliosis Hepatitis: 500 mg orally or IV every 6 hours
Other severe infections: 500 mg orally or IV every 6 hours PLUS rifampin
Duration of therapy: 3 months

Comment: Long-term suppression is recommended in patients with CD4 counts less than 200 cells/mcL if relapse occurs after an initial course of treatment.

Uses:

Treatment of bacillary angiomatosis, bacillary Peliosis hepatitis, bacteremia, and osteomyelitis caused by Bartonella quintana or Bartonella henselae
Treatment of other severe infections caused by B quintana or B henselae

Usual Adult Dose for Osteomyelitis

Impetigo: 7 days
Bacillary angiomatosis: 2 to 8 weeks

Comments:

Some impetigo caused by S aureus and S pyogenes strains may be resistant.
Cellulitis prophylaxis should be performed during the acute stage of cellulitis and should continue as part of routine care for as long as predisposing factors persist.
Prophylaxis should be considered in patients who develop 3 to 4 episodes of cellulitis per year despite controlling for predisposing factors.

Uses:

Treatment of impetigo caused by Staphylococcus and Streptococcus species
Recommended treatment of bacillary angiomatosis

Treatment of bacillary angiomatosis, bacillary Peliosis hepatitis, bacteremia, and osteomyelitis caused by Bartonella quintana or Bartonella henselae
Treatment of other severe infections caused by B quintana or B henselae

Usual Adult Dose for Bartonellosis

Impetigo: 7 days
Bacillary angiomatosis: 2 to 8 weeks

Comments:

Some impetigo caused by S aureus and S pyogenes strains may be resistant.
Cellulitis prophylaxis should be performed during the acute stage of cellulitis and should continue as part of routine care for as long as predisposing factors persist.
Prophylaxis should be considered in patients who develop 3 to 4 episodes of cellulitis per year despite controlling for predisposing factors.

Uses:

Treatment of impetigo caused by Staphylococcus and Streptococcus species
Recommended treatment of bacillary angiomatosis

Treatment of bacillary angiomatosis, bacillary Peliosis hepatitis, bacteremia, and osteomyelitis caused by Bartonella quintana or Bartonella henselae
Treatment of other severe infections caused by B quintana or B henselae

Usual Adult Dose for Impetigo

Impetigo: 7 days
Bacillary angiomatosis: 2 to 8 weeks

Comments:

Some impetigo caused by S aureus and S pyogenes strains may be resistant.
Cellulitis prophylaxis should be performed during the acute stage of cellulitis and should continue as part of routine care for as long as predisposing factors persist.
Prophylaxis should be considered in patients who develop 3 to 4 episodes of cellulitis per year despite controlling for predisposing factors.

Uses:

Treatment of impetigo caused by Staphylococcus and Streptococcus species
Recommended treatment of bacillary angiomatosis

Treatment of bacillary angiomatosis, bacillary Peliosis hepatitis, bacteremia, and osteomyelitis caused by Bartonella quintana or Bartonella henselae
Treatment of other severe infections caused by B quintana or B henselae

Usual Adult Dose for Lyme Disease

IDSA Recommendations:
Early Lyme disease: 500 mg orally 4 times a day

Duration of therapy: 14 to 21 days

Comments:

Use should be reserved for patients who are intolerant or should not take amoxicillin, doxycycline, and cefuroxime axetil.
Patients should be monitored to ensure resolution of clinical manifestations.

Use: Alternative treatment for early Lyme disease, including borrelial lymphocyte and erythema migrans

Usual Adult Dose for Skin and Structure Infection

IDSA Recommendations:
ORAL:
Base, Estolate, Stearate: 250 mg orally 2 times a day

Duration of therapy: 4 to 52 weeks

Comments:

Cellulitis prophylaxis should be performed during the acute stage of cellulitis and should continue as part of routine care for as long as predisposing factors persist.
Prophylaxis should be considered in patients who develop 3 to 4 episodes of cellulitis per year despite controlling for predisposing factors.

Use: Preferred management of recurrent cellulitis in patients with predisposing conditions (e.g., eczema, edema, obesity, toe web abnormalities, venous insufficiency)

Usual Adult Dose for Chancroid

US CDC Recommendations:
ORAL:
Base: 500 mg orally 3 times a day

Duration of therapy: 7 days

Comments:

The efficacy of this drug in female patients with chancroid has not been established.
The patient's sexual partner(s) during the 10 days preceding the onset of symptoms should be evaluated/treated.
Patients should be tested for HIV infection when chancroid is diagnosed and a serologic test for HIV and syphilis should be performed 3 months after diagnosis in patients with negative initial HIV test results.

Use: Recommended treatment of genital ulcer disease in men due to Haemophilus ducreyi (chancroid)

Usual Adult Dose for Granuloma Inguinale

US CDC Recommendations:
ORAL:
Base: 500 mg orally 4 times a day

Duration of therapy: At least 3 weeks (and until all lesions have completely healed)

Comments:

Patients diagnosed with granuloma inguinale should be tested for HIV.
Patients should be monitored until all signs/symptoms have resolved.
The patient's sexual partner(s) during the 60 days preceding the onset of symptoms should be evaluated and offered treatment.

Uses:

Alternative treatment of granuloma inguinale/donovanosis caused by Klebsiella granulomatis (Calymmatobacterium granulomatis)
Preferred treatment of granuloma inguinale/donovanosis in patients who are pregnant or lactating

Usual Adult Dose for Lymphogranuloma Venereum

US CDC Recommendations:
ORAL:
Base: 500 mg orally 4 times a day

Duration of therapy: 21 days

Comments:

Patients diagnosed with granuloma inguinale should be tested for HIV.
Patients should be monitored until all signs/symptoms have resolved.
The patient's sexual partner(s) during the 60 days preceding the onset of symptoms should be evaluated and offered treatment.

Uses:

Alternative treatment of lymphogranuloma venereum (LGV) caused by C trachomatis serovars L1, L2, or L3
Preferred treatment of LGV in patients who are pregnant or lactating

Usual Pediatric Dose for Campylobacter Gastroenteritis

ORAL:
Base or Stearate:
Children: 30 to 50 mg/kg orally per day, given in equally divided doses

Maximum dose: 4 grams/day

Ethylsuccinate:
Children: 30 to 50 mg orally every day, given in equally divided doses every 6 hours

Maximum dose: 4 grams/day

PARENTERAL:
Lactobionate:
Children: 15 to 20 mg/kg IV per day via intermittent IV infusion over 20 to 60 minutes no more than every 6 hours or via slow continuous IV infusion

Maximum dose: 4 grams/day

Duration of therapy: At least 10 days (streptococcal infections)

Comments:

This drug should be taken approximately 1 hour prior to meals.
Higher doses may be increased (up to 4 grams/day), depending on the severity of the infection.
Ethylsuccinate formulations doses may be given every 12 hours in 2 divided doses OR every 8 hours in 3 divided doses if desired.
Many strains of H influenzae are not susceptible to concentrations of this drug typically achieved by dosing; concomitant dosing with sulfonamides should be used in patients with upper respiratory tract infections caused by H influenzae.
Resistant staphylococcal skin infections may reemerge with treatment.
Parenteral formulations should be replaced by oral formulations as soon as possible.

Uses:

As an adjunct to antitoxin to prevent the establishment of carriers and to eradicate the organism in carriers of diphtheria caused by C diphtheriae
Treatment of erythrasma due to C minutissimum
Treatment of listeriosis caused by L monocytogenes
Treatment of mild to moderate lower respiratory tract infections caused by S pneumoniae (D pneumoniae) or S pyogenes (GAS)
Treatment of mild to moderate skin and structure infections caused by S aureus or S pyogenes
Treatment of mild to moderate upper respiratory tract infections caused by H influenzae (when used concomitantly with adequate doses of sulfonamides), S pneumoniae (D pneumoniae), or S pyogenes (GAS)
Treatment of respiratory tract infections due to M pneumoniae

Pediatric Infectious Diseases Society (PIDS) and IDSA Recommendations:
ORAL:
Step-down or mild therapy: 10 mg/kg orally 4 times a day

PARENTERAL:
Lactobionate: 5 mg/kg IV per day, given in dived doses every 6 hours

Uses:

Alternative empiric treatment in patients less than 5 years with presumed atypical pneumonia
Alternative empiric treatment in patients 7 years and older with presumed atypical pneumonia
Adjunctive alternative empiric inpatient treatment in patients who are fully immunized with conjugate vaccines for H influenzae type b and S pneumoniae in areas where local penicillin resistance in invasive strains of pneumococcus is minimal
Adjunctive alternative empiric inpatient treatment in patients who not are fully immunized with conjugate vaccines for H influenzae type b and S pneumoniae in areas where local penicillin resistance in invasive strains of pneumococcus is significant
Alternative parenteral treatment for the treatment of pneumonia caused by M pneumoniae
Alternative oral therapy (e.g., as step-down/mild infection) for the treatment of pneumonia caused by M pneumoniae
Alternative parenteral treatment for the treatment of pneumonia caused by C trachomatis or Chlamydophila pneumoniae
Alternative oral therapy (e.g., as step-down/mild infection) for the treatment of pneumonia caused by C trachomatis or C pneumoniae

Usual Pediatric Dose for Mycoplasma Pneumonia

ORAL:
Base or Stearate:
Children: 30 to 50 mg/kg orally per day, given in equally divided doses

Maximum dose: 4 grams/day

Ethylsuccinate:
Children: 30 to 50 mg orally every day, given in equally divided doses every 6 hours

Maximum dose: 4 grams/day

PARENTERAL:
Lactobionate:
Children: 15 to 20 mg/kg IV per day via intermittent IV infusion over 20 to 60 minutes no more than every 6 hours or via slow continuous IV infusion

Maximum dose: 4 grams/day

Duration of therapy: At least 10 days (streptococcal infections)

Comments:

This drug should be taken approximately 1 hour prior to meals.
Higher doses may be increased (up to 4 grams/day), depending on the severity of the infection.
Ethylsuccinate formulations doses may be given every 12 hours in 2 divided doses OR every 8 hours in 3 divided doses if desired.
Many strains of H influenzae are not susceptible to concentrations of this drug typically achieved by dosing; concomitant dosing with sulfonamides should be used in patients with upper respiratory tract infections caused by H influenzae.
Resistant staphylococcal skin infections may reemerge with treatment.
Parenteral formulations should be replaced by oral formulations as soon as possible.

Uses:

As an adjunct to antitoxin to prevent the establishment of carriers and to eradicate the organism in carriers of diphtheria caused by C diphtheriae
Treatment of erythrasma due to C minutissimum
Treatment of listeriosis caused by L monocytogenes
Treatment of mild to moderate lower respiratory tract infections caused by S pneumoniae (D pneumoniae) or S pyogenes (GAS)
Treatment of mild to moderate skin and structure infections caused by S aureus or S pyogenes
Treatment of mild to moderate upper respiratory tract infections caused by H influenzae (when used concomitantly with adequate doses of sulfonamides), S pneumoniae (D pneumoniae), or S pyogenes (GAS)
Treatment of respiratory tract infections due to M pneumoniae

Alternative empiric treatment in patients less than 5 years with presumed atypical pneumonia
Alternative empiric treatment in patients 7 years and older with presumed atypical pneumonia
Adjunctive alternative empiric inpatient treatment in patients who are fully immunized with conjugate vaccines for H influenzae type b and S pneumoniae in areas where local penicillin resistance in invasive strains of pneumococcus is minimal
Adjunctive alternative empiric inpatient treatment in patients who not are fully immunized with conjugate vaccines for H influenzae type b and S pneumoniae in areas where local penicillin resistance in invasive strains of pneumococcus is significant
Alternative parenteral treatment for the treatment of pneumonia caused by M pneumoniae
Alternative oral therapy (e.g., as step-down/mild infection) for the treatment of pneumonia caused by M pneumoniae
Alternative parenteral treatment for the treatment of pneumonia caused by C trachomatis or Chlamydophila pneumoniae
Alternative oral therapy (e.g., as step-down/mild infection) for the treatment of pneumonia caused by C trachomatis or C pneumoniae

Usual Pediatric Dose for Otitis Media

ORAL:
Base or Stearate:
Children: 30 to 50 mg/kg orally per day, given in equally divided doses

Maximum dose: 4 grams/day

Ethylsuccinate:
Children: 30 to 50 mg orally every day, given in equally divided doses every 6 hours

Maximum dose: 4 grams/day

PARENTERAL:
Lactobionate:
Children: 15 to 20 mg/kg IV per day via intermittent IV infusion over 20 to 60 minutes no more than every 6 hours or via slow continuous IV infusion

Maximum dose: 4 grams/day

Duration of therapy: At least 10 days (streptococcal infections)

Comments:

This drug should be taken approximately 1 hour prior to meals.
Higher doses may be increased (up to 4 grams/day), depending on the severity of the infection.
Ethylsuccinate formulations doses may be given every 12 hours in 2 divided doses OR every 8 hours in 3 divided doses if desired.
Many strains of H influenzae are not susceptible to concentrations of this drug typically achieved by dosing; concomitant dosing with sulfonamides should be used in patients with upper respiratory tract infections caused by H influenzae.
Resistant staphylococcal skin infections may reemerge with treatment.
Parenteral formulations should be replaced by oral formulations as soon as possible.

Uses:

As an adjunct to antitoxin to prevent the establishment of carriers and to eradicate the organism in carriers of diphtheria caused by C diphtheriae
Treatment of erythrasma due to C minutissimum
Treatment of listeriosis caused by L monocytogenes
Treatment of mild to moderate lower respiratory tract infections caused by S pneumoniae (D pneumoniae) or S pyogenes (GAS)
Treatment of mild to moderate skin and structure infections caused by S aureus or S pyogenes
Treatment of mild to moderate upper respiratory tract infections caused by H influenzae (when used concomitantly with adequate doses of sulfonamides), S pneumoniae (D pneumoniae), or S pyogenes (GAS)
Treatment of respiratory tract infections due to M pneumoniae

Alternative empiric treatment in patients less than 5 years with presumed atypical pneumonia
Alternative empiric treatment in patients 7 years and older with presumed atypical pneumonia
Adjunctive alternative empiric inpatient treatment in patients who are fully immunized with conjugate vaccines for H influenzae type b and S pneumoniae in areas where local penicillin resistance in invasive strains of pneumococcus is minimal
Adjunctive alternative empiric inpatient treatment in patients who not are fully immunized with conjugate vaccines for H influenzae type b and S pneumoniae in areas where local penicillin resistance in invasive strains of pneumococcus is significant
Alternative parenteral treatment for the treatment of pneumonia caused by M pneumoniae
Alternative oral therapy (e.g., as step-down/mild infection) for the treatment of pneumonia caused by M pneumoniae
Alternative parenteral treatment for the treatment of pneumonia caused by C trachomatis or Chlamydophila pneumoniae
Alternative oral therapy (e.g., as step-down/mild infection) for the treatment of pneumonia caused by C trachomatis or C pneumoniae

Usual Pediatric Dose for Pharyngitis

ORAL:
Base or Stearate:
Children: 30 to 50 mg/kg orally per day, given in equally divided doses

Maximum dose: 4 grams/day

Ethylsuccinate:
Children: 30 to 50 mg orally every day, given in equally divided doses every 6 hours

Maximum dose: 4 grams/day

PARENTERAL:
Lactobionate:
Children: 15 to 20 mg/kg IV per day via intermittent IV infusion over 20 to 60 minutes no more than every 6 hours or via slow continuous IV infusion

Maximum dose: 4 grams/day

Duration of therapy: At least 10 days (streptococcal infections)

Comments:

This drug should be taken approximately 1 hour prior to meals.
Higher doses may be increased (up to 4 grams/day), depending on the severity of the infection.
Ethylsuccinate formulations doses may be given every 12 hours in 2 divided doses OR every 8 hours in 3 divided doses if desired.
Many strains of H influenzae are not susceptible to concentrations of this drug typically achieved by dosing; concomitant dosing with sulfonamides should be used in patients with upper respiratory tract infections caused by H influenzae.
Resistant staphylococcal skin infections may reemerge with treatment.
Parenteral formulations should be replaced by oral formulations as soon as possible.

Uses:

As an adjunct to antitoxin to prevent the establishment of carriers and to eradicate the organism in carriers of diphtheria caused by C diphtheriae
Treatment of erythrasma due to C minutissimum
Treatment of listeriosis caused by L monocytogenes
Treatment of mild to moderate lower respiratory tract infections caused by S pneumoniae (D pneumoniae) or S pyogenes (GAS)
Treatment of mild to moderate skin and structure infections caused by S aureus or S pyogenes
Treatment of mild to moderate upper respiratory tract infections caused by H influenzae (when used concomitantly with adequate doses of sulfonamides), S pneumoniae (D pneumoniae), or S pyogenes (GAS)
Treatment of respiratory tract infections due to M pneumoniae

Alternative empiric treatment in patients less than 5 years with presumed atypical pneumonia
Alternative empiric treatment in patients 7 years and older with presumed atypical pneumonia
Adjunctive alternative empiric inpatient treatment in patients who are fully immunized with conjugate vaccines for H influenzae type b and S pneumoniae in areas where local penicillin resistance in invasive strains of pneumococcus is minimal
Adjunctive alternative empiric inpatient treatment in patients who not are fully immunized with conjugate vaccines for H influenzae type b and S pneumoniae in areas where local penicillin resistance in invasive strains of pneumococcus is significant
Alternative parenteral treatment for the treatment of pneumonia caused by M pneumoniae
Alternative oral therapy (e.g., as step-down/mild infection) for the treatment of pneumonia caused by M pneumoniae
Alternative parenteral treatment for the treatment of pneumonia caused by C trachomatis or Chlamydophila pneumoniae
Alternative oral therapy (e.g., as step-down/mild infection) for the treatment of pneumonia caused by C trachomatis or C pneumoniae

Usual Pediatric Dose for Pneumonia

ORAL:
Base or Stearate:
Children: 30 to 50 mg/kg orally per day, given in equally divided doses

Maximum dose: 4 grams/day

Ethylsuccinate:
Children: 30 to 50 mg orally every day, given in equally divided doses every 6 hours

Maximum dose: 4 grams/day

PARENTERAL:
Lactobionate:
Children: 15 to 20 mg/kg IV per day via intermittent IV infusion over 20 to 60 minutes no more than every 6 hours or via slow continuous IV infusion

Maximum dose: 4 grams/day

Duration of therapy: At least 10 days (streptococcal infections)

Comments:

This drug should be taken approximately 1 hour prior to meals.
Higher doses may be increased (up to 4 grams/day), depending on the severity of the infection.
Ethylsuccinate formulations doses may be given every 12 hours in 2 divided doses OR every 8 hours in 3 divided doses if desired.
Many strains of H influenzae are not susceptible to concentrations of this drug typically achieved by dosing; concomitant dosing with sulfonamides should be used in patients with upper respiratory tract infections caused by H influenzae.
Resistant staphylococcal skin infections may reemerge with treatment.
Parenteral formulations should be replaced by oral formulations as soon as possible.

Uses:

As an adjunct to antitoxin to prevent the establishment of carriers and to eradicate the organism in carriers of diphtheria caused by C diphtheriae
Treatment of erythrasma due to C minutissimum
Treatment of listeriosis caused by L monocytogenes
Treatment of mild to moderate lower respiratory tract infections caused by S pneumoniae (D pneumoniae) or S pyogenes (GAS)
Treatment of mild to moderate skin and structure infections caused by S aureus or S pyogenes
Treatment of mild to moderate upper respiratory tract infections caused by H influenzae (when used concomitantly with adequate doses of sulfonamides), S pneumoniae (D pneumoniae), or S pyogenes (GAS)
Treatment of respiratory tract infections due to M pneumoniae

Alternative empiric treatment in patients less than 5 years with presumed atypical pneumonia
Alternative empiric treatment in patients 7 years and older with presumed atypical pneumonia
Adjunctive alternative empiric inpatient treatment in patients who are fully immunized with conjugate vaccines for H influenzae type b and S pneumoniae in areas where local penicillin resistance in invasive strains of pneumococcus is minimal
Adjunctive alternative empiric inpatient treatment in patients who not are fully immunized with conjugate vaccines for H influenzae type b and S pneumoniae in areas where local penicillin resistance in invasive strains of pneumococcus is significant
Alternative parenteral treatment for the treatment of pneumonia caused by M pneumoniae
Alternative oral therapy (e.g., as step-down/mild infection) for the treatment of pneumonia caused by M pneumoniae
Alternative parenteral treatment for the treatment of pneumonia caused by C trachomatis or Chlamydophila pneumoniae
Alternative oral therapy (e.g., as step-down/mild infection) for the treatment of pneumonia caused by C trachomatis or C pneumoniae

Usual Pediatric Dose for Skin or Soft Tissue Infection

ORAL:
Base or Stearate:
Children: 30 to 50 mg/kg orally per day, given in equally divided doses

Maximum dose: 4 grams/day

Ethylsuccinate:
Children: 30 to 50 mg orally every day, given in equally divided doses every 6 hours

Maximum dose: 4 grams/day

PARENTERAL:
Lactobionate:
Children: 15 to 20 mg/kg IV per day via intermittent IV infusion over 20 to 60 minutes no more than every 6 hours or via slow continuous IV infusion

Maximum dose: 4 grams/day

Duration of therapy: At least 10 days (streptococcal infections)

Comments:

This drug should be taken approximately 1 hour prior to meals.
Higher doses may be increased (up to 4 grams/day), depending on the severity of the infection.
Ethylsuccinate formulations doses may be given every 12 hours in 2 divided doses OR every 8 hours in 3 divided doses if desired.
Many strains of H influenzae are not susceptible to concentrations of this drug typically achieved by dosing; concomitant dosing with sulfonamides should be used in patients with upper respiratory tract infections caused by H influenzae.
Resistant staphylococcal skin infections may reemerge with treatment.
Parenteral formulations should be replaced by oral formulations as soon as possible.

Uses:

As an adjunct to antitoxin to prevent the establishment of carriers and to eradicate the organism in carriers of diphtheria caused by C diphtheriae
Treatment of erythrasma due to C minutissimum
Treatment of listeriosis caused by L monocytogenes
Treatment of mild to moderate lower respiratory tract infections caused by S pneumoniae (D pneumoniae) or S pyogenes (GAS)
Treatment of mild to moderate skin and structure infections caused by S aureus or S pyogenes
Treatment of mild to moderate upper respiratory tract infections caused by H influenzae (when used concomitantly with adequate doses of sulfonamides), S pneumoniae (D pneumoniae), or S pyogenes (GAS)
Treatment of respiratory tract infections due to M pneumoniae

Alternative empiric treatment in patients less than 5 years with presumed atypical pneumonia
Alternative empiric treatment in patients 7 years and older with presumed atypical pneumonia
Adjunctive alternative empiric inpatient treatment in patients who are fully immunized with conjugate vaccines for H influenzae type b and S pneumoniae in areas where local penicillin resistance in invasive strains of pneumococcus is minimal
Adjunctive alternative empiric inpatient treatment in patients who not are fully immunized with conjugate vaccines for H influenzae type b and S pneumoniae in areas where local penicillin resistance in invasive strains of pneumococcus is significant
Alternative parenteral treatment for the treatment of pneumonia caused by M pneumoniae
Alternative oral therapy (e.g., as step-down/mild infection) for the treatment of pneumonia caused by M pneumoniae
Alternative parenteral treatment for the treatment of pneumonia caused by C trachomatis or Chlamydophila pneumoniae
Alternative oral therapy (e.g., as step-down/mild infection) for the treatment of pneumonia caused by C trachomatis or C pneumoniae

Usual Pediatric Dose for Upper Respiratory Tract Infection

ORAL:
Base or Stearate:
Children: 30 to 50 mg/kg orally per day, given in equally divided doses

Maximum dose: 4 grams/day

Ethylsuccinate:
Children: 30 to 50 mg orally every day, given in equally divided doses every 6 hours

Maximum dose: 4 grams/day

PARENTERAL:
Lactobionate:
Children: 15 to 20 mg/kg IV per day via intermittent IV infusion over 20 to 60 minutes no more than every 6 hours or via slow continuous IV infusion

Maximum dose: 4 grams/day

Duration of therapy: At least 10 days (streptococcal infections)

Comments:

This drug should be taken approximately 1 hour prior to meals.
Higher doses may be increased (up to 4 grams/day), depending on the severity of the infection.
Ethylsuccinate formulations doses may be given every 12 hours in 2 divided doses OR every 8 hours in 3 divided doses if desired.
Many strains of H influenzae are not susceptible to concentrations of this drug typically achieved by dosing; concomitant dosing with sulfonamides should be used in patients with upper respiratory tract infections caused by H influenzae.
Resistant staphylococcal skin infections may reemerge with treatment.
Parenteral formulations should be replaced by oral formulations as soon as possible.

Uses:

As an adjunct to antitoxin to prevent the establishment of carriers and to eradicate the organism in carriers of diphtheria caused by C diphtheriae
Treatment of erythrasma due to C minutissimum
Treatment of listeriosis caused by L monocytogenes
Treatment of mild to moderate lower respiratory tract infections caused by S pneumoniae (D pneumoniae) or S pyogenes (GAS)
Treatment of mild to moderate skin and structure infections caused by S aureus or S pyogenes
Treatment of mild to moderate upper respiratory tract infections caused by H influenzae (when used concomitantly with adequate doses of sulfonamides), S pneumoniae (D pneumoniae), or S pyogenes (GAS)
Treatment of respiratory tract infections due to M pneumoniae

Alternative empiric treatment in patients less than 5 years with presumed atypical pneumonia
Alternative empiric treatment in patients 7 years and older with presumed atypical pneumonia
Adjunctive alternative empiric inpatient treatment in patients who are fully immunized with conjugate vaccines for H influenzae type b and S pneumoniae in areas where local penicillin resistance in invasive strains of pneumococcus is minimal
Adjunctive alternative empiric inpatient treatment in patients who not are fully immunized with conjugate vaccines for H influenzae type b and S pneumoniae in areas where local penicillin resistance in invasive strains of pneumococcus is significant
Alternative parenteral treatment for the treatment of pneumonia caused by M pneumoniae
Alternative oral therapy (e.g., as step-down/mild infection) for the treatment of pneumonia caused by M pneumoniae
Alternative parenteral treatment for the treatment of pneumonia caused by C trachomatis or Chlamydophila pneumoniae
Alternative oral therapy (e.g., as step-down/mild infection) for the treatment of pneumonia caused by C trachomatis or C pneumoniae

Usual Pediatric Dose for Bronchitis

ORAL:
Base or Stearate:
Children: 30 to 50 mg/kg orally per day, given in equally divided doses

Maximum dose: 4 grams/day

Ethylsuccinate:
Children: 30 to 50 mg orally every day, given in equally divided doses every 6 hours

Maximum dose: 4 grams/day

PARENTERAL:
Lactobionate:
Children: 15 to 20 mg/kg IV per day via intermittent IV infusion over 20 to 60 minutes no more than every 6 hours or via slow continuous IV infusion

Maximum dose: 4 grams/day

Duration of therapy: At least 10 days (streptococcal infections)

Comments:

This drug should be taken approximately 1 hour prior to meals.
Higher doses may be increased (up to 4 grams/day), depending on the severity of the infection.
Ethylsuccinate formulations doses may be given every 12 hours in 2 divided doses OR every 8 hours in 3 divided doses if desired.
Many strains of H influenzae are not susceptible to concentrations of this drug typically achieved by dosing; concomitant dosing with sulfonamides should be used in patients with upper respiratory tract infections caused by H influenzae.
Resistant staphylococcal skin infections may reemerge with treatment.
Parenteral formulations should be replaced by oral formulations as soon as possible.

Uses:

As an adjunct to antitoxin to prevent the establishment of carriers and to eradicate the organism in carriers of diphtheria caused by C diphtheriae
Treatment of erythrasma due to C minutissimum
Treatment of listeriosis caused by L monocytogenes
Treatment of mild to moderate lower respiratory tract infections caused by S pneumoniae (D pneumoniae) or S pyogenes (GAS)
Treatment of mild to moderate skin and structure infections caused by S aureus or S pyogenes
Treatment of mild to moderate upper respiratory tract infections caused by H influenzae (when used concomitantly with adequate doses of sulfonamides), S pneumoniae (D pneumoniae), or S pyogenes (GAS)
Treatment of respiratory tract infections due to M pneumoniae

Alternative empiric treatment in patients less than 5 years with presumed atypical pneumonia
Alternative empiric treatment in patients 7 years and older with presumed atypical pneumonia
Adjunctive alternative empiric inpatient treatment in patients who are fully immunized with conjugate vaccines for H influenzae type b and S pneumoniae in areas where local penicillin resistance in invasive strains of pneumococcus is minimal
Adjunctive alternative empiric inpatient treatment in patients who not are fully immunized with conjugate vaccines for H influenzae type b and S pneumoniae in areas where local penicillin resistance in invasive strains of pneumococcus is significant
Alternative parenteral treatment for the treatment of pneumonia caused by M pneumoniae
Alternative oral therapy (e.g., as step-down/mild infection) for the treatment of pneumonia caused by M pneumoniae
Alternative parenteral treatment for the treatment of pneumonia caused by C trachomatis or Chlamydophila pneumoniae
Alternative oral therapy (e.g., as step-down/mild infection) for the treatment of pneumonia caused by C trachomatis or C pneumoniae

Usual Pediatric Dose for Diphtheria

ORAL:
Base or Stearate:
Children: 30 to 50 mg/kg orally per day, given in equally divided doses

Maximum dose: 4 grams/day

Ethylsuccinate:
Children: 30 to 50 mg orally every day, given in equally divided doses every 6 hours

Maximum dose: 4 grams/day

PARENTERAL:
Lactobionate:
Children: 15 to 20 mg/kg IV per day via intermittent IV infusion over 20 to 60 minutes no more than every 6 hours or via slow continuous IV infusion

Maximum dose: 4 grams/day

Duration of therapy: At least 10 days (streptococcal infections)

Comments:

This drug should be taken approximately 1 hour prior to meals.
Higher doses may be increased (up to 4 grams/day), depending on the severity of the infection.
Ethylsuccinate formulations doses may be given every 12 hours in 2 divided doses OR every 8 hours in 3 divided doses if desired.
Many strains of H influenzae are not susceptible to concentrations of this drug typically achieved by dosing; concomitant dosing with sulfonamides should be used in patients with upper respiratory tract infections caused by H influenzae.
Resistant staphylococcal skin infections may reemerge with treatment.
Parenteral formulations should be replaced by oral formulations as soon as possible.

Uses:

As an adjunct to antitoxin to prevent the establishment of carriers and to eradicate the organism in carriers of diphtheria caused by C diphtheriae
Treatment of erythrasma due to C minutissimum
Treatment of listeriosis caused by L monocytogenes
Treatment of mild to moderate lower respiratory tract infections caused by S pneumoniae (D pneumoniae) or S pyogenes (GAS)
Treatment of mild to moderate skin and structure infections caused by S aureus or S pyogenes
Treatment of mild to moderate upper respiratory tract infections caused by H influenzae (when used concomitantly with adequate doses of sulfonamides), S pneumoniae (D pneumoniae), or S pyogenes (GAS)
Treatment of respiratory tract infections due to M pneumoniae

Alternative empiric treatment in patients less than 5 years with presumed atypical pneumonia
Alternative empiric treatment in patients 7 years and older with presumed atypical pneumonia
Adjunctive alternative empiric inpatient treatment in patients who are fully immunized with conjugate vaccines for H influenzae type b and S pneumoniae in areas where local penicillin resistance in invasive strains of pneumococcus is minimal
Adjunctive alternative empiric inpatient treatment in patients who not are fully immunized with conjugate vaccines for H influenzae type b and S pneumoniae in areas where local penicillin resistance in invasive strains of pneumococcus is significant
Alternative parenteral treatment for the treatment of pneumonia caused by M pneumoniae
Alternative oral therapy (e.g., as step-down/mild infection) for the treatment of pneumonia caused by M pneumoniae
Alternative parenteral treatment for the treatment of pneumonia caused by C trachomatis or Chlamydophila pneumoniae
Alternative oral therapy (e.g., as step-down/mild infection) for the treatment of pneumonia caused by C trachomatis or C pneumoniae

Usual Pediatric Dose for Gastroenteritis

ORAL:
Base or Stearate:
Children: 30 to 50 mg/kg orally per day, given in equally divided doses

Maximum dose: 4 grams/day

Ethylsuccinate:
Children: 30 to 50 mg orally every day, given in equally divided doses every 6 hours

Maximum dose: 4 grams/day

PARENTERAL:
Lactobionate:
Children: 15 to 20 mg/kg IV per day via intermittent IV infusion over 20 to 60 minutes no more than every 6 hours or via slow continuous IV infusion

Maximum dose: 4 grams/day

Duration of therapy: At least 10 days (streptococcal infections)

Comments:

This drug should be taken approximately 1 hour prior to meals.
Higher doses may be increased (up to 4 grams/day), depending on the severity of the infection.
Ethylsuccinate formulations doses may be given every 12 hours in 2 divided doses OR every 8 hours in 3 divided doses if desired.
Many strains of H influenzae are not susceptible to concentrations of this drug typically achieved by dosing; concomitant dosing with sulfonamides should be used in patients with upper respiratory tract infections caused by H influenzae.
Resistant staphylococcal skin infections may reemerge with treatment.
Parenteral formulations should be replaced by oral formulations as soon as possible.

Uses:

As an adjunct to antitoxin to prevent the establishment of carriers and to eradicate the organism in carriers of diphtheria caused by C diphtheriae
Treatment of erythrasma due to C minutissimum
Treatment of listeriosis caused by L monocytogenes
Treatment of mild to moderate lower respiratory tract infections caused by S pneumoniae (D pneumoniae) or S pyogenes (GAS)
Treatment of mild to moderate skin and structure infections caused by S aureus or S pyogenes
Treatment of mild to moderate upper respiratory tract infections caused by H influenzae (when used concomitantly with adequate doses of sulfonamides), S pneumoniae (D pneumoniae), or S pyogenes (GAS)
Treatment of respiratory tract infections due to M pneumoniae

Alternative empiric treatment in patients less than 5 years with presumed atypical pneumonia
Alternative empiric treatment in patients 7 years and older with presumed atypical pneumonia
Adjunctive alternative empiric inpatient treatment in patients who are fully immunized with conjugate vaccines for H influenzae type b and S pneumoniae in areas where local penicillin resistance in invasive strains of pneumococcus is minimal
Adjunctive alternative empiric inpatient treatment in patients who not are fully immunized with conjugate vaccines for H influenzae type b and S pneumoniae in areas where local penicillin resistance in invasive strains of pneumococcus is significant
Alternative parenteral treatment for the treatment of pneumonia caused by M pneumoniae
Alternative oral therapy (e.g., as step-down/mild infection) for the treatment of pneumonia caused by M pneumoniae
Alternative parenteral treatment for the treatment of pneumonia caused by C trachomatis or Chlamydophila pneumoniae
Alternative oral therapy (e.g., as step-down/mild infection) for the treatment of pneumonia caused by C trachomatis or C pneumoniae

Usual Pediatric Dose for Amebiasis

ORAL:
Base, Estolate or Stearate:
Children: 30 to 50 mg/kg orally per day, given in equally divided doses

Maximum dose: 4 grams/day

Ethylsuccinate:
Children: 30 to 50 mg/kg orally per day, given in equally divided doses every 6 hours

Maximum dose: 4 grams/day

Duration of therapy: 10 to 14 days

Comments:

This drug should be taken approximately 1 hour prior to meals.
Dosing of ethylsuccinate formulations may be increased (up to 4 grams/day), depending on the severity of the infection; doses may be given every 12 hours in 2 divided doses OR every 8 hours in 3 divided doses if desired.
Patients with extrahepatic amebiasis should be given treatment with other antibiotics.

Use: Treatment of intestinal amebiasis caused by E histolytica

Usual Pediatric Dose for Bacterial Endocarditis Prophylaxis

ORAL: 20 mg/kg (Maximum dose: 1000 mg) orally ONCE 1 hour prior to the procedure, then 10 mg/kg (Maximum dose: 500 mg) orally 6 hours later

Use: Prevention of bacterial endocarditis in patients with penicillin allergies and IHSS, most congenital cardiac malformations, previous history of bacterial endocarditis and mitral valve prolapse with insufficiency when they undergo dental/surgical procedures of the upper respiratory tract, prosthetic cardiac valves, and rheumatic/other acquired valvular dysfunction surgically constructed systemic pulmonary shunts

Usual Pediatric Dose for Rheumatic Fever Prophylaxis

ORAL:
Base or Stearate: 250 mg orally 2 times a day
Duration of therapy:

Initial prophylaxis: 10 days

Comments:

This drug should be limited to use in situations where infections are known/strongly suspected to be caused by susceptible bacteria.
The AHA considers penicillin to be the drug of choice in the prevention of initial and recurrent attack of rheumatic fever.

Uses:

Alternative agent in the prevention of initial attacks of rheumatic fever caused by S pyogenes infections of the upper respiratory tract (e.g., pharyngitis, tonsillitis) in patients with a history of rheumatic heart disease who are allergic to penicillin
Alternative agent in the prevention of recurrent attacks of rheumatic fever caused by S pyogenes in patients who are allergic to penicillin and sulfonamides

Usual Pediatric Dose for Nongonococcal Urethritis

ORAL:
Base or Stearate:
Conjunctivitis of the newborn: 12.5 mg/kg orally 4 times a day

Duration of therapy: At least 2 weeks

Pneumonia of infancy: 12.5 mg/kg orally 4 times a day

Duration of therapy: At least 3 weeks

Children: 30 to 50 mg/kg orally per day, given in equally divided doses

Maximum dose: 4 grams/day
Duration of therapy: At least 7 days

Ethylsuccinate:
Children: 30 to 50 mg orally every day, given in equally divided doses every 6 hours

Maximum dose: 4 grams/day

Comments:

This drug should be taken on an empty stomach.
Dose adjustments may be made in patients who cannot tolerate recommended doses.

Uses:

Treatment of conjunctivitis of the newborn caused by C trachomatis
Treatment of nongonococcal urethritis caused by U urealyticum in situations where tetracyclines are contraindicated or are not tolerated
Treatment of pneumonia of infancy caused by C trachomatis
Treatment of uncomplicated endocervical, rectal, or urogenital infections due to C trachomatis in situations where tetracyclines are contraindicated or not tolerated

US CDC Recommendations:
ORAL:
Base or Ethylsuccinate:
Ophthalmia neonatorum or infantile pneumonia:
Infants and children less than 45 kg: 50 mg/kg orally per day, given in 4 divided doses

Duration of therapy: 14 days

Children:
Base: 500 mg orally 4 times a day
Ethylsuccinate: 800 mg orally 4 times a day
Duration of therapy: 7 days

Comment: Infantile hypertrophic pyloric stenosis (IHPS) occurred in infants younger than 6 weeks of age; patients younger than 6 weeks receiving this drug should be monitored for signs/symptoms of IHPS.

Uses:

Recommended treatment of ophthalmia neonatorum caused by N gonorrhoeae
Recommended treatment of infantile pneumonia caused by C trachomatis
Alternative treatment of mild to moderate urethritis and cervicitis due to C trachomatis
Alternative treatment of nongonococcal urethritis, cervicitis, and chlamydial infections

Usual Pediatric Dose for Chlamydia Infection

ORAL:
Base or Stearate:
Conjunctivitis of the newborn: 12.5 mg/kg orally 4 times a day

Duration of therapy: At least 2 weeks

Pneumonia of infancy: 12.5 mg/kg orally 4 times a day

Duration of therapy: At least 3 weeks

Children: 30 to 50 mg/kg orally per day, given in equally divided doses

Maximum dose: 4 grams/day
Duration of therapy: At least 7 days

Ethylsuccinate:
Children: 30 to 50 mg orally every day, given in equally divided doses every 6 hours

Maximum dose: 4 grams/day

Comments:

This drug should be taken on an empty stomach.
Dose adjustments may be made in patients who cannot tolerate recommended doses.

Uses:

Treatment of conjunctivitis of the newborn caused by C trachomatis
Treatment of nongonococcal urethritis caused by U urealyticum in situations where tetracyclines are contraindicated or are not tolerated
Treatment of pneumonia of infancy caused by C trachomatis
Treatment of uncomplicated endocervical, rectal, or urogenital infections due to C trachomatis in situations where tetracyclines are contraindicated or not tolerated

Duration of therapy: 14 days

Recommended treatment of ophthalmia neonatorum caused by N gonorrhoeae
Recommended treatment of infantile pneumonia caused by C trachomatis
Alternative treatment of mild to moderate urethritis and cervicitis due to C trachomatis
Alternative treatment of nongonococcal urethritis, cervicitis, and chlamydial infections

Usual Pediatric Dose for Pertussis

ORAL:
Base, Ethylsuccinate, or Stearate:
Children: 40 to 50 mg/kg orally per day, given in divided doses

Maximum dose: 4 grams/day
Duration of therapy: 5 to 14 days

Comments:

Dosage recommendations are based on doses used in clinical trials; optimum doses and durations of therapy have not been established.
This drug should be taken approximately 1 hour prior to meals.
This drug eliminates B pertussis from the nasopharynx of infected patients, which renders then noninfectious.
Clinical studies suggest that this drug may be used for prophylaxis of pertussis in susceptible individuals who were exposed.

Use: Treatment of pertussis (whooping cough) caused by B pertussis

Usual Pediatric Dose for Bacterial Infection

American Academy of Pediatrics (AAP) Recommendations:
ORAL:
Neonates (up to 28 postnatal days): 10 mg/kg orally every 6 hours
Pediatric patients beyond the neonatal period: 40 to 50 mg/kg orally per day, given in 3 to 4 divided doses

Maximum dose: 4 grams/day

PARENTERAL:
Neonates (up to 28 postnatal days): 10 mg/kg via IV every 6 hours
Pediatric patients beyond the neonatal period: 5 mg/kg IV (over at least 60 minutes) 4 times per day

Maximum dose: 4 grams/day

Comments:

Infants younger than 6 weeks receiving oral formulations should be monitored for signs/symptoms of IHPS.
If administering via IV, this drug should be given over at least 60 minutes to decrease the risk of cardiac arrhythmias.

Use: Treatment of bacterial infections

Usual Pediatric Dose for Bacteremia

US HHS, US NIH, HRSA, and US CDC Recommendations:
ORAL/PARENTERAL:
Adolescents:
Bacillary angiomatosis, Bacteremia, Osteomyelitis, and Peliosis Hepatitis: 500 mg orally or IV every 6 hours
Other severe infections: 500 mg orally or IV every 6 hours PLUS rifampin
Duration of therapy: 3 months

Comment: Long-term suppression is recommended in patients with CD4 counts less than 200 cells/mcL if relapse occurs after an initial course of treatment.

Uses:

Treatment of bacillary angiomatosis, bacillary Peliosis hepatitis, bacteremia, and osteomyelitis caused by B quintana or B henselae
Treatment of other severe infections caused by B quintana or B henselae

IDSA Recommendations:
ORAL:
Base, Estolate, Stearate: 40 mg/kg orally per day, given in divided doses 3 to 4 times a day

Duration of therapy: 7 days

Comment: Some cases of impetigo caused by S aureus and S pyogenes strains may be resistant.

Use: Treatment of impetigo caused by Staphylococcus and Streptococcus species

Usual Pediatric Dose for Osteomyelitis

Treatment of bacillary angiomatosis, bacillary Peliosis hepatitis, bacteremia, and osteomyelitis caused by B quintana or B henselae
Treatment of other severe infections caused by B quintana or B henselae

IDSA Recommendations:
ORAL:
Base, Estolate, Stearate: 40 mg/kg orally per day, given in divided doses 3 to 4 times a day

Duration of therapy: 7 days

Comment: Some cases of impetigo caused by S aureus and S pyogenes strains may be resistant.

Use: Treatment of impetigo caused by Staphylococcus and Streptococcus species

Usual Pediatric Dose for Bartonellosis

Treatment of bacillary angiomatosis, bacillary Peliosis hepatitis, bacteremia, and osteomyelitis caused by B quintana or B henselae
Treatment of other severe infections caused by B quintana or B henselae

IDSA Recommendations:
ORAL:
Base, Estolate, Stearate: 40 mg/kg orally per day, given in divided doses 3 to 4 times a day

Duration of therapy: 7 days

Comment: Some cases of impetigo caused by S aureus and S pyogenes strains may be resistant.

Use: Treatment of impetigo caused by Staphylococcus and Streptococcus species

Usual Pediatric Dose for Impetigo

Treatment of bacillary angiomatosis, bacillary Peliosis hepatitis, bacteremia, and osteomyelitis caused by B quintana or B henselae
Treatment of other severe infections caused by B quintana or B henselae

IDSA Recommendations:
ORAL:
Base, Estolate, Stearate: 40 mg/kg orally per day, given in divided doses 3 to 4 times a day

Duration of therapy: 7 days

Comment: Some cases of impetigo caused by S aureus and S pyogenes strains may be resistant.

Use: Treatment of impetigo caused by Staphylococcus and Streptococcus species

Usual Pediatric Dose for Lyme Disease

IDSA Recommendations:
ORAL:
Early Lyme disease: 12.5 mg/kg orally 4 times a day

Maximum dose: 500 mg
Duration of therapy: 14 to 21 days

Comments:

Use should be reserved for patients who are intolerant or should not take amoxicillin, doxycycline, and cefuroxime axetil.
Patients should be monitored to ensure resolution of clinical manifestations.

Use: Alternative treatment for early Lyme disease, including borrelial lymphocyte and erythema migrans

Usual Pediatric Dose for Surgical Prophylaxis

ASHP, IDSA, SIS, and SHEA Recommendations:
ORAL:
Erythromycin base: 20 mg/kg orally ONCE

Maximum dose: 1 gram

Use: Antibiotic for colorectal surgery prophylaxis

Usual Pediatric Dose for Skin and Structure Infection

IDSA Recommendations:
ORAL:
Base, Estolate, or Stearate: 20 mg/kg orally 2 times a day

Duration of therapy: 4 to 52 weeks

Comments:

Cellulitis prophylaxis should be performed during the acute stage of cellulitis and should continue as part of routine care for as long as predisposing factors persist.
Prophylaxis should be considered in patients who develop 3 to 4 episodes of cellulitis per year despite controlling for predisposing factors.

Use: Preferred management of recurrent cellulitis in patients with predisposing conditions (e.g., eczema, edema, obesity, toe web abnormalities, venous insufficiency)

Usual Pediatric Dose for Chancroid

US CDC Recommendations:
ORAL:
Adolescents:
Base: 500 mg orally 3 times a day

Duration of therapy: 7 days

Comments:

The efficacy of this drug in female patients with chancroid has not been established.
The patient's sexual partner(s) during the 10 days preceding the onset of symptoms should be evaluated/treated.
Patients should be tested for HIV infection when chancroid is diagnosed and a serologic test for HIV and syphilis should be performed 3 months after diagnosis in patients with negative initial HIV test results.

Use: Treatment of genital ulcer disease in men due to H ducreyi (chancroid)

Usual Pediatric Dose for Granuloma Inguinale

US CDC Recommendations:
ORAL:
Adolescents:
Base: 500 mg orally 4 times a day

Duration of therapy: At least 3 weeks (and until all lesions have completely healed)

Comments:

Patients diagnosed with granuloma inguinale should be tested for HIV.
Patients should be monitored until all signs/symptoms have resolved.
The patient's sexual partner(s) during the 60 days preceding the onset of symptoms should be evaluated and offered treatment.

Uses:

Alternative treatment of granuloma inguinale/donovanosis caused by K granulomatis (C granulomatis)
Preferred treatment of granuloma inguinale/donovanosis in patients who are pregnant or lactating

Usual Pediatric Dose for Lymphogranuloma Venereum

US CDC Recommendations:
ORAL:
Adolescents:
Base: 500 mg orally 4 times a day

Duration of therapy: 21 days

Comments:

Patients diagnosed with granuloma inguinale should be tested for HIV.
Patients should be monitored until all signs/symptoms have resolved.
The patient's sexual partner(s) during the 60 days preceding the onset of symptoms should be evaluated and offered treatment.

Uses:

Alternative treatment of LGV caused by C trachomatis serovars L1, L2, or L3
Preferred treatment of LGV in patients who are pregnant or lactating

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Base: Use with caution.
Ethylsuccinate, Lactate, and Stearate: Data not available

Dose Adjustments

Severe infections:

Base and Stearate: Use of 2 times a day dosing should be avoided in doses that exceed 1 gram/day.

Patients unable to tolerate the recommended regimens:
Urogenital infections during pregnancy:
Base or Stearate: 250 mg orally 4 times a day, 333 mg orally 3 times a day, OR 500 mg orally 2 times a day

Duration of therapy: At least 14 days

US CDC Recommendations:
Chlamydial Infections:
Base: 250 mg orally 4 times a day

Duration of therapy: 14 days

Ethylsuccinate: 400 mg orally 4 times a day

Duration of therapy: 14 days

Comment: Patients with gastrointestinal tolerance concerns may be started on 14-day treatment regimens.

Use: Alternative regimens in the treatment of chlamydial infections in patients with gastrointestinal tolerance concerns

Precautions

CONTRAINDICATIONS:

Hypersensitivity to the active component or to any of the ingredients
Patients taking astemizole, cisapride, dihydroergotamine, ergotamine, pimozide, and/or terfenadine
Patients taking HMG CoA reductase inhibitors (statins) that are extensively metabolized by CYP450 3A4 (e.g., lovastatin, simvastatin) concomitantly

Consult WARNINGS section for additional precautions.

Dialysis

CONTRAINDICATIONS:

Hypersensitivity to the active component or to any of the ingredients
Patients taking astemizole, cisapride, dihydroergotamine, ergotamine, pimozide, and/or terfenadine
Patients taking HMG CoA reductase inhibitors (statins) that are extensively metabolized by CYP450 3A4 (e.g., lovastatin, simvastatin) concomitantly

Consult WARNINGS section for additional precautions.

Other Comments

Administration advice:

Oral formulations: This drug should be administered on an empty stomach.
Parenteral formulations: Lactobionate should be limited to administration via continuous infusion or slow intermittent IV injection.

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.
Patients with gonorrhea who are suspected of having syphilis should undergo syphilis testing prior to treatment and at least every 4 months thereafter.

Monitoring:

HEMATOLOGIC: Whole blood count in patients longer than 3 weeks
HEPATIC: Liver toxicity, especially in patients with liver dysfunction; liver function tests in patients receiving treatment for longer than 3 weeks
RENAL: Renal function tests in patients receiving treatment for longer than 3 weeks

Patient advice:

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.
Advise patients to speak to their healthcare provider if they become pregnant, intend to become pregnant, or are breastfeeding.

Frequently asked questions

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