What is the appropriate dose of Cephalexin (Keflex) for a 2-year-old child weighing 12.9 kilograms with an open toe fracture?

From the Guidelines

For a 2-year-old child weighing 12.9 kg with an open toe fracture, the recommended Keflex (cephalexin) dosage is 20 mg per kg per dose twice daily, which translates to approximately 129 mg per dose given twice daily, with a maximum dose of 500 mg per dose not applicable in this case due to the child's weight. This dosage is based on the strongest and most recent evidence available, specifically the guidelines for managing group A streptococcal pharyngitis, which also apply to the treatment of open fractures with Keflex 1.

Key Considerations

• The duration of treatment typically ranges from 7-10 days, depending on clinical response and wound healing, as there is no clear consensus on the optimal duration for open fractures 1.
• Keflex should be administered with or without food, though giving it with food may help reduce stomach upset.
• It's essential to complete the full course of antibiotics even if symptoms improve before completion.
• Keflex is effective for open fractures because it provides good coverage against common skin bacteria like Staphylococcus aureus and Streptococcus species, which are the most likely contaminants in open fractures.
• This antibiotic therapy should be started as soon as possible after the injury and should accompany appropriate wound cleaning, orthopedic management, and tetanus prophylaxis if needed.

Additional Guidance

• The choice of antibiotic and duration of therapy may vary depending on the severity of the fracture and the presence of other complicating factors, such as soil contamination or tissue damage 1.
• For more severe injuries, additional coverage for gram-negative organisms may be necessary, and the use of a broader-spectrum antibiotic or combination therapy may be considered.

From the FDA Drug Label

Pediatric Patients The usual recommended daily dosage for pediatric patients is 25 to 50 mg/kg in divided doses For streptococcal pharyngitis in patients over 1 year of age and for skin and skin structure infections, the total daily dose may be divided and administered every 12 hours. Cephalexin Suspension Weight125 mg/5 mL250 mg/5 mL 10 kg (22 lb)1/2 to 1 tsp q.i.d.1/4 to 1/2 tsp q.i.d. 20 kg (44 lb)1 to 2 tsp q.i.d.1/2 to 1 tsp q.i.d. 40 kg (88 lb)2 to 4 tsp q.i.d.1 to 2 tsp q.i. d. or Weight125 mg/5 mL250 mg/5 mL 10 kg (22 lb)1 to 2 tsp b.i.d.1/2 to 1 tsp b.i.d 20 kg (44 lb)2 to 4 tsp b.i.d.1 to 2 tsp b.i.d. 40 kg (88 lb)4 to 8 tsp b.i.d.2 to 4 tsp b.i. d.

The child weighs 12.9 kg.

• The recommended daily dosage for pediatric patients is 25 to 50 mg/kg in divided doses.
• For a child weighing 12.9 kg, the total daily dose would be:

• 25 mg/kg: 12.9 kg x 25 mg/kg = 322.5 mg
• 50 mg/kg: 12.9 kg x 50 mg/kg = 645 mg

• The dose can be divided and administered every 12 hours for skin and skin structure infections.
• Based on the provided table, for a child weighing around 12.9 kg ( closest to 10 kg or 20 kg), the dose would be between 1 to 2 tsp of the 125 mg/5 mL suspension, given every 12 hours (b.i.d.) or 1/2 to 1 tsp of the 250 mg/5 mL suspension, given every 12 hours (b.i.d.) 2

From the Research

Antibiotic Prophylaxis for Open Fractures

The use of antibiotic prophylaxis in open fractures is a well-established practice to reduce the risk of infection.

• The recommended antibiotic regimens for open fractures include first-, second-, and third-generation cephalosporins 3.
• For a child with an open toe fracture, the choice of antibiotic and dosage would depend on the type of fracture, the patient's weight, and other factors.

Cephalosporin Dosage for Children

• The dosage of cephalosporins, such as cefazolin or cefalexin (Keflex), for children is typically based on their weight 4.
• However, the provided studies do not specify the exact dosage of Keflex for a 2-year-old child weighing 12.9 kg with an open toe fracture.

General Recommendations

• The administration of prophylactic antibiotics, such as a first-generation cephalosporin, is recommended for patients with open fractures as soon as possible 5.
• The duration of antibiotic therapy remains variable between institutions, and antibiotic choice is not standardized 6.
• It is essential to note that the management of open fractures should be individualized, and the choice of antibiotic and dosage should be determined by a healthcare professional based on the specific circumstances of the patient.

Considerations for Open Toe Fractures

• Open toe fractures are typically classified as type I or II open fractures, and the recommended antibiotic regimen would depend on the severity of the fracture and the presence of any contamination 7.
• The use of expanded gram-negative coverage may be recommended for type II open fractures, and additional anaerobic coverage may be required if the fracture is contaminated with organic or farm-related material 3.