What is the recommended dose of cefotaxime (Cefotaxime) for a 3 kg, 10-day-old neonate?

From the Guidelines

For a 3 kg, 10-day-old neonate, the recommended dose of cefotaxime is 50 mg/kg every 8 hours, which equals 150 mg per dose, as indicated in the ESCMID guideline for community-acquired bacterial meningitis treatment 1.

Dosing Considerations

When administering cefotaxime to neonates, it is crucial to consider their age and weight to ensure appropriate dosing.

• For neonates less than 1 week old, the recommended dose is 50 mg/kg every 8 hours.
• For neonates between 1-4 weeks old, the dose remains at 50 mg/kg but can be administered every 6-8 hours.

Administration

Cefotaxime should be administered intravenously, infused over 30 minutes, or given as an intramuscular injection when IV access is not available.

• It is essential to follow the manufacturer's instructions for reconstitution and ensure proper dilution for neonatal administration.

Rationale

This dosing regimen is based on the pharmacokinetics of cefotaxime in neonates and its efficacy against common pathogens causing neonatal infections, such as sepsis and meningitis, as discussed in the context of community-acquired bacterial meningitis treatment 1.

Clinical Context

The choice of cefotaxime and its dosing should be made considering the clinical context, including the suspected or confirmed infection, the neonate's overall health, and potential renal function maturity, which influences drug clearance 1.

From the FDA Drug Label

Neonates (birth to 1 month): 0-1 week of age 50 mg/kg per dose every 12 hours IV 1-4 weeks of age 50 mg/kg per dose every 8 hours IV The recommended dose of cefotaxime for a 3 kg, 10-day-old neonate is 50 mg/kg per dose every 8 hours IV.

• The dose would be: 3 kg x 50 mg/kg = 150 mg per dose
• The dose should be administered every 8 hours. 2

From the Research

Cefotaxime Dosage for Neonates

The recommended dose of cefotaxime for a 3 kg, 10-day-old neonate can be determined based on several studies:

• A study from 1992 3 suggests that cefotaxime dosage regimens for infants and children employ a dosage of 50 mg/kg every 6 h.
• However, a study from 2016 4 recommends a model-based dosing regimen of 50 mg/kg twice a day to four times a day, according to gestational age (GA) and postnatal age (PNA).
• Another study from 1985 5 suggests that the desirable dose for full-term neonates during the first 8 days seems to be 75 to 150 mg/kg/day in 3 injections, according to the severity of the infection.
• A study from 1982 6 administered cefotaxime at a dosage level of 20 mg/kg by intravenous drip infusion over a 30-minute period, but also treated 4 cases of newborn infection with cefotaxime at 120--504 mg/day (approximately 35--300 mg/kg/day).

Key Considerations

Key considerations for determining the dose include:

• Gestational age (GA)
• Postnatal age (PNA)
• Weight of the neonate
• Severity of the infection
• Desired serum concentrations of cefotaxime

Recommended Dose

Based on the studies, a possible recommended dose for a 3 kg, 10-day-old neonate could be:

• 50 mg/kg every 6-8 hours, as suggested by 3 and 4
• 75-150 mg/kg/day in 3 injections, as suggested by 5 for full-term neonates during the first 8 days

It is essential to consult with a healthcare professional to determine the most appropriate dose for a specific patient, taking into account individual factors and the severity of the infection.