From the Guidelines
The recommended dose of cephalexin for pediatric patients is 20 mg per kg per dose twice daily, with a maximum of 500 mg per dose. This dosing is based on the most recent and highest quality evidence available, specifically the 2013 IDSA guideline update for managing group A streptococcal pharyngitis 1.
Key Considerations
- The dose should be administered twice daily for a duration of 10 days, as recommended by the guideline 1.
- It is essential to note that this dosing is for patients with penicillin allergy, and other antibiotics may be preferred for patients without such allergy.
- The maximum dose of 500 mg per dose should not be exceeded, and the dose should be adjusted according to the patient's weight.
Administration and Precautions
- Cephalexin can be administered with or without food, but it is recommended to be taken with food if gastrointestinal upset occurs.
- Dosage adjustments may be necessary for patients with significant renal impairment, although this is not explicitly stated in the provided guideline 1.
Mechanism and Spectrum of Activity
- Cephalexin is a first-generation cephalosporin antibiotic that works by inhibiting bacterial cell wall synthesis.
- It is effective against many gram-positive bacteria and some gram-negative organisms, making it a suitable option for treating various infections, including skin and soft tissue infections, urinary tract infections, otitis media, and streptococcal pharyngitis in children.
From the FDA Drug Label
- 2 Pediatric Patients (over 1 year of age) The recommended total daily dose of oral cephalexin capsules for pediatric patients is 25 to 50 mg/kg given in equally divided doses for 7 to 14 days. In the treatment of β-hemolytic streptococcal infections, duration of at least 10 days is recommended. In severe infections, a total daily dose of 50 to 100 mg/kg may be administered in equally divided doses For the treatment of otitis media, the recommended daily dose is 75 to 100 mg/kg given in equally divided doses.
The recommended dose of cephalexin for pediatric patients is 25 to 50 mg/kg per day, divided into equal doses, for 7 to 14 days.
- For β-hemolytic streptococcal infections, the treatment duration should be at least 10 days.
- For severe infections, the dose can be increased to 50 to 100 mg/kg per day, divided into equal doses.
- For otitis media, the recommended daily dose is 75 to 100 mg/kg, divided into equal doses 2.
From the Research
Cephalexin Dosing for Pediatric Patients
The recommended dose of cephalexin for pediatric patients varies depending on the specific infection being treated and the patient's age and weight.
- For bone and joint infections, a dose of 45 mg/kg (maximum 1.5 g) three times daily has been shown to be effective and well-tolerated in children 3.
- For Staphylococcus aureus infections, twice-daily (BID) and thrice-daily (TID) cephalexin dosing regimens have been proposed, with doses ranging from 15-45 mg/kg depending on the minimum inhibitory concentration (MIC) of the bacteria 4.
- For lower urinary tract infections, a 3-day course of cephalexin at a dose of 25-50 mg/kg body weight per day has been shown to be effective in children 5.
- For musculoskeletal infections, cephalexin at a dose of 25 mg/kg/dose (maximum 750 mg/dose) administered three times daily has been shown to achieve pharmacodynamic targets for efficacy against methicillin-susceptible Staphylococcus aureus (MSSA) 6.
Special Considerations
- In patients with cystic fibrosis, the pharmacokinetics of cephalexin have been studied, and the results suggest that clearance of cephalexin may not increase in patients with minimal severity of the disease 7.
- The dosing frequency and amount may need to be adjusted based on the individual patient's response to treatment and the specific infection being treated.
- It is essential to consult the prescribing information and follow the recommended dosing guidelines for cephalexin in pediatric patients.