What are the recommended medications and dosages for pediatric patients?

Recommended Medications and Dosages for Pediatric Patients

The most appropriate medications for pediatric patients must be selected based on weight, age, and specific condition, with careful attention to appropriate dosing to ensure safety and efficacy. 1

General Principles of Pediatric Medication Administration

• Pediatric medication dosing should be calculated based on weight (mg/kg) or body surface area, not simply reduced from adult doses 2, 3
• Precalculated dosing guidelines should be used to minimize medication errors 1
• Medication administration should occur in distraction-free zones to prevent errors 1
• All emergency departments should maintain a code sheet with medication dosages precalculated based on the child's actual weight in kilograms 1
• Medications should be administered at the start of a meal to minimize gastrointestinal intolerance 4

Antibiotics for Pediatric Infections

Respiratory Infections

• Amoxicillin is the first-line treatment for presumed bacterial pneumonia in outpatient settings:
  • Dosage: 90 mg/kg/day in 2 doses (maximum 4g/day) 5, 4
  • For children <40 kg with mild/moderate infections: 25 mg/kg/day divided every 12 hours or 20 mg/kg/day divided every 8 hours 4
  • For severe infections: 45 mg/kg/day divided every 12 hours or 40 mg/kg/day divided every 8 hours 4
  • For infants <12 weeks: maximum 30 mg/kg/day divided every 12 hours due to incompletely developed renal function 4

Pneumococcal Infections

• For Streptococcus pneumoniae with penicillin MICs >2.0 μg/mL:
  • Parenteral therapy: Ampicillin (150-200 mg/kg/day every 6 hours) or penicillin (200,000-250,000 U/kg/day every 4-6 hours) 1
  • Alternative: Ceftriaxone (50-100 mg/kg/day every 12-24 hours) 1
  • Oral therapy: Amoxicillin (90 mg/kg/day in 2 doses) 1

Staphylococcal Infections

• For methicillin-susceptible Staphylococcus aureus:
  • Parenteral: Cefazolin (150 mg/kg/day every 8 hours) or oxacillin (150-200 mg/kg/day every 6-8 hours) 1
  • Oral: Cephalexin (75-100 mg/kg/day in 3-4 doses) 1
• For methicillin-resistant S. aureus (MRSA):
  • Parenteral: Vancomycin (40-60 mg/kg/day every 6-8 hours) or clindamycin (40 mg/kg/day every 6-8 hours) 1
  • Oral: Clindamycin (30-40 mg/kg/day in 3-4 doses) 1

Tuberculosis Treatment

• Isoniazid:
  • Children: 10-15 mg/kg daily (maximum 300 mg) 1
  • Twice weekly: 20-30 mg/kg (maximum 900 mg) 1
• Rifampin:
  • Children: 10-20 mg/kg daily (maximum 600 mg) 1

Medications for Behavioral Emergencies

Antipsychotics

• Haloperidol:

  • Child (6-12 years): 0.25-0.5 mg PO/IM 1
  • Adolescent (>12 years): 0.5-1 mg PO/IM 1
  • May repeat every 30-60 minutes as needed 1
  • Monitor for extrapyramidal symptoms 1

• Risperidone:

  • Child (6-12 years): 0.5-2 mg PO 1
  • Adolescent (>12 years): 2-5 mg PO 1
  • May repeat every 2 hours as needed 1
  • Consider combination with diphenhydramine or lorazepam for enhanced effect 1

Benzodiazepines

• Lorazepam:
  • 0.05-0.1 mg/kg PO/IM/IV 1
  • Onset: 15-30 minutes IM; 5-10 minutes IV 1
  • Duration: 6-8 hours 1
  • Monitor for respiratory depression and paradoxical disinhibition, especially in younger children 1

Medications for Allergic Conditions

• Levocetirizine:
  • Has minimal sedative effects at recommended doses 6
  • Avoid combining with other antihistamine-containing products to prevent overdosage 6

Important Safety Considerations

• Use dedicated enteral pumps to prevent inadvertent administration of enteral products via intravenous route 1
• Maintain pediatric emergency medications, including appropriate fluids (10% dextrose, 5% dextrose, normal saline) 1
• Consider renal function when dosing medications:
  • For severe renal impairment (GFR 10-30 mL/min): Reduce dosage or extend interval 4
  • For GFR <10 mL/min: Further reduction in dosage or extension of interval 4
• Monitor patients receiving chemical restraint for respiratory depression, hypotension, and paradoxical behavioral disinhibition 1
• Avoid antipsychotics in patients with anticholinergic delirium or intoxication from drugs with anticholinergic properties 1

Common Pitfalls in Pediatric Medication Administration

• Dosing errors due to decimal point misplacement can result in 10-fold medication errors 1, 7
• Using adult formulations for children without appropriate adjustments 2, 8
• Failure to account for organ maturity in very young children, especially those under 2 months of age 3
• Inadequate monitoring for adverse effects specific to pediatric patients 7
• Off-label use of medications without sufficient pediatric data 8, 7

By following these evidence-based guidelines and dosing recommendations, healthcare providers can ensure safe and effective medication administration for pediatric patients across various clinical scenarios.