What is the recommended antibiotic dosing for a pediatric patient weighing 14kg?

Antibiotic Dosing Guidelines for a 14kg Pediatric Patient

For a 14kg pediatric patient, antibiotic dosing should be calculated based on weight, with careful attention to indication-specific dosing recommendations from established guidelines.

Common Antibiotics and Their Dosing

Penicillins

• Amoxicillin:

  • For mild/moderate infections: 25 mg/kg/day in divided doses every 12 hours (350 mg/day) or 20 mg/kg/day in divided doses every 8 hours (280 mg/day) 1
  • For severe infections: 45 mg/kg/day in divided doses every 12 hours (630 mg/day) or 40 mg/kg/day in divided doses every 8 hours (560 mg/day) 1
  • For respiratory infections in areas with high pneumococcal resistance: 90 mg/kg/day (1260 mg/day) in 2 doses 2

• Ampicillin:

  • 150-400 mg/kg/day IV in 4 divided doses (525-1400 mg/day) 3
  • Maximum daily dose: 12,000 mg/day 3

• Amoxicillin/Clavulanate:

  • For β-lactamase producing H. influenzae: 45 mg/kg/day of amoxicillin component in 3 doses (630 mg/day) or 90 mg/kg/day in 2 doses (1260 mg/day) 2
  • For skin infections: 0.266 ml/kg of 125/31 suspension three times daily (approximately 3.7 ml three times daily for 14kg child) 4

Cephalosporins

• Ceftriaxone:

  • For less severe infections: 50-75 mg/kg/day given once daily or divided every 12-24 hours (700-1050 mg/day) 5
  • For severe infections including pneumonia: 50-100 mg/kg/day given once daily or divided every 12-24 hours (700-1400 mg/day) 5
  • For bacterial meningitis: 100 mg/kg/day divided every 12-24 hours (1400 mg/day) 5

• Cefazolin:

  • 75 mg/kg every 8 hours (1050 mg/day) 3

• Ceftazidime:

  • For children >6 months: 50 mg/kg/dose IV every 8 hours (2100 mg/day) 3
  • For serious Pseudomonas infections: 200-300 mg/kg/day IV in 3 divided doses (2800-4200 mg/day) 3

• Cefepime:

  • 50 mg/kg/dose IV every 8 hours for Pseudomonas infections (2100 mg/day) 3

Aminoglycosides

• Gentamicin:

  • Conventional dosing: 2-2.5 mg/kg/dose IV every 8 hours (84-105 mg/day) 3
  • Once daily dosing: 5-7.5 mg/kg/dose IV every 24 hours (70-105 mg/day) 3

• Amikacin:

  • 5-7.5 mg/kg/dose IV every 8 hours (210-315 mg/day) 3
  • Once daily dosing: 15-22.5 mg/kg/dose IV every 24 hours (210-315 mg/day) 3

Carbapenems

• Meropenem:

  • 30 mg/kg/dose IV every 8 hours (1260 mg/day) 3

• Imipenem:

  • 15-25 mg/kg/dose IV every 6 hours (840-1400 mg/day) 3
  • Maximum daily dose: 4000 mg/day 3

Other Antibiotics

• Ciprofloxacin:

  • 10-20 mg/kg/dose PO every 12 hours (280-560 mg/day) 3
  • 10 mg/kg/dose IV every 8 hours or every 12 hours (420 mg/day or 280 mg/day) 3
  • Maximum dose: 750 mg/dose PO, 400 mg/dose IV 3

• Linezolid:

  • For children <12 years: 10 mg/kg/dose IV/PO every 8 hours (420 mg/day) 3

• Clindamycin:

  • 30-40 mg/kg/day in 3 or 4 doses (420-560 mg/day) 3

Indication-Specific Considerations

Respiratory Tract Infections

• For community-acquired pneumonia, ceftriaxone at 50-100 mg/kg/day (700-1400 mg/day) is recommended 5
• For pneumococcal pneumonia with penicillin resistance, higher doses of ceftriaxone at 100 mg/kg/day (1400 mg/day) are warranted 5
• For Group A Streptococcal infections, amoxicillin at 50-75 mg/kg/day (700-1050 mg/day) in 2 doses is recommended 2

Skin and Soft Tissue Infections

• For methicillin-susceptible S. aureus, cephalexin at 75-100 mg/kg/day (1050-1400 mg/day) in 3 or 4 doses is preferred 3
• For methicillin-resistant S. aureus susceptible to clindamycin, oral clindamycin at 30-40 mg/kg/day (420-560 mg/day) in 3 or 4 doses is recommended 3

Urinary Tract Infections

• For uncomplicated UTIs, nitrofurantoin at 5-7 mg/kg/day PO in 4 divided doses (70-98 mg/day) can be used 3
• Maximum dose: 100 mg/dose 3

Common Pitfalls in Pediatric Antibiotic Dosing

• Underdosing: Weight-based calculations must be precise to avoid underdosing, which can lead to treatment failure and antimicrobial resistance 4
• Inappropriate antibiotic selection: Broad-spectrum antibiotics are often prescribed when narrow-spectrum options would be sufficient 6
• Duration errors: Treatment should generally continue for 48-72 hours beyond symptom resolution 1
• Special considerations for specific infections: Group A Streptococcal infections should be treated for at least 10 days to prevent acute rheumatic fever 1
• Age-specific considerations: Infants and young children often require different dosing regimens than older children 3
• Failure to adjust for severity: Severe infections require higher doses and possibly longer durations 2

Monitoring Recommendations

• Monitor for clinical improvement within 48-72 hours; if no improvement is seen, reassess the diagnosis and consider changing the antimicrobial agent 4
• For aminoglycosides, therapeutic drug monitoring is recommended to ensure appropriate serum levels and minimize toxicity 3
• Monitor for adverse effects, particularly gastrointestinal disturbances with amoxicillin 2
• Complete the full course of antibiotics to prevent treatment failure and potential resistance 4