Cefoperazone Pediatric Dosing
The recommended pediatric dose of cefoperazone is 50-200 mg/kg/day, typically administered as 25-50 mg/kg given 2-3 times daily (every 8-12 hours) for most serious bacterial infections. 1, 2
Standard Dosing Regimens
General Infections
- Most common regimen: 25-50 mg/kg administered 2-3 times daily for approximately 7 days 2
- Dose range: 50-200 mg/kg/day divided into multiple doses 1
- The lower end of the dosing range (25-50 mg/kg twice or three times daily) was used successfully in large multicenter trials across multiple countries 2
Specific Clinical Scenarios
Serious bacterial infections including pneumonia, urinary tract infections, and skin/soft tissue infections respond well to the standard dosing regimen 1, 2:
- Clinical success rates of 89-91% were achieved in pediatric patients with various serious infections 1, 2
- Pneumonia: 95% response rate (18 of 19 patients) 1
- Pyogenic meningitis: 89% response rate (8 of 9 patients) 1
- Meningitis cases: 10 of 11 cases were cured in multicenter trials 2
Hospital-acquired or complicated infections may require higher doses within the 50-200 mg/kg/day range 1:
- Approximately one-third of successfully treated patients had hospital-acquired infections 1
- Complicated upper urinary tract infections showed 83% response rate (5 of 6 patients) 1
Neutropenic patients showed a 70% response rate, suggesting the drug can be effective even in immunocompromised children, though outcomes are somewhat lower than in non-neutropenic patients (91% success rate) 1
Administration Considerations
- Route: Intravenous or intramuscular administration 2
- Duration: Typically 7-10 days depending on infection severity and clinical response 1, 2
- Age range: Successfully used in patients from 6 days to 14 years of age 1
Safety Profile
Cefoperazone demonstrates excellent tolerability in pediatric populations 1, 2:
- Adverse events occurred in only 3.7% of pediatric patients, with most being mild to moderate 1
- Only 14 of 438 children (3.2%) reported mild adverse reactions in multicenter trials 2
- Microbiologic eradication achieved in 94% of initial isolates 1
Important Caveats
Resistance patterns: Approximately 13% of isolates in pediatric patients showed resistance to cefoperazone, emphasizing the importance of local susceptibility data 1
Clinical judgment required: While the standard dose is 25-50 mg/kg 2-3 times daily, more severe infections or resistant organisms may necessitate doses up to 200 mg/kg/day 1
Not first-line in current practice: The provided guidelines 3, 4 for pediatric infections (particularly community-acquired pneumonia) recommend other third-generation cephalosporins like ceftriaxone and cefotaxime as preferred agents, suggesting cefoperazone is not a contemporary first-line choice despite its historical efficacy.