What are the common antibiotic dosages for pediatric patients?

Common Antibiotic Dosages for Pediatric Patients

For pediatric antibiotic dosing, use weight-based calculations stratified by neonatal age/weight categories and older pediatric groups, with specific attention to renal function and infection severity. 1

Beta-Lactam Antibiotics

Amoxicillin

• Mild to moderate respiratory infections: 45 mg/kg/day divided every 12 hours 2, 3
• Severe infections or high-resistance areas: 90 mg/kg/day divided every 12 hours 2, 3
• Group A Streptococcal infections: 50-75 mg/kg/day divided into 2 doses 2
• Maximum dose: 4000 mg/day for severe infections 2
• Infants <3 months: Maximum 30 mg/kg/day divided every 12 hours due to immature renal function 3

Amoxicillin-Clavulanate (Augmentin)

• Standard dosing: 45 mg/kg/day of amoxicillin component in 3 doses OR 90 mg/kg/day in 2 doses 2
• Community-acquired pneumonia: 90 mg/kg/day of amoxicillin component in 2 doses 2
• Maximum daily dose: 4000 mg of amoxicillin component 2
• Duration: 7-10 days for most respiratory infections; 10 days for pneumonia 2

Ampicillin (IV)

• Neonates ≤7 days, ≤2000g: 50 mg/kg/day divided every 12 hours 1, 4
• Neonates ≤7 days, >2000g: 75 mg/kg/day divided every 8 hours 1, 4
• Neonates >7 days, <1200g: 50 mg/kg/day divided every 12 hours 1, 4
• Neonates >7 days, 1200-2000g: 75 mg/kg/day divided every 8 hours 1, 4
• Neonates >7 days, >2000g: 100 mg/kg/day divided every 6 hours 1, 4
• Infants and children: 100-200 mg/kg/day divided every 6 hours 1, 4
• Severe pneumococcal infections: 300-400 mg/kg/day every 6 hours IV 4

Ampicillin-Sulbactam (IV)

• Infants: 100-150 mg ampicillin/kg/day divided every 6 hours 1
• Children: 100-200 mg ampicillin/kg/day divided every 6 hours 1

Cephalosporins

Cefazolin (IV)

• Children >1 month: 75 mg/kg every 8 hours 1

Cefepime (IV)

• Neonates ≤14 days: 30 mg/kg every 12 hours 1
• Infants >14 days and children ≤40 kg: 50 mg/kg every 12 hours 1
• Note: No established dosing for infants 2 weeks to 2 months 1

Ceftazidime (IV)

• Neonates 0-4 weeks, <1200g: 100 mg/kg/day divided every 12 hours 1
• Neonates ≤7 days, 1200-2000g: 100 mg/kg/day divided every 12 hours 1
• Neonates ≤7 days, >2000g: 100-150 mg/kg/day divided every 8-12 hours 1
• Neonates >7 days, ≥1200g: 150 mg/kg/day divided every 8 hours 1

Aminoglycosides

Amikacin (IV)

• Neonates 0-4 weeks, <1200g: 7.5 mg/kg every 18-24 hours 1
• Neonates ≤7 days, 1200-2000g: 7.5 mg/kg every 12 hours 1
• Neonates ≤7 days, >2000g: 7.5-10 mg/kg every 12 hours 1
• Neonates >7 days, <1200g: 7.5-10 mg/kg every 8-12 hours 1
• Neonates >7 days, >2000g: 10 mg/kg every 8 hours 1
• Infants and children: 15-22.5 mg/kg/day divided every 8 hours 1
• Cystic fibrosis or febrile neutropenia: Up to 30 mg/kg/day divided every 8 hours based on serum levels 1

Antifungals

Caspofungin (IV)

• Children 2-11 years: Loading dose 70 mg/m²/day on day 1, then 50 mg/m²/day 1
• Children ≥12 years: Loading dose 70 mg on day 1, then 50 mg once daily 1

Anidulafungin (IV)

• Children 2-17 years: 1.5 mg/kg/day 1
• Maximum: 100 mg/day 1
• Note: Limited pediatric experience 1

Critical Dosing Considerations

Renal Impairment Adjustments

• GFR 10-30 mL/min: Reduce amoxicillin to 250-500 mg every 12 hours 3
• GFR <10 mL/min: Reduce to 250-500 mg every 24 hours 3
• Hemodialysis: Give additional dose during and after dialysis 3

Treatment Duration Principles

• Minimum duration: Continue 48-72 hours beyond symptom resolution 2, 3
• Streptococcus pyogenes: Minimum 10 days to prevent rheumatic fever 3
• Respiratory infections: Typically 7-10 days 2
• Pneumonia: 10 days 2

Common Pitfalls to Avoid

• Never use 875 mg amoxicillin dose in patients with GFR <30 mL/min 3
• Avoid chloramphenicol, sulfonamides, and tetracyclines in neonates due to known toxicity 5, 6
• Do not underdose neonates based on adult calculations—use age and weight-specific categories 1, 4
• Reassess if no clinical improvement within 48-72 hours 2, 4