What are the recommended doses of Amikacin, Ceftriaxone, Pantoprazole, and Paracetamol (acetaminophen) for an 8kg child with severe sepsis?

Pediatric Severe Sepsis Medication Dosing for 8kg Child

Antibiotic Therapy

For an 8kg child with severe sepsis, administer Ceftriaxone 800mg IV once daily (100 mg/kg/day) and Amikacin 200mg IV once daily (25 mg/kg/day) within 1 hour of recognition. 1, 2

Ceftriaxone Dosing

• Dose: 800mg IV once daily (100 mg/kg/day for 8kg child) 2
• Can be given every 12-24 hours due to long half-life 3
• Provides broad-spectrum coverage for likely pathogens in severe sepsis 1

Amikacin Dosing

• Dose: 200mg IV once daily (25 mg/kg/day for 8kg child) 4, 5
• Higher loading doses (≥25 mg/kg) are essential in severe sepsis due to increased volume of distribution 4, 5
• Standard doses of 15 mg/kg are inadequate in septic shock - approximately 30% of patients fail to reach therapeutic peaks even with 25 mg/kg 4
• Once-daily dosing is appropriate and reduces toxicity risk 6
• Monitor peak levels after first dose - target peak >64 mcg/mL (8x MIC) for Gram-negative organisms 4
• Monitor drug toxicity labs closely as drug metabolism is reduced during severe sepsis 1

Antibiotic Timing and Considerations

• Administer within 1 hour of septic shock recognition 1, 2
• Obtain blood cultures before antibiotics when possible, but do not delay administration 1
• Consider adding Vancomycin 15 mg/kg IV q6h if MRSA suspected based on local epidemiology 2
• Reassess daily for de-escalation after 48 hours based on culture results and clinical response 1

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Paracetamol (Acetaminophen) Dosing

Dose: 120mg IV/PO every 6 hours (15 mg/kg/dose, maximum 60 mg/kg/day)

• For fever control and comfort
• Do not exceed 4 doses in 24 hours (480mg total daily for 8kg child)

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Pantoprazole Dosing

Dose: 8mg IV once daily (1 mg/kg/day for 8kg child)

• However, stress ulcer prophylaxis has no specific recommendation in prepubertal children with severe sepsis 1
• Consider omitting unless specific gastrointestinal bleeding risk factors present
• If used, standard pediatric dosing is 0.8-1 mg/kg/day IV

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Critical Management Priorities Beyond Medications

Immediate Fluid Resuscitation

• Administer 160mL boluses (20 mL/kg) of isotonic crystalloid 1, 2
• Continue up to 320-480mL (40-60 mL/kg) in first hour unless signs of fluid overload develop 1, 2
• Correct hypoglycemia and hypocalcemia immediately 1, 2

Hemodynamic Support if Fluid-Refractory

• If shock persists after 40-60 mL/kg fluid, begin inotropic support 2
• For cold shock: start dopamine 5-10 mcg/kg/min, escalate to epinephrine if resistant 1, 2
• Target hemoglobin 10 g/dL during resuscitation phase 1, 2

Common Pitfalls to Avoid

• Do not use standard 15 mg/kg amikacin dosing - this is inadequate in severe sepsis due to increased volume of distribution 4, 5
• Do not delay antibiotics for blood cultures - obtain cultures quickly but prioritize antibiotic administration within 1 hour 1
• Do not continue empiric broad-spectrum coverage beyond 48 hours without reassessment and de-escalation based on cultures 1