What are common medications used in pediatric patients for various conditions?

Common Medications in Pediatric Practice

Antibiotics for Respiratory Infections

Amoxicillin is the definitive first-line antibiotic for pediatric community-acquired pneumonia and most bacterial respiratory infections, dosed at 90 mg/kg/day divided into 2 doses (maximum 4 g/day). 1, 2

Amoxicillin Dosing by Indication

• Community-acquired pneumonia (all ages >3 months): 90 mg/kg/day in 2 divided doses for 10 days 1, 3
• Group A Streptococcal infections (including scarlet fever): 50-75 mg/kg/day in 2 doses for 10 days, maximum 1000 mg per dose 4, 2
• Mild to moderate respiratory infections: 45 mg/kg/day in 2 doses may be sufficient 2

The higher 90 mg/kg/day dosing is critical to overcome pneumococcal resistance—underdosing at 40-45 mg/kg/day is a dangerous and common error. 3

Amoxicillin-Clavulanate (Augmentin)

Use amoxicillin-clavulanate instead of amoxicillin alone when β-lactamase-producing organisms are suspected. 1, 2

• Standard dosing: 90 mg/kg/day of amoxicillin component in 2 doses (maximum 4 g/day) 2
• Alternative dosing: 45 mg/kg/day in 3 doses for β-lactamase producing H. influenzae 4, 2
• Specific indications: Children not fully immunized against H. influenzae type b, concurrent purulent otitis media, or recent antibiotic exposure within 3 months 1, 2

Macrolides for Atypical Pathogens

Azithromycin should be added to β-lactam therapy when atypical pathogens (Mycoplasma or Chlamydophila) are suspected, particularly in children ≥5 years. 4, 1

• Azithromycin dosing: 10 mg/kg on day 1, then 5 mg/kg/day once daily on days 2-5 (outpatient) 1, 3
• Hospitalized atypical pneumonia: 10 mg/kg IV on days 1 and 2, then transition to oral 1, 3

Atypical pathogens are uncommon in children under 5 years, so macrolides are generally not indicated as first-line therapy in this age group. 3

Inpatient Antibiotic Therapy

Fully Immunized, Low-Risk Children

• Preferred: Ampicillin 150-200 mg/kg/day IV every 6 hours OR penicillin G 100,000-250,000 U/kg/day every 4-6 hours 4, 3
• Alternative: Ceftriaxone 50-100 mg/kg/day IV every 12-24 hours 4, 1

Not Fully Immunized or High-Risk Children

• Preferred: Ceftriaxone 50-100 mg/kg/day OR cefotaxime 150 mg/kg/day every 8 hours 4, 1
• Add vancomycin (40-60 mg/kg/day every 6-8 hours) or clindamycin (40 mg/kg/day every 6-8 hours) if MRSA suspected 4, 1

MRSA should be suspected in children with severe pneumonia, necrotizing infiltrates, empyema, or recent influenza infection. 3

Staphylococcal Infections

Methicillin-Susceptible S. aureus (MSSA)

• Outpatient: Cephalexin 75-100 mg/kg/day in 3-4 doses 4
• Inpatient: Cefazolin 150 mg/kg/day every 8 hours OR oxacillin 150-200 mg/kg/day every 6-8 hours 4

Methicillin-Resistant S. aureus (MRSA)

• Outpatient (clindamycin-susceptible): Clindamycin 30-40 mg/kg/day in 3-4 doses 4, 1
• Inpatient: Vancomycin 40-60 mg/kg/day every 6-8 hours (dosing to achieve AUC/MIC ratio >400) 4, 1
• Alternative: Linezolid 30 mg/kg/day every 8 hours for children <12 years; 20 mg/kg/day every 12 hours for children ≥12 years 4

Penicillin Allergy Management

Non-Severe Allergic Reactions

Consider oral cephalosporins with substantial activity against S. pneumoniae (cefpodoxime, cefprozil, or cefuroxime) under medical supervision. 1, 3

Severe Allergic Reactions (Anaphylaxis)

• Levofloxacin: 16-20 mg/kg/day in 2 doses (ages 6 months to 5 years); 8-10 mg/kg/day once daily (ages 5-16 years); maximum 750 mg/day 4, 3
• Linezolid: 30 mg/kg/day in 3 doses (<12 years); 20 mg/kg/day in 2 doses (≥12 years) 4, 3

Antipyretics and Analgesics

Ibuprofen is more effective than acetaminophen as an antipyretic and has comparable analgesic efficacy with longer duration of action. 5, 6, 7

Ibuprofen

• Dosing: 5-10 mg/kg every 6-8 hours 5, 6, 7
• Advantages: More effective fever reduction at 2,4, and 6 hours post-treatment; longer duration of action; safer in overdose than acetaminophen 5, 6, 7
• Efficacy: Maximum temperature reduction occurs 3-4 hours after administration 6

Acetaminophen (Paracetamol)

• Dosing: 10-15 mg/kg every 4 hours 5, 7
• Considerations: Comparable analgesic efficacy to ibuprofen but less effective as antipyretic; more frequent dosing required; severe hepatotoxicity in overdose 5, 8, 7

For pain relief in acute otitis media, both ibuprofen and acetaminophen are more effective than placebo at 48 hours, with no significant difference between the two agents. 9

Antiviral Therapy

Oseltamivir (Tamiflu)

• Treatment dosing (ages 1-12 years): 2 mg/kg twice daily for 5 days OR weight-band dosing 10
• Prophylaxis dosing: 30-60 mg once daily for 10 days (post-exposure) or up to 6 weeks (seasonal) 10
• Infants 2 weeks to <1 year: 2-3.5 mg/kg twice daily for 5 days 10
• Most common adverse reactions: Vomiting (16% vs 8% placebo in treatment trials; 8% vs 2% in prophylaxis trials), nausea, headache 10

Critical Monitoring Parameters

Children on appropriate antibiotic therapy should demonstrate clinical improvement within 48-72 hours. 1, 2, 3

• If no improvement occurs within 48-72 hours, reevaluation is necessary to consider treatment failure, complications, or alternative diagnoses 1, 2, 3
• Fever typically resolves within 24-48 hours for pneumococcal pneumonia, though cough may persist longer 2
• Complete the full prescribed course of antibiotics (typically 7-10 days for most respiratory infections, 10 days for pneumonia), even if symptoms improve before completion 1, 2