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تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Suggested parenteral antibiotic regimens for mastitis or breast abscess in infants without severe complications,* according to most frequent gram stain findings

Suggested parenteral antibiotic regimens for mastitis or breast abscess in infants without severe complications,* according to most frequent gram stain findings
Parenteral antibiotics Infants ≤28 days Infants >28 days
Gram-positive cocci
CA-MRSA not a concern (one of the following)
Nafcillin or oxacillin
  • GA ≤34 weeks:
    • Age ≤7 days: 25 mg/kg IV every 12 hours
    • Age >7 days: 25 mg/kg IV every 8 hours
  • GA >34 weeks:
    • Age ≤7 days: 25 mg/kg IV every 8 hours
    • Age >7 days: 25 mg/kg IV every 6 hours
  • 100 to 200 mg/kg IV per day in 4 to 6 doses
CA-MRSA a concern (one of the following)
Clindamycin
  • PMA ≤32 weeks: 5 mg/kg IV every 8 hours
  • PMA 33 to 40 weeks: 7 mg/kg IV every 8 hours
  • PMA >40 weeks: 9 mg/kg IV every 8 hours
  • 20 to 40 mg/kg IV per day in 3 or 4 doses
VancomycinΔ
  • Loading dose: 20 mg/kg IV
  • Maintenance dosing according to GA and serum creatinine as indicated below. The interval between the loading dose and the first maintenance dose should be the same as the dosing interval for the maintenance regimen. This dosing regimen was designed with a target trough concentration of 5 to 10 mg/L[1].
    • GA ≤28 weeks:
      • <0.5 mg/dL: 15 mg/kg IV every 12 hours
      • 0.5 to 0.7 mg/dL: 20 mg/kg IV every 24 hours
      • 0.8 to 1 mg/dL: 15 mg/kg IV every 24 hours
      • 1.1. to 1.4 mg/dL: 10 mg/kg IV every 24 hours
      • >1.4 mg/dL: 15 mg/kg IV every 48 hours
    • GA >28 weeks:
      • <0.7 mg/dL: 15 mg/kg IV every 12 hours
      • 0.7 to 0.9 mg/dL: 20 mg/kg IV every 24 hours
      • 1 to 1.2 mg/dL: 15 mg/kg IV every 24 hours
      • 1.3 to 1.6 mg/dL: 10 mg/kg IV every 24 hours
      • >1.6 mg/dL: 15 mg/kg IV every 48 hours
  • Refer to UpToDate content related to alternative methods of dosing vancomycin for children older than 28 days◊
Gram-negative organisms (one of the following)
Gentamicin§
  • GA <30 weeks:
    • Age ≤14 days: 5 mg/kg IV every 48 hours
    • Age >14 days: 5 mg/kg IV every 36 hours
  • GA 30 to 34 weeks:
    • Age ≤10 days: 5 mg/kg IV every 36 hours
    • Age >10 days: 5 mg/kg IV every 24 hours
  • GA ≥35 weeks:
    • Age ≤7 days: 4 mg/kg IV every 24 hours
    • Age >7 days: 5 mg/kg IV every 24 hours
  • 6 to 7.5 mg/kg IV per day in 3 doses, or
  • 5 to 7.5 mg/kg IV per day once daily
Amikacin§
  • GA <30 weeks:
    • Age ≤14 days: 15 mg/kg IV every 48 hours
    • Age >14 days: 15 mg/kg IV every 24 hours
  • GA 30 to 34 weeks:
    • Age ≤10 days: 15 mg/kg IV every 36 hours
    • Age >10 days: 15 mg/kg IV every 24 hours
  • GA ≥35 weeks:
    • Age ≤7 days: 15 mg/kg IV every 24 hours
    • Age >7 days: 18 mg/kg IV every 24 hours
  • 15 to 22.5 mg/kg IV per day in 2 or 3 doses or once daily
Cefotaxime¥ (if available)
  • Age <7 days: 50 mg/kg IV every 12 hours
  • Age ≥7 days: 50 mg/kg IV every 8 hours
  • 150 to 180 mg/kg IV per day in 3 doses
  • 200 to 225 mg/kg IV per day in 4 doses for meningitis
Ceftazidime¥ (if cefotaxime not available)
  • Age <7 days: 50 mg/kg IV every 12 hours
  • Age ≥7 days: 50 mg/kg IV every 8 hours
  • 90 to 150 mg/kg IV per day in 3 doses
  • 200 to 300 mg/kg IV per day in 3 doses for suspected Pseudomonas (severe infection)
Ceftriaxone¥‡ (if cefotaxime not available)
  • 50 mg/kg IV every 24 hours
  • 50 to 75 mg/kg IV per day
  • 100 mg/kg IV per day in 1 or 2 doses for meningitis
Gram stain not available or no organisms seen
CA-MRSA not a concern
Nafcillin or oxacillin, plus one of the following:
  • Gentamicin§
  • Amikacin§
  • Cefotaxime¥
  • Ceftazidime¥
  • Ceftriaxone¥
  • Dosing regimens provided above
CA-MRSA a concern
Clindamycin or vancomycin, plus one of the following:
  • Gentamicin§
  • Amikacin§
  • Cefotaxime¥
  • Ceftazidime¥
  • Ceftriaxone¥
  • Dosing regimens provided above
Refer to UpToDate content on mastitis and breast abscess in infants for additional information. The doses in this table are intended for patients with normal renal function. The doses of many of these agents must be adjusted in the setting of renal insufficiency; refer to the drug-specific monographs included within UpToDate for renal dose adjustments. Unless otherwise specified, "age" refers to postnatal age.

AUC: area under the curve; CA-MRSA: community-acquired methicillin-resistant Staphylococcus aureus; GA: gestational age; IV: intravenously; PMA: postmenstrual age; PNA: postnatal age.

* Severe complications include extensive cellulitis, necrotizing fasciitis, osteomyelitis, and shock. Refer to UpToDate content on mastitis and shock in infants.

¶ Clindamycin should not be used if central nervous system infection is a concern. Monitor carefully when used if more than 15% of local community-associated S. aureus isolates are resistant to clindamycin.

Δ Serum creatinine concentration will take approximately 5 to 7 days after birth to reasonably reflect neonatal renal function. Cautious use of creatinine-based dosing strategy with frequent assessment of renal function and vancomycin serum concentrations are recommended in neonates ≤7 days old[2]. A vancomycin dosing method based upon PMA and PNA is provided as an alternative to the serum creatinine-based method listed above and may be useful in some clinical situations[3]. The regimen was designed with a target trough concentration of 10 to 20 mg/L.
  • PMA ≤29 weeks
    • PNA ≤21 days: 15 mg/kg IV every 18 hours
    • PNA >21 days: 15 mg/kg IV every 12 hours
  • PMA 30 to <37 weeks
    • PNA ≤14 days: 15 mg/kg IV every 12 hours
    • PNA >14 days: 15 mg/kg IV every 8 hours
  • PMA 37 to <45 weeks
    • PNA ≤7 days: 15 mg/kg IV every 12 hours
    • PNA >7 days: 15 mg/kg IV every 8 hours

◊ The approach to vancomycin dosing is generally determined at the institutional level. Refer to UpToDate content on invasive staphylococcal infections in children for details of trough-guided and AUC-guided vancomycin dosing for infants ≥28 days of age.

§ Initial aminoglycoside dosing is provided. The optimal, individualized dose of amikacin and gentamicin should be based on determination of serum concentrations. Doses may differ from those recommended by the package insert.

¥ Cefotaxime (if available), ceftazidime, or ceftriaxone is recommended if cerebrospinal fluid is abnormal.

‡ Intravenous ceftriaxone should be avoided in infants who are also receiving or are expected to receive intravenous calcium in any form, including parenteral nutrition.
References:
  1. Capparelli EV, Lane JR, Romanowski GL, et al. The influences of renal function and maturation on vancomycin elimination in newborns and infants. J Clin Pharmacol, 2001; 41:927.
  2. Nelson's Pediatric Antimicrobial Therapy, 27rd ed, Bradley JS, Nelson JD, Barnett ED, et al (Eds), American Academy of Pediatrics, Itasca, IL 2021. p.100.
  3. Radu L, Bengry T, Akierman A, et al. Evoluation of empiric vancomycin dosing in a neonatal population. J Perinatol 2018; 38:1702.

Data adapted from: American Academy of Pediatrics. Tables of antibacterial drug dosages. In: Red Book: 2021-2024 Report of the Committee on Infectious Diseases, 32nd ed, Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH (Eds), American Academy of Pediatrics, Ithasca, IL 2021. p.876.

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