Version June 2024
| Adults | Children | |
| Preferred agents | ||
| Third-generation cephalosporins | ||
| Ceftriaxone* | 1 to 2 g IV once daily | 50 to 75 mg/kg IV or IM once daily or in two divided doses (maximum 2 g/day) |
| Cefotaxime | 1 to 2 g IV every 8 hours | 50 to 60 mg/kg IV or IM every 8 hours (maximum 2 g per dose) |
| Fluoroquinolones¶ | ||
| Ciprofloxacin | Parenteral dosing: 400 mg IV twice daily | Parenteral dosing: 10 mg/kg IV every 8 to 12 hours (maximum 400 mg per dose) |
| Oral dosing: 500 to 750 mg orally twice daily | Oral dosing: 10 to 20 mg/kg per dose every 12 hours (maximum daily dose 1.5 grams) | |
| Levofloxacin | 500 to 750 mg IV or orally once daily | Children 6 months to <5 years of age: 8 to 10 mg/kg IV or orally every 12 hours (maximum 250 mg per dose) Children ≥5 years of age: 10 mg/kg IV or orally once daily (maximum dose 750 mg daily) |
| Alternative agents | ||
| Trimethoprim-sulfamethoxazole (cotrimoxazole)Δ | Parenteral dosing: 8 to 10 mg/kg/day of the trimethoprim component IV divided three times per day Oral dosing: 1 to 2 double-strength tablets every 12 hours◊ | 8 to 12 mg/kg/day of the trimethoprim component IV or orally divided every 12 hours (maximum 160 mg trimethoprim component per dose) |
| Ampicillin (for parenteral therapy) | 2 g IV every 4 hours | 50 mg/kg IV or IM every 6 hours (maximum daily dose 8 g/day) |
| Amoxicillin (for oral therapy) | 500 mg orally three times daily or 875 mg orally two times daily | 40 to 45 mg/kg/day orally divided every 8 hours; maximum 500 mg/dose |
| Azithromycin | Parenteral dosing: 500 mg IV once daily | Parenteral dosing: 10 mg/kg IV once daily (maximum 500 mg per day) |
| Decisions regarding oral dosing should be individualized based on the site and severity of infection, the duration of therapy, and adverse effects. | Decisions regarding oral dosing should be individualized based on the site and severity of infection, the duration of therapy, and adverse effects. | |
Antibiotic selection and duration of therapy depend upon the severity of illness, focal site of infection, surgical options, local resistance patterns, whether oral medications are feasible, host, and other factors. Refer to the topic on treatment of nontyphoidal Salmonella bacteremia and extraintestinal infection for detailed discussion. The doses listed above are intended for patients with normal kidney function; doses of some of these agents must be adjusted in patients with kidney impairment. For specific adjustments, refer to the Lexicomp drug information monographs included with UpToDate.
Certain foci of infection (eg, central nervous system, endocarditis) may warrant higher and/or more frequent dosing than listed above in order to attain adequate concentrations at the site(s) of infection; infectious diseases consultation is advised.IM: intramuscularly; IV: intravenously.
* For patients with involvement of the central nervous system, antibiotic dosing should be adjusted for optimal cerebrospinal fluid penetration (adults: ceftriaxone 2 g IV every 12 hours; children: ceftriaxone 100 mg/kg/day IV in two divided doses [maximum 4 grams per day]).
¶ Although fluoroquinolones are not routinely used as first-line therapy for children <18 years old, their use in children is justified in severe infections, such as nontyphoidal Salmonella bacteremia, when alternatives are not appropriate or available.
Δ Avoid use of trimethoprim-sulfamethoxazole in infants ≤2 months of age.
◊ Each double-strength tablet contains trimethoprim 160 mg and sulfamethoxazole 800 mg.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
