| | Dosing for adults | Dosing for children and adolescents (age ≥1 month through 17 years) | Comments |
| FIRST-LINE ANTIBIOTICS |
| Doxycycline | 100 mg orally every 12 hours | - <45 kg: 2.2 mg/kg orally every 12 hours (max 100 mg/dose)
- ≥45 kg: 100 mg orally every 12 hours
| - First line for empiric treatment and post-exposure prophylaxis.
- For children ≤8 years: Although short-term exposure (<21 days) during tooth development has not been associated with staining or enamel hypoplasia, the risk with longer durations is uncertain.
|
| Minocycline | 200 mg orally once then 100 mg orally every 12 hours | - 4 mg/kg once orally (max 200 mg) then 2 mg/kg orally every 12 hours (max 100 mg/dose)
| - First line for empiric treatment; alternative for post-exposure prophylaxis.
- Not recommended for pregnant or lactating individuals.
- For children ≤8 years: Prolonged exposure during tooth development may result in staining and enamel hypoplasia.
|
| Ciprofloxacin | 500 mg orally every 12 hours | - 15 mg/kg orally every 12 hours (max 500 mg/dose)
| - First line for empiric treatment and post-exposure prophylaxis.
|
| Levofloxacin | Post-exposure prophylaxis: 500 mg orally every 24 hours Treatment: 750 mg orally every 24 hours | - <50 kg post-exposure prophylaxis and treatment: 8 mg/kg orally every 12 hours (max 250 mg/dose)
- ≥50 kg post-exposure prophylaxis: 500 mg orally every 24 hours
- ≥50 kg treatment: 750 mg orally every 24 hours
| - First line for empiric treatment and post-exposure prophylaxis.
|
| Penicillin VK | 500 mg orally every 6 hours | - 12.5 to 18.7 mg/kg orally every 6 hours (max 500 mg/dose)
| - Do not use for empiric therapy; only for documented penicillin-susceptible strains.
|
| Amoxicillin | 1 g orally every 8 hours | - 25 mg/kg orally every 8 hours (max 1 g/dose)
| - Do not use for empiric therapy; only for documented penicillin-susceptible strains.
- Ampicillin 500 mg (or 25 mg/kg; max 500 mg) orally every 6 hours is an alternative to amoxicillin.
|
| ALTERNATIVE ANTIBIOTICS (reserve for when first-line agents cannot be used or are unavailable, as in a crisis setting; listed in descending order of preference) |
| Amoxicillin-clavulanate | - 1 g/62.5 mg formulation: 2 tablets orally every 12 hours
- 875/125 mg formulation: 1 tablet orally every 12 hours
| - For age ≥3 months:
- 200/28.5 mg or 400/57 mg formulation: 22.5 mg/kg amoxicillin orally every 12 hours (max 875/125 mg/dose)
- 600/42.9 mg formulation for children <40 kg: 45 mg/kg amoxicillin orally every 12 hours
- 1 g/62.5 mg formulation for children ≥40 kg: 2 tablets (2 g amoxicillin) orally every 12 hours
| - First-line agent for post-exposure prophylaxis and treatment children.
|
| Moxifloxacin | 400 mg orally every 24 hours | - Age ≥3 to ≥23 months: 6 mg/kg orally every 12 hours (max 200 mg/dose)
- Age 2 to <6 years: 5 mg/kg orally every 12 hours (max 200 mg/dose)
- Age 6 to <12 years: 4 mg/kg orally every 12 hours (max 200 mg/dose)
- Age >12 to <18 years and <45 kg: 4 mg/kg orally every 12 hours (max 200 mg/dose)
- Age >12 to <18 years and ≥45 kg: 400 mg every 24 hours (or 200 mg every 12 hours for those at risk for cardiac events)
| |
| Clindamycin | 600 mg orally every 8 hours | - 10 mg/kg orally every 8 hours (max 600 mg/dose)
| - First-line agent for post-exposure prophylaxis and treatment in children.
|
| Ofloxacin | 400 mg orally every 12 hours | - 11.25 mg/kg orally every 12 hours
| |
| Omadacycline | 450 mg orally every 12 hours for 2 days then 300 mg orally every 24 hours | - Age >8 years: 450 mg orally every 24 hours for 2 days then 300 mg orally every 24 hours orally
| - Children ≤8 years: Prolonged exposure during tooth development may result in staining and enamel hypoplasia.
|
| Linezolid | 600 mg orally every 12 hours | - Age <12 years: 10 mg/kg orally every 8 hours (max 600 mg/dose)
- Age ≥12 years: 600 mg orally every 12 hours
| - Extended use (eg, >2 weeks) warrants monitoring for cytopenias or neurotoxicity.
|
| Tetracycline | 500 mg orally every 6 hours | - 12.5 mg/kg orally every 6 hours (max 500 mg/dose)
| - Not recommended for pregnant or lactating individuals.
- Children ≤8 years: Prolonged exposure during tooth development may result in staining and enamel hypoplasia.
|
| Clarithromycin | 500 mg orally every 12 hours | - 7.5 mg/kg orally every 12 hours (max 500 mg/dose)
| - Only initiate after at least 3 days of treatment with any of the other agents listed.
|
| Dalbavancin | 1 g intravenously once then 500 mg intravenously weekly | - Age ≥3 months to <6 years: 22.5 mg/kg intravenously every 2 weeks for post-exposure prophylaxis or once weekly for treatment (max 1.5 g/dose)
- Age ≥6 to <18 years: 18 mg/kg intravenously every 2 weeks for post-exposure prophylaxis or once weekly for treatment (max 1.5 g/dose)
| |
| Imipenem-cilastatin | 2 g intravenously every 8 hours | - 25 mg/kg every 6 hours (max 1 g/dose)
| - Not recommended for post-exposure prophylaxis.
|
| Meropenem | 2 g intravenously every 8 hours | - 20 mg/kg intravenously every 8 hours (max 2 g/dose)
| - Not recommended for post-exposure prophylaxis.
|
| Vancomycin | 15 mg/kg intravenously over 1 to 2 hours every 12 hours | - 20 mg/kg intravenously over 1 to 2 hours every 8 hours
| - Not recommended for post-exposure prophylaxis.
- For critically ill adults: Loading dose of 20 to 35 mg/kg (max 3 g) once.
- Target AUC of 400 to 600 mcg × h/mL (preferred) or trough concentration 15 to 20 mcg/mL.
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