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Suggested doses of parenteral antibiotics commonly used in the treatment of osteoarticular infections in infants and children

Suggested doses of parenteral antibiotics commonly used in the treatment of osteoarticular infections in infants and children
Intravenous agent Dose for infants 8 to 28 days of age Dose for children >28 days of age
Ampicillin 150 mg/kg per day IV divided in 2 doses 200 to 400 mg/kg per day IV divided in 4 doses; maximum dose 12 g/day
Cefazolin 100 to 150 mg/kg per day IV divided in 3 doses 100 to 150 mg/kg per day IV divided in 3 doses; maximum dose 6 g/day
Cefepime 60 to 100 mg/kg per day IV divided in 2 doses 100 to 150 mg/kg per day IV divided in 3 doses; maximum dose 6 g/day
Cefotaxime 150 to 200 mg/kg per day IV divided in 3 doses 150 to 200 mg/kg per day IV divided in 3 or 4 doses; maximum dose 8 g/day
Ceftazidime 150 mg/kg per day IV divided in 3 doses 125 to 150 mg/kg per day IV divided in 3 doses; maximum daily dose 6 g
Ceftriaxone 50 to 75 mg/kg per day IV in 1 dose 75 to 100 mg/kg per day IV divided in 1 or 2 doses; maximum dose 4 g/day
Clindamycin 20 to 30 mg/kg per day IV divided in 3 doses 25 to 40* mg/kg per day IV divided in 3 or 4 doses; maximum dose 2.7 g/day
Daptomycin NA

1 through 6 years: 12 mg/kg per day IV in 1 dose

7 through 11 years: 9 mg/kg per day IV in 1 dose

12 through 17 years: 7 mg/kg per day IV in 1 dose
Gentamicin 7.5 mg/kg per day IV divided in 3 doses 7.5 mg/kg per day IV divided in 3 doses
Linezolid 30 mg/kg per day IV divided in 3 doses

<12 years: 30 mg/kg per day IV in 3 doses

≥12 years: 600 mg twice per day IV
Nafcillin 100 mg/kg per day divided in 4 doses 150 to 200 mg/kg per day IV divided in 4 doses; maximum dose 12 g/day
Oxacillin 100 mg/kg per day IV divided in 4 doses 150 to 200 mg/kg per day IV divided in 4 to 6 doses; maximum dose 12 g/day
Penicillin 150,000 units/kg per day IV divided in 3 doses 250,000 to 400,000 units/kg per day IV divided in 4 to 6 doses; maximum dose 24 million units per day
VancomycinΔ Loading dose of 20 mg/kg IV followed by maintenance dose according to 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]
  • <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
  • 1.0 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◊
Refer to UpToDate topics on management of osteomyelitis and septic arthritis in children for details regarding indications for particular drugs; recommended doses are for patients with normal renal function and infants born at >34 weeks' gestation. Consultation with an expert in pediatric infectious diseases is suggested for infants born at ≤34 weeks gestation.

IV: intravenous; NA: not available; PMA: postmenstrual age; PNA: postnatal age; AUC: area under the curve.

* 40 mg/kg per day is preferred for children ≥3 months of age.

¶ Daptomycin should not be used in children with concomitant pulmonary involvement and is not recommended in children <1 year of age because of the risk of potential effects on muscular, neuromuscular, and/or nervous systems (peripheral and/or central) observed in dogs. It is not approved for the treatment of osteoarticular infections in children; the appropriate dose for osteoarticular infections has not yet been established but is the subject of clinical trials. The doses provided above are those that are recommended for Staphylococcus aureus bacteremia in children.

Δ Dosing algorithm for vancomycin based upon serum creatinine concentration in neonates born at gestational age >28 weeks. 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.[2] 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.

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. Radu L, Bengry T, Akierman A, et al. Evolution 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, Itasca, IL 2021. p.876.

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